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Digestive system
Digestive system


Endocrine glands
Endocrine glands


Pancreatitis, acute - CT scan
Pancreatitis, acute - CT scan


Definition:

Acute pancreatitis is swelling (inflammation) of the pancreas. The pancreas is a gland located behind the stomach. It releases digestive enzymes and the hormones insulin and glucagon .



Causes, incidence, and risk factors:

The main causes of acute pancreatitis in adults are:

Other causes include:

  • Certain medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine)
  • Common bile duct surgical procedures
  • Surgery to the pancreas
  • Traumatic injury
  • Viral infection (mumps , coxsackie B, mycoplasma pneumonia , and campylobacter)

Acute pancreatitis may also be caused by:

What exactly causes pancreatitis is not well known. It is thought that enzymes the pancreas normally releases in an inactive form become activated inside the pancreas and start to digest the pancreatic tissue. This process is called autodigestion. It causes swelling, bleeding (hemorrhage), and damage to the blood vessels.

The disease affects men more often than women. Alcohol abuse is an important risk factor.

In children, this disorder may be associated with:



Symptoms:
  • Abdominal pain that is greatest in the upper abdomen (upper left quadrant or upper middle of the abdomen)
    • Is persistent or chronic
    • May be worse lying flat on the back
    • May spread (radiate) to the back or below the left shoulder blade
    • May be worse after eating or drinking (occurs within minutes following meals), especially foods with a high fat content
    • May be worse after drinking alcohol
  • Anxiety
  • Fever
  • Mild jaundice
  • Nausea and vomiting
  • Sweating

Other symptoms that may occur with this disease:



Signs and tests:

An examination may show:

  • Fever
  • Low blood pressure
  • Rapid heart rate
  • Rapid breathing (respiratory) rate

Tests that show release of pancreatic enzymes:

Test that show inflammation of the pancreas:

Other blood tests:



Treatment:

Treatment is aimed at supportive measures, such as:

  • Relieving pain
  • Replacing fluids by intravenous (IV) infusion
  • Withholding food or fluid by mouth to limit the activity of the pancreas

Occasionally a tube will be inserted through the nose or mouth to remove the contents of the stomach (nasogastric suctioning). This may be done if there is persistent vomiting or severe pain, or if a paralytic ileus develops.

Treating the condition that caused the problem can prevent recurrent attacks.

In some cases, radiologic or endoscopic therapy is needed to:

  • Drain fluid collections in or around the pancreas
  • Remove gallstones
  • Relieve blockages of the pancreatic duct

In the most severe cases, surgery is necessary to remove dead, infected pancreatic tissue.



Support Groups:



Expectations (prognosis):

Most cases go away in a week. However, some cases develop into a life-threatening illness.

The death rate is high with:

  • Hemorrhagic pancreatitis
  • Liver, heart, or kidney impairment
  • Necrotizing pancreatitis

It is common for the condition to return.



Complications:

Calling your health care provider:

Call your provider if:

  • You have intense, constant abdominal pain
  • You develop other symptoms of acute pancreatitis


Prevention:

To protect against acute pancreatitis, prevent the disorders that cause it:

  • Avoid aspirin when treating a fever in children, especially if they may have a viral illness, to reduce the risk of Reye syndrome.
  • Do not abuse alcohol.
  • Get genetic counseling if you would like to have children and you have a family or personal history of cystic fibrosis.
  • Immunize children against mumps and other childhood illnesses (see: immunizations - general overview ).
  • Use proper safety precautions to avoid abdominal trauma.

If you develop acute pancreatitis as a result of alcohol use, avoid all alcohol in the future. If you develop acute pancreatitis as a result of a medication, avoid the medication in the future.



References:

Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006 Oct;101(10):2379-400.

Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet. 2008;371:143-152.




Review Date: 5/27/2008
Reviewed By: Christian Stone, MD, Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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