Diseases of the Pancreas

The primary diseases of the pancreas are pancreatitis, which may be classified as acute pancreatitis or chronic pancreatitis, and cancer of the pancreas.

Pancreatitis
Pancreatitis is an inflammation of the pancreas. It is caused when the digestive enzymes from the exocrine pancreas become activated inside of the pancreas, instead of in the duodenum, and start “digesting” the pancreas itself. It usually presents with abdominal pain and can cause nausea and vomiting.

• Acute pancreatitis may be a single or a recurring event, and it usually occurs suddenly. The abdominal pain in acute pancreatitis is often severe. The disease may even lead to internal bleeding and infection and can be life-threatening. The most common cause of acute pancreatitis is blockage of the pancreatic duct by gallstones. Secretions can back up in the pancreas and cause permanent damage in just a few hours. Acute pancreatitis often presents with raised levels of pancreatic enzymes in the blood. These enzymes can circulate to other body organs, causing shock and organ failure. Other causes may include biliary tract disease (obstruction, gallstones or sludge), alcohol excess, physical trauma to the abdomen, hyperlipidemia and hypercalcemia.
• Chronic pancreatitis is characterized by chronic or persistent abdominal pain and may or may not present with raised pancreatic enzymes. It develops gradually, often results in slow destruction of the pancreas, and can lead to other problems, such as pancreatic insufficiency (see below), bacterial infections, and type 2 diabetes. The main causes of chronic pancreatitis are gall bladder disease (ductal obstruction) and alcoholism. Other causes of chronic pancreatitis include cystic fibrosis, hypercalcemia, hyperlipidemia, some drugs, and autoimmune conditions.

Pancreatic Cancer
Cancer of the pancreas is the fourth leading cause of cancer death in the United States, killing about 32,000 people a year. Risks include smoking, age, gender (more common in men), chronic pancreatitis, and exposure to some industrial chemicals. Most (95%) pancreatic cancers are adenocarcinomas, developing in the exocrine tissues. Pancreatic cancer is very difficult to detect in the early stages because symptoms are either absent or nonspecific: abdominal pain, nausea, loss of appetite, and sometimes jaundice. Only about 10% of the cancers are still contained within the pancreas at the time of diagnosis.

Pancreatic Insufficiency
Pancreatic insufficiency is the inability of the pancreas to produce and/or transport enough digestive enzymes to break down food in the intestine and allow its absorption. It typically occurs as a result of progressive pancreatic damage - damage that may be caused by a variety of conditions. It is most frequently associated with cystic fibrosis in children and with chronic pancreatitis in adults; it is less frequently but sometimes associated with pancreatic cancer.