Consultant Surgical Gastroenterologist-Minimal Access Surgery, Bariatric, Metabolic & Robotic Surgery, Yashoda Hsopitals Hyderabad
Pancreatitis is inflammation of pancreas where in the pancreatic enzymes ( digestive juices) leak out into retroperitoneal spaces causing auto digestion of surrounding abdominal organs and when these enzymes enter the blood stream they cause systemic inflammatory reaction syndrome(SIRS) leading to capillary leak with extravastion of intra vascular fluid into extra vascular compartment affecting all organs of the body mainly the lungs( ARDS) And kidneys (AKI) but mind you it doesn’t spare any organ in the body. It is classified broadly into two types Acute Pancreatitis when the symptoms and signs are severe and Chronic Pancreatitis which occurs due to repeated insults leading to digestive abnormalities in fat absorption causing Steatorrhoea and abnormalities in glucose metabolism leading to Insulin dependent Diabetes mellites.
Causes of pancreatitis
The two most common preventable causes of pancreatitis are Alcohol consumption and gall stones slipping into BILEDUCT and obstructing the pancreatic duct in the common channel before it enters into the 2 nd part of Duodenum,Other causes which constitute around 20 % are abdominal trauma,high triglycerides,hypercalcemia,viral infections,autoimmune,hereditary gene mutations,cystic fibrosis,reduced blood supply leading to pancreatic ischemia, Drug’s induced pancreatitis, pancreatic cancer obstructing the pancreatic duct and in some cases where in the aetiology is unknown (Idiopathic).
Symptoms of Pancreatitis
The primary and most common symptom of pancreatitis is excruciating sudden severe abdomen pain radiating to the back which makes you to roll in the abdomen and lie down turning over to one side with flexed legs abdomen chest and neck( foetal position) with associated nausea, vomiting with rapid shallow breaths , increased heart rate lower blood pressure lowered urine output and in severe cases alterations of sensorium and in shock . In chronic pancreatitis the pain varies in intensity from mild to severe depending on the attack associated with indigestion, loss of appetite , severe weight loss , fatty poops leaving a oily film in the toilet a sign of fat malabsorption and uncontrolled blood sugar.
Diet
During the acute episode patient needs to avoid fatty foods and take small frequent meals
Treatment
Generally during the acute episode patient needs intravenous fluids with no oral intake along with medications for vomiting and acid reducing and pancreas suppression medications followed by graded nutrition from total parental fluids (TPN ) to enteral tube feeding followed by oral fat less foods
Antibiotics are used in gall stone pancreatitis or patient who needs surgery for severe acute pancreatitis with infected pancreatic necrosis.
Patients with severe acute pancreatitis will need organ supportive treatment like oxygen , ventilation, if there is lung dysfunction , dialysis for kidney failure and inotropes for cardiac support
Patients with infected pancreatic necroses or severe acute pancreatitis with progressive organ dysfunction ( MODS- Multi Organ Dysfunction Syndrome) needs pancreatic necrosectomy and post op ICU care in tertiary care hospitals
Patients with chronic pancreatitis are managed with pancreatic enzyme supplements to control fat malabsorption( Steatorrhoea) with insulin for sugar control and patients who have single stones with dilated ducts and solitary stricture are managed by Endo therapy and those with multiple stones and strictures by surgery
Patients who have severe pain and not candidates for Endo or surgical can be managed by coeliac ganglion block with endoscopic or percutaneous radiological means
Patients with gall stone pancreatitis benefit with laparoscopic cholecystectomy.
