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Chronic pancreatitis - Term Paper Example

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Chronic pancreatitis

General Description Chronic Pancreatitis (CP) is a heterogeneous, progressive disorder of the pancreas characterized by a spectrum of symptoms pain, inflammation, diabetes mellitus, and pancreatic damage leading to significant loss of both endocrine and exocrine functions of the pancreas (Witt and associates, 2007; DiMagno & Dimagno, 2006). Pathology involves fibrosis in the pancreatic parenchyma that manifests irregularly. Other organs in vicinity are also affected as consequence of the disease that may commence as an individual or a group of symptoms resulting from functional impairment of pancreas. The major clinical symptom of disease is recurring or persistent pain within the abdomens. The chief cause of CP in western world is alcohol abuse leading to alcoholic calcific pancreatitis (ACP). The other form of CP known as tropical calcific pancreatitis (TCP) prevalent in tropical countries is of uncertain etiology (Lee, 2011). Based on the risk factors CP is classified by the TIGAR-O (Toxic-metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and severe acute, Obstructive) classification system (Nair tet al., 2007). Figure 1: Anatomy of the pancreas (http://www.britannica.com/bps/media-view/68636/1/0/0) Pancreas: Normal Physiology Pancreas is retroperitoneal structure in upper abdomen that can broadly be divided into head, body and tail (figure 1). Major portion of pancreatic tissue comprises of acini (80%) that are responsible for the exocrine functions of the pancreas. Groups of acini form spherical lobules that are interspersed with connective tissue. The central ducts of each lobule in which the secretions of the surrounding acinar cells accumulate, join to extralobular ducts that finally drain in to the main pancreatic duct. The main pancreatic duct carrying the secreted digestive enzymes enters the hepatopancreatic ampulla along with bile duct. At the duodenal papilla the enzymes enter the duodenum (Adda et al., 1984). The endocrine functions of the pancreas are performed by the richly vascularized islets of Langerhans. The islets of Langerhans comprise of beta, alpha and delta cells that secrete hormones insulin, glucagon, somatostatin respectively. The most abundant beta cells (73-75%) are centrally located and are surrounded by alpha cells (18-20%) and delta cells (4-6%). The rich vascularization allows for the transfer of hormones from the islets while the specific arrangement of the alpha, beta and delta cells allows paracrine regulation of hormones. Thus high concentrations of the insulin secreted from the central beta cells inhibit glucagon release from the peripheral alpha cells. The venous blood flow from the islets of langerhans reaches the hepatic portal vein, rendering the liver the prime target for the impact of pancreatic hormones. The rich innervations in the pancreas ensure the release of several neurotransmitters in the pancreas that regulate the release and concentrations of hormones (Case, 2006). During normal physiology, in basal state, the secreted pancreatic fluid is mildly alkaline comprising of small quantity of proteins. Gastric distension and acid production during eating stimulate duodenal S cells causing the release of secretin. Under the influence of the secretin, a large quantity of the bicarbonate rich watery liquid or the hydraulic secretion is released from the ductal cells of the smaller ducts. During the postprandial stages, ...Show more

Summary

CHRONIC PANCREATITIS Case A 65 year old man with persistent lower abdominal pain and jaundice was detected with elevated levels of hepatobiliary enzymes. Abdominal ultrasonography revealed a diffuse hypoechoic swelling of the pancreas. Contrast enhanced ultrasound (CEUS) exhibited an enhancement of pancreatic parenchyma with inhomogenous staining…
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