Cleveland Clinic𠏋 Pancreas Clinic is one of the few centers in the nation that specializes in patient-centered treatments and frontline research for every type of pancreatic disorder.?
What We Offer
The Pancreas Clinic treats disorders such as:
Why You Should Choose Us
The Pancreas Clinic treats over 600 patients with pancreatitis annually. In 2007 the Cleveland Clinic treated over 400 patients with pancreatic cancer.
The Pancreas Clinic offers a single location for patients to receive the best therapies and treatment options for pancreatic disorders. Patients travel from around the country to receive the innovative treatment provided by Cleveland Clinic𠏋 Pancreas Clinic.
Patients are offered the latest treatments and services including:
- Endoscopic, minimally invasive and radiographic diagnostic imaging
- Islet auto transplantation
- Robotic surgery for pancreatic cancer
- Robotic pancreaticoduodenectomy
- Chronic pain management using pancreatic enzymes, narcotic maintenance, subcutaneous injections of octreotide, and other alternative treatments.
The Pancreas Clinic also conducts research that may lead to the development of a new test for the early detection of pancreatic cancer.
The Digestive Disease Institute is ranked second in the nation by U.S.News and World Report𠏋 2008 Best Hospitals Survey.
Pancreatitis, Acute and Chronic
The pancreas is a large gland located behind the stomach and beside the duodenum or upper part of the small intestine. The pancreas works to:
- Facilitate the digestion of carbohydrates, proteins and fat by the secretion of very powerful digestive enzymes into the small intestine.
- Release two hormones, insulin and glucagon, into the bloodstream. These hormones are involved in blood glucose metabolism.
Pancreatitis is a rare disease in which the pancreas becomes inflamed. Pancreatic damage occurs when the digestive enzymes are activated and begin attacking the pancreas. In very severe cases, pancreatitis can result in bleeding into the gland itself; serious tissue damage, infection and fluid collections may occur. Severe pancreatitis can result in damage to other vital organs such as the heart, lung and kidneys.
There are two forms of pancreatitis: acute and chronic:
- Acute pancreatitis occurs suddenly and may result in life-threatening complications; however the majority of patients (80 percent) recover completely.
- Chronic pancreatitis is usually the result of longstanding damage to the pancreas from alcohol ingestion. Chronic pancreatitis is primarily marked by severe pain and loss of pancreatic function.
Causes
In about 80 percent of the cases, acute pancreatitis is caused by gallstones and alcohol ingestion (see list below). Other causes are usually due to medications and, very rarely, infections, trauma or surgery of the abdomen. In about 10 percent of the cases, the cause is unknown (idiopathic).
- Gallstones (45 percent)
- Alcohol (35 percent)
- Idiopathic (10 percent)
- Other, including medications, trauma or surgery (10 percent)
Medications that can cause acute pancreatitis include:
- Azathioprine
- Thiazide
- Valproic acid
- Dideoxyinosine
- Sulfasalazine
- Trimethoprim-sulfamethoxazole
- Pentamidine
- Tetracycline
Trauma
Types of trauma that can cause acute pancreatitis in rare cases include:
- Postoperative trauma (due to surgery)
- Hyperlipidemia (or excessive amounts of fat and fatty substances in the blood)
- Hypercalcemia (or an abnormally large amount of calcium in the blood)
- Ductal obstruction
- Infectious Agents
Infectious Agents can include:
- Mumps
- Coxsackie B virus
- Cytomegalovirus (CMV)
- Candida
- HIV
- Salmonella
- Shigella
- E. coli
- Legionella
- Leptospirosis
Chronic Pancreatitis Histology
In more than 90 percent of the cases, chronic pancreatitis is caused by prolonged alcohol ingestion resulting in pancreatic damage and scarring (see below list). In a small percentage of the cases, the cause is unknown and, very rarely, patients can have chronic pancreatitis that tends to run in families (hereditary pancreatitis).
Alcohol accounts for 70 percent of cases, while 20 percent are considered idiopathic, or of unknown origin.
Other causes, which account for 10 percent of cases, include:
- Tropical pancreatitis
- Hereditary pancreatitis
- Hyperparathyroidism
- Cystic Fibrosis
- Pancreas Divisum
Risk Factors
Acute pancreatitis occurs in patients with a history of gallstone disease or heavy alcohol consumption. Chronic pancreatitis primarily occurs in patients between 30 and 40 years of age with longstanding alcohol ingestion. Chronic pancreatitis is also more common in men than women.
Symptoms
Most patient with acute pancreatitis have upper abdominal pain that travels through the back. Patients may describe this as a 𢖯iercing sensation?aggravated by eating. The abdomen may be swollen and very tender.
Symptoms of chronic pancreatitis include:
- Pain
- Malabsorption of food leading to weight loss or diarrhea
- Diabetes
- Nausea
- Vomiting
- Fever
- Increased heart rate
The pain of chronic pancreatitis is usually constant in nature and radiates to the back. In some patients, this pain may be disabling. The weight loss is usually due to the patient𠏋 inability to secrete pancreatic enzymes to break down foods so nutrients are not absorbed normally. Finally, diabetes may develop if the insulin-producing cells in the pancreas are damaged.
Diagnosis
Acute pancreatitis is suspected when a patient has symptoms and has risk factors such as alcohol ingestion or gallstone disease. Checking the blood for levels of digestive enzymes such as amylase and lipase helps physicians diagnose pancreatitis. High levels of these two enzymes in the blood are strongly suggestive of acute pancreatitis. As the patient recovers, the digestive enzyme levels will decrease to normal.
Chronic pancreatitis generally is suspected when the patient has symptoms and risk factors such as heavy alcohol ingestion.
Diagnosis can be difficult but today is aided by a number of new techniques, including pancreatic function tests and x-ray imaging of the pancreas gland with a CT scan or retrograde pancreatography (ERCP).
Treatment
Acute pancreatitis is primarily treated with supportive management in the hospital. Generally, patients receive intravenous fluids and pain medication. In up to 20 percent of patients, the pancreatitis can be severe. The patient may need to be placed in the intensive care unit because of damage that has occurred to other vital organs such as the heart, lungs or kidneys. Some cases of severe pancreatitis require surgery to remove irreversibly damaged parts of the gland.
Chronic pancreatitis can be challenging to treat. Physicians will try to relieve pain and improve nutritional and metabolic problems that result from pancreatic function loss. Patients are generally given pancreatic enzymes and insulin to supplement what is not being secreted or released by the pancreas. In some instances, blockage of the pancreatic duct would require a surgical drainage procedure.
Pancreatic Cancer
Carcinoma of the pancreas accounts for approximately 5 percent of cancer diagnosed in the United States and has a five-year survival of 1 percent. More than 90 percent of these tumors are adenocarcinomas and arise from the ductal cells of the gland.
Risk Factors
There are numerous risk factors for pancreatic cancer, including cigarette smoking, a high-fat diet, chronic pancreatitis, hereditary pancreatitis and industrial exposure to coal tar derivatives. Hereditary pancreatitis carries a five-fold increase risk of development of pancreatic cancer when compared to the general population.
Symptoms
The clinical manifestations of pancreatic carcinoma may be non-specific and are often subtle. The tumor has usually reached an advanced stage by the time of diagnosis. Most common symptoms include upper abdominal pain, weight loss, nausea, vomiting and jaundice. Pancreatic carcinoma is usually diagnosed by CT scan or ultrasound. Fine needle aspiration with endoscopic ultrasonography or CT guidance usually confirms the diagnosis.
Treatment
Surgical treatment offers the only chance of cure. Only 10 percent of tumors are resectable at the time of diagnosis. Pancreatic resection procedures are recommended for those patients without advanced disease. Palliative measures such as surgical bypass procedures or endoscopic placement of stents may be undertaken in patients with unresectable or metastatic lesions.
Additional Resources
For more information on pancreatic cancer, please visit the Cleveland Clinic Taussig Cancer Center Web site.