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The Pancreas

The Pancreas


Pancreatitis


Overview

Pancreatitis is inflammation of the pancreas, a gland that takes part both in the digestive and the metabolic process. It is located behind the stomach and close to the duodenum (or upper small intestine). The pancreas produces the metabolic hormones glucagon and insulin as well as other hormones and digestive enzymes. Pancreatitis occurs when the digestive enzymes are activated too early, in the pancreas itself rather than in the small intestine where activation normally happens. The enzymes then attack the pancreas and begin to eat away it.

This condition can either be acute (appearing suddenly) or chronic (developing more slowly over a long period of time). Mild acute cases may improve on their own without treatment, while severe and chronic cases will require medical care to avoid developing serious and sometimes fatal complications such as destruction of the pancreas and nearby tissues.


Symptoms

Acute pancreatitis is generally accompanied by pain in the upper abdomen that may spread to the back and chest. The pain may last for as long as a few days and be accompanied by a swollen and tender abdomen, fever, nausea, vomiting, sweating, and a rapid pulse. People experiencing acute attacks will feel and appear very sick. Extreme cases may also exhibit shock, dehydration, and low blood pressure.

Chronic pancreatitis is marked by intermittent abdominal pain, although some people experience no pain at all or, conversely, constant pain. In many cases the discomfort will lessen over time as the condition worsens and the body stops production of digestive enzymes. Other signs of chronic pancreatitis include weight loss, nausea, vomiting, fatty stools, and diabetes.


Causes and Risk Factors

Gallstones that block the pancreatic duct and trap digestive enzymes are frequently to blame in the development of acute cases of pancreatitis. Acute attacks may also be brought on by single or multiple instances of binge drinking.

Prolonged abuse of alcohol also is a primary cause of chronic pancreatitis. While it is unclear exactly how alcohol affects the pancreas, researchers believe that it may cause enzymes to build up in the pancreas or change the structure of the enzymes in a way that irritates and inflames the pancreas. Abdominal injuries can also lead to chronic pancreatitis.


Other risk factors include:

  • Increased blood levels of triglycerides and calcium
  • Viral infections such as the mumps
  • Cystic fibrosis
  • Some medications (including certain antibiotics, steroids, and anti-inflammatories)
  • Bacterial infections such as tuberculosis
  • A family history of pancreatitis

Diagnosis

Blood tests are used to diagnose acute pancreatitis, specifically by looking for elevated levels of pancreatic enzymes. Changes in white blood cells, liver enzymes, blood sugar and calcium are also signals that acute pancreatitis has developed. An ultrasound or computerized tomography (CT) scan of your abdominal region can confirm the diagnosis as well as look for gallstones, duct blockages, or damage to the pancreas.

Chronic pancreatitis is more difficult to diagnose since the disease progresses slowly and can be hard to distinguish from acute pancreatitis in some cases. Your doctor will most likely order blood and stool tests as well as an ultrasound of the abdomen and x-rays the bile and pancreatic ducts. A pancreatic function test might also be helpful in determining if the pancreas can still produce and secrete digestive enzymes.


Treatment

Acute pancreatitis will usually improve on its own, but in-hospital medical care is required to support bodily functions (such as replacing fluids), to prevent complications, and to control pain while the pancreas heals. In severe cases, intravenous feeding may also be necessary for three to six weeks following the attack. If gallstones are causing the pancreatitis, it will be necessary to treat those as well to avoid future attacks. It is important to seek medical care to avoid complications such as breathing problems, infection, and kidney failure.

Treatment for chronic pancreatitis usually involves pain management, enzyme therapy, dietary changes, and in some instances surgery (to remove a damaged part of the pancreas or to widen a narrow duct, for example). For cases that involved alcohol abuse, counseling to address the addiction is an important part of the process as the patient must abstain from alcohol in order to get better.



Pancreatic Insufficiency


Overview

Pancreatic insufficiency is a condition that occurs when the pancreas does not secrete enough digestive enzymes into the small intestine. This disrupts normal digestive process and, in severe cases, impairs the absorption of nutrients, leading to serious deficiencies.


Symptoms

Symptoms of pancreatic insufficiency include weight loss, diarrhea, abdominal cramping, and pale, greasy, foul-smelling stools, and high blood sugar.


Causes and Risk Factors

Pancreatic insufficiency usually results from damage to the pancreas, commonly found in patients with cystic fibrosis and chronic pancreatitis (or inflammation of the pancreas). Less commonly, pancreatic cancer can trigger the condition.


Diagnosis

In addition to taking a complete medical history and symptom inventory, blood and stool tests can be used to determine whether or not a patient suffers from pancreatic insufficiency based on enzyme and fecal fat levels. Other diagnostic tools include endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance choangiopancreatography (MRCP). These tools can be used to examine the pancreas and document any damage.


Treatment

When possible, the underlying cause of pancreatic insufficiency should be treated to alleviate this condition. Other treatment options include:

  • Pancreatic enzyme replacement therapy to support digestion and increase nutrient absorption
  • Vitamin and mineral supplements
  • A low-fat diet and nutritional counseling

In severe cases, a feeding tube may be necessary to halt weight loss and reverse nutritional deficiencies.

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