Pancreatic Disease

The pancreas is a narrow, flat organ about six inches long, with a head, middle, and tail section. It is located below the liver, between the stomach and the spine, and its head section connects to the duodenum. Inside the pancreas, small ducts (tubes) feed fluids produced by the pancreas into the pancreatic duct. This larger duct carries the fluids down the length of the pancreas, from the tail to the head, and into the duodenum. The common bile duct also runs through the head section of the pancreas, carrying bile from the liver and gall bladder into the small intestine. The bile duct and the pancreatic duct usually join just before entering the duodenum and so have a common opening into the small intestine.

The pancreas consists of two kinds of tissues:

  • Exocrine -- which make powerful enzymes to digest fats, proteins, and carbohydrates. The enzymes normally are created and carried to the duodenum in an inactive form, then activated as needed. Exocrine tissue also makes bicarbonates that work to neutralize stomach acids.
  • Endocrine -- which produce the hormones insulin and glucagon and release them into the blood stream. These hormones regulate glucose transport into the body's cells and are crucial for energy production.

Diseases of the Pancreas:

1. Pancreatitis: Pancreatitis is an inflammation of the pancreas. It is caused when the digestive enzymes from the exocrine pancreas become activated inside of the pancreas, instead of in the duodenum, and start "digesting" the pancreas itself. It usually presents with abdominal pain and can cause nausea and vomiting. Two Types of Pancreatitis

  • Acute pancreatitis : The most common cause of acute pancreatitis is blockage of the pancreatic duct by gallstones. Secretions can back up in the pancreas and cause permanent damage in just a few hours. Acute pancreatitis often presents with raised levels of pancreatic enzymes in the blood. The abdominal pain in acute pancreatitis is often severe. The disease may even lead to internal bleeding and infection and can be life-threatening.
  • Chronic pancreatitis: chronic or persistent abdominal pain and may or may not present with raised pancreatic enzymes. It develops gradually, often results in slow destruction of the pancreas. The main causes of chronic pancreatitis are gall bladder disease (ductal obstruction) and alcoholism. Other causes of chronic pancreatitis include cystic fibrosis, hypercalcemia, hyperlipidemia, some drugs, and autoimmune conditions.

2. Pancreatic Insufficiency : Pancreatic insufficiency is the inability of the pancreas to produce and/or transport enough digestive enzymes to break down food in the intestine and allow its absorption. occurs as the result of progressive pancreatic damage - It is most frequently associated with cystic fibrosis in children and with chronic pancreatitis in adults.

3. Pancreatic Cancer : Main Causes of Pancreatic cancer are chronic pancreatitis, and exposure to some industrial chemicals. Most (95%) pancreatic cancers are adenocarcinomas, developing in the exocrine tissues. Pancreatic cancer is very difficult to detect in the early stages because symptoms are either absent or nonspecific: abdominal pain, nausea, loss of appetite, and sometimes jaundice. Only about 10% of the cancers are still contained within the pancreas at the time of diagnosis.

Symptoms and Treatment:

The main symptoms of pancreatitis are acute, severe pain in the upper abdomen, frequently accompanied by vomiting and fever. The abdomen is tender, and the patient feels and looks ill. The diagnosis is made by measuring the blood pancreas enzymes which are elevated.

When pancreatitis is caused by gallstones, it is necessary to remove the gallstones. This is usually done after the acute pancreatitis has resolved. At times, an ERCP (Endoscopic Retrograde CholangioPancreatography) test is done.