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Acute Pancreatitis

Acute pancreatitis is an inflammation of the pancreas, a condition that affects about 80,000 Americans annually. The pancreas — a large gland located behind the stomach and close to the upper part of the small intestine — secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest the fats, proteins and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it derives from food for energy.

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When the pancreas becomes inflamed, the digestive enzymes attack the tissue that produces them. This can lead to tissue damage and bleeding, and cause the pancreas blood cells and blood vessels to swell.

Pancreatitis has two stages — acute and chronic. Chronic pancreatitis is a more persistent condition. Most cases of acute pancreatitis are mild and involve a short hospital stay for the pancreas to recover. Acute pancreatitis occurs suddenly after the pancreas is damaged. In addition, it can be hereditary.

About 20 percent of acute pancreatitis cases are severe. Severe acute pancreatitis can lead to heart, lung or kidney failure, and even death. Some patients may have more than one attack of acute pancreatitis, but typically recover after each one. In the most severe cases, the pancreas and surrounding tissue can die, resulting in shock and sometimes death.

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Acute pancreatitis usually begins with a sharp, severe pain in the upper abdomen that may last for a few hours or a few days.

Symptoms include:

  • Constant pain in the upper abdomen, in the back and other areas
  • Pain may be sudden and intense or may begin as a mild pain that is aggravated by eating and drinking
  • Elevated pulse
  • Fever
  • Nausea and vomiting
  • Swollen and tender abdomen

Your doctor will ask about your medical history, perform a physical exam and order blood tests to check for certain enzymes.

During acute attacks, the blood contains at least three times more than the normal amount of digestive enzymes formed in the pancreas. Changes may occur in blood levels of glucose, calcium, magnesium, sodium, potassium and bicarbonate. After the pancreas recovers, these levels usually return to normal.

An abdominal ultrasound to look for gallstones and a computerized tomography (CT) scan to check for injury to the pancreas may be performed.

A procedure, called an endoscopic retrograde cholangiopancreatography (ERCP), may determine if there is a bile duct obstruction. During this procedure, a flexible tube is inserted down the throat into the stomach and small intestines. Dye is injected into the drainage tube of the pancreas to locate a possible obstruction.

Treatment for acute pancreatitis depends on the severity of the attack. Many cases get better with time, unless complications develop. Usually, patients are hospitalized to receive intravenous fluids to restore blood volume and hydration as well as medications to control pain. Antibiotics may be given if an infection occurs.

Dietary guidelines are usually prescribed to reduce the fat you eat, since your body has trouble digesting these substances.

Surgery

Surgery may be needed if complications such as infection, cysts or bleeding occur. If gallstrones are the cause of your attack, the gallbladder may be removed.

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UCSF Clinics & Centers

Gastroenterology

Gastroenterology at Mount Zion
1701 Divisadero St., Suite 120
San Francisco, CA 94115
Phone: (415) 502-4444
Fax: (415) 502-2249
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Gastroenterology at Parnassus
350 Parnassus Ave., Suite 410
San Francisco, CA 94143
Phone: (415) 502-2112
Fax: (415) 514-3300
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