ECAB Diabetes and Exocrine pancreas - E-Book

Exocrine and Endocrine Pancreas: Clinical Implications - ECAB - E-Book

The exocrine pancreatic function can be impaired by many different pancreatic disease as well as diseases that do not appear to be directly linked to the exocrine pancreas. Hormones stimulating exocrine function (e.g. CCK) might be reduced in diseases affecting the intestinal mucosa (IBD, celiac disease, AIDS) resulting in decreased exocrine secretion. The function of digestive enzymes might be affected by post-cibal asynchrony or by a decreased intraduodenal pH as in Zollinger-Ellison syndrome (ZE). An atrophy of pancreatic tissue might be caused by a lack of trophic factors, as may occur in IDDM, and pancreatic damage might occur due to drugs used for the treatment of other diseases. While some of these conditions appear to be rather rare and of minor clinical relevance, exocrine pancreatic involvement is very frequent in patients with diabetes mellitus. The diagnosis of the condition can be made by the exploration of the exocrine pancreatic secretion, which has been mainly used for the diagnosis of chronic pancreatitis and detection of pancreatic exocrine insufficiency of any etiology. Thus, diagnosis of the disease is classically based on the demonstration of either the morphological and/or the functional changes that typically develop over time in the course of the disease. Exocrine pancreatic function impairs progressively as chronic pancreatitis develops. Thus, exocrine pancreatic dysfunction refers to a mild, moderate or severe reduction of the exocrine pancreatic secretion. Finally, pancreatic function becomes insufficient to maintain a normal digestive process. Pancreatic exocrine insufficiency refers to the stage of maldigestion and malabsorption of nutrients as a consequence of a primarily and/or secondarily impaired exocrine pancreatic function. Pancreatic enzymes remain as the cornerstone for the effective treatment of various disease pathologies resulting in pancreatic exocrine insufficiency. The rigid criteria set forth by the FDA in the USA will ensure that effective pancreatic enzyme preparations will be available and allow the clinician to successfully treat maldigestion, malabsorption, vitamin deficiencies, protein-calorie malnutrition, and in selected patients, the abdominal pain associated with chronic pancreatitis and PEI. Pancreatic enzymes are particularly underused in chronic pancreatitis patients with PEI, post-gastric and intestinal surgery patients who develop an asynchrony of enzyme delivery to the intestine, and pancreatic cancer patients. Earlier use of potent pancreatic enzymes will enhance the quality of life for these patients. This clinical update has been designed to update the readers on the important aspects of the pancreatic exocrine insufficiency, resulting from different conditions and its impact on the patient. The book has stressed upon the various aspects of the condition like its etiology, diagnosis, evaluation, and management approach to the patient. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians across globe.

ECAB Diabetes and Exocrine pancreas

Chronic pancreatitis (CP) is defined as a continuous or recurrent inflammatory disease of the pancreas characterized by progressive and irreversible morphological changes. It typically causes pain and permanent impairment of pancreatic function. In chronic pancreatitis, areas of focal necrosis are typically associated with perilobular and intralobular fibrosis of the parenchyma, by stone formation in the pancreatic duct, and by the development of pseudocysts. Late in the course of the disease a progressive loss of endocrine and exocrine function occurs. In the past, chronic pancreatitis was considered to be mostly associated with chronic alcohol abuse. During the past 2 decades idiopathic chronic pancreatitis and, moreover, hereditary pancreatitis have been recognized as distinct disease entities. Usually the diagnosis is made by a combination of imaging procedures such as ultrasound and endoscopic retrograde cholangiopancreatography, and exocrine and endocrine function tests. Therapy is presently restricted to symptom control for the lack of a causal treatment strategy. Thirty to sixty percent of all patients develop disease-associated complications such as persistent pain, strictures of the common bile duct, or pancreatic duct stones that may require either endoscopic or surgical treatment. Chronic pancreatitis is a difficult condition to live with as well as to treat. Optimal care needs to be carried out in a multidisciplinary environment that can address both the physical and psychological aspects of the disease. It is commonly seen in alcohol-dependent individuals, but many other groups of individuals suffer with irreversible inflammatory destruction of the pancreas. Abdominal pain is the predominant feature and pain specialists are an important part of any pancreatic team. Exocrine and endocrine failure are addressed by appropriate nutrition with supplements and insulin, whilst the complications that are seen over time, may require a combination of endoscopic and surgical treatment. This clinical update has been designed to update the readers on the important aspects of CP. The book has stressed upon various aspects of the condition like the etiology, pathogenesis, diagnosis and evaluation along with an insight into the management approach of the patient. Supportive case scenarios have also been incorporated with relevance to the topics covered under the book. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.

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