PANCREAS AND ITS ALARMING DISEASES

INTRODUCTION

1. Pancreas is a small retroperitoneal organ with vital role in digestion process and hormonal balance of the body.
2. Important hormones are insulin and glucagon to maintain sugar balance in our body.
3. Pancreatic diseases are in increasing incidence because of alcohol abuse and leading to life threatening problems.
4. Pancreatic cancer incidence has been increasing and because of its late presentation, the treatment is getting delayed with poor outcomes.
5. Awareness about the pancreatic diseases is timely concern in present scenario.

Pancreatic diseases are divided into

1. benign ( non cancers)
2. Malignant (cancers)

Benign

Common is pancreatitis, which includes

1. Acute pancreatitis
2. Chronic pancreatitis

Symptoms

It is a dangerous disease with almost all cases needs hospital admission but 80% of cases recovers well

Mild

Acute severe abdominal pain radiating to back relieving on stooping forward associated with Nausea and vomiting.

Moderate

Above symptomatology plus hypotension ,tachycardia and decrease in urine output.

Severe disease: (infected necrotising pancreatitis) only 20% of cases

Above symptomatology plus organ failure like

1. kidney failure (acute kidney injury ,AKI)
2. Respiratory failure (acute respiratory distress syndrome ,ARDS)
3. Cardiovascular failure
4. Haematological failure .

Diagnosis

Treatment

Depends on the severity of the disease.

Treatment depending on aetiology :-

1. ERCP and calculi removal ( for gall stone pancreatitis) followed by laparoscopic cholecystectomy.
2. surgical Necrosectomy (for infected Necrotising pancreatitis)

SEQUELAE OF PANCREATITIS

1. Chronic pancreatitis
2. Acute fluid collection
3. Pseudo cyst of pancreas
4. Splenic vein thrombosis >>>> portal hypertension
5. Splenic artery aneurysm
6. 1Pancreatic ducal disruption leading to ascites
7. Pancreatico pulmonary fistula.

Surgical treatment of Sequalae of acute pancreatitis

1. Acute fluid collection:- endoscopic drainage
2. Pseudo cyst of pancreas:- cysto gastrostomy, cystojejunostomy (drainage of fluid into intestine).
3. Splenic vein thrombosis and portal hypertension:-splenectomy
4. Splenic artery aneurysm: splenic artery ligation and splenectomy.
5. Pancreatic abscess : per cutaneous drainage
6. Pancreatic ductal disruption with ascites:-
   1. ERP +Stenting
   2. distal pancreatectomy
7. Pancreatico pleural fistula:- It includes management similar to pancreatic ductal disruption plus ICD(chest tube) drainage.

Rare condition asymptotic chronic

pancreatitis also observed.

Diagnosis

1. CT SCAN Abdomen
2. ENDOSCOPIC ULTRASOUND
3. MRCP/ERCP

Treatment

Only to cure symptoms of the disease

1. Pancreatic enzymes
   1. Analgesics
   2. Antioxidants
   3. Obstinacy from alcohol

Surgical

1. If patient is having unrelenting pain not responding to medical management with the pancreatic ductal calculi/Stricture with pancreatic ductal dilatation of >> 7mm with or without head mass will respond to surgical management well.
2. IN selected cases of chronic pancreatitis, surgery will give permanent solution for pain .
3. Frey's procedure( commonly performed) (Pancreatic head coring with jejunal anastomoses with pancreatic duct)
4. Frey's with biliary bypass ( if associated with CBD Stricture).
5. Whipples procedure ( if ass with mass in the head)

SEQUELAE:

1. CBD STRICTURE (jaundice)
2. MALIGNANCY (cancer)(3 out 100 chronic pancreatitis patients).
3. Steatorrhea.
4. Splenic vein thrombosis portal hypertension.
5. Splenic artery aneurysm.
6. Diabetes.

Treatment

Head region

Stage 1,2:-Whipples procedure

Stage 3,:-chemotherapy radiotherapy followed by surgery

body region

Stage 1,2:-central pancreatectomy

Stage 3:- chemotherapy Radiotherapy followed by surgery

Tail region

Stage 1,2,3, :- distal pancreatectomy

Stage 4:- palliative care