Karnataka Gastro Centre

Pancreatitis Overview:
Pancreatitis is an inflammation in the pancreas which is an organ located behind the stomach’s lower part in the human body.

Types of pancreatitis:
-  Acute Pancreatitis

-  Chronic Pancreatitis

Acute Pancreatitis:

Acute Pancreatitis lasts for a shorter duration of time. It is the sudden inflammation of the pancreas in the human body. Acute pancreatitis is a disease where an individual has damage in their tissues, bleeding into the gland, get an infection and is also subject to the formation of a cyst. If this goes untreated, then it might also result in the harm of organs like lungs, kidneys and lungs. Acute Pancreatitis can cause mild discomfort and can also turn into a disease that is life-threatening.

Chronic Pancreatitis:

Chronic Pancreatitis is a long-term disease. The inflammation in the pancreas lasts for a longer duration of time. It can be caused by the consumption of alcohol in large quantities. Though the symptoms might not be visible for a few years, it has the possibilities of developing over the years that causes this chronic condition. Chronic Pancreatitis is a condition that happens after Acute Pancreatitis.

Pancreatitis Symptoms:
The symptoms of Acute Pancreatitis and Chronic Pancreatitis are usually similar but might vary in some terms.

Symptoms of Acute Pancreatitis:

-  If an individual has an increased heart rate, they might have the condition. But, an increased heart rate might be due to a plethora of other reasons. So, other symptoms combined with this should be considered.

-  The swelling of the abdomen region

-  Tenderness in the abdomen

-  Vomiting and feeling nauseated

-  Having a fever

-  Pain in the upper abdomen area. This pain radiating into the back of the body might be a strong symptom of Acute Pancreatitis.

Symptoms of Chronic Pancreatitis:

-  Having a constant pain in the upper abdominal area that radiates into the back means that an individual might be having chronic pancreatitis. The abdominal pain might even be disabling in some individuals

-  Individuals who have Pancreatitis suffer from malabsorption of food which results in weight and diarrhoea. When an individual has pancreatitis, the gland does not release enzymes that are enough to break down the food taken; this results in poor absorption of food

-  In case the damage occurs in the cells that are responsible for the production of insulin, then it might result in diabetes.

Causes of Pancreatitis:
Basic causes:
-  The fat level in blood: high

-  Calcium level in blood: high

-  Pancreatic genetic abnormalities

-  Viral infections

-  Abnormalities in the hormones

-  Damage to pancreas due to injuries in the abdominal area

-  Intake of steroids and/or estrogens

Acute Pancreatitis:
The causes for this ailment are unclear but it is linked to being caused by the following:

-  Acute pancreatitis can be caused because of the presence of gallstones in an individual.

-  It can also be caused by high levels of alcohol consumption.

-  Certain medications and surgeries might also cause the disease.

-  If an individual has an autoimmune disease, trauma, certain infections, disorders of the metabolic system, they might be at a higher risk of developing Acute Pancreatitis.

Chronic Pancreatitis:
20 % to 30 % of the Chronic Pancreatitis cases are unknown in terms of the causes. The rest 80 % to 70 % of cases are because of the following:

-  Presence of gallstones

-  A heavy consumption of alcohol for a long duration of time is also linked to the development of Chronic pancreatitis

-  Chronic pancreatitis can be caused by the presence of Cystic fibrosis and other hereditary conditions

-  Having a high level of lupus and triglycerides can cause chronic pancreatitis

Prevention From Pancreatitis:
The following prevention steps can prevent most of the medical ailments to take a toll on you, let alone Pancreatitis. But, they are specifically for this disease as it can be caused if one does not follow the following prevention steps:

-  Increase your physical activity

The development of gallstones is more likely in the case an individual is overweight. So, excess weight can be reduced to reduce the chances of developing gallstone and further reducing the risk of developing pancreatitis. Engaging in physical activity on a daily basis will help one to reduce excess weight.

-  Do not follow diets that promise immediate weight reduction 

Weight reduction and becoming fit and healthy is a slow process and is not something you can achieve within a span of a few days or even months. It is a slow process that involves dedication to the cause. Crash dieting should be avoided. Following a crash diet could result in the liver to cause increased cholesterol production. This increases the chances of the development of gallstones that might cause Pancreatitis.

-  Eating healthy

One of the major causes of the development of acute pancreatitis is gallstones. And, gallstones can form in case there is a high level of cholesterol that has been accumulated in the bile (a liver substance that aids in the process of digestion of fats). Eating healthy and the reduction of alcohol intake can avoid high levels of cholesterol. Avoid the consumption of foods with high fats and sugars and intake more vegetables, fruits and grains in your diet. A high dairy consumption should also be avoided. High levels of cholesterol and triglyceride can result in the increased risk of the development of acute pancreatitis. Eating more natural and healthy foods is a good way to make sure you stay ailment - free.

Avoid toxic substances:
-  Quit or avoid smoking

If you have not smoked yet, do not start! And, if you do, try to completely quit the intake of tobacco or at least reduce. Smoking is linked to causing acute pancreatitis through the development of gallstones. Quitting smoking might also result in the reduced chances of many other medical ailments, making you a healthier person; it also increases the life expectancy of an individual.

-  Avoiding or reducing the intake of alcohol

Alcohol has been linked to causing many health ailments. Reducing or limiting the consumption of alcohol can help the pancreas be safe from the toxins of alcohol. The increased intake of alcohol is linked to causing Pancreatitis in, both, women and men. This reduces the risk attached to developing Pancreatitis.

If you have been diagnosed with Pancreatitis:

Once diagnosed, it is advised to start the treatment immediately as if it is left untreated, then it might progress and develop into EPI - Exocrine Pancreatic Insufficiency. You should make all the above lifestyle changes immediately to avoid it. 

How is it diagnosed?
One of the methods to check if an individual has Pancreatitis is to suspect the disease through the symptoms that they have been having. When an individual has Pancreatitis, then their blood glucose level is affected, so blood tests are done to check the same. The following tests are performed to check the pancreas for irregularities:

-  X-ray

The X-ray will help check for any damages to the lung like a collapsed lung tissue and any accumulation of fluids in the cavity of the chest.

-  Physical Examination 

A physical examination is carried out by a doctor. They examine the abdominal area to see if any area is sensitive to touch. If any area in the abdomen is found to be sensitive when it is touched, then it might mean that the individual examined has acute pancreatitis. 
What is the indication of acute pancreatitis?: 
The muscle walls of the abdomen are rigid. Also, while the abdomen is being inspected with a stethoscope, then there might be no or less intestinal sounds.

-  MRCP scan - Magnetic Resonance Cholangiopancreatography scan

The Magnetic Resonance Cholangiopancreatography scan is done to see the pancreatic ducts and the bile in a clearer way. This scan shows a more accurate and clear version than the CT scans and is specifically designed for diagnosing Pancreatitis.

-  Ultrasound scan

An ultrasound scan is done on an individual to check the condition of their pancreas. It is a high-frequency sound wave that shows the pancreas and the surroundings on a monitor so that the doctor can examine it for irregularities.

-  CECT scan - Contrast Enhances Computed Tomography

A CECT scan takes several pictures of the area suspected to be affected from various angles. Then, they are placed in a way that a 3-dimensional image is produced so that scanning it for the disease is possible. This can also help in the determination of the collection of fluids in the gland and the number of changes in the gland’s density.

-  Blood Test

A blood test might also be done to check for pancreatitis. In case the levels of lipase and amylase are high in the blood of an individual, it means that they are suffering from pancreatitis. But, blood tests cannot be fully reliable as they might not show any signs of the disease if the tests are done in the first 2 days. In addition to this, the level of lipase returns to normal in 8 days to 14 days and the level of amylase return to normal within a matter of 3 days to 7 days.

-  ERCP scan - Endoscopic Retrograde Cholangio - Pancreatography scan 

This scan is an endoscopy that is inserted into an individual’s digestive system. Ultrasound is used to guide the endoscopy process. The Endoscopic Retrograde Cholangio - Pancreatography scan is also capable of find out the exact location of the gallstone.

Treatment of Pancreatitis:
-  Medication

In case the individual has diabetes, they are given insulin. In the case of a low enzyme level causing problems in the digestion process, artificial digestive enzymes would be prescribed. A painkiller as chronic pancreatitis can cause constant and a high level of pain. In case the individual has autoimmune pancreatitis, then they are given steroids. In the case of chronic pancreatitis, if the pancreas is damaged, then it can’t be reversed. So, medication is given for the purpose of reduction of the pain.

-  Endoscopy

Endoscopy is done in order to get rid of any blockages pain is reduced. This process is also carried out to make sure the pain is reduced. The blockage is removed by inserting a flexible and long tube through the mouth of the individual to remove pancreatic stones. Then, stents are placed by putting in small tubes so that any leaks are closed and achieve an improved flow.

-  Surgery: The last resort

This treatment is only needed in severe conditions. The conditions being that an individual is not responding to the medication and has a severe level of pain. What the surgery does is that it removes a part of the pancreas in order to provide relief from the pain. The surgery is also capable of draining cysts and unblocking the pancreatic duct.

Complications
Complications in Chronic Pancreatitis:

-  Chronic pancreatitis can progress to pancreatic cancer. Though the risk is low, some individuals might develop it.

-  Chronic Pancreatitis can also cause pseudocyst. A pseudocyst is a collection of debris, blood, enzymes of the pancreas, tissue and fluids in the abdomen that is caused by any leaks of the digestive fluid that escaped from an irregular pancreatic duct. If these pseudocysts are infected, they might cause internal bleeding.

-  A case of chronic pancreatitis can take a toll on the mental health of the individual. They might develop depression, stress and/or anxiety. This is due to the constant pain caused by pancreatitis. To cope with this, the individuals can seek help from support groups and therapy.

Complications in Acute Pancreatitis:

-  Acute Pancreatitis can lead to the obstruction of the pancreatic duct or the bile

-  It might also cause the failure of the lung or heart of the individual, leading to death if left untreated

-  Acute Pancreatitis can also cause splenic vein thrombosis

-  Can cause pleural effusion

-  The pancreatic duct can have a leak

-  Can also cause Pseudocysts with the complications of an infection, haemorrhage and/or a rupture

Conclusion
Avoid heavy consumption of alcohol and fatty foods are one of the best ways to make sure your body and system are healthy and to avoid ailments like Pancreatitis. Treatment is extremely important in case of Pancreatitis as if left untreated, it can cause further complications.

LIFT (LIGATION OF INTERNAL FISTULA TRACT ) MININAL INVASIVE PROCEDURE FOR FISTULA IN ANO

What is Fistula in Ano?

A fistula-in-ano is an abnormal tract with an external opening in the perianal area that is communicating with the rectum or anal canal by an identifiable internal opening. Most fistulas are thought to arise as a result of cryptoglandular infection with resultantperirectal abscess.

Treatment of anal fistulas depends on their location and complexity. When considering surgery, the ultimate goal is to protect the sphincter muscle and prevent recurrence of an anal fistula. 

LIFT (ligation of internal fistula tract) technique is yet another approach in treating a fistula-in-ano.

The Technique

LIFT procedure is based on secure closure of the internal opening and removal of infected cryptoglandular tissue through the intersphincteric approach. The LIFT technique is often performed for complex or deep fistulas. The procedure allows surgeon to access the fistula between the sphincter muscles and avoid cutting them.

1. Minimally invasive procedure for fistula in ano
2. Very liitle risk of incontinence
3. Very little risk of recurrence
4. Safe and effective method of treatment
5. No need of repeated dressing
6. No scarring of tissue
7. Early return to work
8. Minimal pain