Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

Acute Pancreatitis

What Is It?

Acute pancreatitis is a sudden inflammation of the pancreas, the large gland located in the upper part of the abdomen, behind the stomach. This condition is most commonly associated with overuse of alcohol or gallstones. Acute pancreatitis is a common reason for people to be admitted to the hospital.

The main function of the pancreas is to produce digestive enzymes and hormones, such as insulin and glucagon, which regulate blood sugar levels. In an attack of pancreatitis, enzymes that normally are released into the digestive tract begin to damage the pancreas itself. The gland becomes swollen and inflamed, and even more enzymes are released into the surrounding tissues and bloodstream. Digestion slows down and becomes painful, and other body functions can be affected. The pancreas can become permanently damaged and scarred if attacks are severe, prolonged or frequent.

It is not known exactly why the enzymes start to damage to the organ that produced them, but there are several factors known to trigger attacks of acute pancreatitis. One of the most common causes is gallstones. The pancreatic duct, which delivers digestive enzymes from the pancreas to the small intestine, merges with the common bile duct, which is attached to the gallbladder and liver. If gallstones escape from the gallbladder and travel down the common bile duct, they can become lodged at the place where the pancreatic duct enters the intestine. When the pancreatic duct becomes blocked, enzymes can't flow properly and can back up into the pancreas. This causes the pancreas to become inflamed.

The other leading cause of pancreatitis is heavy alcohol use. Most people who drink alcohol never develop pancreatitis, but certain people will develop pancreatitis after drinking large amounts of alcohol, either over a period of time or in a single binge. Despite years of intensive research, why alcohol is particularly toxic to the pancreas and why only 10% of heavy drinkers get pancreatitis remains unclear. Alcohol combined with smoking increases the risk of acute pancreatitis.

The third most common cause of acute pancreatitis today is a complication of a medical procedure called endoscopic retrograde cholangiopancreatography (ERCP). The doctor inserts a flexible tube with a small TV camera and a light on one end and an eyepiece on the other into the mouth. The tube is threaded down the esophagus, through the stomach and into the first part of the small intestine. The doctor locates the opening of the bile and pancreatic duct. Dye under pressure is squirted into the opening. Using x-ray, the doctor can view ducts in the pancreas, liver and gallbladder.

Other factors that sometimes can cause pancreatitis include:

• Use of any of a wide variety of medications, such as

  • sulfa drugs

  • water pills (hydrochlorothiazide, furosemide, others)

  • Azathioprine (Imuran)

  • drugs used to treat HIV

• Abdominal surgery or severe trauma, such as a motor vehicle accident

• Metabolic conditions, such as high blood levels of calcium or triglycerides

• Some infections, such as mumps or viral hepatitis

In up to 30% of cases, no cause can be found.