Treatment for Acute Pancreatitis

Pancreatitis is inflammation of the pancreas. This happens when the pancreatic enzymes attack the pancreas itself instead of helping to digest food. There are two types: acute and chronic. Acute pancreatitis, which affects approximately 80,000 Americans each year, comes on suddenly, with the organ swelling and releasing the enzymes within it into the duodenum.

Diagnosis

Symptoms of the acute form include pain in the upper part of the stomach area. Other signs are nausea, vomiting, bloating, belching, hiccups and/or collapse. The pain may be steady and radiate to the back, side or lower stomach area. The patient may also have a fever, shortness of breath or kidney problems if the symptoms are severe.

To make a diagnosis, the doctor will touch the abdomen, which is usually rigid and tender when inflamed. The patient may also be constipated, have a slow pulse and show signs of jaundice. A computed tomography (CT) scan will show if the pancreas is swelling. It will also show if there is fluid in the abdomen or pancreatic "pseudocysts" (pockets of enzymes that can burst, damaging nearby tissues and organs). An ultrasound of the gallbladder will show if there are gallstones in the ducts causing the inflammation.

Causes

We do not yet know what makes the enzymes attack the pancreas. However, we do know some of the triggers:

  • A block in the ducts between the pancreas and the liver
  • Gallstones that get stuck at the bile duct opening causing pancreatic fluids to collect leading to inflammation and sometimes permanent damage
  • Tumors
  • Chemicals in the digestive system
  • Inflammation of nearby organs
  • Certain antibiotics, such as sulfa drugs and tetracycline
  • High exposure to estrogen and some diuretics
  • Binge drinking or regularly drinking large amounts of alcohol
  • Injuries from sports, car accidents or falls
  • Abdominal surgery
  • Complications from a screening procedure called endoscopic retrograde cholangiopancreatography
  • Infections (such as mumps or viral hepatitis) or
  • High levels of calcium or triglycerides in the blood

Since gallstones are a major cause of acute pancreatitis, people at risk of gallstones are also at risk for acute pancreatitis. This includes pregnant women, women who have had many pregnancies and people who are overweight.

Screening and Prevention

There is no way to screen for acute pancreatitis. The type caused by drinking alcohol can turn into chronic pancreatitis with continued alcohol use. The best treatment option - even after only one episode of acute pancreatitis - is to simply stop drinking altogether. Keeping one's weight under control may prevent gallstone-induced attacks.

Treatment Options

Mild cases usually take care of themselves in a few days. Severe ones can last several weeks. If you suspect pancreatitis, avoid all food and drink, as they will only make the symptoms worse. Patients with severe cases are admitted to the hospital and given pain relievers and intravenous (IV) fluids. For cases that last more than a few days, nutritional supplements are usually added to the IV lines.

When gallstones are suspected, the gallbladder (a non-essential organ) is often removed. But that usually is not done until the symptoms have gotten better, since surgery can make them worse.

In life-threatening cases where a blockage of the pancreatic duct is suspected, the doctor may do an endoscopic retrograde cholangiopancreatography (ERCP). To do this, the doctor inserts a flexible tube through the patient's mouth. Using a light and miniature camera at the end of the tube, the doctor can find the blockage and remove it if necessary. The doctor might also widen the duct, allowing the stone to pass by itself.

Sometimes traditional surgery is needed to drain a cyst or stop bleeding.