Acute pancreatitis

The most common symptoms are suddenly emerging abdominal pain, nausea, and vomiting. The pain is often located in the upper abdominal region, it is constant and piercing and can radiat to the back, chest, and flank.

The pancreas plays a central part in the digestion of food – it produces:

1. Bicarbonate for neutralization of the stomach acid.
2. Enzymes for fission of proteins, sugar and fat.
3. Insulin and glucagon for regulation of the blood sugar.

Normally the enzymes of the pancreas will not be activated before they reach the small intestine. In case of pancreatitis the enzymes are activated inside the pancreas and will start to “attack” it.

The illness can be caused by:

1. Excessive use of alcohol (45%)
2. Gallstones (35%)
3. Some types of medicine
4. Hereditary dispositions
5. An endoscopic retrograde cholangiopancreatography examination (ERCP)
6. Smoking
7. In some cases there is no explanation

You will be asked about your alcoholic tendencies and if you smoke. You will also be asked about your medications and assessed for particular risk factors.

The diagnosis will be made on the basis of:

1. Your symptoms
2. Blood samples (amylase and infection levels)
3. An ultrasound or CT scan of your abdomen

In about 80% of the cases the course of treatment will be unproblematic and the symptoms will decrease during 1-5 days.

In more complicated cases necrosis, cysts, abscesses, reduced function of e.g. the kidneys, heart, or lungs may occur. These are conditions that in the most severe cases (5-10%) may require drainage tubes, surgery, and intensive care in a respirator – and ultimately death (1%).

In case of repeated attacks of acute panreatitis, chronic inflammation may develop which could result in a loss of function of the pancreas. Typically resulting in pain, fatty diarrhea, and diabetes.

Chronic inflammation of the pancreas can for periods of time cause outbreaks of pains, which can cause hospitalisation again.

If your pancreatitis is caused by a high consumption of alcohol, we recommend you to stop drinking alcohol and to seek help. Furthermore, we can help in case of possible withdrawal symptoms.

If your pancreatitis is caused by gallstones, it will in many cases be necessary to perform a scan in order to determine whether there are stones in the deep biliary tract (MRCP). Is this the case, the stones will be removed at an endoscopic retrograde cholangiopancreatography examination (ERCP). Based on this it will be considered whether the gallbladder should be removed by surgery.

We measure how much you drink and pee. Thus, it is important that you are peeing in a urine bottle or a bedpan. The urine production should amount to at least 1500 ml every day. If your ingestion of fluids is insufficient, we will give you fluids through a drip. You will be weighed on a daily basis due to the fact that illness often results in fluid retention of the body.

It is important that you notify us in case of pain and nausea, so we can relieve this in the best possible way – and so you will be able to walk around, eat and drink.

It is important to be getting out of bed and be fully ambulant as much as possible. This will prevent thromboses and pneumonia. If you are used to aids and appliances we will help you find this. Furthermore, you will be seen to by a physical therapist.

You will be handed a PEEP tube in which you will have to blow 10 times during every waking hour. This will prevent pneumonia. It is important that you notify us if any breathing problems occur so that we can give you an oxygen boost treatment.

Your intestinal functions may stall due to affection from the pancreas and side effects of the analgesics. It is important that you notify us in such a case. Constipation can be prevented best by being fully ambulant, eating a high fibre diet and drinking plenty of fluids.

Due to nutrition being an important part of your treatment, we will register how much you eat. It is especially important that you reach a certain amount of proteins. If you are not able to ingest a sufficient diet, we will find different ways – depending on the circumstances – to supplement your diet (protein drink, feeding tube, IV nutrition).

Daily controls include blood pressure, pulse, breath, oxygen saturation, calcium, and blood sugar. The latter is taken with a little sting of a needle in the finger.

If the blood sugar level is too high, you will be treated with insulin. In most of the cases such an insulin treatment will be temporary.

Based on your blood samples and general condition we will determine when you may be discharged from the hospital.

For some patients it may be a brief course of disease, for others it may be a longer course.