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Pancreatitis and diseases and tumours of the pancreas

Pancreatitis

The pancreas is a gland that produces insulin and digestive enzymes. Located in the upper posterior abdomen, next to the duodenum, most of the pancreas supports the exocrine function, and the rest is involved in the endocrine function. When the digestive enzymes begin attacking the pancreas, it is inflamed leading to pancreatitis or pancreatic inflammation. It can even cause damage to vital organs such as kidneys, lungs and heart.

Chronic pancreatitis: Characterized by irreversible morphological damage, chronic pancreatitis is a progressive disorder. The gradual inflammatory process of the pancreas leads to impairment of the endocrine and exocrine functions of the pancreas. Pancreatic fibrogenesis is noted with a complex interplay of cytokines and chemokines and deposition of the extracellular matrix and proliferation of fibroblasts.

Diagnosis Blood tests are done to assess the serum amylase and lipase levels, which may be elevated. Fecal tests are done to confirm advanced stages of chronic pancreatitis. Abdominal radiography shows pancreatic calcifications and CT scan shows the subtle abnormalities of chronic pancreatitis. ERCP allows accurate visuals of the pancreatic duct.

Acute Pancreatitis: Acute pancreatitis can be a life-threatening complication and has a sudden onset. Acute edematous pancreatitis occurs involving the parenchyma leading to dysfunction and hemorrhage of the gland. In acute pancreatitis, cellular hemostasis is imbalanced.

Diagnosis The diagnosis consists of laboratory tests inclusive of amylase and lipase levels, AST and ALT levels, BUN, creatinine, cholesterol, serum electrolytes and triglycerides. CBC and hematocrit counts with C-reactive protein are also obtained. Abdominal radiography for KUB, ultrasonography (EUS), CT, ERCP, genetic testing and image-guided aspiration and drainage are also conducted.

Diseases of the pancreas

Pancreatic Cancer – Pancreatic cancer occurs when the cell of the pancreas is damaged and the malignant cell grows out of control. The types of pancreatic cancers are squamous cell carcinoma, adenocarcinoma of the pancreas and adenosquamous carcinoma. Pancreatic cancers are classified as:

  • Primary cancers – that arise in the organ itself

  • Metastatic cancers – that arise in another organ and affect the pancreas

Sphincter of Oddi dysfunction – The Sphincter of Oddi controls the flow of pancreatic juice and prevents backflow of bowel contents. A disorder of the sphincter refers to its dysfunctionality.

Cystic fibrosis – An inherited disease, cystic fibrosis is an abnormality of the sweat glands and mucosal glands. It affects the respiratory system, the GI system and the reproductive system.

Tumours or neoplasms of the pancreas

There are many types of pancreatic neoplasms. Some of them are:

Exocrine pancreas

  • Adenocarcinoma – Microscopic glands are formed, which grow large and invade the nerves and frequently spread to the lymph nodes or liver.

  • Adenosquamous carcinoma – It is a variant of pancreatic cancer forming glands with a squamous differentiation.

  • Colloid carcinoma – A distinctive cancer, they are a form of ductal carcinoma and float in extracellular mucin.

  • IPMN – Intraductal papillary mucinous neoplasms are finger-like formations or papillae growing into the pancreatic duct.

Endocrine pancreas

Neuroendocrine tumours are rare and are also known as islet cell tumours. Highly active and large amounts of insulin hormones are produced that have dramatic symptoms such as hypoglycaemia.

Dr. Deepak and his team of experts treat all pancreatic disorders through stringently designed protocols after careful evaluation of each patient.

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