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Pancreatitis

Pancreatitis - GI Associates · pancreatitis: runlqj zlwk \rx dv d sduwqhu lq khdowk fduh \rxu jdvwurhqwhurorjlvw dw *, $vvrfldwhv zloo ghwhuplqh wkh ehvw gldjqrvwlf dqg wuhdwphqw

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Pancreatitis

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©2011 GI Associates & Endoscopy Center. All rights reserved.

Fax 601/352-4882 • 800/880-1231www.msgastrodocs.com

Jackson1421 N. State Street, Ste 203

Jackson, MS 39202601/355-1234

Vicksburg1815 Mission 66

Vicksburg, MS 39180601/638-8801

Madison106 Highland Way

Madison, MS 39110601/355-1234

Albert F. Chiemprabha, M.D.Pierce D. Dotherow, M.D.

Reed B. Hogan, M.D.James H. Johnston, III, M.D.

Ronald P. Kotfila, M.D.Billy W. Long, M.D.

J. Trippe McNeese, M.D.Paul B. Milner, M.D.

Michelle A. Petro, M.D. Vonda Reeves-Darby, M.D.

Sara Rippel, M.D., Pediatric GIMatt Runnels, M.D.

Vishwanath N. Shenoy, M.D. James Q. Sones, II, M.D.

April Ulmer, M.D., Pediatric GIJames A. Underwood, Jr., M.D.

Mark E. Wilson, M.D.Cindy Haden Wright, M.D.

Keith Brown, M.D., PathologistSamuel Hensley, M.D., Pathologist

Table of Contents����:KDW�LV�WKH�SDQFUHDV"����3DQFUHDWLWLV��JHQHUDO�����$FXWH�3DQFUHDWLWLV����� � � :KDW�FDXVHV�LW"����� � � 6LJQV��V\PSWRPV����� � � +RZ�LV�LW�GLDJQRVHG"����� � � +RZ�VHULRXV�LV�LW"����� � � :KDW�LV�WKH�WUHDWPHQW"�����&KURQLF�3DQFUHDWLWLV������ � :KDW�DUH�WKH�V\PSWRPV"������ � +RZ�LV�LW�GLDJQRVHG"������ � +RZ�LV�LW�WUHDWHG"������ � 6XPPDU\�����&DQFHU�RI�WKH�SDQFUHDV������ � :KDW�FDXVHV�LW"������ � 6LJQV��V\PSWRPV������ � +RZ�LV�LW�GLDJQRVHG"������ � +RZ�VHULRXV�LV�LW"������ � :KDW�LV�WKH�WUHDWPHQW"�����6XPPDU\

What is the pancreas?(YHQ�WKRXJK�ZH�GRQ·W�XVXDOO\�KHDU�D�ORW�DERXW�WKH�SDQFUHDV��LW�LV�YHU\� LPSRUWDQW� WR�JRRG�KHDOWK��7KH�SDQFUHDV�QRW�RQO\�KHOSV� WR�GLJHVW�DQG�XVH�WKH�IRRG�ZH�HDW��EXW�LW�DOVR�DIIHFWV�WKH�ZKROH�ERG\��/HDUQLQJ�DERXW�KRZ�WKH�SDQFUHDV�ZRUNV�QRUPDOO\� FDQ�KHOS�\RX�XQGHUVWDQG�SUREOHPV�RI�WKH�SDQFUHDV�<RXU�SDQFUHDV�L V � D � J O DQG ��ZKLFK� LV� DQ�R UJ D Q � W K D W�PDNHV� VHFUH��WLRQV� WKDW� DUH�XVHG� LQ� RWKHU�SDUWV� RI� WKH�ERG\��,W�LV�WKLQ�DQG� VSRQJ\��D E R X W � V L [�LQFKHV� ORQJ��DQG� ZHLJKV�OHVV � WKDQ� D�SRXQG�� ,W� LV�O R F D W H G�EHKLQG� \RXU� VWRPDFK� DQG� LV� VXUURXQGHG� E\� WKH� ILUVW�ORRS� RI� WKH� VPDOO� LQWHVWLQH�� ,W� OLHV� DFURVV� WKH� XSSHU�SDUW� RI� WKH� DEGRPHQ�� ZLWK� LWV� KHDG� ORFDWHG� RQ� WKH�ULJKW� VLGH� DQG� LWV� QDUURZ� WDLO � WRZDUG� WKH� OHIW � VLGH�RI� WKH�ERG\��XQGHU� WKH�GLDSKUDJP��/LNH�D�GUDLQDJH�V\VWHP�� WKH�SDQFUHDV � KDV � PDQ\ � VPDO O � RSHQ LQJV � �GXF W V � � WKD W�IHHG� LQWR� D� ODUJH� GXFW� FDOOHG� WKH� 'XFW� RI � :LUVXQJ ��WKDW � UXQV� WKH � HQW LUH � OHQJWK� RI � WKH � SDQFUHDV � � 7KH�FRPPRQ� ELOH� GXFW� IURP� WKH� OLYHU� DQG� JDOO� EODGGHU� MRLQVWKH�'XFW�RI�:LUVXQJ�DQG�WKHQ�HPSWLHV�LQWR�WKH�VPDOO�LQWHVWLQH�

The pancreas - two glands in one!7KH�SDQFUHDV� DFWV� OLNH� WZR� JODQGV� LQ�RQH�� ,W� DFWV� DV� DQ� H[RFULQH�JODQG� E\� UHOHDVLQJ� VXEVWDQFHV� WR� WKH� RXWVLGH� RI� WKH� SDQFUHDV�WKURXJK� GXFWV�� ,W� DFWV� DV� DQ� HQGRFULQH� JODQG� E\� UHOHDVLQJ�VXEVWDQFHV�GLUHFWO\�LQWR�WKH�EORRGWUHDP�

How serious is it?3DQFUHDWLF�FDQFHU�FDQ�EH�FXUHG�RQO\�ZKHQ�IRXQG�DW�WKH�YHU\�HDU��OLHVW�VWDJHV��8QIRUWXQDWHO\��WKH�VXUYLYDO�UDWH�IRU�SDQFUHDWLF�FDQFHU�LV�SUHWW\�GLVPDO��EHFDXVH�RIWHQ�E\�WKH�WLPH�LW�LV�GLDJQRVHG��LW�KDV�VSUHDG�WR�RWKHU�SDUWV�RI�WKH�ERG\�

What is the treatment for pancreatic cancer?7KH�WUHDWPHQW�FKRVHQ�IRU�SDQFUHDWLF�FDQFHU��DV�ZHOO�DV�PRVW�RWKHU�W\SHV�RI� FDQFHU��GHSHQGV�RQ� WKH� W\SH�RI� FDQFHU�� DV�ZHOO� DV� WKH�WXPRU�VL]H�DQG�H[WHQW�RI�VSUHDG�WR�RWKHU�DUHDV�7UHDWPHQW�PD\�LQYROYH�VXUJHU\�WR�UHPRYH�WKH�SDQFUHDV��SURYLGH�IRU� EHWWHU� GUDLQDJH� RI� IOXLGV� RU� WR� VHYHU� QHUYHV� WKDW� WUDQVPLW�SDLQ��&KHPRWKHUDS\�� UDGLDWLRQ�� DQG�PHGLFDWLRQ� WR� UHOLHYH�SDLQ� DUH�DOVR�RIWHQ�SDUW�RI�WUHDWPHQW�

In summary…2Q�D�SRVLWLYH�QRWH��FXUUHQW�HYLGHQFH�VXJJHVWV�WKDW�PRUH�SHUVRQV�WKDQ� HYHU� EHIRUH� DUH� EHLQJ� VXFFHVVIXOO\� WUHDWHG� IRU�SDQFUHDWLF�FDQFHU��:H�DUH�PDNLQJ�SURJUHVV��7KH�QHHG�IRU�HDUO\�GHWHFWLRQ�RISDQFUHDWLF� FDQFHU� XQGHUVFRUHV� WKH� QHFHVVLW\� RI� HDUO\�PHGLFDO�HYDOXDWLRQ�RI�V\PSWRPV�VR�WKDW�WUHDWPHQW�FDQ�EH�PRUH�HIIHFWLYH�:LWK� FDQFHU� RI� WKH�SDQFUHDV� �DV�ZLWK� DQ\�RWKHU�*,� FRQGLWLRQ���RXU�JRDO� LV� WR�ZRUN�ZLWK� WKH�SDWLHQW� WR�GHYHORS�D�SODQ�RI� WUHDW��PHQW�WKDW�ZLOO�DOORZ�WKH�SDWLHQW�WR�OLYH�OLIH�WR�WKH�IXOOHVW�ZLWK�WKH�EHVW�SRVVLEOH�UHOLHI�RI�V\PSWRPV��

Early detection, before cancer has spread, is a must for the best treatment outcome!

(��� 116

What does it do?7KH�H[RFULQH�JODQG�ZRUN�RI�WKH�SDQFUHDV��UHOHDVLQJ�VXEVWDQFHV�WRWKH�RXWVLGH�RI�WKH�SDQFUHDV��DFFRXQWV�IRU�DERXW�����RI�LWV�ZRUN��ORDG��7KH�SDQFUHDV�SURGXFHV�DERXW����RXQFHV�RI�SDQFUHDWLF�MXLFHV��D�FROOHFWLRQ�RI�HQ]\PHV�DQG�KRUPRQHV��GDLO\�DQG�VHFUHWHV�WKHP�WKURXJK�LWV�GXFW�V\VWHP�LQWR�WKH�VPDOO�LQWHVWLQH��7KH� ODUJH� DPRXQW�RI� IOXLG�PRYLQJ� WKURXJK� WKH�SDQFUHDV�GDLO\�FRXOG�TXLFNO\� EHFRPH� D�SDLQIXO� SUREOHP� LI� D� EORFNDJH�GHYHO��RSHV� LQ� LWV�GUDLQDJH� �GXFW�� V\VWHP��%ORFNDJH� FDQ�RFFXU� IURP�D�ORGJHG�JDOOVWRQH� RU� IURP� WKH� VZHOOLQJ� WKDW� FDQ�KDSSHQ� LI� WKH�SDQFUHDV�EHFRPHV�LQIODPHG�RU�LQIHFWHG�7KH�SURGXFWLRQ�DQG�UHOHDVH�RI�HQ]\PHV�E\�WKH�SDQFUHDV� LV�FRQ��WUROOHG�E\�KRUPRQHV�PDGH�LQ�WKH�VPDOO� LQWHVWLQH��:KHQ�ZH�HDW��IRRG� HQWHULQJ� WKH� VPDOO� LQWHVWLQH� FDXVHV� WKH� UHOHDVH� RI� VSHFLDO�KRUPRQHV� LQWR� WKH� EORRGVWUHDP��:KHQ� WKRVH�KRUPRQHV� UHDFK�WKH�SDQFUHDV� �WKURXJK� WKH�EORRGVWUHDP�� WKH�SDQFUHDV�NQRZV� WR�SURGXFH� DQG� UHOHDVH� ODUJH� DPRXQWV� RI�ZDWHU�� DQ� DONDOLQH� VXE��VWDQFH��VRGLXP�ELFDUERQDWH��DQG�GLJHVWLYH�HQ]\PHV��WU\SVLQ��DP\ODVH�DQG�OLSDVH���7KRVH�GLJHVWLYH�HQ]\PHV�DUH�SURGXFHG�E\�FHOOV�LQ�WKH�SDQFUHDV� WKDW� ORRN� OLNH� FOXVWHUV�RI�JUDSHV� DQG�DUH� FDOOHG� DFLQDU�

5HVHDUFK�VWXGLHV�KDYH�VKRZQ�WKDW�FKURQLF�DOFRKROLVP�DQG�FKURQ��LF�SDQFUHDWLWLV�DUH�DVVRFLDWHG�ZLWK�WKH�GHYHORSPHQW�RI�SDQFUHDWLF�FDQFHU��$GGLWLRQDOO\�� ORQJ�WHUP� H[SRVXUH� WR� VRPH� FKHPLFDOV��VXFK�DV�WKRVH�LQYROYHG�LQ�VRPH�RFFXSDWLRQV��PD\�LQFUHDVH�RQH·V�ULVN� RI� SDQFUHDWLF� FDQFHU� �IRU� H[DPSOH�� FKHPLFDOV�XVHG� LQ�GU\�FOHDQLQJ�DQG�JDV��FRDO�RU�PHWDO�PLQLQJ��

Pancreatic Cancer…

Signs & symptoms8QIRUWXQDWHO\�� WKH� HDUO\� V\PSWRPV� RI� SDQFUHDWLF� FDQFHU� DUH�PXFK� OLNH� WKRVH� RI� RWKHU� LOOQHVVHV�� ,W� LV� FDOOHG� D� ´VLOHQW�NLOOHUµ�� EHFDXVH� GXULQJ� HDUO\� VWDJHV�� V\PSWRPV�PD\� EH� IHZ�RU� FRPSOHWHO\� DEVHQW��8VXDOO\� WKHUH� DUH� IHZ� V\PSWRPV�XQWLO�WKH� ELOH� GXFW� LV� REVWUXFWHG�� %XW�ZKHQ� WKH� ELOH� GXFW� EHFRPHV�REVWUXFWHG�� LW� XVXDOO\� FDXVHV� MDXQGLFH� �D� \HOORZLVK�JUHHQ�GLVFRORUDWLRQ� RI� WKH� VNLQ� DQG�ZKLWH� SDUW� RI� WKH� H\HV���2WKHU�V\PSWRPV� RI� SDQFUHDWLF� FDQFHU� LQFOXGH� DEGRPLQDO� SDLQ� WKDW�RIWHQ� UDGLDWHV� WR� WKH� EDFN� DQG� D� UDSLG�ZHLJKW� ORVV� RI� ����RU�PRUH�RI�ERG\�ZHLJKW��,WFK\�VNLQ��SUXULWLV��PD\�EH�H[SHULHQFHG�DV�ZHOO�DV�QDXVHD��YRPLWLQJ�DQG�LQWHVWLQDO�EOHHGLQJ�

How is it diagnosed?'LDJQRVLV�LV�EDVHG�RQ�V\PSWRPV�DQG�GLDJQRVWLF�WHVWV�VLPLODU�WR�WKRVH� GHVFULEHG� LQ� WKH� SUHFHGLQJ� VHFWLRQ� DERXW� SDQFUHDWLWLV��7KHUH� LV� FRQVLVWHQW�SURJUHVV� LQWR�DUHDV�RI� UHVHDUFK� WKDW�PD\�EH�LPSRUWDQW�WR�WKH�RXWFRPH�RI�SDQFUHDWLF�FDQFHU�LQ�WKH�IXWXUH��7KH�GHYHORSPHQW�RI� WXPRU�PDUNHUV� �EORRG� WHVWV� WKDW� VHDUFK� IRU� HYL�GHQFH� RI� D� SDUWLFXODU� W\SH� RI� FDQFHU��ZLOO� KHOS�GHWHUPLQH� WKH�SUHVHQFH� RI� SDQFUHDWLF� FDQFHU� DW� HDUOLHU� VWDJHV��$OVR�� KXPDQ�JHQRPH� UHVHDUFK� �WR�GHWHUPLQH� WKH�JHQHWLF� WHQGHQF\� IRU� FHUWDLQFDQFHUV��ZLOO� SUREDEO\� LPSURYH� RXU� DELOLW\� WR� EHWWHU� LGHQWLI\�WKRVH�WKDW�PD\�EH�DW�KLJKHU�WKDQ�QRUPDO�ULVN�

152

FHOOV�� 6RGLXP�ELFDUERQDWH�ZRUNV�ZLWK� WKH� GLJHVWLYH� HQ]\PHVWR�EUHDN�GRZQ�IRRG�LQWR�WLQ\�XQLWV�WKDW�FDQ�EH�DEVRUEHG�IRU�XVH�E\�WKH�ERG\�7KH� HQGRFULQH� JODQG�ZRUN�RI� WKH�SDQFUHDV� �UHOHDVLQJ� VXEVWDQFHV�GLUHFWO\�LQWR�WKH�EORRGVWUHDP��LV�GRQH�E\�VSHFLDO�FHOOV�FDOOHG�WKH�LVOHWV� RI� /DQJHUKDQV�� 7KH\�SURGXFH�DQG� UHOHDVH�ERWK� LQVXOLQ� DQG�JOXFDJRQ� LQWR� WKH� EORRGVWUHDP�� 7KHVH� VXEVWDQFHV� FRQWURO� WKH�DPRXQW�RI� VXJDU�XVHG�DQG� VWRUHG� LQ� WKH�ERG\�� ,QVXOLQ�SURPSWV�FHOOV�WKRXJKRXW�WKH�ERG\�WR�UHPRYH�DQG�XVH�WKH�DYDLODEOH�VXJDU�IURP� WKH�EORRGVWUHDP��2Q� WKH�RWKHU�KDQG��JOXFDJRQ� FDXVHV� WKH�UHOHDVH� RI� VWRUHG� VXJDU� LQWR� WKH� EORRGVWUHDP� WR� LQFUHDVH� WKH�EORRG� VXJDU� OHYHO��7KH�GHOLFDWH�EDODQFH�RI� WKHVH� WZR�KRUPRQHV�PDLQWDLQV� WKH� FRUUHFW� EORRG� VXJDU� OHYHO� WKDW� LV�QHFHVVDU\� IRU� D�KHDOWK\�ERG\�DQG�OLIH�LWVHOI�

What can go wrong with the pancreas?

,QIHFWLRQV��LQMXU\�RU�WXPRUV�RI�WKH�SDQFUHDV�FDQ�GLVUXSW�WKH�QRU��PDO� IXQFWLRQ�RI� WKH�SDQFUHDV��7KH� WZR�PDMRU�SUREOHPV�RI� WKH�SDQFUHDV� WKDW�ZLOO� EH� GLVFXVVHG� RQ� WKH� IROORZLQJ� SDJHV� DUH�SDQFUHDWLWLV� �LQIODPPDWLRQ�RI�WKH�SDQFUHDV��DQG�SDQFUHDWLF�FDQFHU��2I�WKH�WZR��SDQFUHDWLWLV�LV�WKH�PRVW�FRPPRQ�

PancreatitisWhat is it?3DQFUHDWLWLV� LV�DQ�LQIODPHG�RU� LQIHFWHG�SDQFUHDV��'DPDJH�WR�WKH�SDQFUHDV�LWVHOI�KDSSHQV�ZKHQ�LWV�RZQ�GLJHVWLYH�HQ]\PHV�DWWDFN�WKH�SDQFUHDV�LWVHOI��D�SURFHVV�FDOOHG�DXWRGLJHVWLRQ��:H�GR�QRW�FRP�SOHWHO\�XQGHUVWDQG�ZKDW� DFWXDOO\� WULJJHUV� WKLV� SURFHVV�� 7KRVH�GLJHVWLYH�HQ]\PHV�XVXDOO\�ZRUN�RXWVLGH�RI� WKH�SDQFUHDV�� LQ�WKH�LQWHVWLQH��WR�KHOS�GLJHVW�IRRG�,Q� DGGLWLRQ� WR� WKH� SDQFUHDWLF� HQ]\PHV� DWWDFNLQJ� WKH�SDQFUHDV�� WKH� DXWRGLJHVWLYH� SURFHVV� VHHPV� WR� VWLPXODWH�RWKHU� HQ]\PHV�� ZKLFK� DOVR� VWDUW� GLJHVWLQJ� WKH� SDQFUHDV��,Q� VHYHUH� FDVHV�� EOHHGLQJ�� WKH� GHYHORSPHQW� RI� F\VWV��VHULRXV� WLVVXH� GDPDJH� RU� GHDWK� RI� WLVVXH� LQ� WKH� SDQFUHDV�PD\� RFFXU�� 7KH� HQ]\PHV� DQG� WR[LQV� UHOHDVHG� GXULQJ�

Cancer of the pancreas&DQFHU� RI� WKH� SDQFUHDV� UDQNV� �WK� DV� WKH�PRVW� FRPPRQ� FDXVH�RIGHDWK� IURP� FDQFHU� � , WV � RFFXUUHQFH� KDV� JURZQ� RYHU�WKH � ODVW � I L I W\ � \HDUV � � ,Q � PRVW � FRXQWU LHV � � LQFOXGLQJ�WKH � 8�6 � � � L W � RFFXUV � DERXW � WZLFH � DV � RI WHQ � LQ � PHQ�WKDQ� ZRPHQ� � $IU LFDQ� $PHULFDQV� VHHP� WR� GHYHORS�SDQFUHDWLF�FDQFHU�PRUH�IUHTXHQWO\�WKDQ�GR�RWKHU�UDFHV��,W�LV�UDUH�LQ�SHUVRQV�XQGHU�DJH����DQG�LV�XQFRPPRQ�DPRQJ�WKRVH�XQGHU�����$ERXW� ����RI� FDVHV� RFFXU� LQ� SHUVRQV� EHWZHHQ� ��� DQG� ���\HDUV�RI�DJH�

What causes it?7KH�FDXVH�RI�SDQFUHDWLF�FDQFHU��OLNH�RWKHU�FDQFHUV��LV�QRW�HQWLUHO\�NQRZQ��EXW�ZH�NQRZ�WKDW�KHDY\�VPRNHUV�DUH� WZLFH�DV� OLNHO\�WR�GHYHORS�SDQFUHDWLF� FDQFHU��5LVN� LQFUHDVHV�ZLWK� WKH�QXPEHU� RI�FLJDUHWWHV�VPRNHG�SHU�GD\��+LJK�IDW�GLHWV�FRPELQHG�ZLWK�KHDY\�DOFRKRO�XVH�DOVR�VHHP�WR�LQFUHDVH�RQH·V�ULVN��(YLGHQFH�LV�PRXQW��LQJ� WKDW�GLHWV� ORZ� LQ� IDW�� KLJK� LQ� IUXLWV� DQG�YHJHWDEOHV�� DIIRUG�VRPH�SURWHFWLRQ�DJDLQVW�SDQFUHDWLF�FDQFHU�

Cancer of the pancreas ranks 5th as the most common cause of death from cancer.

3

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Two types of Pancreatitis7KHUH� DUH� WZR� EDVLF� W\SHV� RI� SDQFUHDWLWLV�� DFXWH� DQG� FKURQLF��$FXWH� SDQFUHDWLWLV� GHYHORSV� VXGGHQO\�� ZKHQ� WKH� SDQFUHDV�EHFRPHV� LQIODPHG�� ,Q� VRPH� FDVHV�� KRZHYHU�� SDWLHQWV� FRQWLQXH�WR� KDYH� DWWDFNV� RI� YDU\LQJ�GHJUHHV� RI� VHYHULW\��:KHQ�SDQFUH��DWLWLV� EHFRPHV� DQ�RII� DQG�RQ�� ORQJ�WHUP�SUREOHP�� LW� LV� NQRZQ�DV�FKURQLF�SDQFUHDWLWLV�&KURQLF� SDQFUHDWLWLV�PD\�GHYHORS� DIWHU� RQO\� RQH� DFXWH� DWWDFN��H[SHFLDOO\�ZKHQ� WKH� GXFWV� RI� WKH� SDQFUHDV� KDYH� EHHQ� GDP��DJHG�� ,Q� WKH� HDUO\� VWDJHV�� WKH� GRFWRU� FDQQRW� DOZD\V� WHOOZKHWKHU� RU� QRW� WKH� SDWLHQW� KDV� DFXWH� RU� FKURQLF� GLVHDVH�� 7KH�V\PSWRPV�PD\�EH�WKH�VDPH�

Acute Pancreatitis7KHUH� DUH� DERXW� ������� WR� ������� FDVHV� RI� DFXWH�SDQFUHDWLWLV� LQ�WKH�8QLWHG�6WDWHV� HDFK�\HDU��0DQ\�SHRSOH� UHFRYHU� IXOO\� IURP�D�PLOG� FDVH�ZLWKRXW�PHGLFDO� WUHDWPHQW�� EXW� VHYHUH� FDVHV� FDQ�EH�OLIH�WKUHDWHQLQJ�ZLWK�PDQ\�FRPSOLFDWLRQV�

What causes acute pancreatitis?7K H � PR V W � F RPPRQ � F D X V H � R I�DFXWH� SDQFUHDWLWLV� LV� DOFRKRO� DEXVHRU�JDOOVWRQHV��WKDW�EORFN�GXFWV���2WKHU�OHVV�FRPPRQ�FDXVHV�LQFOXGH���&RPSOLFDWLRQ�RI�DEGRPLQDO�VXUJHU\�� ,QMXU\� WR� WKH� SDQFUHDV� �IRU� H[DPSOH��DV�D�UHVXOW�RI�DQ�DXWRPRELOH�DFFLGHQW���6LGH�HIIHFW�RI�VRPH�SUHVFULSWLRQ�GUXJV��%LUWK�GHIHFW�RI�WKH�SDQFUHDV�RU�LQWHVWLQH��6RPH�LQIHFWLRQV��VXFK�DV�WKH�PXPSV��6SKLQFWHU� RI�2GGL�'\VIXQFWLRQ� �DQ� DEQRUPDOLW\� RI� WKH� VPDOO�VSLQFWHU�PXVFOH�WKDW�UHOHDVHV�SDQFUHDWLF�MXLFH�IURP�WKH�GXFW�

How is Chronic Pancreatitis treated?7KLV� FDQ� EH� D� VHULRXV�� OLIH�WKUHDWHQLQJ�SUREOHP�� EXW�ZRUNLQJ�WRJHWKHU�� WKH�JDVWURHQWHURORJLVW� DQG� WKH�SDWLHQW� FDQ�GHYHORS� D�WUHDWPHQW�SODQ�WKDW�ZLOO�NHHS�FRPSOLFDWLRQV� WR�D�PLQLPXP�DQG�ZLOO�DOORZ�WKH�SDWLHQW�WR�OLYH�OLIH�DV�IXOO\�DV�SRVVLEOH�0DMRU�JRDOV�RI�WUHDWPHQW�DUH�

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134

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11

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History, physical examination, symptoms and diagnostic tests will help diagnose pancreatitis.

7

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98

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98

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History, physical examination, symptoms and diagnostic tests will help diagnose pancreatitis.

7

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What are the symptoms of chronic pancreatitis?7KH� V\PSWRPV� RI� FKURQLF� SDQFUHDWLWLV� DUH�PXFK� WKH� VDPH� DV�WKRVH� IRU� DFXWH�SDQFUHDWLWLV�� OLVWHG�RQ�SDJHV��� DQG����+RZHYHU���XQOLNH� DFXWH� SDQFUHDWLWLV�� IURP�ZKLFK� D� SHUVRQ�PD\� UHFRYHU�IXOO\�� SDWLHQWV� ZKR� KDYH� FKURQLF� SDQFUHDWLWLV� PD\� KDYH��RQJRLQJ�SUREOHPV� WKDW�PXVW�EH�DGGUHVVHG��SULPDULO\�SDLQ� DQG�PDODEVRUSWLRQ�

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Signs & symptoms of acute pancreatitis7KH�V\PSWRPV�RI�DFXWH�SDQFUHDWLWLV�PD\�EH�PLOG�RU�VHYHUH�DQG�OLIH�WKUHDWHQLQJ��7KH�V\PSWRPV�OLVWHG�EHORZ�PD\�RU�PD\�QRW�EH�SUHVHQW�

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How is Chronic Pancreatitis diagnosed?/LNH�DFXWH�SDQFUHDWLWLV��GLDJQRVLV�RI�FKURQLF�SDQFUHDWLWLV�LV�EDVHG�RQ�WKH�SDWLHQW·V�KLVWRU\��V\PS��WRPV��SK\VLFDO�H[DPLQD��WLRQ�DQG�WHVWV�WKDW�LQFOXGH�%ORRG��XULQH�DQG�VWRRO�WHVWV�WRFKHFN�IRU�OHYHOV�RI�YDULRXV�VXE��VWDQFHV�DQG�WR�GHWHUPLQH�WKH�VHYHULW\�RI�WKH�SUREOHP�3DQFUHDWLF�IXQFWLRQ�WHVWV�WR�ILQG�RXW�KRZ�ZHOO�RU�LI��WKH�SDQFUHDV�LV�PDNLQJ�GLJHVWLYH�HQ]\PHV�;�UD\��XOWUDVRXQG�RU�&7�VFDQ�WR�FKHFN�IRUDEQRUPDOLWLHV�RU�GDPDJH�LQ�WKH�SDQFUHDV�(5&3��H[SODLQHG�RQ�SDJH����

512

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Two types of Pancreatitis7KHUH� DUH� WZR� EDVLF� W\SHV� RI� SDQFUHDWLWLV�� DFXWH� DQG� FKURQLF��$FXWH� SDQFUHDWLWLV� GHYHORSV� VXGGHQO\�� ZKHQ� WKH� SDQFUHDV�EHFRPHV� LQIODPHG�� ,Q� VRPH� FDVHV�� KRZHYHU�� SDWLHQWV� FRQWLQXH�WR� KDYH� DWWDFNV� RI� YDU\LQJ�GHJUHHV� RI� VHYHULW\��:KHQ�SDQFUH��DWLWLV� EHFRPHV� DQ�RII� DQG�RQ�� ORQJ�WHUP�SUREOHP�� LW� LV� NQRZQ�DV�FKURQLF�SDQFUHDWLWLV�&KURQLF� SDQFUHDWLWLV�PD\�GHYHORS� DIWHU� RQO\� RQH� DFXWH� DWWDFN��H[SHFLDOO\�ZKHQ� WKH� GXFWV� RI� WKH� SDQFUHDV� KDYH� EHHQ� GDP��DJHG�� ,Q� WKH� HDUO\� VWDJHV�� WKH� GRFWRU� FDQQRW� DOZD\V� WHOOZKHWKHU� RU� QRW� WKH� SDWLHQW� KDV� DFXWH� RU� FKURQLF� GLVHDVH�� 7KH�V\PSWRPV�PD\�EH�WKH�VDPH�

Acute Pancreatitis7KHUH� DUH� DERXW� ������� WR� ������� FDVHV� RI� DFXWH�SDQFUHDWLWLV� LQ�WKH�8QLWHG�6WDWHV� HDFK�\HDU��0DQ\�SHRSOH� UHFRYHU� IXOO\� IURP�D�PLOG� FDVH�ZLWKRXW�PHGLFDO� WUHDWPHQW�� EXW� VHYHUH� FDVHV� FDQ�EH�OLIH�WKUHDWHQLQJ�ZLWK�PDQ\�FRPSOLFDWLRQV�

What causes acute pancreatitis?7K H � PR V W � F RPPRQ � F D X V H � R I�DFXWH� SDQFUHDWLWLV� LV� DOFRKRO� DEXVHRU�JDOOVWRQHV��WKDW�EORFN�GXFWV���2WKHU�OHVV�FRPPRQ�FDXVHV�LQFOXGH���&RPSOLFDWLRQ�RI�DEGRPLQDO�VXUJHU\�� ,QMXU\� WR� WKH� SDQFUHDV� �IRU� H[DPSOH��DV�D�UHVXOW�RI�DQ�DXWRPRELOH�DFFLGHQW���6LGH�HIIHFW�RI�VRPH�SUHVFULSWLRQ�GUXJV��%LUWK�GHIHFW�RI�WKH�SDQFUHDV�RU�LQWHVWLQH��6RPH�LQIHFWLRQV��VXFK�DV�WKH�PXPSV��6SKLQFWHU� RI�2GGL�'\VIXQFWLRQ� �DQ� DEQRUPDOLW\� RI� WKH� VPDOO�VSLQFWHU�PXVFOH�WKDW�UHOHDVHV�SDQFUHDWLF�MXLFH�IURP�WKH�GXFW�

How is Chronic Pancreatitis treated?7KLV� FDQ� EH� D� VHULRXV�� OLIH�WKUHDWHQLQJ�SUREOHP�� EXW�ZRUNLQJ�WRJHWKHU�� WKH�JDVWURHQWHURORJLVW� DQG� WKH�SDWLHQW� FDQ�GHYHORS� D�WUHDWPHQW�SODQ�WKDW�ZLOO�NHHS�FRPSOLFDWLRQV� WR�D�PLQLPXP�DQG�ZLOO�DOORZ�WKH�SDWLHQW�WR�OLYH�OLIH�DV�IXOO\�DV�SRVVLEOH�0DMRU�JRDOV�RI�WUHDWPHQW�DUH�

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In Summary…3DQFUHDWLV� FDQ�EH�PLOG�RU� VHYHUH�� D�RQH� WLPH�SUREOHP�RU�D� OLIH��ORQJ�SUREOHP��6RXQG�PHGLFDO� WUHDWPHQW�DQG�JRRG�VHOI� FDUH�DUH�WKH�NH\V� WR�DYRLGLQJ� OLIH�WKUHDWHQLQJ�FRPSOLFDWLRQV��:RUNLQJ� LQ�SDUWQHUVKLS�ZLWK�\RXU�JDVWURHQWHURORJLVW�� WKH�EHVW�SRVVLEOH�RXW��FRPH�FDQ�EH�DFKLHYHG�

134

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What can go wrong with the pancreas?

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PancreatitisWhat is it?3DQFUHDWLWLV� LV�DQ�LQIODPHG�RU� LQIHFWHG�SDQFUHDV��'DPDJH�WR�WKH�SDQFUHDV�LWVHOI�KDSSHQV�ZKHQ�LWV�RZQ�GLJHVWLYH�HQ]\PHV�DWWDFN�WKH�SDQFUHDV�LWVHOI��D�SURFHVV�FDOOHG�DXWRGLJHVWLRQ��:H�GR�QRW�FRP�SOHWHO\�XQGHUVWDQG�ZKDW� DFWXDOO\� WULJJHUV� WKLV� SURFHVV�� 7KRVH�GLJHVWLYH�HQ]\PHV�XVXDOO\�ZRUN�RXWVLGH�RI� WKH�SDQFUHDV�� LQ�WKH�LQWHVWLQH��WR�KHOS�GLJHVW�IRRG�,Q� DGGLWLRQ� WR� WKH� SDQFUHDWLF� HQ]\PHV� DWWDFNLQJ� WKH�SDQFUHDV�� WKH� DXWRGLJHVWLYH� SURFHVV� VHHPV� WR� VWLPXODWH�RWKHU� HQ]\PHV�� ZKLFK� DOVR� VWDUW� GLJHVWLQJ� WKH� SDQFUHDV��,Q� VHYHUH� FDVHV�� EOHHGLQJ�� WKH� GHYHORSPHQW� RI� F\VWV��VHULRXV� WLVVXH� GDPDJH� RU� GHDWK� RI� WLVVXH� LQ� WKH� SDQFUHDV�PD\� RFFXU�� 7KH� HQ]\PHV� DQG� WR[LQV� UHOHDVHG� GXULQJ�

Cancer of the pancreas&DQFHU� RI� WKH� SDQFUHDV� UDQNV� �WK� DV� WKH�PRVW� FRPPRQ� FDXVH�RIGHDWK� IURP� FDQFHU� � , WV � RFFXUUHQFH� KDV� JURZQ� RYHU�WKH � ODVW � I L I W\ � \HDUV � � ,Q � PRVW � FRXQWU LHV � � LQFOXGLQJ�WKH � 8�6 � � � L W � RFFXUV � DERXW � WZLFH � DV � RI WHQ � LQ � PHQ�WKDQ� ZRPHQ� � $IU LFDQ� $PHULFDQV� VHHP� WR� GHYHORS�SDQFUHDWLF�FDQFHU�PRUH�IUHTXHQWO\�WKDQ�GR�RWKHU�UDFHV��,W�LV�UDUH�LQ�SHUVRQV�XQGHU�DJH����DQG�LV�XQFRPPRQ�DPRQJ�WKRVH�XQGHU�����$ERXW� ����RI� FDVHV� RFFXU� LQ� SHUVRQV� EHWZHHQ� ��� DQG� ���\HDUV�RI�DJH�

What causes it?7KH�FDXVH�RI�SDQFUHDWLF�FDQFHU��OLNH�RWKHU�FDQFHUV��LV�QRW�HQWLUHO\�NQRZQ��EXW�ZH�NQRZ�WKDW�KHDY\�VPRNHUV�DUH� WZLFH�DV� OLNHO\�WR�GHYHORS�SDQFUHDWLF� FDQFHU��5LVN� LQFUHDVHV�ZLWK� WKH�QXPEHU� RI�FLJDUHWWHV�VPRNHG�SHU�GD\��+LJK�IDW�GLHWV�FRPELQHG�ZLWK�KHDY\�DOFRKRO�XVH�DOVR�VHHP�WR�LQFUHDVH�RQH·V�ULVN��(YLGHQFH�LV�PRXQW��LQJ� WKDW�GLHWV� ORZ� LQ� IDW�� KLJK� LQ� IUXLWV� DQG�YHJHWDEOHV�� DIIRUG�VRPH�SURWHFWLRQ�DJDLQVW�SDQFUHDWLF�FDQFHU�

Cancer of the pancreas ranks 5th as the most common cause of death from cancer.

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Pancreatic Cancer…

Signs & symptoms8QIRUWXQDWHO\�� WKH� HDUO\� V\PSWRPV� RI� SDQFUHDWLF� FDQFHU� DUH�PXFK� OLNH� WKRVH� RI� RWKHU� LOOQHVVHV�� ,W� LV� FDOOHG� D� ´VLOHQW�NLOOHUµ�� EHFDXVH� GXULQJ� HDUO\� VWDJHV�� V\PSWRPV�PD\� EH� IHZ�RU� FRPSOHWHO\� DEVHQW��8VXDOO\� WKHUH� DUH� IHZ� V\PSWRPV�XQWLO�WKH� ELOH� GXFW� LV� REVWUXFWHG�� %XW�ZKHQ� WKH� ELOH� GXFW� EHFRPHV�REVWUXFWHG�� LW� XVXDOO\� FDXVHV� MDXQGLFH� �D� \HOORZLVK�JUHHQ�GLVFRORUDWLRQ� RI� WKH� VNLQ� DQG�ZKLWH� SDUW� RI� WKH� H\HV���2WKHU�V\PSWRPV� RI� SDQFUHDWLF� FDQFHU� LQFOXGH� DEGRPLQDO� SDLQ� WKDW�RIWHQ� UDGLDWHV� WR� WKH� EDFN� DQG� D� UDSLG�ZHLJKW� ORVV� RI� ����RU�PRUH�RI�ERG\�ZHLJKW��,WFK\�VNLQ��SUXULWLV��PD\�EH�H[SHULHQFHG�DV�ZHOO�DV�QDXVHD��YRPLWLQJ�DQG�LQWHVWLQDO�EOHHGLQJ�

How is it diagnosed?'LDJQRVLV�LV�EDVHG�RQ�V\PSWRPV�DQG�GLDJQRVWLF�WHVWV�VLPLODU�WR�WKRVH� GHVFULEHG� LQ� WKH� SUHFHGLQJ� VHFWLRQ� DERXW� SDQFUHDWLWLV��7KHUH� LV� FRQVLVWHQW�SURJUHVV� LQWR�DUHDV�RI� UHVHDUFK� WKDW�PD\�EH�LPSRUWDQW�WR�WKH�RXWFRPH�RI�SDQFUHDWLF�FDQFHU�LQ�WKH�IXWXUH��7KH�GHYHORSPHQW�RI� WXPRU�PDUNHUV� �EORRG� WHVWV� WKDW� VHDUFK� IRU� HYL�GHQFH� RI� D� SDUWLFXODU� W\SH� RI� FDQFHU��ZLOO� KHOS�GHWHUPLQH� WKH�SUHVHQFH� RI� SDQFUHDWLF� FDQFHU� DW� HDUOLHU� VWDJHV��$OVR�� KXPDQ�JHQRPH� UHVHDUFK� �WR�GHWHUPLQH� WKH�JHQHWLF� WHQGHQF\� IRU� FHUWDLQFDQFHUV��ZLOO� SUREDEO\� LPSURYH� RXU� DELOLW\� WR� EHWWHU� LGHQWLI\�WKRVH�WKDW�PD\�EH�DW�KLJKHU�WKDQ�QRUPDO�ULVN�

152

What is the pancreas?(YHQ�WKRXJK�ZH�GRQ·W�XVXDOO\�KHDU�D�ORW�DERXW�WKH�SDQFUHDV��LW�LV�YHU\� LPSRUWDQW� WR�JRRG�KHDOWK��7KH�SDQFUHDV�QRW�RQO\�KHOSV� WR�GLJHVW�DQG�XVH�WKH�IRRG�ZH�HDW��EXW�LW�DOVR�DIIHFWV�WKH�ZKROH�ERG\��/HDUQLQJ�DERXW�KRZ�WKH�SDQFUHDV�ZRUNV�QRUPDOO\� FDQ�KHOS�\RX�XQGHUVWDQG�SUREOHPV�RI�WKH�SDQFUHDV�<RXU�SDQFUHDV�L V � D � J O DQG ��ZKLFK� LV� DQ�R UJ D Q � W K D W�PDNHV� VHFUH��WLRQV� WKDW� DUH�XVHG� LQ� RWKHU�SDUWV� RI� WKH�ERG\��,W�LV�WKLQ�DQG� VSRQJ\��D E R X W � V L [�LQFKHV� ORQJ��DQG� ZHLJKV�OHVV � WKDQ� D�SRXQG�� ,W� LV�O R F D W H G�EHKLQG� \RXU� VWRPDFK� DQG� LV� VXUURXQGHG� E\� WKH� ILUVW�ORRS� RI� WKH� VPDOO� LQWHVWLQH�� ,W� OLHV� DFURVV� WKH� XSSHU�SDUW� RI� WKH� DEGRPHQ�� ZLWK� LWV� KHDG� ORFDWHG� RQ� WKH�ULJKW� VLGH� DQG� LWV� QDUURZ� WDLO � WRZDUG� WKH� OHIW � VLGH�RI� WKH�ERG\��XQGHU� WKH�GLDSKUDJP��/LNH�D�GUDLQDJH�V\VWHP�� WKH�SDQFUHDV � KDV � PDQ\ � VPDO O � RSHQ LQJV � �GXF W V � � WKD W�IHHG� LQWR� D� ODUJH� GXFW� FDOOHG� WKH� 'XFW� RI � :LUVXQJ ��WKDW � UXQV� WKH � HQW LUH � OHQJWK� RI � WKH � SDQFUHDV � � 7KH�FRPPRQ� ELOH� GXFW� IURP� WKH� OLYHU� DQG� JDOO� EODGGHU� MRLQVWKH�'XFW�RI�:LUVXQJ�DQG�WKHQ�HPSWLHV�LQWR�WKH�VPDOO�LQWHVWLQH�

The pancreas - two glands in one!7KH�SDQFUHDV� DFWV� OLNH� WZR� JODQGV� LQ�RQH�� ,W� DFWV� DV� DQ� H[RFULQH�JODQG� E\� UHOHDVLQJ� VXEVWDQFHV� WR� WKH� RXWVLGH� RI� WKH� SDQFUHDV�WKURXJK� GXFWV�� ,W� DFWV� DV� DQ� HQGRFULQH� JODQG� E\� UHOHDVLQJ�VXEVWDQFHV�GLUHFWO\�LQWR�WKH�EORRGWUHDP�

How serious is it?3DQFUHDWLF�FDQFHU�FDQ�EH�FXUHG�RQO\�ZKHQ�IRXQG�DW�WKH�YHU\�HDU��OLHVW�VWDJHV��8QIRUWXQDWHO\��WKH�VXUYLYDO�UDWH�IRU�SDQFUHDWLF�FDQFHU�LV�SUHWW\�GLVPDO��EHFDXVH�RIWHQ�E\�WKH�WLPH�LW�LV�GLDJQRVHG��LW�KDV�VSUHDG�WR�RWKHU�SDUWV�RI�WKH�ERG\�

What is the treatment for pancreatic cancer?7KH�WUHDWPHQW�FKRVHQ�IRU�SDQFUHDWLF�FDQFHU��DV�ZHOO�DV�PRVW�RWKHU�W\SHV�RI� FDQFHU��GHSHQGV�RQ� WKH� W\SH�RI� FDQFHU�� DV�ZHOO� DV� WKH�WXPRU�VL]H�DQG�H[WHQW�RI�VSUHDG�WR�RWKHU�DUHDV�7UHDWPHQW�PD\�LQYROYH�VXUJHU\�WR�UHPRYH�WKH�SDQFUHDV��SURYLGH�IRU� EHWWHU� GUDLQDJH� RI� IOXLGV� RU� WR� VHYHU� QHUYHV� WKDW� WUDQVPLW�SDLQ��&KHPRWKHUDS\�� UDGLDWLRQ�� DQG�PHGLFDWLRQ� WR� UHOLHYH�SDLQ� DUH�DOVR�RIWHQ�SDUW�RI�WUHDWPHQW�

In summary…2Q�D�SRVLWLYH�QRWH��FXUUHQW�HYLGHQFH�VXJJHVWV�WKDW�PRUH�SHUVRQV�WKDQ� HYHU� EHIRUH� DUH� EHLQJ� VXFFHVVIXOO\� WUHDWHG� IRU�SDQFUHDWLF�FDQFHU��:H�DUH�PDNLQJ�SURJUHVV��7KH�QHHG�IRU�HDUO\�GHWHFWLRQ�RISDQFUHDWLF� FDQFHU� XQGHUVFRUHV� WKH� QHFHVVLW\� RI� HDUO\�PHGLFDO�HYDOXDWLRQ�RI�V\PSWRPV�VR�WKDW�WUHDWPHQW�FDQ�EH�PRUH�HIIHFWLYH�:LWK� FDQFHU� RI� WKH�SDQFUHDV� �DV�ZLWK� DQ\�RWKHU�*,� FRQGLWLRQ���RXU�JRDO� LV� WR�ZRUN�ZLWK� WKH�SDWLHQW� WR�GHYHORS�D�SODQ�RI� WUHDW��PHQW�WKDW�ZLOO�DOORZ�WKH�SDWLHQW�WR�OLYH�OLIH�WR�WKH�IXOOHVW�ZLWK�WKH�EHVW�SRVVLEOH�UHOLHI�RI�V\PSWRPV��

Early detection, before cancer has spread, is a must for the best treatment outcome!

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