Christine McFadden: The pancreas serves a dual purpose

Don’t you wonder how some things ever came to be named?

The word “pancreas” comes from an anatomist named Rufus of Ephesus, who lived about 2,000 years ago. In Greek, pancreas means “all flesh.” And it is a pale pink, scrawny, L-shaped ribbon of an organ sitting in a crook of small intestine near the right side of the stomach wall.

It’s nothing you can really get your hands on during surgery. In fact, you don’t want to get your hands on it during surgery. The pancreas is notoriously sensitive to rough handling, and as a young surgeon, I worried that if I had to gently nudge it to one side to access some intestine or, heaven forbid, hooked it when trying to locate a recalcitrant uterine horn during a spay surgery, that my patient would have a belly ache for days afterward or even die. That turned out not to be true, but even after 30 some years of exploring abdomens, I am still skittish about handling the pancreas and try to avoid any surgical contact.

The pancreas serves two very important yet distinctly separate functions in the body. One is an endocrine (hormonal) function, as the pancreas produces the hormone insulin. When this system runs amok, pets suffer from diabetes mellitus, often called “sugar diabetes.” The other cells of the pancreas exert exocrine (enzymatic) control and produce amylase and lipase, two enzymes that help digest food in the small intestine.

When these exocrine cells malfunction, the digestive enzymes are released willy-nilly into the pancreas, not the intestine, where they start to digest the wrong thing. This is pancreatitis. Inflammation of the pancreas and surrounding abdominal tissue as these enzymes eat away at it is so marked that it may be seen on an X-ray. Tremendous pain over the anterior abdomen is often present. The pancreas is most stimulated to produce its digestive enzymes by high-fat foods and protein.

Kahlua was a doggie princess. A little pudgy in middle age, she was lovingly treated to her fair share of dog food and table goodies, often high in fat. One day she started to vomit her dinner. She was sluggish and screamed in pain when her owner gently picked her up around her tummy. In our office, she was running a low fever and cried when her anterior abdomen was palpated.

Among her blood tests, a special test for pancreatitis, the Spec Cpl (specific canine pancreatic lipase test) was positive. Both amylase and lipase scores were in the thousands. When we told her owner the news, he was ghastly quiet. Finally he raised his eyes and told me quietly that he had just lost his wife to pancreatic cancer. Kahlua was all he had left of her.

He didn’t need to say more. I couldn’t rule out cancer that early because there is no blood test to rule out cancer of the pancreas. If cancer is present, it may be the size of a small pimple and won’t always show up on an ultrasound. We would have to proceed with standard treatment for pancreatitis, and if Kahlua did not improve as expected, we would review our other choices.

After several days on intravenous fluids to flush out her body and absolutely no food (we do not want to stimulate the pancreas during this time), Kahlua brightened up considerably and was no longer in pain over her tummy. Her signs of infection responded well to antibiotics, and when we gave the all clear and offered a tiny meatball of a bland, low-fat food, she gobbled it down and never looked back.

Despite this brush with serious disease, Kahlua never had another problem with her pancreas, though she did maintain a low-fat diet for the rest of her long life. She was another lesson in proceeding cautiously when discussing any particular ailment of a pet that humans might share, as all too often I find that my diabetic patient has a diabetic owner, or that heart disease or cancer “runs in the family.” Kahlua was 7 years old when she developed pancreatitis and lived another 10 years beyond that, a princess to the end.

This story was originally published August 7, 2015 at 10:59 AM with the headline "Christine McFadden: The pancreas serves a dual purpose."