Pancreatic Disorders Overview

Study Notes

The pancreas is a dual-function gland, acting as both an endocrine and exocrine gland
The exocrine portion of the pancreas produces digestive enzymes crucial for protein breakdown in the small intestine
The endocrine component of the pancreas makes insulin, a key hormone regulating blood sugar levels (99% of pancreas is exocrine and 1% is endocrine)
Insulin facilitates glucose uptake by cells, preventing blood sugar from spiking

Inflammation of the pancreas is known as pancreatitis
Common causes include chronic alcohol use and gallstones
Plays a role in diabetes mellitus
Pancreatic cancer may follow chronic pancreatitis or arise from other causes
Often detected at an advanced stage, impacting prognosis due to potential spread to other body areas
Accounts for 3% of all cases requiring hospital admission due to abdominal pain
Majority (80%) cases show favorable outcomes
Severe form causes approximately 20% of deaths, often within the first week, mostly due to multi-organ failure

Common (90%): Gallstones, alcohol
Rare: Idiopathic, post-ERCP, post-surgical (abdominal, cardiopulmonary bypass), trauma, drug side effects (various), metabolic problems, infections (mumps, Coxsackie virus), hereditary disorders, organ transplantation, severe hypothermia, petrochemical exposure

Traditional theories include toxic-metabolic or oxidative stress hypotheses where normal zymogen processing/release is disrupted by a stressor.
Ductal obstruction is also proposed, as a mechanical problem caused by plugs or stones affecting the integrity of acinar cells (frequent in cases involving alcohol and tropical disease).

Glasgow criteria help assess prognosis based on indicators like age, blood oxygen levels, blood cell count, albumin, calcium, glucose, urea, enzymes, and lactate dehydrogenase.
Higher number of criteria met indicates a more severe case.

Severe, constant upper abdominal pain
Nausea, vomiting
Quiet/absent bowel sounds
Oliguria (low urine output)
Hypovolemic shock
Discoloration of flanks (Grey Turner's sign) or periumbilical region (Cullen's sign) (suggests severe haemorrhaging)

Elevated serum amylase or lipase
Ultrasound
CT scans
Plain X-rays (for ruling out other problems like perforation or obstruction and identifying pulmonary complications)

Chronic inflammatory disorder
Fibrosis and destruction of exocrine pancreatic tissue
Leads to loss of exocrine/endocrine functions—increased risk of diabetes mellitus in advanced cases
Recurrent acute pancreatitis or persistent pain characteristics, showing patterns of inflammatory and fibrosing conditions

Pain
Weight loss and malnutrition
Pancreatic insufficiency (endocrine & exocrine)
- Endocrine: Pancreatic diabetes (type 3c), global loss of insulin/glucagon, paradoxical peripheral enhancement and reduced hepatic response to insulin, brittle diabetes
- Exocrine: Diarrhoea, steatorrhea

Suspected based on clinical history and imaging studies
Lab tests: serum amylase or lipase (elevation), elevated liver function tests (bilirubin/alkaline phosphatase may indicate bile duct obstruction)
Imaging: ultrasound, CT, abdominal X-rays, MRCP, endoscopic ultrasound
Collection of pure pancreatic juice (after secretin injection, gold standard but invasive)
Pancreolauryl test, fecal pancreatic elastase tests

AIP (autoimmune pancreatitis)
Mimics cancer but responds to corticosteroids
Abdominal pain, weight loss/obstructive jaundice without acute attacks of pancreatitis, high serum IgG or IgG4 levels, presence of other autoantibodies
Imaging shows a diffusely enlarged pancreas, narrowing of the pancreatic duct, lower bile duct stricturing