Pancreatic Diseases

The pancreas is a dual functioning gland of the digestive system made up of two types of cells: one produces digestive juices and the other releases hormones that help regulate blood sugar levels. 

The different diseases and disorders of the pancreas include:

Pancreatic Cancer

Pancreatic Cancer refers to the abnormal growth of pancreatic cells.

Most pancreatic cancers are formed in the cells that produce digestive enzymes, causing yellowing of the skin and whites of the eyes (jaundice), upper and middle abdominal pain, back pain, unexplained weight loss, appetite loss, fatigue, dark colored urine and light colored stools. You are at an increased risk of developing pancreatic cancer if you are a smoker, overweight, have diabetes, or have family history of pancreatitis (inflammation of the pancreas) or pancreatic cancer.

Pancreatic cancer can be diagnosed by reviewing your medical history and performing a thorough physical examination. Your doctor may order blood tests and other imaging tests such as MRI, CT scan, ultrasound, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiogram (PTC). Your doctor may also perform a biopsy to confirm the diagnosis.

Treatment involves surgery to remove the cancer cells completely. However, if the cancer is in advanced stages and has spread to other parts of the body, treatment involves managing symptoms for the best quality of life.

Pancreatic Cysts

Pancreatic cysts are sac-like pockets of fluid or semisolid matter made up of damaged tissue or debris located on or within the pancreas. They can be noncancerous (pseudo cysts) or cancerous (malignant). The cause of pancreatic cysts is often not very clear. Some cysts can result from a rare genetic disorder known as von Hippel-Lindau disease.

Pancreatic cysts can be asymptomatic or produce moderate to severe symptoms such as persistent and severe abdominal or back pain, bloating, nausea and vomiting. Complications of pancreatic cysts include infection, rupture of the pseudocyst or haemorrhage (bleeding) and high blood pressure of the splenic or portal vein.

Pancreatic cysts are diagnosed with imaging tests such as ultrasound, CT scan of the abdomen, MRI, magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Most often, pseudocysts resolve without the need for treatment. However, if your symptoms are severe and the cysts are growing larger, your doctor may recommend drainage of the cysts. The cysts may be drained through an endoscopy procedure where a long thin tube with a needle is inserted to drain the cyst, percutaneous catheter drainage (a hollow tube is inserted into the body) or surgical drainage through open (long incision is made on the abdomen) or laparoscopic (3 to 4 small incisions are made on the abdomen) techniques.

Pancreatitis

Inflammation of the pancreas leads to a condition called pancreatitis. Pancreatitis can be acute or chronic. Acute pancreatitis is usually a milder form of pancreatitis, characterized by sudden and severe abdominal pain. Other symptoms include fever, vomiting, nausea, sweating, swelling in the abdominal region, feeling of fullness due to gas, mild jaundice and clay-coloured stools.

Acute pancreatitis is most often caused by excessive intake of alcohol, genetic factors, autoimmune problems, blockage of the pancreatic duct or common bile duct, which drains digestive enzymes from the pancreas into the intestine, other conditions such as cystic fibrosis and certain medications such as oestrogens and corticosteroids. Acute pancreatitis affects men more often than women.

Acute pancreatitis is diagnosed by various laboratory tests that measure the levels of pancreatic enzyme and imaging techniques, such as CT scan, MRI and ultrasound, which indicate inflammation of the pancreas.

Treatment of acute pancreatitis is directed towards reducing the inflammation and treating the underlying cause of the condition. Mild cases may require hospital admission, where you will be given pain medication and intravenous fluids, and closely monitored for recovery from your symptoms. Your doctor will stop food and fluid through the mouth to limit the activity of the pancreas. In severe cases, antibiotics may be administered and surgery performed to remove the infected and damaged pancreas, and remove the obstruction blocking the pancreatic ducts.

Once there is improvement in your condition, you should completely avoid smoking, alcoholic drinks and fatty foods.

Pancreatic Insufficiency

Pancreatic insufficiency is a condition in which the pancreas fails to produce the required amount of digestive enzymes, which thereby affects the breakdown and absorption of food. This is mainly caused when the pancreas is damaged due to chronic inflammation, underlying pancreatic diseases, excessive alcohol consumption and surgeries that remove the pancreas. The major symptoms of pancreatic insufficiency include: 

  • Loose stools
  • Diarrhea
  • Steatorrhoea (high fat content in stools)
  • Abdominal pain or discomfort
  • Vitamin deficiencies
  • Loss of appetite
  • Weight reduction
  • Malnutrition

Pancreatic insufficiency can be diagnosed with a test that examines fat content in stools, blood tests to measure the amount of pancreatic enzymes, imaging tests to identify damage of the pancreas, and biopsy (sample of the tissue is removed and examined under the microscope) to examine the pancreatic tissue. 

Treatment for pancreatic insufficiency is determined based on the cause of the condition. The different treatments include pancreatic enzyme medication, a low-fat diet and anti-oxidants which prevent further damage of the organ. 

Pancreatic Necrosis

Pancreatic necrosis is a condition associated with the death of pancreatic tissue due to acute pancreatic inflammation (pancreatitis). This occurs due to excessive alcohol intake or blockage of the duct into which pancreatic juice empties (biliary tract). The necrotic tissue may get infected over a period of time if left untreated and cause serious complications such as formation of an abscess (collection of pus). The symptoms of pancreatic necrosis include: 

  • Pain, bloating or tenderness in the abdomen
  • Back pain
  • Fever
  • Nausea or vomiting
  • Rapid pulse

Your doctor can diagnose pancreatic necrosis by assessing your medical history and ordering blood tests to check for increased levels of white blood cells, and abnormal levels of liver and pancreatic enzymes. Imaging tests such as ultrasound, CT scan, MRI and endoscopic retrograde cholangiopancreatography (narrow tube with a camera is inserted through your mouth and extended into your stomach) may also be performed to view the pancreas and confirm diagnosis. 

Pancreatic necrosis can be treated with the help of medication including antibiotics, pain killers and intravenous fluids. Surgical treatment may be performed to drain the infection from the pancreas and place a drain to remove post-surgical infection. 

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