Pancreatic Disorders

What the pancreas does

The pancreas lies deep in the upper abdomen, behind the stomach, with its head inside the curve of the duodenum. It has two jobs:

• Exocrine (digestive): about 98% of the gland makes enzymes such as lipase, amylase and trypsin, released through the pancreatic duct to digest fat, starch and protein.
• Endocrine (hormonal): clusters of cells (islets) release insulin and glucagon into the blood to control blood sugar.

Problems with either part cause different symptoms, and some diseases affect both.

Main pancreatic disorders

Symptoms of pancreas problems

Pain

Pancreatic pain is usually felt in the upper middle abdomen (epigastrium) and often bores through to the back. It may ease when sitting forward and worsen after eating or alcohol. Pain from acute pancreatitis is severe and constant; chronic pancreatitis causes recurrent or persistent pain; cancer may cause a dull ache in the upper back.

Digestive symptoms

When enzyme output falls below about 10% of normal, fat is poorly digested:

• pale, bulky, oily, foul-smelling stools that float (steatorrhea)
• bloating, gas and abdominal cramps
• weight loss despite eating
• deficiency of vitamins A, D, E and K

Hormonal symptoms

• High blood sugar, thirst and frequent urination (pancreatic diabetes)
• Episodes of sweating, shakiness and confusion from low blood sugar (insulinoma)

Signs of a blocked bile duct

Because the bile duct runs through the head of the pancreas, a tumor, swelling or stone can cause jaundice, dark urine, pale stools and itching.

Causes and risk factors

• Gallstones: the most common cause of acute pancreatitis.
• Alcohol: a leading cause of acute and chronic pancreatitis.
• Smoking: raises the risk of chronic pancreatitis and pancreatic cancer.
• Very high triglycerides (usually above 1,000 mg/dL, 11.3 mmol/L).
• Medicines: azathioprine, some diuretics, valproate and others, rarely.
• Genetics: cystic fibrosis gene variants, hereditary pancreatitis (PRSS1), and inherited cancer syndromes (BRCA2, Lynch, familial pancreatic cancer).
• Procedures and injury: ERCP, abdominal trauma.
• Obesity, diabetes and age for pancreatic cancer.

How pancreatic disorders are diagnosed

• Blood tests: lipase (best test for acute pancreatitis), liver tests and bilirubin, glucose and HbA1c, triglycerides, calcium, IgG4, and the tumor marker CA 19-9 (useful in follow-up, not screening).
• Stool tests: fecal elastase; a low level suggests exocrine insufficiency.
• Imaging: ultrasound for gallstones, contrast CT for pancreatitis complications and tumors, MRI with MRCP for ducts and cysts.
• Endoscopic ultrasound (EUS): a camera with ultrasound in the stomach gives close-up images and allows a needle biopsy.
• ERCP: mainly for treatment, such as removing stones or placing stents.

Treatment overview

• Acute pancreatitis: hospital care with IV fluids, pain relief, early feeding when possible, and removing the gallbladder if gallstones were the cause.
• Chronic pancreatitis: stop alcohol and smoking, pain management, enzyme replacement, diabetes care, and endoscopic or surgical treatment for blocked ducts.
• Enzyme insufficiency: pancreatic enzyme replacement capsules taken with every meal and snack, plus fat-soluble vitamins.
• Cysts: surveillance with MRI or EUS; surgery for cysts with high-risk features.
• Pancreatic cancer: surgery (such as the Whipple procedure) if operable, chemotherapy and radiation.
• Neuroendocrine tumors: surgery, somatostatin analogs and targeted therapies.
• Autoimmune pancreatitis: steroids.

Living with pancreatic disease

Many pancreatic conditions are long-term. The most effective self-care steps are stopping alcohol and smoking, taking enzymes with every meal if prescribed, eating small frequent meals, checking blood sugar, and keeping regular follow-up. People with a strong family history of pancreatic cancer may qualify for surveillance programs.

Frequently asked questions

What are the first signs of pancreas problems?

Early signs depend on the disorder. Common ones are upper abdominal pain that spreads to the back, especially after eating or alcohol, nausea, pale greasy stools, unexplained weight loss, yellowing of the skin and new-onset diabetes. Severe sudden pain with vomiting needs emergency care.

Where is pancreas pain felt?

Pancreatic pain is usually felt in the upper middle abdomen, just below the breastbone, and often goes straight through to the back. It may be worse lying flat and better leaning forward. Pain can also spread to the left side under the ribs.

What are the signs your pancreas is not making enough enzymes?

The typical signs are oily, pale, bulky stools that float and are hard to flush, bloating, gas and weight loss despite a normal appetite. A stool elastase test can confirm it, and enzyme capsules with meals usually improve symptoms quickly.

Can the pancreas heal itself?

After a mild attack of acute pancreatitis, the pancreas usually recovers fully once the cause is removed. Chronic pancreatitis causes permanent scarring, but stopping alcohol and smoking can slow the damage. Lost enzyme and insulin production usually does not return.

What blood test checks the pancreas?

Lipase is the main blood test for acute pancreatitis. Other tests include glucose and HbA1c for diabetes, liver tests and bilirubin for bile duct blockage, and CA 19-9 for monitoring pancreatic cancer. Enzyme insufficiency is checked with a stool elastase test rather than blood.