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Dr Edward Lai - The Stomach Pain That Could Signal Acute Pancreatitis

The symptoms of acute pancreatitis are similar to other illnesses of the digestive system. However, this sudden inflammation of the pancreas can result in varying levels of pain, ranging from mild discomfort to severe life-threatening illness if not treated properly in time. This makes it important to see a doctor immediately if you suspect acute pancreatitis.


Acute pancreatitis is a sudden inflammation of the pancreas which can range from mild to severe. It is a common illness and can be harmful to nearby organs. The most common symptoms are upper abdominal pain which may radiate to back pain, nausea and vomiting. However, these symptoms are similar to other illnesses of the digestive system which makes it possible for people to mistake it for a minor stomach illness or gall bladder problems.


The pancreas is located deep behind the stomach. Therefore to diagnose acute pancreatitis with methods other than traditional clinical procedures, doctors may use tests such as measuring levels of amylase and lipase in the blood, and imaging.

Gallstones major cause of pancreatitis


There are several risk factors for acute pancreatitis. However gallstones, which migrate to the common bile duct and can block the pancreatic duct, are the major cause of acute pancreatitis and account for 70 per cent of all cases in Hong Kong.


The pancreatic duct and bile duct connects the pancreas and gallbladder to the duodenum respectively. When gallstones obstruct the junction of the two ducts at the duodenum, the digestive enzymes produced by the pancreas may return to the pancreas, digesting the pancreatic tissues. This will lead to pancreatic necrosis (death of tissue), a pseudocyst (a fluid-filled cavity resembling a cyst) and even organ failure. If not treated promptly, the result can be life-threatening.


Other than gallstones, heavy drinking of alcohol is another common risk factor. Alcohol causes proteins to precipitate in the ducts of the pancreas. This leads to local pancreatic dilatation and fibrosis. However, compared to western countries, where as many as two thirds of all case of pancreatic are related to heavy drinking, alcoholic pancreatitis is less common in Hong Kong and only accounts for around 20 per cent of all cases.


Using an endoscope to clear the pancreatic duct


Once diagnosed with acute pancreatitis, eating and drinking has to be prohibited in order to minimize the production of pancreatic juice. Patients have to be treated with intravenous therapy (for nutrients, water and electrolytes) and pain medications to relieve pain from inflammation.


In general, the condition will improve after a period of fasting with the pancreas recovering gradually. For complete cure of acute pancreatitis caused by gallstones, removal of the stone in the common bile duct is recommended. This involves inserting an endoscope into the bile duct or pancreatic duct through the throat between 24 and 72 hours after the onset of acute pancreatitis. A radiographic contrast agent is injected to identify the location of stone by X-ray so they can be removed afterwards. This treatment is named “Endoscopic retrograde cholangiopancreatography” (ERCP). In some cases, doctors may insert stents to reduce the risk of recurrence.


The best way to prevent acute pancreatitis is to avoid drinking alcohol and to maintain healthy living habits and a healthy diet. If gallstones are diagnosed, it is recommended they are treated to prevent any other illness from developing. Minimally invasive surgery for pancreatic resection is also an option and is considered the ultimate treatment.


However, it is important anyone experiencing symptoms of upper abdominal pain consult their doctor. If pancreatitis is diagnosed, he or she will be able to give advice on the best treatment options available for each individual.

Source: Dr Edward Lai, Specialist in General Surgery at Hong Kong Adventist Hospital – Stubbs Road