Shining a Light on the Pancreas
By: Kenneth M. Sigman, MD
Mention the pancreas to most non-medical people and you will get a questioning stare. Most do not know where it is, its functions or the diseases that can affect it. Mention the pancreas to most medical professionals and the reactions will most likely be dread and fear of its disease processes. The two best known problems that affect the pancreas are pancreatitis and pancreatic cancer.
Pancreatitis
Pancreatitis is a condition of inflammation of the pancreas. There are many different causes such as gallstones, excessive alcohol use, various medications, hypertriglyceridemia, and auto immune diseases being the most common.
Inflammation may affect only the pancreas in mild cases or cause widespread multi-organ system failure and death in severe cases.
The hallmarks of treatment are intravenous fluids and careful monitoring and treatment of any complications such as respiratory or renal failure, or infections. The pain is usually treated with narcotic analgesia.
The diagnosis and criteria for judging the severity of the inflammatory process is made with several blood tests and imaging studies such as CT scanning.
If there is evidence of one or more gallstones or other processes causing blockage and pancreatitis then a special endoscopic technique – ERCP – can be used to relieve the blockage.
ERCP or Endoscopic Retrograde Cholangiopancreatography is a combined endoscopic and radiographic technique to visualize the bile duct and pancreatic duct. Additional instruments are available to remove stones, take tissue samples and place stents to improve drainage as well. Many of the causes and complications of pancreatitis can be treated with ERCP. This can save patients from having further episodes and long term complications from pancreatitis. We are fortunate to have all of the most modern, cutting edge equipment at Trinity Medical Center for the diagnosis and treatment of pancreatic diseases.
Pancreatic Cancer
Cancer of the pancreas is one of the most deadly and feared diseases in the world. There are approximately 45,000 new cases of pancreatic cancer in the United States each year with the overall 5 year survival less than 5%. The most common presenting signs and symptoms are decreased appetite, weight loss, fatigue and painless jaundice. Although it can begin anywhere in the pancreas, the most common site is in the head of the gland where it blocks the bile duct and causes jaundice. We don’t know the true causes of pancreatic cancer but we do know there is a heredity factor in some cases and that there is an association with tobacco and alcohol use.
The diagnosis is based on a combination of blood tests, imaging studies and endoscopic techniques with tissue sampling. Elevated liver test and the tumor antigen CA19-9 may signal bile duct obstruction.
CT scanning is the best non-invasive radiographic imaging study for evaluating pancreatic cancer and bile duct obstruction as well as local and distant metastatic involvement. Endoscopic Ultrasound is a highly specialized procedure where an ultrasound probe built into the tip of the endoscope allows the operator to “see through the wall” of the stomach and duodenum to better identify the tumor, surrounding blood vessels, and lymph nodes. Also with this technique direct targeted biopsies can be taken with minimal invasion and high diagnostic yield.
Trinity Medical Center was the first hospital in Alabama to have endoscopic ultrasound and continues to provide the most advanced diagnostic equipment anywhere in the Southeast.
ERCP, described above for pancreatitis, also plays a major role in diagnosis and treatment of pancreatic cancer. Tissue samples can be obtained from the bile duct and pancreatic duct and stents can be placed to relieve obstructions. We take a multispecialty team approach to the diagnosis and treatment of pancreatic cancer. Combining the expertise of gastroenterologist, radiologist, surgeons, and oncologist brings the best care for all patients with pancreatic cancer.
Dr. Kenneth Sigman is a gastroenterologist at Birmingham Gastroenterology Associates.