The Pancreas

The Pancreas

Pancreatic Carcinoma


Pathology:                Can be an exocrine tumour (adenocarcinoma) or endocrine (e.g. Insulinoma, VIPoma, gastrinoma)


Aetiology:                 Exocrine tumours more common in patients with chronic pancreatitis and smokers


Symptoms:               Abdominal Pain, weight loss and anorexia


Signs:                          Painless jaundice, steatorrhoea, palpable gallbladder, ascites


Investigations:      Bloods: LFTs show a raised Bilirubin and ALP

Tumour Markers: Raised CA 19-9

Imaging: Ultrasound Abdomen shows a dilated biliary tree and pancreatic mass.

  CT Abdomen shows a  pancreatic mass,


Treatment:              Medical: If unresectable, treatment is chemotherapy

Surgical: If resectable, usually treated with Whipple’s pancreatoduodenectomy


Complications:      Pancreatic leaks, fistula, chronic pain


Prognosis:           Often diagnosed late so prognosis is poor.

Median survival with advanced disease is 8 to 12 months and metastatic disease is 3

to 6 months

Chronic Pancreatitis


Pathology:                Chronic inflammation of the pancreas resulting in disruption of pancreatic architecture, this causes impaired endocrine and exocrine function


Aetiology:                 Alcohol excess is commonest, other causes are genetic, SLE, autoimmune, gallstones and idiopathic


Symptoms:               Epigastric pain, radiating to the back, steatorrhoea, fat malabsorption, diarrhoea and diabetes


Signs:                          Epigastric tenderness


Investigations:      Bloods: FBC, U&E, LFTs, Glucose, Calcium Profile, Faecal Elastase - reduced

Imaging: Abdominal X-ray shows calcification of the pancreas

  CT Abdomen shows calcification of the pancreas and possible pseudocysts


Treatment:              Medical: Analgesia for chronic pain, pancreatic enzyme supplements with meals for

 exocrine function and insulin if patient has diabetes

                                        Surgical: Coeliac Plexus block for analgesia and pancreaticojejunostomy


Complications:      Pancreatic carcinoma, fat soluble vitamin deficiency, pseudocyst formation, gastric

varices, Type 1 diabetes, aneurysm, ascites, biliary obstruction


Prognosis                 Good prognosis with adequate management.                                                                                                                          Overall survival is 70% at 10 years.

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