By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

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

Question: I was recently diagnosed with what the doctor called “acute pancreatitis.” This sounds really scary to me. As you know, pancreatitis is a very painful disease -- but that's not what's worrying me right now. I'm worried that it might lead to pancreatic cancer, which I know can be very deadly. Should I be worried about this?

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. Because of 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 you have a first attack and "chronic" when additional episodes have occurred. Your doctor diagnosed your case as acute pancreatitis because you've had just one attack of this painful condition. This seemingly simplistic differentiation between the two types of pancreatitis is important because acute pancreatitis has several potential causes, while the 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, as I said, has many causes -- one of which can be excessive consumption of alcohol. 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 cause the damage necessary to produce pancreatic pain.

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 blood salts 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 acute pancreatitis can be, it doesn't lead to pancreatic cancer. There may be a correlation between chronic pancreatitis and pancreatic cancer, however.

My advice to you is two-fold: Take steps to address the cause of your pancreatitis, and avoid lapsing into chronic pancreatitis.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.