Pancreas

Patient Guide > Pancreas

Introduction

The pancreas is a spongy, tube-shaped organ about 6 inches long. It is located in the back of the abdomen, behind the stomach. The head of the pancreas is on the right side of the abdomen. It is connected to the duodenum, the upper end of the small intestine. The narrow end of the pancreas, called the tail, extends to the left side of the body.

The pancreas makes pancreatic juices and hormones, including insulin. Pancreatic juices, also called enzymes, help digest food in the small intestine. Insulin controls the amount of sugar in the blood. Both enzymes and hormones are needed to keep the body working right.

The common diseases of pancreas includes acute Pancreatitis, chronic Pancreatitis and cancer of pancreas.

Acute Pancreatitis

This disease occurs when the pancreas suddenly becomes inflamed and then gets better. Some patients have more than one attack but recover fully after each one. Most cases of acute pancreatitis are caused either by alcohol abuse or by gallstones. Other causes may be use of medicines, trauma or surgery to the abdomen. In rare cases, the disease may result from infections, such as mumps.

What Are the Symptoms of AP?

Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain is often severe. It may be constant pain, just in the abdomen, or it may reach to the back and other areas. The pain may be sudden and intense, or it may begin as a mild pain that is aggravated by eating and slowly grows worse. The abdomen may be swollen and very tender. Other symptoms may include nausea, vomiting, fever, and an increased pulse rate. The person often feels and looks very sick.

About 20 percent of cases are severe. The patient may become dehydrated and have low blood pressure. Sometimes the patient's heart, lungs, or kidneys fail. In the most severe cases condition worsens fast leading to shock and sometimes death.

How is AP Diagnosed?

During acute attacks, high levels of amylase & lipase (a digestive enzyme formed in the pancreas) are found in the blood. Changes may also occur in blood levels of calcium. Patients may have high amounts of sugar and lipids (fats) in their blood too. After the pancreas recovers, blood levels of these substances usually normalize.

How is AP Treated?

The treatment a patient receives depends on how bad the attack is. Unless complications occur, acute pancreatitis usually gets better on its own, so treatment is supportive in most cases. Usually the patient goes into the hospital. The doctor prescribes fluids by vein to restore blood volume. The kidneys and lungs may be treated to prevent failure of those organs. Other problems, such as cysts in the pancreas, may need treatment too. Sometimes a patient cannot control vomiting and needs to have a tube through the nose to the stomach to remove fluid and air. In mild cases, the patient may not have food for 3 or 4 days but is given fluids and pain relievers by vein. An acute attack usually lasts only a few days, unless the ducts are blocked by gallstones. In severe cases, the patient may be fed through the veins for 3 to 6 weeks while the pancreas slowly heals.

Antibiotics may be given if signs of infection arise. Surgery may be needed if complications such as infection, cysts, necrosis or bleeding occur. Attacks caused by gallstones may require removal of the gallbladder or surgery of the bile duct. Surgery is sometimes needed for the doctor to be able to exclude other abdominal problems that can simulate pancreatitis or to treat acute pancreatitis. When there is severe injury with death of tissue, an operation may be done to remove the dead tissue.

After all signs of acute pancreatitis are gone, the doctor will determine the cause and try to prevent future attacks. In some patients the cause of the attack is clear, but in others further tests need to be done.

What if the Patient Has Gallstones?

Ultrasound is used to detect gallstones and sometimes can provide the doctor with an idea of how severe the pancreatitis is. When gallstones are found, surgery is usually needed to remove them. When they are removed depends on how severe the pancreatitis is. If it is mild, the gallstones often can be removed within a week or so. In more severe cases, the patient may wait a month or more, until he/she improves, before the stones are removed. The CAT (computer axial tomography) scan may also be used to find out what is happening in and around the pancreas and how severe the problem is. This is important information that the doctor needs to determine when to remove the gallstones. After the gallstones are removed and inflammation subsides, the pancreas usually returns to normal.

CHRONIC PANCREATITIS:

Chronic pancreatitis is a long-standing inflammation of the pancreas that alters its normal structure and functions. It can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption.

Symptoms

Patients with chronic pancreatitis usually present with persistent abdominal pain or steatorrhea resulting from malabsorption of the fats in food (typically very bad-smelling and equally hard on the patient), as well as severe nausea. Diabetes is a common complication due to the chronic pancreatic damage and may require treatment with insulin. Some patients with chronic pancreatitis often look very sick, while others don't appear to be unhealthy at all.
Considerable weight loss, due to malabsorption, is evident in a high percentage of patients, and can continue to be a health problem as the condition progresses. The patient may also complain about pain related to their food intake, especially those meals containing a high percentage of fats and protein.

Causes

At least 70% of adult cases are caused by chronic alcohol use, and most patients have consumed more than 150 g/day of alcohol over six to twelve years. Some cases of chronic pancreatitis are of undetermined or idiopathic origin. A few are inherited or secondary to Sphincter of Oddi dysfunction (SOD). In up to one quarter of cases, no cause can be found. Cystic fibrosis is the most common cause of chronic pancreatitis in children. In some parts of the world, severe protein-energy malnutrition is a common cause.

Diagnosis

The diagnosis of chronic pancreatitis is typically based on tests on pancreatic structure and function, as direct biopsy of the pancreas is considered excessively risky.

Hereditary Pancreatitis (HP) is a rare genetic condition characterized by recurrent episodes of pancreatic attacks, which can progress to chronic pancreatitis. Symptoms include abdominal pain, nausea, and vomiting. Onset of attacks typically occurs between within the first two decades of life, but can begin at any age.

Treatment

The different treatment modalities for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery. Treatment is directed, when possible, to the underlying cause, and to relief of the pain and malabsorption. Diabetes may occur and need long term insulin therapy.

The abdominal pain can be very severe and require high doses of analgesics. Disability and mood problems are common, although early diagnosis and support can make these problems manageable.

Replacement of pancreatic enzymes are often effective in treating the malabsorption, steatorrhea and sometimes pain relief.

Surgery

Traditional Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.

Pain is one of the biggest problems that face patients with chronic pancreatitis and pancreatic cancer. Various options are available, but they are often provide limited relief and are of limited duration.

Pancreatic Cancer

Pancreatic cancer is the fourth or fifth leading cause of death due to cancer. Pancreatic cancer is difficult to detect, hard to diagnose, early to metastasize and resistant to treatment. At least three characteristics of pancreatic cancer contribute to the high mortality and short life expectancy. These characteristics are resistance of pancreatic cancer to chemotherapy and/or radiation therapy, marked muscle and fat wasting (chachexia) and rapid death from a relatively small tumor burden and early metastasis, occurring before detection by usual means. The synergistic interaction of these three features makes pancreatic cancer one of the deadliest of all cancers. Therefore, the early detection of pancreatic cancer is critical to the development of effective treatments.

Although scientists do not know exactly what causes cancer of the pancreas, they are learning that some things increase a person's chance of getting this disease. Smoking is a major risk factor.

Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms. If the tumor blocks the common bile duct and bile cannot pass into the digestive system, the skin and whites of the eyes may become yellow, and the urine may become darker. This condition is called jaundice.

As the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may become worse after the person eats or lies down. Cancer of the pancreas can also cause nausea, loss of appetite, weight loss, and weakness.

How is cancer of the pancreas diagnosed?

Usually Physical examination, tumour markers, some blood tests, CT scan of abdomen are initially done. ERCP (endoscopic retrograde cholangiopancreatogram), is a special x-ray of the common bile duct. For this test, a long, flexible tube (endoscope) is passed down the patient's throat through the stomach and into the small intestine. A dye is injected into the common bile duct, and x-rays are taken. The doctor can also look through the endoscope and take tissue samples. A tube can be inserted at the same time to relieve jaundice. Endoscopic ultrasound is a relatively new procedure that can be used to diagnose pancreatic cancer. Because the ultrasound probe is closer to the pancreas than with transabdominal ultrasound, it is possible to identify small cancers within the pancreas. The cancers also can be biopsied through the endoscope.

A biopsy is the only sure way for the doctor to know whether cancer is present. In a biopsy, the doctor removes some tissue from the pancreas. It is examined under a microscope by a pathologist, who checks for cancer cells.

How is cancer of the pancreas treated?

Treatment for pancreatic cancer depends on a number of factors. Among these are the type, size, and extent of the tumor as well as the patient's age and general health. A treatment plan is tailored to fit each patient's needs.

Cancer of the pancreas is curable only when it is found in its earliest stages, before it has spread. Otherwise, it is very difficult to cure. However, it can be treated, symptoms can be relieved, and the quality of the patient's life can be improved.

Pancreatic cancer is treated with surgery, radiation therapy, or chemotherapy. Surgery may be done to remove all or part of the pancreas. Sometimes it is also necessary to remove a portion of the stomach, the duodenum, and other nearby tissues. This operation is called a Whipple procedure. In cases where the cancer in the pancreas cannot be removed, the surgeon may be able to create a bypass around the common bile duct or the duodenum if either is blocked.

Radiation therapy (also called radiotherapy) uses high-powered rays to damage cancer cells and stop them from growing. The patient doesn't need to stay in the hospital for radiation therapy.

Radiation may be used as a way to kill cancer cells that remain in the area after surgery. In addition, radiation therapy can help relieve pain or digestive problems when the common bile duct or duodenum is blocked and surgery is not possible. Chemotherapy uses drugs to kill cancer cells. The doctor may use just one drug or a combination. Chemotherapy may be given by mouth or by injection into a muscle or vein.