Pancreatitis

Anatomy and Physiology

Pa n cre a s - is a n o rg a n situ a te d in th e u p p e r
p a rt o f o n e ’ s a b d o m e n .
- about 6 inches or 15 cms long and
h a s a fla tte n e d b u lb o u s h e a d th a t is
su rro u n d e d b y p a rt o f th e in te stin e ca lle d
duodenum ,
Exocrine Function
It secretes an alkaline juice with enzymes
such as - amylase and lipase.


The alkaline juice helps to neutralize the

acid secretions of the stomach.


The enzymes are conveyed to the upper

part of the small intestine called
duodenum via a tube called the pancreatic
duct.
Endocrine Function
secretes two important hormones namely -
Insulin and Glucagon which are essential
for regulation of glucose in the blood.


during an attack of pancreatitis, the juices

are activated within the pancreatic gland
and it begin to digest the pancreas itself
causing inflammation, injury and necrosis
resulting in an acutely inflammatory
process that results in pancreatitis – so
called pancreatic auto digestion.
Pancreatitis
Pancreatitis, or inflammation of the
pancreas, is ultimately caused by the
autodigestion of the pancreas as a result of
reflux of bile or doudenal contents into the
pancreatic duct.
 Pathologic changes:
o acute edema, with large amounts of fluid
accumulating in the retroperitoneal space
and an associated decrease in effective
circulating blood volume
o cellular infiltration, leading to necrosis of the
acinar cells, with hemorrhage as a possible
result of necrotic blood vessels
Pathologic changes:

 Pathologic changes:
o intrahepatic and extrahepatic pancreatic fat
necrosis.


 Pancreatitis is generally classified as acute (no

permanent damage to the pancreas) or
chronic (irreversible injury), or
relapsing/recurrent, which can also be either
acute or chronic.
 - commonly occurs in midlife.
 - Painful episodes can occur intermittently,
usually reaching the maximum within minutes
or hours, lasting for several days or weeks, and
frequently accompanied by nausea and
Pancreatitis is often associated with drug
abuse or biliary tract disease, but patients
with hyperlipoproteinemia and those with
hyperpathyroidism are also at a
significantly increased risk for this disease.

Types of Pancreatitis

 1. Acute Pancreatitis


 Acute pancreatitis is inflammation of

the pancreas that occurs suddenly and
usually resolves in a few days with
treatment.
 The most common cause of acute
pancreatitis is the presence of gallstones—
small, pebble-like substances made of
hardened bile—that cause inflammation in
the pancreas as they pass through the
common bile duct.
Other causes of acute
pancreatitis
abdominal trauma
Medications
infections
tissue injury
pancreatic tumors
atherosclerotic disease
shock
pregnany
immunologic factors associated with post
renal transplantation and genetic
abnormalities of the pancreas.

Symptoms
Acute pancreatitis usually begins with
gradual or sudden pain in the upper
abdomen that sometimes extends through
the back. The pain may be mild at first and
feel worse after eating. But the pain is
often severe and may become constant
and last for several days.


usually looks and feels very ill and needs

immediate medical attention.
Other symptoms may include

a swollen and tender abdomen

nausea and vomiting
fever
a rapid pulse
Severe acute pancreatitis may cause
dehydration and low blood pressure.
The heart, lungs, or kidneys can fail. If
bleeding occurs in the pancreas, shock and
even death may follow.

Diagnosis

During acute pancreatitis, the blood contains

at least three times the normal amount of
amylase and lipase, digestive enzymes
formed in the pancreas. Changes may also
occur in other body chemicals such as
glucose, calcium, magnesium, sodium,
potassium, and bicarbonate. After the
person’s condition improves, the levels
usually return to normal.

2. Chronic Pancreatitis


Chronic pancreatitis is inflammation of the

pancreas that does not heal or improve—it
gets worse over time and leads to
permanent damage.
Chronic pancreatitis, like acute pancreatitis,
occurs when digestive enzymes attack the
pancreas and nearby tissues, causing
episodes of pain.
often develops in people who are between
the ages of 30 and 40.

The most common cause of chronic
pancreatitis is many years of heavy alcohol
use. The chronic form of pancreatitis can
be triggered by one acute attack that
damages the pancreatic duct.
Other causes of chronic
pancreatitis
hereditary disorders of the pancreas
cystic fibrosis—the most common inherited
disorder leading to chronic pancreatitis
hypercalcemia—high levels of calcium in the
blood
hyperlipidemia or hypertriglyceridemia—
high levels of blood fats
some medicines
certain autoimmune conditions
unknown causes

Symptoms

Most people with chronic pancreatitis

experience upper abdominal pain,
although some people have no pain at all.
The pain may spread to the back, feel
worse when eating or drinking, and
become constant and disabling. In some
cases, abdominal pain goes away as the
condition worsens, most likely because the
pancreas is no longer making digestive
enzymes.
Other symptoms include
nausea
vomiting
weight loss
diarrhea
oily stools
often lose weight, even when their appetite
and eating habits are normal. This occurs
because the body does not secrete enough
pancreatic enzymes to digest food, so
nutrients are not absorbed normally. Poor
digestion leads to malnutrition due to
excretion of fat in the stool.

Diagnosis

Chronic pancreatitis is often confused with

acute pancreatitis because the symptoms
are similar. As with acute pancreatitis, the
doctor will conduct a thorough medical
history and physical examination. Blood
tests may help the doctor know if the
pancreas is still making enough digestive
enzymes, but sometimes these enzymes
appear normal even though the person has
chronic pancreatitis.
advanced stages of pancreatitis, when
malabsorption and diabetes can occur, the
doctor may order blood, urine, and stool
tests to help diagnose chronic pancreatitis
Laboratory findings

Laboratory findings incluse increased

amylase, lipase, trigycerides, and
hypercalcemia, which is often associated
with underlying hyperpathyroidism.

Hypocalcemia may be found and has been
attributed to the sudden removal of large
amounts of calcium from the extracellular
fluid because of impaired mobilization or
as a result of calcium fixation by fatty
acids liberated by increased lipase action
on triglycerides.

Pancreatic function Tests

Secretin stimulation test

 - The secretin stimulation test measures
the ability of the pancreas to respond to the
hormone secretin.
 - The small intestines produce secretin in
the presence of partially digested food.
Normally, secretin stimulates the pancreas
to secrete a fluid with a high concentration
of bicarbonate. This fluid neutralizes
stomach acid and is necessary for a number
of enzymes to function in the breakdown
and absorption of food.
Fecal elastase test
 - The fecal elastase test measures
elastase, an enzyme found in fluids
produced by the pancreas. Elastase digests
and degrades various kinds of proteins.
During this test, a patient’s stool sample is
analyzed for the presence of elastase.



Computed tomography (CT) scan with
contrast dye
 - This scan can help rule out other
causes of abdominal pain and also can
determine whether tissue is dying
(pancreatic necrosis). CT can identify
complications such as fluid around the
pancreas, a collection of pus (abscess), or a
collection of tissue, fluid, and pancreatic
enzymes
 Abdominal ultrasound
 - An abdominal ultrasound can detect
gallstones and fluid from inflammation in the
abdomen (ascites). It also can show an enlarged
common bile duct, an abscess, or a pseudocyst.


 Endoscopic retrograde
cholangiopancreatography (ERCP)
 - During an ERCP, a health care professional
places a tube down the throat, into the stomach,
then into the small intestine. Dye is used to help
the doctor see the structure of the common bile
duct, other bile ducts, and the pancreatic duct
on an X-ray.
Endoscopic ultrasound
 - During this test, a probe attached to a
lighted scope is placed down the throat and
into the stomach. Sound waves show images
of organs in the abdomen. Endoscopic
ultrasound might reveal gallstones and can
be helpful in diagnosing severe pancreatitis
when an invasive test such as ERCP might
make the condition worse.



Magnetic resonance
cholangiopancreatography
 - This kind of magnetic resonance
imaging (MRI) can be used to look at the bile
ducts and the pancreatic duct.

END OF THE REPORT