Acute Pancreatitis

Dr Tan Yu-Meng
Director, Consultant General Surgeon

What Is Acute Pancreatitis?

Acute pancreatitis is an inflammatory condition of the pancreas that occurs suddenly and is often severe.

The pancreas is a vital organ located behind the stomach and it plays a crucial role in digestion and blood sugar regulation. It produces enzymes that help digest food and hormones such as insulin, which controls blood sugar levels.

This inflammation arises when the digestive enzymes produced by the pancreas become activated while still inside the pancreas, leading to the digestion of pancreatic tissue itself. This can cause swelling, bleeding, and damage to the pancreas and surrounding tissues.

Causes

Gallstones

Gallstones can block the pancreatic duct, which leads to a buildup of pancreatic enzymes inside the pancreas, triggering inflammation.

Alcohol Consumption

Heavy alcohol consumption can induce the pancreas to produce toxic substances that lead to inflammation.

Medications

Certain medications, including some diuretics, antibiotics, and chemotherapy drugs, have been associated with triggering acute pancreatitis in some individuals.

High Triglyceride Levels

Elevated levels of triglycerides in the blood can lead to pancreatitis. This condition often results from obesity, poorly controlled diabetes, or specific genetic disorders.

Autoimmune Disorders

In some cases, the body’s immune system attacks the pancreas, leading to inflammation. This is more common in individuals with other autoimmune conditions.

Genetic Factors

Genetics may play a role in the development of acute pancreatitis, especially in individuals with a family history of the condition.

Infections

Various infections, including mumps, hepatitis, and coxsackievirus, have been linked to acute pancreatitis.

Symptoms And Signs

  • Upper Abdominal Pain: A sudden onset of pain in the upper abdomen, which may radiate to the back.
  • Nausea and Vomiting: Nausea and vomiting may also lead to dehydration and electrolyte imbalances.
  • Fever: A moderate fever is common in acute pancreatitis.
  • Rapid Pulse: The heart rate may increase as the body responds to the pain and inflammation.
  • Swollen and Tender Abdomen: A swollen and tender abdomen is common due to inflammation and fluid accumulation around the pancreas.
  • Changes in Blood Pressure: Blood pressure may drop due to dehydration or the release of inflammatory substances into the bloodstream.
  • Fatigue and Weakness: Fatigue and weakness are common, as the body diverts energy towards fighting the inflammation.

Diagnosis of Acute Pancreatitis

The diagnosis of acute pancreatitis begins with a thorough clinical evaluation, including a detailed medical history and a physical examination.

Blood tests are necessary for diagnosing acute pancreatitis. Elevated levels of pancreatic enzymes, such as amylase and lipase, in the blood are indicative of pancreatitis.

Imaging techniques play a vital role in confirming the diagnosis of acute pancreatitis and assessing its severity. Commonly used imaging methods include:

Abdominal Ultrasound: An abdominal ultrasound can help identify gallstones, which are a common cause of acute pancreatitis.

Computed Tomography (CT) Scan: A CT scan of the abdomen provides detailed images of the pancreas, helping to confirm the diagnosis, assess the severity of inflammation, and identify complications.

Magnetic Resonance Imaging (MRI): MRI is particularly useful in visualizing the bile ducts and pancreatic ducts.

Endoscopic Ultrasound (EUS): EUS can provide detailed images of the pancreas and is useful in diagnosing chronic pancreatitis or identifying pancreatic tumours.

Non-Surgical Treatment Options

Non-surgical management focuses on relieving symptoms and supporting the pancreas as it heals. These interventions are designed to manage the acute phase of the illness and prevent further damage to the pancreas.

Initial Care

  • Fasting: Patients may need to refrain from eating for several days to reduce the workload on the pancreas.
  • Hydration: Intravenous (IV) fluids are administered to prevent dehydration and maintain vital bodily functions.
  • Pain Relief: Effective management of pain often involves non-opioid analgesics, with stronger medications reserved for more severe cases.
  • Nutritional Support: After the initial fasting period, a low-fat diet is gradually introduced. In cases where oral intake is not possible, tube feeding may be utilised.

Alcohol Abstinence

Abstinence is essential for individuals whose condition is related to alcohol use.

Medications

If specific medications are identified as the cause, discontinuation or substitution may be necessary.

Monitoring and Follow-up

Regular monitoring is needed to assess the healing process and manage any arising complications. This approach allows for adjustments in treatment as the patient recovers.

Surgical Management

In some instances, surgical intervention may become necessary, especially when complications like necrosis or abscesses develop.

Necrosectomy

This procedure involves the removal of dead pancreatic tissue. It is generally reserved for cases where there is infected pancreatic necrosis.

Drainage of Abscesses

If abscesses form, they may need to be surgically drained to prevent the spread of infection.

Gallbladder Surgery

For patients with gallstone-induced pancreatitis, removing the gallbladder may be recommended to prevent recurrence.

Complications and Risks

Acute pancreatitis can lead to complications and risks including:

  • Pancreatic Necrosis: Dead pancreatic tissue can become infected, posing a serious risk of sepsis.
  • Pseudocysts: Fluid-filled sacs that may develop in the pancreas, potentially causing pain, infection, or rupture.
  • Acute Fluid Collections: Accumulation of fluid around the pancreas can cause discomfort and interfere with organ function.
  • Organ Failure: Severe acute pancreatitis can lead to failure of the lungs, kidneys, or heart.
  • Sepsis: Infection can spread from the pancreas to the bloodstream, leading to this life-threatening response to infection.
  • Hyperglycemia or Diabetes: Damage to the insulin-producing cells can result in elevated blood sugar levels or diabetes.

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Dr Tan Yu-Meng

Director, Consultant General Surgeon

Dr Tan continues to be one of few surgeons in Asia who perform specialized surgery for peritoneal malignancies in Asia.

  • MBBS (Bachelor of Medicine & Surgery, First Class Honors & Distinction at the University of London) 1994
  • RCSEd (Fellow of the Royal College of Surgeons Edinburgh) 1999
  • Further training in advanced HPB surgery and liver transplantation at the world renowned Liver Unit of Queen Elizabeth Hospital in Birmingham, United Kingdom.
  • Further training in living donor liver transplantation in Japan.

With his interest in gastrointestinal and hepatobiliary-pancreatic (GI-HPB) surgery and the treatment of cancer, Dr Tan joined the department of surgical oncology at the National Cancer Centre in 2003 as a consultant.

Dr Tan’s interest in the management of peritoneal surface malignancies was part of his effort in leading a multidisciplinary team from NCC to Washington Cancer Institute to adopt the techniques and protocols of peritonectomy and HIPEC (Sugarbaker procedure) from Dr Paul Sugarbaker in 2009.

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    Acute Pancreatitis

    Frequently Asked
    Questions

    Can Acute Pancreatitis Become Chronic?

    Yes, in some individuals, repeated episodes of acute pancreatitis can lead to chronic pancreatitis, which refers to the permanent damage and scarring of the pancreas. This can affect the organ’s ability to function properly.

    Can Diet Influence the Recovery from Acute Pancreatitis?

    While diet does not cause acute pancreatitis, following a low-fat, balanced diet during recovery can help manage symptoms and support the healing process. Avoiding alcohol and foods high in fats is particularly important.

    How Long Does It Take to Recover from Acute Pancreatitis?

    The recovery time from acute pancreatitis can vary widely depending on the severity of the condition, the presence of complications, and the individual’s overall health. Mild cases may resolve in a few days, while severe cases can take weeks to months.

    What Is the Difference Between Acute Pancreatitis and Pancreatic Cancer?

    Acute pancreatitis is an inflammation of the pancreas that is usually temporary, whereas pancreatic cancer involves the growth of malignant cells within the pancreas and tends to progress over time.