A Guide to Pancreatitis

What is the pancreas and what does it do?

The pancreas is a gland that is situated deep in the abdomen, behind the stomach.

The pancreas has two main functions. Firstly, it produces digestive enzymes that allow the food we eat to be broken down and efficiently absorbed by the small intestines.

Secondly, the pancreas is responsible for producing hormones such as insulin and glucagon, which regulate blood-sugar levels in the body; keeping diabetes at bay. The body produces insulin to lower the body's blood sugar when it gets too high, and glucagon to raise blood sugar when it gets too low.

What is pancreatitis?

Pancreatitis refers to an inflammation of the pancreas. It can be acute or chronic and is commonly caused by a blockage in the bile duct due to gallstones or heavy alcohol consumption.

Acute pancreatitis

Acute pancreatitis occurs when the pancreas becomes inflamed over a short period of time, leading to severe abdominal pain. The severity of acute pancreatitis can vary from mild to life threatening.

Chronic pancreatitis

Chronic pancreatitis occurs when the pancreas is repeatedly inflamed over an extended period of time, usually several years. In severe cases, it can result in problems with the normal functioning of the pancreas, leading to issues with digestion, as well as diabetes.

What causes pancreatitis?

Besides blockage in the bile duct due to gallstones and heavy alcohol consumption, pancreatitis can be caused by these other factors:

• Side effects of medications
• Viral infections
• Cystic fibrosis
• Hypercalcemia (high levels of calcium in blood)
• High triglyceride levels (high levels of a type of fat found in the blood)
• Trauma
• Cancer of the pancreas
• Rarely after surgery or endoscopy of the bile duct or pancreatic duct

What are the symptoms of pancreatitis?

The symptoms of pancreatitis may vary depending on whether the individual is facing acute or chronic pancreatitis.

The symptoms associated with acute pancreatitis include:

• Severe pain in your upper abdomen, often spreading to the back
• Pain in the abdomen after eating
• Nausea and vomiting
• High fever (if an infected collection or bile duct stone develops)
• High pulse rate

Patients with chronic pancreatitis may experience:

• Unintended weight loss
• Fatty stools (floating and foul-smelling)
• Jaundice (yellowish discolouration of the eyes)

How is pancreatitis diagnosed?

Your specialist may order the following tests to accurately diagnose pancreatitis.

Blood tests

Acute pancreatitis can be detected by looking for elevated levels of amylase (one of the pancreatic enzymes) that have seeped into the bloodstream due to the inflammation in the pancreas.

Stool tests

Stool test results that reveal a high percentage of fat could mean that the digestive system is not absorbing nutrients adequately – a sign of chronic pancreatitis.

Imaging scans

Imaging scans may also be ordered to look for inflammation of the pancreas and the cause of pancreatitis. These include:

Computerised tomography (CT) scan

CT scans will be able to show the degree of inflammation in your pancreas and also exclude other causes of severe abdominal pain.

Magnetic resonance imaging (MRI)

An MRI scan looks out for abnormalities in the pancreas, pancreatic duct, bile duct as well as gall bladder.

Abdominal ultrasound

This is useful for gallstone detection, which is one of the most common causes of pancreatitis.

Advanced endoscopic ultrasound

This endoscopic procedure makes use of high-frequency sound waves to create images of the digestive tract and nearby organs and tissues. It is an advanced endoscopic procedure that can help detect structural abnormalities in the pancreas or bile duct which may indicate the presence of pancreatitis.

During an endoscopic ultrasound, the surgeon will use a thin, flexible tube with an ultrasound device at the tip, and insert it through the patient’s mouth or anus to create images of the desired organ.

How is pancreatitis treated?

Many of the treatments for acute pancreatitis are supportive, allowing time for the pancreas to heal on its own. However, pancreatitis caused by bile duct stones may require additional special endoscopic procedures to treat them. These are some of the common treatment options:

Pain management

Patients will be given pain medication to manage the severe pain that may be experienced due to inflammation from pancreatitis.

For patients with chronic pancreatitis, an endoscopic ultrasound or radiological procedure may also be used to stop the nerves from sending pain signals.

Intravenous (IV) Drip

As pancreatitis patients may find eating induces vomiting and pain, they may be hospitalised and put on an intravenous (IV) drip to ensure that the body has enough hydration.

Endoscopic procedures

Endoscopic Retrograde Cholangiopancreatography (ERCP)

If a patient's pancreatitis is caused by stones in the bile or pancreatic ducts, or a narrowing of the pancreatic duct, the attending surgeon will conduct a procedure known as endoscopic retrograde cholangiopancreatography (ERCP).

This procedure involves passing a long, flexible tube that has a light and camera attached at the end to examine the inside of the patient's bile duct and/or pancreatic duct. Then, depending on what is causing the patient’s pancreatitis, the stones are removed or bile/pancreatic duct is widened. As no incisions need to be made in the skin, this is the preferred method of treatment of bile duct stones.

Endoscopic ultrasound-guided drainage of pancreatic collections

Rarely, a large collection of damaged pancreatic tissue and liquid develop behind the stomach around the area of the pancreas. In some cases such as persistent high fevers, obstruction of the stomach or bile duct, the surgeon will need to do an endoscopic ultrasound guided drainage of the collection directly into the stomach. This will allow all the infection to clear and eventually heal.

Radiological procedures

Sometimes in cases of severe pancreatitis, tubes may have to inserted through the skin under X-Ray guidance to drain fluid or pus that has accumulated around the pancreas.

Surgery

Surgery is often not required in the initial management of acute pancreatitis. However, in cases of severe pancreatitis, where tubes placed radiologically are unable to drain fluid or pus sufficiently, surgery may be recommended.

If gallstones are the cause of the patient’s acute pancreatitis, the surgeon may also recommend the removal of his or her gall bladder to prevent recurrent episodes of acute pancreatitis.

For patients with chronic pancreatitis, endoscopy or surgery may be required to manage chronic pain if other methods have failed, either by removing stones in the pancreatic duct or by removing part of the pancreas.

Additional treatments

As chronic pancreatitis disrupts the production of digestive enzymes, pancreatic enzyme supplements may be prescribed so that a patient can continue to digest food normally. These enzymes are advised to be taken with every meal.

Can pancreatitis be avoided?

With adjustments to one's lifestyle, pancreatitis can potentially be avoided.

Abstain from alcohol

Research has shown that "chronic alcohol consumption causes 17% – 25% of acute pancreatitis cases worldwide". It was also shown that people who consume 4 – 5 drinks daily for 5 years or more are at increased risk of the disease. As such, by abstaining from alcohol, individuals can reduce their risk of developing pancreatitis.

Quit smoking

Research has also shown a link between cigarette smoking and the development of acute and chronic pancreatitis. Quitting the habit can reduce your risk of developing pancreatitis and pancreatic cancer.

Maintain a healthy weight

Obesity increases the likelihood of developing gallstones, and consequently, pancreatitis. Regular exercise and a healthy diet can help ensure you maintain a healthy weight.

When should you see a doctor?

Think you or a loved one might be having symptoms of pancreatitis? If you’re facing persistent pain in your stomach, don’t put off speaking to a gastroenterologist.

However, should the pain be so severe that you are unable to sit still or rest comfortably, seek immediate medical attention at your nearest urgent care centre.