With­out pan­creas, fat passes all the way through the body

The Western Star - - Life - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: I am 57 and gen­er­ally in good health. My doc­tor di­ag­nosed me with chronic pan­cre­ati­tis, af­ter I had weight loss with di­ar­rhea, and was found to have fat in my stool. The CT scan showed that I have a 12-mm stone block­ing my pan­cre­atic duct. He said I have chronic pan­cre­ati­tis. My doc­tor says I need surgery to re­move the stone.

Is this a life-or-death surgery? If no one will per­form the surgery, is there an­other way to get rid of the stone? — C.H.

AN­SWER: Chronic pan­cre­ati­tis is a rel­a­tively com­mon con­di­tion, but some­times can go for a long time with­out be­ing di­ag­nosed. The pres­ence of fat in the stool is a big clue to the di­ag­no­sis: Pa­tients may no­tice that their stools seem oily, and it might take mul­ti­ple flushes of the toi­let to com­pletely re­move it. The di­ar­rhea hap­pens be­cause the pan­cre­atic en­zymes are nec­es­sary for the body to ab­sorb fat: With­out the pan­creas, the fat passes all the way through the body, caus­ing fatty di­ar­rhea, called steat­or­rhea. Many peo­ple have ab­dom­i­nal pain, some­times episodic, but at least 20 per­cent of peo­ple have none.

There are many causes of chronic pan­cre­ati­tis. Chronic al­co­hol abuse is the most com­mon cause that I saw in my train­ing, but ob­struc­tion of the pan­cre­atic duct by stone or tu­mor is an­other. Un­for­tu­nately, re­mov­ing the stone might not stop the pan­cre­ati­tis: In many peo­ple, the changes in the pan­creas from long­stand­ing ob­struc­tion are ir­re­versible. Nonethe­less, I whole­heart­edly agree with re­mov­ing the cause of the ob­struc­tion.

There are sev­eral ap­proaches to re­mov­ing a pan­cre­atic stone, in­clud­ing en­do­scopic re­moval, laser treat­ment and shock­wave lithotripsy (us­ing sound­waves to break up the stone). Only your treat­ing physi­cian can say what the best treat­ment for you is.

Although any of th­ese may be con­sid­ered “surgery,” there also are sur­gi­cal treat­ments for chronic pan­cre­ati­tis, and I’m not sure if your doc­tor is rec­om­mend­ing one of those. Surgery for chronic pan­cre­ati­tis (as op­posed to re­mov­ing the stone) usu­ally is used for peo­ple whose pain can’t be con­trolled.

An­other im­por­tant treat­ment in chronic pan­cre­ati­tis is the use of re­place­ment en­zymes. Th­ese help digest the fat and pro­tein in the food, re­liev­ing the di­ar­rhea and, in some peo­ple, re­liev­ing pain. They also can help the body ab­sorb fat-sol­u­ble vi­ta­mins.

DEAR DR. ROACH: I re­cently had a PET scan. It showed that my stom­ach is al­most com­pletely up in my tho­rax with a large hi­atal her­nia. I have no dis­com­fort or symp­toms. Is this dan­ger­ous? Should I have surgery? — C.V.

AN­SWER: The di­aphragm is a large sheet of mus­cle that sep­a­rates the chest from the ab­domen. It has a hole in it, called the di­aphrag­matic hia­tus, that al­lows the esoph­a­gus to carry food into the stom­ach. In some peo­ple, that hole is large enough for part of the stom­ach to go up into the chest. This con­di­tion is called a hi­atal her­nia, and it may bring on vari­able symp­toms, es­pe­cially heart­burn. Usu­ally, it’s a “slid­ing” hi­atal her­nia -- the stom­ach can go into the chest but later come back in the ab­domen where it be­longs.

In peo­ple with no symp­toms, surgery rarely is re­quired. How­ever, if the en­tire stom­ach is in the chest, it’s pos­si­ble for it to get stuck, which pre­dis­poses a per­son to bleed­ing and, rarely, to a con­di­tion called volvu­lus, when the stom­ach twists in the chest against the part left in the ab­domen. Th­ese com­pli­ca­tions of­ten need surgery: I have seen only two cases in my ca­reer.

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