Pancreatitis

How are Pancreatitis Diagnosed?

If you present with symptoms suggestive of pancreatitis, your healthcare provider will begin by reviewing your medical history and performing a physical examination, focusing on your abdomen for pain or tenderness. Diagnosis is confirmed through a combination of blood tests and imaging studies, which help determine the severity and underlying cause of the condition.

Blood and Laboratory Tests

• Pancreatic enzyme levels: Blood tests will check for elevated amylase and lipase. Levels three times above normal strongly suggest pancreatitis.
• Glucose test: For chronic pancreatitis, this test checks if your pancreas is still producing insulin effectively.
• Stool elastase: To assess if your pancreas is making enough digestive enzymes, which can indicate pancreatic exocrine insufficiency.
• Nutritional blood tests: These evaluate your nutritional status, including fat-soluble vitamin levels.

Imaging Tests

• Ultrasound: Often the first imaging test, it can reveal gallstones or pancreatic inflammation.
• CT scan (Computerised Tomography): Provides detailed cross-sectional images to detect swelling, fluid deposits, and other abnormalities.
• MRI (Magnetic Resonance Imaging): Offers high-resolution images of the pancreas and surrounding structures, useful for identifying chronic changes or complications.
• Endoscopic Ultrasound (EUS): A thin tube with an ultrasound probe is passed through your digestive tract, providing detailed images of the pancreas and bile ducts.

Specialised Diagnostic Procedures

• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure uses a flexible endoscope and imaging to examine and treat blockages in the bile or pancreatic ducts, often caused by gallstones.

How is Pancreatitis Treated?

Treatment for pancreatitis depends on whether it is acute or chronic, the underlying cause, and the severity of your condition. Most patients require hospitalisation for initial management, especially for acute episodes.

Treatment Options for Pancreatitis

Treatment for pancreatitis depends on whether it is acute or chronic, the underlying cause, and the severity of your condition. Most patients require hospitalisation for initial management, especially for acute episodes.

Acute Pancreatitis

• Supportive care:
  • Intravenous fluids: Hydration is critical for recovery, as pancreatitis can cause significant fluid loss to third spaces in our body.
  • Pain relief: Medications are provided intravenously or orally to manage pain.
  • Nutritional support: If you cannot eat by mouth, nutrition may be given through a feeding tube or, in severe cases, intravenously (parenteral nutrition).
• Gallstone removal:
  • ERCP: Used to remove gallstones from the bile ducts. The endoscope is inserted through the mouth, and tools are used to extract stones while images are viewed on a monitor.
  • Gallbladder removal (cholecystectomy): Minimally invasive (laparoscopic) surgery is often performed to prevent future episodes if gallstones are the cause. Some may require open surgery depending on their condition.
• Additional support:
  • Antibiotics: Prescribed if infection is suspected.
  • Drainage or removal of dead tissue: Procedures may be needed if complications such as infected fluid collections or necrosis develop.
  • Intensive care: For severe or complicated cases, close monitoring in an intensive care unit may be necessary.

Chronic Pancreatitis

• Referral to a specialist: Chronic cases are usually managed by a gastroenterologist.
• Pain management: Long-term pain may require a combination of medications, nerve blocks (such as celiac plexus block), or endoscopic procedures to remove scar tissue or stones.
• Enzyme and nutritional supplements: Many patients develop pancreatic exocrine insufficiency (PEI) and require pancreatic enzyme replacement therapy (PERT) and additional vitamins or minerals. Some may develop diabetes and may need insulin.

Lifestyle changes:

• Stop alcohol and smoking: Both accelerate disease progression and increase risk of complications.
• Low-fat diet: Emphasise fruits, vegetables, and adequate hydration.

Surgical options:

• Partial resection: Removal of a diseased portion of the pancreas if pain or complications are localised.
• Total pancreatectomy: Rarely, the entire pancreas may be removed for severe, unmanageable cases.

Lifestyle and Home Care After Hospital Discharge

Recovery from pancreatitis continues at home. Key steps include:

• Abstain from alcohol: Essential for both acute and chronic cases.
• Quit smoking: Reduces further pancreatic damage.
• Follow a low-fat, nutrient-rich diet: It helps prevent symptoms and supports healing.
• Stay hydrated: Drink plenty of fluids daily.

Complementary Therapies

While alternative therapies cannot cure pancreatitis, some patients find relief from chronic pain with meditation, relaxation exercises, yoga, or acupuncture.

Always consult your healthcare provider before starting any complementary therapy.

Preparing for Your Appointment

To make the most of your consultation:

• Write down all symptoms, even those that seem unrelated.
• List all medications, supplements, and herbal remedies.
• Bring a family member or friend for support.
• Prepare questions about treatment options, need for specialist referral, or dietary advice.

SJMC’s multidisciplinary team of gastroenterologists, surgeons, dietitians and support team offers end-to-end care for pancreatitis from diagnosis through long-term management.