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School of Medicine
What is acute pancreatitis?
Acute pancreatitis is an inflammation of the pancreas that occurs suddenly. It differs from chronic pancreatitis in that there is a discrete episode, which may be classified as mild, moderate or severe, depending on the amount of damage and organ dysfunction caused by the episode.
What causes acute pancreatitis?
Biliary stones are the cause of 35 to 50 percent of the cases of acute pancreatitis. Alcohol intake is the second leading cause of acute pancreatitis. Several drugs may cause pancreatitis. These include immunosuppressants, estrogens, acetaminophen, sulindac, tetracycline, salicylates, erythromycin, pentamidine, thiazide diuretics, furosemide and valproic acid.
Viral causes include hepatitis A, B, and non-A/non-B; cytomegalovirus; mumps; and coxsackievirus. Bacterial causes may include Legionella, mycoplasma and mycobacterium tuberculosis. Parasitic infections may also cause acute pancreatitis. Pancreas divisum (a congenital defect of the pancreatic ducts), microlithiasis (microscopic stones), metabolic imbalances (hyperlipidemia and hypercalcemia), sphincter of Oddi dysfunction, scorpion stings and trauma may also cause acute pancreatitis.
What are the symptoms of acute pancreatitis?
Abdominal pain, nausea and vomiting are the most frequent symptoms of acute pancreatitis. Fever, jaundice, hypotension and tachycardia are not uncommon. Peritonitis and shock with confusion or coma may occur. Laboratory tests reveal elevated serum pancreatic enzymes (amylase and lipase).
Can acute pancreatitis become chronic pancreatitis?
Yes. Chronic pancreatitis results when inflammation in the pancreas has caused damage and resulted in fibrosis, calcifications and ductal inflammation. It is also possible for patients with chronic pancreatitis to have episodes of acute pancreatitis.
How is acute pancreatitis diagnosed?
Diagnosis of acute pancreatitis is made when the sudden onset of abdominal pain is accompanied by elevated serum amylase and/or lipase (pancreatic enzymes). Additional diagnostic tests may be necessary to evaluate damage or severity of the disease. Abdominal and chest X-rays, computed tomography (CT) scans, ultrasound studies, and endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are useful in detecting stones, strictures in the ducts, tumors, abscesses, pseudocysts or necrosis (death of tissue).
Can I prevent acute pancreatitis?
Avoidance of known causes of pancreatitis (i.e., alcohol consumption) may help prevent the onset of the disease. Lifestyle factors such as obesity, alcoholism, hepatitis and others that contribute to a poor state of overall health lead to complications of acute pancreatitis and to a poorer prognosis for recovery.
What is the treatment of acute pancreatitis?
The treatment of acute pancreatitis depends on its severity. If the disease is considered mild, the patient is usually fed intravenously and treated supportively with pain control medication, intravenous fluids and possibly a nasogastric tube to relieve vomiting.
Severe pancreatitis requires close monitoring of the patient to detect possible systemic complications. The patient may be admitted to an intensive care unit. Organisms may reach the pancreas and infect it by crossing the colonic wall. Antibiotics may be used to prevent sepsis. Surgical debridement and drainage may be necessary if infected pancreatic necrosis (cell death) arises. CT scan-guided aspiration of necrotic areas may be done to identify the infecting organism so that it may be treated effectively.
Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) may be performed in the early stages of acute pancreatitis to remove gallstones and may require sphincterotomy (cutting the sphincter muscle to allow drainage from the biliary/pancreatic tract).
What are the possible complications from acute pancreatitis?
Complications can be localized or systemic. Systemic complications are usually seen in severe acute pancreatitis. These include hypotension (drop in blood pressure), pulmonary edema and adult respiratory distress syndrome. Inflammation may extend to surrounding organs such as the kidneys, colon and stomach, causing renal dysfunction, colitis, gastrointestinal bleeding, peptic ulcer disease and varices. Localized complications include fluid collections, pancreatic pseudocysts, pancreatic necrosis and infectious pancreatic necrosis.
Is there a hereditary link with acute pancreatitis?
No. There may, however, be genetic influence in chronic pancreatitis.