Acute pancreatitis

It's thought that acute pancreatitis begins when something goes wrong with certain enzymes (chemicals) inside the pancreas, causing them to start digesting the organ itself.

Acute pancreatitis is most often linked to:

• gallstones, which account for around half of all cases
• alcohol consumption, which accounts for about a quarter of all cases

Cutting down on alcohol and adjusting your diet to make gallstones less likely can help lower your chances of developing acute pancreatitis.

Read more about the causes of acute pancreatitis and how to prevent it.

Who is affected?

Acute pancreatitis is more common in middle aged and elderly people, though it can affect someone at any age. Men are more likely to develop the alcohol related form, while women more often develop it because of gallstones.

Causes of acute pancreatitis

Most cases are closely tied to gallstones or alcohol use, though the exact cause is not always clear.

Gallstones

Gallstones are hard, stone like pieces of material that form inside the gallbladder. If one moves out of the gallbladder and blocks the opening of the pancreas, it can trigger acute pancreatitis.

This blockage disrupts some of the enzymes the pancreas produces. Normally these enzymes help digest food in the intestines, but when the opening is blocked, they can end up digesting the pancreas instead.

That said, not everyone with gallstones develops acute pancreatitis. Most gallstones never cause any problems.

If a gallstone is behind the pancreatitis, you may need a procedure called endoscopic retrograde cholangiopancreatography (ERCP), or your gallbladder may need to be removed.

Gallbladder removal may be done during the same hospital stay, or planned for a few weeks later. Losing the gallbladder should not seriously affect your health, apart from making it a bit harder to digest certain foods, such as fatty or spicy dishes.

ERCP is an alternative way to treat gallstones. It uses a narrow, flexible tube called an endoscope, fitted with a camera at one end. X-rays help guide the endoscope into your digestive system, and surgical instruments passed down the tube are used to remove the gallstones.

The best way to prevent gallstones is to eat a healthy, balanced diet with plenty of fresh fruit and vegetables, at least 5 portions a day. Your diet should also include wholegrains, found in wholemeal bread, oats and brown rice, which help lower cholesterol levels in the body. There is also evidence that eating nuts regularly, such as peanuts or cashews, can help cut your risk of gallstones.

Because cholesterol seems to play a role in how gallstones form, it is wise to limit fatty foods that are high in cholesterol, such as:

• meat pies
• sausages and fatty cuts of meat
• butter and lard
• cakes and biscuits

Carrying excess weight also raises your chances of developing gallstones, so keeping to a healthy weight through a balanced diet and regular exercise can help lower your risk too.

Alcohol consumption

It is not fully understood how alcohol causes the pancreas to become inflamed. One theory is that it disrupts the normal working of the pancreas, prompting its enzymes to start digesting it.

Whatever the exact cause, there is a clear link between alcohol use and acute pancreatitis. Binge drinking, taking in a large amount of alcohol over a short time, is also thought to raise the risk.

If alcohol was the cause of your pancreatitis, it should be avoided completely once you have recovered. If that proves difficult, you will likely need extra support.

Treatment options for alcohol dependence include:

• one to one counselling
• self help groups, such as Alcoholics Anonymous
• a medication called acamprosate, which helps reduce alcohol cravings

Other causes

Less common causes of acute pancreatitis include:

• accidental injury to the pancreas, for example during a procedure to remove gallstones or examine the pancreas
• certain medications, such as some antibiotics, weight loss drugs or chemotherapy medicines, which can unexpectedly trigger acute pancreatitis in a small number of people
• a viral infection, such as mumps or measles
• a complication of cystic fibrosis
• certain rare conditions, including hyperparathyroidism, Reye's syndrome and Kawasaki disease

Severe pancreatitis

It is still not well understood why some people go on to develop severe acute pancreatitis. Factors thought to raise the risk include:

• being 70 years of age or older
• being obese, meaning a body mass index (BMI) of 30 or above
• having 2 or more alcoholic drinks a day
• smoking

Researchers have also found that people with a specific genetic mutation, known as the MCP 1 mutation, are 8 times more likely to develop severe acute pancreatitis than the general population. A genetic mutation happens when the instructions (DNA) inside living cells become scrambled, leading to a genetic disorder or a change in characteristics.

Diagnosing acute pancreatitis

Most cases of acute pancreatitis are diagnosed in hospital because of the risk of serious complications.

The doctor in charge of your care will ask you about the history of your symptoms. They may also carry out a physical examination. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch.

A blood test will be carried out to help confirm a diagnosis. This can detect signs of acute pancreatitis, such as a high level of 2 chemicals called lipase and amylase.

At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. You’ll be monitored closely for signs of serious problems, such as organ failure.

People with mild acute pancreatitis tend to improve within a week and experience either no further problems or problems that resolve within 48 hours. People with severe acute pancreatitis develop persistent serious problems.

Further testing

Several tests may be used to help determine the severity of your condition and assess your risk of developing more serious complications.

You may have any of the following tests:

• a computerised tomography (CT) scan – where a series of X-rays are taken to build up a more detailed, 3D image of your pancreas
• a magnetic resonance imaging (MRI) scan – where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body
• an ultrasound scan – where high-frequency sound waves are used to create an image of part of the inside of the body
• endoscopic retrograde cholangiopancreatography (ERCP)

An ERCP uses a narrow, flexible tube known as an endoscope, which has a camera on one end. The endoscope will be passed through your mouth and towards your stomach. A special dye that shows up on X-rays is then injected through the endoscope into your bile and pancreatic ducts. After the dye has been injected, X-rays will be taken.

This test can be useful in cases of gallbladder-associated acute pancreatitis, because it can pinpoint exactly where the gallstone is located. In some cases, it may be possible to pass surgical instruments down the endoscope, so the gallstone can be removed.

How it’s treated

Treatment for acute pancreatitis focuses on supporting the functions of the body until the inflammation has passed.

This usually involves admission to hospital so you can be given fluids into a vein (intravenous fluids), as well as pain relief, nutritional support and oxygen through tubes into your nose.

Most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days.

However, recovery takes longer in severe cases, as complications that require additional treatment may develop.

Read more about treating acute pancreatitis.

Treating acute pancreatitis

Acute pancreatitis is treated in hospital, where you’ll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen.

Many people are well enough to leave hospital after 5 to 10 days.

In severe cases, complications can develop that require specific additional treatment and you’ll need to be admitted to a high dependency unit or intensive care unit (ICU). In these cases, recovery may take much longer, and the condition can be fatal.

Read about the potential complications of acute pancreatitis for more information on severe cases.

Fluids

Your body can become dehydrated during an episode of acute pancreatitis, so fluids are provided through a tube connected to one of your veins (this is known as intravenous, or IV, fluid).

In severe cases of acute pancreatitis, IV fluids can help to prevent a serious problem called hypovolemic shock, which occurs when a drop in your fluid levels lowers the amount of blood in your body.

Nutritional support

Although the diet of many people with mild acute pancreatitis isn’t restricted, some people are advised not to eat. This is because trying to digest solid food could place too much strain on your pancreas.

Depending on the severity of the condition, you may not be able to eat solid foods for a few days or longer.

If you need to avoid solid food, a feeding tube may be used to provide your body with nutrients. This is known as enteral feeding and often involves using a tube inserted into your stomach through your nose (nasogastric tube).

Oxygen

To ensure your vital organs have enough oxygen, it will usually be supplied through tubes into your nose. The tubes can be removed after a few days, once your condition is improving.

In severe cases, ventilation equipment may also be used to assist with your breathing.

Painkillers

Acute pancreatitis often causes severe abdominal (tummy) pain, so strong painkilling medication will probably be required, such as morphine.

Some of the painkillers used can make you feel very drowsy. If you’re visiting someone who is in hospital with acute pancreatitis, don’t be alarmed or concerned if they appear drowsy or unresponsive.

Treating the underlying cause

Once the condition is under control, the underlying cause may need to be treated.

Acute pancreatitis is often brought on by gallstones or by drinking too much alcohol, so taking care of your general health can lower your chances of ever developing it.

Cutting down on how much alcohol you drink can help protect your pancreas from damage and reduce your risk of getting acute pancreatitis. It can also lower your chances of developing other serious conditions, such as liver cancer.

Complications

About 4 out of 5 cases of acute pancreatitis improve quickly and don’t cause any serious further problems. However, 1 in 5 cases are severe and can result in life-threatening complications, such as multiple organ failure.

In severe cases where complications develop, there’s a high risk of the condition being fatal.

If a person survives the effects of severe acute pancreatitis, it’s likely to be several weeks or months before they’re well enough to leave hospital.

Read more about the possible complications of acute pancreatitis.

Complications of acute pancreatitis

Although most people with acute pancreatitis recover without experiencing further problems, severe cases can have serious complications.

Pseudocysts

Pseudocysts are sacs of fluid that can develop on the surface of the pancreas. They’re a common complication of acute pancreatitis, thought to affect around 1 in 20 people with the condition.

Pseudocysts usually develop 4 weeks after the symptoms of acute pancreatitis start. In many cases, they don’t cause any symptoms and are only detected during a computerised tomography (CT) scan.

However, in some people, pseudocysts can cause bloating, indigestion and a dull abdominal (tummy) pain.

If the pseudocysts are small and not causing any symptoms, there may be no need for further treatment, as they usually go away on their own.

Treatment is usually recommended if you’re experiencing symptoms or if the pseudocysts are large. Larger pseudocysts are at risk of bursting, which could cause internal bleeding or trigger an infection.

Pseudocysts can be treated by draining the fluid out of the cyst by inserting a needle into it through your skin. This can also be done by carrying out an endoscopy, where a thin, flexible tube called an endoscope is passed down your throat, and tiny tools are used to drain away the fluid.

Infected pancreatic necrosis

In around 1 in 3 severe cases of acute pancreatitis, a serious complication called infected pancreatic necrosis occurs.

In infected pancreatic necrosis, high levels of inflammation cause an interruption to the blood supply of your pancreas. Without a consistent supply of blood, some of the tissue of your pancreas will die. Necrosis is the medical term for the death of tissue.

The dead tissue is extremely vulnerable to infection from bacteria. Once an infection has occurred, it can quickly spread into the blood (blood poisoning) and cause multiple organ failure. If left untreated, infected pancreatic necrosis is almost always fatal.

Infected pancreatic necrosis usually develops 2 to 6 weeks after the symptoms of acute pancreatitis starts. Symptoms include increased abdominal pain and a high temperature. The infection is treated with injections of antibiotics, and the dead tissue needs to be removed to prevent the infection returning.

In some cases, it may be possible to drain away the dead tissue using a thin tube called a catheter, which is placed through the skin.

Alternatively, laparoscopic surgery (keyhole surgery) can be used. A small cut is made in your back and an endoscope is inserted to wash away any dead tissue. If laparoscopic surgery isn’t possible, a cut can be made in your abdomen to allow the dead tissue to be removed.

Infected pancreatic necrosis is a very serious complication. Even with the highest standards of medical care, the risk of dying from organ failure is estimated to be around 1 in 5.

Systemic inflammatory response syndrome (SIRS)

Another common complication of severe acute pancreatitis is systemic inflammatory response syndrome (SIRS). SIRS develops in an estimated 1 in 10 severe cases of acute pancreatitis.

In SIRS, the inflammation affecting the pancreas spreads throughout the body, which can cause one or more organs to fail. It usually develops during the first week after the symptoms start, with most cases developing on the same day.

Symptoms of SIRS include:

• a rise in body temperature to above 38C (100.4F) or a fall in body temperature to below 36C (96.8F)
• a rapid heartbeat of more than 90 beats a minute
• an unusually fast breathing rate (more than 20 breaths a minute)

There’s currently no cure for SIRS, so treatment involves trying to support the body’s functions until the inflammation has passed. The outcome depends on how many organs fail. The higher the number of organs affected, the greater the risk of death.

Chronic pancreatitis

If you have repeated episodes of acute pancreatitis, the damage to your pancreas may lead to chronic pancreatitis.

Chronic pancreatitis is a long-term condition that can have a serious impact on your quality of life.