The following points highlight the two major diseases of Pancreas. The diseases are: 1. Acute Pancreatitis 2. Anemia’s.
Pancreas: Disease # 1. Acute Pancreatitis:
This is a serious disorder which may lead to hemorrhagic necrosis of the pancreas, peritonitis and death. It usually occurs in middle-aged and elderly persons. The main symptom is the sudden onset of agonizing pain in the epigastrium which may radiate to the back.
It may follow a heavy meal or an excess of alcohol. Nausea and vomiting are frequently present. Moderate fever occurs and jaundice may develop. In addition there are signs of peritonitis and profound shock.
(a) Medical management consists of the relief of pain and the control of shock.
(b) Continuous gastrointestinal suction is essential to reduce vomiting and distension.
(c) It also removes acid gastric juice, a stimulus to pancreatic secretion.
(d) Production of gastric juice is inhibited by cimetidine and ranitidine.
(e) Antibiotics should be administered to prevent secondary infection.
Pancreas: Disease # 2. Anemia’s:
There are three main causes of anemia:
a. Loss of blood from the circulation, i.e. external or internal hemorrhage.
b. Hemolysis, i.e. increased destruction of R.B.C.
c. Reduced production of erythrocytes and hemoglobin-dyshaemopoiesis.
For the production of R.B.C. many nutrients are needed. The most important are iron, folic acid, and Vitamin B12, but others are protein, pyridoxine, Vit. C, copper and Vit. E. The anemia occurs in a healthy person as a result of poor diet.
The diet often contains insufficient one or more of the essential nutrients to meet increased needs caused by chronic hemorrhage, infection and genetic defects affecting the R.B.C. disorders of the alimentary tract often leads to impaired absorption of the essential nutrients and so to anemia. So the extra needs are to be met by increased nutrients.
i. Clinical Features of Anemia:
(a) Symptoms of anemia arise when the transport of oxygen by the blood is insufficient to meet the needs of the body. The need for oxygen is related to physical activity. A person leading a sedentary life may have a moderate degree of anemia but entirely free of symptoms.
(b) The severity of the clinical features does not depend on the degree of anemia but depends on the rapidity of its development.
(c) Common symptoms are general fatigue and lassitude, breathlessness on exertion, giddiness, dimness of vision, headache, insomnia, palor of the skin, palpitation, anorexia and dyspepsia, tingling and ‘pins and needles’ in the fingers and toes.
(d) Angina pectoris (due to myocardial hypoxia) is sometimes present.
(e) Physical signs include palor of mucous membranes and finger-nails, tachycardia, functional systolic murmurs, evidence of cardiac dilatation and in severe cases, oedema of the ankles and crepitation’s at the bases of the lungs.
(f) There are signs of nutritional deficiency, particularly angular stomatitis, koilonychia and glossitis.
(g) Atrophy of the papillae and mucous membranes gives the tongue a smooth glazed appearance. The atrophy begins at the edges and later affects the whole tongue. As a result the tongue appears moist and exceptionally clean.
(a) The most valuable dietary sources are meats and liver; they should preferably be eaten once a day.
(b) Eggs also have a high iron content but this is poorly absorbed because of phospholipid inhibitors in the yolk.
(c) Less expensive sources of iron are beans, especially soya beans and nuts.
(d) Fresh fruits and vegetables are of greater value because of their ascorbic acid content which facilitates iron absorption.
(e) Milk is a poor source of dietary iron.
iii. Genetic Defects of R.B.C.:
There are hereditary defects of R.B.C. that make them more susceptible to hemolysis and persons who carry these genes are liable to become anemic. Heterozygotes are at increased risk of becoming severely anemic.
(A) Thalassemia (Greek Thalassa Means Sea):
(a) It is defined by a defect in the synthesis of part of the polypeptide chain of hemoglobin A which is partially compensated by persisting synthesis of fetal hemoglobin (Hb-F).
(b) There are also abnormalities of the red cell membrane.
(c) Homozygotes have thalassemia major, a severe hemolytic anemia and rarely survive into adult life.
(d) Heterozygotes may or may not have a mild anemia, thalassemia minor.
(B) Sickle cell trait:
(a) This is due to an abnormal hemoglobin, hemoglobin S, differing only in having a single molecule of valine instead of one of glutamic acid in one of the polypeptide chains.
(b) The configuration of the molecules of Hb-S distort the R.B.C. into a characteristic sickle shape. Such corpuscles are abnormally sensitive to hypoxia.
(c) Persons with the sickle cell trait are at risk of hemolytic crisis when flying and cabin pressure is reduced.
(d) Heterozygotes have the sickle cell trait and are only occasionally anemic.
(e) Homozygotes have a severe anemia, sickle cell disease.
(a) This is the commonest congenital defect of R.B.C.
(b) The abnormality lies in the cell membranes which are more than normally permeable to sodium ions.
(c) The cells assume the shape of spheres which are more easily trapped in the microcirculation of the spleen, where hemolysis takes place.
(d) In most cases the increased loss of cells by hemolysis is slight and can be made good by increased production in the bone marrow.
(e) When anemia develops, removal of the spleen reduces hemolysis and cures the anemia but does not change the defect.
(D) Glucose-6-phosphate dehydrogenase deficiency:
Persons with the defect are liable to develop anemia when treated with oxidant drugs; these include antimalarial, sulphonamides, antipyretics and analgesics.
Anaemia in Tropical Countries:
The demands for iron may be greatly increased by the loss of hemoglobin in the feces and urine resulting from hemorrhage due to parasitic diseases, such as hookworm. In addition, significant amounts of iron may be lost in the sweat during muscular work in hot climates.
The protozoal, helminthic infections, and bacterial infections which are common in the tropics may be responsible for anemia. The nutritional megaloblastic anemia’s of tropical climates are always associated with diets poor in animal protein and fresh vegetables, and hence low in Vitamin B12 and especially folate.
(a) An attack of malarial fever due to Plasmodium falciparum is always accompanied by hemolysis and in a severe or prolonged attack severe anemia may ensure.
(b) After the parasites have been removed from the blood, hemolysis may continue due to a complement-mediated immune response, and there may also be a mild depression of erythropoiesis.
(c) Malarial infection, if associated with pregnancy and malnutrition, the anemia may present as megaloblastic anemia due to folate deficiency, but is more usually hypochromic and microcytic because of iron deficiency.
(d) Since the blood destruction is intravascular, most of the iron liberated from the destroyed red cells is retained in the body and can be used again for synthesis of hemoglobin.
(e) A vicious circle develops in communities suffering from chronic malaria-sickness, weakness and anemia, economic inefficiency, poverty, malnutrition, bad housing and social conditions, reinfection.
ii. Hookworm Infection:
(a) Infection with hookworm is a common cause of anemia where there is ‘wet’ cultivation of the land.
(b) Hemorrhages occur at the site of the attachment of the worms to the intestinal mucous membrane. These are certainly in part responsible for the anemia.
(c) A patient with a heavy infection, namely about 1,000 worms, can sustain a heavy loss of blood and anemia may quickly develop.
(d) Heavy hookworm infection usually occurs in populations whose dietary intake of iron is unsatisfactory.
(e) The hypochromic anemia is in part due to a poor diet and in part to the worms. This combination causes much ill-health; it may reduce greatly the working capacity of all and in these directly responsible for the poverty of many families in the tropics.
(f) Heavy infections may cause severe anemia with hemoglobin levels below 4 gm./100 ml. In such seriously ill patient, before administering a vermifuge, blood transfusion should be given and the general condition of the patient improves by bed rest, diet and iron.
Other Causes of Anemia:
(a) A mild or moderate anemia may develop due to chronic infection, particularly if fever is present.
(b) Many drugs can cause anemia by impairing red cell formation, by causing hemolysis or by loading to bleeding. Small repeated hemorrhages in the stomach due to aspirin is a common example.
(c) In chronic renal disease anemia is common but the bone marrow remains cellular until renal damage is marked. Deficiency of erythropoietin is a possible cause.
(d) If megaloblastic anemia occurs this is probably due to primary malnutrition and is found in chronic alcoholics with cirrhosis.
(e) Malignant disease causes anemia. They include impaired appetite, malabsorption or blood loss from the alimentary tract, multiple deposit in the bone marrow and increased hemolysis.
(f) Abnonnal utilization of iron by the marrow may cause anemia. Some cases respond to pyridoxine therapy.