Introduction

Acute pancreatitis is a sudden and potentially life-threatening condition characterized by inflammation and damage to the pancreas.

Acute pancreatitis can range in severity from mild to severe and can have a variety of underlying causes, including heavy alcohol consumption, gallstones, high levels of triglycerides in the blood, and certain medications.

Symptoms of acute pancreatitis can include severe abdominal pain, nausea, vomiting and fever. Complications of acute pancreatitis can include infections, and systemic inflammatory response syndrome (SIRS).

Treatment of acute pancreatitis involves identifying and addressing the underlying cause, managing symptoms, and preventing complications.

Prevalence

The annual incidence of acute pancreatitis ranges from 5 to 80 cases per 100,00 people worldwide.

It is difficult to estimate the prevalence of acute pancreatitis in the UK as no comprehensive national data exists for this condition.

However, numerous studies have estimated the incidence of acute pancreatitis. A study by Gut in 2017 estimated that acute pancreatitis occurs in around 23 cases per 100,000 people a year.

While no data could be found in the UK, a study in the journal of emergency medicine in 2018, found that acute pancreatitis was among the top 10 common medical conditions encountered by ambulance services in the US.

Acute pancreatitis can occur in all ages but is more commonly diagnosed in people over the age of 50. The incidence of acute pancreatitis increases with age.

Men are more likely to develop the condition than women, with a ration of approximately 1.5 male: 1 female.

Prognosis

The prognosis of acute pancreatitis in the UK varies depending upon the severity, underlying cause, and the patient’s overall health.

Acute pancreatitis ranges from mild and self-limited to severe and potentially life threatening.

A study by British journal of surgery 2019, estimated the mortality rate for acute pancreatitis in the UK was 4.8% with the highest rates seen in patients with severe acute pancreatitis that developed complications such as pancreatic necrosis or multi-organ failure.

Risk factors can increase a person’s likelihood of developing acute pancreatitis.

Risk Factors 

•  Heavy alcohol consumption.
• Gallstones.
• Increased levels of triglycerides.
• Smoking.
• Certain medications.
• Familar history.
• Infections (mumps, hepatitis B).
• Pancreas trauma.

Pathophysiology

Acute pancreatitis occurs due to inflammation and damage to the pancreas (a gland located behind the stomach that produces digestive enzymes). The simple pathophysiology of acute pancreatitis involves a process known as autodigestion.

Normally, the exocrine digestive enzymes produced by the pancreas are released into the small intestine, where they help to break down food. However, in acute pancreatitis, these enzymes are activated within the pancreas itself, causing damage to pancreatic tissue.

This autodigestion occurs when the normal regulation of the exocrine digestive enzymes is disrupted (due to hypersecretion or backflow), leading to their premature activation within the pancreas. The enzymes then start to break down and damage the pancreatic tissue, leading to inflammation, swelling, and pain.

The release of inflammatory molecules and cytokines contributes to the development of oedema, or swelling, within the pancreas. In severe cases, the inflammatory response can lead to necrosis of the pancreatic tissue.

Causes

Most common causes of acute pancreatitis in the UK are due to heavy alcohol consumption or gallstones.

A useful Mnemonic (I GET SMASHED) can help remember the causes of acute pancreatitis.

Idiopathic

Gallstones

Ethanol (Alcohol)

Trauma

Steroids

Mumps

Autoimmune disease

Scorpion sting

Hypertriglyceridemia / Hypercalcemia

ERCP

Drugs

Assessment

Assessing the standard <C>ABCDE algorithm will identify any time-critical features they will require a time-critical transfer to the nearest hospital.

After a <C>ABCDE assessment has been carried out, providing no major problems have been identified, a through abdominal assessment should be carried out, including a pain assessment and full patient history.

An ECG should also be performed for all patients presenting with epigastric pain (to avoid missing MI).

A urinalysis can also be carried out – but unlikely to show any abnormalities as the urological system is unlikely to be the cause of sudden onset epigastric pain).

Management

Any <C>ABCDE problems should be corrected promptly. Other management includes:

• Intravenous fluid resuscitation (following fluid guidelines).
• Analgesia (IV is advised as quicker acting).
• Antiemetics to treat nausea or vomiting.
• Constant monitoring of blood glucose and correction if needed.

Patients should be nil by mouth until pain improves (with gradual re-introduction).

Complications

If acute pancreatitis is not identified complications may include:

• Necrotising pancreatitis
• Infected pancreatic necrosis
• Pancreatic abscess

Differential Diagnoses

Sudden onset of severe epigastric pain can have several other causes: These include:

• Perforated peptic ulcer.
• Bowel obstruction
• Ruptured abdominal aortic aneurysm.
• Myocardial infarction
• Viral hepatitis
• Ruptured ectopic pregnancy.
• Gastroenteritis

Key Points

• Acute pancreatitis is characterised by inflammation and damage to the pancreas which is often sudden and potentially life-threatening.
• The inflammation of the pancreas is due to the process of autodigestion, where exocrine digestive enzymes are released into the pancreas.
• Most cases of acute pancreatitis in the UK are due to heavy alcohol use or gallstones.
• Symptoms of acute pancreatitis can include severe sudden epigastric pain, nausea and vomiting with clinical findings of abdominal tenderness, distension, and markers of systemic inflammatory response.
• Treatment of acute pancreatitis involves identifying and addressing the underlying cause, managing symptoms, and preventing complications.
• Complications of acute pancreatitis can include infections and systemic inflammatory response syndrome (SIRS).