HYDERABAD: Pancreatic diseases are some of the most challenging diseases which can only be treated by medical and surgical gastroenterologists (GI). The pancreas basically consists of two parts - the exocrine portion which produces digestive juices and endocrine portion which produces hormones that are directly inducted in to the blood. When the endocrine portion is affected, it could lead to diabetes while affected exocrine of the pancreas can lead to acute and chronic pancreatitis and tumours. Acute pancreatitis is a very dangerous disease caused due to excessive consumption of alcohol and also a bile duct stone blocking the pancreatic opening. In such conditions, the route of the digestive enzymes into the intestine is blocked and they become active inside the gland, leading to digesting the gland and its surrounding tissues, creating a burning sensation. In 2/3rd of patients this is milder and the patient gradually recovers to normal health whereas in the remaining 1/3rd, the disease is more extensive and a part of the pancreas and surrounding tissue die or get infected. Sometimes fluid released from the pancreas and surrounding tissue collects and becomes a ball of liquid in the abdomen called a pseudocyst. If these pseudo cysts become large they need to be drained by performing an operation like pseudocyst-gastrostomy, where the pseudocyst is connected to the stomach and the small intestine. Approximately 20 per cent of people still die of acute pancreatitis especially when their other organs start failing and they need to be put on ventilator to help them breathe or their kidneys fail. Chronic pancreatitis is caused by excessive alcohol consumption and due to gene mutations in genes which produce the digestive enzymes. These genetic abnormalities are SPINKI and Cystic Fibrosis Transmembrane conductance regulator (CFTR) mutations. The organs becomes hard, stones are formed on both inside and outside the duct which block the ducts resulting in pain and inflammation of the duct.Patients come to the doctor with abdominal pain, inability to digest food, weight loss, diabetes, jaundice due to blockage of the bile duct etc. GI surgeons need to step in when the pain becomes too intense and too frequent and prevents the patient from following their routine life. Patients must stop drinking alcohol and smoking otherwise the operation fails and the pain returns. Chronic pancreatitis also predisposes to pancreatic cancer. Tropical chronic pancreatitis thought to be due to toxins in food and due to gene abnormalities is commonly seen in South India especially in Kerala. This disease affects young individuals and can lead to early appearance of diabetes. Certain forms of chronic pancreatitis such as heriditary pancreatitis and chronic pancreatitis in smokers and alcohol drinkers are more prone to develop pancreatic cancer. Pancreatic cancer is often detectable only much later; about 30 per cent are operable at that time.Tumours affecting the head of the pancreas are usually accompanied by Jaundice, weight loss, loss of appetite or ill-defined abdominal pain. In later stages these tumours block parts of the upper intestine resulting in vomiting. Contrast enhanced CT scan is the most commonly used diagnostic test. Once the surgeon decides that the lesion is operable, the patient undergoes an operation and if found that it can be removed a Pancreaticoduodenectomy is performed. It is a major operation where about 35 per cent of patients develop complications and 5-10 per cent die due to complications from the operation. Following recovery, patients receive chemotherapy or chemoradiotherapy to prevent recurrences. A survival rate of 45 per cent over two years can be expected in these patients. Dr Rajendra Desai is a consultant gastro surgeon at Olive Hospital, MehdipatnamContact 9297002249
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