Pancreas disorders

The pancreas is affected by a variety of congenital and acquired diseases. Because of the dual functional role, the diseases of the exocrine portion of the pancreas will be separated from the endocrine lesions in this discussion.

The most frequent congenital lesion of the pancreas is more appropriately designated as a developmental abnormality—ectopic or aberrant pancreas. Ectopic pancreas can be found anywhere within the gastrointestinal tract, but is more frequent in the stomach and duodenum.

Cystic fibrosis (mucoviscidosis) is a systemic disease in which mucus secretion is altered so that a viscid mucus is produced. The disease is inherited as a mendelian recessive. Cystic fibrosis affects all exocrine glands, including the acinar portion of the pancreas. Production of altered mucus leads to dilation of the exocrine ducts (cystic), destruction of acinar tissue, and replacement of the destroyed tissue by fibrous connective tissue (fibrosis). The islets are not affected by this disease. Elevation in secretion of sodium and chloride in sweat is also common.

Acute hemorrhagic pancreatitis is a serious disease of unknown etiology which causes sudden liberation of activated pancreatic enzymes that digest the pancreatic parenchyma. The digestive process leads to dissolution of fat and production of calcium soaps. In addition, rupture of pancreatic vessels occurs with resultant hemorrhage and shock. This disease is associated with biliary tract disease, especially gallstones (cholelithiasis), alcoholism, hyperlipidemia, and hypercalcemia. See also Alcoholism; Gallbladder disorders.

Chronic pancreatitis, perhaps better designated chronic relapsing pancreatitis, is a condition in which recurrent episodes of pancreatitis occur without the production of symptoms or with the production of mild symptoms. Destruction of the pancreatic tissue, with repair by fibrosis, calcification, and cyst formation, is frequent.

Diabetes mellitus is the principal disease associated with the endocrine portion of the pancreas. Two clinical forms of the disease are recognized—insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus. While many factors are involved in the causation of this disease, basically the disease is a result of the failure of the beta cells of the pancreas to produce appropriate kinds and amounts of insulin to meet metabolic needs. See also Diabetes.

Tumors of the pancreas can be either benign or malignant. They affect both the endocrine and exocrine portions of the pancreas. Benign tumors of the exocrine pancreas are extremely rare. Malignant tumors of the exocrine pancreas arise most frequently from the pancreatic ducts. Acinar carcinomas also exist but are very rare. Exocrine pancreatic carcinomas are very malignant tumors. Islet cell lesions are quite rare but may be associated with increased hormone production. The tumors can be single or multiple, benign or malignant, and they can form anywhere in the pancreas. Hyperfunction of the islets of Langerhans can result in three distinct clinical syndromes: hyperinsulinism and hypoglycemia, the Zollinger-Ellison syndrome (gastrinoma), and multiple endocrine neoplasia. See also Oncology; Pancreas.