About Pancreatitis

About Pancreatitis

What is the Pancreas

Diagram of the relative position of the pancreas

The pancreas is a spongy, tube-shaped organ about 6 inches long. It is located in the back of the abdomen, behind the stomach. The head of the pancreas is on the right side of the abdomen. It is connected to the duodenum, the upper end of the small intestine. The narrow end of the pancreas, called the tail, extends to the left side of the body.

The pancreas makes pancreatic juices and hormones, including insulin. Pancreatic juices, also called enzymes, help digest food in the small intestine. Insulin controls the amount of sugar in the blood. Both enzymes and hormones are needed to keep the body working right.

As pancreatic juices are made, they flow into the main pancreatic duct. This duct joins the common bile duct, which connects the pancreas to the liver and the gallbladder. The common bile duct, which carries bile (a fluid that helps digest fat), connects to the small intestine near the stomach.

What is Pancreatitis?

Dr. Steve Freedman, Director of the Pancreas Center, explains pancreatitis

How is  it diagnosed?

ULTRASONOGRAPHY OR ULTRASOUND (US) SCAN:

This is a simple, painless and relatively quick investigation which can be used to obtain a picture of the inside of the abdomen.

COMPUTERISED TOMOGRAPHY (CT SCAN)

This is more complex and time consuming than an ultrasound scan but produces excellent pictures of the pancreas and other abdominal structures.

NEEDLE BIOPSY OR CYTOLOGY USING ULTRASOUND OR CT SCAN

Occasionally a small piece of tissue from the pancreas needs to be taken to help make a diagnosis.

ENDOLUMINAL ULTRASOUND (EUS)

This is a special investigation for taking ultrasound pictures of the pancreas, pancreatic and bile ducts and surrounding tissue such as blood vessels. The pictures are taken by a special probe inserted into the stomach and duodenum.

ERCP

This is a special investigation for taking pictures of the bile and pancreatic ducts and is mainly used for treatment of bile duct and pancreatic duct problems. The full name of ERCP is rather a mouthful: endoscopic retrograde cholangio-pancreatography! Sometimes it is necessary to insert a temporary (plastic) or permanent (metal mesh) tube into the bile duct to keep a good flow of bile. These tubes are called stents after Dr Stent who first used these small tubes. Stents or temporary tubes (also called a cannula) may also be inserted into the main pancreatic duct.

These are HIGHLY dangerous to us with Pancreatitis.  Our advice is ALWAYS make sure they are properly qualified and they are doing it for a valid reason – see statistics in Information Pack download for risk statistics. (Webmaster editor)

 ERCP must be:

Performed by a specialist.
Performed for a good reason.

MAGNETIC RESONACE IMAGING (MRI)

An MRI scan is similar to a CT scan but uses magnetic resonance to image the pancreas instead of X-rays. Very powerful magnets are used to generate the pictures. For this reason patients that have certain metal parts inside their bodies (that can respond to the magnet) must not have this procedure. Most modern appliances introduced into patients, such as clips
during open surgery or a heart valve with metal parts, are made of material which cannot respond to the magnet and are therefore safe. As a precaution you must tell your doctors if you have any such appliances in your body to let them decide.

PET Scan

This is a special scan performed in the Nuclear Medicine Department and is sometimes performed in certain centres if there is uncertainty as to the diagnosis. In other words this is performed if the doctors are not sure if you have chronic pancreatitis or a small pancreatic cancer. The full term or a PET scan is Positron Emission Tomography.

SPECIAL TESTS FOR PANCREATIC FUNCTION IN PANCREATITIS

TESTS FOR DIABETES – Although it does not autimatically mean you will be diabetic it is the same organ that houses your insulin cells.

 The urine can be tested for glucose using a simple technique of dipping a special strip of paper into a urine sample.

More precise tests involve measuring the actual glucose level in the blood by taking a blood sample from an arm vein. A patient who is thought to be developing diabetes can be tested by a glucose tolerance test. This involves taking a glucose drink following an overnight fast and then measuring the blood glucose level from blood samples taken over the next 2-3 hours.

TESTS FOR PANCREATIC ENZYME PRODUCTION

Faecal Elastase Test

Elastase is one of the enzymes produced by the pancreas to digest protein. There is always a small extra amount produced which means that it can be measured in the stool.

PLT or Pancreato-Lauryl Test

A standard meal is taken following an overnight fast along with a test food (with PLT). One or more blood tests or a urine test is then made to see if the test food has been digested (by the pancreatic enzymes) and then absorbed.

Triolein breath test

This is a more specific test for fat digestion and absorption and is fairly simple to perform.

Faecal fat test

This is an excellent way of determining fat digestion but involves collecting stools for 1-3 days.

Secretin test

This is performed in only a few very specialist pancreas units and is very accurate (like the faecal fat test).

The often quoted gold standard Amylase Test (However, this should be treated with caution as evidence or otherwise of an attack and it is suggested a more accurate measure is Protease).

The blood amylase test is ordered, often along with a lipase test, to help diagnose and monitor acute or chronic pancreatitis (inflammation of the pancreas) and other disorders that may involve the pancreas. A urine amylase test may also be ordered. Typically, its level will mirror blood amylase concentrations, but both the rise and fall occur later. Sometimes a urine creatinine clearance may be ordered along with the urine amylase to help evaluate kidney function since decreased kidney function can result in a slower rate of amylase clearance.Amylase tests are sometimes used to monitor treatment of some cancers involving the pancreas and after removal of gallstones that have caused gallbladder attacks.

When is it ordered?

A blood amylase test may be ordered when a patient has symptoms of a pancreatic disorder, such as severe abdominal pain, fever, loss of appetite, or nausea. A urine amylase test may be ordered along with or following a blood amylase test. One or both may also be ordered when a doctor wants to monitor a patient to evaluate the effectiveness of treatment and to determine whether amylase levels are increasing or decreasing over time.

What does the test result mean?

In acute pancreatitis, amylase in the blood increases (often to 4-6 times higher than the highest reference value, sometimes called upper limit of normal). The increase occurs within 12 hours of injury to the pancreas and generally remains elevated until the cause is successfully treated. Then the amylase values will return to normal in a few days. In chronic pancreatitis, amylase levels initially will be moderately elevated but often decrease over time with progressive pancreas damage.Amylase levels may also be significantly increased in patients with pancreatic duct obstruction, cancer of the pancreas, and gallbladder attacks. Urine and blood amylase levels may also be elevated with a variety of other conditions, such as ovarian cancer, lung cancer, tubal pregnancy, mumps, intestinal obstruction, or perforated ulcer, but amylase tests are not generally used to diagnose or monitor these disorders. Decreased blood and urine amylase levels may indicate permanent damage to the amylase-producing cells in the pancreas. Increased blood amylase levels with normal to low urine amylase levels may indicate decreased kidney function or the presence of a macroamylase, a benign complex of amylase and other proteins that accumulates in the blood.

Since reference values for amylase vary from laboratory to laboratory, depending on the test method used, there is no universally accepted number that can be called normal or high.

Is there anything else I should know?

In acute pancreatitis, elevated amylase levels usually parallel lipase concentrations, although lipase levels may take a bit longer to rise than blood amylase levels and will remain elevated longer.Chronic pancreatitis is often associated with alcoholism. It may also be caused by trauma, pancreatic duct obstruction, and seen in association with genetic abnormalities such as cystic fibrosis. Amylase levels may be moderately elevated with chronic pancreatitis but often decrease over time with progressive pancreas damage.

What is Protease?

A protease is a member of a very large group of enzymes that have a variety of functions in the body. A primary one is as a digestive enzyme to process protein. Without protease, the body would not be able to digest the protein in food. Other types of proteases are involved in the regulation of cellular events, such as blood clotting. These are also called proteolytic enzymes or proteinases.
 What Enzymes does the Pancreas Secreate?

The pancreas is the main digestive gland in our body. It secretes the enzymes:

  • Trypsin, is a protease that breaks down proteins at the basic amino acids.
  • Chymotrypsin, is a protease that breaks down proteins at the aromatic amino acids.
  • Steapsin, degrades triglycerides into fatty acids and glycerol.
  • Carboxypeptidase, is a protease that takes off the terminal acid group from a protein
  • Several elastases that degrade the protein elastin and some other proteins.
  • Several nucleases that degrade nucleic acids, like DNAase and RNAase
  • Pancreatic amylase that, besides starch, and glycogen, degrades most other carbohydrates. Humans lack the enzyme to digest the carbohydrate cellulose.
  • Pancreatic Secretion: Bile from the liver, which emulsifies fat, allowing more efficient use of lipase in the duodenum in converting lipids to smaller more manageable sizes. Bile is not considered an enzyme, but aids macronutrient degradation.

MUCH more information than here can be read in the downloadable booklets on

Acute Pancreatitis .  Chronic Pancreatits   Cancer of the Pancreas

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