Pancreatic Disorders: Chronic Pancreatitis & Tumours

Disorders Of The Pancreas The Pancreas is located at the rear of the abdomen and is necessary for production of various hormones and its digestive enzymes. Among the important hormones secreted is Insulin. The Digestive enzymes it secretes are essential for digestion of carbohydrates, proteins and fat. In some people, the pancreas may become inflamed, giving rise to a condition known as ‘Pancreatitis’. Improper functioning of Pancreas can lead to disorders such as Diabetes, Malabsorption. Chronic Pancreatic Symptoms Symptoms such as Abdominal Pain which is intermittent and persistent. This can be of two types; one is persistent mid abdominal pain which varies in intensity. In the other type there is intermittent flare ups (bout or attacks of pain). This pain is severe and lasts for several hours a day. As the disease slowly destroys the enzyme producing cells, symptoms may arise such as:-

• Weight Loss
• Symptoms of Diabetes: Frequent urination and tiredness
• Bulky smelling stools (steatorrhea)

Diagnosis Of Chronic Pancreatitis: If you visit a Doctor with the above mentioned complaints, he will suspect Chronic Pancreatitis, even if there is no history of alcohol intake.  He will advise one or more of the following:

• Blood Tests: To check the levels of blood sugar and enzymes such as lipase and amylase.
• Computed Tomography: CT scan reveals the changes in the pancreas.
• Magnetic Resonance Imaging: A special MRI called MRCP (Magnetic Resonance Cholangio Pancreatography) which shows the structure of pancreas more clearly than a CT.

Risks Other than conditions such as Diabetes and Malabsportion, people with Chronic Pancreatitis are at an increased risk of developing Pancreatic Cancer. Treatment: Lateral Pancreaticojejunostomy Patients with disabling abdominal pain due to chronic pancreatitis, pancreatic ductal dilatation with strictures and calcifications, are best managed by ductal decompression, with special attention to coring out the head of pancreas- Frey procedure Partial Pancreatic Resection Although preservation of pancreatic tissue is desired to maintain both exocrine and endocrine function, partial pancreatic resection (such as distal pancreatectomy or even pancreaticoduodenectomy) is at times the preferred treatment . While alternative procedures such as endoscopic sphincterotomy and pancreatic ductal stenting may provide short- term relief of symptoms, long –term results are not as good as surgery. At Fortis Hospitals, partial pancreatic resections are done Laparoscopically in suitable patients. In this method, after the anaesthetist administers general anaesthesia, the surgeon makes a fewtiny incisions in the abdomen. The Abdomen is inflated with Carbon Dioxide to create room for easy manoeuvring of instruments. A miniature video camera and a laparoscope are inserted through these holes. The camera sends a magnified image from the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The affected part of the pancreas is then removed while preserving as much of the healthy tissue as possible. In cases of cancer of distal body and tail of pancreas, Laparoscopic distal pancreatectomy with splenectomy can be done. Advantages Of A Laparoscopic Surgery:

• Less pain as compared to open surgery
• Preservation of healthy pancreatic tissue
• Better cosmetic results as the incisions are very small
• Reduced hospital stay and faster healing post-surgery

Effect Post-Operation: Post operatively; diabetes and steatorrhea (lost light colored stools) may occur in a minority of patients, depending upon the amount of the pancreas that has been removed and the condition of the remaining pancreas. Your doctor will explain it to you based on the results of investigations and biopsies. It can be very difficult to distinguish between chronic pancreatitis and pancreatic cancer. Marked elevation of serum CA 19-9 in a patient without jaundice is highly suggestive of pancreatic cancer.