Acute Pancreatitis

Acute pancreatitis is characterized by the abrupt onset of injury and inflammation of the pancreas.

Signs and Symptoms

Affected people usually develop severe belly pain that sometimes goes to the back, and often have nausea, vomiting, and inability to tolerate food. They may also have fevers and chills, and -- rarely -- visible bruises around the belly button or flanks.

Causes

An initial trigger causes injury and inflammation in the pancreas. This results in leakage of pancreatic digestive enzymes that cause further inflammation and injury. In industrialized nations, the two most common causes of acute pancreatitis are excessive alcohol consumption, and gallstones. Other causes include medications (ACE inhibitors, protease inhibitors, hiazides, or sulfas), excessively high triglyceride levels in the blood, blunt trauma, some viral infections, and anatomic abnormalities in the pancreatic drainage system, which connects to the bile ducts.

Diagnosis

Laboratory tests for amylase and lipase levels in the blood are usually elevated in acute pancreatitis. Abdominal CT scans may show inflammation, and can be used to stage the degree of severity. A test called MRCP is often used to better determine the anatomy of the pancreas and its associated drainage system.

Complications

Acute pancreatitis can be life threatening if complications arise, such as pancreatic infection, shock, acute respiratory distress syndrome (ARDS), acute kidney failure, and gastrointestinal hemorrhage. Sometimes the pancreatitis does not completely resolve and chronic pancreatitis can develop. Longer-term complications can include the development of pancreatic abscesses and pseudocysts.

Treatment

Treatment of acute pancreatitis and its complications is primarily supportive. Aggressive hydration with intravenous fluids is key. Eating and drinking are typically delayed until the nausea, vomiting, and belly pain subside. Pain medications are often used for symptom relief. The role of early antibiotics is controversial and continues to be debated. Once infection is definitely determined, antibiotics and possible surgical debridement are mainstays of therapy.