PANCREATITIS (ACUTE & CHRONIC)

What is the pancreas?

The pancreas is in the upper abdomen and lies behind the stomach and guts (intestines). It makes a fluid that contains chemicals (enzymes) that are needed to digest food.

Groups of special cells called 'Islets of Langerhans' are scattered throughout the pancreas. These cells make the hormones insulin and glucagon.

The bile duct carries bile from the liver and gallbladder. This joins the pancreatic duct just before it opens into the duodenum. Bile also passes into the duodenum and helps to digest food.

What is pancreatitis?

Pancreatitis means inflammation of the pancreas. There are two types:

Acute pancreatitis - when the inflammation develops quickly, over a few days or so. It often goes away completely and leaves no permanent damage. Sometimes it is serious.

Chronic pancreatitis - when the inflammation is persistent. The inflammation tends to be less intense than acute pancreatitis but as it is ongoing it can cause scarring and damage

What are the causes of acute pancreatitis?

Gallstones or alcohol cause more than 8 in 10 cases.

Uncommon Causes

  1. Viral infections like mumps
  2. High Triglyceride levels
  3. High calcium levels
  4. Autoimmune - this is where your own immune system attacks the pancreas
  5. Unknown - no cause is found in about 2-5 % of cases. However, a number of these cases are probably due to tiny gallstones or 'gallstone sludge' that passes through the bile duct.

What happens in acute pancreatitis?

  1. In the majority of the cases, the inflammation is mild and settles within a week.
  2. Around 20% the attack is severe and causes damage to other organs. This can lead to shock, respiratory failure, kidney failure and other complications.

What are the symptoms of acute pancreatitis?

  1. Abdominal pain
  2. Vomiting
  3. Backache
  4. Fever
  5. Feeling unwell

How is acute pancreatitis investigated?

A combination of tests will help to detect the cause and assess the severity of the attack.

  1. Blood tests ( including amylase and lipase levels)
  2. CT scan of the abdomen or MRI (MRCP)
  3. Depending on the reports- a score can be calculated to quantify the severity of pancreatitis

What is the treatment for acute pancreatitis?

  1. Patient will need hospitalization to the hospital. Sometimes the patient will need ICU stay.
  2. Mainline of treatment includes painkillers, antibiotics and intravenous fluids
  3. Surgery is sometimes needed to remove infected or damaged tissue.
  4. Removal of the gallbladder is advised if a gallstone was the cause.
  5. If it is secondary to alcohol, the patient will need to completely abstain from alcohol
  6. High triglyceride levels may need medications

What is the outlook (prognosis) for acute pancreatitis?

As mentioned, acute pancreatitis is classified as mild if no complications develop (about 4 in 5 cases). In this case the outlook is very good and full recovery is usual.

Severe acute pancreatitis (about 1 in 5 cases) means that one or more complications develop. Despite intensive care treatment, up to a quarter of people with severe acute pancreatitis die.

Will it happen again?

An attack of acute pancreatitis may be a one-off event. However, if there is an underlying cause, then it may recur unless the cause is corrected. One of the following may be relevant to prevent a recurrence, depending on the cause:

  1. An operation to remove your gallbladder is usually advised if a gallstone was the cause.
  2. Alcohol-related concerns: You should not drink alcohol for at least several months after a bout of acute pancreatitis, even if alcohol was not the cause of your pancreatitis. If alcohol is the cause of pancreatitis, you should stop drinking alcohol altogether.
  3. A high blood fat level (hyperlipidaemia) is sometimes the cause. This may need treating with medication.

CHRONIC PANCREATITIS

What are the causes of chronic pancreatitis?

  1. Alcohol - is the commonest cause (about 7 in 10 cases). In most cases the person has been drinking heavily for 10 years.
  2. Autoimmune - this is where your own immune system attacks the pancreas.
  3. Genetic - there are some rare genetic conditions like cystic fibrosis which can lead to chronic pancreatitis.

What are the symptoms of chronic pancreatitis?

  1. Abdominal pain - spreading through to the back. Eating often makes the pain worse. Patient gets several recurrent episodes of pain and may need repeated admissions
  2. Weight loss- fear of eating leads to weight loss.
  3. Poor digestion (malabsorption) - Undigested fat from the diet is passed with stools. This causes pale, smelly, loose stools that are difficult to flush away (steatorrhoea).
  4. Diabetes - occurs in about 1 in 3 cases. This occurs when the pancreas cannot make sufficient insulin.

What happens in chronic pancreatitis?

  1. A persistent inflammation develops in the pancreas.
  2. Inflammation causes damage to parts of the pancreas.
  3. Leads to inadequate production of digestive enzymes and insulin causing malabsorption of food and diabetes.
  4. Stone formation within the pancreatic duct.

How is chronic pancreatitis diagnosed?

  1. There is no single test to detect chronic pancreatitis.
  2. Simple blood tests like blood count, Liver and Kidney profile, Blood sugar testing
  3. Stool test for fat content
  4. CT scan and/or MRI of the abdomen

What are the complications that can develop?

  1. Pseudo-cyst - This is when pancreatic fluid collects into a cyst due to a blocked tube.
  2. Pancreatic duct stones- Due to excessive calcium deposition.
  3. Blockage of the bile duct -this can cause jaundice.
  4. Cancer of the pancreas - The risk increases in smokers and with increasing age.

What is the treatment for chronic pancreatitis?

  1. Stop alcohol and smoking
  2. Painkillers - Apart from painkillers, other techniques to block the pain may be considered, such as celiac axis nerve blocks to the pancreas. (can be done through transcutaneous or with endoscopic sonography)
  3. Enzyme replacement medication.
  4. Dietary restrictions.
  5. Diabetes treatment- may need insulin injections.
  6. Surgery- Especially if there are pancreatic duct stones, pseudocyst or suspicion of cancer.