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Anatomy

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 occurs suddenly and lasts for a short period of time and
usually resolves.
Acute pancreatitis is usually caused by drinking too much alcohol or by gallstones.
A gallstone can block the pancreatic duct, trapping digestive enzymes in the
pancreas and causing pancreatitis.

•  Chronic pancreatitis does not resolve itself 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.

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 - until the inflammation settles down.
  • Endoscopy - a thin tube is inserted through your oesophagus to allow
    the doctor to see your pancreas.
  • 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.

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ANZGOSA - Australia & New Zealand Gastric & Oesophageal Surgery Association Your Practice Online