Acute pancreatitis
This can be a medical emergency. Seek emergency care for severe upper abdominal pain radiating to the back, especially with vomiting.
Sudden inflammation of the pancreas as its digestive enzymes activate inside the gland. Most attacks are mild, but about one in five becomes severe with organ failure.
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What happens in the body
Premature activation of trypsin within acinar cells triggers auto-digestion, inflammation and, in severe cases, necrosis and a systemic inflammatory response.
Causes
- Gallstones (most common)
- Alcohol
- Very high triglycerides
- ERCP
- Medicines (azathioprine, valproate, some diuretics)
- High calcium
- Trauma, infections, genetic causes
Risk factors
- Gallstones
- Heavy drinking
- Obesity
- Smoking
Symptoms
- Severe upper abdominal pain radiating to the back
- Nausea and vomiting
- Fever and fast pulse
- Tender abdomen; pain eased by leaning forward
Diagnosis — tests and examinations
- Serum lipase or amylase over 3× normal
- Ultrasound for gallstones
- CT after 72 hours for complications
- Severity scores (Glasgow, BISAP)
Treatment
Medicines and medical treatment
- Moderate intravenous fluids
- Strong pain relief
- Early oral or tube feeding
- Treat the cause (lower triglycerides, stop the drug)
- Antibiotics only for infected necrosis
Operations and procedures
- ERCP for cholangitis or obstructing stones
- Cholecystectomy during the same admission for gallstone pancreatitis
- Endoscopic or surgical drainage of infected necrosis
Self-care, home remedies and lifestyle
- Stop alcohol completely if alcohol-related
- Stop smoking
Possible complications
- Pancreatic necrosis and infection
- Pseudocysts
- Organ failure (lungs, kidneys)
- Diabetes
- Chronic pancreatitis
Prevention
- Removing gallstones after an attack
- Avoiding alcohol
Outlook
Mild attacks resolve in about a week; severe pancreatitis has a mortality of 15–30%.
When to see a doctor
Seek emergency care for severe upper abdominal pain radiating to the back, especially with vomiting.
Sources and further reading
These sources cover this condition. They have not been checked against every statement on this page.
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