ACUTE PANCREATITIS

3. PANCREATITIS

3.1 ACUTE PANCREATITIS           

The majority of patients  of                                

pancreatitis   (80%)    have                                     

associated   gallstones   or                                     

history of  excess   alcohol                        

intake.     The     relative                             

inportance  of   these   two                        

principal causes is variable.    

CLINICAL MANIFESTATIONS

In  most  cases the patients

give history of a heavy meal 

or  an acute excess  alcohol

intake episode preceding the

attack

*  Pain    usually    begins

   suddenly

*  Is located in midepigast-

   rium and may  radiate  to 

   the back

*  It  may  range  in  intesity  and  is  steady  knife  like  or

   penetrating pain

*  Accompaning vomiting and/or retching is common

Examination usually shows:

*  Upper abdominal tenderness

*  Guarding

*  In addition, there is fever

*  Tachycardia

*  Leukocytosis

*  Shock  may be profound because of loss of fluid or blood  into

   retroperitoneum or abdominal cavity

*  Fluid deficiency is also a result of persistent vomiting

*  Ileus soon develops with extracellular fluid deficit

*  Renal insufficiency often occur as the ultimate outcome

*  Carpopedal  spasms  appear  due to loss  of  large  amount  of

   calcium from the blood

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Endocrine Pancreas

ENDOCRINE PANCREAS

Islets of Langerhans constitute only 1.5% of pancreas by weight.

*  Alpha cells are the source of glucagon

*  Beta cells manufacture, store secrete insulin and are upto 60-

   80% cells of each islet.

*  Somatostatin is released from the delta cells

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Control Of Secretions

CONTROL OF SECRETION

There are three phases of secretion:

*  Cephalic

*  Gastric

*  Intestinal

The vagus nerve is the secretory nerve for cephalic phase.

Existence  of a gastropancreatic reflex set of by  distension  of

the stomach, increases the volume of enzyme output due to release

of secretin and CCK (cholecystokinin) from the duodenal mucosa.

*  Loss  of  pancreatic juice, due to total  external  pancreatic

   fistula results in impairment of the digestion and absorption,

   particularly of fat

*  Loss of fat in the stool occurs in patients in whom pancreatic

   juice is completely excluded from the intestines resulting  in

   steatorrhea

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PANCREAS PYSIOLOGY Secretions

PHYSIOLOGY

EXOCRINE PANCREATIC JUICE

The  gland  produces  1500  to  2500  ml/day  of  the  colourless

pancreatic juice.

*  With a pH of 8.0 to 8.3 and

*  It is isotonic

*  It contains

   -  amylolytic

   -  proteolytic and

   -  lipolytic enzymes that act at an optimal pH greater than 7

*  Lipase splits fat into glycerol and fatty acids in presence of

   bile salts.

Pancreatic Secretion

The exocrine function of the pancreas represents the secretion of proenzymes required for the degestion of carbohydrate proteins and fats as well as bicarbonate which causes the duodental luminal fluid to have a pH near 8.0.

The proteolytic, amylolytic, lipolytic, and mucolytic enzymes are secreted from the pancreas as proenzmes. They are activated in the lumen, duodenum, and jejunm by the active form of the enzymes itself as well by enterokinase, produced by the brush border membrane of the duodenal and jejunal enterocytes.

The volume of pancreatic secretion is nearly 1 L/day.

Pancreatic juice is isotonic with plasma at all rates of secretion.

The acinar cell has receptors for several secretagogue agonists: acetylcholine, gastrin CCKB, substance P, and secretin/VIP

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