Surgical Conditions

Infections and Inflammations

An infection is the condition of multiplication of parasitic organisms or microorganisms within the body. An inflammation is the reactions that occur in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic agent. Many people use the terms interchangeably since they have several symptoms in common and usually are treated similarly.

Appendicitis :: Pancreatitis :: Hepatitis :: Cholecystitis
Oesophagitis :: Peritonitis

Pancreatitis

Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it takes from food for energy.

Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start digesting" the pancreas itself. This process is called autodigestion and causes swelling, haemorrhage, and damage to the blood vessels. An attack may last for 2 days

Types

•  Acute pancreatitis usually occurs suddenly and causes severe pain in the upper abdomen that radiates through to the back. Acute pancreatitis is usually caused alcohol or gallstones. A gallstone can block the pancreatic duct, trapping digestive enzymes in the pancreas and causing pancreatitis. The majority of attacks are considered mild and resolve with conservative management over several days. About 10% of attacks are severe and can cause life-threatening complications.

•  Chronic pancreatitis is a result of ongoing or repeated attacks and results in a slow destruction of the pancreas. Chronic pancreatitis occurs when digestive enzymes attack and destroy the pancreas and nearby tissues. Chronic pancreatitis is usually caused by many years of alcohol abuse, excess iron in the blood, and other unknown factors. However, it may also be triggered by only one acute attack, especially if the pancreatic ducts are damaged. Damage to the pancreas can cause chronic pain, impair digestion of food and impair insulin production causing diabetes to develop.

Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Pseudocysts, accumulations of fluid and tissue debris, may also develop. And enzymes and toxins may enter the bloodstream, injuring the heart, lungs, and kidneys, or other organs.

Acute pancreatitis generally causes severe pain and the sufferer will need emergency treatment in a hospital. Pancreatitis is generally diagnosed quickly, by examination of the abdomen, and confirmed using a series of medical tests, including:

• General tests - such as blood tests, physical examination and x-rays.
• Ultrasound - sound waves form a picture that detects the presence of gallstones.
• CT scan - a specialised x-ray takes three-dimensional pictures of the pancreas.

Complications

Some of the complications from pancreatitis are: low blood pressure, heart failure, kidney failure, ARDS (adult respiratory distress syndrome), diabetes, ascites (accumulation of fluid in the abdomen) and cysts or abscesses in the pancreas.

Treatment options

Treatment depends on the causes and severity of the condition, but may include:

Acute pancreatitis

• Hospital care - in all cases of acute pancreatitis.
• Intensive care in hospital - in cases of severe acute pancreatitis.
• Fasting and intravenous fluids - resting the bowel and pancreas helps the inflammation settle down.
• ERCP – may be used if the pancreatitis is caused by a gallstone blocking the bile duct
• Surgery - if gallstones are present, removing the gallbladder will help prevent further attacks. In rare cases, surgery is needed to remove damaged or dead areas of the pancreas.
• Lifestyle change - eliminating alcohol.

Chronic pancreatitis

• Lowering fat intake
• Supplementing digestion by taking pancreatic enzyme tablets with food
• Eliminating alcohol
• Insulin injections, if the endocrine function of the pancreas is compromised
• Analgesics for pain.