Pancreatitis - Acute

The pancreas is a solid organ behind the stomach. It has cells that produce enzymes to break down food during digestion. Pancreatitis is a condition in which the pancrease becomes swollen and tender. It can be either acute (sudden and severe) or chronic (milder and recurring).

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Symptoms

Affecting 50,000 to 80,000 Americans each year, acute pancreatitis comes on suddenly. 

Symptoms include pain in the upper part of the stomach area, nausea, vomiting, bloating, belching, hiccups or collapse. The pain may be steady and radiate to the back, side or lower stomach area. There may also be a fever, shortness of breath or kidney problems if the symptoms are severe.

Causes and Risk Factors

Pancreatitis can have several triggers, including:

  • Pancreatic cancer
  • A block in the ducts between the pancreas and the liver. This includes gallstones that force pancreatic fluids to back up, causing inflammation and permanent damage.
  • Tumors
  • Chemicals in the digestive system
  • Inflammation of nearby organs
  • Antibiotics, such as sulfa drugs and tetracycline
  • High exposure to estrogen and some diuretics
  • Binge drinking or regularly drinking large amounts of alcohol
  • Abdominal surgery
  • Complications from a screening procedure called endoscopic retrograde cholangiopancreatography (ERCP)
  • Infections (such as mumps or viral hepatitis)
  • High levels of calcium or triglycerides in the blood

People at risk of gallstones are also at risk for acute pancreatitis. This includes pregnant women, women who have had many pregnancies and people who are overweight.

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Diagnosis

To make a diagnosis, the doctor will touch the abdomen, which is usually hard and tender. The patient may also be constipated, have a slow pulse and show signs of jaundice.

The doctor may also request these tests:

  • Computed tomography (CT) scan to see if the pancreas is swelling or if there is fluid in the abdomen or pancreatic "pseudocysts" (pockets of enzymes that can burst, damaging nearby tissues and organs)
  • Ultrasound of the gallbladder to see if gallstones are in the ducts
  • Endoscopic retrograde cholangiopancreatography (ERCP), a minimally invasive procedure to find and remove blocks in the gallbladder and bile ducts and diagnose pancreatic tumors. It is more accurate than CT scans.

Prevention

Acute pancreatitis that is caused by drinking alcohol can turn into chronic pancreatitis with continued alcohol use. The best treatment option, even after only one episode of acute pancreatitis, is to simply stop drinking. Keeping one's weight under control may prevent gallstone-induced attacks.

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Treatments

Treatment for pancreatic cancer includes surgery, chemotherapy, radiation therapy or a combination, depending on the stage of the disease.

Exploratory surgery is performed through an incision in the abdomen (laparotomy). This allows the surgeon to assess the extent of the disease. If the tumor can be removed, a Whipple procedure (pancreatoduodenectomy) is used, which can be very effective and results in few complications. Only five to 20% of patients have tumors that can be surgically removed.

Laparoscopy, a less invasive procedure, is sometimes done. The surgeon inserts a laparoscope (flexible telescope with a camera attached) into the abdomen to see how far the disease has progressed.

Chemotherapy or radiation may benefit the patient if the tumor cannot be removed. Neither can be done until the patient has sufficiently recovered from the exploratory surgery, which usually takes about six weeks.