1. ACUTE PANCREATITIS PANCREATIC DISEASE
The pancreas secretes 1.5 liters of enzyme-rich fluid every day for the digestion of fats, starch, and protein. Normal pancreatic juice is clear, colorless, isotonic, and alkaline.
A large volume of alkaline, enzyme-rich fluid enters the duodenum to neutralize gastric chyme for optimal digestion.

2. Facts of Exocrine Pancreas
1.5 liters of enzyme-rich fluid every day: digests of fats, starch, and protein.
Normal pancreatic juice is clear, colorless, isotonic, and alkaline.
Neutralizes acidic gastric contents in duodenum
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3. ACUTE PANCREATITIS ESSENTIALS
Abrupt onset of deep epigastric pain
Often with radiation to the back.
History of previous episodes, often related to alcohol intake.
Nausea, vomiting, sweating, weakness.
Abdominal tenderness and distention and fever.
Leukocytosis
Elevated serum amylase
Elevated serum lipase.
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4. Etiology Reflux of bile into pancreatic duct
Injury to pancreatic gland cells
Hypercalcemia
Hyperlipidemias
Drugs- Chemo/ HIV
Infections- Mumps/ CMV
Cystic fibrosis
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5. Pain characteristics:
Abrupt epigastric/ upper abdo. pain (dull and boring)
Radiates to the back
Worse on recline & walking
Better when sitting and leaning forward
Weakness, sweating, and anxiety present
Preceded by alcohol intake
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6. Symptoms and Signs Tender distended upper abdomen
Bowel sounds absent (ileus)
Fever (38-39◦C)
Tachycardia/ Shock/ Pallor
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7. Severe Pancreatitis >55 yrs WBC >16,000
Blood glucose >200 mg/dL
Serum LDH >350 u/L
AST >250 u/L
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8. Lab Workup Serum amylase and lipase > 3 x normal
Urine- protein +, casts +, glycosuria +
AXR
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9. CT: Acute Pancreatitis
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10. CT: Pseudocyst
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11. Pancreatic Pseudocyst: Draining into Stomach
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12. Therapy ICU Pain relief Fluid Volume control Prevent complications
Fatal- 5-20%
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13. PANCREATIC DISEASE
CHRONIC PANCREATITIS

14. Essentials Chronic or intermittent epigastric pain Steatorrhea
Weight loss
Abnormal pancreatic imaging.
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15. Predisposing Factors Toxic-metabolic- Alcoholic (80%)/ Tobacco
Idiopathic (20%)
Genetic- chr.7
Autoimmune
Recurrent and severe acute pancreatitis or
Obstructive
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16. Steatorrhea: bulky, foul, fatty stools
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17. Signs & Symptoms
Episodic epigastric and left upper quadrant pain radiating to the upper left lumbar region are typical
Anorexia
Nausea, vomiting, constipation, flatulence, and
Weight loss
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18. Lab Workup Serum amylase and lipase + / - ALP and Bili may be elevated
Excess fecal fat – pancreatic insufficiency
AXR- calcification
ERCP
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19. ERCP
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20. Therapy Correct strictures Low fat diet Forbid alcohol Avoid narcotics
Pancreatic enzyme supplements
Raniitidine, Omeprazole suppress acid- help pancreatic enzymes
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21. Coated Uncoated Enteric-coated microspheres 5,000 10,000 20,000
Commonly Available Pancreatic Enzyme Preparations
Preparation
Form
Enzyme Content (USP Units)
Lipase
Protease
Amylase
Uncoated
Cotazym
Capsule
8,000
30,000
Pancreatin
Tablet
12,000
60,000
Viokase
Coated
Creon 5/10/20
Enteric-coated microspheres
5,000 10,000 20,000
18,750 37,500 75,000
16,600 33,200 66,400
Pancrease MT 4/10/16/20
Enteric-coated microtablets
4,000 10,000 16,000 20,000
12,000 30,000 48,000 44,000
12,000 30,000 48,000 56,000
Ultrase MT 6/12/16/20
6,000 12,000 18,000 20,000
19,500 39,000 58,500 65,000
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22. COMPLICATIONS Opioid addiction DM Pseudocyst / Abscess
Steatorrhea / Malnutrition
Pancreatic cancer (4% after 20 yrs)
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23. Treatment of Steatorrhea
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24. Prognosis
Leads to chronic disability
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25. PANCREATIC DISEASE
CANCER PANCREAS

26. Essentials Obstructive jaundice (may be painless).
Enlarged gallbladder (may be painful).
Late Manifestations:
Upper abdominal pain with radiation to back
Weight loss and
Thrombophlebitis
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27. Cancer Pancreas Location: 75% in the head of pancreas
25% in the body & tail
Ampulla of Vater / CBD / Head of Pancreas have similar presentation
90% of these are due to Cancer head of Pancreas
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28. Risk Factors Age Obesity Tobacco use Chronic pancreatitis
Prior abdominal radiation and
Family history
‘New Diabetic’ after 50 yrs of age (suspect)
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29. Symptoms and Signs Vague, diffuse epigastric / LUQ pain (70%)
Pain indicates tumor spread beyond pancreas
Maldigestion / diarrhea are early signs
Weight loss a late sign
Painless jaundice obstructive
Sister Joseph's (Umbilical nodule)
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30. Diagnostic Test Multiphase thin-cut spiral CT scanning (80%) FNAC
PET scanning
Endoscopic US scanning
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31. Therapy Explorative surgery (30%) / Laparoscopy
If localized - Radical pancreaticoduodenal (Whipple) resection
Adjuvant chemo:
Gemcitabine (Gemzar®)
Fluorouracil, 5-FU (Adrucil®)
Stenting of the duct
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32. Prognosis Body & Tail – poor (<2-5% 5 year survival)
Ampulla better (20-40%)
Jaundice and lymph node involvement –poor
Palliative care are essential
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