Acute pancreatitis

Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time. The pancreas is a small organ behind the stomach and below the ribcage.

Most people with acute pancreatitis get better within a week and have no further problems. But severe cases can bring serious complications and can even be fatal.

Acute pancreatitis is not the same as chronic pancreatitis, where the inflammation of the pancreas goes on for many years.

The most common symptoms are:

• suddenly getting severe pain in the centre of your abdomen (tummy)
• feeling or being sick
• diarrhoea

If you suddenly get severe pain in your abdomen, see a doctor straight away. If you can't reach one, call a doctor or the 16263 health line, and ask for advice on what to do.

Doctors think acute pancreatitis happens when something goes wrong with some of the enzymes (chemicals) in the pancreas, so that they start to digest 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

If you cut down on alcohol and change your diet so that gallstones are less likely, you can help lower your chances of developing acute pancreatitis.

Acute pancreatitis is more common in middle-aged and elderly people, though it can affect people of any age.

Men are more likely to develop the alcohol-related kind. Women, on the other hand, are more likely to develop it because of gallstones.

Treatment for acute pancreatitis focuses on supporting the body's functions until the inflammation has passed. Usually this means you'll be admitted to hospital. There you'll be given fluids into a vein (intravenous fluids), along with pain relief, nutritional support and oxygen through tubes into your nose.

Most people with acute pancreatitis get better within a week and are well enough to leave hospital after 5 to 10 days. In severe cases, though, recovery takes longer, because complications can develop and these need extra treatment.

About 4 out of 5 cases of acute pancreatitis get better quickly and don't lead to any serious further problems. But 1 in 5 cases are severe, and these can bring life-threatening complications, such as multiple organ failure.

When a severe case does develop complications, the risk of the condition being fatal is high.

A person who survives severe acute pancreatitis will probably need several weeks or months before they're well enough to leave hospital.

The main symptom of acute pancreatitis is a severe, dull pain around the top of your stomach that comes on suddenly.

This aching pain often gets steadily worse, and it can travel along your back or below your left shoulder blade. Eating or drinking may make you feel worse very quickly, especially fatty foods.

Leaning forward or curling into a ball may ease the pain, but lying flat on your back often makes it worse.

When gallstones cause acute pancreatitis, it usually starts after a large meal. If alcohol is the cause, the pain often begins 6 to 12 hours after you've had a significant amount to drink.

Acute pancreatitis can cause other symptoms too, including:

• nausea (feeling sick) or vomiting
• diarrhoea
• indigestion
• a high temperature (fever) of 38C (100.4F) or above
• jaundice, which is yellowing of the skin and the whites of the eyes
• tenderness or swelling of the abdomen (tummy)

Contact a doctor immediately if you suddenly develop severe abdominal pain. If you can't do that, contact a doctor or the 16263 health line, or your local out-of-hours service, for advice.

Most cases of acute pancreatitis are closely linked to gallstones or to drinking alcohol. In some people, though, the exact cause isn't clear.

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

When that opening is blocked, some of the enzymes (chemicals) made by the pancreas can be disrupted. Normally these enzymes help digest food in your intestines. With the blockage, they can start to digest the pancreas instead.

That said, not everyone with gallstones will develop acute pancreatitis. Most gallstones don't cause any problems.

Doctors don't fully understand how alcohol leads to an inflamed pancreas. One theory is that alcohol disturbs the normal workings of the pancreas, so the enzymes start to digest the organ itself.

Whatever the exact cause, the link between alcohol and acute pancreatitis is clear.

Binge drinking, which means drinking a lot of alcohol in a short period of time, is also thought to raise your risk of developing acute pancreatitis.

Acute pancreatitis has some less common causes too:

• accidental damage or injury to the pancreas, for example during a procedure to remove gallstones or examine the pancreas
• certain types of medicine, such as some antibiotics, weight loss medicine or chemotherapy medicine (acute pancreatitis can be an unexpected side effect of these 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

No one knows exactly why some people develop severe acute pancreatitis. Some things are thought to raise your risk:

• being 70 years of age or over
• being obese (a person is considered obese if they have 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 particular genetic mutation, called the MCP-1 mutation, are 8 times more likely to develop severe acute pancreatitis than the general population. A genetic mutation is when the instructions (DNA) found in all living cells become scrambled. This can lead to a genetic disorder or a change in characteristics.

Doctors diagnose most cases of acute pancreatitis 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 examine you. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch.

You will have a blood test to help confirm the diagnosis. It can pick up signs of the condition, such as a high level of 2 chemicals called lipase and amylase.

At first, it can be hard to tell whether your acute pancreatitis is mild or severe. So you'll be watched closely for signs of serious problems, such as organ failure.

People with mild acute pancreatitis tend to get better within a week. They have either no further problems or problems that clear up within 48 hours. People with severe acute pancreatitis develop serious problems that don't go away.

Doctors may use several tests to find out how severe your acute pancreatitis is and how likely you are to develop more serious complications. You may have any of the following:

• 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 called an endoscope, which has a camera on one end. The endoscope is 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. Once the dye is in, X-rays are taken.

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

Acute pancreatitis is treated in hospital. There, doctors will watch you closely for signs of serious problems, and you'll be 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 need specific additional treatment, and you'll have to be admitted to a high dependency unit or intensive care unit (ICU). Recovery may then take much longer, and the condition can be fatal.

You can read about the potential complications of acute pancreatitis for more information on severe cases.

During an episode of acute pancreatitis, your body can become dehydrated. To deal with this, you're given fluids through a tube connected to one of your veins (this is called intravenous, or IV, fluid).

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

Many people with mild acute pancreatitis don't have to change what they eat, but some are advised not to eat at all. The reason is that trying to digest solid food could put too much strain on your pancreas.

How long you must avoid solid foods depends on how severe the condition is. It may be a few days or longer.

If you can't have solid food, a feeding tube may be used to give your body the nutrients it needs. This is called enteral feeding, and it often means a tube is passed through your nose and down into your stomach (a nasogastric tube).

Your vital organs need enough oxygen, so in acute pancreatitis it's usually given through small tubes placed in your nose. The tubes can come out after a few days, once you're getting better.

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

Acute pancreatitis often causes severe pain in the abdomen (the tummy), so you will probably need a strong painkilling medicine such as morphine.

Some of these painkillers can make you feel very drowsy. If you're visiting someone in hospital with acute pancreatitis, don't be alarmed or worried if they seem drowsy or don't respond to you.

Once the acute pancreatitis is under control, the cause behind it may also need treatment.

If a gallstone has caused your acute pancreatitis, you may need a procedure called endoscopic retrograde cholangiopancreatography (ERCP), or your gallbladder may need to be taken out.

The gallbladder operation may be done while you're in hospital, or it may be planned for several weeks later. Losing your gallbladder should have no significant effect on your health. The only change is that some foods, such as fatty or spicy ones, may become harder to digest.

ERCP is another way of treating gallstones. The doctor uses a narrow, flexible tube called an endoscope, which has a camera on one end. X-rays guide the endoscope into your digestive system, and surgical instruments are passed down it to remove the gallstones.

If alcohol caused your acute pancreatitis, you should stay away from it completely once you've recovered. If you find that hard, you'll probably need extra treatment.

Treatment options for alcohol dependence include:

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

Most people with acute pancreatitis get better without any further problems. In severe cases, though, serious complications can develop.

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

Pseudocysts usually develop 4 weeks after the symptoms of acute pancreatitis start. Often they cause no symptoms at all and are only found during a computerised tomography (CT) scan. In some people, though, they can cause bloating, indigestion and a dull abdominal (tummy) pain.

If the pseudocysts are small and not causing any symptoms, you may not need any further treatment, because they usually go away on their own.

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

The fluid can be drained out of the cyst by putting a needle into it through your skin. It can also be done with 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.

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

With infected pancreatic necrosis, heavy inflammation interrupts the blood supply to your pancreas. Without a steady supply of blood, some of the pancreatic tissue dies. Necrosis is the medical term for the death of tissue.

Dead tissue is very open to infection from bacteria. Once infection sets in, it can spread quickly into the blood (blood poisoning) and cause multiple organ failure. If it isn't treated, infected pancreatic necrosis is almost always fatal.

It usually develops 2 to 6 weeks after the symptoms of acute pancreatitis start. The symptoms are increased abdominal pain and a high temperature. The infection is treated with injections of antibiotics, and the dead tissue has to be removed so the infection doesn't return.

In some cases, the dead tissue can be drained away through a thin tube called a catheter, which is placed through the skin.

Another option is laparoscopic surgery (keyhole surgery). The surgeon makes a small cut in your back and puts in an endoscope to wash away any dead tissue. If laparoscopic surgery isn't possible, a cut can be made in your abdomen so the dead tissue can 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.

Severe acute pancreatitis can lead to another common complication, systemic inflammatory response syndrome (SIRS). It develops in an estimated 1 in 10 severe cases.

In SIRS, the inflammation that affects the pancreas spreads throughout the body, and this can cause one or more organs to fail. It usually starts during the first week after the symptoms begin, and most cases appear 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 means trying to support the body's functions until the inflammation has passed. How well a person does depends on how many organs fail. The more organs are affected, the greater the risk of death.

If you have repeated episodes of acute pancreatitis, the damage to your pancreas can lead to chronic pancreatitis. This is a long-term condition, and it can have a serious effect on your quality of life.

Gallstones and drinking too much alcohol are common causes of acute pancreatitis, so living a healthy life can lower your chances of getting it.

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, which you get from wholemeal bread, oats and brown rice. They help lower the amount of cholesterol in your body. There is also evidence that eating nuts regularly, such as peanuts or cashews, can help reduce your risk of developing gallstones.

Cholesterol seems to play a part in how gallstones form, so it's advisable not to eat too many fatty foods that are high in cholesterol. These include:

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

Being overweight also raises your chances of developing gallstones. So keeping to a healthy weight, by eating a balanced diet and getting plenty of regular exercise, can help lower your risk too.

Limiting the amount of alcohol you drink can help stop your pancreas from being damaged, and it reduces your risk of developing acute pancreatitis. It can also lower your chances of developing other serious conditions, such as liver cancer.

Read the pages on drinking and alcohol for more information and advice.