Diseases of pancreas

Diseases Of Pancreas

What Is The Pancreas?

The pancreas is an organ present in the back of the abdomen behind the stomach and drapes over and in front of the backbone. It is a delicate yet complex organ that has two main functions. The pancreas produces several digestive enzymes, which help in the digestion of sugars, proteins and fats in our diet, breaking them into small molecules which are then absorbed into the bloodstream in the intestine. Pancreas also has small clusters of specialized cells which produce hormones to maintain stable blood glucose levels in the body- the most well-known of these is the hormone insulin, whose deficiency leads to diabetes.

Pancreas can be easily damaged by alcohol consumption leading to potentially life-threatening diseases such as pancreatitis. Chronic smoking can also cause injury to the pancreas leading to the development of pancreatic cancer.

Acute Pancreatitis

Overview

Acute pancreatitis is a sudden inflammation of the pancreas. It can develop quickly and trigger other complications. The most common causes are alcohol abuse and gall stones.

Signs and symptoms

Patients usually experience sudden pain in the centre of the abdomen, right below the breast bone. The pain is accompanied by vomiting, loss of appetite, rapid pulse, fever, breathlessness and sometimes, jaundice.

Causes and risk factors

Acute pancreatitis is mainly caused by alcohol abuse or gallstones. Occasionally auto-immune diseases, metabolic diseases, drug side-effects, and trauma can also cause acute pancreatitis.

Complications

Serious cases of acute pancreatitis face a risk of developing infections in the pancreas, obstruction in the bile duct or pancreatic duct, pseudocyst with a risk of rupture and internal bleeding, and splenic vein thrombosis. Heart, lung and kidney failure may also occur.

Diagnosis

To diagnose the condition, the doctor will require a patient’s medical history, a physical exam, a panel of blood tests, a chest X-ray, an abdominal ultrasound and an endoscopic retrograde cholangiopancreatography.

Treatment and Surgical Interventions

Treatment for a mild case of acute pancreatitis, where the risk of complications is low, focuses on relieving symptoms while allowing the body to repair the pancreas. This involves painkillers, intravenous fluids. In more severe cases of acute pancreatitis, tissue necrosis (death) has usually already occurred. This increases the risk of sepsis. Severe acute pancreatitis cases are treated with antibiotics, breathing assistance with a ventilator, surgical intervention to remove the necrosed tissue, and intravenous fluids to prevent dehydration and hypovolemic shock.

Prevention

Alcohol consumption is the biggest risk factor for acute pancreatitis. Repeated episodes of pancreatitis can develop if alcohol intake is not stopped.

Chronic Pancreatitis

Overview

Chronic pancreatitis is an inflammation of the pancreas which doesn’t subside or improve over a long-term period, leading to permanent damage. Calcium stones and cysts may develop, causing blockages in the bile and pancreatic ducts and other complications.

Signs and symptoms

The condition causes severe pain in the upper abdomen, diarrhoea, fatty stools, nausea, vomiting, shortness of breath, fatigue and unexplained weight loss. The patient may also experience fluid build-up in the pancreas, jaundice, internal bleeding and intestinal blockages as the disease progresses.

Causes and risk factors

The most common cause of chronic pancreatitis is long-term alcohol abuse. Pre-existing inflammatory bowel syndrome, chronic liver disease and primary biliary cholangitis are associated with an increased risk of chronic pancreatitis. Smoking and drinking also increase your risk of developing chronic pancreatitis.

Complications

Chronic pancreatitis can lead to complications like nutrient malabsorption, diabetes, and pseudocysts which can rupture and get infected.

Diagnosis

To diagnose the condition, the doctor will require the patient’s medical history, a physical exam, a panel of blood tests, a chest X-ray, an abdominal ultrasound and an endoscopic retrograde cholangiopancreatography.

Treatment and Surgical Interventions

Treatment for chronic pancreatitis focuses on reducing pain and improving digestive function. The patient is administered pain medication, insulin, artificial digestive enzymes and steroids as required. Some treatment programs use endoscopy to relieve pain and eliminate blockages. Surgical intervention is usually not required but may help patients with severe symptoms and complications.

Prevention

To prevent chronic pancreatitis, quit alcohol and tobacco consumption.

Pancreatic Duct Stones (Pancreatic Duct Calculi)

Overview

Pancreatic stones are hard, calcified deposits that occur in the pancreatic duct. Pancreatic duct stones are an indicator of chronic pancreatitis.

Signs and symptoms

Pancreatic stones may cause chills, fever, jaundice, nausea, upper abdominal pain and vomiting.

Causes and risk factors

Pancreatic duct stones are gallstones that have left the gallbladder and obstruct the pancreatic duct. This causes fluid build-up in the pancreas and the liver. Being overweight, of advanced age or eating a high cholesterol diet puts you at a higher risk for pancreatic duct stones.

Complications

Pancreatic duct stones can cause serious complications if left untreated, including cholangitis, jaundice and pancreatic necrosis.

Diagnosis

The condition is diagnosed based on patient medical history, a physical exam, and a panel of blood and imaging tests to identify the extent of pancreatitis and the location of the obstruction.

Treatment and Surgical Interventions

If the inflammation of the pancreas is mild, the issue may be resolved by replacing eating and drinking with IV fluids for a few days. In more severe cases, the stone is removed surgically or in an endoscopic procedure known as ERCP.

Prevention

Pancreatic duct stones are not entirely preventable; However, the risk can be managed by eating healthy, exercising and controlling your cholesterol levels.

Pancreatic Cancer

Overview

Pancreatic cancer occurs in the digestive juice producing tissues of the pancreas. Due to the location of the pancreas in the abdomen, pancreatic cancer may be difficult to detect and is often diagnosed in the later stages.

Signs and symptoms

Early pancreatic cancer doesn’t usually cause any symptoms. In the advanced stages, pancreatic cancer causes loss of appetite, unexplained weight loss, abdominal and lower back pain, blood clots and jaundice. The patient may also experience an enlarged gall bladder and dark urine output.

Causes and risk factors

The cause of pancreatic cancer is unknown. However, inherited gene mutations and acquired gene mutations are known risk factors for pancreatic cancer. Smoking increases your risk of pancreatic cancer.

Complications

As the tumor grows, it can involve surrounding organs, causing jaundice, vomiting, back pain.

Diagnosis

Early diagnosis of pancreatic cancer increases the chances of cure. The doctor will review the patient’s medical history, conduct a physical exam, a panel of blood tests, CT scans, and endoscopic ultrasound and if necessary, a biopsy of the tumor.

Treatment and Surgical Interventions

Pancreatic cancer is difficult to cure as it is usually diagnosed at late stages. There are two surgical procedures performed to remove a cancerous tumour in the pancreas depending on the location of the tumor. A whipple procedure is used when the tumor is in the head region of the pancreas, while a distal pancreatectomy is used when the tumor is in the tail region of the pancreas.

Prevention

To reduce your risk of developing pancreatic cancer, quit smoking. Reducing your alcohol intake and maintaining a healthy weight are also recommended.

Pancreatic Cysts

Overview

Pancreatic cysts are fluid-filled sacs present within the pancreas. Pancreatic cysts are usually found during imaging tests to treat other conditions. Pancreatic cysts are of two types based on their potential to become cancerous– neoplastic cysts and non-neoplastic cysts. Most pancreatic cysts are not cancerous and develop as complications of inflammation in the pancreas (pancreatitis).

Signs and symptoms

Pancreatic cysts may cause persistent abdominal pain, nausea, vomiting, weight loss, and bloating. Sometimes, the cyst may become infected and cause fever as well.

Causes and risk factors

The cause of pancreatic cysts is unknown. Some are caused by rare illnesses like Polycystic kidney disease or von Hippel-Lindau disease. Acute or chronic inflammation of the pancreas (Pancreatitis) or abdominal trauma increases your risk of developing pancreatic cysts.

Complications

The risk of complications increases as the size of the pancreatic cyst increases. Cysts may rupture, get infected, have interval bleeding or press on surrounding organs, causing pain, vomiting or jaundice.

Diagnosis

Most pancreatic cysts are diagnosed incidentally during abdominal scans for other conditions. The doctor will also consider the patient’s medical history and a physical exam. A biopsy may also be required to rule out a malignancy.

Treatment and Surgical Interventions

Small benign cysts can be left untreated as long as they are being monitored. Very large cysts may be drained endoscopically or through the skin. Cysts with a risk of cancer may require surgical removal.

Prevention

The key strategy to pancreatic cyst prevention is to avoid pancreatitis. This can be done by avoiding alcohol consumption and gallstones.

Neuroendocrine Tumor

Overview

Neuroendocrine tumours are cancers that begin in the specialised neuroendocrine cells in the pancreas. There are many types of neuroendocrine tumours, and they progress at different paces. These tumours cause a change in the patient’s hormone levels and can cause symptoms unrelated to the organ involved.

Signs and symptoms

Neuroendocrine tumours cause a lump in the abdomen along with pain, fatigue and unintended weight loss. The hormones produced in these tumors may cause diarrhoea, dizziness, frequent urination and increased thirst.

Causes and risk factors

Cause of neuroendocrine tumours is unknown, though there appears to be a genetic link. The risk is higher in patients with genetic diseases like von Hippel-Lindau disease, tuberous sclerosis, neurofibromatosis.

Complications

The most significant complication associated with neuroendocrine tumours is metastases, where the tumors can spread to other organs such as the liver. Once such a spread occurs, a complete cure is more difficult to obtain.

Diagnosis

Neuroendocrine tumours are diagnosed based on a physical exam, a patient medical history, a panel of blood and urine tests, imaging tests and a biopsy.

Treatment and Surgical Interventions

The treatment for neuroendocrine tumours depends on the type of tumour, the size and number of tumours in the pancreas. One of the most common treatments is the surgical removal of the tumours. Radiofrequency ablation, hormone therapy, radiation therapy, chemotherapy, embolization therapy and liver transplantation have also proven effective against neuroendocrine tumours especially in advanced cases.

Prevention

As the cause of the condition is unknown, neuroendocrine tumours cannot be prevented.

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