Pancreatitis: An Overview of Acute and Chronic Pancreatitis
Guest: Dr. David Adams – Department of Surgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am talking with Dr. David Adams who is Professor of Surgery and Head of the division of Gastrointestinal and Laparoscopic Surgery. Dr. Adams, I know that one of your areas of interest is chronic pancreatitis. Let’s start by explaining what pancreatitis is as well as the difference between acute and chronic.
Dr. David Adams: Pancreatitis means inflammation of the pancreas. The pancreas is a small banana-shaped organ that sits right in the middle of your body, right in the middle of everything, and when it gets inflamed it causes, really, very severe pain. So, that is the main problem that patients find when they have pancreatitis. They have a pain that is, I think, like no other pain that patients get. You know, patients will stay at home with appendicitis or bowel obstruction, or diverticulitis, but when they have pain from pancreatitis, they come to the emergency room.
Dr. Linda Austin: Where, in the belly, is the pain?
Dr. David Adams: The pain is right in the middle, below the breast bone and the upper abdomen, and it goes right through to the back. So, it is really just searing back pain that patients get.
Dr. Linda Austin: Does something trigger that?
Dr. David Adams: It can be triggered by a lot of factors. Ninety-five percent of pancreatitis is related to gallstones. Patients who have stones in their gallbladder that get out of the gallbladder can block off the pancreas. Or, it is related to alcohol. Alcohol stimulates the pancreas and injures the pancreas. There are a lot of other factors that are related to the plumbing of the pancreas, how it drains, differences in anatomy that patients are born with. Those are a lot of the patients that we see here because we see a lot of unusual patients with pancreatitis.
Dr. Linda Austin: You said it could be triggered by alcohol. Is that after years of alcohol use or after a single blast of alcohol?
Dr. David Adams: Most commonly, it is after a blast of alcohol. It is an important issue with pancreatitis because, normally, when a patient comes to the emergency room, it is assumed that the injury to the pancreas is related to alcohol use. So, there is sort of a moral problem affixed to having pancreatitis, but I think most patients who have pancreatitis probably have some genetic factor, some molecular structure, in their pancreas that makes them susceptible to alcohol injury.
Dr. Linda Austin: A lot of people drink, obviously, and most do not get pancreatitis. How common is pancreatitis?
Dr. David Adams: Pancreatitis is uncommon in people who drink. It is common in emergency room presentations for abdominal pain.
Dr. Linda Austin: Any other characteristics of populations who are most likely, or people who are most likely, to get pancreatitis?
Dr. David Adams: People most likely are those patients with gallstones and those are usually middle-aged patients, more commonly women. Patients who have disorders of their pancreatic duct are most commonly women in their middle-aged years too.
Dr. Linda Austin: If left untreated, let’s say there is a single acute episode, what is the natural course of that episode?
Dr. David Adams: The majority of pancreatitis is what we call Saturday night pancreatitis. In other words, it is someone who comes in who has severe pain. They have some fever. Their measurement of pancreatic enzymes is elevated. They usually get better in about 72 hours. They may not have another attack or they may have a cause, such as gallstones, that needs to be fixed. A small number of patients go on and have severe pancreatitis and they are some of the sickest patients that we take care of in the hospital. They may be in an ICU for months or in the hospital for three to six months, getting over a severe attack of pancreatitis.
Dr. Linda Austin: You mentioned doing blood studies to make the diagnosis. What are you looking for in those blood studies?
Dr. David Adams: The pancreas has two functions. It makes enzymes that help you absorb fat and protein and then it also helps control your blood sugar, so it makes insulin. So, the blood tests that we use to measure pancreatitis relate to the enzymes that help you absorb fat and proteins. They are called amylase and lipase. So, typically those will be checked when you come into an emergency room with abdominal pain. If they are elevated, it is usually assumed that it is due to pancreatitis.
Dr. Linda Austin: And do you typically do imaging studies as well?
Dr. David Adams: Yes. Patients with a suspicion of having pancreatitis would be evaluated with an ultrasound to look at their gallbladder, to see if they have gallstones and then also with a CAT scan, which is the most effective way to image the pancreas and to see if the pancreas is inflamed or damaged.
Dr. Linda Austin: Dr. Adams, thanks so much. We will talk about the treatment of pancreatitis in another podcast.
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