Acute Pancreatitis

Acute pancreatitis causes abdominal pain. It usually settles in a few days but sometimes it becomes severe and very serious. Gallstones or drinking a lot of alcohol are the usual causes.

What is the pancreas?

The pancreas is in the upper abdomen and lies behind the stomach and intestines (guts). It makes a fluid that contains enzymes (chemicals) that are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny ducts (tubes). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the duodenum (the part of the gut just after the stomach). The enzymes are in an inactive form in the pancreas (otherwise they would digest the pancreas). They are 'activated' in the duodenum to digest food.

Groups of special cells called 'Islets of Langerhans' are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are passed (secreted) directly into the bloodstream to control the blood sugar level.

The bile duct carries bile from the liver and gallbladder. This joins the pancreatic duct just before it opens into the duodenum. Bile also passes into the duodenum and helps to digest food.

What is pancreatitis?

Pancreatitis means inflammation of the pancreas. There are two types.

• Acute pancreatitis - when the inflammation develops quickly, over a few days or so. It usually goes away completely and leaves no permanent damage. Sometimes it is serious.
• Chronic pancreatitis - when the inflammation is persistent. The inflammation tends to be less intense than acute pancreatitis but as it is ongoing it can cause scarring and damage. Chronic pancreatitis is not dealt with further in this leaflet.

About 2 people in 100,000 have acute pancreatitis each year in the UK.

What are the causes of acute pancreatitis?

Gallstones or alcohol cause more than 8 in 10 cases. Other causes are rare.

• Gallstones - are the commonest cause in the UK. Many people form gallstones in the gallbladder but they usually cause no harm. Sometimes a stone passes into the bile duct and is carried out into the duodenum without any problem. However, in some people a gallstone gets stuck in the bile duct or where the bile duct and pancreatic duct open into the duodenum. This can affect the enzymes in the pancreatic duct (or even block them completely) and trigger a pancreatitis.
• Alcohol - is the other common cause. How alcohol actually triggers the inflammation in the pancreas is not clear. Symptoms typically begin about 6-12 hours after a heavy drinking session. In some people pancreatitis can develop even after a small amount of alcohol. In these people a 'sensitivity' to alcohol develops in their pancreas.
• Uncommon causes - include: virus infections (eg mumps); a rare side effect to some medicines; injury or surgery around the pancreas; parasite infections; high blood fat or calcium levels; abnormal structure of the pancreas. There is also a rare hereditary form of pancreatitis.
• Unknown - no cause is found in about 1 in 10 cases. However, a number of these cases are probably due to tiny gallstones or 'gallstone sludge' that passes through the bile duct but is too small to be seen on scans or other tests.

What happens in acute pancreatitis?

The digestive enzymes (chemicals) that are made in the pancreas become activated and start to 'digest' parts of the pancreas. (They are normally only activated after they reach the duodenum). This leads to a range of chemical reactions that cause inflammation in the pancreas. How the above causes actually trigger this sequence of events is not clear.

• In most cases (about 4 in 5), the inflammation is mild and settles within a week or so. Symptoms may be bad for a few days but then settle and the pancreas fully recovers.
• In some cases (about 1 in 5) the inflammation quickly becomes severe. Parts of the pancreas and surrounding tissues may die (necrose). Pancreatic enzymes and chemicals may get into the bloodstream and cause inflammation and damage to other organs in the body. This can lead to shock, respiratory failure, kidney failure and other complications. This is a very serious situation which can be fatal.

What are the symptoms of acute pancreatitis?

• Abdominal pain - just below the ribs is the usual main symptom. It usually builds up quickly (over an hour or so). The pain can become severe and is typically felt spreading through to the back.
• Vomiting, fever and generally feeling unwell are common.
• If the pancreatitis becomes severe and other organs become involved then various other symptoms may develop.

What happens if acute pancreatitis is suspected?

Admission to hospital is usual if a doctor suspects that you have acute pancreatitis. There are lots of causes of abdominal pain and vomiting so tests are done to rule out other problems and to confirm the diagnosis. One test is to check the blood level of amylase or lipase (enzymes made by the pancreas). Although not 100% reliable, a high blood level of amylase and/or lipase strongly suggests that pancreatitis is the cause of symptoms. An ultrasound scan may be done to look for a gallstone if this is the suspected underlying cause.

Close observation is usual to check for signs of complications or if other organs are being affected. If symptoms do not settle over a couple of days or so then other tests may be done to see if the pancreatitis has become severe, for example, scans of the pancreas.

What is the treatment for acute pancreatitis?

• Strong painkillers by injection are usually needed to ease the pain.
• The stomach and gut are best kept empty. So, food and drink are stopped. A tube may also be passed down the nose into the stomach (nasogastric tube) to suck out the fluid from stomach. These measures also help to reduce vomiting.
• A 'drip' is needed to give fluid into the body until symptoms settle.

There is no treatment that will take the inflammation away. However, in most cases the pancreatitis settles over a few days although symptoms can get worse before they get better. Less commonly, complications develop and the situation can get very serious. Other treatments that may then be needed include the following

• Intensive care treatment.
• A procedure to remove a blocked gallstone if this is found to be the cause.
• Antibiotics if the pancreas or surrounding tissue become infected.
• Surgery is sometimes needed to remove infected or damaged tissue.

What is the outlook (prognosis) for acute pancreatitis?

As mentioned, acute pancreatitis is classified as mild if no complications develop (about 4 in 5 cases). In this case the outlook is very good and full recovery is usual. Severe acute pancreatitis (about 1 in 5 cases) means that one or more complications develop. Despite intensive care treatment, up to a quarter of people with severe acute pancreatitis die.

Will it happen again?

A bout of acute pancreatitis may be a one-off event. However, if there is an underlying cause then it may recur unless the cause is corrected. One of the following may be relevant to prevent a recurrence, depending on the cause.

• Removal of the gallbladder is usually advised if a gallstone was the cause. This prevents further gallstone formation.
• Alcohol related concerns.
  • Alcohol should not be taken for at least several months after a bout of acute pancreatitis, whatever the cause.
  • If alcohol is the cause of pancreatitis then stopping drinking for good may be advised.
  • Sometimes a pancreatitis is the first indication of an alcohol dependency problem. Further help, advice and counselling may be offered if a drinking problem is the root cause.
• A high blood fat level (hyperlipidaemia) is sometimes the cause. This may need treating.
• A side effect from medication is a rare cause of acute pancreatitis. A change in medication may be needed by some people to prevent further bouts.

In summary

• Acute pancreatitis causes abdominal pain and vomiting.
• Most cases are due to gallstones or drinking a lot of alcohol.
• Hospital treatment is needed but in most cases symptoms go after a few days.
• Sometimes it progresses to severe acute pancreatitis which can be fatal.
• Removal of the gallbladder will prevent further bouts if a gallstone is the cause.
• Don't drink alcohol after acute pancreatitis until your doctor advises it is safe to do so.

Further help and information

Pancreatitis Supporters Network
P O Box 8938, Birmingham, B13 9FU
Tel: 0121 449 0667   Web: www.pancreatitis.org.uk/
Provides information and support for people with pancreatitis.

© EMIS and PIP 2004   Updated: May 2001   CHIQ Accredited