Major Clinical Syndromes. Exocrine Pancreatic Insufficiency

Exocrine Pancreatic Insufficiency

This symptom complex is characterized by disordered secretion by the pancreas of its juice containing the main digestive enzymes, such as tryp-sin, lipase, amylase and others (over 15 altogether), and also hydrocar-bonates that ensure the optimum medium for the activity of these enzymes. Exocrine insufficiency of the pancreas can be primary (congenital) and secondary (acquired). Primary exocrine insufficiency of the pancreas can be due to its underdevelopment and mucoviscidosis (congenital systemic cystofibrosis of the exocrine glands, e.g. the pancreas, bronchial, salivary or sweat glands, which is manifested by increased viscosity of their secre­tion due to high mucopolysaccharide content). The secondary exocrine in­sufficiency of the pancreas arises in the presence of any disease attended by the affection of a considerable part of the pancreatic parenchyma (pan­creatitis, cysts, etc.), and by obstruction of the secretion outflow (obstruc­tion of the duct by a stone, tumour, etc.).

If the pancreatic juice is delivered to the intestine in deficient quantity (normally from 1.5 to 2 1 per 24h) or if the amount of the main enzymes in the juice is deficient, normal digestion is upset and conditions for ac­celerated reproduction of microorganisms in the small intestine are created to cause dysbacteriosis which upsets digestion to a greater extent. Rumbl­ing and sounds of pouring liquid are heard in the abdomen; the patient suf­fers from meteorism and characteristic pancreatogenic diarrhoea (polyfaecalia, yellowish faeces with fatty lustre). Coprological studies reveal steatorrhoea, creatorrhoea, and amylorrhoea. But early stages of pancreatic insufficiency can proceed without marked intestinal dysfunction because of the high reserve potentialities of the pancreas.

Owing to the upset intestinal function, undigested food particles can be determined coprologically. Apart from the cavitary digestion the parietal intestinal digestion (affected mainly by the intestinal enzymes) and the ab­sorption of the products of enzymatic hydrolysis are also upset. The pa­tient develops cachexia, signs of polyhypovitaminosis, symptoms of defi­ciency of the major microelements (iron, manganese, ions of calcium, sodium, potassium etc.) are observed. The function of many endocrine glands is upset secondarily. The patient complains of general weakness and

Special Part