Acute pancreatitis

Acute pancreatitis almost always causes severe upper abdominal pain. The pain can spread to your back and is often accompanied by nausea and vomiting. Other common symptoms include fever, a bloated stomach and feeling weak and light-headed.

The pain is usually sudden and so severe that most people go straight to a doctor. They are then typically advised to go to a hospital the same day.

Acute pancreatitis is most commonly caused by gallstones. The pancreas produces digestive juices that flow into the duodenum (the first section of the small intestine) through a tube called the pancreatic duct. Just before the pancreatic duct reaches the duodenum, it is joined by the common bile duct. If gallstones form and enter the common bile duct, they may end up blocking the shared opening. As a result, the bile and pancreatic juices can't flow out into the duodenum and they start to build up. This is probably what causes the pancreas to become inflamed.

The digestive juices usually don't start to work until they reach the small intestine. But if the pancreas is inflamed, they already become active in the pancreas. As a result, the pancreas starts “digesting itself.”

The second most common cause of pancreatitis is drinking too much alcohol. It is still not known exactly how alcohol causes pancreatitis, but a link has been observed in many studies.

Other factors that can increase the risk of pancreatitis include a narrowing of the bile duct and high levels of specific fats (triglycerides) or calcium in the bloodstream. Acute pancreatitis is sometimes also caused by medications or a viral infection. Surgery on the gallbladder or bile ducts can cause pancreatitis too, but only in very rare cases.

In as many as 10 out of 100 cases of pancreatitis, no clear cause is found.

In Germany about 53,000 people are treated at a hospital for acute pancreatitis every year. That's about 60 out of every 100,000 people. Most people who develop pancreatitis are over the age of 45, and it's somewhat more common in men than in women.

The course of pancreatitis can vary depending on how severe the inflammation is and how badly it damages the tissue. About 80% of people who have treatment for acute pancreatitis recover after a week. About 20% of them develop serious complications. For instance, part of the pancreas may die and become infected with bacteria. It can then take weeks or even months to get better again.

After leaving the hospital, some people still have pain or problems with digestion, or they might feel very exhausted. Recovery sometimes takes a long time, and there may be setbacks. It often takes some time before you can get back to your normal routine.

Pancreatitis often comes back if gallstones were the cause. To prevent this from happening, doctors recommend removing the gallbladder.

One common complication of acute pancreatitis is something called pseudocysts. These digestive-juice-filled sacs may develop in the pancreas several weeks after the inflammation arises. Pseudocysts often remain small and go undetected, but they sometimes become so large that they cause problems like indigestion or bloating. Larger pseudocysts are also at risk of tearing open and bleeding or causing an infection.

A rare but serious complication of pancreatitis is called infected pancreatic necrosis. This complication occurs if a part of the pancreas dies (“necrotizes”) and becomes infected with bacteria. It usually starts in the second or third week after pancreatitis has developed and is very dangerous because it can provoke a condition referred to as SIRS (systemic inflammatory response syndrome). In SIRS, the inflammation spreads from the pancreas to the entire body. The first warning signs may include a high or low body temperature, a drop in blood pressure and a faster heart rate or breathing rate. SIRS can cause organ failure in one or several organs.

Overall, about 3 to 5% of people who develop acute pancreatitis die of complications.

To find out whether you have acute pancreatitis, the doctor will first feel your abdomen (belly) with their hands. They will also ask about various risk factors for pancreatitis, such as alcohol consumption, medication use and possible signs of gallstones such as a cramping pain in the upper abdomen (biliary colic). They usually take a sample of blood and will likely also do an ultrasound scan. If you are diagnosed with pancreatitis, you will be referred to a hospital. The symptoms of pancreatitis can also be caused by other medical conditions, such as an inflamed gallbladder, a heart attack or a gastric perforation from an ulcer.

Various things are measured in the blood sample, including the lipase levels in the blood. Lipase is an enzyme that is made in the pancreas and usually flows into the intestine. Abnormally high levels of lipase in the blood are a sign of pancreatitis. Having certain other substances in the blood can be a sign of a blocked bile duct.

An ultrasound scan of the belly is usually enough to tell whether gallstones are the cause or whether the inflammation has caused changes in the pancreas.

Sometimes more testing is needed. For instance, a magnetic resonance imaging (MRI) scan can be done to create a picture of the bile ducts and any gallstones. Another option is to use an endoscope to look for gallstones in the bile duct. The endoscope passes into the duodenum through the esophagus (endoscopic ultrasound).

A computed tomography (CT) scan can be used to detect complications such as dying tissue and to get an idea of how the inflammation is developing. If the pancreatitis is associated with gallstones or a bile duct infection, endoscopic retrograde cholangiography (ERC) may be needed for the diagnosis. This also involves moving an endoscope passed through the esophagus down to the bile duct opening in the duodenum. A contrast medium (dye-like substance) is then injected into the duct to make any stones that are there show up in the x-ray image. With the help of the endoscope, these stones can also be removed during the examination. But ERC involves exposure to radiation, and may cause various complications such as bleeding or infection.

Although there aren't any treatments that fight the cause of pancreatitis, there are a number of treatment options that aim to reduce the strain on the pancreas and relieve the symptoms. Because acute pancreatitis often leads to dehydration, people are first given extra fluids through a drip. Medication can provide relief from pain, nausea and vomiting. Stronger painkillers known as opioids are often needed, and they may make you feel drowsy or light-headed.

To give the pancreas a chance to recover, solid foods are avoided until you feel better again and your appetite returns. In mild cases of pancreatitis, it's often possible to return to eating solid foods after just two days. If the symptoms last longer, artificial feeding may be necessary to supply your body with enough nutrients.

If the pancreatitis is caused by gallstones, the stones may need to be removed soon using endoscopic retrograde cholangiography. After having acute treatment for pancreatitis, the gallbladder is surgically removed to prevent relapses.

If the pancreatitis was alcohol-related, people are advised to drink a lot less alcohol afterwards. This is often difficult, but there are many places that offer support when trying to cut down on alcohol.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.