Dr O’Kelly’s Story
Dr James O'Kelly is Guts UK's current pancreatitis research fellow. He shares a typical day in hospital as a surgical registrar.
Describe a typical day in hospital for you
I’m a surgical registrar, so when I’m on-call, I’ll do a run of 12 hour day/night shifts, where I work as part of the team responsible for emergency surgical admissions to hospital. Typically, the day will start with a handover from the night team, where we discuss those admitted during the night. This will then be followed by a ‘ward round’, where the team review every patient who has come in during that on-call week. As a registrar, I’ll then spend the rest of the day operating on patients with the consultant on-call. I’ll also review new admissions and sick patients, as well as helping my more junior colleagues.
Acute pancreatitis patients present to hospital as an emergency with severe abdominal pain. They come under the care of my team. In the hospital I work in, I would expect to admit a couple of patients with pancreatitis during an ‘average’ on-call week. The majority of patients will have a mild attack of pancreatitis. But 1 in 5 patients will become severely unwell and need to be treated in high dependency or intensive care.
Describe the crucial steps when a pancreatitis patient is admitted to hospital
The crucial first step is establishing the diagnosis. For most patients, a simple blood test will diagnose pancreatitis. A small proportion may need a CT scan either to confirm pancreatitis diagnosis or suggest another cause.
Next we administer strong painkillers to control their pain and we give fluid through a drip. During the first 48-72hrs, the heart rate, blood pressure, oxygen levels and how much urine a patient produces are all closely monitored. This is to see how the pancreatitis is responding, and identify patients developing severe pancreatitis, requiring more invasive monitoring and treatment in critical care.
Finally, we want to identify the underlying cause of the pancreatitis. The majority of UK cases are caused by alcohol or gallstones. Nowadays if a patient has gallstones, we aim to remove their gallbladder whilst they are in hospital to prevent another attack. In patients with severe pancreatitis, this will be delayed until they have recovered.
How many of your patients are aware they have pancreatitis?
For most patients, this will be their first attack of pancreatitis. Thankfully, we have a sensitive blood test allowing us to make diagnosis quickly for most patients. This means we can inform the patient and the family quickly that the diagnosis is pancreatitis.
A small proportion of patients will have more attacks of acute pancreatitis. There is a small number of patients with chronic pancreatitis, who can present with severe flares of pain, which requires admission to get on top of their symptoms.
For those with severe acute pancreatitis, how long can you expect patients to have to stay in hospital?
Severe pancreatitis is a horrible condition and can vary. Some patients may be in ICU for a few days, others for several months. The longer you are very unwell for, the longer the recovery afterwards will be.
Patients will lose weight and become physically weak. Physiotherapists will help patients build their strength back up, so they’re fit enough to leave hospital. However, it will be months before they are close to how they were before being admitted to hospital. Older patients may never fully regain their strength, so may require input from Occupational Therapy.
The big problem is that we don’t currently have any cures for pancreatitis. All we can do is support patients as their pancreatitis burns itself out. Guts UK are currently funding my research fellowship. This research that myself and the team are doing is so important. We hope it will lead to a much better understanding and new treatments in the future. Please donate to Guts UK to support this potentially life-saving research.
There is no effective treatment for pancreatitis. There is no cure.
Guts UK is the only UK charity funding a research fellowship into pancreatitis.
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