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Pancreatic disease: Wikis

  

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Pancreatic disease
Classification and external resources
ICD-10 K85.-K86., Q45.0-Q45.3
ICD-9 577, 751.7
MeSH D010182

Pancreatic diseases include:

Contents

Pancreatitis

Pancreatitis is inflammation of the pancreas. There are two forms of pancreatitis, which are different in causes and symptoms, and require different treatment:

Diabetes mellitus

The pancreas is central in the pathophysiology of both major types of diabetes mellitus. In type 1 diabetes mellitus, there is direct damage to the endocrine pancreas that results in insufficient insulin synthesis and secretion. Type 2 diabetes mellitus, which begins with insulin resistance, is characterized by the ultimate failure of pancreatic β cells to match insulin production with insulin demand.

Exocrine pancreatic insufficiency

Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. EPI is found in humans afflicted with cystic fibrosis and Shwachman-Diamond Syndrome. It is caused by a progressive loss of the pancreatic cells that make digestive enzymes. Chronic pancreatitis is the most common cause of EPI in humans. Loss of digestive enzymes leads to maldigestion and malabsorption of nutrients.

Cystic fibrosis

Cystic fibrosis, also known as mucoviscidosis, is a hereditary disease that affects the entire body, causing progressive disability and early death. There is no cure for cystic fibrosis, and most affected individuals die young from lung failure. Cystic fibrosis is caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The product of this gene helps create sweat, digestive juices, and mucus. Although most people without CF have two working copies of the CFTR gene, only one is needed to prevent cystic fibrosis. Cystic fibrosis develops when neither gene works normally. Therefore, it is considered an autosomal recessive disease. The name cystic fibrosis refers to the characteristic 'fibrosis' (tissue scarring) and cyst formation within the pancreas. Cystic fibrosis causes irreversible damage to the pancreas, which often results in painful inflammation. (pancreatitis).

Pseudocysts

A pancreatic pseudocyst is a circumscribed collection of fluid rich in amylase and other pancreatic enzymes, blood and necrotic tissue, typically located in the lesser sac.

Cysts

CT scan (X-ray computed tomography) findings of cysts in the pancreas are common, and often are benign. In a study of 2,832 patients without pancreatic disease, 73 patients (2.6%) had cysts in the pancreas.[1] 85% of these patients had a single cyst. Cysts ranged in size from 2 to 38 mm (mean, 8.9 mm). There was a strong correlation between the presence of cysts and age. No cysts were identified among patients less than 40 years of age, while 8.7 percent of the patients age 80 to 89 years had a pancreatic cyst.

Cysts also may be present due to intraductal papillary mucinous neoplasm.

Congenital malformations

Pancreas divisum

Pancreas divisum is a malformation in which the pancreas fails to fuse together. It is a rare condition that affects only 6% of the world's population and of these few only 1% ever have symptoms that require surgery.

Annular pancreas

Annular pancreas is characterized by a pancreas that encircles the duodenum. It results from an embryological malformation in which the early pancreatic buds undergo inappropriate rotation and fusion, which can lead to small bowel obstruction.

Neoplasms

See pancreatic cancer.

Zollinger-Ellison syndrome

Zollinger-Ellison syndrome is a collection of findings in individuals with gastrinoma, a tumor of the gastrin-producing cells of the pancreas. Unbridled gastrin secretion results in elevated levels of the hormone, and increased hydrochloric acid secretion from parietal cells of the stomach. It can lead to ulceration and scarring of the stomach and intestinal mucosa.

Hemosuccus pancreaticus

Hemosuccus pancreaticus, also known as pseudohematobilia or Wirsungorrhage, is a rare cause of hemorrhage in the gastrointestinal tract. It is caused by a bleeding source in the pancreas, pancreatic duct, or structures adjacent to the pancreas, such as the splenic artery, that bleed into the pancreatic duct. Patients with hemosuccus may develop symptoms of gastrointestinal hemorrhage, such as blood in the stools, maroon stools, or melena. They may also develop abdominal pain. Hemosuccus pancreaticus is associated with pancreatitis, pancreatic cancer and aneurysms of the splenic artery. Angiography may be used to treat hemosuccus pancreaticus, where the celiac axis is injected to determine the blood vessel that is bleeding, because embolization of the end vessel may terminate the hemorrhage. Alternatively, a distal pancreatectomy may be required to stop the hemorrhage.

See also

References

  1. ^ Laffan T, Horton KM, Klein AP, et al. (Sep 2008). "Prevalence of unsuspected pancreatic cysts on MDCT". AJR Am J roentgenol 191 (3): 802-807. PMID 18716113.  







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