Expert Pancreatitis Treatment in Bathinda — Dr. Raman Garg, Surgical Gastroenterologist

Pancreatitis — inflammation of the pancreas — is a serious condition that can range from mild and self-limiting to life-threatening with systemic complications. Dr. Raman Garg at Bombay Gastro & Cancer Institute, Bathinda has managed hundreds of cases of both acute and chronic pancreatitis with excellent outcomes. As a Surgical Gastroenterologist, Dr. Garg provides both medical management and surgical interventions for complicated pancreatitis — all under one roof in Bathinda.

What is the Pancreas and What Does It Do?

The pancreas is a gland behind the stomach that has two vital functions:

• Exocrine function: Produces digestive enzymes (amylase, lipase, protease) that are released into the duodenum to digest food
• Endocrine function: Produces insulin and glucagon (hormones) to control blood sugar

When pancreatitis occurs, the digestive enzymes are activated prematurely inside the pancreas itself — causing it to "digest itself" and become inflamed.

Types of Pancreatitis

Acute Pancreatitis

Sudden onset inflammation. Most cases (80%) are mild and resolve within a week with treatment. However, 20% develop severe pancreatitis with complications:

• Pancreatic necrosis (death of pancreatic tissue)
• Pseudocyst formation (fluid collection)
• Infected necrosis (pancreatic abscess)
• Multiorgan failure

Chronic Pancreatitis

Recurrent episodes of acute pancreatitis or ongoing inflammation causing permanent damage to the pancreas. Leads to:

• Chronic abdominal pain (often severe, requiring opioid pain relief)
• Exocrine insufficiency (malabsorption, steatorrhoea — fatty stools)
• Endocrine insufficiency (diabetes — pancreatogenic diabetes, Type 3c)
• Pancreatic duct strictures and stones
• Pseudocysts, biliary obstruction, portal hypertension
• Increased risk of pancreatic cancer

Causes and Risk Factors

• Gallstones (40–70%): Most common cause of acute pancreatitis — gallstone blocks the ampulla of Vater, triggering enzyme activation
• Alcohol (30%): Chronic alcohol use is the leading cause of chronic pancreatitis
• Hypertriglyceridaemia: Very high triglycerides (>1000 mg/dL) can cause acute pancreatitis
• Post-ERCP pancreatitis
• Autoimmune pancreatitis — responds dramatically to steroids
• Hereditary pancreatitis — genetic mutations (PRSS1, SPINK1, CFTR)
• Trauma
• Medications: Azathioprine, valproate, tetracyclines
• Idiopathic (10–15%): No identifiable cause

Symptoms

• Acute pancreatitis: Severe, sudden upper abdominal pain radiating to the back ("knife-like"). Nausea and vomiting. Fever. Abdominal tenderness. Elevated serum amylase and lipase (3× normal).
• Chronic pancreatitis: Recurrent or persistent upper abdominal pain (often severe). Oily, pale, foul-smelling stools (steatorrhoea). Weight loss. Diabetes. Jaundice (if bile duct compressed).

Pancreatitis Diagnosis

• Serum amylase and lipase: Elevated >3× normal = acute pancreatitis
• Abdominal ultrasound: Checks for gallstones (cause), pancreatic swelling, pseudocysts
• CECT abdomen (CT with contrast): Assesses severity, detects necrosis, complications
• MRI/MRCP: Detailed imaging of pancreatic and biliary ducts
• ERCP: Therapeutic for gallstone pancreatitis — clears bile duct stones Read more →
• Fecal elastase: Tests pancreatic exocrine function
• IgG4 levels: For autoimmune pancreatitis

Treatment

Acute Pancreatitis Management

• Hospitalisation and IV fluids: Aggressive IV hydration (Ringer's lactate) is the most important treatment — reduces severity and complications
• Pain management: IV opioid analgesics
• Nutritional support: Early oral/enteral feeding (within 24 hours) is preferred over bowel rest — improves outcomes
• Antibiotics: Only for infected necrosis — not routine
• ERCP for gallstone pancreatitis: Within 72 hours for severe cases with jaundice
• Laparoscopic cholecystectomy: After recovery from acute pancreatitis — prevents recurrence Read more →
• Drainage of pseudocysts/abscesses: Endoscopic or surgical
• Necrosectomy: Minimally invasive or open removal of infected pancreatic necrosis

Chronic Pancreatitis Management

• Alcohol abstinence: Absolutely essential — the most important intervention
• Pain management: Analgesics, NSAIDs, gabapentin, opioids (for severe pain); coeliac plexus block
• Pancreatic enzyme replacement therapy (PERT): Creon or other pancreatic enzymes with each meal — for exocrine insufficiency and steatorrhoea
• Diabetes management: Insulin for pancreatogenic diabetes
• Endoscopic therapy: ERCP for duct stones and strictures; pseudocyst drainage
• Surgery: Lateral pancreaticojejunostomy (Puestow procedure) for chronic pain with dilated duct; distal pancreatectomy for head-dominant disease

Frequently Asked Questions — Pancreatitis Bathinda