The pancreas is an abdominal organ involved in digestion and insulin production. Pancreatitis is defined as inflammation of the pancreas. The main types of pancreatitis include:
(i) Acute pancreatitis – a discrete episode of pancreatic damage
(ii) Chronic pancreatitis – long term scarring and malfunction
Many people experience a single episode of pancreatitis which can vary in severity but may require hospitalization. Recurrent attacks however can lead to long term scarring and pancreatic insufficiency. This happens when the pancreas is so damaged from chronic inflammation that it no longer produces insulin or the digestive enzymes necessary to digest our food.
Acute pancreatitis has a long list of causes. The 2 most common causes of pancreatitis are:
(i) gallstones pancreatitis: a gallstone from the gallbladder migrates into the common bile duct. If the stone is big enough and settles in the wrong place, it can obstruct the main pancreatic duct. This causes a backup of pancreatic enzymes in the pancreas causing irritation, inflammation and damage to the pancreas.
(ii) alcohol-induced pancreatitis: the toxicity of alcohol damages the cells of the pancreas bringing them on a pathway of inflammation and ‘auto-digestion’. Alcohol can cause both ‘acute’ episodes of pancreatitis, as well as ‘chronic’ pancreatitis. The latter is generally caused by high levels of drinking over a long period of time is characterized by scarring and poor function.
Other causes of pancreatitis are:
-Medications – classically antibiotics, diuretics, and immunosuppressants.
-High triglycerides in the bloodstream
-High Calcium in the bloodstream
-Viruses – e.g. mumps and HIV
-Autoimmune diseases – e.g. lupus, IgG4 related disease
-Genetic diseases – e.g. cystic fibrosis
The most common symptoms of acute pancreatitis include:
(i) Pain – while this can vary in intensity it is often moderate to severe. Classically, the pain will start in the upper-mid abdomen and radiate to the back. Usually, the pain is severe enough to require hospitalization.
(ii) Nausea +/- vomiting
Chronic pancreatitis can follow an episode of acute pancreatitis or it can slowly develop without a severe episode of acute pancreatitis. Chronic pancreatitis will often cause a persistent low grade pain in the upper central part of the abdomen that is worsened by eating. Nausea and bloating after eating are common symptoms.
If the chronic pancreatitis persists long enough, pancreatic insufficiency can occur. In pancreatic insufficiency, the pancreas does not have the ability to produce enough enzymes to adequately digest foods. The result is a chronic feeling of indigestion and bloating, followed by diarrhoea. The most difficult to digest foods are fatty foods. Pancreatic insufficiency will may also result in weight loss, micronutrient deficiencies, and can cause secondary diabetes.
The treatment of acute pancreatitis involves supportive care. This includes pain relief, aggressive fluid resuscitation and carefully managing other organ dysfunction such as kidney failure. Most patients with acute pancreatitis require hospitalization.
The underlying cause of pancreatitis will also be treated:
1.Gallstones: if found to be blocking the pancreas, they may need to be removed at the time of surgical gallbladder removal or using a procedure called an ERCP. Dr Simon Hew at GastroX specializes in these procedures and has completed advanced training overseas in both advanced ultrasound techniques (see section on endoscopic ultrasound) and ERCP.
2.Alcohol: acute withdrawal symptoms are often best managed in hospital with a longer-term alcohol cessation strategy developed collaboratively.
Offending medications will be substituted with safe medications.
3.High triglycerides: will be treated with a combination of dietary modification and lipid lowering medications.
4.Viral infections: will be treated with anti-virals and autoimmune diseases will be treated with appropriate immunosuppressants.
Diligent follow is essential to monitor for complications related to acute pancreatitis.
For chronic pancreatitis there are several key aspects to management:
1.Adequate pain relief
2.Appropriate dietary and nutritional support – with chronic pancreatitis and pancreatic insufficiency 3.A specialized diet that consists of eating easy to digest fats, proteins, and carbohydrates may help alleviate symptoms as well as promote a healthy weight. A discussion with an experienced dietitian is essential in this setting.
4.Pancreatic enzymes can also be used to help the pancreas digest foods. It’s important this is done with your doctor (or specialist) to get advice on the right dose and the right formulation.
6.If you are a smoker, and you have chronic pancreatitis, it is recommended that you stop smoking. There is considerable evidence that smoking prolongs inflammation of the pancreas and is a key factor in development of pancreatic cancer.