Pancreatic Disorders PDF

Pancreatic Disorders The pancreas is an organ of the digestive system and endocrine system. It functions as a gland. The pancreas is heterocrine gland, i.e., it has both an endocrine and a digestive exocrine function. The exocrine pancreas produces enzymes that help to digest food, particularly...

Pancreatic Disorders The pancreas is an organ of the digestive system and endocrine system. It functions as a gland. The pancreas is heterocrine gland, i.e., it has both an endocrine and a digestive exocrine function. The exocrine pancreas produces enzymes that help to digest food, particularly protein. The endocrine pancreas makes the hormone insulin, which helps to control blood sugar levels. 99% of the pancreas is exocrine and 1% is endocrine.  As an endocrine gland, it functions mostly to regulate blood sugar levels, secreting the hormones insulin, glucagon, somatostatin and pancreatic polypeptide. As a part of the digestive system, it functions as an exocrine gland secreting pancreatic juice into the duodenum through the pancreatic duct. This juice contains bicarbonate, which neutralizes acid entering the duodenum from the stomach; and digestive enzymes, which break down carbohydrates, proteins and fats in food entering the duodenum from the stomach.  Pancreatitis Inflammation of the pancreas is known as pancreatitis, with common causes including heavy chronic alcohol use and gallstones. Because of its role in the regulation of blood sugar, the pancreas is also a key organ in diabetes mellitus. Pancreatic cancer can arise following chronic pancreatitis or due to other reasons, and carries a very poor prognosis, as it is often only identified after it has spread to other areas of the body.  Acute pancreatitis Acute pancreatitis accounts for 3% of all cases of abdominal pain admitted to hospital. About 80% of all cases are mild and have a favourable outcome. About 98% of deaths from pancreatitis occur in the 20% of patients with severe disease and about one-third of these occur within the first week, usually from multi-organ failure. Pathophysiology  Clinical features severe, constant upper abdominal pain nausea vomiting quiet or absent bowel sounds oliguria hypovolaemic shock discoloration of the flanks (Grey Turner’s sign) or the periumbilical region (Cullen’s sign) is a feature of severe pancreatitis with haemorrhage  Investigations raised serum amylase or lipase concentrations ultrasound CT plain X-rays for exclusion of other diagnoses, such as perforation or obstruction, and to identify pulmonary complications  Chronic pancreatitis Chronic pancreatitis is a chronic inflammatory disease characterised by fibrosis and destruction of exocrine pancreatic tissue. Diabetes mellitus occurs in advanced cases because the islets of Langerhans are involved. Chronic pancreatitis MARSEILLES-ROME ClASSIFICATION  Autoimmune pancreatitis Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis that can mimic cancer but which responds to corticosteroids. It is characterised by abdominal pain, weight loss or obstructive jaundice, without acute attacks of pancreatitis. Blood tests reveal increased serum IgG or IgG4, and the presence of other autoantibodies. Imaging shows a diffusely enlarged pancreas, narrowing of the pancreatic duct and stricturing of the lower bile duct.  Thank you for your attention!