Pancreatology

Pancreatic disorders can present with various symptoms including severe abdominal pain that may radiate to the back, nausea, vomiting, weight loss, changes in stool (pale, fatty, or floating), new-onset diabetes, and jaundice. Chronic pancreatitis may cause ongoing pain and digestive problems, while acute pancreatitis typically presents with sudden, severe pain. Early diagnosis and treatment are important for preventing complications.

ERCP (Endoscopic Retrograde Cholangiopancreatography) is a specialized procedure that combines endoscopy and X-ray imaging to diagnose and treat problems in the pancreatic and bile ducts. It's used for conditions like pancreatic stones, strictures, tumors, or bile duct blockages. ERCP can be both diagnostic and therapeutic, allowing doctors to remove stones, place stents, or take tissue samples. The procedure is performed under sedation and typically takes 30-90 minutes.

Acute pancreatitis is most commonly caused by gallstones (40%) and alcohol use (30%). Other causes include medications, high triglycerides, trauma, infections, and genetic factors. Treatment involves hospitalization with IV fluids, pain management, nutritional support, and treating underlying causes. Most cases resolve with conservative care, but severe cases may require intensive care and surgical intervention. Recovery typically takes days to weeks, and preventing recurrence involves addressing the underlying cause.

Chronic pancreatitis involves permanent damage to the pancreas with irreversible scarring and loss of function. Unlike acute pancreatitis which can heal completely, chronic pancreatitis progressively worsens over time. It's most commonly caused by long-term alcohol use, but can also result from genetic mutations, cystic fibrosis, or autoimmune conditions. Symptoms include persistent abdominal pain, diabetes, and digestive problems from enzyme deficiency. Treatment focuses on pain management, enzyme replacement, and diabetes control.

Pancreatic enzymes (lipase, protease, and amylase) break down fats, proteins, and carbohydrates in food. Enzyme supplements are needed when the pancreas doesn't produce enough enzymes, causing maldigestion and malabsorption. This occurs in chronic pancreatitis, pancreatic cancer, cystic fibrosis, or after pancreatic surgery. Symptoms include fatty stools, weight loss, and nutrient deficiencies. Enzyme replacement therapy involves taking pills with meals and snacks to aid digestion and prevent malnutrition.

Early pancreatic cancer often has no symptoms, making early detection challenging. Warning signs include unexplained abdominal or back pain, unintentional weight loss, new-onset diabetes (especially in people over 50), jaundice (yellowing of skin and eyes), changes in stool color, nausea, and loss of appetite. Blood clots and fatigue may also occur. These symptoms can be caused by other conditions, but persistent symptoms warrant medical evaluation. Family history of pancreatic cancer or genetic syndromes increase risk and may require screening.

Pancreatic cancer diagnosis involves imaging studies (CT, MRI, endoscopic ultrasound), blood tests including tumor markers (CA 19-9), and tissue biopsy for confirmation. Staging determines cancer extent and treatment options. Early-stage cancers confined to the pancreas may be surgical candidates, while advanced cancers require systemic therapy. PET scans help detect distant spread. Endoscopic ultrasound with fine needle aspiration provides tissue diagnosis and local staging information. Multidisciplinary evaluation is essential for optimal treatment planning.

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis caused by the immune system attacking the pancreas. Unlike typical chronic pancreatitis, AIP can mimic pancreatic cancer with pancreatic enlargement and bile duct narrowing. It's often associated with other autoimmune conditions and elevated IgG4 levels. Diagnosis involves imaging, blood tests, and sometimes tissue biopsy. The key difference is that AIP responds dramatically to steroid treatment, unlike cancer or typical chronic pancreatitis. Early recognition and treatment can prevent permanent pancreatic damage.

Dietary management for pancreatic disorders focuses on supporting digestion and nutrition. Key recommendations include taking prescribed pancreatic enzymes with all meals and snacks, eating smaller frequent meals, limiting alcohol completely, reducing fat intake initially (though some fat is necessary), staying hydrated, and maintaining stable blood sugar levels. Avoid raw or undercooked foods to prevent infections. Medium-chain triglycerides (MCT oil) may be easier to digest. Work with a registered dietitian experienced in pancreatic disorders for personalized recommendations.

Pancreatic cancer prognosis depends on stage at diagnosis. Early-stage resectable cancers have better outcomes, with 5-year survival rates of 20-25% for localized disease. Advanced cancers have poorer prognosis, but new treatments are improving outcomes. Treatment options include surgery (Whipple procedure, distal pancreatectomy), chemotherapy, radiation therapy, and targeted therapies. Immunotherapy and precision medicine based on genetic testing offer new hope. Palliative care focuses on symptom management and quality of life. Clinical trials may provide access to experimental treatments.