Disorders of the Pancreas: Acute Pancreatitis and Pancreatic Cancer

Introduction

• Discussion begins on page four of the class packet.
• Focus on disorders of the pancreas, specifically acute pancreatitis and pancreatic cancer.

Acute Pancreatitis

Etiology

• Triggered by various factors: virus, bacteria, trauma.
• Alcohol is a known trigger but exact mechanism is unclear.

Pathophysiology

• Inflammation leads to capillary dilation and plasma fluid movement into tissue.
• Swelling compresses pancreatic ducts causing enzymes to digest the pancreas (auto-digestion).

Signs and Symptoms

• Acute onset of pain.
• Characterized by abdominal pain (left upper quadrant, epigastric, back).
• Aggravated by eating (stimulation of enzyme release).
• Associated with nausea, vomiting, and autonomic nervous system effects.

Diagnosis

• Elevated serum amylase and lipase due to enzyme backup.
• Leukocytosis (increased white blood cells) due to inflammation.
• Hyperglycemia related to stress response.
• Elevated serum bilirubin due to bile flow obstruction.
• Ultrasound and CAT scan can show pancreatic swelling and fluid.

Treatment

• Pain management crucial.
• Rest the pancreas (NPO: nothing by mouth).
• Removal of gallstones via ERCP or surgical cholecystectomy.

Pancreatic Cancer

Characteristics

• High mortality rate, often found at advanced stages.
• No early warning signs or simple diagnostic tests.
• Risk factors: smoking, genetics (BRCA2 mutation).

Pathophysiology

• Cancer commonly located at the head of the pancreas, obstructing bile flow.
• Jaundice is a common presenting sign.
• Pain due to tissue invasion and auto-digestion.

Diagnosis

• Elevated amylase, lipase, and bilirubin levels.
• Tumor markers (CEA, CA 19-9) are checked but are non-specific.
• Imaging: ultrasound, CAT scan, MRI.
• Biopsy confirms cancer.

Treatment

• Often supportive due to advanced stage.
• Surgery (Whipple procedure) for localized tumors.
• Stenting to relieve obstruction and symptoms of jaundice.

Conclusion

• Understanding the processes and treatments associated with pancreatitis and pancreatic cancer is critical.
• Treatment often focuses on symptom management and, where possible, removing obstructions to restore normal pancreatic and biliary function.
• Early detection of pancreatic cancer remains a challenge due to its asymptomatic nature in early stages.