Pancreas Anatomy

The pancreas is a retroperitoneal organ located behind the stomach and is divided into three parts — head, body and tail.

The head of the pancreas is surrounded by the duodenum and the common bile duct passes through it. Tumors in this region may cause vomiting and jaundice due to obstruction.

Pancreatic juice drains through the pancreatic duct which joins the bile duct near the duodenum forming the ampulla of Vater. Tumors arising in this region are known as periampullary cancers.

Pancreas Function

The pancreas has both exocrine and endocrine functions.

Exocrine Function

• Secretion of digestive enzymes
• Amylase for carbohydrate digestion
• Lipase for fat digestion

Fat digestion is usually affected first in pancreatic diseases.

Endocrine Function

• Insulin production
• Glucagon production
• Blood sugar regulation

Pancreatic diseases may lead to diabetes or episodes of low blood sugar.

Acute Pancreatitis

Acute pancreatitis is inflammation of the pancreas and is the most common pancreatic disorder.

Common Causes

• Alcohol consumption
• Gallstones

Diagnosis

• Severe upper abdominal pain radiating to the back
• Raised serum amylase and lipase
• CT Scan after 72 hours to assess severity

Treatment

• Critical care monitoring
• Respiratory support if required
• Early enteral nutrition
• Naso-jejunal feeding if required
• Drainage of collections
• Pancreatic necrosectomy when infected

Treatment requires a multidisciplinary team including critical care specialists, interventional radiologists and GI surgeons.

Pancreatic Pseudocyst

Pancreatic pseudocyst develops when fluid collections persist after an episode of acute pancreatitis.

Many pseudocysts resolve spontaneously and do not require treatment.

Intervention is required when cysts increase in size or cause symptoms.

Treatment Options

• Endoscopic drainage
• Laparoscopic cystogastrostomy
• Cystojejunostomy

MRI helps determine whether the cyst contents are liquid or solid before treatment.

Chronic Pancreatitis

Chronic pancreatitis is most commonly caused by long-term alcohol intake.

Repeated inflammation leads to pancreatic damage and loss of function.

Symptoms

• Severe abdominal pain
• Frequent hospital admissions
• Diabetes
• Fat malabsorption
• Steatorrhea

Treatment

• Pain control
• Pancreatic enzyme supplements
• Diabetes treatment
• Surgery for severe pain

Surgery involves opening the pancreatic duct and draining it into the intestine.

Pancreatic Cancer

Risk Factors

• Smoking
• Alcohol use
• Chronic pancreatitis

Symptoms

• Jaundice
• Vomiting
• Abdominal pain
• Weight loss
• Loss of appetite

Diagnosis

• CT Scan abdomen
• PET Scan when required
• Staging laparoscopy

Pancreatic Cancer Surgery

• Whipple procedure for head tumors
• Distal pancreatectomy for body and tail tumors
• Surgery after chemotherapy in advanced cases

Pancreatic Duct Stones

Pancreatic duct stones develop as a complication of chronic pancreatitis.

• ERCP stone removal
• Shock wave lithotripsy
• Surgery for large stones

Laparoscopic Pancreatic Surgery

• Pancreatic necrosectomy
• Pseudocyst drainage
• Pancreaticojejunostomy

Complex surgeries such as Whipple procedure are usually performed by open approach.

Pancreatic Surgery Cost

Pancreatic surgery is complex and should be performed in tertiary care hospitals.

• Depends on patient condition
• Depends on ICU requirement
• Laparoscopic surgery costs more

Keep Your Pancreas Healthy

• Avoid alcohol
• Stop tobacco use
• Healthy diet low in fat
• Regular exercise
• Maintain healthy weight
• Treat gallstones early