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Acute Pancreatitis

Sudden inflammation of the pancreas due to damage from its own enzymes

  • Almost exclusively affects adults
  • Excessive alcohol consumption is a risk factor
  • Gender and genetics are not significant factors

In acute pancreatitis, the pancreas suddenly becomes inflamed, causing severe abdominal pain. The condition is serious and can be life-threatening if left untreated. The main function of the pancreas is to secrete a fluid containing enzymes that aid digestion. In addition, the pancreas secretes the hormones insulin and glucagon, which control the level of sugar in the blood.

What are the causes?

Often, the cause of acute pancreatitis is unclear. If there is a cause, it may be a gallstone blocking the common bile duct (the duct that transports bile from the liver to the duodenum). The gallstone obstructs the flow of digestive juices from the pancreas so that enzymes in these juices leak into the pancreatic tissue and cause severe inflammation.

Excessive alcohol consumption over a long period can also cause the disorder. However, it is not fully understood how alcohol causes inflammation of the pancreas. Typically, an attack of acute pancreatitis occurs 12-24 hours after a heavy bout of drinking.

Certain drugs such as immunosuppressants and thiazide diuretics can cause pancreatitis. Less common causes include viral infection of the pancreas and high levels of fatty substances in the blood (see Inherited hyperlipidaemias).

What are the symptoms?

Acute pancreatitis causes a range of symptoms that occur suddenly and may be severe. These symptoms may include:

  • Severe upper abdominal pain, often spreading to the back and made worse by movement.

  • Nausea and vomiting.

  • Bruised appearance of the skin around the abdomen.

  • Fever.

In severe cases, inflammation affects the whole abdomen, making it rigid and increasing the pain (see Peritonitis). There is also a risk of shock, a potentially fatal condition in which blood pressure falls extremely low.

How is it diagnosed?

If your doctor suspects that you have acute pancreatitis, you will be admitted to hospital, where you may have blood tests to detect pancreatic enzymes that have leaked directly into the blood. You may need imaging tests, such as CT scanning, ultrasound scanning, or MRI, to look for a blockage of the common bile duct by gallstones. The imaging tests may also reveal enlargement of the pancreas due to inflammation.

Acute pancreatitis

The enlarged pancreas seen in this CT scan through the abdomen is due to the inflammatory disorder acute pancreatitis.

What is the treatment?

If you have acute pancreatitis and the condition is severe, you may need continuous monitoring in an intensive therapy unit. Your stomach will be kept empty to prevent the pancreas from being stimulated to produce more enzymes. A tube will be passed through your nose into your stomach to remove its contents by suction, and you will be given fluids intravenously. If imaging tests have detected a gallstone, ERCP may be performed to locate the stone more precisely and remove it. In rare cases, damaged pancreatic tissue becomes infected and may need to be drained. If the pancreatitis was caused by gallstones, it may be advisable to have your gallbladder removed once you have recovered.

What is the prognosis?

About 9 in 10 people survive an attack of acute pancreatitis, but the gland may be damaged so that it is unable to produce adequate amounts of enzymes. You may then need to take enzyme supplements. Severe damage to the hormone-secreting areas of the pancreas may affect the production of insulin and lead to diabetes mellitus. Treatment with insulin will then be necessary to control your blood sugar levels. A single attack of acute pancreatitis may not cause permanent damage, and long-term treatment is needed only if the condition recurs. If your gallbladder is removed because of stones, there should be no long-term ill effects.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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