hepatopancreaticobiliary

COMMON DISORDERS OF THE PANCREAS (கணையம் - Kaṇaiyam)

There are a variety of disorders of the pancreas including Acute pancreatitis, Chronic pancreatitis, Pseudocyst of Pancreas, Hereditary pancreatitis, and Pancreatic cancer. The evaluation of pancreatic diseases can be difficult due to the inaccessibility of the pancreas. There are multiple methods to evaluate the pancreas. Initial tests of the pancreas include a physical examination, which is difficult since the pancreas is deep in the abdomen near the spine. Blood tests like serum amylase, lipase are often helpful in determining whether the pancreas is involved in a specific symptom but may be misleading. The best radiographic tests to evaluate the structure of the pancreas include CT (computed tomography) scan, endoscopic ultrasound, and MRI (magnetic resonance imaging).

Tests to evaluate the pancreatic ducts include ERCP (endoscopic retrograde cholangiopancreatography), a speciality service at Gateway Clinics and MRCP (magnetic resonance cholangiopancreatography). There are also instances in which surgical exploration is the only way to confirm the diagnosis of pancreatic disease.

Acute Pancreatitis

Acute pancreatitis is a sudden attack causing inflammation of the pancreas and is usually associated with severe upper abdominal pain. The pain may be severe and last several days. Other symptoms of acute pancreatitis include nausea, vomiting, diarrhea, bloating, and fever. One of the most common cause of acute pancreatitis is gallstones. Other causes include chronic alcohol consumption, hereditary conditions, trauma, medications, infections, electrolyte abnormalities, high lipid levels, hormonal abnormalities, or other unknown causes. The treatment is usually supportive with medications showing no benefit. Most patients with acute pancreatitis recover completely with possible chances of recurrent attacks.

Chronic Pancreatitis

Chronic pancreatitis is the progressive disorder associated with the destruction of the pancreas. The disease is more common in men and usually develops in persons between 30 and 40 years of age. Initially, chronic pancreatitis may be confused with acute pancreatitis because the symptoms are similar. The most common symptoms are upper abdominal pain and diarrhea. As the disease becomes more chronic, patients can develop malnutrition and weight loss. If the pancreas becomes destroyed in the latter stages of the disease, patients may develop diabetes mellitus.

The most common cause of chronic pancreatitis in our practice is chronic alcohol consumption. Additional causes include cystic fibrosis and other hereditary disorders of the pancreas. For a significant percentage of patients there is no known cause.

The treatment for chronic pancreatitis depends on the symptoms. Most therapies concentrate on pain management and nutritional support. Oral pancreatic enzyme supplements are used to aid in the digestion of food. Patients who develop diabetes require insulin to control blood sugar. The avoidance of alcohol is central to therapy.

Hereditary Pancreatitis

In some cases, pancreatitis is related to inherited abnormalities of the pancreas or intestine. Acute recurrent attacks of pancreatitis early in life (under age 30) can often progress to chronic pancreatitis. The most common inherited disorder that leads to chronic pancreatitis is cystic fibrosis. Recent research demonstrates genetic testing can be a valuable tool in identifying patients predisposed to hereditary pancreatitis.

As in chronic pancreatitis, hereditary pancreatitis is a progressive disease with a high risk of permanent problems. Patients with these disorders may have chronic pain, diarrhea, malnutrition, or diabetes. Treatment focuses on pain control and pancreatic enzyme replacement.

Pancreatic Cancer

Cancer of the pancreas is resistant to many standard treatments including chemotherapy and radiation therapy. This cancer grows insidiously and initially does not cause symptoms. The classic presentation of pancreatic cancer is referred to as painless jaundice, a yellowish skin discoloration with no other symptoms. The diagnosis is usually made using different radiographic imaging techniques.

If detected in the early stages, pancreatic cancer can be cured by surgical resection. Unfortunately, early detection is more the exception than the rule. At later stages, treatment can improve the quality of life by controlling symptoms and complications.

Liver

Why is the liver important?

The liver is the second largest organ in your body and is located under your rib cage on the right side
The liver performs many jobs in your body. It processes what you eat and drink into energy and nutrients your body can use. The liver also removes harmful substances from your blood.

There are many kinds of liver diseases. Viruses cause some of them, like hepatitis A, hepatitis B and hepatitis C. Others can be the result of drugs, poisons or drinking too much alcohol. If the liver forms scar tissue because of an illness, it's called cirrhosis. Jaundice, or yellowing of the skin, can be one sign of liver disease.

Cancer can affect the liver. You could also inherit a liver disease such as hemochromatosis.

Alcohol Related Liver Disease

Explore this section to learn more about the ways in which alcohol affects the liver and how alcohol-induced liver disease is diagnosed and treated.

How does alcohol affect the liver?

Alcohol can damage or destroy liver cells. The liver breaks down alcohol so it can be removed from your body. Your liver can become injured or seriously damaged if you drink more alcohol than it can process.

What are the different types of alcohol-related liver disease?

There are three main types of alcohol-related liver disease: alcoholic fatty liver disease, alcoholic hepatitis, and alcoholic cirrhosis.

Alcoholic fatty liver disease

Alcoholic fatty liver disease results from the deposition of fat in liver cells. It is the earliest stage of alcohol-related liver disease. There are usually no symptoms. If symptoms do occur, they may include fatigue, weakness, and discomfort localized to the right upper abdomen. Liver enzymes may be elevated, however tests of liver function are often normal. Many heavy drinkers have fatty liver disease. Alcoholic fatty liver disease may be reversible with abstinence of alcohol.

Alcoholic hepatitis

Alcoholic hepatitis is characterized by fat deposition in liver cells, inflammation and mild scarring of the liver. Symptoms may include loss of appetite, nausea, vomiting, abdominal pain, fever and jaundice. Liver enzymes are elevated and tests of liver function may be abnormal. Up to 35 percent of heavy drinkers develop alcoholic hepatitis and of these 55% already have cirrhosis.

Alcoholic hepatitis can be mild or severe. Mild alcoholic hepatitis may be reversed with abstinence. Severe alcoholic hepatitis may occur suddenly and lead to serious complications including liver failure and death.

Alcoholic cirrhosis

Alcoholic cirrhosis, the most advanced type of alcohol induced liver injury is characterized by severe scarring and disruption of the normal structure of the liver -- hard scar tissue replaces soft healthy tissue. Between 10 and 20 percent of heavy drinkers develop cirrhosis. Symptoms of cirrhosis may be similar to those of severe alcoholic hepatitis. Cirrhosis is the most advanced type of alcohol-related liver disease and is not reversed with abstinence. However, abstinence may improve the symptoms and signs of liver disease and prevent further damage.

How does alcohol-related liver disease progress?

Many heavy drinkers will progress from fatty liver disease to alcoholic hepatitis to alcoholic cirrhosis over time. However, some heavy drinkers may develop cirrhosis without first having alcoholic hepatitis first. Others may have alcoholic hepatitis but never have symptoms. Additionally, alcohol consumption may worsen liver injury caused by non-alcoholic liver diseases such as chronic hepatitis C.

Since an individual's susceptibility to the toxic effects of alcohol may vary by many factors including age, gender, genetics and coexistent medical conditions, it is reasonable for you to review alcohol use with your physician.

How does alcohol-related liver disease progress?

What are the complications of alcohol-related liver disease?

They may include liver related conditions that are a consequence of portal hypertension:

Build up of fluid in the abdomen

Bleeding from veins in the esophagus or stomach

Enlarged spleen

Brain disorders and coma

Kidney failure

Liver cancer

In addition alcoholic liver disease may be accompanied by multi-organ non-liver conditions.

How is alcohol-related liver disease diagnosed?

Alcohol-related liver disease may be suspected based on a person's history of alcohol abuse, laboratory or radiologic abnormalities or medical conditions related to alcohol abuse. Blood tests may be used to rule out other liver diseases. Your doctor also may need to do a liver biopsy. During a biopsy, a small piece of liver tissue is removed and studied in the lab.

How is alcohol-related liver disease treated?

Treatment for alcohol-related liver disease requires a healthy diet including avoiding alcohol. Your doctor may suggest changes in your diet to help your liver recover from the alcohol-related damage. Treatment may require you to participate in an alcohol recovery program. Medications may be needed to manage the complications caused by your liver damage. Individuals with advanced alcoholic liver disease that does not improve with abstinence and medical management may benefit from a liver transplant.