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The pancreas is a long, flat, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones, including insulin. Acute pancreatitis is inflammation of the pancreas that occurs suddenly and resolves with proper treatment.
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Pancreatitis occurs when digestive enzymes are activated in the pancreas instead of the small intestine. Acute pancreatitis has several causes. In some cases, the cause may be unknown.
Known causes of acute pancreatitis include
Obstruction of the pancreatic duct from:
- Diseases of the duodenum, the first section of the small intestine, where the pancreas empties
- Surgery or trauma to the pancreas
- Certain medications, such as those that treat cancer
- Ischemia—insufficient blood supply to the pancreas
- Complications of having endoscopic retrograde cholangiopancreatography
Factors that may increase your risk of acute pancreatitis include:
- Alcohol abuse
- Family history of pancreatitis
- Personal history of previous acute pancreatitis
- Congenital conditions, such as pancreas divisum
- HIV or other viral infections, such as mumps or hepatitis B
- Bacterial and parasitic infections
- Hypertriglyceridemia—elevated blood triglyceride levels
- Taking certain medications, such as those that treat high blood pressure
- Pancreatic cancer
- Hyperlipidemia—elevated blood fat levels
- Hypercalcemia—elevated blood calcium levels
- Cystic fibrosis
- Scorpion bite
- Occupational exposure to certain toxins
Symptoms may occur one time or many times. Repeated flare ups of symptoms are known as attacks.
Acute pancreatitis may cause:
Severe pain in the center of the upper abdomen that:
- Sometimes spreads into the upper back
- Is often made worse by eating, walking, or lying down on your back
- Nausea and vomiting
- Low grade fever
- Jaundice—yellowing of the skin and eyes
- Rarely, shock—a medical emergency in which the organs and tissues don't receive adequate blood or fluids
Untreated acute pancreatitis may progress into chronic pancreatitis, a serious condition where the pancreas becomes permanently damaged.
You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor will ask how much alcohol you drink and what medications you take. Diagnosis can be determined by your symptoms and results from blood tests.
Your body fluids may be tested. This can be done with:
- Blood tests
- Urine tests
Images may be taken of your body structures. This can be done with:
Treatment for acute pancreatitis depends on the severity of the attack and what is causing it. For example, if medication is the cause of your pancreatitis, your doctor may change to a different medication or adjust the dose.
In most cases, acute pancreatitis isn't severe and can be treated. Treatment includes:
Generally, acute pancreatitis treatment requires hospitalization. Fluid and nutritional support can be given by IV while your pancreas heals. During this time, you will be unable to eat or drink. Supplemental oxygen may also be given.
If you have severe pancreatitis, you may need a nasogastric tube. A long, thin tube is threaded through your nose and into your stomach for feeding.
You may also start treatment for any underlying causes of your pancreatitis.
Your doctor may recommend:
- Pain medications
- Protease inhibitors—to reduce the effects of digestive enzymes
- Insulin—to help regulate blood glucose levels
- Antibiotics—to treat any identified infections
In general, surgery isn't necessary for mild pancreatitis. It may be necessary when medical treatment doesn't work for more severe cases. Surgery may also be used to treat underlying conditions.
Surgical procedures include:
- Percutaneous catheter drainage—One or many thin tubes are inserted into the abdomen to drain fluid from the pancreas.
- ECRP—To remove gallstones or open any collapsed ducts.
- Cholecystectomy—To remove the gallbladder. Will also reduce your chance of getting acute pancreatitis again.
- Necrosectomy—Removal of dying or dead (necrotic) pancreatic tissue. Pancreatic necrosis is more serious if an infection is present. This procedure can also be done with endoscopy.
To help reduce your chance of getting acute pancreatitis, take these steps:
- Limit intake of alcohol to a maximum of 2 drinks per day for men and 1 drink per day for women.
- If you have hyperlipidemia, restrict your intake of fat and follow your doctor’s treatment plan to lower your lipids.
- Increase your vegetable consumption.
- Increase your activity level to help lose excess weight. Aim for 30 minutes per day on most days of the week.
- Make sure your vaccinations are up to date. This includes mumps, rubella hepatitis B, and varicella.
National Institute of Diabetes and Digestive and Kidney Diseases
National Pancreas Foundation
Canadian Association of Gastroenterology
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Causes of acute pancreatitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 31, 2015. Accessed November 13, 2015.
Pancreatitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/liver-disease/pancreatitis/Pages/facts.aspx. Updated August 16, 2012. Accessed November 13, 2015.
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4/7/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Baker ME, Nelson RC, et al. ACR Appropriateness Criteria for acute pancreatitis. American College of Radiology (ACR); 2013. 11 p. Available at: http://www.guideline.gov/content.aspx?id=47649. Accessed April 7, 2014.
8/28/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Johnson CD, Besselink MG, et al. Acute pancreatitis. BMJ. 2014 Aug 12;349:g4859.
- Reviewer: Michael Woods, MD
- Review Date: .1/2015
- Update Date: 12/20/2014