Pancreatitis

The pancreas is an organ with dual inter-related “endocrine” and exocrine functions. The exocrine portion of the pancreas produces digestive juices, proteins and chemicals which facilitate the proper digestion (and thence absorption by the gut) of ingested food. The endocrine portion of the pancreas (usually located in islands of endocrine cells in the tail end, known as the Islets of Langerhan) produces hormones such as insulin and pancreatic polypeptide which are important in controlling the metabolism and processing of digested foods once their products reach the circulation. It does this by the production of hormones, such as insulin which regulated the levels of carbohydrate (sugar) in the blood. Exocrine and endocrine function are both closely linked to gut and wider metabolic function. Pancreatitis is a descriptive term for inflammation arising within the pancreas. Such inflammation may be acute or chronic (long-standing. Often patients suffer reccurent episodes of acute pancreatitis which then becomes chronic leading to pancreatic dysfunction, mal-digestion and destruction of the insulin producing cells. This can lead to poor nutrition and diabetes.

 

Acute pancreatitis commonly presents with severe upper abdominal pain, nausea and vomiting. It is  associated with the combination of excess alcohol and tobacco use, in over half of all cases. Although tobacco alone rarely causes acute inflammation it is a significant contributing factor to chronic pancreatic disease. Gallstones slipping from the gallbladder and causing obstruction to the pancreatic duct as it enters the bowel (at the ampulla) account for a further 25% or so of acute pancreatitis. Autoimmune pancreatitis and genetic disease such as cystic fibrosis and pancreatic neoplasms (growths) may also be linked to the development of pancreatitis.

 

In general things which cause acute pancreatitis may reccur or persist and cause persistent or chronic pancreatic inflammation, known as chronic pancreatitis. For many individuals with low grade ongoing pancreatic inflammation tobacco smoking is a significant factor in perpetuating such inflammation. Many individuals who suffer from chronic pancreatitis also have pancreatic insufficiency.

 

Treatment of pancreatitis depends on the cause and on the effect that the disease has had on pancreatic endocrine and exocrine function. For those with gallstone pancreatitis secondary to stones obstructing the pancreatic duct, removal of the stones is required, this usually requires ERCP. If further gallstones remain within the gallbladder, as they often do removal of the gallbladder is a standard next step, unless of course patients are too unwell or have significant co-morbidities which might preclude successful surgical intervention. For those where pancreatitis is related to lifestyle avoidance of both tobacco and alcohol (complete abstinence is advised, since even small amounts of alcohol may provoke recurrent inflammation). Assessment of pancreatic exocrine (faecal elastase) is advised following an episode of acute pancreatitis. Those with pancreatic exocrine insufficiency require treatment with pancreatic enzyme supplements and steps taken to ensure they have no nutritional deficiencies. Patients who develop diabetes need to have their diabetes carefully managed.