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Pancreatitis

Dr Thng Yongxian

Hepatopancreatobiliary & General Surgeon
MBBS • MMed • MRCS (IRE) • FRCSED • FAMS

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What Is Pancreatitis?

Pancreatitis is an inflammatory condition of the pancreas that can impair its ability to function normally.

It can manifest as acute pancreatitis, which appears suddenly and lasts for a short period, or as chronic pancreatitis, where inflammation persists over an extended period. Understanding pancreatitis is key to managing symptoms and preventing potential complications.

Causes of Pancreatitis

Understanding the underlying causes of pancreatitis contributes to its prevention and treatment. Common causes include:

Gallstones

Gallstones can block the bile duct, leading to pancreatitis. This blockage prevents pancreatic enzymes from flowing into the small intestine, causing them to accumulate and damage the pancreas.

Alcohol Consumption

Excessive alcohol consumption is a leading cause of chronic pancreatitis. It can trigger the premature release of digestive enzymes, which can damage pancreatic tissue.

Genetic Factors

Specific genetic mutations may predispose individuals to pancreatitis, indicating a hereditary component to the disease.

Medications

Some medications have been linked to the development of pancreatitis, though this is less common.

Other Causes

Other factors, including abdominal surgery, cigarette smoking, cystic fibrosis, and high levels of calcium or triglycerides in the blood, can also contribute to the onset of pancreatitis.

Types of Pancreatitis

Pancreatitis can manifest in various forms, each with distinct characteristics and implications for patient care. Types include:

Acute Pancreatitis

Acute pancreatitis is characterised by sudden inflammation that lasts for a short period. It can range from mild discomfort to severe, life-threatening illness but typically resolves with proper medical treatment

Chronic Pancreatitis

Chronic pancreatitis develops over many years and is characterised by persistent inflammation that leads to irreversible damage. This condition often results from prolonged alcohol abuse or genetic disorders and can severely affect the pancreas’s ability to function.

Autoimmune Pancreatitis

This rare form involves the immune system attacking the pancreas, causing inflammation. It can mimic the symptoms of pancreatic cancer, making diagnosis challenging.

Hereditary Pancreatitis

Hereditary pancreatitis is a genetic condition that leads to recurrent episodes of pancreatitis, significantly increasing the risk of developing chronic pancreatitis and pancreatic cancer over time.

Symptoms of Pancreatitis

Identifying the symptoms of pancreatitis is crucial for timely diagnosis and treatment. Here are the common signs people may experience during an episode of pancreatitis.

  • Upper Abdominal Pain
  • Nausea and Vomiting
  • Fever and Increased Heart Rate
  • Weight Loss and Malnutrition
  • Jaundice

Diagnosis Of Pancreatitis

Diagnosis of pancreatitis typically begins with a thorough medical history and physical examination. Blood tests are also used, as elevated levels of pancreatic enzymes can indicate pancreas inflammation.

 

Imaging tests, including abdominal ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI), might be used to assess the pancreas’s condition. In more complex cases, endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) might be used to get a detailed view of the pancreas and bile ducts.

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Treatment Options for Pancreatitis

Treatment strategies for pancreatitis aim to relieve symptoms, address the underlying cause, and prevent complications. Treatment options include:

Initial Management

  • Hydration and Fasting: To rest the pancreas, patients may need to avoid food and fluids orally, receiving hydration intravenously instead.
  • Pain Management: Pain relief is crucial and may involve the use of prescriptions.

Treating the Underlying Cause

  • Removing Gallstones: Procedures like endoscopic retrograde cholangiopancreatography (ERCP) can remove gallstones obstructing the bile or pancreatic ducts.

Medications

  • Enzyme Supplements: To aid digestion, especially in chronic pancreatitis where enzyme production is compromised.
  • Insulin: Some patients may require insulin due to pancreatic damage affecting insulin production.

Surgery

In severe cases or when complications arise, surgery might be necessary to remove damaged tissue or relieve duct obstructions.

 

In gallstone pancreatitis, laparoscopic cholecystectomy is needed to prevent a recurrence.

Lifestyle Adjustments

Adopting a low-fat diet, drinking plenty of fluids, smoking cessation and avoiding alcohol can help manage and prevent further episodes of pancreatitis.

 

Managing and Preventing Pancreatitis

Effective management and prevention of pancreatitis involve:

  • Dietary Changes: Adopting a low-fat diet and eating smaller, more frequent meals can help manage pancreatitis symptoms and prevent future episodes.
  • Alcohol and Smoking: Avoiding alcohol and smoking is crucial in preventing pancreatitis, especially for individuals with a history of alcohol-related pancreatitis.
  • Regular Medical Checkups: Regular follow-ups with a doctor can help monitor the condition and prevent complications.
  • Staying Hydrated: Adequate hydration is essential, especially during episodes of acute pancreatitis, to support overall health and kidney function.
  • Managing Underlying Conditions: Effectively managing conditions like gallstones, high triglyceride levels, and autoimmune disorders can reduce the risk of pancreatitis.

Complications Associated with Pancreatitis

Chronic or severe pancreatitis can lead to complications that affect overall health:

Pancreatic Infection

Pancreatitis can lead to pancreas infection, requiring prompt antibiotic treatment or surgery to remove infected tissue.

Pancreatic Pseudocyst

Fluid and debris accumulating in cyst-like pockets in the pancreas can cause pain, infection, or even rupture.

Malnutrition

Chronic pancreatitis can impair the pancreas’s ability to produce digestive enzymes, leading to malabsorption and weight loss.

Diabetes

Damage to insulin-producing cells in the pancreas from chronic pancreatitis may result in diabetes.

Pancreatic Cancer

Long-term inflammation of the pancreas is associated with an increased risk of pancreatic cancer, especially in individuals with hereditary pancreatitis.

Dr Thng Yongxian

Senior Consultant

HEPATOPANCREATOBILIARY & GENERAL SURGEON

MBBS (SG) • MMed (Surg) • MRCS (Ire) • FRCSEd (Gen) • FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery
  • National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.


Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.


Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

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