ConditionDigestive system
Acute Pancreatitis
Acute pancreatitis is sudden inflammation of the pancreas, the gland behind the stomach that makes digestive enzymes and insulin. It causes severe, constant upper belly pain that often spreads to the back, with nausea and vomiting. The two main causes are gallstones and heavy alcohol use. Most cases are mild and settle within a week with hospital care, fluids and pain relief, but about 1 in 5 become severe and can affect other organs.
Also called: Acute pancreatic inflammation, gallstone pancreatitis, alcoholic pancreatitis
At a glance
- What it is
- Sudden inflammation of the pancreas, where digestive enzymes start damaging the gland itself.
- Main causes
- Gallstones and alcohol together cause most cases. Others: very high triglycerides, medicines, ERCP, trauma.
- Key symptom
- Severe, constant upper abdominal pain, often boring through to the back, with vomiting.
- Diagnosis
- Typical pain plus blood lipase over 3 times normal, and/or imaging.
- Treatment
- Hospital admission, IV fluids, pain relief, early feeding, and treating the cause (often gallbladder removal).
When to get help
Call 911 or go to the ER
- Severe, constant upper belly pain spreading to the back, especially with vomiting
- Belly pain with fainting, a racing heart, confusion or difficulty breathing
- Belly pain with yellow skin or eyes and fever
See a doctor within a day or two
- Moderate upper belly pain after heavy drinking or a fatty meal that is not easing after a few hours
- Known gallstones with new constant pain and vomiting
Book a routine appointment
- Recurrent episodes of upper belly pain after meals
- Greasy, foul-smelling stools and weight loss after a previous attack
- New diabetes after an episode of pancreatitis
What happens in acute pancreatitis
The pancreas makes powerful digestive enzymes that are normally activated only once they reach the intestine. In pancreatitis, they are activated inside the pancreas, which starts to digest itself. This triggers inflammation, swelling and, in severe cases, tissue death (necrosis) and a body-wide inflammatory response that can affect the lungs, kidneys and circulation.
Symptoms
- Severe upper abdominal pain, in the middle or upper left, coming on over minutes to hours and staying constant
- Pain spreading to the back in about half of people
- Pain eased by sitting up and leaning forward, worse lying flat
- Nausea and vomiting
- Fever and a fast heart rate
- A tender, sometimes swollen abdomen
- Jaundice if a gallstone blocks the bile duct
In severe cases: low blood pressure, rapid breathing, confusion and reduced urine. Rarely, bruising appears around the belly button or the flanks after a day or two, a sign of bleeding into the tissues.
Causes and risk factors
| Cause | Notes |
|---|---|
| Gallstones | Most common cause in many countries; a stone blocks the shared opening of the bile and pancreatic ducts |
| Alcohol | Usually after years of heavy drinking; see alcohol use disorder |
| Very high triglycerides | Usually above 1,000 mg/dL (11.3 mmol/L); see hyperlipidemia |
| ERCP | A procedure on the bile ducts causes pancreatitis in a small percentage |
| Medicines | Including azathioprine, valproate, some diuretics, certain HIV drugs and others |
| High calcium | From overactive parathyroid glands |
| Injury | Blunt trauma to the abdomen |
| Infections | Mumps and some other viruses |
| Genetic and anatomical causes | Cystic fibrosis gene variants, pancreas divisum |
| Autoimmune pancreatitis | Rare; responds to steroids |
| Tumors | Pancreatic cancer can cause pancreatitis, especially in people over 40 with no obvious cause |
Smoking and obesity increase the risk. In about 1 in 10 to 1 in 5 cases, no cause is found (idiopathic).
Diagnosis
Acute pancreatitis is diagnosed when two of three criteria are met:
- typical abdominal pain
- blood lipase (or amylase) at least 3 times the upper limit of normal
- characteristic findings on imaging
Other tests:
- Abdominal ultrasound to look for gallstones, done in everyone
- Blood tests: liver function, blood count, kidney function, calcium, triglycerides, blood sugar and markers of severity
- CT scan if the diagnosis is uncertain or the person is not improving after 2 to 3 days, to look for necrosis or fluid collections
- MRCP (MRI of the bile ducts) if a retained bile duct stone is suspected
Severity
| Severity | Features |
|---|---|
| Mild | No organ failure; usually resolves within a week |
| Moderately severe | Temporary organ failure (under 48 hours) or local complications |
| Severe | Organ failure lasting more than 48 hours; higher risk of death |
Treatment
Treatment takes place in hospital.
- Intravenous fluids: given early to support circulation. Current guidance favors moderate, goal-directed fluid amounts rather than very aggressive volumes.
- Pain relief: often strong painkillers, including opioids.
- Early feeding: eating by mouth as soon as pain and nausea allow, often within 24 to 48 hours in mild cases. If you cannot eat, feeding through a tube into the gut is preferred over IV nutrition.
- Antibiotics: not given routinely; used only for proven infection, such as infected necrosis or cholangitis.
- Treating gallstones: gallbladder removal (cholecystectomy), ideally during the same hospital stay for mild gallstone pancreatitis, to prevent recurrence. ERCP is used urgently if a stone is blocking the bile duct with infection (cholangitis).
- Treating other causes: stopping alcohol, lowering triglycerides, stopping the triggering medicine.
- Intensive care for organ failure.
Treating complications
Fluid collections and necrosis often settle by themselves. If they become infected or cause symptoms, they may be drained through an endoscope, a needle, or surgery, usually after several weeks.
Complications
- Pancreatic necrosis, which can become infected
- Pseudocysts and walled-off fluid collections
- Organ failure: breathing failure, kidney injury, shock
- Sepsis
- Diabetes: new diabetes develops in a meaningful proportion of people after acute pancreatitis
- Recurrent attacks and progression to chronic pancreatitis, especially if drinking continues
Recovery and prevention
Most people with mild pancreatitis go home within a week and recover fully. After a severe attack, recovery can take weeks to months. To reduce the risk of another attack:
- stop drinking alcohol completely if alcohol was a cause, and get support if needed
- have your gallbladder removed if gallstones caused it
- stop smoking
- keep triglycerides low with diet, weight loss and medicines
- follow up for diabetes and digestive symptoms such as greasy stools
Frequently asked questions
What are the symptoms of acute pancreatitis?
The main symptom is sudden, severe, constant pain in the upper abdomen, often spreading to the back and eased by leaning forward. Nausea, vomiting, fever and a fast heart rate are common. Severe cases cause breathing problems, low blood pressure and confusion.
What causes acute pancreatitis?
Gallstones and heavy alcohol use cause most cases. Other causes include very high triglycerides, certain medicines, high calcium levels, abdominal injury, a procedure called ERCP, infections, and rarely tumors or genetic factors.
How long does acute pancreatitis last?
Mild acute pancreatitis usually improves within 3 to 7 days with hospital treatment. Severe pancreatitis can require weeks in hospital and months of recovery, especially if complications such as necrosis or fluid collections develop.
Can acute pancreatitis come back?
Yes, especially if the cause is not removed. Removing the gallbladder after gallstone pancreatitis and stopping alcohol after alcohol-related pancreatitis greatly reduce the risk. Repeated attacks can lead to chronic pancreatitis.
Is acute pancreatitis dangerous?
Most cases are mild and recover fully. About 1 in 5 cases are severe, with organ failure or infected tissue, and these carry a significant risk of death. Prompt hospital care improves outcomes.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Gastroenterology: ACG Guideline: Management of Acute Pancreatitis
- American Gastroenterological Association: Clinical Practice Update on Management of Acute Pancreatitis
- NIDDK: Pancreatitis
- NHS: Acute pancreatitis
- MedlinePlus: Pancreatitis