Definition & Overview
The pancreas is a 6-inch organ located in the upper abdomen behind the stomach. Its head is connected to the duodenum (the upper section of the small intestine) through the pancreatic duct while its tail extends to the left side of the body.
The pancreas serves two functions -- it produces enzymes that help the body digest the proteins, fats, and carbohydrates coming from the stomach before they eventually get absorbed by the intestine. It also makes hormones, particularly insulin that regulates the breakdown of sugar in the body.
Pancreatic problems arise when the pancreas start to deteriorate leading to its failure to effectively perform its job. Pancreatitis, the swelling of the pancreas, is the most common problem associated with this organ. When the pancreas becomes inflamed (from whatever cause), it leads to the swelling of nearby blood vessels, bleeding, infection and damage. This condition leads to the digestive juices (enzymes and hormones) being trapped in the pancreas and making them “digest” the pancreas itself.
Cause of Condition
As mentioned, pancreatitis is one of the most common conditions when the pancreas breaks down. Pancreatitis has two types – acute and chronic, and both involve the swelling and inflammation of the pancreas. Acute pancreatitis is the sudden inflammation of the organ and signaled by upper abdominal pain. The first attack usually lasts a short time and is relatively mild. Gallstones, which are small solid masses that form from bile, usually cause the inflammation in either the pancreas or the bile duct. However, other causes like alcohol, medications, heredity and infections also affect the ability of the pancreas to function fully.
Chronic pancreatitis, on the other hand, is the repetitive occurrence of acute pancreatitis. With acute pancreatitis, the pancreas gets a chance to return to its normal state when the attack dissipates. However, if the attack happens repeatedly, it becomes chronic pancreatitis, and this prevents the pancreas from returning to its normal state. Eventually, the damage worsens and may cause complications like pancreatic cancer, diabetes, pancreatic infection and kidney damage.
Acute pancreatitis is usually diagnosed when there is abdominal pain in the middle or upper left part of the abdomen. The pain may become more severe after eating or when lying flat on the back. Together with these indications, other symptoms include:
- Nausea and vomiting
- Rapid heartbeat
- If acute pancreatitis causes severe abdominal pain, there may be some skin discoloration around the belly button
Chronic pancreatitis may be initially diagnosed as acute pancreatitis since they have similar symptoms – upper abdominal pain and diarrhea. However, as the disease progresses, symptoms like the following may also be present:
- Bleeding (due to anemia)
- Liver problems (jaundice)
- Weight loss
- Inability to produce insulin
- Steatorrhea, where fatty stools give off a foul odor
Who to See & Types of Treatments Available
Patients with pancreatic problems are referred to gastroenterologists who specialize in the diagnosis, treatment, and management of diseases of the pancreas as well as esophagus, stomach, small intestine, gallbladder, liver, colon, bile ducts, and rectum. Patients who exhibit the symptoms listed above typically go through a physical examination to determine if there is a mass in the pancreas. Their medical and family history will likewise be assessed. Depending on the results, laboratory tests may also be performed including:
- Complete blood count (CBC)
- Pregnancy test
- Tests for electrolyte anomalies
If the tests are inconclusive, diagnostic imaging tests are the next step. They may include:
- Computed Tomography (CT) scan of the pancreas and abdomen
- Magnetic Resonance Imaging (MRI), which shows more detailed images of the abdomen
- Endoscopic retrograde cholangiopancreatography (ERCP) – a camera is attached to a flexible tube that is inserted into the mouth and advanced to the intestine to check the pancreas head.
- Ultrasound - helps examine the gallbladder and all other organs connected to the pancreas
Acute pancreatitis is ideally treated in a hospital setting. Doctors will recommend “bowel rest” for a few days to give the pancreas a chance to heal. This means no food or liquid intake by mouth so feeding will be done intravenously. In some cases, a nasogastric feeding tube may be required. It is a tube that is fed through the nose directly into the stomach. After a few days, most patients feel better. However, since an attack to the pancreas is now evident, extra care should be taken to avoid the recurrence of another. A healthy lifestyle must now be adapted, starting with a full halt on drinking of alcoholic beverages and minimizing the intake of fatty foods. It will also help the pancreas to always have soft foods and lots of liquids in the diet. People suffering from acute pancreatitis may regain full control of their pancreas if the cause of the inflammation is treated immediately, especially in the case of too much alcohol in the body or when there’s an infection.
Meanwhile, the treatment of chronic pancreatitis focuses on relieving pain without having to go to the hospital, unless the pain becomes severe and other symptoms arise. It also involves a lifestyle change to accommodate the requirement of the pancreas. Patients are encouraged to have a low-fat diet, with smaller but more frequent meals in a day. If there is a sudden attack, patients should initiate a bowel rest for a day but must take notice not to succumb to dehydration. If there is no change, medical care should be initiated.
Though most treatments for pancreatitis involve pain management and a healthy diet, there may be a need for surgery if the cause for the pancreatitis is gallstones. The removal of gallstones, and possibly the gallbladder, may relieve the pressure from the pancreas and reduce its swelling and inflammation.
References: * National Cancer Institute: “Pancreatic and Biliary Tract Cancers.” * The Ohio State University Medical Center: “The Pancreas: Anatomy and Functions.”