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Definition

The pancreas is a long, flat, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones, including insulin. Acute pancreatitis is inflammation of the pancreas that occurs suddenly and resolves with proper treatment.

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Pancreatitis

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Causes

Pancreatitis occurs when digestive enzymes are activated in the pancreas instead of the small intestine. Acute pancreatitis has several causes. In some cases, the cause may be unknown.

Known causes of acute pancreatitis include

  • Obstruction of the pancreatic duct from:
    • Gallstones
    • Cancer
    • Diseases of the duodenum, the first section of the small intestine, where the pancreas empties
  • Alcohol
  • Surgery or trauma to the pancreas
  • Certain medications, such as those that treat cancer
  • Ischemia—insufficient blood supply to the pancreas
  • Complications of having endoscopic retrograde cholangiopancreatography
Risk Factors

Factors that may increase your risk of acute pancreatitis include:

Symptoms

Symptoms may occur one time or many times. Repeated flare ups of symptoms are known as attacks.

Acute pancreatitis may cause:

  • Severe pain in the center of the upper abdomen that:
    • Sometimes spreads into the upper back
    • Is often made worse by eating, walking, or lying down on your back
  • Nausea and vomiting
  • Low grade fever
  • Jaundice—yellowing of the skin and eyes
  • Rarely, shock—a medical emergency in which the organs and tissues don't receive adequate blood or fluids

Untreated acute pancreatitis may progress into chronic pancreatitis, a serious condition where the pancreas becomes permanently damaged.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will ask how much alcohol you drink and what medications you take. Diagnosis can be determined by your symptoms and results from blood tests.

Other tests may include:

  • Blood tests—to look for elevated levels the digestive enzymes amylase and lipase
  • Urine tests

Imaging tests can be used to evaluate the pancreas and nearby structures. Imaging tests include:

Treatment

Treatment for acute pancreatitis depends on the severity of the attack and what is causing it. For example, if medication is the cause of your pancreatitis, your doctor may change to a different medication or adjust the dose.

In most cases, acute pancreatitis isn't severe and can be treated. Treatment includes:

Hospitalization

Generally, acute pancreatitis treatment requires hospitalization. Fluid and nutritional support can be administered by IV while your pancreas heals. During this time, you will be unable to eat or drink.

If you have severe pancreatitis, you may need a nasogastric tube. A long, thin tube is threaded through your nose and into your stomach for feeding.

You may also start treatment for any underlying causes of your pancreatitis.

Medications

Your doctor may recommend:

  • Antibiotics—to treat any infections
  • Pain medications
  • Protease inhibitors—to reduce the effects of digestive enzymes
  • Insulin—to help regulate blood glucose levels
Surgery

In general, surgery isn't necessary for mild pancreatitis. It may be necessary when medical treatment doesn't work for more severe cases. Surgery may also be used to treat underlying conditions.

Surgical procedures include:

  • Necrosectomy—Removal of dying or dead (necrotic) pancreatic tissue. Pancreatic necrosis is more serious if an infection is present. This procedure can also be done with endoscopy.
  • Percutaneous catheter drainage—One or many thin tubes are inserted into the abdomen to drain fluid from the pancreas.
  • ECRP—To remove gallstones or open any collapsed ducts.
  • Cholecystectomy—To remove the gallbladder.
Prevention

To help reduce your chance of getting acute pancreatitis, take these steps:

  • Limit intake of alcohol to a maximum of two drinks per day for men and one drink per day for women.
  • If you have hyperlipidemia, restrict your intake of fat and follow your doctor’s treatment plan to lower your lipids.
  • Increase your vegetable consumption.
  • Increase your activity level to help lose excess weight. Aim for 30 minutes per day on most days of the week.
  • Make sure your vaccinations are up to date. This includes mumps, rubella, hepatitis B, and varicella.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

National Pancreas Foundation
http://www.pancreasfoundation.org

CANADIAN RESOURCES:

Canadian Association of Gastroenterology
http://www.cag-acg.org

Health Canada
http://www.hc-sc.gc.ca

References:

Acute pancreatitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 23, 2013. Accessed December 4, 2013.

Acute pancreatitis. Tulane University School of Medicine website. Available at: http://tulane.edu/som/pancreas-biliary/diseases/acute-pancreatitis.cfm. Accessed December 4, 2013.

Causes of acute pancreatitis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 31, 2013. Accessed December 4, 2013.

Pancreatitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis. Updated August 16, 2012. Accessed December 4, 2013.

Prevention of acute pancreatitis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated November 12, 2013. Accessed December 4, 2013.

4/7/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Baker ME, Nelson RC, et al. ACR Appropriateness Criteria for acute pancreatitis. American College of Radiology (ACR); 2013. 11 p. Available at: http://www.guideline.gov/content.aspx?id=47649. Accessed April 7, 2014.



Last reviewed December 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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