Pancreatitis

An inflammation of the pancreas is called pancreatitis. Pancreatitis can either be acute (a sudden)  or chronic (recurring).When pancreas is inflamed, digestive enzymes become activated while still inside the pancreas, which can cause the pancreas to begin “digesting” its own tissues ( auto digestion).

Acute Pancreatitis.
This is sudden inflammation of the pancreas. In over half the cases it is caused by a gallstone passing from the gallbladder, through the bile duct and temporarily blocking the exit from the bile duct and pancreatic duct. This causes obstruction of the pancreas, and may allow bile to reflux into the pancreatic duct
When the pancreas is inflamed, digestive enzymes become activated while still inside the pancreas, which can cause the pancreas to begin “digesting” its own tissues ( auto digestion).

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About a quarter of cases of acute pancreatitis are caused by drinking too much alcohol and there is a long list of other rare causes including a wide variety of prescription medications, virus infections including mumps, hypothermia and (in the tropics) scorpion stings. Most attacks of pancreatitis (about 80%) are relatively mild and settle spontaneously over a period of 4 or 5 days. The usual symptoms of pancreatitis are severe pain in the upper part of the abdomen, often going into the back, and occasional vomiting.

If the pancreatitis is caused by gallstones it is essential to ensure that appropriate treatment to prevent a further attack is completed before the patient leaves hospital. This will usually be either by a laparoscopic Cholecystectomy (removal of the gallbladder) or an endoscopic procedure (ERCP and sphincterotomy) which opens the lower end of the bile duct and allows any stones in the duct to pass easily without causing obstruction .Anyone who has alcohol-associated pancreatitis is at risk of further attacks should abstain from alcohol indefinitely

About 1 in 5 people develop serious complications, either in or around the pancreas, or involving other systems in the body especially the lungs and the kidneys. These systemic complications are due to an excessive inflammatory reaction to the damage in the pancreas. At the moment treatment for this phase of the illness is supportive, and may require transfer to the intensive care unit if the condition is serious. 

Chronic pancreatitis.

This is the recurring inflammation and progressive damage in the pancreas. Symptoms usually include abdominal pain particularly in the upper abdomen, and often going into the back. Other symptoms may be jaundice, weight loss, changes in the bowel motions including frequency, and loose pale stools
Finally, it must be recognized that chronic pancreatitis is an ongoing disease that does not have a simple treatment or cure, and frequently represents a process of remissions and relapses requiring interventions and problem solving.

The commonest cause of chronic pancreatitis is long term alcohol consumption. However there are many other causes, and in at least a quarter of patients no known cause is found. The rare causes include exposure to industrial toxins. Congenital variations and stricture (s) in the pancreatic duct system are the main cause. It might also associated with stone (s) in the pancreatic duct system and pancreatic parenchyma( pancreatolithiasis)

Most patients with chronic pancreatitis require multidisciplinary management . This includes replacement of pancreatic enzymes (enzyme supplements) attention to nutrition with a proper balanced diet. The most important aspect of treatment for many patients is pain control.

Medical management is avoidance of any precipitating factors. For this reason any patient with chronic pancreatitis is advised strongly to avoid alcohol completely..
Surgical treatment: There are many reasons for surgical treatments in chronic pancreatitis. Surgery may be required to deal with stricture of pancreatic duct, removal of stone (s), relieve of pain from the pancreas, or to treat complications such as jaundice or pseudocysts.

 

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