Pancreatitis, acute

Page last reviewed: 13/07/2011

Pancreatitis is inflammation of the pancreas. The main symptom of pancreatitis is abdominal pain, which can often be severe.

The pancreas

The pancreas is a small, leaf-shaped organ that is located behind the stomach and below the ribcage.

The pancreas has two important functions:

  • it produces digestive juices that are used by the intestines to help digest food, and
  • it produces powerful 'messenger chemicals', called hormones, which have an important affect on all the cells in the body.

Insulin is the most important hormone that is produced by the pancreas because it regulates the levels of sugar (glucose) in the blood.

Types of pancreatitis

There are two types of pancreatitis:

  • Acute pancreatitis in which the pancreas becomes inflamed over a short period of time. The inflammation passes after a few days.
  • Chronic pancreatitis in which the inflammation of the pancreas persists for many years, causing it to become more and more damaged. Chronic pancreatitis can often develop after repeated previous episodes of acute pancreatitis.

This section focuses on acute pancreatitis. See Useful links for more information about chronic pancreatitis.

How common is acute pancreatitis?

Acute pancreatitis is uncommon. The condition is slightly more common in men than it is in women.

There are 5-80 new cases of pancreatitis out of every 100,000 of the population annually.

Rates of acute pancreatitis have risen significantly over the past 40 years. It is thought that this has been caused by the rise in alcohol misuse, because the excessive consumption of alcohol is a major risk factor for acute pancreatitis, accounting for 36% of all cases.

The other major risk factor for acute pancreatitis is gallstones (lumps of fatty material that can form in the gallbladder). Gallstones account for 38% of all cases of acute pancreatitis.

The average age for the development of alcohol-related acute pancreatitis is 38. The average age for the development of gallstone-related acute pancreatitis is 69.

Outlook

The outlook for acute pancreatitis is mixed. In 80% of cases, the inflammation of the pancreas will be mild and will not cause any serious complications. Admission to hospital is always required, though, because the functions of the body need to be supported until the pancreas recovers.

In the remaining 20% of cases of acute pancreatitis the inflammation of the pancreas is severe and causes serious complications such as:

  • a massive drop in blood pressure,
  • blood poisoning (sepsis), and
  • multiple organ failure.

This more severe form of acute pancreatitis is a medical emergency and requires admission to an intensive care unit (ICU).

The most effective way to reduce your risk of developing acute pancreatitis is avoid the excessive consumption of alcohol. See Prevention, for more information.

Page last reviewed: 13/07/2011

Pain

The main symptom of acute pancreatitis is the sudden onset of pain in the centre of your upper abdomen.

The pain of acute pancreatitis often gets steadily worse until it reaches a constant ache. The ache can be severe and may travel from your abdomen and along your back. The pain may feel worse after you have eaten.

You may feel that leaning forward or curling into a ball helps to relieve the pain to a certain extent.

You should see your GP if you are experiencing a constant abdominal pain.

Other symptoms

Other symptoms of acute pancreatitis can include:

  • nausea,
  • vomiting,
  • diarrhoea,
  • loss of appetite,
  • a high temperature (fever) of 38°C (100.4°F) or above,
  • tenderness of the abdomen and, less commonly,
  • yellowing of the skin and whites of the eyes (jaundice).

Glossary

Acute
Acute means occuring suddenly or over a short period of time.
Enzymes
Enzymes are proteins that speed up and control chemical reactions such as digestion in the body.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Vomit
Vomiting is when you bring up the contents of your stomach through your mouth.
Nausea
Nausea is when you feel like you are going to be sick.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.

Page last reviewed: 13/07/2011

Trypsin

Acute pancreatitis is caused as a result of damage done to the normal workings of the pancreas (e.g. alcohol misuse, gallstones - see below). As a result of this damage, a chemical called trypsin is activated inside the pancreas.

Trypsin is an enzyme that is produced by the pancreas. It is used to help break down the proteins in food to aid digestion.When trypsin is produced by the pancreas, it remains in an 'inactive' state and has no digestive properties.

It is not until it is moved out of the pancreas and into the intestines that it becomes active and is able to start breaking down proteins.

In cases of acute pancreatitis, trypsin is activated while it is still in the pancreas. The trypsin begins to break down the cells of the pancreas. In other words, the pancreas starts to digest itself, causing it to become irritated and inflamed. 

Risk factors

Alcohol misuse and gallstones are the two main risk factors for acute pancreatitis.

Alcohol misuse

It is not completely understood how alcohol activates trypsin when it is still the pancreas.

One theory is that the ethanol molecules in alcohol interfere with the normal workings of the cells of the pancreas, causing them to activate trypsin prematurely.

Whatever the cause, there is a clear link between alcohol misuse and acute pancreatitis. Acute pancreatitis is known to occur in 10% of cases of chronic alcohol misuse.

Chronic alcohol misuse is defined as drinking more than 10 units of alcohol a day. More than four pints of lager or more than five glasses of wine a day on a daily basis equals more than 10 units of alcohol a day.

Gallstones

Gallstones are hard pieces of stone-like material that can form if your bile has too much cholesterol in it.

Sometimes, a gallstone can move out of the gallbladder and block the openings (ducts) to the pancreas. The blockage interferes with the normal workings of the pancreas, activating trypsin while it is still inside the pancreas and causing the pancreas to become irritated and inflamed.

For more information see the A-Z topic on gallstones.

Less common causes

Less common causes of pancreatitis include:

  • bacterial infections, such as salmonella (a type of food poisoning), or Legionnaires' disease (an infection that is usually caused by inhaling droplets of contaminated water),
  • viral infections, such as mumps or hepatitis B,
  • conditions where the immune system attacks healthy tissue (autoimmune conditions), such as lupus or Sjogren's syndrome, and
  • injury to the pancreas.

Idiopathic pancreatitis

In an estimated 15% of cases of acute pancreatitis, no obvious cause can be found. This type of pancreatitis is known as idiopathic pancreatitis.

Glossary

Acute
Acute means occuring suddenly or over a short period of time.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.

Page last reviewed: 13/07/2011

In order to diagnose acute pancreatitis, your GP will have to ask you about your symptoms and carry out a physical examination of your abdomen. Acute pancreatitis will make certain areas of your abdomen very tender to touch.

Blood tests

The next stage in the diagnosis is to carry out a blood test. During acute pancreatitis, your pancreas will begin to produce higher than usual levels of two chemicals called amylase and lipase. Raised levels of amylase and lipase can be detected during a blood test.

If the blood test reveals raised levels of amylase and lipase, it is likely that you will be admitted to hospital.

Further testing

Further testing may be carried out in hospital in order to observe the extent of the inflammation of your pancreas and to assess your risk of developing more serious complications.

The tests that you may have include:

  • an ultrasound scan,
  • a computerised tomography (CT) scan, and
  • an endoscopic retrograde cholangio-pancreatography (ERCP).

A CT scan is like an X-ray, but it uses multiple scans, or images, in order to build up a more detailed, three-dimensional picture of the inside of your body.

An ERCP uses a narrow, flexible tube that has a camera on the end. This tube is known as an endoscope. The endoscope guided into your digestive system using an ultrasound scanner.

An ERCP can be useful in cases of gallbladder-associated acute pancreatitis because it can pinpoint exactly where the gallstone that is causing the problem is located.

In some cases, it is possible to pass surgical instruments down the endoscope so that the gallstone can be removed.

Page last reviewed: 13/07/2011

The treatment that you receive for acute pancreatitis will depend on whether you have the mild form of the condition, which causes no complications, or the serious form, which can cause serious complications.

Mild acute pancreatitis

The main goal in treating mild acute pancreatitis is to support the functions of the body while the pancreas has the time to recover.

This support takes three main forms:

  • Pain relief. Even mild acute pancreatitis can cause moderate to severe pain, so strong painkillers can be used to treat your symptoms. You may also be given medication to help control symptoms of nausea and vomiting.
  • Nutrition. In order to rest your pancreas as much as possible, it is unlikely that you will be able to eat normally. Instead, nutrients can be provided by way of feeding tubes.
  • Intravenous (IV) fluids. Because your body can become dehydrated during an episode of acute pancreatitis, fluids will be provided through a tube that is connected to one your veins.

Most people who have mild acute pancreatitis are well enough to leave hospital within five to seven days.

Severe acute pancreatitis

In cases of severe acute pancreatitis, the inflammation of the tissue of the pancreas is so severe that some of the pancreas dies (necrosis).

Tissue necrosis is potentially very dangerous. This is because the dead tissue provides an ideal breeding ground for a severe bacterial infection, which can spread into the blood (sepsis) and the rest of the body, causing multiple organ failure.

The other main danger with severe pancreatitis is that the body can lose a massive amount of fluid, which, in turn, can lead to a reduction of the volume of blood in your body (hypovolemic shock).

Hypovolemic shock can be life-threatening because your body can become quickly starved of the oxygen-rich blood it needs to survive.

To deal with both of these threats, you will be admitted to an intensive care unit (ICU). Injections of antibiotics may be used to prevent any dead tissue from becoming infected.

Intravenous fluids will be used to restore any lost fluids and to prevent you going into hypovolemic shock.

Ventilation equipment may be used to assist you with your breathing and feeding tubes may be used to provide your body with nutrients. Surgery may be required to remove any dead tissue from your pancreas.

You will probably have to stay in the ICU until your treatment team has confirmed that the risk of widespread infection, organ failure and hypovolemic shock has passed. This could take up to 14 days but it may be longer if your acute pancreatitis is particularly severe.

Treating underlying causes

Once acute pancreatitis has passed, it is important that any underlying causes are treated so that you don't have any further episodes of the condition.

If gallstones are responsible for your condition, you will probably be referred for surgery to remove them once your pancreas has recovered. You may also be advised to eat a low-fat diet because this will reduce the amount of cholesterol in your blood, and reduce the risk of further gallstones developing.

See the A-Z topic on gallstones for more information about treatment.

If alcohol misuse is responsible for your condition, you will probably be referred to a treatment programme for alcohol misuse. See the A-Z topic on alcohol misuse for more information about how it can be treated.

Page last reviewed: 13/07/2011

Alcohol misuse and gallstones are the two leading risk factors for acute pancreatitis. Both of these risk factors can be reduced by making changes to your diet and lifestyle.

Alcohol

Limiting the amount of alcohol that you drink can help to prevent damage to your pancreas and lower your risk of getting acute pancreatitis. It can also lower your chances of developing other serious conditions, such as liver cancer.

The guidelines about alcohol consumption state that men should not drink more than 21 standard drinks of alcohol a week, and women should not drink more than 14 standard drinks a week. A standard drink of alcohol is equal to about half a pint of normal strength beer, a small glass of wine, or a pub measure or spirits.

Gallstones

The most effective way to prevent gallstones is to eat a healthy, low-fat diet, including plenty of fresh fruit and vegetables (at least five portions a day). Your diet should also include whole grains, found in wholemeal bread, oats, and brown rice, because it will help to lower the amount of cholesterol in your bile.

Being overweight also increases the amount of cholesterol in your bile and your chances of developing gallstones. You should therefore control your weight by eating a healthy diet and taking plenty of regular exercise.

For most people, 30 minutes of vigorous exercise a day, at least five times a week, is recommended. The exercise should be strenuous enough to leave your heart beating faster, and you should feel slightly out of breath afterwards. Examples of vigorous exercise include going for a brisk walk, or walking up a hill.

However, if you have never exercised before, or if you have not exercised for some time, you should seek advice from your GP before starting a new programme of exercise.

 

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

Browse Health A-Z