the Cranky Panky

                   Spreading Awareness for Pancreas Research



Diseases of the Pancreas...

There are many diseases of the pancreas in forms of pancreatitis and pancreatic cancer.  Pancreatitis can be acute (meaning sudden inflammation of the pancreas) or chronic (inflammation of the pancreas that does not heal and permanently damages the organ).  The symptoms of pancreatitis can include severe abdominal pain, fatty stools, nausea, vomiting, weight loss, jaundice, fever, etc.  Some cases are severe and can damage other organs.  Pancreatitis, along with pancreatic cancer, can even lead to death.  

There are multiple factors that can cause pancreatic disease.  These include injury to the pancreas, cysts/tumors, autoimmune disorders, pancreatic insufficiency (the inability for the pancreas to produce or secrete enzymes) and anomalies of the pancreas such as Pancreatic Divisum (the common bile duct and the pancreatic duct, or duct of Wirsung,  fail to fuse prenatally, thus not allowing the pancreas to drain properly).  There can be variations of problems with the pancreatic or bile duct.  Sphincter of Oddi Dysfunction is another rare disease causing pancreatic insufficiency.  Pancreatitis can also be caused by alcoholism; however, studies are showing that alcohol is not the cause in more than half of the cases of pancreatitis.  Studies show that pancreatitis is commonly idiopathic - meaning the cause is unknown.  Chronic pancreatitis can sometimes even be linked to a mutation in the cystic fibrosis gene (some studies state up to 30% of chronic pancreatitis cases), but the abnormalities of the gene are unique; therefore, patients do not have the lung disease that is often prominent with typical cystic fibrosis.


Tests...

Tests to determine pancreatic disease can include a CT scan, MRCP, ERCP, Fecal Fat test, Amylase and Lipase tests, EUS, etc.  Accurate and conclusive testing to determine damage to the pancreas can be tricky, and even a very sick pancreas does not always appear so on many of these tests.  Studies show that elevated lipase and amylase levels, along with markers for pancreatitis, are not always present until extensive damage is done.  A patient may suffer many years before the organ shows damage.  Once the pancreas becomes diseased, it cannot heal itself, and potentially "dies" off.  There is no cure for pancreatic diseases.  


Treatments...

Treatments for pancreatic diseases are limited.  Pain medicine (pill form, pain patches, i.v. pain medication, even pain blocks), discontinuing food and fluids by mouth, receiving  i.v. fluids, a nasogastric (NG) tube to drain contents in stomach, enzyme supplements, diabetic treatment, and change in diet are often the only options.  The treatment is determined by your condition, symptoms, test results, and your doctor.  In more severe or chronic diseases, sphincterotomies or other surgical treatments are available, but with much risk.  



Surgeries...  

ERCP with Sphincterotomy:  This surgery is usually performed for patients who have stones obstructing the flow of the pancreatic juices, sphincter anomalies such as SOD, bile duct tumors, or to determine other problems within the pancreas .  For an ERCP (Endoscopic Retrograde Cholangiopancreatography)  the patient is put to sleep, a scope is inserted through the esophagus, stomach, and duodenum (the first part of your intestine) until it reaches the area of the biliary tree and pancreas.  The pancreatic duct can be cut to allow better drainage and a stent is inserted.  Typically, the stent will fall out on its own in approximately two weeks.  The patient will need an x-ray to check that the stent has fallen out.  The risk of this surgery is mainly acquiring pancreatitis, and often requires an overnight stay in the hospital (if not longer).  There is some discrepancy among medical professionals as to the success and use of this treatment. 

Whipple:  This surgery removes the head of the pancreas, along with part of the bile duct, small intestines, and sometimes part of the stomach.  It is usually used for pancreatic cancer and sometimes chronic pancreatitis where just the head of the pancreas is diseased.  The re-construction of the "plumbing" is complicated, attaching the remainder of the pancreas to another part of the small intestines, re-connecting the stomach, etc.  The surgery can last up to 6 hours.  The patient is typically cut from the lower breastbone to the navel (approximately 10 inches).  A central line in your neck or a PICC line is used for sedation, pain medication, etc.  The patient also can have an epidural for pain control, along with a catheter, drains in the abdomen, and an NG tube (through the nose).  It requires at least 10-14 days in the hospital if there are no complications.  Recovery is very long, at least 6 months.  Studies show long-term results are usually unsatisfactory for pancreatitis.  There are many complications that can occur, including bleeding, infection, motility disorders, malabsorption (not absorbing nutrients through your intestine),etc.  Also, the patient can become a diabetic.

Puestow:  This is another surgery where the cut is typically from the breastbone to the navel.  Then, a lateral cut is made from the head to the tail of the pancreas.  It is attached to part of your small intestines.  The purpose of this surgery is to allow better drainage from the pancreas.  Unfortunately, pancreatitis can still occur and continue to cause pain.  The patient usually has a central line or PICC, an epidural, drainage tubes, a catheter, NG tube, etc.  The stay in the hospital is 10-14 days with a long recovery.  There are serious complications that can occur, like the Whipple.  Again, you can become diabetic.

Frey:  This surgery is just like the Puestow with additional removal of a section of the pancreas.


Total Pancreatectomy with Islet Autotransplantation (TP/IAT):  This is the newest of pancreatic surgeries.  It is total removal of the pancreas (and usually the spleen due to the organs sharing a major blood supply).  It also usually involves removing part or all of the duodenum, the bottom of the stomach, and the bile duct.   It's typically a large cut down the entire abdomen, from the breast bone to the navel. After the pancreas is out, it is taken to a lab and the islet cells (that produce insulin) are separated from the organ.  This can take about 4 hours.  The cells are then transplanted into the patient's liver and are often able to produce insulin in their new "home", decreasing the severity of diabetes.  The entire surgery is about 10-14 hours.  The patient will have a central line or PICC, an epidural for added pain control, drainage tubes from the abdomen, a catheter, NG tube, etc.  Complications can be severe as with any of these surgeries, including gastroparesis (paralysis of stomach), malabsorption, the need for blood transfusions, serious infections, motility disorders, etc.  Recovery consists of at least 2-3 days in ICU, then a 12-14 day hospital stay, and about a year for full recovery.  Pancreatitis itself is no longer an issue; however, some patients still require some long-term pain medication.  Most are on much smaller doses, and some patients are able to wean off completely within a year.  The goal of this surgery is to eliminate pancreatitis and the pain associated with it, and to improve quality of life.  A majority of the patients report that their life is greatly improved after recovering from this surgery.  This surgery requires acceptance of life-long diabetes and the need for enzyme supplements to be taken with every meal.  Diabetes can be anywhere from “brittle” to eventually needing no insulin injections.  



*NOTE:  Every surgery center/hospital and doctor has their own protocol and techniques for each surgery.  The details of the procedures vary depending on each patient, surgeon, and hospital.  For instance, someone from the UK mentioned that patients there are often cut horizontally instead of vertically.  Always remember that each circumstance and individual is unique.  




As you see, each of these surgeries can cause diabetes and usually requires the patient to take enzyme supplements; however, continued pancreatitis can also lead to diabetes and the need for enzymes.  Chronic pancreatitis can also lead to cancer or death.  As stated many times, there are no cures for pancreatic diseases or cancer.  This is why awareness, knowledge, and more research are critical!