Acute Pancreatitis (AP): Symptoms, Causes, Risk Factors, Complications, Treatment & Prevention

Acute pancreatitis definition

It is a common gastrointestinal condition that is characterised by a (acute- short-term) sudden inflammation of the pancreas and is the primary cause of hospitalisation among gastrointestinal disorders in many countries. Enzymes typically activate only in the small intestine. If they activate in the pancreas, they can digest pancreatic tissue, causing swelling, bleeding, and damage to the organ and its blood vessels.

Acute pancreatitis, in contrast to chronic pancreatitis, usually results from a triggering event and goes away quickly with the proper medical care. Inflammation of the pancreas causes digestive problems, pain in the abdomen, and, in rare instances, serious systemic complications. Most individuals with this condition may recover within a week and have no further problems; however, severe cases can lead to serious complications and may even be fatal.

Acute Pancreatitis Meaning

• Acute: Short term condition
• Pancreatitis: Inflammation of the pancreas
  

Acute Pancreatitis Prevalence

The highest rate of acute pancreatitis occurs in individuals during their fifth (ages 40-49) and sixth (ages 50-59) decades of life; however, mortality rates increase with age.

The mortality rate of acute pancreatitis ranges from 3% in individuals with mild pancreatitis to as high as 20% in those with pancreatic necrosis.

In 2019, it was estimated that there were 2,814,972 cases of acute pancreatitis globally, with 115,053 deaths (4.1%).

In 2024, the incidence of acute pancreatitis in India is estimated to range from 12 to 20 cases per 100,000 individuals per year, with common causes including idiopathic factors, gallstones, and biliary ascariasis.

Acute Pancreatitis Classification

This condition is classified on the basis of the presence of necrosis and the severity of the condition, with the two main types being interstitial oedematous Pancreatitis (mild) and necrotising Pancreatitis (severe). 

Here's a breakdown of the types of acute pancreatitis:

Interstitial Oedematous Pancreatitis (Mild) or Acute Oedematous Pancreatitis

• This condition doesn't have significant tissue death (necrosis). However, it is characterised by swelling and inflammation of the pancreas and surrounding tissues.
• It may be associated with peripancreatic fluid collections. 
• Often resolves without complications.

Necrotizing Pancreatitis (Severe) or Acute Necrotizing Pancreatitis

• Characterised by tissue death (necrosis) within the pancreas and/or surrounding tissues. 
• It can lead to more severe complications such as prolonged illness and organ failure 
• It may be further classified as sterile or infected necrosis. 
• It can be associated with acute necrotic collections and walled-off necrosis. 

Severity Classification (Based on the Revised Atlanta Classification)

• Mild Acute Pancreatitis: No pancreatic or peripancreatic necrosis, organ failure, local or systemic complications. 
• Moderate Acute Pancreatitis: Sterile pancreatic or peripancreatic necrosis, transient organ failure (<48 hours), or both.
• Severe Acute Pancreatitis: Infected pancreatic or peripancreatic necrosis or persistent organ failure (>48 hours).

Acute Pancreatitis Symptoms

Acute pancreatitis presents as an emergency, requiring urgent admission to the hospital. Typically, signs of acute pancreatitis develop suddenly and may range from mild to severe. Below-mentioned are common acute pancreatitis signs and symptoms, including:

• Severe tummy pain: Patients almost always mention severe, constant abdominal pain (similar to peritonitis), usually of sudden onset and, in 80% of cases, associated with vomiting.

• The pain may radiate to the back, usually to the lower thoracic area.

• Fever: In some cases, fever accompanies acute pancreatitis due to inflammation.

• Rapid Heart Rate (Tachycardia): An increased heart rate is common due to systemic inflammation and fluid loss.

• Abdominal Swelling: Abdominal examination shows epigastric tenderness, with muscle guarding that may occur due to fluid accumulation and inflammation.

• Jaundice: Yellowish discolouration of the skin and eyes can be seen in patients with acute pancreatitis, which occurs when the bile ducts are obstructed.

• Low Blood Pressure: A drop in blood pressure can be seen in severe cases, causing organ failure and shock.

Acute Pancreatitis Causes

It is an unpredictable and potentially lethal disease that has a variety of causes, with the most common causes being gallstones (50%) and alcohol (25%), as per European and North American studies:

• Gallstones: Gallstones are the most common cause. Migrating gallstones cause transient obstruction of the pancreatic duct, a mechanism shared by other causes such as endoscopic retrograde cholangiopancreatography (ERCP), as well as potential causes (i.e., pancreas divisum and sphincter of Oddi dysfunction). 

• Alcohol: It is the second most common cause of acute pancreatitis. It usually occurs in individuals who consume four to alcoholic five drinks daily for over five years. Heavy drinkers have a lifetime risk of 2% to 5% for developing pancreatitis. The risk is higher for men than for women, possibly due to differences in alcohol intake or genetic background.

Other causes (5%) and acute pancreatitis risk factors include:

• Medications: Certain drugs account for less than 5% of all cases of acute pancreatitis, although hundreds of drugs have been implicated. Some medications, such as corticosteroids, certain antibiotics, and chemotherapy drugs, can increase the risk of acute pancreatitis.

• Elevated fat levels: Elevated triglyceride levels in the blood can increase the risk of developing acute pancreatitis.

• Trauma or Injury: Physical trauma to the abdomen, such as a car accident, can injure the pancreas and lead to acute pancreatitis.

• Infections: Certain viral or bacterial infections, including mumps, can result in acute pancreatitis.

• Morbid obesity: It is one of the risk factors for both acute pancreatitis and severe acute pancreatitis.

• Genetic mutations: Specific mutations and polymorphisms in several genes are linked with acute (and chronic) pancreatitis.

• Type 2 diabetes: As per some studies, it was found that this condition also increases the risk of acute pancreatitis by a factor of 2 or 3. However, both obesity and diabetes are also risk factors for chronic pancreatitis and pancreatic cancer.
  

Complications of Acute Pancreatitis

After acute pancreatitis, pancreatic exocrine and endocrine dysfunction develops in approximately 20 to 30% of patients, and clear-cut chronic pancreatitis develops in one-third to one-half of those patients. The following are the other systemic and local complications:

• Systemic complications
• Organ Failure

• Local Complications 
• Peripancreatic fluid collections or pseudocysts 
• Pancreatic or peripancreatic necrosis (either sterile or infected)
  

Acute Pancreatitis Diagnosis

Involves several tests to confirm the condition and determine its severity:

• Clinical Examination
• Blood Tests
• Imaging Tests
• CT scan
• MRI
• Ultrasound
• Abdominal X-ray 
• Endoscopic Ultrasound (EUS)
  

Acute Pancreatitis Treatment

Treatment for acute pancreatitis focuses on managing symptoms, supporting the pancreas, and preventing complications:

• Hospitalisation
• Fluid Replacement
• Pain Management
• Antibiotics
• Nutritional support
• Surgical Intervention
• Endoscopic Procedures
  

Prevention of Acute Pancreatitis

Acute pancreatitis and recurrent episodes can be prevented by taking the following precautions:

• Reducing alcohol consumption
• Maintaining a healthy weight and avoiding obesity
• Quitting smoking 
• Early Gallstone Treatment
• Dietary Adjustments (A diet low in fat)