Pancreatitis

What is Pancreatitis?

Pancreatitis is actually an inflammation of the pancreas. This inflammation could be an acute one which could eventually disappear in some days. However, if the inflammation is chronic then it can span through years.

Pancreatitis causes attacks of abdominal pain, nausea and vomiting worsened by eating and drinking alcohol. Acute Pancreatitis can be life threatening.

What is Pancreas?

The pancreas is a gland behind the stomach and close to the duodenum. The pancreas secretes digestive juices (enzymes) into the duodenum through a tube called the pancreatic duct. Pancreatic enzymes along with bile helps in digestion of food. The pancreas also releases the hormones insulin and glucagon. These hormones help the body regulate the glucose it takes from food for energy.

Symptoms of Pancreatitis

Here are some of the symptoms that you need to look for:

  • Upper abdominal pain

  • Abdominal pain that radiates to your back

  • Abdominal pain that feels worse after eating

  • Nausea

  • Vomiting

  • Swelling &Tenderness in the abdomen

Chronic pancreatitis signs and symptoms include

  • Indigestion

  • Losing weight without trying

  • Oily, smelly stools (steatorrhea)

Severe Acute Pancreatitis May cause Dehydration and Low blood pressure

Causes of Pancreatitis

Pancreatitis happens when the digestive enzymes produced by our pancreas get activated while being inside the pancreas thereby causing damage to the organ.

Normally, pancreatic digestive enzymes do not become active until they reach the small intestine.

A number of causes have been identified for acute pancreatitis and chronic pancreatitis, including:

  • Alcoholism

  • Gallstones

  • Abdominal surgery

  • Certain medications

  • Cigarette smoking

  • Cystic fibrosis

  • Endoscopic retrograde cholangiopancreatography (ERCP), when used to treat gallstones

  • Family history of pancreatitis

  • High calcium levels in the blood (hypercalcemia)

  • High levels of parathyroid hormone in the blood (hyperparathyroidism)

  • High triglyceride levels in the blood (hypertriglyceridemia)

  • Infection

  • Injury to the abdomen

  • Pancreatic cancer

How is Acute Pancreatitis Diagnosed?

  • Through medical history and physical examination

  • Blood test:

Pancrease enzyme levels During acute pancreatitis amylase and lipase are increased almost 3 times.

Glucose, calcium, magnesium, sodium, potassium and bicarbonate

  • Abdomen Ultra Sonography:

  • CT Scan may show gall stones and extent of damage to pancreas

  • Endoscopic Ultrasound (EUS) to see visual images of the pancreas and bile duct.

  • Magnetic resonance cholangiopancreatography (MRCP).

MRCP uses magnetic imaging tht produces cross section images of parts of the body, help to show pancreas, gall bladder , pancreas and bile ducts.

Pancreatitis in Children?

Chronic pancreatitis in children is rare. More often cause of pancreatitis in children is unknown, often preceded by viral infection such as URI. Trauma to the pancreas and hereditary pancreatitis are two known causes of childhood pancreatitis. Children with cystic fibrosis may be at risk of developing pancreatitis

General Treatment for Pancreatitis

For treating Acute pancreatitis, it is important to bring down the inflammation of the pancreas. This can be done by hospitalization. The initial treatment includes:

  • Fasting: In order to give your pancreas rest and in turn a chance to recover. If vomiting occurs, a tube may be placed through the nose and into the stomach to remove fluid and air. During this time, you may be administered Intravenous fluids (IV) in order to provide the necessary energy to your body.

  • Diet: Once the inflammation in your pancreas is under control, you may be given clear liquids and eventually bland solid food. With time, you can resume your normal diet. However, if your pancreatitis persists and if you still experience pain when eating, your doctor may recommend a feeding tube to help you get nutrition.

  • Medications: Your doctor may prescribe medications to help control the pain, antibiotics.

  • Enzymes to improve digestion may be given.

  • Avoidance of Alcohol and smoking is to be done.

  • The stay in the hospital will depend on your condition and may vary from person to person. In case there are no complications, then your stay at the hospital could be shorter.

Treating Underlying Cause of Pancreatitis

Once your pancreatitis is brought under control, it is important to treat the underlying cause of your pancreatitis. This treatment will depend on the cause of your pancreatitis.

  • Remove bile duct obstructions. Pancreatitis caused by a narrowed or blocked bile duct may require procedures to open or widen the bile duct in order to avoid recurrence of the problem. For this, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) is conducted. In this procedure, a long tube with a camera on the end is used to examine your pancreas and bile ducts. The tube is passed down your throat, and the camera then sends pictures of your digestive system to a monitor. ERCP can help in diagnosing problems that may exist in the bile duct and in rectifying the same.

  • Gallbladder surgery: If the pancreatitis is caused because of gallstones, then your doctor may recommend surgery to remove your gallbladder (cholecystectomy).

  • Pancreas surgery: A surgery for the pancreas may be necessary to drain the fluid from your pancreas or to remove the diseased tissue.

Treating Complication of Pancreatitis:

Abscess & necrotic pancreatic tissue- Exploratory surgery may be necessary to find the source of any bleeding, necrotic pancreatic tissue.

Pseudocysts drainage – Pseudocyst is accumulations of fluid and tissue debris in the pancreas & can be drained using ERCP or EUS. If left untreated, enzymes and toxins can affect the heart, lungs, kidneys, or other organs.

Laparoscopy for Pancreatitis

A Laparoscopic surgery is performed by using just 3 or 4 half-inch or one-inch incisions instead of one large incision. Fine surgical instruments are used to carve out a tumor or to remove an entire section of a gland, after the nearby blood vessels are controlled.

The laparoscopic management of pancreatitis is one of the most challenging especially when we consider of pancreatic resection.

Our pancreas is located deep and in the centre of our abdomen. Also, pancreas is the softest organ in our abdomen and has a “wet sponge” like texture. This makes it a unique organ for the surgeons to conquer. The pancreas lacks a capsule, or a covering, and is thus prone to bleed or leak juices with even a small degree of rough handling.

Hence, it is always better to get this surgery performed by a specialist who is familiar with the standard tissue handling techniques for the pancreas.

Advantages of Laparoscopic Treatment

Here are some of the benefits of opting for a laparoscopic surgery of the pancreatitis:

  • Less pain

  • Shorter hospitalization

  • Lower rates of blood transfusion

  • Quicker return to activity and work

  • Increased likelihood of preserving the spleen

  • Lower rates of wound infections and other complications

  • Lower rates of subsequent hernia development

  • Minimal scaring

Right Candidates for Laparoscopic Treatment

Doctors generally recommend laparoscopic surgery for patients who have tumors at the pancreas tail. The candidacy for this type of treatment is determined by reviewing your CT scan images.

Larger tumors present in any part of the pancreas for which an open operation is required can be started laparoscopically in order to look for cancer spread before making the large incision. This helps you to avoid large incision at a time when comfort is the goal.

When to See a Doctor?

HSeek an appointment with your doctor if you have persistent abdominal pain. You need immediate medical help if your abdominal pain is so severe that you are unable to sit still or find a position that makes you more comfortable


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