Gastrointestinal Disorders 3: Pancreas (Exocrine)

Pancreatitis

Pancreatitis can either be acute or chronic. We will mainly talk about acute pancreatitis here.

Acute pancreatitis

Characteristics: enzymatic necrosis and inflammation of pancreas, increase in pancreatic enzymes in blood and urine

Result: acute onset of epigastric pain (worse in supine position, radiates to back), cause and vomiting, abdominal distention due to fluid accumulation, pseudocyst (cyst with fibrous or granulation tissue), systemic organ shock, renal failure, intravascular coagulation, duodenal obstruction

Cause: alcohol, gallstones, trauma

Pathogenies: amylase, lipase and protease leak out of pancreatic acinus and pancreatic duct, causing a steep rise in amylase and smaller rise in lipase blood levels. Lipase causes fat necrosis and protease causes blood vessel destruction and haemorrhage.

Diagnosis: sharp increase amylase, followed by smaller, slower increase in lipase levels

Consequences of chronic pancreatitis

  • Pancreatic pseudocyst
  • Common bile duct obstruction
  • Intestinal malabsorption
  • Secondary diabetes

Carcinoma of the Pancreas

Carcinoma arising in the exocrine portion of the gland from ductal epithelium (mostly in the head of the pancreas)

Age group: 60-80 years

Risk: smoking

Result: bile obstruction, distention of biliary tree (both due to head carcinoma), metastasis, abdominal pain, obstructive jaundice, weight loss, migratory thrombophlebitis, pain

NOTE: if the tail or neck of pancreas is affected, symptoms remain silent for some time

Diagnosis: ultrasonography and CT

Cholelithiasis

Formation of gallstones due to insufficient bile salts and lecithin in proportion to cholesterol

Symptoms: pain in upper right quadrant or epigastric area, referred pain to the back, jaundice due to biliary obstruction

Gallstone composition: 75% cholesterol, 25% pigment or calcium bilirubinate stones

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