What is the Pancreas?
   

SINGLE INCISION LAPAROSCOPIC PANCREAS SURGERIES

- The pancreas is a gland organ that is located in the abdomen.

 

- It is part of the digestive system and produces important enzymes and hormones that help break down foods.

 

- The pancreas has an endocrine function because it releases juices directly into the bloodstream, and it has an exocrine function because it releases juices into ducts.

- Enzymes, or digestive juices, produced by the pancreas are secreted into the small intestine to further break down food after it has left the stomach.

 

- The gland also produces the hormone insulin and secretes it into the bloodstream in order to regulate the body's glucose or sugar level.

What are the problems associated with the Pancreas?

 

  • Pancreatitis

 

- Pancreatitis is a disease characterized by acute or chronic inflammation of the pancreas.

- Inflammation can occur if the main duct from the pancreas is blocked by a gallstone or tumor.

- This blockage results in pancreatic juices accumulating in the organ, which may damage the pancreas or lead to the

   pancreas actually digesting itself.

- Pancreatitis is also known to be a complication associated with mumps, alcohol use, steroids, trauma, and drugs.

 

  • Pancreatic Cancer

 

- It is also possible for cancer to develop in the pancreas.

- While difficult to diagnose the reason, often linked to smoking or heavy drinking.

- Other risk factors include diabetes, chronic pancreatitis, liver problems, and stomach infections.

- Pancreatic cancer is also more common in men than women and among African-Americans than among whites.

- Symptoms of pancreatic cancer may not appear until the cancer is in advanced stages - often too late for successful

   treatment.

Signs & Symptoms

 

  • Acute Pancreatitis

    • Upper abdominal pain that radiates into the back; it may be aggravated by eating, especially foods high in fat.

    • Swollen and tender abdomen

    • Nausea and vomiting

    • Fever

    • Increased heart rate

 

  • Chronic Pancreatitis

    • The symptoms of chronic pancreatitis are similar to those of acute pancreatitis.

    • Patients frequently feel constant pain in the upper abdomen that radiates to the back.

    • In some patients, the pain may be disabling.

    • Other symptoms are weight loss caused by poor absorption (malabsorption) of food. This malabsorption happens because the gland is not releasing enough enzymes to break down food.

    • Also, diabetes may develop if the insulin-producing cells of the pancreas are damaged.

 

  • Pancreatic Cancer

     

    Within the Pancreas

    • Pancreatic cancer in the body or tail of the pancreas usually causes

      • Belly pain

      • Back pain

      • Weight loss

    • Pancreatic cancer in the head of the pancreas tends to cause symptoms such as:

      • Weight loss

      • Jaundice (yellow skin)

      • Dark urine

      • Light stool color

      • Itching

      • Nausea

      • Vomiting

      • Abdominal pain

      • Back pain

      • Enlarged lymph nodes in the neck

    • Pancreatic Cancer and Digestive System

      • Urine may become darker

      • Pale-colored stools

      • Diarrhea

      • Nausea

      • Bloating and uncomfortable swelling in abdomen

      • Dull ache in the upper abdomen radiating to the back. The pain may come and go.

    • Pancreatic Cancer and the Whole Body

      • Weight loss

      • Malaise

      • Loss of appetite

      • Elevated blood sugars, possibly Diabetes

    • Pancreatic Cancer and Skin

      • Jaundice

      • Dark urine

      • Light-colored stools.

      • Itching

 

  • Rare Pancreatic Cancers

    • Islet cell tumors, also called neuroendocrine tumors

      • Account for only 1.5% of all pancreas tumors

      • Abdominal pain

      • Weight loss

      • Nausea

      • Vomiting.

    • Hormones released by an islet cell tumor can also cause symptoms:

      • Insulinomas (excess insulin)

        • Sweating

        • Anxiety

        • Lightheadedness

        • Fainting from low blood sugar

      • Glucagonomas (excess glucagon)

        • Diarrhea

        • Excessive thirst or urination

        • Weight loss

      • Gastrinomas (excess gastrin)

        • Abdominal pain

        • Non-healing stomach ulcers

        • Reflux

        • Weight loss

      • Somatostatinomas (excess somatostatin)

        • Diarrhea

        • Weight loss

        • Abdominal pain

        • Foul-smelling fatty stools

      • VIPomas (excess vasoactive intestinal peptide)

        • Abdominal cramping

        • Watery diarrhea

        • Facial flushing

 

How do you know if it’s something to worry about?

 

  • Severe belly (abdominal) pain with vomiting that does not go away after a few hours, or mild to moderate pain that does not improve with home treatment after a couple of days.

 

  • Pancreatitis can be a severe, potentially life-threatening illness. It is not appropriate to take a wait-and-see approach. If you have severe pain in the upper area of the abdomen that does not go away in a few hours, seek medical advice.

 

How are Pancreas diseases diagnosed?

 

  • Pancreatitis

 

- Chronic pancreatitis is best diagnosed with tests that can evaluate the structure of the pancreas via radiography (x-ray

  exams)—blood tests are generally not helpful for making the diagnosis of chronic pancreatitis. As with acute pancreatitis,

  a doctor will conduct a thorough medical history and physical examinations.

 

- Trans-abdominal ultrasound: sound waves are sent toward the pancreas via a handheld device that a technician glides

  over the abdomen. The sound waves bounce off the pancreas, gallbladder, liver, and other organs, and their echoes

  generate electrical impulses that create an image—called a sonogram—on a video monitor. If gallstones are causing

  inflammation, the sound waves will also bounce off of them, showing their location.

 

- Endoscopic ultrasound: after spraying a solution to numb the patient’s throat, the doctor inserts an endoscope—a thin,

  flexible, lighted tube—down the throat, through the stomach, and into the small intestine. They then turn on an ultrasound

  attachment to the endoscope, which produces sound waves to create visual images of the pancreas and bile ducts.

 

- Magnetic resonance cholangiopancreatography (MRCP): MRCP uses magnetic resonance imaging (MRI), a non-invasive

  procedure that produces cross-section images of parts of the body. After being lightly sedated, the patient lies in a

  cylinder-like tube. The technician injects dye into the patient’s veins, which helps show the pancreas, gallbladder, and

  pancreatic and bile ducts.

 

- Computerized tomography (CT): A CT scan is a noninvasive radiograph (x-ray) that produces 3-dimensional images of

  parts of the body. The patient lies on a table that slides into a donut-shaped machine. The test can show gallstones and

  the extent of damage to the pancreas.

 

- Occasionally, blood tests, such as a test for IgG4 to assess for autoimmune pancreatitis, can be used to help diagnose

  the cause of chronic pancreatitis. However, blood tests are not typically used to make the diagnosis of chronic

  pancreatitis.

  • Pancreatic Cancer

 

- Medical history, a doctor learns the story of the illness, such as the time of onset, nature and location of pain, smoking

  history, and other medical problems.

 

- Physical exam, a doctor might feel a mass in the abdomen and notice swollen lymph nodes in the neck, jaundiced skin,

  or weight loss.

 

- Lab tests may show evidence that bile flow is being blocked, or other abnormalities.

 

- Imaging Tests

 

  i. Computed tomography (CT scan)

  ii. Magnetic resonance imaging (MRI)

  iii. Ultrasound

  iv. Positron emission tomography (PET scan)

 

- If imaging studies detect a mass in the pancreas, a pancreatic cancer diagnosis is likely, but not definite. Only a biopsy

  can diagnose pancreatic cancer. Biopsies can be performed in several ways:

 

  i. Percutaneous needle biopsy: Under imaging guidance, a radiologist inserts a needle into the mass, capturing some

     tissue.

  ii. Endoscopic retrograde cholangiopancreatography (ERCP): A flexible tube with a camera and other tools on its end

     (endoscope) is put through the mouth to the small intestine, near the pancreas.

  iii. Endoscopic ultrasound: Similar to ERCP, an endoscope is placed near the pancreas. An ultrasound probe on the

      endoscope locates the mass, and a needle on the endoscope plucks some tissue from the mass.

  iv. Laparoscopy is a surgical procedure that uses several small incisions. Using laparoscopy, a surgeon can collect

      tissues for biopsy, as well as see inside the abdomen to determine if pancreatic cancer has spread. However,      

      laparoscopy has higher risks than other biopsy approaches.

 

Treatment Options

 

  • Pancreatitis

 

Treatment for pancreatitis usually requires hospitalization. Once your condition is stabilized in the hospital and inflammation in the pancreas is controlled, doctors can treat the underlying cause of your pancreatitis. How long you stay in the hospital will depend on your situation. Some people recover quickly and others develop complications that require a longer hospitalization.

 

  • Hospitalization to stabilize pancreatitis

    • Fasting

      • You'll stop eating for a couple of days in the hospital in order to give your pancreas a chance to recover. Once the inflammation in your pancreas is controlled, you may begin drinking clear liquids and eating bland foods. With time, you can go back to your normal diet. If your pancreatitis persists and you still experience pain when eating, your doctor may recommend a feeding tube to help you get nutrition.

 

  • Pain medications

    • Pancreatitis can cause severe pain. Your health care team will give you medications to help control the pain.

  • Intravenous (IV) fluids

    • As your body devotes energy and fluids to repairing your pancreas, you may become dehydrated. For this reason, you'll receive extra fluids through a vein in your arm during your hospital stay.

 

  • Treating the underlying cause of Pancreatitis

 

Once your pancreatitis is brought under control, your health care team can treat the underlying cause of your pancreatitis. Treatment will depend on the cause of your pancreatitis, but examples of treatment may include:

 

  • Procedures to remove bile duct obstructions. Pancreatitis caused by a narrowed or blocked bile duct may require procedures to open or widen the bile duct. A procedure called endoscopic retrograde cholangiopancreatography (ERCP) uses a long tube with a camera on the end to examine your pancreas and bile ducts. The tube is passed down your throat, and the camera sends pictures of your digestive system to a monitor. ERCP can aid in diagnosing problems in the bile duct and in making repairs.

  • Gallbladder surgery. If gallstones caused your pancreatitis, your doctor may recommend surgery to remove your gallbladder (cholecystectomy).

  • Pancreas surgery. Surgery may be necessary to drain fluid from your pancreas or to remove diseased tissue.

 

  • Treatment for alcohol dependence

 

- Drinking several drinks a day over many years can cause pancreatitis. If this is the cause of your pancreatitis, your doctor may recommend you enter a treatment program for alcohol addiction. Continuing to drink may worsen your pancreatitis and lead to serious complications.

  • Additional treatments for chronic pancreatitis

 

- Chronic pancreatitis may require additional treatments, depending on your situation. Other treatments for chronic

  pancreatitis may include:

  • Pain management.

    • Chronic pancreatitis can cause persistent abdominal pain. Your doctor may recommend medications to control your pain and may refer you to a pain specialist. Severe pain may be relieved with surgery to block nerves that send pain signals from the pancreas to the brain.

  • Enzymes to improve digestion. Pancreatic enzyme supplements can help your body break down and process the nutrients in the foods you eat. Pancreatic enzymes are taken in tablet form with each meal.

  • Changes to your diet. Your doctor may refer you to a dietitian who can help you plan low-fat meals that are high in nutrients.

 

Pancreatic Cancer

 

  • Surgery

    • Surgery for pancreatic cancer may be curative or palliative.

    • Potentially curative surgery is used when imaging studies tell the surgeon that it is possible to remove all the cancer.

    • Research has shown that the risk of major complications and mortality are significantly reduced if the Whipple procedure or other pancreatic surgery is performed at an institution that performs a high volume of these.

    • Palliative surgery may be done if imaging studies show that the tumor is too widespread to be completely removed. Palliative surgery can relieve symptoms like jaundice and prevent certain complications.

 

  • Radiation therapy

    • Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors.

 

  • Chemotherapy

    • Chemotherapy is the use of cytotoxic (anti-cancer) medicines to target and destroy cancer cells.  It is an important treatment option for many types of cancer and clinical trials.

    • You may have chemotherapy on its own or alongside other treatments such as radiotherapy or surgery.  Usually you will be given chemotherapy by injection into a vein (intravenously). You may also be able to have certain types of chemotherapy by mouth (tablets).

There are a number of drugs currently being used to treat pancreatic cancer: The international standard for first-line treatment of advanced pancreatic cancer is gemcitabine (Gemzar®). Chemotherapy drugs currently used to treat pancreatic cancer.

Preventing Pancreatitis

 

  • Limit alcohol consumption.

    • By drinking less or not at all, you can help protect your pancreas from the toxic effects of alcohol and reduce your risk for pancreatitis.

 

  • Eat a low-fat diet.

    • Gallstones, a leading cause of acute pancreatitis, can develop when too much cholesterol accumulates in your bile, the substance made by your liver to help digest fats.

    • To reduce your risk for gallstones, eat a low-fat diet that includes whole grains and a variety of fresh fruits and vegetables.

 

  • Exercise regularly and lose excess weight.

    • People who are overweight are more likely to develop gallstones, putting them at greater risk for acute pancreatitis.

  • Skip crash diets.

 

  • The caveat to losing weight is to do it gradually.

  • When you go into crash-diet mode, prompting quick weight loss, your liver ramps up cholesterol production in response, which increases your risk for gallstones.

 

  • Don't smoke.

    • Studies show that smoking cigarettes is linked to acute pancreatitis.

 

Pancreatitis can be a serious condition and if left unmanaged it may progress to EPI. If you have risk factors for pancreatitis or have experienced it before, make the appropriate lifestyle changes to prevent it from occurring in the future.

 

Preventing Pancreatic Cancer

 

While there is no sure way to prevent pancreatic cancer, there are things you can do to lower the risk:

 

  • Don’t smoke

    • Smoking is the most important avoidable risk factor for pancreatic cancer. Quitting smoking helps lower risk

 

  • Stay at a healthy weight

    • Getting to and staying at a healthy weight might also help lower your risk.

    • While the effects of getting physical activity and eating well on pancreatic cancer risk are not as clear, both of these can help you stay at a healthy weight.

  • Limit alcohol use

    • Heavy alcohol use has been tied to pancreatic cancer in some studies but not in others.

    • This link is still not certain, but heavy alcohol use can lead to conditions such as chronic pancreatitis and cirrhosis, which are known to increase pancreatic cancer risk.

 

  • Limit exposure to certain chemicals in the workplace

    • Avoiding workplace exposure to certain chemicals may reduce your risk for pancreatic cancer.