What is acute pancreatitis?
Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time.
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 sick
When to seek medical help
You should contact your doctor immediately if you suddenly develop severe abdominal pain. If this is not possible, contact your local out-of-hours service for advice.
Why it happens
It's thought 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 reduce your chances of developing 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.
How it acute pancreatitis treated
There is currently no cure for acute pancreatitis, so treatment focuses on supporting the functions of the body until the inflammation has passed.
This usually involves admission to hospital so you can be given fluids into a vein (intravenous fluids), pain relief, nutritional support and oxygen through tubes into your nose.
Most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5-10 days.
However, recovery will take longer in severe cases, as complications that require additional treatment may develop.
Read more about treating acute pancreatitis
Complications of acute pancreatitis
About four out of five cases of acute pancreatitis improve quickly and don't cause any serious further problems. However, one in five cases are severe and can result in life-threatening complications, such as multiple organ failure.
In severe cases where complications develop, there is a high risk of the condition being fatal.
If a person survives the effects of severe acute pancreatitis, it is likely to be several weeks or months before they are well enough to leave hospital.
Read more about the possible complications of acute pancreatitis.
Acute pancreatitis 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 may travel along your back. You may feel worse after you have eaten. Leaning forward or curling into a ball may help relieve the pain.
If you have acute pancreatitis caused by gallstones, the pain often 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 of acute pancreatitis can include:
- nausea (feeling sick)
- loss of appetite
- a high temperature (fever) of 38°C (100.4°F) or above
- tenderness of the abdomen (tummy)
When to seek medical advice
You should contact your doctor immediately if you suddenly develop severe abdominal pain. If this is not possible, contact your local out-of-hours service for advice.
Acute pancreatitis causes
Most cases of acute pancreatitis are closely linked to gallstones and alcohol consumption, although the exact cause is not always clear.
Gallstones are hard pieces of stone-like material that can 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 do not cause any problems.
It is 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.
Less common causes of acute pancreatitis include:
- accidental damage to the pancreas that occurs during a type of surgery known as endoscopic retrograde cholangiopancreatography (ERCP), which is used to remove gallstones or examine the pancreas or surrounding tissue
- 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
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
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.
Acute pancreatitis diagnosis
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 will help detect signs of acute pancreatitis, such as a high level of two chemicals called lipase and amylase.
Further testing may be carried out to see the extent of the inflammation of your pancreas 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
- 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 inserted through your mouth and guided into your digestive system using an ultrasound scanner.
This type of 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.
Grading acute pancreatitis
Determining whether a person has mild or severe acute pancreatitis can be very difficult in the early stages.
You will be monitored closely for signs of serious problems that can develop, such as organ failure, as these help indicate the severity of the condition.
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.
Several tests may also be used to help determine the severity of your condition, including further blood tests and sometimes X-rays and a CT scan.
Acute pancreatitis treatment
There is no specific treatment for acute pancreatitis, but for most people the condition gets better on its own within a week.
During this time, you will be closely monitored for signs of serious problems. Supportive treatment, such as fluids and oxygen, will be used. Many people are well enough to leave hospital after 5-10 days.
In severe cases, complications can develop that require specific additional treatment. In these cases, recovery may take much longer, and the condition can be fatal.
See complications of acute pancreatitis for more information about severe cases.
Your body can become dehydrated during an episode of acute pancreatitis, so fluids will be provided through a tube connected to one of your veins. This is known as intravenous fluid (IV).
In severe cases of acute pancreatitis, IV fluids can help prevent a serious problem called hypovolemic shock, which occurs when a drop in your fluid levels causes a reduction in the volume of blood in your body.
Although the diet of many people with mild acute pancreatitis is not 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 that's inserted into your stomach through your nose (nasogastric tube).
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 it is clear your condition is improving.
In severe cases, ventilation equipment may also be used to assist with your breathing.
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 are 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.
If a gallstone is responsible for the pancreatitis, you may need to have a procedure called endoscopic retrograde cholangiopancreatography (ERCP), or your gallbladder may need to be removed.
Gallbladder removal surgery may be done while you are 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.
An ultrasound scan will be used to guide the endoscope into your digestive system and surgical instruments will be passed down the endoscope so the gallstone can be removed.
Everyone who has had acute pancreatitis should avoid alcohol completely for at least six months, whatever the cause of the condition. This is because alcohol can cause further damage to the pancreas during your recovery.
If you find this difficult to do, you will 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 reduce your cravings for alcohol
Read more about treating alcohol misuse.
How to prevent acute pancreatitis
As acute pancreatitis is often caused by gallstones and alcohol consumption, a healthy lifestyle can reduce your chances of developing the condition.
The most effective way of preventing gallstones is eating a healthy low-fat diet that includes plenty of fresh fruit and vegetables (at least five portions a day). Your diet should also include whole grains, which are found in wholemeal bread, oats and brown rice. This will help lower the amount of cholesterol in your body.
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 the developing condition.
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.
It is recommended that men should not drink more than 3-4 units of alcohol a day and women should not drink more than 2-3 units a day. A unit of alcohol is equal to about half a pint of normal strength lager, a small glass of wine or a pub measure (25ml) of spirits.
Acute pancreatitis complications
Although most people with acute pancreatitis recover without experiencing further problems, severe cases can have serious complications.
Pseudocysts are sacs of fluid that can develop on the surface of the pancreas. They are a common complication of acute pancreatitis and are 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 do not 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 will usually be recommended if you are 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 common and 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 will almost certainly result in death.
Infected pancreatic necrosis usually develops two to six weeks after the symptoms of acute pancreatitis started. It is marked by increased abdominal pain and a high temperature. The infection will need to be treated with injections of antibiotics, and the dead tissue will need 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.
It isn't always possible to use a laparoscopic approach in cases where an area of dead tissue is not easily accessible, for example, or if you are obese. In such circumstances, a cut is 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 started, with most cases developing on the same day.
Symptoms of SIRS include:
- a rise in body temperature to above 38°C (100.4°F) or a fall in body temperature to below 36°C (96.8°F)
- a rapid heartbeat of more than 90 beats a minute
- an unusually fast breathing rate (more than 20 breaths a minute)
There is 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.