Pancreatitis

What Is Pancreatitis?

Amongst the myriad of conditions that can cause abdominal pain, pancreatitis, whether acute or chronic, ranks very high in the list of debilitating conditions. Often described as a sharp shooting stabbing pain originating in the middle of the gut and occasionally radiating to the back, is due to inflammation of the pancreas and surrounding tissues. The pancreas is rich in cells that create and secrete digestive enzymes. Contained in the appropriate pathways, these digestive enzymes are usually harmless.

However, when these self-protective mechanisms are destroyed, these digestive enzymes can run amok, digesting the pancreas, creating inflammation, cyst formation, pseudo-cyst formation, and scarring. Surrounding tissues, including the gallbladder and liver, can also be affected, leading to hepatitis and gastritis. The diagnosis is often made by a gastroenterologist and, in some conditions, an oncologist.

Imaging studies, including CAT scans, MRIs, and ultrasound, are often the primary steps followed by extensive directed bloodwork looking for products of enzymatic digestive release. Besides treating the cause of pancreatitis, treatment options include dietary modifications, avoiding fats, controlling carbohydrate intake, and strict fluid regulation. Pain management treatment options include sympathetic (celiac plexus) blocks, reducing the pain significantly.

Subsequent radiofrequency ablation of neural-sensitive nerves can provide a long-term reduction of pain. Opioid management can also be effective. However, careful titration is necessary to avoid overtaxing the metabolic pathways of the liver.