Table of contents
The pancreas is an important endocrine organ that sits behind the stomach. It plays an important role in digestion by producing digestive enzymes and endocrine-organ-releasing hormones into the blood circulation.
Acute pancreatitis is an acute inflammation of the pancreas which can affect multiple organs. Patients may suffer a spectrum of diseases from mild to severe life-threatening acute pancreatitis.
Incidence reported varies worldwide, but rising incidence consistent with increasing rates of obesity and obesity-related complications such as gallstones and diabetes.
Causes of Acute Pancreatitis
The two most common causes of acute pancreatitis are gallstones (about 40% of cases) and alcohol abuse (about 35% of cases). Other risks include high triglyceride level, blunt or penetrating abdominal trauma, ERCP (procedure), toxins, and medication such as azathioprine, oestrogen, furosemide, tetracycline, and valproic acid. (1) However, sometimes it has no known cause or reason known as ‘idiopathic’ pancreatitis.
Symptoms of Acute Pancreatitis
The most common presenting symptom is severe epigastric or central abdominal pain which is worse after eating or drinking. (2) The pain may last for days and may radiate to the back and may worsen when the patient is lying facing upwards. Other common presenting symptoms are multiple episodes of vomiting, abdominal fullness, and distension.
Management of Acute Pancreatitis
Most episodes of acute pancreatitis are mild, needing only brief hospitalisation (2). A small percentage of patients may develop acute pancreatitis with organ failure or severe local complications needing close monitoring and organ support in an intensive care unit. Acute pancreatitis is mostly managed conservatively with aggressive hydration with intravenous fluids and strong analgesia (2).
There is no role for antibiotics unless there is strong evidence of infection (if patients have positive blood cultures or evidence of infection of imaging) (2). ERCP is performed in patients with gallstone pancreatitis to remove any gallstones obstructing the biliary tree (3). These patients will undergo early cholecystectomy to decrease the risk of recurrent acute pancreatitis.
Majority of patients will have only one attack of acute pancreatitis. However, about 18% of patients experience recurrence and 8% go onto develop chronic pancreatitis (4)
- Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med. 2016 Nov 17;375(20):1972-1981
- Tenner S, Baillie J, DeWitt J, Vege SS; American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013 Sep;108(9):1400-15
- American Gastroenterological Association (AGA) Institute on “Management of Acute Pancreatitis" Clinical Practice and Economics Committee, AGA Institute Governing Board. AGA Institute medical position statement on acute pancreatitis. Gastroenterology. 2007 May;132(5):2019-21
- Lee PJ, Papachristou GI. New insights into acute pancreatitis. Nat Rev Gastroenterol Hepatol. 2019 Aug;16(8):479-496. doi: 10.1038/s41575-019-0158-2. PMID: 31138897.