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The pancreas lies in the upper abdomen, hidden on the back wall. Although many consider it unimportant, it performs very important functions. It supplies the digestive tract with one of the digestive juices and “releases” hormones responsible for carbohydrate metabolism into the blood. When is it worth taking care of and how to research?
This busy organ, like the liver and kidneys, is susceptible to damage caused by a harmful lifestyle – alcohol and drug abuse, smoking, and a high-fat diet. Pancreatic diseases can also be caused by previous infections, injuries and operations, and can be genetic, so they can be inherited. Laboratory diagnosis of pancreatic diseases covers a range of tests, from simple biochemical tests to modern molecular methods.
Acute pancreatitis
The enzymes produced by the pancreas are responsible for the exocrine function of the pancreas, which breaks down nutrients, which allows them to be absorbed. However, these enzymes do not distinguish between particles supplied with food and compounds that build the body. Under physiological conditions, this is not a problem – the function of enzymes is regulated by a number of specialized mechanisms. In pathological conditions, however, this control is broken, which may result in the activation of enzymes in the lumen of the pancreas. This leads to self-digestion of the organ and its surrounding tissues, known as acute pancreatitis (acute pancreatitis). This condition requires hospitalization, as in 5-20 percent cases can lead to a generalized inflammatory reaction, shock and multiple organ failure.
The first symptom of acute pancreatitis is sudden, severe abdominal pain, possibly with vomiting and fever. The disease is confirmed by testing pancreatic enzymes – amylase in blood and urine, and lipase in blood. Among them, the fastest (within a few hours after the pain attack) and the most significantly (at least 5 or even 15 times in relation to the upper limit of reference values) increases the activity of serum amylase. After 3-4 days, this parameter normalizes, but its increased activity is still observed in the urine. However, the increased activity of lipase, which is also an enzyme more specific for the pancreas, persists for up to 10 days, which means that changes in its activity with greater than in the case of amylase certainly indicate diseases of this organ. In addition, blood counts show leukocytosis, i.e. an increased level of white blood cells (WBC), and an increase in the concentration of inflammatory markers (e.g. CRP protein) in the blood serum.
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Chronic pancreatitis
Slower disease progression and less severe symptoms are seen in chronic pancreatitis (CP). This disease leads to irreversible loss of pancreatic parenchyma, which is associated with its failure. Exocrine insufficiency reflects a reduction in the activity of pancreatic elastase in the stool. Over time, endocrine failure may develop – glucose intolerance and / or diabetes mellitus (elevated fasting glucose and oral glucose load test). During periods of exacerbation of CP, an increase in serum lipase and amylase activity is observed.
The main cause of pancreatitis in adults is alcohol abuse. Interestingly, the disease does not develop in most alcoholics, but in people who are hypersensitive to the toxic effects of alcohol. Also, the occurrence of this disease in children and adolescents suggests that there are factors that predispose to it. These are congenital mutations in one of three genes: PRSS1, SPINK1 and CFTR, which can be detected by genetic blood tests. They are recommended in order to explain the causes of early (before the age of 30) attacks of acute pancreatitis, recurrent pancreatitis, or a family history of CP.
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- Read more: Acute and chronic pancreatitis – symptoms, treatment
Pancreatic cancer prophylaxis
Moreover, it was found that there is a relationship between pancreatitis and the development of pancreatic cancer, and in the case of patients who are carriers of the above-mentioned mutations, the risk of developing this cancer increases several dozen times. This is very important information due to the fact that pancreatic cancer is most often detected at an advanced stage and, unfortunately, has a poor prognosis. This is because its symptoms are non-specific and do not get worse until the late stage of the disease. Early prophylaxis – giving up stimulants, proper diet and medical control in people at risk, including carriers of PRSS1, SPINK1 or CFTR mutations, may contribute to preventing the development of this cancer. In the advanced stage of cancer, there are laboratory abnormalities – increased activity of ALP and GGTP enzymes, increased bilirubin levels and, finally, the tumor marker CA19-9. This marker is widely used in monitoring pancreatic cancer treatment and for detecting its recurrence.
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Pancreatic insufficiency can be a symptom of cystic fibrosis (CF) – a genetic disease that affects the respiratory and reproductive systems in addition to the digestive system. The disease develops when a defective copy of the CFTR gene is inherited from both parents. Since July 2009, all newborns in Poland are subjected to screening tests for this disease, and its confirmation is the detection of mutations in both versions of the CFTR gene. It is also recommended to perform this test in the case of suspected CF, in relatives of the patient or in couples struggling with infertility.