Overview of Acute Pancreatitis
Acute pancreatitis is a sudden inflammation of the pancreas — a gland located behind the stomach that plays a crucial role in digestion and blood sugar regulation. This condition occurs when pancreatic enzymes become prematurely activated within the pancreas, causing the organ to begin digesting itself. Acute pancreatitis can range from mild and self-limiting to severe and life-threatening, potentially leading to organ failure and systemic complications.
Most patients recover completely with prompt treatment, but severe cases require intensive care. The condition is a leading cause of gastrointestinal hospitalizations worldwide and often recurs if the underlying cause is not addressed.
Commonly Associated with Acute Pancreatitis
Acute pancreatitis is commonly associated with:
- Gallstones – the most frequent cause, as they block the pancreatic duct.
- Chronic alcohol use – heavy alcohol consumption can trigger inflammation.
- Hypertriglyceridemia – extremely high triglyceride levels (>1000 mg/dL).
- Medications – certain drugs such as azathioprine, valproic acid, and some diuretics.
- Abdominal trauma – especially blunt trauma.
- Endoscopic retrograde cholangiopancreatography (ERCP) – a diagnostic procedure that can rarely trigger pancreatitis.
- Viral infections – such as mumps or coxsackievirus.
- Autoimmune conditions – autoimmune pancreatitis.
- Genetic mutations – particularly in younger patients (e.g., PRSS1, SPINK1).
- Post-surgical complications – following abdominal surgery.
Causes of Acute Pancreatitis
Acute pancreatitis results from premature activation of pancreatic digestive enzymes (particularly trypsin) within the pancreas, leading to auto-digestion and inflammation. This triggers a cascade of local tissue injury, inflammatory response, and potentially systemic complications.
Key causes include:
- Gallstones: Obstruction of the pancreatic duct increases pressure and enzyme activation.
- Alcohol abuse: Chronic heavy drinking alters pancreatic enzyme secretion and promotes inflammation.
- Hypertriglyceridemia: High triglycerides are broken down into free fatty acids, which damage pancreatic tissue.
- Hypercalcemia: Excess calcium can activate pancreatic enzymes.
- Medications and toxins: Some drugs directly injure pancreatic cells.
- Genetic and autoimmune factors: Predispose certain individuals to pancreatic inflammation.
In about 10–20% of cases, the cause is idiopathic (unknown).
Symptoms of Acute Pancreatitis
Symptoms typically develop suddenly and may range from mild discomfort to severe, life-threatening illness. The hallmark symptom is acute upper abdominal pain.
Common signs and symptoms include:
- Severe upper abdominal pain that may radiate to the back or worsen after eating.
- Nausea and vomiting.
- Abdominal tenderness and bloating.
- Fever and rapid pulse.
- Jaundice (yellowing of skin and eyes) if bile flow is obstructed.
- Severe cases: Low blood pressure, difficulty breathing, confusion, or signs of organ failure.
In mild cases, symptoms often resolve within a few days. Severe pancreatitis can lead to complications like pancreatic necrosis, pseudocysts, or multi-organ failure.
Exams & Tests for Acute Pancreatitis
Diagnosis is based on clinical presentation, laboratory tests, and imaging studies. At least two of the following three criteria are required for diagnosis:
- Typical abdominal pain consistent with acute pancreatitis.
- Elevated pancreatic enzymes (amylase or lipase ≥3 times the upper limit of normal).
- Imaging evidence of pancreatic inflammation.
Key diagnostic tools include:
- Blood tests:
- Elevated serum amylase and lipase (lipase is more specific).
- Abnormal liver function tests if gallstones are involved.
- Triglyceride and calcium levels to identify underlying causes.
- Imaging studies:
- Ultrasound: Detects gallstones and biliary obstruction.
- CT scan: Evaluates pancreatic inflammation, necrosis, or complications.
- MRI/MRCP: Offers detailed ductal imaging without radiation.
Treatment of Acute Pancreatitis
There is no specific cure for acute pancreatitis — treatment focuses on supportive care, treating underlying causes, and preventing complications.
1. Supportive Care (Mainstay of Treatment):
- Hospitalization and fluid resuscitation: IV fluids to prevent dehydration and maintain organ perfusion.
- Pain management: Opioids or other analgesics for severe pain.
- Fasting (NPO): The pancreas is rested by withholding food until inflammation improves.
- Nutritional support: Gradual reintroduction of oral intake or enteral nutrition if prolonged fasting is required.
2. Treating Underlying Causes:
- Gallstones: Endoscopic retrograde cholangiopancreatography (ERCP) or surgery to remove stones.
- Alcohol-induced: Cessation of alcohol and supportive care.
- Hypertriglyceridemia: Plasmapheresis or insulin to rapidly lower triglyceride levels.
- Hypercalcemia: Treating the underlying cause to reduce calcium levels.
3. Managing Complications:
- Antibiotics: Only if infection is confirmed (e.g., infected pancreatic necrosis).
- Drainage or surgery: For pseudocysts, abscesses, or necrotic tissue.
- Intensive care: For severe cases with organ failure.
Most patients with mild pancreatitis recover within 3–5 days, while severe cases may require weeks of hospitalization and multidisciplinary care.
Source
- Banks PA, Bollen TL, Dervenis C, et al. “Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus.” Gut 2013; 62(1):102–111.
- Tenner S, Baillie J, DeWitt J, Vege SS. “American College of Gastroenterology guideline: management of acute pancreatitis.” Am J Gastroenterol 2013; 108(9):1400–1415.
- National Institute for Health and Care Excellence (NICE). “Acute pancreatitis: diagnosis and management.” NICE Guideline NG104, 2018.
