Acute Pancreatitis

• What is acute pancreatitis?
• What are the symptoms of acute pancreatitis?
• What causes acute pancreatitis?
• How is acute pancreatitis diagnosed?
• What treatments are available for acute pancreatitis?
• What happens after treatment for acute pancreatitis?

Q. What is acute pancreatitis?
A. Acute pancreatitis is inflammation of the pancreas that occurs suddenly, and produces severe, upper abdominal pain. The pain may last for several days and is often debilitating.

Q. What are the symptoms of acute pancreatitis?
A. The foremost symptom of acute pancreatitis is severe upper abdominal pain. The pain may also radiate to the back and through the trunk. Some patients find that the pain subsides by leaning forward, but that lying down or walking can increase the pain. Other symptoms include:

• Nausea
• Vomiting
• Diarrhea
• Swollen abdomen
• Fever
• Mild jaundice (yellowing of skin and eyes)
• Clammy skin

Q. What causes acute pancreatitis?
A. There are several possible causes of acute pancreatitis, but the vast majority of cases are related to gallstones or excessive alcohol use. Other risk factors include:

• Structural abnormalities of the pancreas or the common bile duct, including pancreas divisum
• Hereditary pancreatitis
• Other hereditary conditions such as cystic fibrosis gene mutations, familial hypertriglyceridemia
• Medications (such as corticosteroids and nonsteroidal anti-inflammatory drugs, some antibiotics, and blood pressure lowering drugs, such as thiazide diuretics)
• Traumatic injury
• Injury to the pancreas or common bile duct from surgery or endoscopic procedures
• Pancreatic cancer
• Viral or bacterial infection

In some cases, the cause of acute pancreatitis is not known. This is called idiopathic pancreatitis, which may be acute, recurrent, or chronic.

Q. How is acute pancreatitis diagnosed?
A. Because the symptoms of acute pancreatitis resemble those of other medical problems, physicians need to confirm the diagnosis and determine the underlying cause.

Your medical history can be a chief indicator of the cause of pancreatitis. It's important for our physicians to know if gallstones are present, or if you regularly drink large amounts of alcohol.

The thorough examination will include lab and imaging tests. Some of the tools used to diagnose acute pancreatitis include:

• Pancreatic enzyme tests (serum amylase and lipase)
• Liver function tests
• Blood calcium and glucose tests, as well as a complete blood count
• Urinalysis
• X-rays
• Abdominal ultrasound exams
• Computed tomography (CT) scans. Here, our radiologists offer 64-slice CT exams, which can produce superior three-dimensional images.
• Endoscopic retrograde cholangiopancreatography (ERCP), an exam performed by our interventional endoscopy experts. In an ERCP, the physician inserts a thin tube, called an endoscope, down the throat and into the gastrointestinal tract. This instrument has a light and camera at the end of it to view inside the tract.
• Endoscopic ultrasound (EUS), which uses an endoscope that is specially equipped with a device that emits and detects sound waves as they bounce off tissue. The device sends this data to a computer, which then creates an image of the tissue for evaluation. This test can also be combined with administration of the hormone secretin to get information about how well the pancreas is able to produce digestive fluid and empty this fluid into the intestine.
• Genetic tests may be performed if it is suspected that you may have hereditary pancreatitis or other genetic risk factors such as the cystic fibrosis gene (CFTR).

Q. What treatments are available for acute pancreatitis?
A. Treatments are tailored to the severity and the cause of the acute pancreatitis. Most people with moderate to severe pancreatitis will need to spend a few days in the hospital. While at the University of Chicago, our physicians and nurses will monitor your condition and provide intravenous fluids to maintain blood volume. Antibiotics are prescribed for patients who have infections or those who are at a higher risk for infection. Because pain is a major symptom of pancreatitis, our team will provide pain medicine to help keep you comfortable.

Proper nutritional care is key to helping you recover. You may not be able to eat until the pancreatitis has improved. In those cases, nutrition may be delivered directly into the small intestine or intravenously.

On occasion, when gallstones cause your pancreatitis, our interventional gastroenterology specialists can use endoscopic techniques to remove the stones that have become trapped at the junction of the bile duct and pancreatic duct in the vicinity of the sphincter of Oddi. Endoscopes can also be used to insert stents (hollow tubes) into narrowed bile ducts to keep them propped open so bile and fluid can drain properly. In most cases, the gallbladder should be removed following recovery from pancreatitis to prevent future attacks.

An operation is sometimes required if infection, bleeding, necrosis of the pancreas, or disruption of the pancreatic ducts (leading to the formation of collections of pancreatic juice called pseudocysts) occurs. Whenever possible, our gastrointestinal surgeons use minimally invasive approaches to perform the surgery. Benefits of minimally invasive surgery include small incisions, little to no scarring, and typically a faster recovery. Our surgeons have many years of experience performing a wide variety of pancreatic procedures, and are adept at removing diseased tissue while preserving as much healthy tissue as possible.

Acute pancreatitis can affect other organs--including the kidneys, heart, and lungs--and cause life-threatening complications. If problems like kidney failure or lung injury occur, our patients have access to some of the nation's best experts in those specialties. Some patients with very severe pancreatitis may be cared for in our state-of-the-art intensive care unit, staffed by renowned critical care physicians and nurses.

Q. What happens after treatment for acute pancreatitis?
A. Fortunately, most people who have a bout of acute pancreatitis will recover completely, especially if the cause--such as gallstones--is removed. However, in some cases, a single attack of severe pancreatitis can damage the pancreas and progress to chronic pancreatitis, which requires ongoing care.

Even if your pancreatitis is not linked to alcohol consumption, it's important to stop drinking alcohol. Alcohol consumption can further damage the pancreas and increase the risk for recurring attacks.

More Information

• Acute Pancreatitis
• Chronic Pancreatitis
• Hereditary Pancreatitis
• Autologous Islet Cell Transplantation
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