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Learning Objectives

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  1. Understand the differences between acute and chronic pancreatitis and the laboratory test results used to establish the diagnosis of each.

  2. Learn the clinical, laboratory, and radiographic abnormalities in patients with cancer of the pancreas.

  3. Learn the clinical and laboratory criteria for the diagnosis of diabetes mellitus, gestational diabetes mellitus, and hypoglycemia.

  4. Identify the different islet cell tumors and learn their associated laboratory test results.

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Introduction

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Disorders involving the pancreas are generally divided into 2 categories. One group includes diseases of the exocrine portion of the pancreas, which secretes digestive enzymes into the gastrointestinal tract. The other category includes the disorders of the endocrine portion of the pancreas, which contains beta cells for secretion of insulin, alpha cells for secretion of glucagon, and delta cells for secretion of somatostatin. The cells that secrete hormones are arranged in islets within the exocrine pancreas.

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The most frequently encountered disorders of the exocrine pancreas are pancreatitis and pancreatic neoplasms (usually cancer). Pancreatitis may be acute, or chronic with recurrent bouts of acute pancreatitis. Pancreatic tumors of the exocrine pancreas almost always originate in the pancreatic ductal epithelium. The major disease of the endocrine pancreas is diabetes mellitus (DM). Several neoplasms are also associated with the endocrine pancreas but are much rarer than those associated with the exocrine pancreas.

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Acute Pancreatitis

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Description

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Acute pancreatitis is a potentially lethal disorder associated with intracellular activation of digestive enzymes in the pancreas. This results in autodigestion of the pancreatic tissue by the powerful enzymes normally secreted into the gastrointestinal tract to degrade ingested foods. The damage to the pancreas can produce inflammation, edema, necrosis, hemorrhage, and liquefaction, and may obstruct the pancreatic duct and block the flow of pancreatic enzymes into the gastrointestinal tract. The obstruction further enhances the progression of acute pancreatitis. Clinically, a bout of acute pancreatitis is characterized by midepigastric pain frequently radiating to the back, nausea, and vomiting.

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Acute pancreatitis is a potentially lethal disorder associated with intracellular activation of digestive enzymes in the pancreas. This results in autodigestion of the pancreatic tissue by the powerful enzymes normally secreted into the gastrointestinal tract to degrade ingested foods.

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The cause of acute pancreatitis in the majority of the cases is either alcohol abuse or gallstones. There are, however, other causes, such as hypertriglyceridemia, hypercalcemia, selected infections, obstructing pancreatic tumors, and trauma to the pancreas. Hereditary forms of acute pancreatitis have also been described due to mutations in the trypsinogen gene or the trypsin inhibitor gene. In addition, many medications have been associated with the development of acute pancreatitis. Selected examples are asparaginase, azathioprine, estrogens, furosemide, sulfonamides, tetracycline, and thiazide diuretics. The mechanism of pancreatic injury following ingestion of these medications may be related to hypersensitivity to the drug or accumulation of a toxic drug metabolite in the pancreas. In ...

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