Conditions

Acute pancreatitis is inflammation of the pancreas caused by the digestive enzymes normally produced by the gland attacking its own tissues. Acute pancreatitis has several causes and can be prevented from recurring if the underlying cause is removed. If not, the condition can continue, leading to chronic pancreatitis, a major risk factor for pancreatic cancer.

What does a healthy pancreas do?

The pancreas is a complex gland that has two functions:

• 1It produces the hormone insulin, which controls blood glucose levels. People who cannot produce insulin have type 1 diabetes.
• 2It produces digestive enzymes, including trypsin (which breaks down proteins) and pancreatic amylase (which breaks down carbohydrates).

The insulin that is produced is carried from the pancreas in the blood but the digestive enzymes are released directly into the small intestine nearby through the pancreatic duct. This is a small and delicate tube that lies right next to the bile duct that carries bile out of the gallbladder and into the intestine. The two ducts share a common opening.

Blockage of the pancreatic duct

If the pancreatic duct gets blocked, the enzymes produced inside the pancreas cannot escape. They are produced in an inactive form but any delay causes activation inside the organ. The digestive enzymes break down the cells of the pancreas, causing damage and acute inflammation.

What causes acute pancreatitis?

Different events and circumstances can lead to an attack of acute pancreatitis, including:

• 1Complicated gallstone disease: inflammation of the bile duct or gallbladder due to damage by gallstones or because the bile duct has been blocked by a stone can cause swelling that blocks the pancreatic duct
• 2Alcohol abuse: very heavy drinking that continues over a long period of time leads to activation of trypsin before it is released. The pancreatic duct is not blocked, but the tissue damage causes inflammation in the pancreas
• 3Treatment with some medicinal drugs such as thiazide diuretics or steroids
• 4Pancreatic cancer: even a small tumour near to the pancreatic duct can cause a blockage, which can lead to acute pancreatitis
• 5Having an endoscopic retrograde cholangiopancreatography (ERCP): this specialised form of endoscopy that is used to investigate and treat problems in the bile duct or pancreatic duct can sometimes damage one or both ducts, leading to inflammation. If this blocks the pancreatic duct, pancreatitis can develop
• 6Some viral infections.

How common is acute pancreatitis?

In the UK, up to 2,500 people get acute pancreatitis in any 12-month period. In eight out of ten of them, prompt care will prevent ongoing complications and chronic pancreatitis.

Complications of acute pancreatitis

Unfortunately, the other two out of ten people experience ongoing problems such as an abscess, a pancreatic pseudocyst or a bowel obstruction. All of these can be treated surgically but need to be done by an expert surgeon with experience in complex pancreatic surgery.