Pancreatitis

What is pancreatitis?

Pancreatitis is a gland situated behind the stomach. Pancreas has two main functions, it secretes insulin, which prevents diabetes and it also contributes enzymes (chemicals) that break the food down in gut, so that it can be absorbed.

Inflammation of the pancreas is a very painful condition called pancreatitis. There are two main varieties; acute pancreatitis occurs more abruptly and tends to settle over time, chronic pancreatitis is more indolent and causes symptoms in the long-term.

What are the symptoms?

Acute pancreatitis is a very painful condition, there is moderate to severe pain below breast bone that travels to both sides and frequently there is back pain, mainly upper abdominal but it may spread to the rest of the belly.

Bending or stooping forwards may improve the pain. There is frequently associated vomiting. Pancreatitis may at times be associated with jaundice, if there is any obstruction to bile flow.

How is it diagnosed?

Pancreatitis is diagnosed by a detailed history, examination and blood test (blood levels of Amylase). Ultrasound is performed to assess for gallstones; which is the leading cause of pancreatitis, CT and MRI scans may also help in delineating the cause and severity of the pancreatitis.

What is the treatment?

The treatment of pancreatitis is supportive, meaning, eliminating pain and replacing fluid and salts in blood. At times, antibiotics are given at the discretion of the doctors. The important part of treatment is to search for the cause and treat it.

Commonest cause of pancreatitis include gallstones and alcohol, other less common causes include abnormalities of blood cholesterol, attack of patient’s own blood cells damaging pancreas (auto-immune), high levels of calcium in blood, viral illness, medication, genetic pre-disposition and elevation of certain hormone levels. Pancreatic tumours sometimes present with pancreatitis.

Patients with unclear cause of pancreatitis should be seen by specialists to arrive at a definitive diagnosis.

What about Chronic Pancreatitis?

This is a challenging progressive inflammatory condition of the pancreas characterised by scar tissue formation and pancreatic damage. Overtime this may lead to pancreatic failure causing the patient to be diabetic and deficient in pancreatic enzymes. The lack of enzymes (digestive chemicals produced by pancreas) lead to excessive wind, diarrhoea – which is pale, fat containing, foul and may be difficult to flush. There is associated weight loss.

Pain is a usual feature but chronic pancreatitis may progress with-out pain until complications arise. The commonest cause is alcohol, it shares most of the causes of acute pancreatitis if left untreated – the condition progresses to a chronic phase.

Diagnosis is usually made by way of a CT scan or an MRI scan. Treatment consists of addressing the cause and the complications that have arisen. Patients will require medication to help digest the food, to replicate the function of the pancreas. This is done by taking pancreatic enzyme supplements at meal or snack times. It is important to control pain and diabetes.

Treatment by a specialist is recommended.

Gall Stone Pancreatitis

Gall Stone Pancreatitis

Royal College of Surgeons American College of Surgeons University of Liverpool Mayo Clinic