Acute pancreatitis: symptoms and attack

Pain in the upper abdomen that makes you want to double over is not a case where it is reasonable to wait until morning. Acute pancreatitis begins suddenly, and it is treated in hospital. Below — how to distinguish an attack from "just indigestion", why the gland starts digesting itself, and at what point it is time to call 103.

What acute pancreatitis is and what it is not

The pancreas is an organ in the middle of the abdomen: it helps digest food and produces hormones such as insulin. In acute pancreatitis the gland suddenly becomes inflamed, swollen and painful, and this condition requires urgent treatment in hospital.

The essence lies in the mechanism: enzymes that are supposed to break down food in the intestine become activated prematurely and begin to digest the tissue of the gland itself. Doctors call this enzyme autoaggression.

Let us clarify right away: acute pancreatitis is not the same as chronic pancreatitis, in which the gland is irreversibly damaged and the condition only worsens over time.

Why the pancreas becomes inflamed

The two most common causes are gallstones blocking the outlet of the duct and a large amount of alcohol. Alcohol, among other things, increases sphincter tone, impedes the outflow of secretion and increases the production of gastric juice, which further stimulates the gland.

Less often the causes are trauma to the gland, including during surgery, certain medications — steroids, cardiac drugs and antiepileptic drugs — as well as lupus, mumps, pancreatic cancer, and elevated blood calcium levels. Risk factors also include high triglycerides, smoking and type 2 diabetes.

Symptoms of an acute pancreatitis attack

The main symptom is abdominal pain. It is often accompanied by high fever, nausea and vomiting. Pain in acute pancreatitis:

• begins suddenly and does not go away;
• is severe, sharp, "like a knife";
• is in the upper abdomen between the ribs, on one side or throughout the abdomen;
• radiates to the sides and to the back;
• worsens after eating, with movement and in a lying position, and eases if you lean forward or pull your knees to your chest.

A similar picture occurs with appendicitis and stomach ulcer, so a diagnosis is not made on sensations alone. There may also be bloating, abdominal muscle tension and vomiting that brings no relief.

Forms of acute pancreatitis

The classification distinguishes edematous (interstitial) pancreatitis and pancreatic necrosis — sterile and infected. Most people with acute pancreatitis begin to feel better within a week and return home after 5–10 days.

There is no clear clinical picture. In this regard, a whole range of additional investigations is needed for an accurate diagnosis of acute pancreatitis.

The figures that explain why no one "waits it out": mortality in acute pancreatitis overall is 7–15%, and in destructive forms — 40–70%.

How acute pancreatitis is diagnosed

The diagnosis is made by blood tests, and sometimes a CT scan is additionally performed. The blood is checked for, in particular, amylase and lipase — pancreatic enzymes. In hospital, doctors assess how severe the condition is and whether infection and other problems have set in.

If abdominal pain appears suddenly, is severe, does not go away or returns, and the temperature is elevated or there are chills — an urgent medical examination is needed. If acute pancreatitis is suspected, the person is immediately referred to hospital for examination.

Complications and when a doctor is urgently needed

Most people recover fully, but complications do occur: cysts in the gland, which often resolve on their own and sometimes require removal if infected; pancreatic necrosis — death of part of the tissue, which may require surgery and treatment of infection to prevent sepsis; and progression to chronic pancreatitis with repeated attacks. Acute pancreatitis can be life-threatening, so the condition is constantly monitored in hospital.

Call 103 or 112 if, with sudden severe abdominal pain, the pain spreads to the back, bloating does not go away or returns, the heartbeat is rapid or it is difficult to breathe, and the skin around the navel, at the waist or on the upper thigh turns blue or looks like a bruise.

This material is for reference: it helps you get your bearings, but does not replace a doctor's consultation — the pancreas is not an organ with which experiments are appropriate.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer