PANCREATITIS

The pancreas, located at the back of the abdomen, is an organ responsible for the production of digestive juices and the hormones insulin and glucagon which control blood sugars. Inflammation of the pancreas leads to a condition called pancreatitis. Pancreatitis can be acute or chronic.

ACUTE PANCREATITIS

Acute pancreatitis is characterized by sudden and severe abdominal pain that can radiate through to the back. Other symptoms may include fever, vomiting, nausea, sweating, swelling in the abdominal region and a feeling of fullness due to gas, jaundice (yellowish eyes and/or skin) and pale-coloured stools.

Acute pancreatitis affects men more often than women. It is most often caused by excessive intake of alcohol or the presence of gallstones however there are other rarer causes including genetic factors, autoimmune problems, certain medications and some medical procedures such as Endoscopic Retrograde Cholangiopancreatography (ERCP).

DIAGNOSIS

Acute pancreatitis is diagnosed by laboratory tests that measure the levels of pancreatic enzymes in the blood (amylase and/or lipase) as well as imaging investigations such as CT, MRI and ultrasound scans.

TREATMENT

The treatment of acute pancreatitis is directed towards supporting organ function during the inflammation while also treating the underlying cause of the condition. Mild cases may require hospital admission, where you will be given pain medication and intravenous fluids and closely monitored for recovery from your symptoms. In severe cases, treatment might need to occur in an intensive care unit where antibiotics may be administered and radiological or surgical procedures may be required.

If gallstones are thought to be the cause of the acute attack, then the gallbladder may need to be removed.

PANCREATIC CANCER

Pancreas cancer develops when normal pancreatic cells change into abnormal cells that grow without restriction. There are sometimes no symptoms present when pancreas cancer exists. If symptoms exist they can include pain, weight loss, diarrhoea or yellowing of the skin and eyes (jaundice). The urine can become very dark and the bowel motions very pale. It is important to remember that these symptoms can exist in people without cancer.

DIAGNOSIS

There are several tests that can be performed to determine whether a person has pancreatic cancer. These include a variety of blood tests, ultrasound, CT and/or MRI scans. Some tests require a procedure such as an Endoscopic retrograde cholangiopancreatography (ERCP), an Endoscopic Ultrasound (EUS) or a Percutaneous Transhepatic Cholangiogram (PTC). A biopsy (sample of tissue) is sometimes needed however is not always performed prior to surgery.

Once pancreas cancer is diagnosed, it is important to clarify if the cancer has spread. This is called cancer staging and will help work out what treatment will be the most beneficial. This may involve scans or a small operation called a laparoscopy.

TREATMENT

Treatments for pancreas cancer can include surgery, chemotherapy, radiation therapy or a combination of the above. Which treatment is appropriate depends on the extent to which the cancer involves structures around the pancreas such as blood vessels and whether the cancer has spread to other organs. Even if it is not possible to cure the cancer, there are always treatments that can help with symptoms.

PANCREATIC SURGERY

The pancreas is a gland located at the back of the abdomen. It produces several digestive enzymes and also plays a vital role in maintaining blood sugar levels.

There are many indications for pancreatic surgery however the most common reason is cancer or pre-cancerous problems. There is also a range of operations that are performed.

PANCREATODUODENECTOMY (WHIPPLE PROCEDURE)

A Whipple procedure removes the head of the pancreas along with several other adjacent organs including the gallbladder, duodenum, a part of the bile duct and sometimes a part of the stomach. The remaining bile duct, intestine, and pancreas are then reconnected so that enzymes and bile can flow back into the intestines. Infection, bleeding, diarrhoea, weight loss and diabetes are possible surgical complications of this procedure. You will be able to eat small amounts of food and may have to take medications to assist digestion.

DISTAL PANCREATECTOMY/RADICAL ANTEROGRADE MODULAR PANCREATECTOMY (RAMP)

If a tumour is located in the body or tail of the pancreas, it can be removed with either a Distal pancreatectomy or Radical Anterograde Modular Pancreatectomy (RAMP) depending on the severity of the disease. When compared to a Whipple procedure, it has a smaller risk profile and is usually associated with a shorter period of recovery.

CENTRAL PANCREATECTOMY

Sometimes only a central part of the pancreas is involved with a disease and a central pancreatectomy allows this region to be removed while leaving the remainder of the pancreas. This decreases the risk of diabetes and pancreatic exocrine insufficiency after the surgery. It is generally only performed for pre-cancerous lesions.