Some people have more than one attack and recover completely
after each, but acute pancreatitis can be a severe,
life-threatening illness with many complications. About 80,000
cases occur in the United States each year; some 20 percent of
them are severe.
Acute pancreatitis is usually caused by drinking too much
alcohol or by gallstones. A gallstone can block the pancreatic
duct, trapping digestive enzymes in the pancreas and causing
pancreatitis. Some prescription drugs, pancreatic or intestinal
abnormalities, abdominal trauma, or surgery can also cause
pancreatitis. In some cases, recurrent pancreatitis is hereditary
and caused by mutations in genes. In rare cases, the disease may
result from infections, such as mumps, and in about 15 percent of
the cases, the cause is unknown.
Acute pancreatitis usually begins with pain in the upper
abdomen that may last for a few days. The pain may be severe and
may become constant--just in the abdomen--or it may reach to the
back and other areas. It may be sudden and intense or begin as a
mild pain that gets worse when food is eaten. Someone with acute
pancreatitis often looks and feels very sick. Other symptoms may
- swollen and tender abdomen
- rapid pulse
Severe cases may cause dehydration and low blood pressure. The
heart, lungs, or kidneys may fail. If bleeding occurs in the
pancreas, shock and sometimes even death follow.
Besides asking about a person's medical history and doing a
physical exam, a doctor will order a blood test to diagnose acute
pancreatitis. During acute attacks, the blood contains at least
three times more amylase and lipase than usual. Amylase and lipase
are digestive enzymes formed in the pancreas. Changes may also
occur in blood levels of glucose, calcium, magnesium, sodium,
potassium, and bicarbonate. After the pancreas improves, these
levels usually return to normal.
A doctor may also order an abdominal ultrasound to look for
gallstones and a CAT (computerized axial tomography) scan to look
for inflammation or destruction of the pancreas. CAT scans are
also useful in locating pseudocysts. (See the section on chronic
Treatment depends on how bad the attack is. If no complications
in the form of kidney failure or lung problems occur, acute
pancreatitis usually improves on its own. Treatment is designed to
support vital functions and prevent complications. A hospital stay
will be necessary so that fluids can be replenished intravenously.
Acute pancreatitis can also cause breathing problems. Many
people develop hypoxia, which means that cells and tissues are not
receiving enough oxygen. Doctors treat hypoxia by giving oxygen
through a face mask. Despite treatment, some people still
experience lung failure and require a ventilator.
If pancreatic cysts occur and are considered large enough to
interfere with the pancreas's healing, your doctor may drain or
surgically remove the cysts.
Sometimes a person cannot stop vomiting and needs to have a
tube placed in the stomach to remove fluid and air. In mild cases,
a person may not eat for 3 or 4 days and instead may receive
fluids and pain relievers through an IV (intravenous) line.
Unless the pancreatic duct or bile duct is blocked by
gallstones, an acute attack usually lasts only a few days. In
severe cases, a person may be fed intravenously for 3 to 6 weeks
while the pancreas slowly heals. This process is called total
parenteral nutrition. However, for mild cases of the disease,
total parenteral nutrition offers no benefit.
If an infection develops, the doctor may prescribe antibiotics.
Surgery may be needed for extensive infections. Surgery may also
be necessary to find the source of bleeding, to rule out problems
that resemble pancreatitis, or to remove severely damaged
Before leaving the hospital, a person will be advised not to
drink alcohol and not to eat large meals. After all signs of acute
pancreatitis are gone, the doctor will try to decide what caused
it in order to prevent future attacks. In some people, the cause
of the attack is clear, but in others, more tests are needed.
Gallstones and Pancreatitis
Gallstones can cause pancreatitis and they usually require
surgical removal. Ultrasound or a CAT scan can detect gallstones
and can sometimes give an idea of the severity of the pancreatitis.
When gallstone surgery can be scheduled depends on how severe the
pancreatitis is. If the pancreatitis is mild, gallstone surgery
may proceed within about a week. More severe cases may mean
gallstone surgery is delayed for a month or more.
After the gallstones are removed and inflammation goes away,
the pancreas usually returns to normal.