Pancreatic Diseases
The pancreas is a gland located behind the stomach and next to the small intestine. It has two main functions. The endocrine part makes the hormones insulin and glucagon and releases them directly into the bloodstream to control sugar levels. The exocrine part makes enzymes and releases them through ducts to help break down proteins, fats, and carbohydrates for absorption in the intestine.
Pancreatitis is inflammation of the pancreas due to alcohol, biliary obstruction, viral disease and immune system activity that causes swelling and pain. Acute pancreatitis occurs quickly and has mortality of about 10%. In the USA, there are more than 300,000 hospitalizations per year for acute pancreatitis, with costs of $2+ billion. Chronic pancreatitis (CP) can damage the cells that produce insulin leading to diabetes. One in three Americans will likely have diabetes by 2050. Diabetes can increase the risk of pancreatic cancer. Pancreatic cancer incidence is about 37,000 new cases per year in the USA.
In the basal state, the pancreas excrete small amounts of protein-rich fluid. During a meal, gastric distension and acid production stimulate the duodenal “S” cells to release the hormone secretin into the blood, which signals the pancreatic ductal cells to secrete bicarbonate-rich fluid. Similarly, the postprandial increase in amino and fatty acids stimulates the duodenal “I” cells to release the hormone cholecystokinin (CCK) which signals the pancreatic acinar cells to secrete enzyme-rich fluid. With CP, pancreas production shows decreased fluid volume, bicarbonate and enzymes in response to secretin and CCK compared to the normal pancreas.
A 2008 publication in the World Journal of Gastroenterology, titled “Pancreatic function testing: Here to stay for the 21st century” surveyed the available tests for diagnosing pancreatic diseases. The diagnosis of CP is based on the detection of abnormal structure or function of the pancreas. Radiographic and endoscopic structural changes are insensitive and can be nonspecific, especially for early CP. Pancreatic function tests (PFT) are more accurate than tests of structure in diagnosing CP. Unfortunately, PFT’s (invasive or non-invasive) have significant drawbacks.
A 2008 publication in the World Journal of Gastroenterology, titled “Pancreatic function testing: Here to stay for the 21st century” surveyed the available tests for diagnosing pancreatic diseases. The diagnosis of CP is based on the detection of abnormal structure or function of the pancreas. Radiographic and endoscopic structural changes are insensitive and can be nonspecific, especially for early CP. Pancreatic function tests (PFT) are more accurate than tests of structure in diagnosing CP. Unfortunately, PFT’s (invasive or non-invasive) have significant drawbacks.
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