Pancreatitis

Pancreatitis is defined as inflammation of the pancreas, which can be either acute or chronic.

The pancreas is a yellow fleshy organ, which lies behind the stomach and is approximately 12-15cm in length. It does have two major functions:

  1. Endocrine - production of hormones such as insulin and glucagon which control the level of glucose (sugar) in the body.
  2. Exocrine - production of pancreatic juices, which contain special enzymes designed to digest food, such as amylase, trypsin and lipase.

What is Acute Pancreatitis?

Acute pancreatitis is an inflammatory condition of the pancreas, which presents with very severe central abdominal pain. The pain can sometimes be so severe that patients are often very poorly. Acute pancreatitis can also involve other organs such as the lungs and kidneys to varying degrees, which helps define how severe an attack is (mild or severe)

What can cause Acute Pancreatitis?

The main causes of acute pancreatitis include:

1) Gallstones - 60%
2) Excessive alcohol consumption - 20%
3) Unknown/ rare causes - 20%:

a. Medical procedures - ERCP
b. Use of steroids
c. Abdominal trauma
d. Viral illness
e. High blood lipids
f. Cystic fibrosis

How is it Diagnosed?

The main symptom experienced is severe abdominal pain along with nausea and vomiting. Symptoms and signs of severe dehydration are also noted and occasionally in severe attacks the pain can be misdiagnosed as possible 'peritonitis' (perforation). A diagnosis of acute pancreatitis once suspected requires immediate admission to hospital.

How do we manage patients with Acute Pancreatitis?

On admission to hospital patients are managed as a priority as they are in severe pain and dehydrated. Strong pain killers are used (usually morphine) along with rehydration with plenty of fluids. Patients undergo blood tests which will include a serum amylase level, which if very high, is diagnostic of acute pancreatitis.

After the initial pain and other symptoms settle an ultrasound examination of the abdomen is performed as the initial investigation. This is usually followed by a Computer Tomography Scan (CAT) scan. Ultrasound is useful to diagnose gallstones as these are the commonest cause of pancreatitis but as a test is not ideal to visualise the pancreas. A CAT scan is performed to determine if part of the pancreas has undergone 'necrosis' serious damage.

The mainstay care for an attack of acute pancreatitis involves support for the body with adequate fluids, painkillers and antibiotics for any infections that may arise. Patients are continually monitored to ensure that adequate recovery is taking place, along with further specialised tests and investigations performed as required, depending upon the patient's condition.

In mild cases of gallstone pancreatitis, the recommended treatment is to undergo a Laparoscopic Cholecystectomy 'key hole' surgery, to remove the gallbladder on admission or within four weeks following discharge. At the time of surgery a specialised x-ray of the bile ducts is performed (cholangiogram) to ensure that there are no residual stones present. Stones found in the bile duct are removed at the time of surgery if possible (Laparoscopic bile duct exploration), or later via ERCP.

Some patients with a diagnosis of acute pancreatitis may also present with Jaundice (cholangitis). If this occurs, an ERCP is performed prior to any intended surgery.

Alcohol induced severe acute pancreatitis is managed similarly to acite gallstone pancreatitis. Once patients have recovered advice is given on abstinence from alcohol.

Very severe attacks of pancreatitis require in some cases admission to a specialised unit with intensive care treatment and surgery.

What is Chronic pancreatitis?

Chronic Pancreatitis is a condition associated with chronic central abdominal pain, which may radiate into the back. The pain can be quite debilitating and is associated with other symptoms such as poor appetite, weight loss and vomiting.

What are the causes?

The main cause of chronic pancreatitis is consumption, above the recommended amounts, of alcohol over a prolonged period of time. Usually the head of pancreas is involved and can lead to both Jaundice and  superimposed attacks of acute pancreatitis.

How is it best treated?

The treatment of chronic pancreatitis is by firstly obtaining an accurate diagnosis with a careful consultation followed by either a CT (computer tomography) or MR (magnetic resonance) scan. Pain relief is supplied by careful oral analgesia and in some cases, specialised nerve blocks are required which, can involve surgery. Chronic pancreatitis requires specialised care and there is some evidence to suggest that antioxidants may be helpful.