Pancreatitis

What is Pancreatitis?

08/07/2022

Pancreatitis is a disorder where there is inflammation of the pancreas causing release of its enzymes leading to auto digestion of the organ and surrounding tissues.

The pancreas is a gland deep in the abdomen, behind your stomach & in front of your spine.

  • It produces enzymes that help break down food and allows for easy digestion
  • It releases insulin, glucagon and other hormones into your bloodstream. These hormones help your body control how it uses food for energy.

Causes of Pancreatitis

Gallbladder disease and excess alcohol consumption account for most cases

Gallstones cause acute pancreatitis by blocking the bile duct, causing back-pressure in the main pancreatic duct.

Less common causes of acute pancreatitis include:

  • Injury - post-endoscopic retrograde cholangiopancreatography (ERCP), blunt trauma.
  • Viral - Coxsackie B, hepatitis and mumps (prodromal diarrhoea is indicative).
  • Metabolic - Hyperlipoproteinaemia, Hyperparathyroidism, Hypothermia, Uraemia, Anorexia.
  • Drugs - Thiazides, Valproate, Azathioprine, L-asparaginase, Corticosteroids (all rare).
  • Malignancy - Peri-ampullary tumour, pancreatic carcinoma, metastases to the pancreas.
  • Ischaemia - Visceral Thromboembolism, Abdominal Vascular Surgery, Cardiopulmonary bypass.
  • Inflammatory bowel disease
  • Other rare causes - Alpha-1-antitrypsin deficiency, Sclerosing Cholangitis, Duodenal Re-duplication, Annular pancreas, Vasculitis

Types of Pancreatitis

There are 2 types of Pancreatitis

  • Acute Pancreatitis - Acute pancreatitis comes on suddenly & may only last for a short time. It can range from mild discomfort to severe life-threatening illness & can cause bleeding, serious tissue damage, infections, organ failure etc.
  • Chronic Pancreatitis - Chronic pancreatitis occurs when the pancreas is repeatedly inflamed over months or years. This can eventually lead to irreversible damage to your pancreas & if left untreated, pancreatitis can lead to chronic pain, Endocrinopathies and may be associated with a higher incidence of cancer.

Symptoms of Pancreatitis

Acute Pancreatitis

  • Starts as severe upper abdominal pain of sudden onset with vomiting.
  • Pain is focused in the left upper quadrant of the abdomen and penetrates to the back. Occasionally, it encircles the abdomen.
  • Pain tends to decrease steadily over 72 hours.
  • Nausea/ Vomiting
  • High Fever
  • Distended abdomen
  • Higher Heart Rate
  • Reduced urine output, increased respiratory rate

Chronic Pancreatitis

Chronic pancreatitis often leads to the same symptoms as acute pancreatitis, but you may also have

  • Diarrhoea / Weight loss
  • Diabetes / Hypoglycemia
  • Fat soluble vitamin deficiencies

Diagnosis of Pancreatitis

  • Based on a good clinical history and examination.
  • Serum amylase and serum lipase being three or more times normal is the traditional way of diagnosing acute pancreatitis.
  • FBC, U&E, glucose and C-reactive protein (CRP) indicate prognosis
    • Raised bilirubin and/or serum aminotransferase suggest gallstones.
    • Hypocalcaemia is relatively common.
  • Plain erect (if possible) abdominal X-ray:
    • This excludes some other causes (eg, intestinal obstruction and perforation) and may show calcification.
    • CXR may show elevation of one hemidiaphragm, infiltrates ± acute respiratory distress syndrome (ARDS) or pleural effusions in severe cases.
  • CT scan with contrast enhancement may be diagnostic where clinical and biochemical results are equivocal on admission.
  • Contrast-enhanced CT scanning can identify pancreatic swelling, fluid collection and change in density of gland. Such criteria can have prognostic value and predict the need for surgery.
  • Ultrasound:
    • Ultrasound can show a swollen pancreas, dilated common bile duct and free peritoneal fluid.
    • It is useful to detect the presence of gallstones.
    • Endoscopic ultrasound is a safe minimally invasive technique which is more accurate than transabdominal ultrasound and can accurately detect bile duct stones and other causes of recurrent acute pancreatitis.
  • MRI may reveal fluid collections , inflammation of the pancreas, CBD stones etc

Treatment for Pancreatitis

Acute Pancreatitis

  • Pain should be controlled with intravenous analgesia.
  • IV fluids with nil by mouth.
  • Nasogastric tube only for severe vomiting.
  • Antibiotics should not be given prophylactically but only for specific infections.
  • In mild cases, when pain and other symptoms have resolved and blood tests are normal, oral fluids and then solids, can be resumed. If gallstones are the cause then consider common bile duct clearance and cholecystectomy after recovery, preferably during original admission.
  • Treat severe cases in ICU or a high dependency unit.
  • Offer people with acute pancreatitis an endoscopic approach for managing infected or suspected infected pancreatic necrosis when anatomically possible.
  • Offer a percutaneous approach when an endoscopic approach is not anatomically possible.
  • When deciding on how to manage infected pancreatic necrosis, balance the need to debride promptly against the advantages of delaying intervention.
  • Surgery is only required where there is infection and necrosis. Open surgical debridement is being largely replaced by newer minimally invasive techniques such as transgastric endoscopy and video-assisted translumbar retroperitoneal necrosectomy followed by closed lavage of infected pancreatic necrosis.

Chronic Pancreatitis

  • Pain management
  • ERCP and Pancreatic stunting in select cases
  • Surgery - Frey’s Procedure , Whipples procedure in select patients
  • EUS guided coeliac plexus blocade

Why Gleneagles Global Hospital, Lakdikapul?

At Gleneagles Global Hospital, Lakdi-ka-Pul we have a dedicated multidiciplinary team of experts who leads the hospital’s flagship programme Centre of Excellence for Pancreatic Disorders.

We ensure Accurate diagnosis, immediate support to prevent the disease from getting worse, early identification and prevention of complications, management of complications etc in a early comprehensive manner for the best results.

We are here to help you through every step of your treatment. We offer a range of treatments and services to meet your needs, and we're driven to provide you with the highest level of care possible. Enquire Now at Gleneagles Global, Lakdikapul, Department of Gastroenterology, to know more.

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