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Source: Bolesta S, Montgomery PA. Pancreatitis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146059813. Accessed April 18, 2017.
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Long-standing pancreatic inflammation leads to destruction of pancreatic tissue with fibrin deposition with loss of exocrine and endocrine function.
Abdominal pain may be caused by increased pancreatic parenchymal pressure from obstruction, inflammation, and necrosis.
Malabsorption of protein and fat occurs when capacity for enzyme secretion reduced by 90%.
Complications may include pancreatic pseudocyst, abscess, and ascites or common bile duct obstruction leading to cholangitis or secondary biliary cirrhosis.
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Occurs in 6 per 100,000 population, with peak incidence between ages 35 and 54.
About 85% of cases occur in men.
Prevalence varies widely based on geographic location.
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PREVENTION AND SCREENING
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Increased or excessive alcohol consumption.
Cigarette smoking.
High fat and protein diet.
Hypertriglyceridemia.
Hereditary or familial pancreatitis.
Possible gene mutations.
Pancreatic duct obstruction.
Chronic kidney disease
Medications.
Toxins.
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CLINICAL PRESENTATION
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Deep, penetrating epigastric or abdominal pain that may radiate to the back.
Pain often occurs with meals and at night, and may be associated with nausea and vomiting.
Steatorrhea, azotorrhea, diarrhea, bloating, and weight loss may occur.
Pancreatic diabetes a late manifestation associated with pancreatic calcification.
Jaundice occurs in ~10% of patients.
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MEANS OF CONFIRMATION AND DIAGNOSIS
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Serum amylase and lipase usually normal or only slightly elevated but may be increased in acute exacerbations.
Total bilirubin, alkaline phosphatase, and hepatic transaminases may be elevated with ductal obstruction.
Serum albumin and calcium may be low with malnutrition.
Pancreatic function tests include:
Serum trypsinogen (<20 ng/mL abnormal)
Fecal elastase (<200 mcg/g of stool abnormal)
72-hour fecal fat estimation (>7 g/day abnormal)
Secretin stimulation (evaluates duodenal bicarbonate secretion)
13C-mixed triglyceride breath test.
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DIAGNOSTIC PROCEDURES
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Endoscopic ultrasonography (EUS)
Endoscopic retrograde cholangiopancreatography (ERCP)
Histology generally not recommended.