Gallbladder

Pancreas: Conditions and Treatment

The pancreas is an organ located behind the stomach and in front of the spine. It is also surrounded by the liver, small intestine and spleen. The pancreas is shaped like a flat pear that sits horizontally across the center of the abdomen. Its head is attached to the duodenum (the first part of the small bowel) via the pancreatic duct.

What Is the Function of the Pancreas?

The pancreas serves two main functions:
Exocrine
The pancreas produces digestive enzymes that help break down fats, carbohydrates and proteins. These enzymes typically travel down the bile duct in their inactive forms, and will only be activated once they reach the duodenum. Additionally, the pancreas’ exocrine tissue secretes bicarbonate to neutralize stomach acid and facilitate the activation of the enzymes.
Endocrine
The pancreas contains cell groups which secrete hormones that are released into the bloodstream. These hormones, which are insulin and glucagon, regulate blood sugar level.

Common Diseases of the Pancreas

The pancreas plays a vital role in digestion and metabolic processes. Pancreatic diseases, if not treated, can lead to serious and long-term illnesses.
Some conditions can be treated through medication while others may require pancreatic surgery.

The three most common diseases affecting the pancreas are as follows:

Pancreatitis

Pancreatitis

Pancreatitis occurs when digestive enzymes that the endocrine tissues produce become prematurely activated while still in the pancreas. This irritates the pancreatic cells, causing the pancreas to become inflamed. Pancreatitis can be acute or chronic, but both have serious consequences if not attended to promptly. Complications include infections, diabetes and kidney failure.

Pancreatitis is typically caused by gallstones that block the common bile duct or in some cases, excessive alcohol intake. It is characterized by severe pain in the abdomen that can extend to the back, nausea and vomiting, bloating, indigestion, diarrhea and fever.

Treatment-wise, pancreatitis often requires hospitalization, antibiotics, pain medication and intravenous (IV) fluids. In cases where pancreatitis is caused by an obstructed bile duct, surgery is necessary. Gallstones can be removed and prevented by gallbladder removal. Pancreatic surgery in Singapore is also done to drain the pancreas from any dead tissues that can cause further infection.

Diabetes

Diabetes

Diabetes mellitus is a disorder characterized by a blood sugar level that is too high. It develops when as a result of the pancreas not producing sufficient insulin (type 1 diabetes), or the body being unable to use insulin properly (type 2 diabetes). Insulin is a hormone that transports sugar (glucose) from the blood into the cell, providing them energy to function. With diabetes, there is a lack of insulin, resulting in glucose staying in the blood. This leads to high sugar levels (hyperglycemia).

Diabetes is a serious condition that can have long-lasting or even life-threatening consequences if not treated. These include vision problems, gum disease, kidney failure, heart attack or stroke, nerve damage and loss of limb. Symptoms of diabetes to watch out for are frequent urination, increased thirst and hunger, unexplained weight loss, slow-healing wounds, blurred vision and extreme fatigue.

The first-line treatment for diabetes is insulin, in which insulin is regularly injected into the bloodstream. Other medicines that help stimulate the pancreas to secrete more insulin, and those that prevent the liver from releasing glucose, may be prescribed. In cases where there is pancreas failure, a pancreatic surgeon may recommend a transplant.

Pancreatic Cancer

Pancreatic Cancer

Pancreatic cancer occurs when abnormal cells develop and multiply in the pancreas, forming tumours. Among the different types of cancer, pancreatic cancer one of the rarest but also one of the most dangerous with a 5-year survival rate of only 10%, making prompt detection and treatment even more crucial.

Surgery is the main treatment for pancreatic cancer. In most cases, the Whipple procedure (pancreaticoduodenectomy) is performed. The Whipple surgery in Singapore involves the removal of the pancreas head, duodenum, gallbladder, part of the common bile duct and surrounding lymph nodes. Sometimes the pylorus (part of the stomach that connects to the duodenum) is also removed. The remaining organs will then be attached together to help facilitate digestion.

Aside from a Whipple operation in Singapore, other surgical treatments are available to treat pancreatic cancer, depending on the size and location of the tumour. These include:

  • Distal pancreatectomy, which involves the removal of the body and tail of the pancreas. The spleen may also be surgically removed.
  • Total pancreatectomy, which involves the removal of the whole pancreas.
  • Pancreatic surgery that involves removing or repairing only the affected tissues and blood vessels of the pancreas.

These surgical treatments may be done alongside chemotherapy or radiation therapy. A person can live without a pancreas, though he or she will need to regularly take insulin and other supplements to make up for the function of the lost organ.

Dr Wong Jen San
Consultant Hepatobiliary & Pancreatic Surgeon
MBChB (UK), MMed (S’pore), Msc (S’pore), FRCS (Edin), FAMS
Upon graduating from the University of Leicester and completing his basic surgical training in the United Kingdom, Dr Wong went on to complete advanced training in Singapore before embarking on his HMDP clinical fellowship in Japan—specializing in living donor liver transplantation.

Prior to establishing his own practice, Dr Wong was previously a consultant with the Department of Hepatopancreatobiliary & Transplant Surgery at SGH, an adjunct assistant professor at the Duke-NUS Graduate Medical School and a visiting consultant at the National Cancer Centre Singapore.

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The Hepatobiliary-Pancreatic System
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