Pancreatitis

Pancreatic Conditions
Home » Conditions » Pancreas » Pancreatitis

What is pancreatitis?

Pancreatitis is a condition involving the inflammation of the pancreas. The pancreas is an important organ located at the top of the abdomen that spans to either end. It releases enzymes used in digestion as well as hormones including insulin which control blood sugar levels.

Obstruction of the pancreatic duct by a gallstone resulting in pancreatitis
The consequences of gallstones include obstruction along the biliary tree that can result in pancreatitis

Firstly conservative management is carried out, this includes hospital admission and being kept nil by mouth, having intravenous fluids and under close observation to assess for deterioration or evidence of complications.

Secondly an ERCP can be done if the underlying cause is a stone blocking the pancreatic ducts, this is a radiological procedure and the stone can be removed, however it is associated with a risk of pancreatitis and infection as such is used in the acute setting if the patient’s condition warrants treatment that outweighs the risk.

The basic physiology explaining pancreatitis and the common symptoms patients may experience
Symptoms of pancreatitis include fever, rapid pulse, upper abdominal pain and tenderness, nausea and vomiting

If a patient has pancreatitis multiple times it then becomes chronic pancreatitis, and results in pale stool, dark urine and signs of malnutrition as the pancreas is unable to produce the enzymes needed in digesting important vitamins.

How is pancreatitis diagnosed?

As one of the most common causes of pancreatitis is gallstones, patients may have an abdominal ultrasound to assess for evidence of gallstones. In an acute setting, in the emergency department or during admission depending on the severity of the conditions, patients may undergo a CT scan which will be able to assess the pancreas but also to look for evidence of complications associated with acute pancreatitis that may alter management.  If the cause of the acute presentation is found to be a stone blocking the ducts of the pancreas then an ERCP (Endoscopic Retrograde Cholangiopancreatography) is performed.

What is the treatment for pancreatitis?

Acute pancreatitis can be managed in three ways depending on the severity and clinical condition of the patient.

A gallstone lodged in the pancreatic duct resulting in pancreatitis is one of the common aetiologies
Acute pancreatitis can be managed in three ways: conservative management, ERCP and surgery

Firstly conservative management is carried out, this includes hospital admission and being kept nil by mouth, having intravenous fluids and under close observation to assess for deterioration or evidence of complications.

Secondly an ERCP can be done if the underlying cause is a stone blocking the pancreatic ducts, this is a radiological procedure and the stone can be removed, however it is associated with a risk of pancreatitis and infection as such is used in the acute setting if the patient’s condition warrants treatment that outweighs the risk.

Diagrammatic representation of an ERCP procedure
The ERCP procedure involves a bendable, lighted tube (endoscope) being passed through the mouth and into the stomach and first part of the small intestine (duodenum) to examine the pancreatic and bile ducts

Lastly is surgery, this may involve removal of the gallbladder if the stones are found to be originating from there. Typically the patient will be treated with antibiotics initially and have an urgent planned operation, either open or keyhole (laparoscopic) removal of the gallbladder (cholecystectomy). In some cases the patient’s condition may warrant an emergency open cholecystectomy.

Surgery may also be needed for dealing with any associated complications for example the formation of an abscess that may need drainage or if the pancreas becomes necrotic and results in sepsis. Other complications include bleeding and mutli-organ failure and as such patients may require an admission to intensive care.

Long term management will depend on the underlying causes, but enzyme supplements will be needed, a diet low in fat, and avoidance of alcohol consumption. Patient will also be monitored for developing diabetes which is a complication that may occur down the line is the pancreas if severely affected.