Pain in the pancreas occurs in a variety of conditions that affect the pancreas. Pancreatitis and pancreatic cancer are the two main causes of pancreas pain. However, not all cases of pancreas pain are restricted to pancreatic problems. For example, the injury responsible for acute pancreatitis (inflammation of the pancreas) may also involve the surrounding tissues such as the stomach, duodenum, and the bile ducts. Pain originating from these surrounding structures may also contribute to the presentation of pancreas pain.
The pancreas is a key secretory organ of both the digestive and the endocrine systems. The pancreatic juice contains a mixture of various enzymes that help in the digestion and absorption of lipids, proteins, and carbohydrates present in the food. The key hormones produced by the pancreas include insulin, glucagon, pancreatic polypeptide and somatostatin. These hormones play critical roles in the regulation of blood glucose level and cellular metabolism.
Location of Pancreas Pain
The pancreas is located behind the stomach within the upper middle and upper left regions of the abdominal cavity. These abdominal quadrants are also referred to as the epigastrium (upper middle quadrant) and the left hypochondrium (upper left quadrant). Within this abdominal space, the C-shaped loop of the duodenum also wraps around the pancreas.
The pancreas lies in a retroperitoneal location at the level of lumbar vertebrae L1 and L2, where it traverses the transpyloric plane (also known as the Addison’s plane). Due to this retroperitoneal location of the pancreas, pancreas pain emanates from deep within the upper abdominal cavity. Pancreas pain may also radiate to the left shoulder and the back regions.
Other Pain Near the Pancreas
Since the pancreas is surrounded by other abdominal organs, pancreas pain is often mistaken for pain emanating from organs such as the stomach, duodenum, kidneys, spleen, liver, and colon. Sometime, pancreas pain may even be confused with chest pain. Therefore, it is important to distinguish pancreas pain from pains that arise from other surrounding organs.
Some of the common types of abdominal pain that may be confused with pancreas pain include the following:
- Pain due to gastritis: Gastritis refers to stomach inflammation, which causes a burning pain or a gnawing ache in the upper left and the upper middle quadrants of the abdomen. The pain due to gastritis usually intensifies with hunger and eating. Similar pain is caused by peptic ulcers present in the stomach and the duodenum.
- Pain in the abdominal wall: Unlike the deep-seated pancreas pain, the pain arising from the abdominal wall is felt more superficially. However, tenderness in the epigastric region may also be present in the early stage of acute pancreas pain.
- Pain due to gallstones: Pain caused by gallstones is usually episodic in nature. An attack of gallstone pain may last for as long as two hours. Pain of duration longer than two hours may indicate inflammation of the gallbladder (technically referred to as cholecystitis) or an infection of the bile ducts (technically referred to as cholangitis). Pain due to gallstones increases upon intake of fatty foods. Pain due to pancreatic problems is also aggravated by a fatty diet.
- Pain caused by myocardial infarction: Myocardial infarction is a technical term for heart attack. Pain caused by myocardial infarction can extend to the epigastric region. Since pancreas pain also occurs in this region, an electrocardiogram (commonly abbreviated as ECG) is frequently used to distinguish between pancreatitis and heart attack.
- Pain caused by perforation of an abdominal organ: Pain caused by perforation of an abdominal organ is similar to pancreas pain. Perforation of abdominal organ results in the escape of the organ contents and air into the abdominal cavity (a condition referred to as pneumoperitoneum). Unlike pancreas pain, however, pain due to perforated abdominal organ is accompanied by abdominal distension and signs of peritonitis.
Causes and Symptoms
The exact nature of pancreas pain depends on the cause of the pancreas pain. The pain may be constant or recurrent. The intensity of pain may vary from a mild discomfort to an excruciating pain in the upper abdominal region. The pain usually intensifies after eating. The following are some of the signs and symptoms of pancreas pain that may occur due to different causes:
Pain due to acute pancreatitis
Acute inflammation of the pancreas is one of the most common causes of pancreas pain. The pain caused by acute pancreatitis has a sudden onset and may last for more than 24 hours. The pain itself may be severe and constant. The primary location of the pain is in the epigastrium and the left hypochondrium. However, the pain may also radiate to the back and the left shoulder regions.
Excessive alcohol consumption (as in binge drinking) is a common cause of acute pancreatitis. Apart from pain, acute pancreatitis may also be characterized by nausea, vomiting, rapid heart rate (technically referred to as tachycardia), jaundice and absence of bowel sounds. Excessive pain may also result in sweating, dizziness and fainting. Based on these characteristics, one may mistake the condition to be a heart attack.
The pain in acute pancreatitis usually intensifies while lying down flat or standing up straight. Curling up or stooping forward tends to ease the pain.
Read more on pancreatitis.
Pain due to chronic pancreatitis
Chronic pancreatitis is characterized by pain that is usually recurrent in nature. In the later stages, the pain may also become constant. However, some patients with chronic pancreatitis may not display any pain symptom at all. Apart from pain, people suffering from chronic pancreatitis may have fatty stools (technically referred to as steatorrhea), jaundice, diarrhea, nutrient deficiencies and unintentional weight loss.
Pain due to pancreatic cancer
The signs and symptoms of pancreatic cancer are similar to that of pancreatitis. The head of the pancreas is the most affected part in pancreatic cancers. The surrounding organs may also be affected. Some of the common signs and symptoms of pancreatic cancer include pain, unintentional weight loss, obstructive jaundice, lack of appetite, and wasting of the body (technically referred to as cachexia). Pancreatic cancer is suspected when the above mentioned signs and symptoms are present along with a palpable gallbladder or abdominal mass.