Acute pancreatitis is usually caused by gallstones or consumptions of alcohol. Even gallbladder sludge (powder-like material) can also be the cause. Rarely acute pancreatitis results from abdominal trauma, procedures like ERCP (Endoscopic retrograde cholangiopancreatography), drugs like steroids and scorpion bite. Based on the severity it can be classified into mild, moderate and severe variety. Severe acute pancreatitis is a life-threatening condition characterized by persistent organ failure or fluid collection or necrosis (dead tissues) in and around the pancreas. Pancreatic enzymes like amylase/lipase will be elevated in blood investigations.
Severe epigastric (upper abdominal) pain radiating to back is typical of acute pancreatitis. This is often accompanied by fever, nausea, and vomiting. If the bile duct is blocked, then the patient may have jaundice. Associated organ dysfunction may present with difficulty in breathing and decreased urine output.
Treatment of acute pancreatitis is mainly supportive, using medicines. Mild and moderate acute pancreatitis often improve with this alone. Severe acute pancreatitis patients require a prolonged time to recover fully and usually stay in the hospital for a long duration. If respiratory failure is there, ventilatory support is required. CT scan is done to assess the extent of the damage. Abstinence from alcohol intake is a must. Those who have common bile ducts have to get it cleared by the endoscopic method (ERCP - Endoscopic retrograde cholangiopancreatography).
An ERCP (endoscopic retrograde cholangiopancreatography) procedure is done to treat those with bile duct stones. This involves inserting a long tube with a camera at the end down the throat into the duodenum (first part of the small intestine). The bile duct is cannulated and its opening widened by cutting its sphincter muscle (sphincterotomy) and then the stones are removed. Plastic stent (tube) may be inserted to keep the drainage intact. The plastic stent should be removed at a later date.
If the pancreatitis is caused by gall bladder stones, then the doctors will suggest a cholecystectomy which is the surgical removal of the gallbladder. Laparoscopic (Keyhole) Cholecystectomy is the gold standard nowadays. Through 4 small holes (two 10mm, two 5mm) the gallbladder can be removed. By this, big scars can be avoided after surgery. The patient can resume normal activity early. However, they may require taking pain-killers (analgesics) for a few days.
A pseudocyst is a collection of pancreatic enzyme-rich fluid in the vicinity. If it is uncomplicated and asymptomatic, it can safely be observed. Symptomatic fluid collections require drainage via endoscopy or surgery.
Necrotic tissue means dead tissue. Either part of the pancreas or peripancreatic fatty tissue becomes necrotic and can act like a potential nidus for infection to develop. Infected necrotic collection requires drainage either through a small tube (inserted under CT scan or ultrasound scan guidance) or by surgery. Endoscopists, interventional radiologist and surgeons should work together to choose an optimal approach.
Our gastroenterology services treat all kinds of digestive system disorders. Book an appointment now with our GI Specialists and have the best team of doctors treating you!
BOOK YOUR APPOINTMENT