Acute Pancreatitis

What is Acute Pancreatitis 

Acute pancreatitis is a condition in which the pancreas suddenly gets irritated and swollen (has inflammation).

The pancreas is a large gland behind the stomach. It makes enzymes that help to digest food. The pancreas also makes hormones that help to control your blood sugar.

Acute pancreatitis is pancreatic inflammation resulting from autodigestion by activated pancreatic enzymes, most commonly a result of alcohol abuse and gallstones.

Patients often present with nausea, vomiting, and midepigastric pain and have a variable prognosis that is predominantly based on the severity of pancreatitis and the presence of complications.

Acute pancreatitis happens when the enzymes attack the pancreas and damage it. Most attacks last a couple of days and can cause serious problems.

How is acute pancreatitis diagnosed?

CT and MRI features of acute pancreatitis

On CT and MRI, the pancreas can appear normal in the setting of mild pancreatitis.

Imaging findings with increasing severity of pancreatitis include pancreatic enlargement (diffuse or focal); loss of the normal acinar pattern; decreased attenuation/T1-weighted signal intensity and increased T2-weighted signal intensity of the pancreas related to edema; haziness of the peripancreatic fat related to inflammation, edema, or peripancreatic fat necrosis; peripancreatic collections (acute peripancreatic fluid collections [APFC] or acute necrotizing collections [ANC] [when ≤ 4 weeks of symptom onset] or pseudocysts or walled-off necrosis [WON] [when >4 weeks of symptom onset]), sometimes with presence of gas owing to fistula formation to adjacent bowel or superinfection; and pancreatic necrosis (seen as focal or diffuse lack of enhancement of pancreatic parenchyma), sometimes with sterile or infected ANC or WON.

Collections are often present in the anterior pararenal space of the retroperitoneum but may also commonly involve the lesser sac of the peritoneal cavity and the transverse mesocolon.

Complications of acute pancreatitis

Complications of acute pancreatitis may include

  • formation of pancreatic or peripancreatic collections,
  • superinfection of collections,
  • hemorrhage,
  • venous thrombosis (most commonly involving the splenic vein and superior mesenteric vein),
  • and arterial pseudoaneurysm formation (often involving the splenic, gastroduodenal,
  • pancreaticoduodenal, hepatic, and left gastric arteries) with the potential for subsequent rupture.

Follow these instructions at home:

Eating and drinking

  • Follow instructions from your doctor about diet. You may need to:
    • Avoid alcohol.
    • Limit how much fat is in your diet.
  • Eat small meals often. Avoid eating big meals.
  • Drink enough fluid to keep your pee (urine) clear or pale yellow.
  • Do not drink alcohol if it caused your condition.

General instructions

  • Take over-the-counter and prescription medicines only as told by your doctor.
  • Do not use any tobacco products. These include cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your doctor.
  • Get plenty of rest.
  • If directed, check your blood sugar at home as told by your doctor.
  • Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

  • You do not get better as quickly as expected.
  • You have new symptoms.
  • Your symptoms get worse.
  • You have lasting pain or weakness.
  • You continue to feel sick to your stomach (nauseous).
  • You get better and then you have another pain attack.
  • You have a fever.

Get help right away if:

  • You cannot eat or keep fluids down.
  • Your pain becomes very bad.
  • Your skin or the white part of your eyes turns yellow (jaundice).
  • You throw up (vomit).
  • You feel dizzy or you pass out (faint).
  • Your blood sugar is high (over 300 mg/dL).

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