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 - E-Book

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.

Recent Advances in Pancreas - ECAB - E-Book

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

Surgery of Pancreatic Cancer: Current Issues - ECAB

Pancreas - ECAB - E-Book

ECAB Clinical Update – Pancreatic Tumors - E-Book

Alcoholic hepatitis involves an acute or chronic inflammation of liver occurring as a consequence of alcohol abuse The pathological changes occur in 3 stages namely, fatty liver, alcoholic hepatitis and cirrhosis, with the final stage traditionally considered to be irreversible Alcoholic liver disease is responsible for a significant number of premature deaths per annum all around the globe There is an urgent need to educate the masses about the hazards of alcohol abuse An efficient system to encourage and prolong the period of alcohol abstinence is the need of the hour The importance of lifestyle modifications like weight reduction and cessation of smoking in the progression of liver disease needs to be communicated to the patients and the medical community as well Moreover, realization of the role of nutrition in the management and recovery of ALD would enhance the treatment strategies for this condition This book has been designed to update the readers on the important aspects of ALD and is a step forward to enable the society in combating the social and economic losses that occur as a result of alcohol abuse The book has stressed upon various aspects of ALD like the role of nutrition, epidemiology and pathogenesis, and the possible therapeutic strategies involved 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

Acute pancreatitis is defined as an acute inflammatory process of the pancreas that may also involve peripancreatic tissues and/or remote organ systems. It typically presents with sudden deep, boring pain that starts in the epigastrium and radiates to the back, which usually worsens on intake of food. It may be of varying severity ranging from mild to severe. Mild disease, if managed promptly and adequately resolves with minimal or no sequelae and seldom leads to extended morbidity or mortality. However Severe Acute Pancreatitis has a longer course of resolution, usually requires hospitalization and has a greater propensity to lead to adverse outcomes. As a thumb rule, it has greater morbidity and mortality rates as compared to Mild Acute Pancreatitis. Understandably, the management protocol for the severe acute pancreatitis is more invasive and emergent, and may require intensive care management. Hence understanding and assessment of the condition in the first 48 hours is a critical step in deciding the outcome. The various assessment criteria that are used to prognosticate and plan the management for this disease have been discussed in this clinical update. Previously, the condition was thought to be caused by infection, but now it is an established fact that it is an acute inflammation of the pancreatic gland with activation of the pancreatic enzymes within the gland leading to its autodigestion. Previously, acute pancreatitis was considered to be mostly associated with chronic alcohol abuse or acute bouts of binge drinking. With the availability of data from recent studies in India and the Asian subcontinent, Biliary disease is emerging as the commonest etiological agent. Extensive genetic analysis and mapping have helped put a cause to the erstwhile "idiopathic" cases. Newer diagnostic modalities and minimal invasive procedures have made the conventional surgeries nearly obsolete now. The rationale and use of antimicrobial treatment in the medical management of the condition has also undergone a change. This clinical update has been designed to update the readers on the important aspects of Acute Pancreatitis. 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 including the supportive and nutritional management. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.