COMMON DISORDERS OF THE PANCREAS
There
are a variety of disorders of the pancreas including acute pancreatitis, chronic pancreatitis, hereditary pancreatitis, and pancreatic cancer.
The
evaluation of pancreatic diseases can be difficult due to the inaccessibility
of the pancreas. There are multiple methods to evaluate the pancreas. Initial
tests of the pancreas include a physical examination, which is difficult since
the pancreas is deep in the abdomen near the spine. Blood tests are often
helpful in determining whether the pancreas is involved in a specific symptom
but may be misleading. The best radiographic tests to evaluate the structure of
the pancreas include CAT (computed tomography) scan, endoscopic ultrasound, and
MRI (magnetic resonance imaging). Tests to evaluate the pancreatic ducts
include ERCP (endoscopic retrograde cholangiopancreatography) and MRCP(magnetic
resonance cholangiopancreatography). There are also instances in which surgical
exploration is the only way to confirm the diagnosis of pancreatic disease.
Acute Pancreatitis
Acute
pancreatitis is a sudden attack causing inflammation of the pancreas and is
usually associated with severe upper abdominal pain. The pain may be severe and
last several days. Other symptoms of acute pancreatitis include nausea,
vomiting, diarrhea, bloating, and fever. In the United States, the most common
cause of acute pancreatitis is gallstones. Other causes include chronic alcohol
consumption, hereditary conditions, trauma, medications, infections,
electrolyte abnormalities, high lipid levels, hormonal abnormalities, or other
unknown causes. The treatment is usually supportive with medications showing no
benefit. Most patients with acute pancreatitis recover completely.
Chronic Pancreatitis
Chronic
pancreatitis is the progressive disorder associated with the destruction of the
pancreas. The disease is more common in men and usually develops in persons
between 30 and 40 years of age. Initially, chronic pancreatitis may be confused
with acute pancreatitis because the symptoms are similar. The most common
symptoms are upper abdominal pain and diarrhea. As the disease becomes more
chronic, patients can develop malnutrition and weight loss. If the pancreas
becomes destroyed in the latter stages of the disease, patients may develop
diabetes mellitus.
The
most common cause of chronic pancreatitis in the United States is chronic
alcohol consumption. Additional causes include cystic fibrosis and other
hereditary disorders of the pancreas. For a significant percentage of patients
there is no known cause. More research is needed to determine other causes of
the disease.
The
treatment for chronic pancreatitis depends on the symptoms. Most therapies
center on pain management and nutritional support. Oral pancreatic enzyme
supplements are used to aid in the digestion of food. Patients who develop
diabetes require insulin to control blood sugar. The avoidance of alcohol is
central to therapy.
Hereditary Pancreatitis
In
some cases, pancreatitis is related to inherited abnormalities of the pancreas
or intestine. Acute recurrent attacks of pancreatitis early in life (under age
30) can often progress to chronic pancreatitis. The most common inherited
disorder that leads to chronic pancreatitis is cystic fibrosis. Recent research
demonstrates genetic testing can be a valuable tool in identifying patients
predisposed to hereditary pancreatitis.
As
in chronic pancreatitis, hereditary pancreatitis is a progressive disease with
a high risk of permanent problems. Patients with these disorders may have
chronic pain, diarrhea, malnutrition, or diabetes. Treatment focuses on pain
control and pancreatic enzyme replacement.
Pancreatic Cancer
Pancreatic
cancer is the fourth most common cause of cancer death in men and the fifth in
women. It accounts for more than 37,000 new cases per year in the United
States. Cancer of the pancreas is resistant to many standard treatments
including chemotherapy and radiation therapy. This cancer grows insidiously and
initially does not cause symptoms. The classic presentation of pancreatic
cancer is referred to as painless jaundice, a yellowish skin discoloration with
no other symptoms. The diagnosis is usually made using different radiographic
imaging techniques.
If
detected in the early stages, pancreatic cancer can be cured by surgical
resection. Unfortunately, early detection is more the exception than the rule.
At later stages, treatment can improve the quality of life by controlling
symptoms and complications.
