What is acute pancreatitis?

Pancreatitis is a condition that occurs when the pancreas, an organ behind the stomach, becomes inflamed.

The pancreas produces digestive enzymes needed to break down food. It also makes insulin, which regulates the level of glucose in the blood. The digestive enzymes flow into the small intestine. Insulin is released into the blood.

Pancreatitis can be acute or chronic. Acute pancreatitis occurs as one sudden episode. In acute pancreatitis the pancreas can usually return to its normal condition. Chronic pancreatitis means ongoing pancreatitis in which there is permanent damage to the pancreas.

How does it occur?

The cause of acute pancreatitis is not completely understood. About half of the people who have pancreatitis have gallstones. Alcohol abuse can also lead to pancreatitis. Less frequent causes are stomach or duodenal ulcers or injury, certain drugs, Hypercalcaemia, hypertriglyceridaemia.

What are the symptoms?

The main symptom is severe pain in the middle of your upper abdomen. Pain often occurs 12 to 24 hours after a large meal or heavy drinking. It spreads to your back and chest, is steady and sudden, becomes worse when you walk or lie down, and lessens when you sit or lean forward. Usually you also vomit.

In severe cases, signs of shock may occur, including:

• Restlessness
• Fast heartbeat
• Disorientation
• Cold, sweaty extremities.

If you have any of these signs of shock with abdominal pain, see your health care provider immediately.

How is it diagnosed?

Your health care provider will ask about your medical history, particularly about how much alcohol you drink and if you have had symptoms of gallstones. He or she will examine you and order blood tests. A sample of your urine may also be tested.

You may have the following tests:

• X-rays of your abdomen and chest
• Ultrasound exam of the pancreas
• ERCP, a way of looking at your pancreas through a slim flexible tube called an endoscope, which is passed through your mouth to where your pancreas and your intestines are connected
• CT scans of the pancreas.

How is it treated?

• You will probably stay in the hospital.
• To decrease the amount of enzymes your pancreas is producing, you cannot eat or drink anything for a while. You will not start drinking or eating again until the abdominal pain stops.
• You will be given fluids through your vein (IV).
• A tube may be put through your nose down into your stomach to remove fluids and prevent nausea and vomiting. This is called nasogastric suction.
• A narcotic drug or other pain reliever will be prescribed for your abdominal pain.
• You will need to stay in bed and take it easy.
• You may be given medication to reduce the flow of pancreatic enzymes.
• When the pain stops, you can start drinking clear liquids and gradually progress to eating a diet of low-fat foods.

Your health care provider may decide you can leave the hospital when you no longer have pain and are able to eat. Most people treated with nasogastric suction and IV fluids start feeling better in 1 to 3 days and go home in 5 to 10 days. More severe disease requires treatment in an intensive care unit (ICU) and a hospital stay of several weeks and carries considerable mortality.

How long do the effects last?

Most people recover completely, especially if the disease is diagnosed early enough. Severe pancreatitis can be fatal.

Your health care provider may test you for gallstones while you are in the hospital. If you have stones, they may be removed to prevent another attack of pancreatitis.

How can I take care of myself?

• Follow the instructions for any prescription your health care provider gives you.
• Don't take any other medications, including nonprescription drugs, without asking your health care provider.

How can I help prevent another attack of acute pancreatitis?

Pancreatitis can recur and may become an ongoing problem. To prevent another attack:

• Avoid drinking alcohol unless your health care provider approves.
• Avoid smoking cigarettes.
• Follow the diet your health care provider prescribes.
• Follow your provider's recommendations for physical activity.