Pancreatic diseases mechanics, symptoms, diagnosis and treatments

1. PANCREATIC
DISEASES

2. PANCREATITIS

3. PANCREATITIS
• Pancreatitis is inflammation in the pancreas. The
pancreas is a long, flat gland that sits tucked behind the
stomach in the upper abdomen. The pancreas produces
enzymes that help digestion and hormones that help
regulate the way your body processes sugar (glucose).
• Pancreatitis can occur as acute pancreatitis — meaning
it appears suddenly and lasts for days. Or pancreatitis
can occur as chronic pancreatitis, which is pancreatitis
that occurs over many years.
• Mild cases of pancreatitis may go away without
treatment, but severe cases can cause life-threatening
complications.

4. ACUTE
PANCREATITI
S

5. • Acute pancreatitis is a sudden attack
causing inflammation of the pancreas and
is usually associated with severe upper
abdominal pain. The pain may be severe
and last several days.
• Acute pancreatitis is caused directly or
indirectly. Direct causes affect the
pancreas itself, its tissues, or its ducts.
Indirect causes result from diseases or
conditions that originate somewhere else
in your body.

6. Symptoms
• Acute pancreatitis usually begins with gradual or sudden pain in
the upper abdomen that sometimes extends to the back. The
pain may be mild at first and become worse after eating. The
pain is often severe, constant, and commonly lasts for several
days in the absence of treatment. A person with acute
pancreatitis usually looks and feels very ill and needs immediate
medical attention. Most cases require hospitalization for 3 to 5
days for close monitoring, pain control, and intravenous
hydration. Other symptoms can include:
• Swollen and tender abdomen
• Nausea and vomiting
• Fever
• Rapid pulse

7. Diagnosis
• Your doctor can diagnose AP by using blood tests and
scans. The blood test looks for enzymes (amylase and
lipase) leaking from the pancreas. An ultrasound, CT,
or MRI scan allows your doctor to see any abnormalities
in or around your pancreas. Your doctor will also ask
about your medical history and ask you to describe your
discomfort.

8. Treatment
• Mild cases usually take care of themselves in a few
days. Severe ones can last several weeks. If you
suspect pancreatitis, avoid all food and drink, as they
will only make the symptoms worse. Patients with
severe cases are admitted to the hospital and given
pain relievers and intravenous (IV) fluids. For cases
that last more than a few days, nutritional supplements
are usually added to the IV lines.
• When gallstones are suspected, the gallbladder (a
non-essential organ) is often removed. But that usually
is not done until the symptoms have gotten better,
since surgery can make them worse.

9. Treatment
• In life-threatening cases where a blockage of the
pancreatic duct is suspected, the doctor may do an
endoscopic retrograde cholangiopancreatography
(ERCP). To do this, the doctor inserts a flexible tube
through the patient's mouth. Using a light and
miniature camera at the end of the tube, the doctor
can find the blockage and remove it if necessary. The
doctor might also widen the duct, allowing the stone to
pass by itself.
• Sometimes traditional surgery is needed to drain a
cyst or stop bleeding.

10. CHRONIC
PANCREATITI
S

11. • A persistent inflammation develops in the
pancreas. Over time the inflammation causes
scarring and damage to parts of the
pancreas. This can then lead to not enough
enzymes and insulin being made. A lack of
enzymes causes poor digestion of food
(malabsorption). A lack of insulin causes
diabetes.
• Over time clumps of calcium are deposited
and can form stones in the pancreas.
Calcium stones and/or scarring of the
pancreatic ducts may block the flow of
enzymes along the pancreatic ducts.

12. Symptoms
• Abdominal pain
• Nausea
• Vomiting
• Weight loss
• Diarrhea
• Oily or fatty stools
• Clay-colored or pale stools

13. Symptoms
• Individuals with chronic pancreatitis frequently lose
weight, even when their appetite and eating habits
are normal. The weight loss occurs because the
body does not secrete enough pancreatic
enzymes to digest food, so nutrients are not
absorbed normally, leading to malnutrition.
• Patients who have chronic pancreatitis may have
a decreased quality of life due to pain and often
require admission to the hospital for treatment of
symptoms.

14. Diagnosis
• Unfortunately, there is currently no single test for chronic
pancreatitis.
• Once the damage and scarring to the pancreas is more
severe, or when calcium stones start to form, then the
damaged pancreas can be detected by X-rays or scans.
Tests done usually include:
• Blood tests to check your blood count, kidney and liver
function.
• Blood tested for diabetes.
• Your doctor may also request a sample of your feces for
testing.
• An X-ray or CT scan of your abdomen may be performed.
• A cholangiogram is a test which produces a picture of the bile
ducts. This is often done using an MRI scan.

15. Treatment
• Stop drinking alcohol for good.
• Painkillers - are usually needed to ease the
pain.
• Capsules containing artificial enzymes are
taken with meals.
• Restricting fat in the diet - may be advised if
steatorrhoea is bad.
• Insulin - if diabetes develops
• Vitamins - may be needed to be taken.
• Do not smoke.

16. • Surgery. Most people with chronic pancreatitis do
not need surgery but an operation is sometimes
needed. The common reason for surgery is for
persistent bad pain that is not helped by painkillers
or other methods. The operation usually involves
removing part of the pancreas.
• Surgery may also be needed if a complication
develops. For example, if a blocked bile duct or
pseudocyst develops. What is the outlook
(prognosis) for chronic pancreatitis?
• If you continue to drink alcohol and pancreatitis
becomes severe than life expectancy is typically
reduced by 10-20 years. This is due to
complications of pancreatitis or to other alcohol-
related illnesses. If you stop drinking alcohol
completely in the early stages of the condition then
the outlook is better.

17. HEREDITARY
PANCREATITI
S

18. • Hereditary pancreatitis is a genetic condition
characterized by recurrent episodes of
inflammation of the pancreas (pancreatitis).
The pancreas produces enzymes that help
digest food, and it also produces insulin, a
hormone that controls blood sugar levels in
the body. Episodes of pancreatitis can lead to
permanent tissue damage and loss of
pancreatic function.

19. Symptoms
• Abdominal pain
• nausea
• vomiting
• fever
• These symptoms are acute, meaning they occur
suddenly, and may last for several days. Later in
life, these acute episodes begin to recur, meaning
they begin to happen more frequently. This begins
the development of chronic pancreatitis, in which
the pancreas is continually in stress from
inflammation.

20. Diagnosis
• If there is a family history of chronic
or acute pancreatitis, yet no cause for
either condition can be determined,
genetic testing may be performed to look
for a mutation in the specific gene known
as PRSS1. This gene has been found in a
large percentage of people whom have
pancreatitis.

21. Treatment
The most fundamental treatments that a patient can
do for pancreatitis are:
• alcohol cessation — alcohol is a known risk factor
in the development of pancreatitis
• smoking cessation — tobacco products are a
known risk factor for many conditions
• diet — obesity and high fat foods need to be
controlled
Other treatment methods may also include:
• pain medications
• enzyme replacement therapy

22. Treatment
• Procedural or surgical options for chronic
pancreatitis may include:
• ERCP — a procedure that can remove
stones from the biliary tract
• Pancreatectomy — a surgical removal of all
or part of the pancreas
• autologous islet cell transpantation— the
infusion of a patient's own pancreatic islet
cells into the liver's portal vein where they
can begin producing insulin

23. AUTOIMMUNE
PANCREATITI
S

24. • Autoimmune pancreatitis, also called AIP, is a
chronic inflammation that is thought to be caused
by the body's immune system attacking the
pancreas and that responds to steroid therapy.
Two subtypes of AIP are now recognized, type 1
and type 2.
• Autoimmune pancreatitis is a rare, newly
recognized disease and can be mistakenly
diagnosed as pancreatic cancer. Both conditions
have similar signs and symptoms, but very
different treatments, so it is very important to
distinguish one from another.

25. • Type 1 AIP is also called IgG4-related pancreatitis and
is part of a disease called IgG4-related disease (IgG4-
RD) that often affects multiple organs including the
pancreas, bile ducts in the liver, salivary glands,
kidneys and lymph nodes.
• Type 2 AIP seems to affect only the pancreas,
although about one-third of people with type 2 AIP
have associated inflammatory bowel disease.
• Both subtypes of autoimmune pancreatitis are treated
with steroids, which in many people dramatically
improve the condition.

26. Symptoms
• Dark urine
• Pale stools or stools that float in the toilet
• Yellow skin and eyes (jaundice)
• Pain in your upper abdomen or middle part of
your back
• Nausea and vomiting
• Weakness or extreme tiredness
• Loss of appetite or feelings of fullness
• Weight loss for no known reason

27. Diagnosis
• There are two types of autoimmune pancreatitis.
Doctors will use a number of tests to determine if you
have AIP and if so, which type you have.
• People with AIP type 1 have:
• One or more masses in the pancreas.
• A high level of (elevated) serum IgG4 in the pancreas.
• In some cases, evidence of the disease in other
organs, called other organ involvement (OOI), such as
masses or elevated serum IgG4.
• A rapid response to treatment with steroids.
• A likelihood of relapse if treatment is discontinued.

28. Diagnosis
• In contrast, people with AIP type 2 have:
• No evidence of the disease other than in the
pancreas.
• No serum IgG4 elevation.
• No OOI.
• GELs. Granulocyte epithelial lesions (GELS) are a
type of white blood cell (neutrophils) in the ducts of
the pancreas, often causing destruction of the
ducts.
• Little likelihood of relapse after treatment is
discontinued.

29. Diagnosis
• No single test or characteristic feature identifies
autoimmune pancreatitis. Until recently, different
diagnostic approaches around the world made the
diagnosis more difficult. Researchers established the
International Consensus Diagnostic Criteria (ICDC) in
2011:
• Microscopic analysis of cells and tissues (histology)
• Imaging, such as CT, MRI or ERCP
• Serology (serum IgG4 levels)
• Other organ involvement
• Optionally, response to steroid therapy — usually a
two-week steroid trial

30. Diagnosis
• Specific tests may include:
• Imaging tests
• Blood tests
• Endoscopic core biopsy
• Steroid trial

31. Treatment

32. PANCREATIC
CANCER

33. • Pancreatic cancer begins in the tissues of your
pancreas — an organ in your abdomen that lies
horizontally behind the lower part of your stomach.
Your pancreas releases enzymes that aid
digestion and hormones that help manage your
blood sugar.
• Pancreatic cancer typically spreads rapidly to
nearby organs. It is seldom detected in its early
stages. But for people with pancreatic cysts or a
family history of pancreatic cancer, some
screening steps might help detect a problem early.

34. Symptoms
• Cancer symptoms are quite varied and
depend on where the cancer is located,
where it has spread, and how big the tumor
is. Pancreatic cancer is often called a "silent"
disease because it rarely shows early
symptoms and presents non-specific later
symptoms. Tumors of the pancreas cancers
are usually too small to cause symptoms.
However, when the cancer grows, symptoms
include:

35. Symptoms
• Pain in the upper abdomen from the tumor
pushing against nerves
• A painless yellowing of the skin and eyes and
darkening of the urine called jaundice,
created when the cancer interferes with the
bile duct and the liver.
• Loss of appetite, nausea, and vomiting
• Significant weight loss and weakness
• Acholic stool (pale or grey stool) and
steatorrhea (excess fat in stool)

36. Diagnosis
• Imaging tests that create pictures of your
internal organs.
• Using a scope to create ultrasound
pictures of your pancreas.
• Removing a tissue sample for testing
(biopsy)
• Blood test.

37. Treatment
• Surgery
– Surgery for tumors in the pancreatic head
– Surgery for tumors in the pancreatic body and tail.
– Surgery to remove the entire pancreas.
– Surgery for tumors affecting nearby blood vessels.
• Chemotherapy
• Radiation therapy
• Clinical trials
• Supportive (palliative) care
• Alternative medicine
– Art therapy
– Exercise
– Meditation
– Music therapy
– Relaxation exercises
– Spirituality

38. DIABETES
MALLITUS

39. • Diabetes mellitus is a disease that prevents
your body from properly using the energy
from the food you eat. Diabetes occurs in one
of the following situations:
• The pancreas (an organ behind your
stomach) produces little insulin or no insulin
at all. (Insulin is a naturally occurring
hormone, produced by the beta cells of the
pancreas, which helps the body use sugar for
energy.); or
• The pancreas makes insulin, but the insulin
made does not work as it should. This
condition is called insulin resistance.

40. Types of Diabetes
• Type 1 diabetes occurs because the insulin-
producing cells of the pancreas (beta cells) are
damaged. In Type 1 diabetes, the pancreas makes
little or no insulin, so sugar cannot get into the
body's cells for use as energy. People with Type 1
diabetes must use insulin injections to control their
blood glucose. Type 1 is the most common form of
diabetes in people who are under age 30, but it
can occur at any age. Ten percent of people with
diabetes are diagnosed with Type 1.

41. • In Type 2 diabetes, the pancreas makes insulin, but it
either doesn't produce enough, or the insulin does not
work properly. Nine out of 10 people with diabetes have
Type 2. This type occurs most often in people who are
over 40 years old and overweight. Type 2 diabetes may
sometimes be controlled with a combination of diet,
weight management, and exercise. However, treatment
also may include oral glucose-lowering medications
(taken by mouth) or insulin injections (shots).
• Other types of diabetes might result from pregnancy
(gestational diabetes), surgery, use of certain medicines,
various illnesses, and other specific causes.

42. Symptoms
• Increased thirst
• Increased hunger (especially after eating)
• Dry mouth
• Frequent urination
• Unexplained weight loss (even though you are eating and feel
hungry)
• Weak, tired feeling
• Blurred vision
• Numbness or tingling in the hands or feet
• Slow-healing sores or cuts
• Dry and itchy skin (usually in the vaginal or groin area)
• Frequent yeast infections

43. Diagnosis
• Diabetes is diagnosed with fasting sugar blood tests or
with A1c blood tests, also known as glycated hemoglobin
tests. A fasting blood sugar test is performed after you
have had nothing to eat or drink for at least eight hours.
• Normal fasting blood sugar is less than 100 mg/dl (5.6
mmol/l). You do not have to be fasting for an A1c blood
test.

44. Diagnosis
• Diabetes is diagnosed by one of the following (see chart):
• Your blood sugar level is equal to or greater than 126 mg/dl (7
mmol/l).
• You have two random blood sugar tests over 200 mg/dl (11.1
mmol/l) with symptoms.
• You have an oral glucose tolerance test with results over 200
mg/dl (11.1 mmol/l).
• Your A1c test is greater than 6.5% on two separate days.
• An A1c test should be performed in a laboratory using a
method that is certified by the National Glycohemoglobin
Standardization Program (NGSP) and standardized to the
Diabetes Control and Complications Trial (DCCT) assay.

45. Treatment
• Management of type 2 diabetes includes:
• Healthy eating
• Regular exercise
• Possibly, diabetes medication or insulin therapy
• Blood sugar monitoring
• These steps will help keep your blood sugar level
closer to normal, which can delay or prevent
complications.
• No. A cure for diabetes has not yet been found.
However, diabetes can be treated and controlled. Most
people with diabetes manage their disease and lead
normal lives.

46. EXOCRINE
PANCREATIC
INSUFFIECIENCY

47. • Exocrine pancreatic insufficiency (EPI) is a
condition characterized by deficiency of the
exocrine pancreatic enzymes, resulting in the
inability to digest food properly, or
maldigestion.
• EPI is associated with certain diseases and
conditions that affect the pancreas. Some of
these diseases you are born with, like cystic
fibrosis, while others may occur later in life,
as is the case with chronic pancreatitis.

48. Symptoms
• Because EPI makes it harder for your body to
break down food, you’ll have symptoms that
overlap with other digestive conditions.
Symptoms include:
• bloating
• flatulence
• diarrhea
• abdominal pain
• Foul-smelling, greasy stools (steatorrhea)

49. • Abdominal discomfort with gas or bloating
• Muscle cramps
• Bone pain
• Easy skin bruising or bleeding
• Night blindness
• Weight loss

50. Diagnosis
• These tests are commonly used to help diagnose
exocrine pancreatic insufficiency:
• A fecal fat test involves looking at a stool sample under a
microscope. A stool sample can also be checked to see
if the pancreatic enzymes trypsin and elastase are in the
intestine as they should be.
• Blood tests can measure trypsinogen, the pancreatic
enzyme that converts to trypsin.
• An endoscopic retrograde cholangio-pancreatography
(ERCP) is a test that uses a flexible telescope inserted
through the mouth and passed down through the
stomach to take pictures of the pancreas and look for
damage to it. A biopsy of the pancreas may be taken
during ERCP to be used for additional testing.

51. Treatment
• Treatment options your doctor may suggest
include:
• Taking pancreatic digestive enzyme
medications, which is usually the most
effective form of treatment.
• Following a very low-fat diet.
• Taking antioxidants, such as vitamins A, E,
and C, as well as dietary supplements like
methionine, selenium, and grape seed
extract, which may help prevent
further damage to the pancreas.

52. PANCREATIC
PSEUDOCYST
S

53. • A pancreatic pseudocyst is a collection of tissue
and fluids that forms on an organ located behind
your stomach called the pancreas. It’s usually
the result of a hard blow to your abdomen or
pancreatitis, which is an inflammation of the
pancreas.
• “Pseudo” means false. A pseudocyst looks like a
cyst but is made from different kinds of tissue
than a true cyst. A true cyst is more likely to be
cancerous than a pseudocyst.

54. Symptoms
• high, persistent fever
• severe pain in your upper stomach area,
with pain radiating to your back
• unexplained fainting
• vomiting blood
• weak, rapid heartbeat

55. However, you should also watch for the following
symptoms, especially if you’ve recently had pancreatitis or
a blow to the torso:
• nausea and vomiting
• pain in the area of your upper stomach,
sometimes radiating to your back
• a lump you can feel in the area of your
upper stomach
• difficulty eating and digesting food

56. Diagnosis
• If your doctor thinks you may have a pancreatic
pseudocyst, they’ll order imaging tests to get a better
look at the structure of your pancreas and to gather more
detailed information about the cyst.
• Your doctor may also order an endoscopic ultrasound.
This procedure uses high-powered sound waves to
create an image of the abdomen and organs. Your
doctor will then insert a thin, flexible tube with a light and
camera attached to it into your mouth and down into the
upper part of the small intestine. This instrument is called
an endoscope. This procedure allows your doctor to
gather a small amount of fluid from the cyst to determine
if the mass is cancerous.

57. Treatment
• If your doctor determines that you have a
pseudocyst but you don’t have any symptoms,
they may suggest you wait to see if the cyst goes
away on its own. Regular imaging tests can
monitor the growth or shrinking of the cyst.
• When a pseudocyst compresses your other
organs, your doctor will need to drain it to reduce
its size. It also needs draining if it grows so large
that it could rupture. Drainage requires surgery
under general anesthesia, meaning that you’ll be
in a pain-free sleep during the procedure.

58. Treatment
• Surgery involves making a very small incision
to drain the pseudocyst with a needle guided
by ultrasound or an endoscopic camera.
Alternatively, your doctor might make a larger
incision to view the pseudocyst directly.
• Your doctor will drain or suction out the
contents of the pseudocyst. They’ll send a
sample of the contents to a lab to test for
infections and signs.

59. PANCREATIC
CYSTS

60. • Pancreatic cysts are saclike pockets of fluid on or
in your pancreas, a large organ behind the
stomach that produces hormones and enzymes
that help digest food.
• Most pancreatic cysts aren't cancerous, and many
don't cause symptoms. They're typically found
during imaging testing for another problem. Some
are actually noncancerous (benign) pockets of
fluids lined with scar or inflammatory tissue, not
the type of cells found in true cysts (pseudocysts).

61. • But some pancreatic cysts can be or can
become cancerous. Your doctor might take
a sample of the pancreatic cyst fluid to
determine if cancer cells are present. Or
your doctor might recommend monitoring
a cyst over time for changes that indicate
cancer.

62. Symptoms
• Persistent abdominal pain, which may radiate to
your back
• A mass you can feel in your upper abdomen
• Nausea and vomiting
• Fainting
• Severe abdominal pain
• Decreased consciousness
• Weak and rapid heartbeat
• Vomiting of blood

63. Diagnosis
• Medical history. Previous abdominal injury or
pancreatitis might indicate a pseudocyst.
• CT scan. This imaging test can provide detailed
information about the size and structure of a
pancreatic cyst.
• MRI scan. This imaging test can highlight subtle
details of a pancreatic cyst, including whether it has
any components that suggest a higher risk of cancer.
• Endoscopic ultrasound. This test, like MRI, can
provide a detailed image of the cyst. Also, fluid can be
collected from the cyst for analysis in a laboratory for
possible signs of cancer.

64. • The characteristics and location of the pancreatic cyst, with
your age and sex, can help doctors pinpoint the type of cyst
you have:
• Serous cystadenoma can become large enough to displace
nearby organs, causing abdominal pain and a feeling of
fullness. Serous cystadenomas occur most frequently in
women older than 60 and only rarely become cancerous.
• Mucinous cystadenoma is usually situated in the body or tail
of the pancreas and occurs most often in middle-aged
women. Mucinous cystadenoma is precancerous, which
means it might become cancer if left untreated. Larger cysts
might already be cancerous when found.
• Intraductal papillary mucinous neoplasm (IPMN) is a
growth in the main pancreatic duct or one of its side branches.
IPMN may be precancerous or cancerous. It occurs most
often in men and women older than 50. Depending on its
location and other factors, IPMN may require surgical
removal.

65. • Papillary cystic tumor is usually situated in
the body or tail of the pancreas and occurs
most often in women younger than 35. Also
known as papillary cystic neoplasm, it's rare
and usually cancerous.
• Cystic islet cell tumor is mostly solid but
can have cystlike components. Cystic islet
cell tumors are rare. They can be confused
with other pancreatic cysts and may be
precancerous or cancerous.

66. Treatment
• Surveillance
– CT scans
– endoscopic ultrasound
• Draining the Cyst
– The endoscope is equipped with a needle to
drain the cyst and can collect the fluids and, if
necessary, tissue samples to be analyzed for
cancerous cells.
• Surgery

67. SPHINCTER
OF ODDI
DYSFUNCTIO
N

68. • The sphincter of Oddi is a muscular valve
that controls the flow of digestive juices (bile
and pancreatic juice) through ducts from the
liver and pancreas into the first part of the
small intestine (duodenum). Sphincter of
Oddi dysfunction (SOD) describes the
situation when the sphincter does not relax at
the appropriate time (due to scarring or
spasm). The back-up of juices causes
episodes of severe abdominal pain.

69. Symptoms
• Abdominal pain (the most common symptom)
• Nausea
• Vomiting
• Fever
• Chills
• Diarrhea.
These symptoms can come and go, and can be mild
one time and severe the next.

70. Diagnosis
• When sphincter of Oddi dysfunction is suspected, your
doctor will first check to see if the abdominal pain is caused
by another condition. It is important to make sure patients
with abdominal pain don't have serious conditions such as
cancer of the pancreas or bile ducts, peptic ulcer disease, or
stones in the ducts that carry the bile from the liver. In some
cases, even heart conditions such as angina or ischemia can
cause pain that seems to be coming from the abdomen.
• Your doctor may want to take a close look at the sphincter of
Oddi to see if it is functioning normally. This is done by
placing a small plastic tube into the pancreas duct or bile
duct near the sphincter of Oddi to measure how well it is
contracting and expanding. Patients are placed under
sedation for this procedure, which is called sphincter of Oddi
manometry.

71. Treatment
• ERCP (endoscopic retrograde
cholangiopancreatography)—is a procedure for
the examination or treatment of the bile duct and
pancreatic duct. The procedure carries a risk of
serious complications and is done under sedation
by experts trained in the technique. It combines
the use of x-rays and an endoscope that is passed
down to the duodenum, where the bile duct and
pancreatic ducts drain, and a dye that is injected
into the ducts.

72. NEUROENDOCRIN
E TUMOR

73. • Neuroendocrine tumors are abnormal growths that
begin in specialized cells called neuroendocrine cells.
Neuroendocrine cells have traits similar to nerve cells
and to hormone-producing cells.
• Neuroendocrine tumors are rare and can occur
anywhere in the body. Most neuroendocrine tumors
occur in the lungs, appendix, small intestine, rectum
and pancreas.
• Neuroendocrine tumors can be noncancerous (benign)
or cancerous (malignant).

74. Symptoms
• Hyperglycemia (too much sugar in the blood)
• Hypoglycemia (too little sugar in the blood)
• Diarrhea
• Persistent pain in a specific area
• Loss of appetite/weight loss
• Persistent cough or hoarseness
• Thickening or lump in any part of the body
• Changes in bowel or bladder habits
• Unexplained weight gain or loss
• Jaundice (yellowing of the skin)
• Unusual bleeding or discharge
• Persistent fever or night sweats
• Headache
• Anxiety
• Gastric ulcer disease

75. Diagnosis
• Biopsy
• Blood/urine tests.
• X-ray.
• Computed tomography (CT or CAT) scan.
• Magnetic resonance imaging (MRI)
• Molecular testing of the tumor.
• Positron emission tomography (PET) or PET-
CT scan.

76. Treatment
• Surgery
• Radiation therapy
• Chemotherapy
• Targeted therapy

77. Pancreatic
neuroendocrine
tumor

78. • Pancreatic neuroendocrine tumors (pancreatic
NETs or PNETs), also called pancreatic endocrine
tumors or islet cell tumors, are tumors that form
from the abnormal growth of hormone-producing
cells in the pancreas called islet cells. The
pancreas produces hormones that regulate blood
sugar level, stomach acid production, the rate of
food absorption and amount of water in the
intestines. Pancreatic neuroendocrine tumors are
either functional (produce hormones) or
nonfunctional (do not produce hormones).

79. Symptoms
• diabetes
• hypoglycemia (low blood sugar)
• gallstones
• stomach ulcers
• severe diarrhea
• sudden growth of the hands and feet
(acromegaly)

80. Diagnosis
• Endoscopic Ultrasound
• Biopsy
• MRI and Triphasic CT Scanning
• OctreoScan (Somatostatin Receptor
Scintigraphy) Imaging

81. Treatment
• Surgery
• Hormone Therapy
• Radiation Therapy and Chemotherapy
• MIBG Radiolabeled Therapy
• Investigational Approaches

82. PANCREAS
DIVISUM

83. • Pancreas divisum is a common congenital anomaly
(an anomaly that is present at birth) of the pancreatic
duct(s).
• The pancreas is a deep-seated organ located behind
the stomach.
• One of its functions is to produce enzymes that are
important for the digestion of food in the intestine.
• The digestive enzymes, in the form of digestive juice,
drain from the pancreas via the pancreatic duct into
the duodenum (the uppermost portion of the small
intestine) where they aid in digesting food.

84. Symptoms
• Most individuals born with pancreas divisum
experience no symptoms throughout life, will
remain undiagnosed, and will not require
treatment. A small number of patients with
pancreas divisum will experience repeated
episodes of pancreatitis. Pancreatitis is an
inflammation of the pancreas that can
cause abdominal pain as well as more severe
complications. Some patients with pancreas
divisum may develop chronic abdominal
pain without pancreatitis.

85. Diagnosis
• The most accurate test to diagnose pancreas
divisum is ERCP (endoscopic retrograde
cholangio-pancreatography), which can
demonstrate the presence of two separately
draining pancreatic ducts. However, ERCP
itself sometimes can cause attacks of
pancreatitis. Other tests that can help
diagnose pancreas divisum without the risk of
causing pancreatitis include endoscopic
ultrasound (EUS), and MRI(magnetic
resonance imaging).

86. Treatment
• Pancreas divisum without symptoms needs no
treatment. Treatment of patients with
abdominal painand recurrent pancreatitis attributable
to pancreas divisum has not been well established.
Some doctors will attempt sphincterotomy (cutting of
the minor papilla during ERCP to enlarge its opening).
Others will insert a stent during ERCP into the duct to
prevent duct blockage. These procedures are not risk
free. Therefore, patients with symptomatic pancreas
divisum are best evaluated and treated by doctors in
centers experienced in treating pancreatic diseases.