FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

FRIEND'S PAINFUL PANCREAS IS NOT A PRE-CANCEROUS CONDITION

Question: A friend of mine was recently diagnosed with pancreatitis. This sounds really scary to me. I understand that this can be a very painful disease, but how serious is it? What causes it, and can it lead to pancreatic cancer, which I know can be very deadly? Any help you can give me in understanding this disease better will be appreciated.

Answer: The pancreas has two main functions. First, it produces insulin, which helps the body's cells efficiently absorb sugar (glucose) from the blood. Second, it produces enzymes that are used in the digestion of food. This essential gland is located in the abdomen behind the stomach. As you might guess from its location, an inflamed pancreas -- what doctors call pancreatitis -- produces abdominal pain, back pain, nausea and vomiting. And, because of impaired insulin production, pancreatitis can also cause an increase in blood sugar.

Pancreatitis is classified as acute when the first attack occurs and chronic when additional episodes have occurred. Your friend has acute pancreatitis, since this is the first episode she has experienced. This seemingly simplistic differentiation is important because acute pancreatitis has several potential causes, while chronic disease is due to alcohol use in almost 90 percent of the cases.

Gallstones can cause acute pancreatitis. The exact mechanism by which this occurs is debated by medical experts, but the most widely accepted theory states that the condition begins with small gallstones. These stones are then expelled from the gallbladder and travel down the bile duct, the tube that connects the gallbladder to the duodenum (the fist portion of the small intestine). The end of this duct also connects to the duct that drains enzymes from the pancreas. It is postulated that the passage of small gallstones can temporarily block the area where these two ducts come together. This blockage, then, causes bile to "back up" into the pancreas and, thereby, activates the pancreatic enzymes inside the pancreas instead of within the small intestine. Thus the pancreatic enzymes begin to digest the pancreas itself, causing inflammation in the gland. In other words, pancreatitis.

Acute pancreatitis can also be caused from alcohol excess. The exact mechanism by which alcohol irritates the pancreas isn't known, either. For most drinkers, though, it takes heavy alcohol use for more than a decade to do this.

Pancreatitis is caused by other conditions as well. Chronic malnutrition is a common cause in developing countries, but fortunately, it is an uncommon one here. There is even a rare inherited form caused by a genetic alteration that produces a specific enzyme defect.

Pancreatitis is serious regardless of the cause. The pain can be quite intense, but fortunately, it isn't always. Nausea and vomiting from this disease often produce significant dehydration and altered balance of the salts in the blood called electrolytes. This problem typically requires treatment with intravenous, or IV, fluids. Elevated blood sugar from pancreatitis is usually controlled by the administration of insulin. Although all of this sounds pretty bleak, there are two pieces of good news. First, almost everyone recovers from the first attack of pancreatitis if he or she addresses the underlying cause -- has the gallbladder removed, stops drinking alcohol, etc. The other positive note is that as painful as pancreatitis can be, it doesn't lead to pancreatic cancer.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.