Pancreas Disease

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Pancreas Disease

The pancreas is called the " hidden organ " because it is located deep in the

abdomen behind the stomach. About six to eight inches long in the adult, the

organ contains thin tubes that come together like the veins of a leaf. These

tubes join to form a single opening into the intestine that is located just

beyond the stomach.

The pancreas produces juices and enzymes that flow through these tubes 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.

What Are the Diseases of the Pancreas?

A number of problems can occur in the pancreas. These include:

Diabetes mellitus

Acute pancreatitis

Chronic pancreatitis

Pancreatic enzyme deficiency

Pancreas tumor

Diabetes Mellitus

Many cases of diabetes are caused by a deficiency of insulin. Insulin is needed

to help glucose, which is a major source of energy, enter the body's cells. It

is not known why insulin-producing cells in the pancreas die off. When they

cease to function, glucose accumulates in the blood and eventually spills into

the urine. These patients require daily insulin injections. More importantly,

high blood glucose levels, over time, result in significant changes in blood

vessels in the eyes, kidneys, heart, legs, and nerves. Damage to these vital

organs represents the major risk for patients with diabetes.

Other patients who develop diabetes later in life seem to have sufficient

insulin in the pancreas, but for some unknown reason it is not available for the

body's use. These patients typically are overweight and, therefore, weight loss

is critical for them. In addition, oral medications can be taken that help

release insulin from the pancreas. All diabetics need to maintain normal or

near-normal blood glucose levels to prevent or delay the complications of this

disease.

Acute Pancreatitis

This condition occurs when the pancreas becomes quickly and severely inflamed.

The major causes are:

Heavy alcohol ingestion

Gallstones or gallbladder disease

Trauma

Drugs

High blood fats (triglycerides)

Heredity

Unknown factors

Binge alcohol drinking is a common cause of acute pancreatitis. Gallbladder

disease, especially where a gallstone becomes lodged in the main bile duct next

to the pancreas, also causes this condition. Accidents, such as the upper

abdomen hitting the steering wheel during a car accident, can cause

pancreatitis. Certain drugs, such as diuretics, can produce the disorder as can

extremely high blood fat levels (triglycerides). Heredity seems to play a role

since in some families the condition develops in several members of the family.

Finally, there are the occasional cases that occur for unknown reasons. In

pancreatitis, the digestive enzymes of the pancreas break out into the tissues

of the organ rather than staying within the tubes (ducts). Severe damage to the

pancreas then results.

Symptoms, Diagnosis, 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. A sound wave test (ultrasound) or abdominal

CT exam often shows an enlarged pancreas. The condition is treated by resting

the pancreas while the tissues heal. This is accomplished through 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. At

times, an ERCP (Endoscopic Retrograde CholangioPancreatography) test is

recommended. This involves passing a flexible tube through the mouth and down to

the small intestine. A small catheter is then inserted into the bile duct to see

if any stones are present. If so, they are then removed with the scope.

Course and Outcome

Most patients with this condition recover well, although a few, especially those

who have alcohol-induced pancreatitis, may become desperately sick. When

recovered, the patient needs to make life-style changes to prevent a recurrence.

For example, avoiding alcohol and drugs, reducing blood triglycerides, or having

gallbladder surgery.

Chronic Pancreatitis

This condition occurs mostly in alcoholics or people who repeatedly binge drink

alcohol. The main symptoms are recurrent, dull, or moderate pain without the

severe toxic features of acute pancreatitis. 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.

Diagnosis of this condition is made by measuring blood enzymes and by performing

abdominal CT, x-rays, and ultrasound exams. An ERCP endoscopic test is often

performed. In this test, a flexible endoscope is passed through the mouth into

the intestine while the patient is lightly sedated. A small plastic catheter is

inserted into the pancreas ducts and an x-ray dye is injected. The internal

anatomy of the pancreas can then be viewed by x-ray.

Occasionally a problem develops when the patient becomes dependent on, or even

addicted to, narcotic pain medicines used to control symptoms. In some cases,

surgery is recommended to provide relief of pain.

Pancreas Enzyme Insufficiency

Digestive enzymes from the pancreas are necessary to break down protein, fat,

and carbohydrates in foods that are ingested. When there is a deficiency of

these enzymes, nutrients are not broken down, resulting in malnutrition and

weight loss. This condition is called malabsorption because the intestine is

unable to absorb these vital nutrients.

The two major symptoms are diarrhea (frequently with fat droplets in the stool)

and weight loss. This condition can result from any cause of pancreatitis,

including trauma and infection. Pancreatic enzymes can be taken by mouth to

replace those that are no longer made by the pancreas.

Pancreatic Tumors

The pancreas, like most organs of the body, can develop tumors. Some of these

are benign and cause no problems. However, some benign tumors can secrete

hormones which, when present in high levels, have a detrimental effect. For

example, insulin can be secreted in excessive amounts and result in dangerously

low blood sugar levels (hypoglycemia). Another hormone, gastrin, can stimulate

the stomach to secrete its strong hydrochloric acid causing recurrent stomach

and peptic ulcers, with many complications. Fortunately, there is much that can

be done about these tumors.

Cancer of the pancreas is a serious malignancy which is difficult to treat. The

disorder occurs in middle- or older-aged people, with the first symptom 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. Surgery is the only effective form

of treatment for pancreas cancer.

Summary

The pancreas -- the quiet, hidden gland -- is vital to good health. It is

subject to a variety of problems, some of which result from the patient's own

actions. There are now effective ways to diagnose pancreatic conditions and, in

most cases, good treatment programs can be outlined by the physician.

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