In this section you will find basic information about the pancreas and chronic pancreatitis together with details about the available treatments, the assessment for surgery and management in the post-operative period.
What is the pancreas?
The pancreas (also known as the sweetbread gland) is an 18cm to 25 cm long organ located behind the stomach in the back of the abdomen near the spine. It is spongy and shaped somewhat like a fish (about the size and shape of a kipper) that is lying horizontally across the abdomen.
The head of the pancreas is the largest part and lies on the right side of the abdomen where the stomach is attached to the first part of the small intestine. It is here that the stomach empties partially digested food into the small intestine and this mixes with the secretions from the pancreas.
The tail or body of the pancreas (its narrowest part) extends to the left side of the abdomen next to the spleen. There is a duct that runs the length of the pancreas, and it is joined by several small branches from the glandular tissue.
What does the pancreas do?
The pancreas has two main functions:
- The exocrine and endocrine functions – Exocrine cells of the pancreas produce enzymes that help with digestion. When food enters the stomach, exocrine cells release digestive enzymes into a system of ducts which lead to the main pancreatic duct. The pancreatic duct empties the enzymes into the first portion of the small intestine, where the enzymes aid in the digestion of fats, carbohydrates and proteins in foods.
- The second function of the pancreas is the endocrine function – This involves the production of hormones. Hormones are substances that are made in one part of the body and circulate in the bloodstream to influence a different part of the body. The two main pancreatic hormones (it produces a large number) are insulin and glucagon. The islet cells (endocrine cells), which make up just 2% of the pancreas, produce and secrete insulin and glucagon into the bloodstream. Insulin serves to lower blood sugar levels while glucagon raises blood sugar levels. These two main hormones work together to maintain the proper level of sugar in the blood.
What is chronic pancreatitis?
Chronic pancreatitis is inflammation of the pancreas that does not heal or improve, gets worse over time, and leads to permanent damage by fibrosis (the production of scar tissue).
As a result of prolonged damage to the substance of the gland, the pancreas fails to produce enough digestive enzymes to permit adequate digestion of food. This leads to weight loss and the frequent passage of pale greasy stools which contain excess amounts of fat (called steatorrhoea).
The destruction of the cells which produce insulin may eventually lead to the development of diabetes and if the condition is not treated. This happens in more than a half of the patients with chronic pancreatitis.
There are several causes of chronic pancreatitis and although the most common is alcohol, there are a number of others including problems relating to gallstones, genetic disorders and damage to the pancreatic duct.
Sometimes it may not always be possible to attribute a specific cause to the condition and it is then known as idiopathic.
What is the treatment for chronic pancreatitis?
Treatment for chronic pancreatitis depends on the symptoms. Most treatments focus on pain management and nutritional support. Oral pancreatic enzyme supplements are used to aid in the digestion of food and patients who develop diabetes require tablets or insulin to control their blood sugar levels.
However a number of patients continue to experience severe pain and have to undergo surgery to treat this. One surgical option is to remove part of the pancreas, although these patients may continue to experience pain.
If pain does continue to be a problem, further surgery may be required. At this stage removing the whole pancreas completely is the preferred option and this is known as a total pancreatectomy. The problem with removing the whole pancreas is that the islet cells (that produce insulin) are also removed causing you to have diabetes.
Diabetes occurs because both hormones controlling blood sugar are lost. If you diabetes you have will then have to control your blood sugar using insulin injections.
Often blood sugar levels can swing rapidly from too high to too low. Low blood sugar can cause confusion, incoordination, drowsiness and in extreme cases even seizures or death.
High blood glucose over time can lead to complications of diabetes including blindness, kidney failure and nerve damage that can lead to amputations.
