Mr Charles Imber offers expert abdominal surgery. The operations that he performs can treat a variety of conditions that affect the organs inside the abdomen (pancreas, gallbladder, liver, spleen, small and large intestine) or the abdominal wall (hernias).
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Acute pancreatitis is inflammation of the pancreas caused by the digestive enzymes normally produced by the gland attacking its own tissues. Acute pancreatitis has several causes and can be prevented from recurring if the underlying cause is removed. If not, the condition can continue, leading to chronic pancreatitis, a major risk factor for pancreatic cancer.
What does a healthy pancreas do?
The pancreas is a complex gland that has two functions:
- It produces the hormone insulin, which controls blood glucose levels. People who cannot produce insulin have type 1 diabetes.
- It produces digestive enzymes, including trypsin (which breaks down proteins) and pancreatic amylase (which breaks down carbohydrates).
The insulin that is produced is carried from the pancreas in the blood but the digestive enzymes are released directly into the small intestine nearby through the pancreatic duct. This is a small and delicate tube that lies right next to the bile duct that carries bile out of the gallbladder and into the intestine. The two ducts share a common opening.
Blockage of the pancreatic duct
If the pancreatic duct gets blocked, the enzymes produced inside the pancreas cannot escape. They are produced in an inactive form but any delay causes activation inside the organ. The digestive enzymes break down the cells of the pancreas, causing damage and acute inflammation.
What causes acute pancreatic?
Different events and circumstances can lead to an attack of acute pancreatitis, including:
- Complicated gallstone disease: Inflammation of the bile duct or gallbladder due to damage by gallstones or because the bile duct has been blocked by a stone can cause swelling that blocks the pancreatic duct.
- Alcohol abuse: Very heavy drinking that continues over a long period of time leads to activation of trypsin before it is released. The pancreatic duct is not blocked, but the tissue damage causes inflammation in the pancreas.
- Treatment with some medicinal drugs such as thiazide diuretics or steroids.
- Pancreatic cancer: Even a small tumour near to the pancreatic duct can cause a blockage, which can lead to acute pancreatitis.
- Having an endoscopic retrograde cholangiopancreatography (ERCP): This specialised form of endoscopy that is used to investigate and treat problems in the bile duct or pancreatic duct can sometimes damage one or both ducts, leading to inflammation. If this blocks the pancreatic duct, pancreatitis can develop some viral infections.
How common is acute pancreatitus
In the UK, up to 2,500 people get acute pancreatitis in any 12-month period. In eight out of ten of them, prompt care will prevent ongoing complications and chronic pancreatitis.
Comh2lications of acute pancreatitis
Unfortunately, the other two out of ten people experience ongoing problems such as an abscess, a pancreatic pseudocyst or a bowel obstruction. All of these can be treated surgically but need to be done by an expert surgeon with experience in complex pancreatic surgery.
- Acute pain just under the ribs, towards the left-hand side that moves into the back. Pain can be extremely severe, sometimes needing hospital admission, and can last for a few days.
- Dehydration, raised heart rate, sweating and vomiting: If you develop acute pancreatitis, you feel very unwell.
- Jaundice: If the problem arises from gallstones, the bile duct may be blocked and may affect the pancreatic duct. If bile can’t flow into the intestine, the skin and eyes will become yellow and you will produce dark urine and pale faeces.
- Blood tests to detect raised levels of pancreatic digestive enzymes in the blood. X-ray to look for bowel obstruction or the presence of gallstones. CT scanning for more information on whether the pancreas is being badly damaged.
- Supportive hospital care with painkillers and antibiotics if necessary. No food is given and nutrition is provided via a drip to rest the pancreas.
- Laparoscopic gallbladder removal (laparoscopic cholecystectomy) to remove gallstones and to relieve pressure on the bile duct and pancreatic duct.
- Open gallbladder removal (open cholecystectomy) if laparoscopic surgery is not possible.
- Treatment for alcohol abuse.
- In severe cases, the pancreas may need to be removed surgically. Islet cells can be transplanted to prevent type 2 diabetes afterwards.