Pathogenesis of chronic pancreatitis

Article Abstract:

Chronic pancreatitis (CP), inflammation of the pancreas, results in destruction of pancreatic tissue that can lead to diabetes and steatorrhea (fatty stools caused by absence of digestive enzymes). CP and acute pancreatitis were for many years thought to be manifestations of a single disorder. However, the two conditions have since been found to typically occur at different ages and are linked to different causes. Also, two different types of CP have been distinguished, obstructive and calcifying. Obstructive CP occurs when pancreatic ducts, through which bicarbonate and secreted enzymes flow, are obstructed by tumors, cysts, scars, or duct narrowing. This leads to fairly uniform lesions in obstructed areas, but less destruction and fewer plugs or calculi (stones) occur than in calcifying CP. Chronic calcifying pancreatitis is the usual form of CP. Plugs and stones of material become deposited in pancreatic ducts, the contents of which are usually a calcium compound and a pancreatic protein, PSP. The function of PSP is not well understood, and it is not similar to any known protein. However, it is secreted from pancreatic cells along with digestive enzymes, one of which can chop PSP into smaller pieces. The digestive juice has high levels of calcium, which interacts with PSP, probably by absorbing or binding. Although patients with CP show signs of increased pancreatic protein secretion, it appears that they secrete less PSP. This may mean that calcium is more available to form stones. In addition, the PSP that is available may be more easily chopped, as one of these fragments forms plugs in the pancreatic ducts, which may progress to calculi containing PSP and calcium. The occurrence of calcifying CP is associated with alcohol consumption, fat, a high protein diet, smoking, high levels of calcium, and is also seen in tropical countries where malnutrition is common. In addition, there are also inherited and unknown (idiopathic) causes of CP. The appearance of calculi are identical in alcoholic and tropic CP. The mechanisms by which alcohol is associated with CP have been hypothesized, while the cause of tropical CP is not known, but is thought to be related to a very low fat and protein intake. Overall, pancreatic juice appears to be important in the genesis of CP. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Development and progression, Alcoholism, Alcoholic myopathy

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Cancer of the pancreas

Article Abstract:

Pancreatic cancer has a very poor prognosis and is often fatal. Even with currently available screening and diagnostic strategies, discovery of the presence of this disease is almost always delayed until it has spread beyond the point of surgical cure. Other methods of treatment offer little hope, and most patients with pancreatic cancer die within a year of diagnosis. A variety of risk factors are recognized as being important in the development of pancreatic cancer, including increasing age, high levels of fat and protein in the diet, cigarette smoking, urban life, occupational exposure to carcinogens, family history of pancreatitis and African heritage. More controversial risk factors include coffee and alcohol consumption, diabetes, gall stone disease, ulcer surgery, and pernicious anemia. Some dietary constituents, such as raw soya flour and unsaturated fats, are thought to increase the risk of cancer of the pancreas by promoting pancreatic growth, which becomes uncontrolled in some cases. Drugs that act as antagonists for the gastrointestinal hormone cholecystokinin may have a role in the prevention of pancreatic cancer, but important differences between animal models and human forms of pancreatic cancer cloud the interpretation of the studies on which this theory is based. A critical need exists for the development of screening techniques that will allow the detection of presymptomatic forms of pancreatic cancer. Improvements in the surgical approach to treatment of pancreatic cancer make this strategy feasible in a limited number of patients with cancer of one segment (the head) of the pancreas; however, mortality is still quite high, even in the best of cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Risk factors, Pancreatic cancer

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Hepatobiliary complications in chronic pancreatitis

Article Abstract:

Evidence of hepatobiliary disease, a disease of the liver and bile or biliary ducts, was looked for in 39 patients undergoing surgery for chronic pancreatitis, or inflammation of the pancreas. Chronic pancreatitis may accompany or even result in various hepatobiliary disorders. Some of the potential problems include obstructive jaundice or, more rarely, cholangitis or secondary biliary cirrhosis. Each patient in the study underwent pre-operative liver function tests and liver biopsy. Sixteen of the patients were diagnosed with common bile duct stenosis and eleven showed signs of extrahepatic biliary obstruction. A pre-operative liver biopsy may be valuable in assessing patients with inflammation of the pancreas.

Causes of, Surgery, Pancreas, Biliary tract diseases

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