·
Severe pain, exocrine and endocrine pancreatic
insufficiency
·
Pain for months/ years
·
Eased by
sitting upright or drawing knees up to the jack knife position
·
Aggravated by meals
·
Local effects – biliary obstruction, duodenal obstruction,
gastric compression
·
Mean age of onset – 49 years
·
Damage to cells, metabolic abnormalities,
Obstruction àRecurrent
attacks of acute pancreatitis à
fibrosed duct à
obstruction à
chronic pancreatitis
·
More in males (1:4)
·
Causes
o
Hereditary pancreatitis
§
Autosomal dominant disorder with 80% penetrance
§
Mutations in the cationic trypsinogen gene or
chromosome 7
o
CF
o
Infantile malnutrition
o
Idiopathic
§
30%
§
Early onset and late onset
§
In people in warm climates
·
Increased risk of pancreatic cancer, specially
with tobacco smoking
·
Clinical features
o
Pain
§
Dull
§
Gnawing
§
Affects sleep and work
o
Nausea
o
Vomiting
o
Weight loss
o
Steatorrhoea
o
Diabetes
·
Analgesic abuse
·
Complications are similar to acute pancreatitis
Investigations
·
Increased serum amylase in early stages
·
Pancreatic function – pancreatic insufficiency (>70%
of gland destruction)
·
Abdominal X-ray à
pancreatic calcifications
·
CT
·
MRI
·
MRCP – biliary obstruction
·
ERCP
·
EUS
o
Presence of stones
o
Visible side branches
o
Cysts
o
Lobularity
o
Irregular main pancreatic duct
o
Hyperechoic foci and strands
o
Dilation of main pancreatic duct
o
Hyperechoic margins of the pancreatic duct
o
4 or more are highly suggestive
Treatment
·
Medical measures
o
Treat addiction
o
Alleviate abdominal pain
o
Nutritional and digestive measures
o
Treat Diabetes Mellitus
·
Endoscopic pancreatic sphincterectomy
·
Placement of stent – only for 4-6 weeks
·
Extract stones by ERCP
·
Extracorporeal shock wave lithotripsy
·
In patients with a mass in the head of pancreas à Beger procedure
(duodenum preserving resection of pancreatic head)
·
If duct is markedly dialated à Frey procedure
longitudinal pancreatojejunostomy)
·
If in the duct à
distal pancreatectomy
·
Intractable pain and diffuse disease à total pancreatectomy,
operative mortality is 10%
·
Radiological, surgical
o
Hi,
ReplyDeleteTook Onglyza off and on for a year. I have an enlarged adrenal gland. Still I await the outcome of that CT, but I know that much. Will find out more.
I had the CT because of chronic pancreatic pain that started out as "attacks" from a couple of times a month to finally after 3 months of use without interruption, "attacks" 2-3 times a week. My PA put Onglyza on my allergies list.
In the meantime, I lost almost 50 lbs in 5 months due to illness. Loss of appetite, pancreatic pain, chronic diarrhea, then eventually, inability to move my bowels. Severe back pain from the pancreas, and severe chest pain sent me to the ER where I was worked up for cardiac pain. I was cardiac cleared, but told my amylase was very low.
Still seeking a diagnosis, but I lay the blame squarely on Onglyza. I'd had pancreatic issues in the past, and argued with the PA that prescribed it, she was calling me non-compliant, and I feared repercussion from my insurance company.
I even took an article about the dangers of Onglyza, particularly in patients with a history, and she made me feel foolish.
I wish I had listened to my instincts, I fear not only damage to my pancreas that is irreversible, but also severe damage to my left kidney, though I have bilateral kidney pain.
I was off all diabetes meds, and control sugars strictly low to no carb. I can barely eat anymore, I have severe anorexia.
I would warn anyone taking Onglyza to consider a change and try Dr Itua Herbal Medicine, and anyone considering taking it, to select a different avenue. I have been suffering severely for about 9 months, but the past 7 months have been good with the help of Dr Itua herbal medicine which I took for 4 weeks.
I have been off Onglyza now, for 7 months, and simply 100% improvement with the help of Dr Itua. I had none of these issues except a history of pancreatitis in my distant past.
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