Pancreatitis

This book is for internists and surgeons in clinics and private practice as well as for medical students, all with an interest in acute and chronic pancreatitis. Comprehensive, up-to-date, and clinically oriented, this book is particularly useful for patient care. Particular attention is given to diagnosis and treatment. Included is also recognition and management of important complications such as necrotizing pancreatitis, pancreatic pseudocysts, and pancreatic insufficiency. Medical and surgical options in both acute and chronic pancreatitis are described in detail. Figures, tables and algorithms illustrate important concepts. The book gives not only the actual state of the art based on established literature, but also brings the experience of both authors from the two sides of the Atlantic to bear on controversial areas. The bibliography is complete through 1996 with approximately 1900 references.

1 General Considerations: Embryology.- 1.1 Normal Development.- 1.2 Congenital Abnormalities.- References.- 2 General Considerations: Anatomy.- References.- 3 General Considerations: Physiology.- 3.1 Function of the Exocrine Pancreas.- 3.2 Pancreatic Enzymes.- 3.3 Enzyme Synthesis.- 3.4 Protective Mechanisms to Prevent Autodigestion.- 3.5 Pancreatic Secretagogues.- 3.6 Phases of Pancreatic Secretion.- 3.7 Ductular Secretion.- 3.8 Acinar Secretion.- 3.9 Action of Pancreatic Lipase.- 3.10 What Turns the Pancreas Off?.- References.- 4 General Considerations: Classification.- 4.1 Marseille Classification of 1963.- 4.2 Cambridge Classification of 1983.- 4.3 Revised Pancreatitis Classification of Marseille 1984.- 4.4 Pancreatitis Classification of Marseille-Rome 1988.- 4.5 Pancreatitis Classification - Cambridge vs. Marseille: Features in Common and Differences.- 4.6 Classification System for Acute Pancreatitis of Atlanta 1992.- 4.7 Comment.- References.- 5 Acute Pancreatitis: Etiology.- 5.1 Biliary Tract Disease.- 5.2 Alcoholism.- 5.3 Obstruction of Pancreatic Ducts.- 5.4 Infections.- 5.5 Drugs.- 5.6 Toxins.- 5.7 Endocrine and Metabolic Disorders.- 5.8 Vascular Disease.- 5.9 Trauma.- 5.10 Medical Procedures.- 5.11 Surgical Procedures.- 5.12 Cystic Fibrosis.- 5.13 Inborn Errors of Metabolism.- 5.14 Reye's Syndrome.- 5.15 Kawasaki Disease.- 5.16 Hereditary Acute Pancreatitis.- 5.17 Idiopathic Acute Pancreatitis.- References.- 6 Acute Pancreatitis: Pathophysiology.- 6.1 Mechanisms of Pancreatic Injury.- 6.2 Gallstone-induced Acute Pancreatitis.- 6.3 Alcohol-induced Acute Pancreatitis.- 6.4 Concept of Oxidative Stress.- 6.5 Theories Explaining the Pathogenetic Mechanism of Acute Biliary Pancreatitis.- 6.6 The Pros and Cons of the Theories.- References.- 7 Acute Pancreatitis:Pathology.- 7.1 Gross Pathology.- 7.2 Histopathology.- 7.3 Sequential Changes and Outcome.- References.- 8 Acute Pancreatitis: Epidemiology.- References.- 9 Acute Pancreatitis: Diagnosis.- 9.1 Clinical Manifestation.- 9.2 Laboratory Investigations.- 9.3 Imaging Procedures.- 9.4 Synopsis of Diagnostic Procedures and Grading of Severity.- References.- 10 Acute Pancreatitis: Complications.- 10.1 Local Complications.- 10.2 Systemic and Other Extrapancreatic Complications.- References.- 11 Acute Pancreatitis:Treatment.- 11.1 Basic Treatment.- 11.2 Treatment of Local Complications.- 11.3 Treatment of Systemic Complications.- 11.4 Treatment of Metabolic Complications.- 11.5 Treatment of Extrapancreatic Complications.- References.- 12 Acute Pancreatitis: Prognosis.- 12.1 Introduction.- 12.2 Etiology.- 12.3 Initial or Repeated Episodes.- 12.4 Severity.- 12.5 Systemic Complications.- 12.6 Mortality.- 12.7 Late Morphological and Functional Consequences of the Pancreas.- 12.8 Quality of Life.- References.- 13 Chronic Pancreatitis: Etiology.- 13.1 Alcohol-induced Chronic Pancreatitis.- 13.2 Idiopathic Chronic Pancreatitis.- 13.3 Tropical Pancreatitis.- 13.4 Hereditary Diseases of the Pancreas.- 13.5 Congenital Abnormalities Including Pancreas Divisum.- 13.6 Obstructive Chronic Pancreatitis.- 13.7 Drug-induced Chronic Pancreatitis.- 13.8 Stress-induced Chronic Pancreatitis.- 13.9 Radiation-induced Chronic Pancreatitis.- 13.10 Hyperparathyroidism.- References.- 14 Chronic Pancreatitis: Pathophysiology.- 14.1 Concept of Primary Intraductal Obstruction.- 14.2 Concept of Primary Toxic-Metabolic Action of Alcohol.- 14.3 Concept of Oxidative Stress.- 14.4 Concept of Necrosis-Fibrosis Sequence.- References.- 15 Chronic Pancreatitis: Pathology.- 15.1 Gross Pathology.- 15.2 Histopathology.-15.3 Chronic Pancreatitis With Focal Necrosis.- 15.4 Chronic Pancreatitis With Segmental or Diffuse Fibrosis.- 15.5 Obstructive Chronic Pancreatitis.- References.- 16 Chronic Pancreatitis: Epidemiology.- References.- 17 Chronic Pancreatitis: Diagnosis.- 17.1 Clinical Manifestation.- 17.2 Laboratory Investigations.- 17.3 Imaging Procedures.- 17.4 Synopsis of Diagnostic Procedures.- References.- 18 Chronic Pancreatitis: Complications.- 18.1 General.- 18.2 Intrapancreatic Complications.- 18.3 Extrapancreatic Complications.- References.- 19 Chronic Pancreatitis: Treatment.- 19.1 Pain.- 19.2 Exocrine Pancreatic Insufficiency.- 19.3 Endocrine Pancreatic Insufficiency.- 19.4 Postoperative Syndromes.- 19.5 Evaluation of Follow-up Results.- References.- 20 Chronic Pancreatitis: Prognosis.- 20.1 Introduction.- 20.2 Pain.- 20.3 Exocrine Pancreatic Insufficiency.- 20.4 Endocrine Pancreatic Insufficiency.- 20.5 Complications.- 20.6 Pancreatic and Extrapancreatic Carcinomas.- 20.7 Quality of Life.- 20.8 Mortality.- 20.9 Factors of Prognosis.- References.- 21 Addendum: Hereditary Pancreatic Diseases.- 21.1 Hereditary Pancreatic Diseases Associated With Exocrine Pancreatic Insufficiency.- 21.2 Hereditary Diseases of the Exocrine Pancreas Associated With Pancreatitis.- References.