Health Matters: What causes pancreatitis?
Q. I suddenly developed belly pain that radiated to my back. My doctor told me I had pancreatitis. What is it, and what can I expect in the future?
A. Pancreatitis is an inflammation of the pancreas gland, which is located in the upper abdomen toward the back. That's why your pain was felt in the upper belly as well as the back. The pancreas produces two types of substances—one, called bile, to help us digest the food in our intestine, and the other (insulin) to help us use the sugar that we absorb from food in the intestine. Pancreatitis occurs when the bile compounds intended to break down food products so we can absorb them actually leak into the pancreas gland itself and try to break it down! This can occur suddenly as in your case, or chronically over years. The two major causes of pancreatitis are gall stones and excessive alcohol intake, although there are other causes. Your doctor undoubtedly is looking for a stone in your bile duct. If you have such a stone, removing it will go a long way to helping you get over your pancreatitis and prevent a reoccurrence. Other treatment hallmarks include giving the patient fluids by vein, pain management, and, in some cases, surgery. When we should allow someone to eat after a bout of pancreatitis is uncertain. There is concern that feeding a patient too soon may further stimulate the pancreas to make bile and thus delay healing. Unfortunately, clinical studies investigating when best to feed people with pancreatitis have reached inconsistent results, and doctors don't agree on whether we should delay feeding or not. But avoiding alcohol certainly is a good idea, especially if there is any suggestion that alcohol may be the cause of the pancreatitis. The outlook for patients with acute pancreatitis varies, but if a stone caused your bout, removing it may prevent future reoccurrences.
Q. I was just diagnosed with prostate cancer. Can you tell me something about it?
A. Prostate cancer is common in men, especially as they age. Only skin cancer is more common, and it affects about 3.5 million men in the United States. The big issue with prostate cancer is that despite its frequency, many men have tumors that grow so slowly that they may never cause any detectable harm. But some cause much damage and can lead to death. Prostate cancer now is the third-leading cause of cancer death in men, so there is no question that having prostate cancer is of concern. Because of the great spectrum of clinical outcomes—from a nuisance to metastatic disease and death—there are multiple suggested management strategies. Perhaps most accepted is an approach where we risk-stratify prostate cancer patients into two groups. Those in the higher-risk group undergo what is called active surveillance where the cancer is monitored, and if it progresses, treatment is implemented. Treatment with surgery and radiation therapy can achieve cures of prostate cancer, but can have important side effects like urinary incontinence and impotence. Other treatments can include chemotherapy, hormone therapy, and promising new medications that offer hope for some patients with advanced disease. Let's hope that you fall into the low-risk second group, where your prostate cancer is one of the many that grows very slowly and won't cause you any major problems in the future.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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