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Pancreas


March 2012

pancreasA colleague was whisked into hospital the other day because they suspected he had problems with his pancreas.

I didn’t have a clue what the pancreas did, so I thought it was worth looking into.

The pancreas has the key role of producing various enzymes to help us digest food. These are especially important to help us digest proteins, carbohydrates and fats. The pancreas also produces bicarbonate, that traditional health remedy to help neutralise acid in the stomach.

And that’s not all. This important gland also produces a range of hormones to maintain our sugar levels, and these include the production of insulin. Most of us know that insulin deficiency is associated with diabetes so clearly the pancreas is very important indeed.

The pancreas is actually a soft long gland located behind the stomach at the back of the upper abdominal cavity. It is divided into two key areas; the top which contains the main bile duct and the central and lower area which is positioned very near to the kidney on the left of our body.

Problems with the pancreas are generally known as pancreatitis, but because of its positioning, they can be difficult to identify.

If digestive enzymes leak into the pancreas, they can start to digest it. Yes, it is quite scary what can go on inside our bodies! This initially sets up an inflammation although nature often steps in and stops the problem. However, a longterm result of this initial inflammation is scarring of the pancreas and this can distort its shape, so the digestive enzymes again creep in and the problem repeats itself.

The pancreas can also be damaged in other ways. Excessive alcohol consumption increases the risk of developing chronic pancreatitis and high levels of calcium in the blood can also cause problems. Sometimes certain drugs can be indicated in pancreatic problems, but sometimes no cause can be identified.

It is not a straightforward matter to identify pancreatitis. The first indication of a problem is often from pain, sometimes very vague and short or it can be long or intense. The pain often radiates to the back and can be brought on by eating. It seems to occur more severely at night.

The pain tends to be constant rather than come in waves, and can last for just an hour or two or for days at a time. However, often similar pains can indicate other problems from the abdomen including gallstones, irritable bowel syndrome or a peptic ulcer, so confirming pancreatitis can be difficult.

One indication can be weight loss plus a change in stools to a pale greasy stool containing high levels of fat. Diarrhoea can occur.

Sometimes however there are no symptoms and pancreatitis is diagnosed by accident during another medical procedure.

If it is suspected that you are suffering from pancreatitis, then you may be offered an ultrasound, a CT or an MRI scan. None of these are foolproof however, and another procedure, an ERCP, is more complex but gives good results. Here a specially contrasting material is injected into the bile and pancreatic duct to that it shows up clearly on X-ray pictures. This procedure has to be done under sedation but can demonstrate changes in the pancreas.

If you are found to be suffering from pancreatitis, then a main treatment is to try and rest the pancreas. Certain drugs which contain pancreatic enzymes plus can help reduce acid secretion may be recommended, and patients are advised to follow a low-fat diet. Patients are usually advised to avoid alcohol.

Chronic pancreatitis is of major concern and associated with a reduction in life expectancy. The main symptom of pain is usually treated with morphine type drugs. However, there is no cure at the moment and once the pancreas is damaged, it is not able to be returned to normal function.

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