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Acute Pancreatitis

WHAT IS ACUTE PANCREATITIS?

When the pancreas suddenly becomes inflamed, it is referred to as acute pancreatitis.  This can last for a short time, then the pancreas returns to normal. Acute pancreatitis may cause serious problems or be deadly in severe cases.  

At Loma Linda University Health, we have physicians board-certified in gastroenterology and surgery with advanced training and experience in this area. We have the ability to diagnose and treat acute pancreatitis in addition to other underlying pancreatic conditions.   

WHAT ARE THE SYMPTOMS OF ACUTE PANCREATITIS?

The symptoms of acute pancreatitis vary.  Symptoms may include:

  • Severe belly/abdominal pain that may spread to your back and chest (this may feel worse after eating)
  • Nausea
  • Vomiting
  • Rapid heart rate
  • Fever
  • Swelling and feeling sore or tender in the upper belly/abdomen
  • Fluid buildup in the belly/abdomen
  • Lowered blood pressure
  • Yellowing of the skin and eyes (jaundice)

WHAT CAUSES ACUTE PANCREATITIS?

The most common causes of acute pancreatitis are alcohol abuse and gallstones. Other causes include:

  • Belly injury or surgery
  • High levels of fat particles (triglycerides) in the blood
  • Very high levels of calcium in the blood
  • Certain medications such as estrogens, steroids, and thiazide diuretics
  • Infections, such as mumps, hepatitis A or B, or salmonella
  • Cystic fibrosis
  • A tumor
  • Certain genetic defects
  • Congenital abnormalities in the pancreas
  • Trauma to the pancreas
  • Cigarette smoking
  • After having a procedure called an ERCP
  • Hereditary causes
  • Sometimes, the cause is unknown

HOW IS ACUTE PANCREATITIS DIAGNOSED?

Pancreatitis is diagnosed by:

  • Medical history
  • A physical exam
  • Blood tests
  • Imaging studies

Additional tests may be needed to determine the underlying cause.  This is to ensure that the correct treatment is given to prevent this from recurring.

Loma Linda University Health offers a full range of diagnostic options, including:

  • Blood tests, which may reveal elevated pancreatic enzymes
  • Abdominal x-rays, which provide images of internal tissues, bones, and organs  
  • Ultrasound to see the internal organs of the belly and check how blood is flowing through different blood vessels
  • Computed tomography (CT) scan or magnetic resonance imaging (MRI)  
  • Magnetic Resonance Cholangiopancreatography (MRCP) to make detailed images of the pancreas, gallbladder, and the pancreas and biliary ducts
  • Endoscopic Ultrasound (EUS) to evaluate the pancreas during sedation

HOW IS ACUTE PANCREATITIS TREATED?

At Loma Linda Health University, we offer the most advanced treatments and technologies found only in major metropolitan academic medical centers. These include:

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is a procedure in which a physician with specialized training passes a flexible, thin tube with a camera attached to the end through the patient’s mouth and into the first part of the small intestine, where the bile duct and pancreatic duct exit. With this device, a small catheter can be passed into the bile duct to remove gallstones that might have gotten stuck and are the cause of pancreatitis. In certain situations, a special catheter can also be passed into the pancreatic duct to help the pancreas heal.

Procedures that can be performed with ERCP

  • Sphincterotomy – Using a small wire on the endoscope, a physician finds the muscle that surrounds the pancreatic duct or bile duct and makes a tiny cut to enlarge the duct opening. This allows the physician to gain access to the duct and help with duct drainage.
  • Gallstone Removal – The endoscope is used to remove pancreatic or bile duct stones with a tiny basket. Gallstone removal is sometimes performed along with a sphincterotomy.
  • Stent Placement – Using the endoscope, a physician places a tiny piece of plastic or metal that looks like a straw into a narrowed pancreatic or bile duct to keep it open.
  • Balloon Dilatation – The physician can use a balloon to dilate, or stretch, a narrowed pancreatic or bile duct. A temporary stent may be placed for a few months to keep the duct open.

It is well documented that one of the main side effects of ERCP is pancreatitis; however, there are several clearly defined situations when urgent ERCP is indicated for acute pancreatitis.

Fluids

One of the primary therapies for acute pancreatitis is adequate early fluid resuscitation, especially within the first 24 hours of onset. Pancreatitis is associated with a lot of swelling and inflammation. Giving fluids intravenously prevents dehydration and ensures that the rest of the organs of the body get adequate blood flow to support the healing process.

Nutritional Support

Initially, no nutrition is given to allow the pancreas and bowels to rest during the first 24 to 48 hours. After 48 hours, a plan to provide nutrition should be implemented because acute pancreatitis is a highly active state of inflammation and injury that requires a lot of calories to support the healing process. In most cases, patients can start to take in food on their own by 48 hours. If this is not possible, then a feeding tube that is passed through the nose into the intestines can be used to provide nutrition. This method is safer than providing nutrition intravenously. There is no benefit to using probiotics for acute pancreatitis.

Pain Control

Intravenous medications, typically potent narcotic pain medications, are effective in controlling pain associated with acute pancreatitis. Nausea is a common symptom and can be due to pancreatic inflammation as well as slowing of the bowels. Effective intravenous medications are available for nausea. Pain and nausea will decrease as the inflammation resolves.

Treatment of Underlying Cause

In addition to providing supportive care, underlying causes need to be promptly evaluated. If the acute pancreatitis is thought to be due to gallstones, medication, high triglycerides, or high calcium levels within the patient’s body (or other external causes), directed therapy can be implemented.

WHAT ARE THE COMPLICATIONS OF ACUTE PANCREATITIS?

Acute pancreatitis usually gets better on its own over time, and many people recover without any problems.  A small number of cases end up with fluid collections around the pancreas that require drainage.

If acute pancreatitis is left untreated, this can lead to serious complications, including:

  • Bleeding
  • Dehydration
  • Infection
  • Narrowing or blockage in a bile or pancreatic duct
  • Leakage from the pancreatic duct
  • Pancreatic pseudocysts
  • Chronic pancreatitis
  • Damage to your pancreas
  • Necrotizing pancreatitis
  • Heart, lung, or kidney failure
  • Death

WHO IS AT RISK FOR ACUTE PANCREATITIS?

There are preventable habits that are likely to contribute to pancreatitis, such as:

  • Obesity
  • Smoking
  • Heavy drinking

Individuals with certain medical conditions are also at risk of developing pancreatitis. These conditions include:

  • Diabetes
  • Gallstones
  • High triglycerides
  • Genetic disorders of the pancreas
  • Some autoimmune conditions
  • Cystic fibrosis

In addition, certain groups of people are more likely to develop pancreatitis. For example:

  • Men are more likely to have pancreatitis than women.
  • African-Americans have a higher rate of pancreatitis than other ethnic groups.
  • Those with a family history of pancreatitis are at greater risk.
  • Those with a personal history of gallstones are at greater risk.

NEXT STEPS

  • Be proactive. Because complications of acute pancreatitis are serious and the symptoms of pancreatitis may look like other health problems, it’s important to be proactive. Take steps to reduce any habits that increase your risk of developing this condition.
  • Seek medical intervention. If left untreated, acute pancreatitis can be life-threatening. If you are experiencing any of the symptoms of pancreatitis, request an evaluation at Loma Linda University Health. Contact your provider or schedule the appointment through MyChart.