Acute pancreatitis

Acute pancreatitis is sudden inflammation of the pancreas, the organ behind the stomach that makes digestive enzymes and insulin. In pancreatitis those digestive enzymes activate inside the pancreas and start to damage the gland itself, triggering intense inflammation. The two commonest causes by far are gallstones (blocking the duct the pancreas shares with the bile system) and alcohol; others include very high blood triglycerides, high calcium, certain medications, and some procedures. It classically causes severe, constant pain in the upper abdomen that often bores through to the back and may ease when leaning forward, with nausea and vomiting. Diagnosis rests on this picture plus a blood lipase (or amylase) raised typically to three or more times normal, and imaging. Most attacks are mild and settle over a few days with supportive care (fluids, pain relief, treating the cause). But a minority become severe, with complications affecting the whole body and the pancreas itself, and can be life-threatening — which is why it is always treated as an emergency.

• Lipase — the preferred blood test; typically raised to 3+ times the upper normal limit in acute pancreatitis.
• Amylase — also raised; lipase is more specific and stays up longer.
• CRP — helps gauge severity, especially after the first day or two.
• Calcium — can fall in severe pancreatitis (a marker of severity); high calcium can also be a cause.
• Triglycerides — very high levels are a cause.
• Liver enzymes and ultrasound — look for gallstones as the trigger.
• Glucose, urea, blood count — help assess severity.

• Severe, constant pain in the upper abdomen, often boring through to the back
• Pain that may ease when leaning forward and worsen after eating or drinking
• Nausea and vomiting
• A tender, sometimes swollen upper abdomen
• Fever
• A fast heartbeat
• In severe cases: dehydration, low blood pressure, breathing difficulty, confusion