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Acute pancreatitis is an acute inflammatory process in which there is moderate to severe inflammation of the pancreas but minimal organ dysfunction and intervention for recovery is usually unnecessary. It ranges from mild, in which the patients recover on their own in a few days, to severe in which there may be necrosis, hemorrhage, or multiorgan failure (such as pulmonary insufficiency, renal failure, or shock) and is associated with mortality. For mild cases, there may be a short period of hospitalization during which supportive care may include pain management, restoration of fluid balance, and nutritional management. Severe cases of acute pancreatitis may involve a prolonged hospitalization to manage organ failure or sepsis.

It is estimated that acute pancreatitis affects 80,000 people a year in the U.S. of which approximately 15-20% are severe with multiple complications. Complications include:

• Pseudocyst - collection of pancreatic juice enclosed in a sac of fibrous tissue
• Abscess - intra-abdominal collection of pus
• Pseudoaneurysm formation - malformation of blood vessel walls adjacent to the pancreas due to exposure to pancreatic enzymes often associated with presence of pseudocyst. This is a rare complication.
• Sepsis - presence of toxins in the blood or tissue
• Necrosis - death of pancreatic tissue

In developed countries, the majority of cases of acute pancreatitis are caused by two factors: alcohol abuse, and gallstones (typically small gallstones) which settle in the ducts and prevent the bile from the gallbladder and the enzymes from the pancreas from entering the duodenum. Gallstones and alcohol abuse are thought to be the cause of approximately 80% of acute cases worldwide even though only a small percentage of people who have gallstones and who abuse alcohol develop acute pancreatitis. Some cases of acute pancreatitis are idiopathic, meaning that no cause can be found. Other causes, which are rare, include:

• Hypercalcemia - elevated levels of calcium in the blood
• Hypertriglyceridemia - elevated levels of triglycerides in the blood
• Pancreatic tumor
• Drug reaction
• Hypothermia - low core body temperature
• Trauma
• Pancreas divisum (congenital anomaly in which internal pancreatic ducts fail to fuse)
• Metabolic disorders
• Vascular disorders such as ischemia (restricted blood flow to an area of the body)

Usually the patient with acute pancreatitis experiences upper abdominal pain which may radiate to the back. The pain may be sudden and intense or mild and may be exacerbated by eating. This may be accompanied by fever, nausea, or vomiting and a tender abdomen. Severe cases may cause dehydration, low blood pressure, and other symptoms. Diagnosis is difficult because there are many other conditions that may present with similar symptoms. Final diagnosis is usually based on:

• Elevated pancreatic enzyme levels (typically at least 3 times higher than normal) but serum amylase and lipase are normal or mildly elevated.
• Abdominal CT scan to visualize inflamed tissue or pseudocyst
• Abdominal ultrasound to visualize biliary and pancreatic stones

In most cases, an elevated serum amylase in conjunction with either a positive CT scan or positive ultrasound image provides sufficient diagnostic information to accurately identify acute pancreatitis in approximately 80-95% of patients. If there is obstruction of the biliary tract (ducts coming from the liver) there may be jaundice of elevated bilirubin as well.