ACUTE PANCREATIC

Definition
The pancreas is a long, flat, pear-shaped organ located behind the stomach. It
makes digestive enzymes and hormones, including insulin. Acute pancreatitis is
inflammation of the pancreas that occurs suddenly and resolves with proper
treatment.
Causes
Pancreatitis occurs when digestive enzymes are activated in the pancreas instead of
the small intestine. Acute pancreatitis has several causes. In some cases, the cause
may be unknown.
Known causes of acute pancreatitis include
Obstruction of the pancreatic duct from:
Gallstones
Cancer
Diseases of the duodenum, the first section of the small intestine, where the
pancreas empties
Alcohol
Surgery or trauma to the pancreas
Certain medications, such as those that treat cancer
Ischemiainsufficient blood supply to the pancreas
Complications of having endoscopic retrograde cholangiopancreatography
Risk Factors
Factors that may increase your risk of acute pancreatitis include:

Alcohol abuse
Family history of pancreatitis
Personal history of previous acute pancreatitis
Congenital conditions, such as pancreas divisum
HIV or other viral infections, such as mumps or hepatitis B
Bacterial and parasitic infections
Hypertriglyceridemia elevated blood triglyceride levels
Taking certain medications, such as those that treat high blood pressure
Pancreatic cancer
Hyperlipidemia elevated blood fat levels
Hypercalcemia elevated blood calcium levels
Cystic fibrosis
Scorpion bite
Occupational exposure to certain toxins

Symptoms

Symptoms may occur one time or many times. Repeated flare ups of symptoms are
known as attacks.
Acute pancreatitis may cause:

Severe pain in the center of the upper abdomen that:

Sometimes spreads into the upper back
Is often made worse by eating, walking, or lying down on your back
Nausea and vomiting
Low grade fever
Jaundice yellowing of the skin and eyes
Rarely, shock a medical emergency in which the organs and tissues don't
receive adequate blood or fluids
Untreated acute pancreatitis may progress into chronic pancreatitis , a
serious condition where the pancreas becomes permanently damaged.

Diagnosis
You will be asked about your symptoms and medical history. A physical exam will be
done. Your doctor will ask how much alcohol you drink and what medications you
take. Diagnosis can be determined by your symptoms and results from blood tests.
Your body fluids may be tested. This can be done with:
Blood tests
Urine tests
Images may be taken of your body structures. This can be done with:
Abdominal ultrasound
Abdominal CT scan
Abdominal MRI scan
Magnetic resonance cholangiopancreatography (MRCP)
Treatment
Treatment for acute pancreatitis depends on the severity of the attack and what is
causing it. For example, if medication is the cause of your pancreatitis, your doctor
may change to a different medication or adjust the dose.
In most cases, acute pancreatitis isn't severe and can be treated. Treatment
includes:
Hospitalization
Generally, acute pancreatitis treatment requires hospitalization. Fluid and nutritional
support can be given by IV while your pancreas heals. During this time, you will be
unable to eat or drink. Supplemental oxygen may also be given.
If you have severe pancreatitis, you may need a nasogastric tube. A long, thin tube
is threaded through your nose and into your stomach for feeding.
You may also start treatment for any underlying causes of your pancreatitis.

Medications
Your doctor may recommend:
Antibioticsto treat any infections
Pain medications
Protease inhibitorsto reduce the effects of digestive enzymes
Insulinto help regulate blood glucose levels
Surgery
In general, surgery isn't necessary for mild pancreatitis. It may be necessary when
medical treatment doesn't work for more severe cases. Surgery may also be used to
treat underlying conditions.
Surgical procedures include:
NecrosectomyRemoval of dying or dead (necrotic) pancreatic tissue. Pancreatic
necrosis is more serious if an infection is present. This procedure can also be done
with endoscopy.
Percutaneous catheter drainageOne or many thin tubes are inserted into the
abdomen to drain fluid from the pancreas.
ECRPTo remove gallstones or open any collapsed ducts.
Cholecystectomy To remove the gallbladder
Prevention
To help reduce your chance of getting acute pancreatitis, take these steps:
Limit intake of alcohol to a maximum of 2 drinks per day for men and 1 drink per
day for women.
If you have hyperlipidemia, restrict your intake of fat and follow your doctors
treatment plan to lower your lipids.
Increase your vegetable consumption.
Increase your activity level to help lose excess weight. Aim for 30 minutes per day
on most days of the week.
Make sure your vaccinations are up to date. This includes mumps, rubella , hepatitis
B, and varicella .
Revision Information
Reviewer: Michael Woods, MD
Review Date: 12/2014 Update Date: 12/20/2014 -