Know your pancreas

“You rarely hear anyone use the word pancreas in a not-horrible context,” Christian Finnegan had famously said while performing a stand-up comedy act to a live audience.

That statement isn’t far from the truth. The pancreas is a flattened pear-shaped organ situated behind the stomach and placed around the intestines. It pours its secretions into the intestines by joining with a tube that drains bile from the liver and the gallbladder. It not only releases various enzymes that help in the digestion of proteins but also secretes hormones into the blood, which regulate the blood sugar levels and carbohydrate, lipid and protein metabolism in the body.

Important roles

So, if proteins are the building blocks of life, the pancreas is the organ that actually breaks down those proteins to be the building blocks.

Insulin, the hormone famously associated with diabetes mellitus, is produced by the pancreas to maintain blood glucose (sugar) levels. The pancreas also releases other hormones like glucagon, which aid in the maintenance of blood sugar levels. The pancreas is incredibly important in the pathogenesis of diabetes and other metabolic disorders.

An insult to the pancreas can lead to dangerous complications. Alcohol is implicated as the most potent toxin to the pancreas, which can cause it to release all the digestive enzymes out of the tube into the body of the pancreas. This leads to autodigestion, which means that the enzymes can literally eat up the pancreas. This condition, known as acute pancreatitis, is one of the most dreaded and lethal medical diagnosis.

A vulnerable organ

Occasionally, a stone from the gallbladder can migrate into the tube that connects to the tube inside the pancreas and opens into the intestines. If this stone gets impacted at the opening of the tubes, it can cause acute pancreatitis, as well. It is fearing this dreaded complication that most patients with gallbladder stones are subjected to surgical removal of the gallbladder. Some other nutritional conditions can rarely cause pancreatitis but the numbers are far lower than those due to alcohol and gallstones.
This disease usually drains the patients and their families emotionally and financially. The surgeons are left in a quandary as to when and whether to operate. The dictum goes “Go in too early and do too much, or go in too late and do too little “

Acute pancreatitis can lead to sequelae such as fluid-filled bags called pseudocysts or when infected as a pancreatic abscess.

Cancers of the pancreas are usually diagnosed late in the day due to its location in the human body and are mostly diagnosed as a case of jaundice. They cause intense jaundice (due to blockage of the flow of bile from the liver into the intestines), itching, weight loss, fatigue and occasional vomiting. Around 70% to 80% of all these patients are diagnosed at an advanced state.

They can be incredibly fast spreading and usually fatal within a year of the diagnosis.
Rarely growths like neuro-endocrine tumours actually bear a good prognosis after surgical intervention.

Line of treatment

Non-invasive investigation modalities such as the ultrasound, MRCP and CT scan do help, sometimes you may need an invasive modality such as an ERCP.

Technology has ensured that beta cell transplants can help in some diabetics and pancreatic transplants are difficult but possible in certain patients.

The pancreas is an incredibly important and complicated organ seared in the midst of important structures and vessels.
Avoidance of alcohol (especially binge drinking), maintaining a healthy weight with food, which is moderate in fat content, will ensure that your pancreas remains healthy. A healthy pancreas is the answer to a healthy body and eventually a healthy life.

(The author is founder & chief surgeon — Digestive Health Institute by Dr. Muffi)