Diseases of the Pancreas
The pancreas is one of the most important organs in the human body. It plays an important in producing digestive enzymes and certain hormones such as insulin. It is one of the major organs studied in gastroenterology/gastroenterological surgery since we encounter different complicated disease entities related to it. The most important of which is inflammation of the pancreas, which results in either acute or chronic pancreatitis.
Patients with acute pancreatitis usually present with sudden severe episodes of upper abdominal pain, typically reduced by leaning forward, vomiting etc. It usually develops secondary to heavy alcohol consumption, gallstones or other rare causes, including drugs, smoking, medical interventions like ERCP or hereditary causes. The symptoms may last for a couple of days. To diagnose it; two of the following three are required:
- Typical abdominal pain
- Threefold or more elevation of pancreatic enzymes in blood tests
- Inflammation of the gland demonstrated on a CT or MRI scan.
The severity can range from mild to severe, even life-threatening. Treatment depends on the severity, and the most important parts are hydration with intravenous fluids and appropriate pain management. The patient may be asked to fast until the pain subsides. There are certain procedures/surgeries which may be needed in certain cases, like removing gall stones in gall stone related pancreatitis or draining fluid collections around the pancreas (Pseudocysts). Once recovered, the patient should abstain from alcohol and smoking, drink plenty of fluids, eat more fresh fruits and vegetables and be on a low-fat diet.
Chronic pancreatitis occurs when the inflammation of the pancreas occurs over the years. Here too, patients have long-standing abdominal pain and might have unintentional weight loss, diabetes and passage of greasy stools. The most common causes are alcohol, hereditary causes and blockage of the pancreatic duct with stones or strictures. In addition to pain management, patients might have to be treated with enzyme supplements to help properly digest food. They may have diabetes which needs to be properly treated.
Pancreatic cancer is seldom detected early since it does not produce any symptoms at early stages. Some well-known risk factors are smoking and obesity. Patients may complain of unintentional weight loss, abdominal pain, yellowish discolouration of eyes, generalized body itching, or passage of tea-coloured urine. The main investigation for diagnosis and staging is a CT scan of the abdomen, but other investigations may be required. Depending on the stage, we can decide on removing cancer surgically (Tumor resectability). The patient needs to undergo a complicated surgery if it is resectable. Suppose there is a widespread tumour. The patient may need to be treated with chemotherapy or radiotherapy, or both.