Acute pancreatitis
Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time. The pancreas is a small organ located behind the stomach and below the ribcage.
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 or being sick
- diarrhoea
Read more about the symptoms of acute pancreatitis and diagnosing acute pancreatitis.
When to seek medical help
Contact your GP immediately if you suddenly develop severe abdominal pain. If this isn't possible, contact NHS 111 or your local out-of-hours service for advice.
Why it happens
It's thought that 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 to reduce your chances of developing acute pancreatitis.
Read more about the causes of acute pancreatitis and preventing 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 25,000 people were admitted to hospital with acute pancreatitis between 2013 and 2014.
Symptoms
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 can travel along your back or below your left shoulder blade. Eating or drinking may also make you feel worse very quickly, especially fatty foods.
Leaning forward or curling into a ball may help to relieve the pain, but lying flat on your back often increases the pain.
Acute pancreatitis caused by gallstones usually 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) or vomiting
- diarrhoea
- indigestion
- a high temperature (fever) of 38C (100.4F) or above
- jaundice – yellowing of the skin and the whites of the eyes
- tenderness or swelling of the abdomen (tummy)
When to seek medical advice
Contact your GP immediately if you suddenly develop severe abdominal pain. If this isn't possible, contact NHS 111 or your local out-of-hours service for advice.
Causes
Most cases of acute pancreatitis are closely linked to gallstones or to alcohol consumption, although the exact cause isn't always clear.
Gallstones
Gallstones are hard pieces of stone-like material that 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 don't cause any problems.
Alcohol consumption
It's 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 or injury to the pancreas – for example, during a procedure to remove gallstones or examine the pancreas
- 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
- a complication of cystic fibrosis
- certain rare conditions – including hyperparathyroidism, Reye's syndrome and Kawasaki disease
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.
Diagnosing
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 can detect signs of acute pancreatitis, such as a high level of two chemicals called lipase and amylase.
At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. You'll be monitored closely for signs of serious problems, such as organ failure.
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.
Further testing
Several tests may be used to help determine the severity of your condition 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
- an ultrasound scan – where high-frequency sound waves are used to create an image of part of the inside of the 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.
Treatment
Acute pancreatitis is treated in hospital, where you'll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen.
Many people are well enough to leave hospital after 5-10 days.
In severe cases, complications can develop that require specific additional treatment and you'll need to be admitted to a high dependency unit or intensive care unit (ICU). In these cases, recovery may take much longer, and the condition can be fatal.
Read about the potential complications of acute pancreatitis for more information on severe cases.
Fluids
Your body can become dehydrated during an episode of acute pancreatitis, so fluids are provided through a tube connected to one of your veins (this is known as intravenous, or IV, fluid).
In severe cases of acute pancreatitis, IV fluids can help to prevent a serious problem called hypovolemic shock, which occurs when a drop in your fluid levels lowers the amount of blood in your body.
Nutritional support
Although the diet of many people with mild acute pancreatitis isn't 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 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 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're 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 a procedure called endoscopic retrograde cholangiopancreatography (ERCP), or your gallbladder may need to be removed.
Gallbladder removal surgery may be done while you're 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 guide the endoscope into your digestive system, and surgical instruments are passed down the endoscope to remove the gallstones.
Alcohol consumption
After recovering from acute pancreatitis, alcohol should be completely avoided if this was the cause of the condition. If you find this difficult, you'll 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 to reduce your alcohol cravings
Read more about treating alcohol misuse.
Complications
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're a common complication of acute pancreatitis, 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 don't 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 is usually recommended if you're 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 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 is almost always fatal.
Infected pancreatic necrosis usually develops two to six weeks after the symptoms of acute pancreatitis starts. Symptoms include increased abdominal pain and a high temperature. The infection is treated with injections of antibiotics, and the dead tissue needs 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. If laparoscopic surgery isn't possible, a cut can be 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 start, with most cases developing on the same day.
Symptoms of SIRS include:
- a rise in body temperature to above 38C (100.4F) or a fall in body temperature to below 36C (96.8F)
- a rapid heartbeat of more than 90 beats a minute
- an unusually fast breathing rate (more than 20 breaths a minute)
There's 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.
Prevention
As acute pancreatitis is often caused by gallstones or excessive 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, balanced diet that includes plenty of fresh fruit and vegetables (at least five portions a day).
Your diet should also include wholegrains, found in wholemeal bread, oats and brown rice. This helps lower the amount of cholesterol in your body.
There is also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones.
Because of the role cholesterol appears to play in the formation of gallstones, it's advisable to avoid eating too many fatty foods with a high cholesterol content.
Foods high in cholesterol include:
- meat pies
- sausages and fatty cuts of meat
- butter and lard
- cakes and biscuits
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 developing the condition.
See exercise, healthy eating and losing weight for more information and advice.
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.
- men and women are advised not to regularly drink more than 14 units a week
- spread your drinking over three days or more if you drink as much as 14 units a week
A unit of alcohol is equal to about half a pint of normal-strength lager or a pub measure (25ml) of spirits. A small glass of wine or an alcopop is 1.5 units.
Read the pages on drinking and alcohol for more information and advice.
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