What is the pancreas?
- The pancreas lies behind the stomach and guts (intestines). It produces enz yme s that he lp in digestion of food.
- Pancreas also releases the hormones- insulin and glucagon which control the blood sugar level.
- The bile duct which carries bile from the liver joins the pancreatic duct just before it opens into the duodenum.
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 - A gallstone can pass through and get stuck at the lower end of the bile duct , thus irritating the pancreas and causing an acute attack of pancreatitis.
- Alcohol – Heavy intake over a longer duration or binge drinking can cause a severe attack.
- Uncommon Causes –
- Viral infections like mumps
- High Triglyceride levels
- High calcium levels
- Autoimmune - this is where your own immune system attacks the pancreas
- 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?
- In the majority of the cases, the inflammation is mild and settles within a week.
- Around 20% the attack is severe and causes damage to other organs. This can lead to shock, respiratory failure, kidney failure and other complications.
- Acute pancreatitis can be life-threatening
What are the symptoms of acute pancreatitis?
- Abdominal pain
- Feeling unwell
How is acute pancreatitis investigated?
A combination of tests will help to detect the cause and assess the severity of the attack.
- Blood tests ( including amylase and lipase levels)
- USG of the abdomen
- CT scan of the abdomen
- Depending on the reports- a score can be calculated
What is the treatment for acute pancreatitis?
- Patient will need hospitalization to the hospital. Sometimes the patient will need ICU stay.
- Mainline of treatment includes painkillers, antibiotics and intravenous fluids
- Surgery is sometimes needed to remove infected or damaged tissue.
- Removal of the gall bladder is advised if a gallstone was the cause.
- If it is secondary to alcohol, the patient will need to completely abstain from alcohol
- High triglyceride levels may need medications
- Rarely, an attack of acute pancreatitis may be a oneoff event.
What are the causes of chronic pancreatitis?
- Alcohol - is the commonest cause (about 7 in 10 cases). In most cases the person has been drinking heavily for 10 years.
- Autoimmune - this is where your own immune system attacks the pancreas.
- Genetic - there are some rare genetic conditions like cystic fibrosis which can lead to chronic pancreatitis.
What are the symptoms of chronic pancreatitis?
- 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
- Weight loss- fear of eating leads to weight loss.
- 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).
- Diabetes - occurs in about 1 in 3 cases. This occurs when the pancreas cannot make sufficient insulin.
What happens in chronic pancreatitis?
- A persistent inflammation develops in the pancreas.
- Inflammation causes damage to parts of the pancreas.
- Leads to inadequate production of digestive enzymes and insulin causing malabsorption of food and diabetes.
- Stone formation within the pancreatic duct.
How is chronic pancreatitis diagnosed?
- There is no single test to detect chronic pancreatitis.
- Simple blood tests like blood count, Liver and Kidney profile, Blood sugar testing
- Stool test for fat content
- CT scan and/or MRIof the abdomen
What are the complications that can develop?
- Pseudo-cyst - This is when pancreatic fluid collects into a cyst due to a blocked tube.
- Pancreatic duct stones- Due to excessive calcium deposition.
- Blockage of the bile duct -this can cause jaundice.
- Cancer of the pancreas - The risk increases in smokers and with increasing age.
What is the treatment for chronic pancreatitis?
- Stop alcohol and smoking
- 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)
- Enzyme replacement medication.
- Dietary restrictions
- Diabetes treatment- may need insulin injections.
- Surgery- Especially if there are pancreatic duct stones, pseudocyst or suspicion of cancer.