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In acute pancreatitis, the digestive enzymes produced by the pancreas are activated too early. This triggers self-digestion of the organ and damages the tissue. These processes can also spread to neighboring structures in the abdomen and lead to inflammation and tissue damage. This creates typical complaints that can range from pain in the upper abdomen to life-threatening complications.
The most common causes are - in addition to high alcohol consumption (alcohol-induced pancreatitis) - biliary tract diseases such as bile duct stones (biliary pancreatitis). These can lead to a narrowing or to a closure of the common mouth of the pancreas and the bile duct in the duodenum and thus to a backlog of pancreatic juice. Less common causes of acute pancreatitis include:
In acute pancreatitis, the digestive enzymes produced by the pancreas are activated too early. This triggers self-digestion of the organ and damages the tissue. These processes can spread to neighboring structures in the abdomen and lead to inflammation. This can lead to ascites, pleural effusion and massive stress on the circulatory system and kidneys. Dead tissue and accumulations of fluid can subsequently become infected and lead to sepsis. Furthermore, fluid-filled chambers (pseudocysts) can develop in the pancreas. These often regress on their own.
The following symptoms can indicate acute pancreatitis:
Acute inflammation of the pancreas is a serious condition that requires hospitalization. The course can be very different: In many patients, the inflammation subsides after one to two weeks. However, a severe course with complications can take weeks to months. Acute inflammation of the pancreas can sometimes be fatal. The following complications can occur, among others:
In a detailed discussion (anamnesis), the doctor collects the symptoms and possible causes and carries out a physical examination. The upper abdomen is palpated and attention is paid to bluish to greenish discoloration of the skin (Cullens or Gray-Turners signs), which may indicate pancreatitis. The following examinations may be necessary for more detailed clarification:
If necessary, imaging procedures are used to confirm the diagnosis and to clarify the causes, especially:
Since no prognosis can be made about the course of acute pancreatitis at the beginning, all patients are initially admitted to a hospital for a few days. The focus is on intravenous fluid and electrolyte replacement, the administration of antibiotics in the event of infection and the inhibition of gastric acid secretion (proton pump inhibitors) as well as pain relief with medication. Any bile duct stones are removed endoscopically, infected necroses are repaired surgically or endoscopically. If there is ascites or pleural effusion, drainage is carried out using drains. If pseudocysts do not resolve on their own over the course of several weeks, they are removed endoscopically or surgically.
Tube feeding is usually started on the second day in the hospital. As soon as the patient is free of pain, a slow diet is built up. Alcohol abstinence is recommended in any case to avoid a relapse.
To clarify pancreatic complaints, the first point of contact should be a general practitioner. A visit to the following doctors may be necessary for further clarification and therapy:
The most common cause of chronic pancreatitis is high alcohol consumption over a long period of time. The second most common cause is gallstones. Smoking, congenital malformations and genetic and autoimmune causes are also responsible for the disease. In some cases, the pancreas is gradually destroyed for unexplained causes. Typical complaints are upper abdominal pain and indigestion. Therapy ranges from eliminating the causes to replacing missing digestive enzymes.
A recurring, rarely persistent epigastric pain that can radiate into the back is typical. The pain often occurs during or after eating. This is accompanied by impaired digestion (maldigestion) with nausea, bloating and flatulence.
In advanced cases, the following symptoms may occur as a result of the inadequate pancreatic function:
Pseudocysts: Here, vesicles filled with secretion form in or on the pancreas, which cause mild symptoms such as stomach pain, but can also go unnoticed. In many cases they resolve on their own. Sometimes infection or bleeding can occur.Narrowing of the duodenum or bile duct.
Splenic vein thrombosis with enlargement of the spleen.
Pancreatic cancer appears to be slightly more common in people with chronic pancreatitis.
The anamnesis is followed by a physical examination by the doctor as well as pancreatic function tests (e.g. elastase-1 concentration, fluorescein dilaurate test, secretin-pancreozymin test) and stool examinations. If necessary, imaging procedures such as the endoscopic examination of the bile and pancreatic ducts (endoscopic retrograde cholangiopancreatography, ERCP), x-rays of the bile ducts (cholangiogram), ultrasound, magnetic resonance tomography, computed tomography and endosonography are used.
The following measures are used to treat chronic inflammation of the pancreas:
To clarify pancreatic complaints, the first point of contact should be a general practitioner. A visit to the following doctors may be necessary for further clarification and therapy:
The pancreas is the only organ in the body that has a double function. In the case of pancreatic insufficiency, it can no longer adequately fulfill its functions. In the case of so-called endocrine pancreatic insufficiency, there is a lack of hormones that regulate blood sugar levels. In the case of exocrine pancreatic insufficiency, not enough digestive secretions are formed - this leads to problems in particular with fat digestion. Both forms can also occur together.
The endocrine part of the pancreas - the so-called islet apparatus, which consists of the islets of Langerhans - normally produces the hormones insulin and glucagon, which regulate the sugar level. In the case of endocrine pancreatic insufficiency, these hormones can no longer be produced in sufficient quantities. The result is usually diabetes. For more information, see Diabetes mellitus.
The exocrine part of the pancreas produces an average of 1.5 liters of fluid with important digestive enzymes every day. They break down the proteins, fats and carbohydrates contained in the food into the smallest building blocks. These get from the intestines into the blood and are distributed throughout the body. Pancreatic exocrine insufficiency occurs when the pancreas does not produce enough digestive enzymes.
Pancreatic exocrine insufficiency (EPI) can have a number of causes, including:
Pancreatic disorders often go undetected for a long time. The symptoms usually appear in phases and sometimes only after years in their entirety. Many symptoms are only clearly recognizable when 90 percent of the digestive function has already been lost.
Classic symptoms of exocrine pancreatic insufficiency include:
Pancreatic cancer can in principle occur in any area of the organ. The various forms of cancer are based on different types of tissue:
The causes of pancreatic cancer are not known. Certain factors can increase the risk of the disease, especially when they are combined, e.g .:
First and foremost are a healthy lifestyle and the avoidance of possible risk factors (especially smoking and alcohol). It is not yet fully understood which nutritional factors play a role in the development of pancreatic cancer. Large studies have shown that a diet rich in fruits and vegetables, high in fiber and vitamins, can lower the risk of cancer in general. A balanced diet also helps to maintain or achieve a healthy body weight.
Pancreatic cancer rarely causes symptoms in the early stages. They usually only occur when the tumor is so large that it hinders the production of digestive enzymes or their drainage into the duodenum, or when it has already spread to other organs such as the stomach, duodenum, liver or peritoneum. Among other things, the following complaints arise:
If these complaints occur, a doctor should be consulted immediately for a detailed clarification. The earlier a pancreatic cancer is discovered, the greater the chances of recovery.
If pancreatic cancer is suspected, the doctor initiates the necessary diagnostic steps. Important examinations for the detection of pancreatic cancer are:
If pancreatic cancer is diagnosed, further examinations are necessary to determine the extent of the tumor, for example:
The treatment strategy depends primarily on the type of tumor, the stage of the disease and the patient's general state of health. Complete healing can only be achieved if the tumor can be completely removed surgically. Therefore, if pancreatic cancer is suspected, the investigation must be carried out quickly. All other therapy options serve primarily to reduce the size of the tumor before a planned operation, to limit further tumor growth or to alleviate symptoms.
The aim is to eliminate the tumor tissue and the surrounding lymph nodes as completely as possible. The operation used to be considered very complicated. The postoperative results have improved significantly, not least due to specialization in pancreatic surgery, so that the procedure can now be rated as safe.
Pancreatic head carcinoma: With the head of the pancreas, the gallbladder, the lower part of the bile duct, the duodenum and sometimes also part of the stomach are removed (so-called Whipple operation). The interrupted connections are then re-established. A hospital stay of several weeks and a longer recovery phase are required after the operation.
Pancreatic tail carcinoma: Usually the spleen has to be removed as well.
Total pancreatectomy: In some cases, the entire pancreas must be removed.
Lymph nodes: In the course of the operation, lymph nodes (at least twelve) are also removed from the immediate vicinity of the pancreas. If they do not contain cancer cells, this indicates that the tumor has not spread. The number of affected lymph nodes also gives an indication of the later course of the disease.
Cytostatics are designed to kill cancer cells throughout the body, but cannot cure the tumor on their own. An adjuvant chemotherapy, i.e. performed after the operation, can have a beneficial effect on the course of the disease and improve the chance of recovery. Above all, gemcitabine, erlotinib, nab-paclitaxel, 5-FU / folinic acid, irinotecan and oxaliplatin are available. In the case of locally advanced tumors that cannot be safely removed by surgery, chemotherapy is carried out before the operation (neoadjuvant) in order to reduce the size of the tumor and achieve a better starting position for the surgery. If a tumor is no longer curable, palliative chemotherapy is carried out to possibly reduce the size of the tumor and alleviate the symptoms.
In the case of locally advanced tumors that could not initially be operated successfully, radiation can be carried out in combination with chemotherapy before the planned operation (neoadjuvant chemoradiotherapy). The tumor and the tumor extensions in the surrounding tissue are thereby reduced in size. This increases the chance that the tumor can be completely removed during the subsequent operation.In addition, radiation therapy is also used to eliminate tumor symptoms (e.g. pain) (palliative treatment).
These drugs (e.g. the tyrosine kinase inhibitor Erlotinib) target malignant tissue and largely spare healthy tissue. For example, they are directed against factors that promote tumor growth, cut off the blood supply to the tumor or prevent the transmission of signals between tumor cells.
It is used when the disease has progressed so far that a cure or effective tumor treatment is no longer possible. Palliative treatment includes, among other things, the relief of tumor-related complications and complaints, pain therapy, nutrition and psychosocial counseling or care for those affected, e.g. in the context of self-help groups or special psycho-oncological facilities or through psychotherapy.
A tumor or surgery-related destruction of the pancreas can lead to digestive enzymes and hormones no longer being formed in sufficient quantities. Severe digestive disorders (exocrine pancreatic insufficiency) and / or diabetes mellitus can result. The missing enzymes or hormones (insulin) can be permanently supplied to the body in the form of medication.
Regular check-ups should be carried out after tumor therapy. Tumor aftercare pursues the following goals:
Follow-up treatment (rehabilitation) is often recommended in order to accelerate the recovery and recovery process. There are specially set up aftercare clinics that can also carry out certain parts of a chemotherapy cycle if necessary. In addition, help is provided in matters of nutrition and in coping with psychological or social problems.
Several medical specialties are involved in the diagnosis and treatment of pancreatic cancer. If you have any abnormalities or warning signals, contact your general practitioner. This / the latter initiates the further clarification in which, among other things, specialists in nuclear medicine, internal medicine and surgery can be called in. If you are already undergoing treatment or follow-up care, regular appointments will be made with the treating doctor.
Hospitalization is usually required for the diagnosis and treatment of pancreatic cancer. The hospital costs are billed for. The patient has to pay a contribution to the costs per day. Further medication treatment at home takes place by prescription from the general practitioner or specialist.
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