Dr Arthur Richardson - Hepato-Biliary, Upper Gastro-Intestinal and General Surgeon Associate Professor,University of Sydney
 
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Pancreatitis

Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it takes from food for energy.

Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start ‘digesting’ the pancreas itself. This process is called autodigestion and causes swelling, haemorrhage, and damage to the blood vessels. An attack of pancreatitis may last from a few hours to a few days.

Types

  • Acute pancreatitis occurs suddenly and lasts for a short period of time and usually resolves. Acute pancreatitis is usually caused by drinking too much alcohol or by gallstones. A gallstone can block the pancreatic duct, trapping digestive enzymes in the pancreas and causing pancreatitis.
  • Chronic pancreatitis does not resolve and results in a slow destruction of the pancreas. Chronic pancreatitis occurs when digestive enzymes attack and destroy the pancreas and nearby tissues. Chronic pancreatitis is usually caused by many years of alcohol abuse, excess iron in the blood, and other factors. However, it may also be triggered by only one acute attack, especially if the pancreatic ducts are damaged.

Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Pseudocysts, accumulations of fluid and tissue debris, may also develop. Enzymes and toxins may enter the bloodstream, injuring the heart, lungs, and kidneys, or other organs.

Acute pancreatitis generally causes severe pain and the sufferer will need emergency treatment in a hospital. Pancreatitis is generally diagnosed quickly, by examination of the abdomen, and confirmed using a series of medical tests, including:

  • General tests – including blood tests, physical examination and x-rays.
  • Ultrasound - sound waves form a picture that detects the presence of gallstones.
  • CT scan - a specialised x-ray taking three-dimensional pictures of the pancreas.

Complications

Some of the complications from pancreatitis may include: low blood pressure, heart failure, kidney failure, ARDS (adult respiratory distress syndrome), diabetes, ascites (accumulation of fluid in the abdomen) and cysts or abscesses in the pancreas.

Treatment options

Treatment depends on the causes and severity of the condition and may include the following:

Acute pancreatitis

  • Hospital care – in all cases of acute pancreatitis.
  • Intensive care in hospital – in cases of severe acute pancreatitis
  • Fasting and intravenous fluids – until the inflammation settles down
  • Endoscopy – a thin tube is inserted through your oesophagus to allow the doctor to examine your pancreas.
  • Surgery – if gallstones are present, removing the gallbladder will help prevent further attacks. In rare cases, surgery is needed to remove damaged or dead areas of the pancreas.
  • Lifestyle change - eliminating alcohol

Chronic pancreatitis

  • Lowering fat intake
  • Supplementing digestion by taking pancreatic enzyme tablets with food
  • Eliminating alcohol
  • Insulin injections, if the endocrine function of the pancreas is compromised
  • Analgesics for pain

In uncomplicated cases, a 2-3 day hospital stay is typical. The patient can go home when their temperature is normal and their bowel starts to function again.

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