The pancreas produces juices and enzymes that flow into the intestine, where they mix with food. The enzymes digest fat, protein, and carbohydrates so they can be absorbed by the intestine. Pancreatic juices, therefore, play an important role in maintaining good health. The pancreas also produces insulin, which is picked up by the blood flowing through the organ. Insulin is important in regulating the amount of sugar, or glucose, in the blood.
A number of problems can occur in the pancreas. These include the following:
ACUTE PANCREATITIS:
Acute pancreatitis occurs when the pancreas becomes quickly and severely inflamed. The digestive enzymes of the pancreas then leak into the tissues of the organ itself, rather than staying within the tubes (ducts) that normally transfer these enzymes to the safety of the small intestine. This results in severe damage to the pancreas.
There are a number of causes of acute pancreatitis, including the following:
The main symptoms of acute pancreatitis are sudden, severe pain in the upper abdomen, frequently accompanied by vomiting and fever. The abdomen is tender and the patient feels and looks ill.
The first step towards diagnosis of acute pancreatitis is a clinical history and physical exam. A suspected diagnosis of acute pancreatitis will be confirmed after blood tests measuring pancreatic enzymes are drawn and show abnormally elevated levels. An abdominal ultrasound or CT can also indicate pancreatitis by showing the enlargement of the pancreas.
The condition is treated by resting the pancreas while the tissues heal. This is accomplished thorough bowel rest, hospitalization, intravenous feeding, and pain medications. When pancreatitis is caused by gallstones, it is necessary to remove the gallbladder. This is usually done after the acute pancreatitis has resolved.
Chronic Pancreatitis:
Chronic pancreatitis is long-standing inflammation of the pancreas without improvement that leads to permanent changes in the organ’s normal structure and functions over time.
Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. This condition occurs mostly in alcoholics or people who repeatedly binge drink alcohol. Genetics may be a factor in some cases. In other cases, the cause is not known.
The main symptoms of chronic pancreatitis are recurrent, dull, or moderate pain with possible nausea, vomiting, weight loss, and diarrhea. Chronic pancreatitis does not display the severe toxic features of acute pancreatitis.
The first step towards diagnosis of chronic pancreatitis is a clinical history and physical exam. A suspected diagnosis of chronic pancreatitis will then require blood tests measuring pancreatic enzymes. Additionally, an abdominal CT, x-rays, and/or ultrasound exam is often preformed. An endoscopic retrograde cholangiopancreatography (ERCP) can be utilized to view the internal anatomy of the pancreas.
Treatment consists of rest, medication, and certain food restrictions. Alcohol consumption is absolutely prohibited. However, in cases where damage is extensive, chronic pancreatitis and pain can occur even when alcohol consumption has stopped. In some cases, surgery is recommended to provide relief of pain.
Pancreatic Enzyme Insufficiency
Pancreatic enzyme insufficiency is the under-production of digestive enzymes from the pancreas used to break down proteins, fats, and carbohydrates in food. The under-production of pancreatic enzymes means that these nutrients are not broken down, resulting in malabsorption, the inability to absorb vital nutrients.
This condition can result from pancreatitis, pancreatic surgery, or a few genetic diseases, including cystic fibrosis and Shwachman-Diamond syndrome.
Symptoms of pancreatic enzyme insufficiency include:
The first step towards diagnosis of pancreatic enzyme insufficiency is a clinical history and physical exam. A stool test is often collected and analyzed for high fat content (stetorrhea), which is a sign of malabsorption. Blood work for malabsorption will also be run. Many possible additional tests are similar to those preformed to check for pancreatitis, including CT, x-ray, and abdominal ultrasound.
Pancreatic enzymes can be taken by mouth to replace those that are no longer made by the pancreas.
Pancreatic Cancer
Cancer of the pancreas is a serious malignancy which is difficult to treat. The most common, pancreatic adenocarcinoma, starts in the part of the pancreas that produces digestive enzymes. Less commonly, a neuroendocrine tumor can arise from the hormone-producing part of the pancreas.
Pancreatic cancer is fundamentally a disease caused by damage to the DNA. This damage can be inherited, it can be the result of personal behavior and exposure to carcinogens, or it can be the result of a chance mutation. The exact causes of pancreatic cancer are unknown, but important risk factors include cigarette smoking, age, race, gender, chronic pancreatitis, diabetes, and diet.
The first symptom of pancreatic cancer is often being dull pain in the upper abdomen that may radiate into the back. At times, skin jaundice occurs when the bile duct, which carries yellow bile from the liver and through the pancreas, is blocked. As the cancer grows, symptoms may include pain in the upper abdomen or upper back, jaundice, weakness, loss of appetite, nausea and vomiting, and weight loss.
In the early stages pancreatic cancer is extremely difficult to detect because there are no symptoms. If a mass is seen on a CT or MRI exam, the diagnosis of pancreatic cancer is confirmed by an ERCP (Endoscopic Retrograde CholangioPancreatography) or an EUS (Endoscopic UltraSound) with percutaneous needle biopsy of the mass tissue.
Surgery is the only effective form of treatment for pancreatic cancer. If pancreatic cancer seems very likely, and the tumor appears removable by surgery, doctors may recommend surgery without a biopsy.
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