The pancreas is located in the center of the abdomen. It performs both exocrine, meaning it excretes into a duct, and endocrine functions. Its exocrine function involves secreting numerous digestive enzymes into the gastrointestinal tract. Its endocrine function involves secreting hormones, such as insulin, into the circulation. Certain conditions can cause pain emanating from the pancreas and interfere with its enzymes.
Abdominal Pain
Abdominal pain is a symptom of many different problems, which means it is non-specific. Pancreatic problems can be painful or may not cause any pain at all. The pain from pancreatic disorders can be sharp, dull, throbbing, aching and occur anywhere in the abdomen. One element of pain that suggests it may be pancreatic in origin is pain that radiates from the abdomen to the back, although this type of pain is found in other conditions as well. The condition causing the pain can also interfere with enzymes in the pancreas.
Mass Lesions
Mass lesions, or tumors, can be benign. A benign tumor is an overgrowth of cells that does not invade the surrounding tissue. It can still cause problems, however. Benign lesions can grow in the pancreas to obstruct the surrounding ducts leading from the pancreas to the intestine, blocking enzymes from entering the intestines. This can interfere with digestion, causing further damage to the pancreas and if the enzymes enter the blood, damage to other areas of the body as well. In contrast to benign mass lesions, malignant mass lesions, or cancer, invade the surrounding tissue.
Inflammation
Inflammation of the pancreas is called pancreatitis. Normally, digestive enzymes secreted by the pancreas are not active until they reach the small intestine. But when the pancreas is inflamed, the enzymes inside the pancreas attack and damage the tissues that produce them. Some causes include gallstones getting lodged in the biliary system near the pancreas, trauma, alcohol, high fat levels in the blood, scorpion bites, drugs and toxins. Inflammation can be chronic, or ongoing, or acute, which means quick onset and severe. Chronic pancreatitis is more likely to "burn out" the pancreas, slowly destroying its functions. In this case, pancreatic enzyme supplements can replace the digestive pancreatic enzymes. Also, hormones, such as insulin, will need replacement as well. Acute pancreatitis can have the same effect. In addition, it can leak enzymes into the blood, causing inflammation throughout the body, and even cause severe damage to the lungs.
Diagnosis and Treatment
The diagnosis of pancreatic conditions begins with a detailed medical history and proceeds to a physical exam, relevant laboratory tests and likely imaging studies. The management depends on the cause. Some mass lesions can be removed surgically. This may require removal of most of the pancreas, an operation called the Whipple procedure. Other lesions may respond more favorably to chemotherapy or radiation treatment. Pancreatitis may be treated with supportive measures such as fluid administration. A severe case can require ICU admission. It is important to consult with a physician for the diagnosis and treatment of health conditions.
References
- "Physiology"; Linda S.Costanzo; 4th Ed 2008
- "Harrison's Principles of Internal Medicine"; Anthony S Fauci, et al.; 17th Ed 2008
- "Current Medical Diagnosis and Treatment 2011"; Stephen McPhee, et al.; 50th Ed 2010
- National Digestive Diseases Information Clearinghouse; Pancreatitis; July 2008
