Diseases of the Pancreas

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Diseases of the Pancreas

The pancreas is located in the abdomen. It lies behind the stomach, in front of

the spine, and is surrounded by the intestines and liver. The gland is

approximately six inches long and resembles a compressed bunch of grapes. Proper

pancreas function is essential for the production of a number of hormones and

digestive enzymes.

The Endocrine System: Insulin and Glucagon Production

The pancreas plays an important role in the endocrine system: it secretes

hormones and other chemical substances which are released into the bloodstream.

Specialized clusters of pancreatic cells, known as islet cells, produce a

variety of hormones, with each cluster specializing in the production of a

specific hormone. For example two hormones produced by these specialized cells

are glucagon and insulin. Glucagon breaks down glycogen in the liver, which

raises blood sugar levels. Insulin makes it possible for cells to use blood

glucose for energy. Thus, healthy pancreas function is necessary for maintaining

correct blood sugar levels.

Pancreas Function and the Digestive System

The digestive system is also affected by pancreas function. The gland secretes

pancreatic " juices, " which travel from the gland through a duct and into the

duodenum (the beginning of the small intestine). These juices contain enzymes

that are necessary for proper digestion.

Exocrine vs. Endocrine

When pancreas function is discussed, the terms exocrine and endocrine are used.

The endocrine system releases hormones into the bloodstream. The exocrine system

secretes substances and enzymes required for digestion into the small intestine.

Common Diseases of the Pancreas

When pancreas function is compromised, a number of possible health complications

can arise. The location of the gland, buried as it is in the abdomen, makes it

difficult to detect problems. Physical palpation of the gland is not possible,

so blood tests and diagnostic imaging are often needed to diagnose pancreatic

health difficulties. Health problems may include:

Pancreatitis is inflammation of the organ, and is often a source of pain.

Pancreatitis may have a number of causes, and can be acute or chronic,

hereditary or acquired. In some cases, pancreatitis can be fatal.

Pancreatic Cancer is the fifth leading cause of cancer deaths worldwide. The

disease has a high mortality rate, and treatment options are, at present,

limited. Diabetes and pancreatitis are considered to be risk factors.

Type 1 Diabetes occurs when insulin production either shuts down or is severely

reduced. The body is then unable to maintain appropriate blood sugar levels.

Type 2 Diabetes occurs when insulin production is normal, but the body's cells

no longer respond correctly to the hormone.

Cystic Fibrosis is a genetic disorder that causes the body to produce thick

mucus that interferes with both respiratory function and the exocrine system.

The mucus blocks the pancreas ducts, preventing digestive enzymes from reaching

the small intestine. This results in insufficient digestion and malnutrition.

The Inflamed Pancreas: Acute and Chronic Pancreatitis

Pancreatic enzymes play an important role in digestion. The enzymes travel to

the small intestine, where they break down protein, fats and other nutrients. If

pancreatic enzymes are unable to pass into the intestine, they begin to work on

surrounding tissue, resulting in an inflamed pancreas. An inflamed pancreas, or

pancreatitis, presents as both acute and chronic conditions.

Acute Pancreatitis

Acute pancreatitis affects over 80,000 people in the United States every year.

Sixty to eighty percent of these cases can be traced to two causes: gallstones

and alcohol damage. Gallstones can block central ducts, preventing digestive

enzymes from leaving the pancreas. Over time, alcoholism damages the gland and

hinders its ability to function.

Certain medications and infections can also trigger acute attacks of the

disease. In up to fifteen percent of cases, however, the cause of the

inflammation is unknown.

Acute Pancreatitis Symptoms and Diagnosis

One of the most common pancreatitis symptoms is upper abdominal pain. It often

radiates to the back and may last for several days. Although upper abdominal

pain is usually present, some people don't experience pain at all. Other

pancreatitis symptoms include fever, nausea and vomiting.

Hypoxia may occur as a result of pancreatitis. Hypoxia occurs when the body's

cells do not receive enough oxygen, and is usually treated by administering

oxygen through a facemask. Although rare, complications from an inflamed

pancreas can be fatal. Lung, kidney and heart failure may all occur in severe

cases.

Blood tests that measure levels of lipase and amylase may indicate inflammation.

Lipase and amylase are both pancreatic enzymes. If the pancreas function is

affected due to inflammation, tests for the two enzymes may be as high as three

times normal levels.

Ultrasound imaging is often used to detect duct-blocking gallstones. CT scans

can help detect signs of infection or damage to glandular tissue.

Treatment Options

For most acute attacks, pain management with analgesics is all that is required.

If infection causes the inflammation, treatment may include antibiotics. Surgery

may be required to remove gallstones, drain obstructed bile ducts or remove

fluid-filled cysts.

After treatment, alcohol abstinence is highly recommended. Heavy meals should

also be avoided, as they place greater demands on the pancreas to produce

digestive enzymes.

Chronic Pancreatitis

Chronic pancreatitis is a series of recurring inflammatory attacks that

gradually causes irreversible damage to the pancreas and surrounding tissue.

Alcoholism is the primary cause of chronic inflammation: between seventy to

eighty percent of cases can be traced to excessive, habitual alcohol

consumption. Damage caused by alcoholism takes years to develop: most chronic

pancreatitis symptoms don't appear until people are in their thirties or

forties.

While alcoholism is the primary cause of chronic inflammation, the condition can

be traced to other causes: cystic fibrosis, drugs, genetic disposition and

radiation therapy may all trigger the disease. In some cases, no cause can be

determined.

Without treatment, chronic inflammation gradually destroys the pancreas' ability

to function. Reduced digestive enzymes cause malabsorbtion of nutrients, leading

to both weight loss and poor quality bowel movements. If insulin-producing islet

cells are damaged, diabetes may develop. Chronic inflammation carries with it a

heightened risk of pancreatic cancer.

Chronic Pancreatitis Symptoms and Diagnosis

Chronic pancreatitis symptoms resemble those of an acute inflammatory attack,

but recur over time. Upper abdominal pain may become chronic, and may be

aggravated by eating or drinking.

Pancreatic enzyme tests are used to assess how much inflammatory damage the

gland has endured. Blood tests, urine analysis and stool samples can help

monitor advanced chronic inflammation and the disease's progress.

Ultrasound, CT scans and other diagnostic imaging tools can detect physical

problems associated with chronic inflammation, including calcification of the

pancreatic tissue (calcium deposits may build up in the gland, causing tissues

to harden).

Treatment Options

When alcoholism is the cause of the inflammation, complete abstinence from

alcohol is required. People suffering from alcoholism may need to seek therapy

or support groups to stop drinking. A low fat, high carbohydrate diet, which

requires fewer enzymes to digest, is recommended. If damage to the gland is

severe, enzyme supplements to aid digestion can be taken with meals. Surgical

options include draining blocked ducts, and in advanced cases, removal of a

portion of the gland.

Hereditary Factors

Heredity accounts for approximately one percent of pancreatitis cases. If

heredity is responsible for the disease, inflammation is likely to be chronic,

and to strike at relatively early ages. Hereditary inflammation also appears to

increase the likelihood of pancreatic cancer; by age seventy, forty percent of

people suffering from hereditary pancreatitis display some symptoms of cancer.

Type 1 and Type 2 Diabetes: An Overview

The pancreas produces insulin, a hormone that allows blood sugar to be used by

the body as a source of energy. If insulin production drops, or if the body

ceases to use the hormone properly, diabetes results.

Type 1 Diabetes, Blood Sugar, and the Pancreas

Type 1 diabetes, or juvenile diabetes, occurs when the pancreas no longer

produces sufficient insulin to allow blood sugar to be used as energy. A number

of conditions may cause the disease. The auto-immune system may mistakenly

perceive insulin-producing cells as a threat, for instance, or chronic

inflammation caused by pancreatitis may destroy insulin-producing cells.

Treatment requires the monitoring of daily blood sugar levels. A diabetic diet

must be followed, and regular injections of insulin are necessary to control and

use blood sugar.

Type 2 Diabetes and Insulin

Type 2, or adult onset, diabetes is the most common form of the disease,

accounting for ninety percent of all diabetic cases. Insulin is still produced,

but the body does not use the hormone correctly. Changing eating and lifestyle

habits can often control the disease.

Although once considered a disease of middle age, rates of the disease are

increasing among children and adolescents. Obesity and sedentary lifestyles have

been linked to the rise of the disease in children.

Diabetic Symptoms

Diabetic symptoms can be very subtle, and are often discounted. A large number

of type 2 diabetics are unaware they have a problem at all until blood tests

reveal abnormal results. Symptoms can include:

Chronic fatigue

Mood changes

Excessive thirst

Slow healing times

High infection rates

Blurry vision

Frequent urination.

Complications

If the condition is left untreated a wide range of diabetic complications are

possible. Blood sugar levels may rise or fall to dangerous levels, in extreme

cases leading to coma or death. High cholesterol, heart disease, kidney failure

and blindness have all been linked to damage caused by unregulated blood sugar

levels.

Childhood Onset Genetic Disorders: Cystic Fibrosis

Cystic fibrosis, or CF, is a genetic disease that affects the exocrine glands,

including the pancreas. Exocrine glands are responsible for controlling

perspiration, and the production of important digestive enzymes and the mucus

lubricating the respiratory tract. Cystic fibrosis causes exocrine glands to

malfunction, and thick mucus to develop in the lungs and pancreas, affecting

lung capacity and digestion.

CF can strike anyone, from any ethnic group, but people of Northern European

descent are at higher risk than other groups. The abnormal gene that causes

cystic fibrosis is quite common: as many as one in twenty people carry the

recessive gene. Like many other genetic disorders, only when both parents carry

the gene can cystic fibrosis develop in a child. Parents who both have the gene

have a 25 percent chance that their child will have CF.

Shortness of Breath and Other Cystic Fibrosis Symptoms

Cystic fibrosis symptoms vary among affected individuals. Some symptoms are more

common than others. No one individual experiences all symptoms. Shortness of

breath and other lung-related complications are extremely common, and most

people living with CF have some degree of digestive problems. Cystic fibrosis

symptoms include:

Shortness of breath

Persistent cough

Hyperhydrosis (excessive sweating)

Limited lung capacity

" Salty " skin

Wheezing

Abdominal pain

Pneumonia

Excessive appetite but little weight gain

Large, foul-smelling stools

Diarrhea.

Hyperhydrosis

Cystic fibrosis affects the exocrine glands, including the body's sweat glands.

Hyperhydrosis is the medical term for excessive sweating. One of the most common

tests for CF is a " sweat test, " that measures the amount of salt in

perspiration.

Exocrine Pancreatic Insufficiency

Most people with CF have a condition known as exocrine pancreatic insufficiency.

The pancreas becomes clogged with thick mucus, and cannot deliver enough

pancreatic enzymes to the digestive system. This hinders the ability to

adequately digest food, and may cause weight loss, excessive appetite, abdominal

pain and abnormal bowel movements.

Exocrine pancreatic insufficiency can be treated. Supplements of vitamins and

pancreatic enzymes are important for the promotion of normal growth. Often,

individuals with CF need to consume more calories than normal to ensure

sufficient absorption of fats and proteins.

Lung Capacity and Respiratory Treatment Options

Limited lung capacity and lung disease are high risk complications of cystic

fibrosis: lung disease is the most common cause of death amongst people with CF.

Chest physical therapy is a standard way to clear the lungs of mucus buildup in

the morning. A family member " drums " on the person's back with cupped hands. The

percussion loosens lung mucus. Lung infections, which worsen CF symptoms by

further reducing lung capacity, are treated with antibiotics.

Cancer of the Pancreas: An Overview

Pancreatic cancer accounts for two percent of all cancer cases in the United

States: every year 29,000 Americans are diagnosed with the disease. Despite its

low occurrence rate, it is the fifth leading cause of cancer deaths in the US.

A number of reasons account for the disease's high mortality rate. The gland is

well protected by surrounding organs, making it impossible to palpate. Symptoms

are vague, and can easily be mistaken for other diseases. In addition, symptoms

generally only develop after the disease has reached an advanced state.

Exocrine Adenocarcinomas

The most common type of tumor to develop in the pancreas is an adenocarcinoma.

An adenocarcinoma develops from the lining of a glandular organ. Most pancreatic

adenocarcinomas develop in the exocrine cells, which produce digestive juices.

Risk Factors

Anyone can develop cancer of the pancreas, but certain factors increase an

individual's risk levels. Risk factors include:

Smoking

Chronic Pancreatitis

Diabetes

Male

African American ethnicity.

Learn more about risk factors and types of pancreatic tumors on the Information

site.

Symptoms

As noted above, symptoms are vague, and can easily be mistaken for a number of

other diseases. Symptoms include:

Jaundice

Abdominal pain

Upper/middle back pain

Weight loss

Lack of appetite

Fatigue.

If a tumor is suspected, diagnostic imaging tools and a biopsy will be required

to attain a firm diagnosis. Further information can be found on our Symptoms

site.

The Whipple Procedure and Other Treatment Options

Treatment options depend on how early the tumor is detected. If the disease has

metastasized (spread to other organs), pain management and palliative care using

chemotherapy and radiation therapy are the only real options. If however, the

tumor is detected at an early stage, a number of surgical options exist. A

pancreatectomy, which removes either the entire gland or a portion of it, may be

performed.

A surgical option known as the Whipple procedure may also be used. The Whipple

procedure removes the broadest portion of the pancreas (the head), the gall

bladder, a portion of both the stomach and the small intestine, and the bile

duct. Enough of the pancreas remains to produce necessary digestive juices and

insulin.

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