Acute pancreatitis is a sudden inflammation of the pancreas, the large gland located in the upper part of the abdomen, behind the stomach. This condition is most commonly associated with overuse of alcohol or gallstones. Acute pancreatis is a common reason for people to be admitted to the hospital.

The main function of the pancreas is to produce digestive enzymes and hormones, such as insulin and glucagon, which regulate blood sugar levels. In an attack of pancreatitis, enzymes that normally are released into the digestive tract begin to damage the pancreas itself. The gland becomes swollen and inflamed, and even more enzymes are released into the surrounding tissues and bloodstream. Digestion slows down and becomes painful, and other body functions can be affected. The pancreas can become permanently damaged and scarred if attacks are severe, prolonged or frequent.

It is not known exactly why the enzymes start to damage to the organ that produced them, but there are several factors known to trigger attacks of acute pancreatitis. One of the most common causes is gallstones. The pancreatic duct, which delivers digestive enzymes from the pancreas to the small intestine, merges with the common bile duct, which is attached to the gallbladder and liver. If gallstones escape from the gallbladder and travel down the common bile duct, they can become lodged at the place where the pancreatic duct enters the intestine. When the pancreatic duct becomes blocked, enzymes can't flow properly and can back up into the pancreas. This causes the pancreas to become inflamed.

The other leading cause of pancreatitis is heavy alcohol use. Most people who drink alcohol never develop pancreatitis, but certain people will develop pancreatitis after drinking large amounts of alcohol, either over a period of time or in a single binge. Despite years of intensive research, why alcohol is particularly toxic to the pancreas and why only 10% of heavy drinkers get pancreatitis remains unclear. Alcohol combined with smoking increases the risk of acute pancreatitis.

The third most common cause of acute pancreatitis today is a complication of a medical procedure called endoscopic retrograde cholangiopancreatography (ERCP). The doctor inserts a flexible tube with a small TV camera and a light on one end and an eyepiece on the other into the mouth. The tube is threaded down the esophagus, through the stomach and into the first part of the small intestine. The doctor locates the opening of the bile and pancreatic duct. Dye under pressure is squirted into the opening. Using X-ray, the doctor can view ducts in the pancreas, liver and gallbladder.

Other factors that sometimes can cause pancreatitis include:

• Use of any of a wide variety of medications, such as
• Sulfa drugs
• Water pills (hydrochlorothiazide, furosemide, others)
• Azathioprine (Imuran)
• Drugs used to treat HIV
• Abdominal surgery or severe trauma, such as a motor vehicle accident
• Metabolic conditions, such as high blood levels of calcium or triglycerides
• Some infections, such as mumps or viral hepatitis

In up to 30% of cases, no cause can be found.

The most common symptom of acute pancreatitis is upper abdominal pain, which can range from tolerable to severe. The pain usually occurs in the middle of the body, just under the ribs, but it sometimes can be felt on either the left or right side. This steady, drilling or "boring" pain can radiate to the back, flank, chest or lower abdomen. Pain reaches a maximum intensity quickly, often within 20 to 30 minutes. In alcohol-induced pancreatitis, the pain tends to begin one to three days after a binge. It may be difficult to find a comfortable position, although bending over or lying on your side may reduce the pain. Eating usually makes the pain worse.

Other symptoms of acute pancreatitis include nausea and vomiting, loss of appetite and abdominal bloating. In severe cases, fever, difficulty breathing, weakness and shock may develop.

Your doctor will diagnose acute pancreatitis based on your symptoms, a physical examination and certain laboratory tests. For example, blood tests usually reveal high levels of two pancreatic enzymes, amylase and lipase. In some cases, a computed tomography (CT) scan may be done to look for swelling of the pancreas and accumulation of fluid in the abdomen. The scan also may show whether you have pancreatic pseudocysts, which are pockets of digestive enzymes that develop in some cases of severe pancreatitis or after repeated attacks. Serious complications can result if the cysts burst and spill enzymes onto vulnerable tissues.

If gallstones are suspected, an ultrasound examination of the gallbladder may be performed.

Mild to moderate pancreatitis often goes away on its own within three to seven days, but severe cases can last several weeks. If significant damage is done to the pancreas in a single severe attack or several repeat attacks, chronic pancreatitis can develop. Approximately 10% of patients with alcohol-related acute pancreatitis develop chronic (long-term) pancreatitis.

Avoiding heavy alcohol use will help to prevent pancreatitis. Anyone who already has had one episode of pancreatitis caused by alcohol should stop drinking entirely to prevent the condition from coming back or becoming chronic.

Most first episodes of acute pancreatitis that are not related to alcohol use cannot be prevented. However, taking steps to prevent the development of gallstones, such as maintaining a normal weight and avoiding rapid weight loss, may help to prevent gallstone-related acute pancreatitis.

If the cause is gallstones, gallbladder surgery (cholecystectomy) will usually be recommended to prevent future attacks. When a medication is the likely cause, it will be stopped if possible.

If you suspect you have acute pancreatitis, do not eat or drink anything until you see a doctor. Food and drink trigger the release of enzymes from the pancreas, which will only make the pain worse.

Most people who develop pancreatitis are admitted to the hospital and treated with pain relievers and fluids given intravenously (into a vein). You will not be allowed to eat or drink until your symptoms begin to improve. In most cases, nothing can be done to speed healing or shorten an episode. If the episode is prolonged, and a patient cannot eat for longer than a week, nutrition may be given intravenously. In some cases, antibiotics may be prescribed to prevent or treat infection in the pancreas or surrounding tissues, but most cases do not need any additional medications.

If you have an attack of pancreatitis caused by gallstones, you may need to have an ERCP. During the test, the doctor may make a tiny cut into the opening of the bile duct to treat current or future blockage. In almost all cases, you will be advised to have your gallbladder removed. This usually is done days to weeks after the episode of pancreatitis has gone away because immediate surgery is technically more difficult and can make pancreatitis worse.

In rare cases, surgery may be needed to drain a pseudocyst, treat an abscess or stop bleeding.

If you have intense abdominal pain that lasts longer than 30 minutes, or if you have pain accompanied by vomiting or severe nausea, call your doctor or go to the nearest hospital emergency room.

In most cases, acute pancreatitis goes away on its own after a couple of days with no complications and no further problems. About 10% of patients develop complications, such as a pseudocyst or abscess in the pancreas, that may require monitoring or additional treatment.

Pancreatitis caused by heavy drinking is likely to come back if drinking continues. Over time, permanent damage may be done to the pancreas, and a chronic form of the disease may develop.

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