Acute
pancreatitis is a serious condition where the pancreas becomes inflamed over a
short period of time. Most people with acute
pancreatitis improve within a week and experience no further problems, but
severe cases can have serious complications and can even be fatal.
Acute pancreatitis is different
to chronic pancreatitis, where the inflammation
of the pancreas persists for many years. The most common symptoms of acute
pancreatitis include:
- suddenly
getting severe pain in the centre of your abdomen (tummy)
- feeling
sick
- vomiting.
When to seek medical help
You should contact your doctor immediately if you suddenly develop severe abdominal pain. If this is not
possible, you must visit your nearest Accident and Emergency department.
Why it happens
It is thought acute pancreatitis
occurs when a problem develops with some of the enzymes (chemicals) in the
pancreas, which causes them to try to digest the organ. Acute pancreatitis is most
often linked to:
- gallstones, which accounts for around
half of all cases
- alcohol
consumption, which accounts for about a quarter of all cases.
By reducing your alcohol intake and
altering your diet to make gallstones less likely, you can help reduce
your chances of developing acute pancreatitis.
Who is affected?
Acute pancreatitis is more
common in middle-aged and elderly people, but it can affect people of any age. Men are more likely to develop
alcohol-related pancreatitis, while women are more likely to develop it as a
result of gallstones. In England, more
than 20,000 people were admitted to hospital with acute
pancreatitis between 2011 and 2012.
How it is treated
There is currently no cure for acute
pancreatitis, so treatment focuses on supporting the functions of the body
until the inflammation has passed. This usually involves admission
to hospital so you can be given fluids into a vein (intravenous fluids), pain
relief, nutritional support and oxygen through tubes into your nose.
Most people with acute pancreatitis
improve within a week and are well enough to leave hospital after 5-10 days. However, recovery will take longer in
severe cases, as complications that require additional treatment may
develop.
Complications
About four out of five
cases of acute pancreatitis improve quickly and don't cause any serious
further problems. However, one in five cases are severe and can
result in life-threatening complications, such as multiple organ failure.
In severe cases where complications
develop, there is a high risk of the condition being fatal. In
England, just over 1,000 people die from acute pancreatitis every year. If a person survives the effects of
severe acute pancreatitis, it is likely to be several weeks or months before
they are well enough to leave hospital.
Anatomy of the abdomen
The pancreas
The pancreas is a small organ located
behind the stomach and below the ribcage. It has two important functions:
- it
produces digestive chemicals (enzymes) that are used by the
intestines to help digest food
- it
produces powerful hormones, the most important being insulin, which
regulates the level of sugar (glucose) in the blood.
Causes of acute pancreatitis
Most cases of acute pancreatitis
are closely linked to gallstones and alcohol consumption, although the
exact cause is not always clear.
Gallstones
Gallstones are hard pieces of stone-like
material that can form in your gallbladder. They can trigger acute pancreatitis
if they move out of the gallbladder and block the opening of the pancreas.
The blockage can disrupt some of the
enzymes (chemicals) produced by the pancreas. These enzymes are normally used
to help digest food in your intestines, but they can start to digest
the pancreas instead if the opening is blocked. However, not everyone with gallstones
will develop acute pancreatitis. Most gallstones do not cause any problems.
Alcohol consumption
It is not fully understood how
alcohol causes the pancreas to become inflamed. One theory is that it
interferes with the normal workings of the pancreas, causing the enzymes to
start digesting it.
Whatever the cause, there is a clear
link between alcohol use and acute pancreatitis. A very large study found that
people who regularly drank more than 35 units of alcohol a week were four times
more likely to develop acute pancreatitis than people who never drank alcohol
(35 units is the equivalent of drinking around 16 cans of strong lager or
four bottles of wine a week). Binge drinking, which is drinking a lot
of alcohol in a short period of time, is also thought to increase your risk of
developing acute pancreatitis.
Other causes
Less common causes of acute
pancreatitis include:
- accidental
damage to the pancreas that occurs during a type of surgery known as
endoscopic retrograde cholangiopancreatography (ERCP), which is used to
remove gallstones or examine the pancreas or surrounding tissue
- certain types of medication, such as some antibiotics or chemotherapy medication – acute
pancreatitis can be an unexpected side effect of these in a small
number of people
- a viral infection such as mumps or measles.
The major causes of acute pancreatitis.
Severe pancreatitis
Little is known about why some people
develop severe acute pancreatitis. Factors thought to increase your risk
include:
- 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
two or more alcoholic drinks a day
- smoking.
Researchers have also discovered that
people with a specific genetic mutation, known as the MCP-1 mutation, are eight
times more likely to develop severe acute pancreatitis than the general
population. A genetic mutation is where the instructions (DNA) found in all
living cells become scrambled, resulting in a genetic disorder or a change in
characteristics.
Gallstones
Gallstones are the most common cause of emergency
hospital admission for people with abdominal pain. About 8% of the adult
population has gallstones and 50,000 people a year have an operation to remove
their gallbladder.
Symptoms of acute pancreatitis
The main symptom of acute
pancreatitis is a severe, dull pain around the top of your stomach that
develops suddenly. This aching pain often gets steadily
worse and may travel along your back. You may feel worse after you have eaten.
Leaning forward or curling into a ball may help relieve the pain.
If you have acute pancreatitis caused
by gallstones, the pain often develops after eating a large meal. If the
condition is caused by alcohol, the pain often develops 6-12 hours after
drinking a significant amount of alcohol.
Other symptoms
Other symptoms of acute pancreatitis
can include:
- nausea
(feeling sick)
- vomiting
- diarrhoea
- loss
of appetite
- a
high temperature (fever) of 38°C (100.4°F) or above
- tenderness
of the abdomen (tummy).
When to seek medical advice
You must contact your doctor immediately
if you suddenly develop severe abdominal pain. If this is not
possible, then you must visit your nearest Emergency department/ hospital, or call for an ambulance.
Diagnosing acute pancreatitis
Most cases of acute pancreatitis are
diagnosed 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 carry out a
physical examination. If you have acute pancreatitis, certain areas of your
abdomen will be very tender to touch.
A blood test will be carried out to help
confirm a diagnosis. This will help detect signs of acute pancreatitis, such
as a high level of two chemicals called lipase and amylase.
Drawing showing an acutely inflammed pancreas.
Further testing
Further testing may be carried out to
see the extent of the inflammation of your pancreas and assess your risk of
developing more serious complications. You may have any of the following
tests:
- a computerised tomography (CT) scan, where
a series of X-rays are taken to build up a more detailed,
three-dimensional 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
- endoscopic
retrograde cholangiopancreatography (ERCP).
An ERCP uses a narrow, flexible tube
known as an endoscope, which has a camera on one end. The endoscope will be
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. After the dye has been injected,
X-rays will be taken.
This test can be useful in cases of
gallbladder-associated acute pancreatitis, because it can pinpoint exactly
where the gallstone is located. In some cases, it may be possible to pass
surgical instruments down the endoscope so the gallstone can be removed.
Grading acute pancreatitis
Determining whether a person has mild
or severe acute pancreatitis can be very difficult in the early stages. You will be monitored closely for
signs of serious problems that can develop, such as organ failure, as
these help indicate the severity of the condition.
People with mild acute pancreatitis
tend to improve within a week and experience either no further problems or
problems that resolve within 48 hours. People with severe acute pancreatitis
develop persistent serious problems. Several tests may also be used to
help determine the severity of your condition, including further blood
tests and sometimes X-rays and a CT scan.
Preventing acute pancreatitis
As acute pancreatitis is often caused
by gallstones and alcohol consumption, a healthy lifestyle can reduce your
chances of developing the condition.
Gallstones
The most effective way of
preventing gallstones is eating a healthy low-fat
diet that includes plenty of fresh fruit and vegetables (at least five portions
a day). Your diet should also include whole grains, which are found in
wholemeal bread, oats and brown rice. This will help lower the amount of cholesterol
in your body.
Being overweight also increases your
chances of developing gallstones, so maintaining a healthy weight by
eating a balanced diet and taking plenty of regular exercise can
also help reduce your risk of the developing condition.
Alcohol
Limiting the amount of alcohol you
drink can help prevent your pancreas being damaged and reduce your risk of
developing acute pancreatitis. It can also lower your chances of developing
other serious conditions, such as liver cancer.
It is recommended that
men should not drink more than 3-4 units of alcohol a day and women should
not drink more than 2-3 units a day. A unit of alcohol is equal to about half a
pint of normal strength lager, a small glass of wine or a pub measure (25ml) of
spirits.
Treating acute pancreatitis
There is no specific treatment
for acute pancreatitis, but for most people the condition gets better
on its own within a week. During this time, you will be closely
monitored for signs of serious problems. Supportive treatment, such as fluids
and oxygen, will be used. Many people are well enough to leave hospital
after 5-10 days.
In severe cases, complications can
develop that require specific additional treatment. In these cases,
recovery may take much longer, and the condition can be fatal.
Fluids
Your body can become dehydrated
during an episode of acute pancreatitis, so fluids will be provided through a
tube connected to one of your veins. This is known as intravenous fluid
(IV). In severe cases of acute
pancreatitis, IV fluids can help prevent a serious problem called hypovolemic
shock, which occurs when a drop in your fluid levels causes a reduction in
the volume of blood in your body.
Nutritional support
Although the diet of many people with
mild acute pancreatitis is not restricted, some people are advised not
to eat. This is because trying to digest solid food could place too much
strain on your pancreas. Depending on the severity of the
condition, you may not be able to eat solid foods for a few days or
longer.
If you need to avoid solid food,
a feeding tube may be used to provide your body with nutrients. This is
known as enteral feeding and often involves using a tube that's
inserted into your stomach through your nose (nasogastric tube).
Oxygen
To ensure your vital organs have
enough oxygen, it will usually be supplied through tubes into your nose. The
tubes can be removed after a few days once it is clear your condition is
improving. In severe cases, ventilation
equipment may also be used to assist with your breathing.
Painkillers
Acute pancreatitis often causes
severe abdominal (tummy) pain, so strong painkilling medication will probably
be required, such as morphine. Some of the painkillers used can make
you feel very drowsy. If you are visiting someone who is in hospital with acute
pancreatitis, don't be alarmed or concerned if they appear drowsy or
unresponsive.
Treating the underlying cause
Once the condition is under
control, the underlying cause may need to be treated. Treatments for the most
common causes of acute pancreatitis – gallstones
and alcohol consumption – are outlined below.
Gallstones
If a gallstone is responsible for the
pancreatitis, you may need to have a procedure called endoscopic
retrograde cholangiopancreatography (ERCP), or your gallbladder may need
to be removed. Gallbladder removal surgery may be done
while you are in hospital, or it may be planned for several weeks' time.
Having your gallbladder removed should have no significant effect on your
health other than making it more difficult to digest certain foods, such as
fatty or spicy foods.
An ERCP procedure is an alternative
treatment for gallstones. It involves using a narrow, flexible tube known
as an endoscope, which has a camera on one end. X-rays will be used to guide the
endoscope into your digestive system and surgical instruments will be
passed down the endoscope so the gallstone can be removed.
Alcohol consumption
Everyone who has had acute
pancreatitis should avoid alcohol completely for at least six months,
whatever the cause of the condition. This is because alcohol can cause further
damage to the pancreas during your recovery. If you find this difficult to do, you
will probably need additional treatment. Treatment options for alcohol
dependence include:
- one-to-one counselling
- self-help groups, such as Alcoholics
Anonymous
- a medication called acamprosate, which helps reduce your
cravings for alcohol.
Where will I be treated?
People with pancreatitis are usually
treated in the general ward of a specialist hospital unit.
If you develop severe acute
pancreatitis, you will need to be admitted to a high dependency unit or intensive care unit (ICU).
Complications of acute
pancreatitis
Although most people with acute
pancreatitis recover without experiencing further problems, severe
cases can have serious complications.
Pseudocysts
Pseudocysts are sacs of fluid that
can develop on the surface of the pancreas. They are a common complication
of acute pancreatitis and are thought to affect around 1 in 20 people with the
condition. Pseudocysts usually develop four
weeks after the symptoms of acute pancreatitis start. In many cases, they do
not cause any symptoms and are only detected during a computerised tomography (CT) scan.
However, in some people pseudocysts
can cause bloating, indigestion and a dull abdominal (tummy) pain. If the pseudocysts are small and not
causing any symptoms, there may be no need for further treatment as they
usually go away on their own. Treatment will usually be recommended
if you are experiencing symptoms or if the pseudocysts are large. Larger
pseudocysts are at risk of bursting, which could cause internal bleeding or
trigger an infection.
Pseudocysts can be treated by
draining the fluid out of the cyst by inserting a needle into it through
your skin. This can also be done by carrying out 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.
Infected pancreatic necrosis
In around one in
three severe cases of acute pancreatitis, a common and serious
complication called infected pancreatic necrosis occurs. In infected pancreatic necrosis, high
levels of inflammation cause an interruption to the blood supply of your
pancreas. Without a consistent supply of blood, some of the tissue of your
pancreas will die. Necrosis is the medical term for the death of tissue.
The dead tissue is extremely
vulnerable to infection from bacteria. Once an infection has occurred, it can
quickly spread into the blood (blood poisoning) and cause multiple organ
failure. If left untreated, infected pancreatic necrosis will almost certainly
result in death. Infected pancreatic necrosis usually
develops two to six weeks after the symptoms of acute pancreatitis
started. It is marked by increased abdominal pain and a high temperature.
The infection will need to be treated with injections of antibiotics, and the dead tissue will need to
be removed to prevent the infection returning.
In some cases, it may be possible to
drain away the dead tissue using a thin tube called a catheter, which is placed
through the skin. Alternatively, laparoscopic surgery
(keyhole surgery) can be used. A small cut is made in your back and
an endoscope is inserted to wash away any dead tissue.
It is not always possible to use a
laparoscopic approach in cases where an area of dead tissue is not easily
accessible, for example, or if you are obese. In such circumstances, a cut is
made in your abdomen to allow the dead tissue to 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 one in five.
Systemic inflammatory response syndrome (SIRS)
Another common complication of severe
acute pancreatitis is systemic inflammatory response syndrome (SIRS). SIRS
develops in an estimated 1 in 10 severe cases of acute pancreatitis.
In SIRS, the inflammation affecting
the pancreas spreads throughout the body, which can cause one or more organs to
fail. It usually develops during the first week after the symptoms
started, with most cases developing on the same day. Symptoms of SIRS include:
- a
rise in body temperature to above 38°C (100.4°F) or a fall in body
temperature to below 36°C (96.8°F)
- a
rapid heartbeat of more than 90 beats a minute
- an
unusually fast breathing rate (more than 20 breaths a minute).
There is currently no cure for SIRS,
so treatment involves trying to support the body's functions until the
inflammation has passed. The outcome depends on how many organs fail. The
higher the number of organs affected, the greater the risk of death.
Chronic pancreatitis
If you have repeated episodes of
acute pancreatitis, the damage to your pancreas may lead to chronic pancreatitis. Chronic pancreatitis is a long-term
condition that can have a serious impact on your quality of life.
Source: NHS Choices.