Pancreatic Disorders

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The pancreas is subject to many disorders; however, several occur much more frequently than others. These include diabetes, pancreatitis, pancreatic cancer and pseudocysts of the pancreas.

Diabetes

Diabetes is a metabolic disorder found in three forms — type 1, type 2 and gestational. Type 1 is an autoimmune disease; the immune system destroys the pancreas’ insulin-producing beta cells, reducing or eliminating the pancreas’ ability to produce insulin. Type 1 diabetes patients must take daily insulin supplements to sustain life.1 Symptoms typically develop quickly and include increased thirst and urination, chronic hunger, weight loss, blurred vision and fatigue. Type 2 diabetes is the most common, found in 90 percent to 95 percent of diabetes sufferers. It is associated with older age, obesity, family history, previous gestational diabetes, physical inactivity and ethnicity. Approximately 80 percent of type 2 patients are overweight. It is more frequently being diagnosed in children and adolescents as America’s youth becomes more inactive and eats less healthy meals. Symptoms may develop slowly and can include fatigue, nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections and slow wound healing. Gestational diabetes occurs only in pregnancy. It is found more frequently in African-Americans, Native Americans, Hispanic Americans and in women with a family history of diabetes. Women who develop gestational diabetes have a 20 percent to 50 percent chance of developing type 2 diabetes within five to 10 years. Diagnosis is made via a fasting plasma glucose test and is most reliable if done in the morning. But a diagnosis may be made after any of three tests, with confirmation from a second positive test on a different day. These include a random plasma glucose value of 200 mg/dL or more, with symptoms of diabetes; a plasma glucose value of 126 mg/dL or more after an eight-hour fast; or an oral glucose tolerance test plasma glucose value of 200 mg/dL or more in a blood sample taken two hours after consuming 75 grams of glucose dissolved in water. This test measures plasma glucose at timed intervals over three hours. Treatment involves healthy diet, physical activity and insulin for type 1 diabetics; healthy eating, physical activity and blood glucose testing are used to manage type 2. Some of these patients require insulin supplementation.

Pancreatitis

Pancreatitis — the inflammation and autodigestion of the pancreas — can be either acute or chronic. In autodigestion, the pancreas is destroyed by its own enzymes, which cause inflammation. Acute pancreatitis typically involves only a single incidence, after which the pancreas will return to normal. Women are 1.5 times more likely to suffer acute pancreatitis due to gallstones, while men are six times more likely than women to have acute pancreatitis due to alcoholism. Up to 90 percent of affected patients recover with no complications.2

Chronic pancreatitis, however, involves permanent damage to the pancreas and pancreatic function and can lead to fibrosis. Alternately, it may resolve after several attacks.

Pancreatis is most frequently caused by gallstones blocking the pancreatic duct or by alchol abuse, which can cause the small pancreatic ductules to be blocked. Other causes include abdominal trauma or surgery, infections, kidney failure, lupus, cystic fibrosis, a tumor or a scorpion’s venomous sting.

Symptoms frequently associated with pancreatitis include abdominal pain, possibly radiating to the back or chest, nausea or vomiting, rapid pulse, fever, upper abdominal swelling, ascites, lowered blood pressure or mild jaundice. Symptoms may be attributed to other maladies before being identified as associated with pancreatitis.

Pancreatitis is diagnosed using abdominal X-ray, blood testing, ultrasound, ERCP, computer tomography scan or electrocardiogram. It may be treated in several ways — hospitalization that includes observation and IV feeding, surgery, antibiotics, pain management, blood tests, bed rest, a nasogastric tube, fasting or the avoidance of alcohol. Chronic pancreatitis patients may also be given enzyme supplements to assist digestion, insulin, small high-protein meals and medications to decrease gastric acid production. Pancreatitis leads to more than 100,000 hospital admissions each year; approximately 2,000 of these patients die due to severe pancreatitis.3

Pancreatic Cancer

Pancreatic cancer — the fourth most common cancer in the U.S. — mainly occurs in people over the age of 60, and has the lowest five-year survival rate of any cancer.4 Adenocarcinoma, the most common type of pancreatic cancer, occurs in the lining of the pancreatic duct; cystadenocarcinoma and acinar cell carcinoma are more rare. However, benign tumors also grow within the pancreas; these include insulinoma — a tumor that secretes insulin, gastrinoma — which secretes higher-than-normal levels of gastrin, and glucagonoma — a tumor that secretes glucagon.

Pancreatic cancer has no known causes, but several risks, including diabetes, cigarette smoking and chronic pancreatitis. Symptoms may include upper abdominal pain, poor appetite, jaundice, weight loss, indigestion, nausea or vomiting, diarrhea, fatigue, itching or enlarged abdominal organs. Diagnosis is made using ultrasound, computed tomography scan, magnetic resonance imaging, ERCP, percutaneous transhepatic cholangiography, pancreas biopsy or blood tests. Treatment may involve surgery, radiation therapy or chemotherapy, medication for pain or itching, oral enzymes preparations or insulin treatment.

Pseudocysts of the Pancreas

Pseudocysts of the pancreas are abnormal collections of fluid, dead tissue, pancreatic enzymes and blood that can cause a painful pancreatic mass, according to the University of Virginia Health System.5 Symptoms may include abdominal pain, nausea, vomiting or poor appetite, weight loss, diarrhea, fever, jaundice, ascites or a detectable, tender mass in the abdomen. However, these symptoms may often be associated with other maladies.

Diagnosis is made via blood tests, chest X-ray, computed tomography scan, ultrasound or endoscopic retrograde cholangiopancreatography (ERCP). The patient may be treated with surgical drainage of the cyst or by close monitoring using scans to identify growth or shrinkage of the cyst. Patients not undergoing treatment or monitoring may suffer a rupture of the pseudocyst, which can cause severe pain, blood loss or infection.


Works Cited

1. http://diabetes.niddk.nih.gov/dm/pubs/overview/index.htm

2. www.healthsystem.virginia.edu/uvahealth/adult_liver/pseupanc.cfm

3. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/

4. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/

5. www.healthsystem.virginia.edu/uvahealth/adult_liver/pseupanc.cfm

6. www.pancreasfoundation.org/cgi/csNews/csNews.cgi?database=learn_genetics.db&command=viewone&id=1&op=t


Disorders Affecting Children

Children are often diagnosed with pancreatic disorders as well. The pancreas makes more than 25 different digestive enzymes. These are secreted into the intestine to break down dietary protein, fat and starches, says Peter R. Durie, MD, FRCPC.6

Durie notes that because the pancreas has such an extensive reserve capacity, more than 95 percent of pancreatic function must be lost before the pancreas fails and the patient develops symptoms of bloating and maldigestion. “The exocrine pancreas is not fully developed at birth,” he continues. “All healthy infants show some degree of maldigestion due to the fact that the pancreas is immature and does not have the same ability to produce enough enzymes ... However, the pancreas matures after birth and by 2 years of age, it is functioning in the same way as an adult pancreas.”

Several disorders occur more frequently than others; the first, cystic fibrosis (CF), is the most common — 90 percent of childhood-onset pancreatic disorders, Durie says. The next most common is Shwachman Diamond syndrome. Other disorders are much more rare — Johansson Blizzard syndrome, Pearson’s bone marrow syndrome and hereditary pancreatitis. Even more uncommon is the birth of a child with no pancreas.

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