10 acute pancreatitis facts

10 acute pancreatitis facts

Key Points

• Pancreatitis is the inflammation of the pancreas, an organ located behind the stomach. It can be acute (short-term) or chronic (long-term).
• Acute pancreatitis is a potentially life-threatening condition requiring prompt diagnosis and treatment. It is usually of rapid onset.
• Abdominal pain (typically in the epigastrium), vomiting and fever are common presenting symptoms.
• Early recognition and management of severe cases are crucial to improve outcome.
• Gallstones and excessive alcohol consumption are the most common causes.

• Acute pancreatitis is a rapid inflammation of the pancreas, causing abdominal pain and potentially life-threatening complications. The condition can range from mild to severe.

Types

• Mild acute pancreatitis: No organ dysfunction or local complications.
• Moderate acute pancreatitis: Transient organ dysfunction or local complications.
• Severe acute pancreatitis: Persistent organ dysfunction or severe local complications.

2. Epidemiology

• Approximately 4,800 hospital admissions occur annually in the UK.
• Incidence: 50-80 per 100,000 population per year.
• Mortality rate: 5-10%.

3. Risk Factors

• Age: Peak incidence between 45-55 years.
• Sex: Slightly more common in men.
• Ethnicity: Higher incidence in African Americans.

4. Causes

• Gallstones (45%): Most common cause in the UK.
• Alcohol (20-30%): More common in men.
• Drugs: Steroids, azathioprine, and valproate.
• Infections: Viral (e.g. mumps) and bacterial.
• Trauma: Abdominal injury.
• Metabolic disorders: Hypertriglyceridaemia.
• Genetic disorders: Hereditary pancreatitis.
• Idiopathic: No identifiable cause.

5. Symptoms

• Severe, persistent abdominal pain – typically in the epigastrium, and of rapid onset (making a perforated abdominal viscus an important differential diagnosis)
• Nausea and vomiting.
• Fever.
• Abdominal tenderness.
• Guarding (muscle tension).

6. Diagnosis

• Clinical suspicion based on symptoms, physical examination and investigations.

Investigation

• Blood tests: Amylase (key diagnostic test), lipase, inflammatory markers (e.g CRP).
• Imaging: Abdominal ultrasound, CT scan.
• Abdominal X-ray: To exclude other causes.

Differential Diagnosis

• Acute cholecystitis.
• Peptic ulcer disease (including a perforated PU, and any abdominal viscus)
• Gastroenteritis.
• Inflammatory bowel disease.

• There is no specific treatment.
• Supportive care: Fluid resuscitation, analgesia, and nutritional support.
• Endoscopic retrograde cholangiopancreatography (ERCP): For gallstone-related pancreatitis.
• Surgery: For necrotising pancreatitis or complications.

• Almost all patients should go to A&E
• Severe abdominal pain.
• Fever above 38.5°C.
• Difficulty breathing.

• Pancreatic necrosis: Death of pancreatic tissue.
• Infection: Bacterial or fungal.
• Pseudocyst: Fluid collection.
• Abscess: Infected fluid collection.
• Systemic inflammatory response syndrome (SIRS): Organ dysfunction.

• Mortality rate: 5-10%.
• Morbidity: Variable, depending on severity.

10. Prevention

• Avoid excessive alcohol consumption.
• Manage underlying conditions: Gallstones (remove if more than one bad attack of acute cholecystitis), hypertriglyceridaemia.
• Vaccination: Against influenza and pneumococcus.