4 common disorders affecting the pancreas

4 common disorders affecting the pancreas

For an organ we rarely think about, the pancreas can have its share of problems. When troubles do arise, evaluating pancreatic disease can be difficult due to the inaccessibility of its location in the body.

What is the pancreas and what does it do?

The pancreas is a large gland which lies behind the stomach and is responsible for secreting digestive enzymes that are involved in the digestion of our food.  These digestive enzymes are collectively known as pancreatic juice and they join together with bile from the gallbladder - bile is made in the liver and stored in the gallbladder – to help break down food.  Both pancreatic juice and bile are carried to the small intestine through the pancreatic and common bile ducts.

Another very important function of the pancreas is to release the hormones insulin and glucagon into the bloodstream which keeps our blood sugar known as glucose regulated in the body.  Glucose is necessary to feed and supply energy to all the cells throughout the body.

The digestive enzymes are normally inactive in the pancreas and only become activated on entering the upper portion of the small intestine. In pancreatitis, the unreleased digestive enzymes become activated and begin to attack and do damage to pancreatic tissue.  In severe cases, the enzymes escape into the general circulation causing inflammation in distant organs. 

Three type of pancreatitis

A condition called pancreatitis is the medical term for when the pancreas becomes inflamed.  There can be many reasons why someone develops it and can result in various symptoms.  Pancreatitis may be acute, developing very suddenly and lasting for only a few days or it could be chronic pancreatitis in which case the condition can occur over many years.

There are three types of pancreatitis – acute, chronic, and hereditary.  Each type is considered serious and can lead to complications with severe cases leading to bleeding, infection, and permanent tissue damage.

Here’s an overview of each type:

1. Acute pancreatitis

Acute pancreatitis means the inflammation of the pancreas occurs suddenly and should resolve in a matter of days after treatment.  In the United States around 210,000 people are diagnosed with acute pancreatitis and about 75% to 85% of the cases are attributed to alcohol abuse or gallstones.

In women, a gallstone affecting the distal common bile-pancreatic duct is usually the reason while in men alcohol abuse is generally the cause.  There can be hereditary factors that can also contribute to pancreatitis.

Symptoms usually begin gradual or sudden and can include:

·      Excruciating pain in the left upper quadrant

·      Nausea and vomiting accompanying the attack

·      A swollen or tender abdomen

·      Fever

·      A rapid pulse

Diagnosing acute pancreatitis involves inquiring about the person’s medical history and conducting a thorough physical exam.  Blood tests will be ordered and one or more of the following tests may also be done – abdominal ultrasound, CT scan, endoscopic ultrasound or magnetic resonance cholangiopancreatography (MRCP).

The treatment for acute pancreatitis usually is a day or more stay in the hospital for intravenous fluids, antibiotics, and medication to rest the pancreas and relive pain.  No food or drink is allowed during this time.  Unless there are complications, acute pancreatitis should resolve in a few days.  There are restrictions to not smoke, drink alcoholic beverages, or eat fatty meals.

2. Chronic pancreatitis

Chronic pancreatitis is when persistent inflammation results in permanent structural damage with fibrosis and ductal structures. It is generally considered to be associated with alcohol consumption even though only 10% of heavy drinkers develop chronic pancreatitis.  Other factors are believed to also be at play such as smoking, hereditary pancreatitis, autoimmune pancreatitis, hyperparathyroidism, and obstruction of the main pancreatic duct.

Symptoms for chronic pancreatitis include the following:

·      Nausea and vomiting

·      Weight loss

·      Upper abdominal pain which may spread to the back and feel worse when eating or drinking

·      Diarrhea

·      Oily stools known as steatorrhea

Diagnosing chronic pancreatitis can be difficult as it is often confused with acute pancreatitis due to the similarity of symptoms. A review of medical history and a thorough physical exam along with blood tests, ultrasound of the abdomen, CT scan, and MRCP will also be conducted to make a definitive diagnosis.

The treatment may require hospitalization to manage pain, intravenous hydration and nutritional support.  Once a person is able to return to a normal diet, they may be prescribed pancreatic enzymes of the pancreas is not secreting any of its own. 

3. Hereditary pancreatitis

In some cases, pancreatitis is related to inherited abnormalities of the pancreas or intestine. Acute recurrent attacks of pancreatitis in early life (under age 30) can often progress to chronic pancreatitis. The most common inherited disorder that leads to chronic pancreatitis is cystic fibrosis. Recent research demonstrates genetic testing can be a valuable tool in identifying patients predisposed to hereditary pancreatitis.

As in chronic pancreatitis, hereditary pancreatitis is a progressive disease with a high risk of permanent problems. Patients with these disorders may have chronic pain, diarrhea, malnutrition, or diabetes. Treatment focuses on pain control and pancreatic enzyme replacement.

4. Pancreatic cancer

Pancreatic cancer is the fourth most common cause of cancer death in men and the fifth in women. It accounts for more than 37,000 new cases each year in the U.S. Cancer of the pancreas is resistant to many standard treatments including chemotherapy and radiation therapy. This cancer grows insidiously and initially does not cause symptoms. The classic presentation of pancreatic cancer is referred to as painless jaundice, a yellowish skin discoloration with no other symptoms. The diagnosis is usually made using different radiographic imaging techniques.

If detected in the early stages, pancreatic cancer can be cured by surgical resection. Unfortunately, early detection is more the exception than the rule. At later stages, treatment can improve quality of life by controlling symptoms and complications.

In conclusion

Being informed and knowledgeable about the symptoms and causes of common disorders of the pancreas is critical.  It can make the difference between getting a timely, accurate diagnosis to avoid and reduce complications or ignoring symptoms that could result in a much more serious and potentially life-threatening situation.