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Diseases of the Pancreas

Acute Pancreatitis

Acute Pancreatitis is an inflammation of the pancreas of sudden onset that is short-lived and usually resolves over a period of time. It is most commonly caused by alcohol abuse or gallstones. It is characterized by sudden onset of severe upper abdominal and back pain and is diagnosed by elevated serum amylase and/or lipase levels. Most attacks are clinically mild, and resolve with supportive care over a period of 7-10 days, but in 20% of patients this disease can run a severe course that is prolonged and life threatening. Early detection of severe acute pancreatitis and referral to a centre equipped to handle these patients is vital. Severe pancreatitis is associated with areas of pancreatic cell death(necrosis). When pancreatic necrosis becomes infected patients are likely to require radiological or surgical drainage of infected collections. Surgical drainage, when necessary is often performed laparoscopically nowadays.

Chronic Pancreatitis

Chronic pancreatitis is a progressive illness that causes scarring, calcification and atrophy of the pancreas over many years. It commonly causes repeated attacks of severe upper abdominal pain, along with progressive loss of pancreatic function. The latter may result in diabetes mellitus and less commonly in diarrhea and weight loss. Patients with this disease are at an increased risk of pancreatic cancer. The most common cause for this disease is alcohol abuse, but it can occur as a consequence of severe acute pancreatitis or as sequelae of major abdominal trauma. The exact cause is undetermined and may be genetic in the majority of patients. Treatment is aimed at preventing and controlling abdominal pain. It involves a combination of radiological, endoscopic and surgical procedures that need to be individualized depending on the patients symptoms and the specific changes induced by the disease on the anatomy of the patients pancreas. Surgical intervention usually involves duodenum-preserving resection of the head of the pancreas with drainage of the pancreatic duct (Frey’s Procedure)

Pancreatic Carcinoma

The symptoms of pancreatic cancer depend on which part of the pancreas the tumour arises from. Tumours in the head of pancreas produce symptoms relatively early by compressing the adjacent bile duct or duodenum causing jaundice and vomiting/bleeding respectively. Tumours arising from the body or tail of the pancreas usually do not produce symptoms until the tumour has grown to a very large size although the patient may experience non-specific symptoms like tiredness or loss of appetite and weight. Diagnosis of this disease is usually by CT scan, MRI scan or, in difficult cases by Endoscopic Ultrasound. Unfortunately many patients with pancreatic cancer, whether from the head, body or tail of the pancreas, have advanced disease at the time of diagnosis. Surgical resection of the tumour by pancreaticoduodenectomy or distal pancreatectomy depending on the location of the tumour provides the best chance for cure, even when this requires resection of the portal vein which runs through the pancreas. Pancreaticoduodenectomy is a major operation that needs to be performed by an experienced team of doctors to get good results. Distal pancreatectomy is often possible laparoscopically. Patients benefit from chemotherapy after operation.

When disease is very advanced at diagnosis, surgery may not be possible, in which case the cancer will need treatment using chemotherapy and biological agents. In borderline cases, such treatment may permit surgery at a later date.