Quick answer

What is acute pancreatitis?

Acute pancreatitis is sudden inflammation of the pancreas — usually causing severe constant upper abdominal pain radiating to the back, vomiting, and feeling very unwell. Common causes are gallstones and heavy alcohol use. It is a medical emergency needing hospital admission — IV fluids, pain relief, and treating the cause. Severe cases can affect other organs — ICU care. Phone 999 or go to A&E for sudden severe tummy pain with vomiting — do not wait for GP appointment.

Acute pancreatitis — pancreatic emergency

Acute pancreatitis — sudden inflammation of pancreas — autodigestion by prematurely activated enzymes.

~50 per 100,000 UK admissions yearly — potentially life-threatening — hospital mandatory.

Presentation

Hallmark pain:

  • sudden onset epigastric
  • severe, constant
  • radiates to back
  • relieved sitting forward, worse supine

Associated:

  • persistent vomiting
  • fever, tachycardia
  • ** abdominal guarding**

Severe:

  • jaundice — gallstone in bile duct
  • Grey-Turner/Cullen sign — flank/periumbilical bruising — haemorrhagic pancreatitis — rare

Causes — GET SMASHED mnemonic (partial)

  • Gallstones — #1 UK
  • Ethanol (alcohol)
  • Triglycerides >10 mmol/L
  • ERCP complication
  • Meds, Mumps (viral)
  • Autoimmune, Scorpion (travel)
  • Hypercalcaemia, Hypothermia
  • Endoscopic trauma
  • Drugs — azathioprine, valproate, GLP-1 rare

Diagnosis

Requires 2 of 3:

  1. Compatible pain
  2. lipase/amylase ≥3× ULN
  3. Imaging consistent — CT if uncertain

CT with contrast — severity staging — not day 1 unless doubt

Ranson/Glasgow/Apache — prognostic scores

Severity

Mild (80%):

  • no organ failure
  • recover days to week

Severe:

  • persistent organ failure — lung, kidney, cardiovascular
  • pancreatic necrosis — infected necrosis — worst prognosis

Treatment

Supportive backbone:

  • aggressive IV crystalloid — Ringer’s lactate — reduce necrosis
  • analgesia — IV opioids — adequate pain control
  • early enteral nutrition when tolerating — NG tube if needed — better than prolonged NPO
  • monitor urine output, oxygen saturation

Gallstone pancreatitis:

  • MRCP/ USS — CBD stone
  • ERCP sphincterotomy if cholangitis/obstruction
  • cholecystectomy same admission once mild-moderate episode settling — NICE

Alcohol:

  • absolute abstinence — dependency support

Severe ICU:

  • ventilation, RRT, nutrition
  • step-up necrosis management — endoscopic/necrosectomy

After recovery

Exocrine insufficiency — steatorrhoea — Pancreatin enzymes

Diabetes — beta cell loss

Recurrent attacks — investigate — genetics, sphincter of Oddi, continued alcohol/gallstones

Epigastric pain to the back + vomit — 999 not antacids — lipase in A&E confirms.

Common questions

What are the symptoms of pancreatitis?
Sudden severe upper abdominal pain — constant, boring, radiating to back, worse when lying down, eased sitting forward. Vomiting, fever, rapid heart rate, swollen tender abdomen. Severe cases — jaundice if bile duct blocked, confusion, breathlessness (ARDS), low blood pressure.
What causes acute pancreatitis?
Gallstones passing through ampulla (most common UK), alcohol (second), hypertriglyceridaemia, ERCP procedure, medicines (azathioprine, sodium valproate), viral infections, trauma, genetics (PRSS1 etc.). Idiopathic after investigation in some.
How is pancreatitis treated?
Hospital admission — nil by mouth initially, IV fluids (aggressive hydration improves outcomes), IV pain relief (often opiates), oxygen if needed. Treat cause — urgent cholecystectomy for gallstone pancreatitis when settled; stop alcohol. Severe — ICU, nutrition via tube, treat organ failure. Antibiotics not routine unless infected necrosis.
Can you die from pancreatitis?
Yes — overall mortality roughly 5 to 10% — higher in severe necrotising pancreatitis with organ failure. Early supportive care in hospital reduces risk. First episode from gallstones usually milder than alcohol-related recurrent disease.
What should I eat after pancreatitis?
Restart oral food when pain and nausea settle — usually low-fat initially. After gallstone pancreatitis — cholecystectomy before discharge prevents recurrence. Long-term — avoid alcohol completely if alcohol-induced; low-fat diet if chronic pancreatic insufficiency develops.

Sources