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Acute pancreatitis is usually caused by gallstones or drinking too much alcohol, but sometimes no cause can be identified. Gallstones are small stones that form in your gallbladder. They can sometimes trigger acute pancreatitis if they move out of the gallbladder and block the opening of the pancreas. Alcohol consumption.
- Treatment
Acute pancreatitis often causes severe tummy pain, so you'll...
- Diagnosis
Acute pancreatitis is usually diagnosed in hospital, where...
- Symptoms
Causes; Diagnosis; Treatment; Complications; Prevention; The...
- Pancreatitis
Causes of acute pancreatitis. Acute pancreatitis is most...
- Treatment
Causes of acute pancreatitis. Acute pancreatitis is most often linked to: gallstones drinking too much alcohol; But sometimes the cause is not known. By reducing how much alcohol you drink and altering your diet to make gallstones less likely, you can reduce your chances of developing acute pancreatitis.
- Introduction
- Aetiology
- Clinical Features
- Diagnosis
- Differential Diagnoses
- Investigations
- Complications
- Key Points
- References
Acute pancreatitis refers to acute inflammation of the pancreas.1 In the United Kingdom, the prevalence of pancreatitis is around 56 cases per 100,000 annually.2 Though it is mild in most people (mortality <1%), patients can deteriorate quickly. There is a high mortality rate (~15%) in patients with severe pancreatitis.
Anatomy
The pancreas is a soft, spongy, lobulated organ that sits in the upper part of the retroperitoneal spaceof the abdomen. The pancreas has four parts: 1. a head,which sits in the C-shaped cavity created by the duodenum, and usually has a small uncinate process which hooks upwards behind the superior mesenteric artery and superior mesenteric vein 2. the constrictedneck connects the head to the body, behind this theportal vein formsfrom the union of the splenic and superior mesenteric veins 3. th...
Pathophysiology
The inflammation in acute pancreatitis is typically caused by hypersecretion or backflow (due to obstruction) of exocrine digestive enzymes, which results in autodigestionof the pancreas. Pancreatic damage can be classified into two major categories:1 1. Interstitial oedematous pancreatitis: most common, better prognosis 2. Necrotising pancreatitis: less common, around 5-10%, more severe The damage that occurs during acute pancreatitis is potentially reversible (to varying degrees), whereas c...
Causes of pancreatitis
Most cases of pancreatitis in the UK are caused by gallstones or alcohol. A commonly used mnemonic to help remember the less common causes is I GET SMASHED: 1. Idiopathic 2. Gallstones 3. Ethanol 4. Trauma 5. Steroids 6. Mumps/malignancy 7. Autoimmune disease 8. Scorpion sting 9. Hypertriglyceridemia/Hypercalcaemia 10. ERCP (endoscopic retrograde cholangiopancreatography) 11. Drugs: commonly azathioprine, thiazides, septrin, tetracyclines
History
Typical symptomsof acute pancreatitis include: 1. Epigastric pain: typically severe, sudden onset and may radiate through to the back 2. Nausea and vomiting 3. Decreased appetite Other important areas to coverin the history include: 1. Past medical history: history of gallstones, biliary disease or previous episodes of pancreatitis 2. Past surgical history: recent surgical procedures (e.g. ERCP) 3. Drug history: regular medications and over the counter medications 4. Social history: alcohol i...
Clinical examination
A thorough abdominal examinationshould be performed on all patients with suspected acute pancreatitis. Typicalclinical findingsmay include: 1. Epigastric tenderness 2. Abdominal distention: due to local reactive ileus or retroperitoneal fluid 3. Reduced bowel sounds: if an ileus has developed 4. Evidence of a systemic inflammatory response: indicative of severe pancreatitis. If febrile and hypotensive on admission the patient is more likely to develop organ failure during their hospital stay....
The International Association of Pancreatology criteria state that two of three criteria must be satisfied for a diagnosis of acute pancreatitis to be made:4 1. Abdominal pain plus a history suggestive of acute pancreatitis 2. Serum amylase/lipase of overthree times the upper limit of normal 3. Imaging findings characteristic of acute pancreatitis
Severe, sudden onset epigastric pain has several other serious causes.These include: 1. Leaking abdominal aortic aneurysm 2. Aortic dissection 3. Myocardial infarction 4. Perforated gastric/duodenal ulcer 5. Oesophageal rupture Imaging (e.g. CT) is often required to rule out alternate pathology.
Bedside investigations
Relevantbedside investigationsinclude: 1. ECG: a baseline investigation that should be performed for all patients presenting with epigastric pain (to avoid missing the myocardial infarction masquerading as epigastric pain) 2. Urinalysis: a routine investigation in acute abdominal pain (however, the urological system is unlikely to be the cause of sudden onset epigastric pain)
Laboratory investigations
Relevantlaboratory investigations include:5 1. FBC: anaemia (may increase cardiovascular strain), raised WCC (part of the SIRS response) 2. CRP: non-specific, however elevated levels at admission can be used as an indicator of severity 3. U&Es: fluid depletion is extremely common in pancreatitis, so pay close attention to urea and creatinine 4. LFTs: may be deranged, more commonly (but not exclusively) in obstructive causes of pancreatitis (e.g. gallstone disease) 5. Lipase: very specific, no...
Imaging
As mentioned previously, the diagnosis of acute pancreatitis can and should be made clinically, however, imaging is sometimes used to support the diagnosis or rule out other pathology. Relevant imaging investigations include:6 1. Erect chest X-ray: used to look for free gas under the diaphragm (pneumoperitoneum) in patients who present with epigastric tenderness. 2. Abdominal ultrasound (USS): a useful investigation to assess the biliary tree for evidence of obstruction (e.g. biliary dilatati...
Early complications
Early complications of acute pancreatitis include:16 1. Necrotising pancreatitis 2. Infected pancreatic necrosis: occurs when necrosing pancreatic tissue becomes infected, patients require antibiotics and necrosectomy 3. Pancreatic abscess: occurs when peripancreatic collections of fluid become infected, urgent drainage is required 4. Acute respiratory distress syndrome (ARDS): associated with the SIRS response of acute pancreatitis. Typical CXR appearance of widespread bilateral pulmonary in...
Late complications
Late complications of acute pancreatitis include:17 1. Pancreatic pseudocysts: collections of fluid that are not surrounded by epithelium. They are typically amylase-rich and can become infected, rupture or bleed. Pseudocysts typically accumulate within four weeks after acute pancreatitis. Only 40% resolve spontaneously, therefore intervention is usually advised (drainage/excision). 2. Portal vein/splenic thrombosis: secondary to ongoing inflammation, anticoagulation required 3. Chronic pancr...
Acute pancreatitis refers to acute inflammationof the pancreas.The pancreas is a soft, spongy, lobulated organ which sits in the upper part of the retroperitoneal spaceof the abdomen. It has endocrine and exocrine functions.The inflammation in acute pancreatitis is typically caused by hypersecretion or backflow (due to obstruction) of exocrine digestive enzymes, which results in autodigestionof the pancreas.Most cases of pancreatitis in the UK are caused by gallstones or alcohol.International Pancreatic Association/American Pancreatic Association. Evidence-based guidelines for the management of acute pancreatitis. Published in 2013. Available from: [LINK]BMJ Best Practice. Acute Pancreatitis. Last updated in 2013. Available from: [LINK]Van Brummelen SE et al. Acute idiopathic pancreatitis: does it really exist or is it a myth? Published in 2003. Available from: [LINK]International Pancreatic Association/American Pancreatic Association. Evidence-based guidelines for the management of acute pancreatitis. Published in 2013. Available from: [LINK]Aug 15, 2023 · The most common causes are gallstones and excessive alcohol consumption. Initial treatment focuses on resuscitation with intravenous fluids, analgesia, and nutritional support, with early oral feeding favoured if tolerated.
Acute pancreatitis is most commonly caused by gallstones or alcohol misuse, which account for around 75% of cases. Other risk factors include post-endoscopic procedures, trauma, surgery, hyperglyceridaemia, hypercalcaemia, drugs, chronic pancreatitis, anatomical disorders, autoimmune conditions, and pancreatic malignancy.
Why it happens. It’s thought that acute pancreatitis occurs when a problem develops with some of the enzymes (chemicals) in the pancreas, which causes them to try to digest the organ. Acute pancreatitis is most often linked to: gallstones – which accounts for around half of all cases.
What are the causes of acute pancreatitis? Pancreatitis in adults 8 in 10 cases of pancreatitis in adults are caused by either gallstones or excessive alcohol consumption.
