Inflammation of the pancreas (or pancreatitis) is one of the more common complaints related to the pancreas. For most patients this is often a relatively mild illness that may cause pain and tenderness in the upper abdomen. The pain can be quite disabling but may settle quickly.
Conversely, pancreatitis can be much more severe and potentially life threatening. One of the problems with the disease is the fact that it can be difficult to predict which patient will progress and develop severe disease. Additionally, this can happen relatively quickly and within the space of hours, multi-organ failure may be established and the outcome can be poor. The goal is being able to identify which patients are at risk and to engage in high acuity, supportive care before it is too late. Professor Gundara’s research interests involve answering this very question and he continues to investigate new and better ways of predicting disease severity toward better outcomes.
Following recognition of disease severity, it is important to identify what may have caused the episode of pancreatitis. Alcohol and gallstones are the most common causative agents for acute pancreatitis and this is often the focus of history and examination. Even a small amount of alcohol can induce the inflammatory cascade with abstinence being the only effective strategy to prevent future episodes. Gallstones are also very common in the community, so it is no surprise that they often to blame for the acute bout of pancreatitis. This occurs when stones escape the confines of the gallbladder and irritate the pancreas as they traverse the bile and pancreatic ducts. The only reliable way of mitigating this risk in future is by removing the gallbladder (and the stones within it). Yet another of Professor Gundara’s research interests involves identifying which patients with pancreatitis and also gallstones will truly benefit from having their gallbladder removed. Merely having both is not enough; we need to prove that the stones have traversed the ducts and irritated the pancreas. Interestingly we still do not have a good test for this. Experience and a dedicated interest in the field does help however.
In addition to gallstones and alcohol there are a myriad of other causes of pancreatitis and an experienced pancreatic specialist will be able to help you tease this out. Additional blood tests and scans may be requested to facilitate this with the overriding goal being identification and management of the causative agent.
