American Medical Association Family Medical Guide - American Medical Association [528]
Diagnosis
Chronic pancreatitis is sometimes difficult to diagnose. Your doctor may recommend a test to determine if your pancreas is making sufficient amounts of digestive enzymes. You may also have an imaging procedure such as ultrasound (see page 111), ERCP (see page 796), or a CT scan (see page 112) to look for signs of chronic pancreatitis, such as calcification of the pancreas. In more advanced stages, after a person has developed problems such as diabetes or malabsorption (inability to absorb nutrients from food), a doctor will use blood, urine, and stool tests to diagnose chronic pancreatitis or to monitor its progression.
Treatment
The first step in treating chronic pancreatitis is to relieve the pain. Your doctor will tell you that to avoid painful attacks, you must avoid alcohol and closely follow a special diet high in carbohydrates and low in fat. He or she will give you detailed dietary guidelines. If your pancreas is not producing enough digestive enzymes, your doctor may prescribe pancreatic enzymes to take with meals to help your body digest food. If you have diabetes, your doctor will prescribe insulin or a glucose-lowering medication to control your blood sugar level. If you stop drinking alcohol permanently, follow your prescribed diet, and take the pancreatic enzymes, your chances of long-term improvement are good.
In some cases, as the disease progresses and the pain becomes even more severe, surgery may be recommended to relieve the pain by, for example, draining an enlarged pancreatic duct, removing damaged tissue from the pancreas, or cutting the nerves that transmit pain signals from the pancreas to the brain.
Cancer of the Pancreas
Pancreatic cancer is the second most common gastrointestinal cancer after colon cancer and the fourth leading cause of cancer death in the United States. The exact cause of cancer of the pancreas is not known. As with most cancers, the risk of developing pancreatic cancer increases with age. People who smoke are two to three times more likely than nonsmokers to develop pancreatic cancer. People who have diabetes (see page 889) and people who have a family history of pancreatic cancer are also at increased risk. The cancer is more common in men than in women and is more prevalent in African Americans than in other people.
Symptoms
Pancreatic cancer is often called a silent disease because it seldom causes symptoms in the early stages. As the cancer progresses, symptoms can include loss of appetite, weight loss, nausea and vomiting, and jaundice (yellowing of the skin and whites of the eyes; see page 785). If the cancer affects the body and tail of the pancreas, a person will experience pain in the upper abdomen that may spread to the back. Cancer in the head of the pancreas often causes no symptoms until the tumor has become incurable.
Diagnosis
If you have symptoms of pancreatic cancer, your doctor will want to rule out other possible causes, such as gallstones (see page 793). He or she will perform a physical examination to look for jaundice and feel your abdomen for any changes in the pancreas or surrounding organs and for a buildup of fluid. You will probably have blood, urine, and stool tests to look for abnormalities in substances such as the liver protein bilirubin, which can build up in the blood, urine, or stool if the common bile duct is blocked by a tumor.
To examine the pancreas, your doctor may also recommend an imaging procedure such as a CT scan (see page 112), an endoscopic ultrasound or MRI (see page 113), or ERCP (see page 796). In ERCP, the doctor can examine the pancreas, liver, and gallbladder ducts to look for narrowing or blockage of the ducts, which can be a sign of pancreatic cancer in some people. A doctor may take a sample of tissue from the pancreas