The pancreas is located in the upper middle part of the abdomen, mainly within the abdominal quadrant known as the epigastrium and extending into the left hypochondrium. It lies behind the stomach and is embraced by the C-loop of the duodenum.
A number of pancreas problems may cause pain but with many of these conditions, especially acute pancreatitis which is common, the injury is not isolated to the pancreas. It can extend to the bile ducts, duodenum and stomach. Therefore the pain may emanate from one or more of these structures as well contributing to the overall presentation of pancreas pain.
The pancreas lies retroperitoneally so the pain felt in various pancreas conditions may be felt deep within the upper abdomen. It lies around the level of the L1 and L2 vertebrae traversing the transpyloric plane and the pain can radiate to the back or even to the left shoulder.
It is not uncommon for pancreas pain to be mistaken for :
Pancreas Pain and Discomfort
The nature of pancreas pain may vary depending on the pancreatic disease and extent of injury. It can range from mild upper abdominal discomfort to a constant dull ache or excruciating pain that is seen in an acute abdomen. The pain is either constant or recurrent, exacerbating immediately after eating.
Due to close proximity of other structures, it is important to differentiate between pancreas pain and pain of other common conditions in the area.
- Gastritis (stomach) is a gnawing or burning ache mainly in the left quadrant but extending to the upper middle abdominal area. The pain is aggravated by hunger and after eating. Peptic ulcers (stomach or duodenum) may present in a similar manner.
- Gallstone pain typically comes on as attacks that can last for about 2 hours. If it persists for longer, it may be related to cholecystitis (inflamed gallbladder) or cholangitis (bile duct infection). Like pancreatitis, these conditions are often aggravated after eating particularly fatty foods.
- Abdominal wall pain is usually felt more superficially and while epigastric tenderness is also present with pancreas problems, often in the early stages of acute pancreas pain, rebound tenderness and guarding is absent.
- Myocardial infarction (heart attack) may refer to the epigastric region and pancreas pain may also refer to the chest. A heart attack is often considered as a differential diagnosis in acute pancreatitis and an ECG should be done to rule out cardiac emergencies.
- Perforated abdominal organ (pneumoperitoneum) may also be a consideration in pancreas pain as the contents of the organ escapes and air enters the abdominal cavity. The presentation is similar although the distended abdomen and signs of peritonitis are more likely to be associated with a perforation.
Acute Pancreatitis Pain
Acute pancreatitis is a fairly common pancreatic condition and noting the characteristics of the pain in this condition is therefore important. Acute pancreatitis pain :
- Sudden, severe and constant
- Located in the epigastrium extending to the left hypochondrium
- Lasts for more than 24 hours
- Radiates into the back and may also refer to the left shoulder
- Often follows alcohol consumption, especially excessive drinking (binge drinking)
Pancreas Pain Signs and Symptoms
The concomitant signs and symptoms associated with pancreas pain depends on the causative condition.
Among the more common cause like acute pancreatitis, the pain is often associated with nausea and vomiting, absent bowel sounds, fever, tachycardia (rapid heart rate) and sometimes jaundice. The pain is usually constant and severe. It is often excacerbated by standing up straight or lying flat. It is eased when stooping forward or curling up in a ball. Severe pain may also cause sweating, dizziness and fainting, similar to a heart attack.
With chronic pancreatitis, the pain may be recurrent and only constant yet dull in the latter stages. It is not uncommon for no pain to be present. Unintentional weight loss, jaundice, steatorrhea (fatty stool), diarrhea and signs of nutrient deficiencies are commonly present. Patients may report several attacks of acute pancreatitis in their life.
Read more on Pancreatitis Symptoms.
In pancreatic cancer, the symptoms are similar to pancreatitis but often long standing. Since most pancreatic cancers affect the head of the pancreas, it is not uncommon for the surrounding organs to also be involved. Obstructive jaundice, weight loss and pain are the characteristic features and therefore the distinction with pancreatic cancer has to be made with relevant diagnostic investigation. Patients report a lack of appetite for a prolonged period and cachexia may be noted. A palpable abdominal mass or a palpable gallbladder with the symptoms discussed above should immediately raise concern about pancreatic cancer.
Read more on Pancreatic Cancer Symptoms.
The pancreatic conditions discussed above are not the only pancreas diseases but it is often difficult to differentiate the other pathology without further diagnostic investigations. Read more on Pancreatic Diseases Symptoms.