Pancreatitis - Acute Pancreati

Your pancreas is a large gland behind your stomach and close to your duodenum. The pancreas secretes powerful digestive enzymes that enter the small intestine through a duct. These enzymes help you digest fats, proteins, and carbohydrates. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones play an important part in metabolizing sugar.

Pancreatitis is a rare disease in which the pancreas becomes inflamed. Damage to the gland occurs when digestive enzymes are activated and begin attacking the pancreas. In severe cases, there may be bleeding into the gland, serious tissue damage, infection, and cysts. Enzymes and toxins may enter the bloodstream and seriously injure organs, such as the heart, lungs, and kidney.

There are two forms of pancreatitis. The acute form occurs suddenly and may be a severe, life-threatening illness with many complications. Usually, the patient recovers completely. If injury to the pancreas continues, such as when a patient persists in drinking alcohol, a chronic form of the disease may develop, bringing severe pain and reduced functioning of the pancreas that affects digestion and causes weight loss.

An estimated 50,000 to 80,000 cases of acute pancreatitis occur in the United States each year. This disease occurs when the pancreas suddenly becomes inflamed and then gets better. Some patients have more than one attack but recover fully after each one. Most cases of acute pancreatitis are caused either by alcohol abuse or by gallstones. Other causes may be use of prescribed drugs, trauma or surgery to the abdomen, or abnormalities of the pancreas or intestine. In rare cases, the disease may result from infections, such as mumps. In about 15 percent of cases, the cause is unknown. Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain is often severe. It may be constant pain, just in the abdomen, or it may reach to the back and other areas. The pain may be sudden and intense, or it may begin as a mild pain that is aggravated by eating and slowly grows worse. The abdomen may be swollen and very tender. Other symptoms may include nausea, vomiting, fever, and an increased pulse rate. The person often feels and looks very sick.

About 20 percent of cases are severe. The patient may become dehydrated and have low blood pressure. Sometimes the patient's heart, lungs, or kidneys fail. In the most severe cases, bleeding can occur in the pancreas, leading to shock and sometimes death.

During acute attacks, high levels of amylase (a digestive enzyme formed in the pancreas) are found in the blood. Changes may also occur in blood levels of calcium, magnesium, sodium, potassium, and bicarbonate. Patients may have high amounts of sugar and lipids (fats) in their blood too. These changes help the doctor diagnose pancreatitis. After the pancreas recovers, blood levels of these substances usually return to normal. The treatment a patient receives depends on how bad the attack is. Unless complications occur, acute pancreatitis usually gets better on its own, so treatment is supportive in most cases. Usually the patient goes into the hospital. The doctor prescribes fluids by vein to restore blood volume. The kidneys and lungs may be treated to prevent failure of those organs. Other problems, such as cysts in the pancreas, may need treatment too.

Sometimes a patient cannot control vomiting and needs to have a tube through the nose to the stomach to remove fluid and air. In mild cases, the patient may not have food for 3 or 4 days but is given fluids and pain relievers by vein. An acute attack usually lasts only a few days, unless the ducts are blocked by gallstones. In severe cases, the patient may be fed through the veins for 3 to 6 weeks while the pancreas slowly heals.

Antibiotics may be given if signs of infection arise. Surgery may be needed if complications such as infection, cysts, or bleeding occur. Attacks caused by gallstones may require removal of the gallbladder or surgery of the bile duct. Surgery is sometimes needed for the doctor to be able to exclude other abdominal problems that can simulate pancreatitis or to treat acute pancreatitis. When there is severe injury with death of tissue, an operation may be done to remove the dead tissue.

After all signs of acute pancreatitis are gone, the doctor will determine the cause and try to prevent future attacks. In some patients the cause of the attack is clear, but in others further tests need to be done.

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