Diseases of the Pancreas

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The pancreas, or sweetbread, is a glandular organ lying behind the stomach and near the back wall of the abdomen.

Insulin is produced in the ‘tail’ part of the organ, and a deficiency of this hormone causes diabetes mellitus.

Acute Pancreatitis
This disease is usually found in persons between 40 and 70 years of age, who in many cases have suffered from gallstones. Obstruction of the mouth of the common bile duct, or of the pancreatic duct itself, usually by a gallstone, causes an increase in the pressure of secretion of the pancreas, and a release of enzymes which damage the cells of the gland.

Acute pancreatitis is also occasionally seen in influenza, typhoid fever and smallpox, and is a rare complication of mumps.

Symptoms
The disease when fully developed is remarkable for the intensity of the symptoms, and for their extraordinary suddenness. Without any warning, sudden agonising pain is felt in the upper abdomen and across the back. After a short time copious vomiting begins, and is continued at short intervals. The abdomen becomes distended, in contrast to the rigidity in peritonitis.

Diagnosis
The possibility of acute pancreatitis should be considered in all cases of acute symptoms in the upper abdomen in adults, especially if the patient is an elderly obese and alcoholic individual.

It may have to be distinguished from acute cholecystitis (which may actually be present at the same time), perforated peptic ulcer, acute intestinal obstruction, coronary thrombosis, and acute appendicitis. Changes in the composition of the urine are of great importance, and may include blood, bile, sugar, acetone bodies and increased urinary diastase.

Treatment
Modern treatment tends to be conservative, and consists of intravenous therapy with saline and calcium gluconate for three to four days, and continuous gastric suction to relieve vomiting and distension. No food is taken by mouth during this period.

Pain is relieved by pethedine 100 milligrammes and by atropine 1 mg injected at four hour intervals. Penicillin and streptomycin are usually given by injection as a prophylactic against peritonitis. Operation should only be undertaken if there is uncertainty about the diagnosis, in the presence of acute cholecystitis or obstructive jaundice, and when there is spreading peritonitis.

Cancer of the Pancreas
Cancer of the pancreas is fairly common in persons over 50 years of age. It is twice as common in men as in women. The head of the pancreas is affected in over 60 per cent of cases, causing obstruction of the pancreatic duct and later of the common bile duct.

Symptoms
Jaundice is a very common symptom and it increases until it becomes an intense greenish tinge. Bile is completely absent from the faces, which are bulky and pale. The patient complains of a dull aching pain in the upper abdomen, passing to the back. There is rapid loss of weight, the disease being fatal within a few months to a year.

Treatment
Apart from operation, no treatment is known which has any effect upon its course.

Cystic Fibrosis of Pancreas
This disorder is genetically determined, the tissue of the pancreas being unable to function properly as it becomes fibrous and cystic. The liver and other glands are defective and a child so born is unable to combat infections, especially staphylococci in the lungs. In many cases the infant dies of pulmonary sepsis by the age of fourteen months. If a child survives, his heart is so strained that death is usual about puberty.

Treatment
Most children have to be permanently on antibiotic therapy. Diet should be rich in protein, low in fat, and plenty of salt taken.

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