Acute Pancreatitis

The foremost symptom of acute pancreatitis is severe upper abdominal pain. The pain may also radiate to the back and through the trunk. Some patients find that the pain subsides by leaning forward, but that lying down or walking can increase the pain. Other symptoms include:

• Clammy skin
• Diarrhea
• Fever
• Mild jaundice (yellowing of skin and eyes)
• Nausea
• Swollen abdomen
• Vomiting

There are several possible causes of acute pancreatitis, but the vast majority of cases are related to gallstones or excessive alcohol use. Other risk factors include:

• Medications such as 6-mercaptopurine, azathioprine, corticosteroids and nonsteroidal anti-inflammatory drugs; some antibiotics and blood pressure-lowering drugs, such as thiazide diuretics
• Structural abnormalities of the pancreas or the common bile duct, including pancreas divisum
• Genetic mutations, including hereditary pancreatitis (PRSS1), cystic fibrosis gene mutations (CFTR) and pancreatic secretory trypsin inhibitor (SPINK)
• Metabolic conditions that lead to hypertriglyceridemia and hypercalcemia; in rare cases, hypothyroidism and celiac disease
• Traumatic injury
• Injury to the pancreas from endoscopic procedures
• Pancreatic cancer
• Viral or bacterial infection

In some cases, the cause of acute pancreatitis is not known. This is called idiopathic pancreatitis.

Symptoms of acute pancreatitis can resemble other medical conditions. Physicians must confirm the diagnosis and determine the underlying cause.

A combination of medical history (history of gallstones, heavy tobacco or alcohol use), laboratory test data (elevation of amylase/lipase), clinical presentation (physical signs or symptoms) and radiological data (X-rays or other scans that show pancreatic inflammation) will determine the diagnosis of pancreatitis.

Treatments are tailored to the severity and the cause of the acute pancreatitis. Patients with moderate to severe pancreatitis typically spend a few days in the hospital. While you are at UChicago Medicine, our physicians and nurses will monitor your condition to ensure your pain is under control and will provide intravenous fluids to maintain blood volume.

When necessary, our pancreas team will start enteral nutrition (feeding via the small bowel) and avoid parenteral nutrition (feeding intravenously via central veins) to assure optimal nutrition.

When gallstones cause pancreatitis, our interventional gastroenterology specialists can use endoscopic techniques to remove the stones that have become trapped in the bile duct and pancreatic duct in the vicinity of the sphincter of Oddi — a small sphincter that is strategically placed at the junction of the bile duct and pancreatic duct with the duodenum. Endoscopes can also be used to insert stents (hollow tubes) into narrowed bile ducts to keep them propped open so bile and other fluid can drain properly. In most cases, the gallbladder is removed following recovery from mild pancreatitis and prior to discharge from the hospital to prevent future attacks.

Our pancreas team also offers endoscopic, percutaneous or minimally invasive surgical drainage of pancreatic and peripancreatic fluid collections. Benefits of minimally invasive surgery include small incisions, little to no scarring and faster recovery. Our endoscopists, interventional radiologists and surgeons have many years of experience performing a wide variety of pancreatic procedures and are experts at removing diseased tissue while preserving as much healthy tissue as possible.

Most people who have a bout of acute pancreatitis will completely recover, especially if the cause — such as gallstones — is removed. However, in some cases, a single attack of severe pancreatitis can damage the pancreas and progress to chronic pancreatitis, which requires ongoing care. Patients who require long-term follow-up care are seen in a dedicated outpatient pancreas clinic.