PANIC ATTACK
DISORDERS OFTHE PANCREAS
Serious disruption of pancreatic
function occurs only when the
secretory tissue of the gland has been
damaged or destroyed in advanced
disease. The most common pancreatic
disorder is
d ia b e te s m e llitu s
,
in which
the insulin-producing cells in the
gland are destroyed.
Congenital and genetic disorders
About
85
per cent of people with the
genetic disorder
c y stic f ib ro s is
produce
totally inadequate quantities of
pancreatic digestive enzymes, which
results in
m a la b so rp tio n
of fats and
proteins. This, in turn, may produce
steatorrhoea (excess fat in the faeces)
and muscle wasting.
Genetic factors are thought to play
some part in diabetes mellitus,
although they are not the primary
cause of the disease.
Chronic
p a n cre a titis
(inflammation
of the pancreas) may, in rare cases, be
hereditary; chronic pancreatitis often
causes diabetes.
Infection
Acute pancreatitis may result from
certain viral infections, especially with
the
m u m p s
or
h e p a titis
viruses. Other
viruses, such as coxsackievirus, may
also cause pancreatitis. In some cases,
coxsackievirus infection may contribute
to the development of diabetes.
Tumour
Pancreatic cancer is one of the fairly
common cancers (see
p a n cre a s, c a n c e ro f).
It is difficult to diagnose and, in most
cases, has spread extensively by the
time it is detected.
Trauma
Injury to the pancreas —
as a result of a
blow to the abdomen, for example —
may
cause acute pancreatitis. The mechanism by
which this occurs is not fully established,
but it is believed that pancreatic enzymes
(most of which are inactive until they
reach the intestine) are released within
the gland and then activated, with the
result that they digest the pancreas.
Poisons and drugs
Excessive alcohol intake is a common
cause of pancreatitis. It can also be caused
by various drugs, such as sulphonamides,
o e stro g e n d ru g s
(including oestrogen-
containing contraceptive pills), and
thiazide
d iu re tic d ru g s
;
c o rtic o ste ro id d ru g s
may also cause pancreatitis.
Autoimmune disorders
The cause of the damage to the pancreas
in diabetes mellitus remains controversial.
However, there is increasing evidence
that, possibly in response to a viral
infection, the body’s immune system
produces antibodies (proteins made by
the immune system) that inappropriately
attack and destroy the pancreatic cells.
Other disorders
The condition most often associated with
pancreatitis, other than alcohol overuse,
is
g a lls t o n e s
. T h e s e
occasionally block
the exit of the pancreatic duct into the
duodenum, leading to inflammation of
the pancreas.
INVESTIGATION
Diagnosis of pancreatic disorders may
involve
ultrasound scanning, CTscanning,
or
MRI
of the abdomen; tests to measure
levels of pancreatic enzymes in the
blood or duodenum; and endoscopic
examination of the gland (see
ERCP
).
A c u t e
p a n c r e a t i t i s
i s
t r e a t e d w i t h
in tra -
v e n o u s in f u s io n
o f f l u i d s
a n d s a l t s
a n d
o p i o i d
a n a lg e s ic d ru g s
( p a i n k i l l e r s ) .
I n
s o m e c a s e s , t h e a b d o m i n a l c a v i t y m a y
b e w a s h e d o u t w i t h s t e r i l e f l u i d ;
E R C P
( a n e n d o s c o p i c X - r a y p r o c e d u r e )
m a y
b e u s e d t o f i n d a n d r e m o v e g a l l s t o n e s ;
o r a
p a n c re a t e c t o m y
( s u r g i c a l r e m o v a l o f
d a m a g e d t i s s u e ) m a y b e p e r f o r m e d .
T r e a t m e n t
f o r
t h e
c h r o n i c
f o r m
i s
w i t h p a i n k i l l e r s ,
in s u lin , p a n c re a t in ,
a n d ,
i n s o m e c a s e s , p a n c r e a t e c t o m y .
p a n c re a to g ra p h y
I m a g i n g
o f t h e
p a n c r e a s
o r
i t s
d u c t s
u s i n g
C T s c a n n in g
,
M R I
,
u lt ra s o u n d s c a n -
n in g , X -ra y
( a f t e r a r a d i o p a q u e
c o n tra st
m e d iu m
i s i n j e c t e d i n t o t h e d u c t s d u r i n g
e x p l o r a t o r y s u r g e r y ) , o r w i t h
E R C P
( a n
e n d o s c o p i c X - r a y p r o c e d u r e ) .
p a n c y to p e n ia
A s i m u l t a n e o u s a n d s e v e r e r e d u c t i o n i n
t h e n u m b e r s o f r e d b l o o d c e l l s ( c a u s i n g
a n a e m ia
) ; w h i t e
b l o o d
c e l l s
( a
c o n d i -
t i o n
c a l l e d
le u c o p e n ia
) ;
a n d
p l a t e l e t s ,
i n v o l v e d i n c l o t t i n g (
t h ro m b o c y t o p e n ia
) .
T h i s
c o n d i t i o n
m a y
b e
a
r e s u l t
o f
d a m a g e
t o
t h e
b o n e m a rro w ,
w h e r e
b l o o d c e l l s a r e m
a d e ; s u c h d a m a g e m a y
b e d u e t o c a n c e r i n t h e m a r r o w , o r t o
d e s t r u c t i o n o f t h e m a r r o w b y
ra d io t h e r -
a p y
o r
a n tic a n c e r d ru g s .
P a n c y t o p e n i a
m a y a l s o b e d u e t o
h y p e r s p le n is m
( o v e r -
a c t i v i t y
o f t h e
s p l e e n ) ,
i n
w h i c h
t h e
s p l e e n
d e s t r o y s
e x c e s s i v e
n u m b e r s
o f
b l o o d c e l l s .
( S e e
a l s o
a p la s tic a n a e m ia
;
F a n c o n i’s a n a e m ia .)
p a n d e m ic
A m e d i c a l t e r m t h a t i s a p p l i e d t o a d i s -
e a s e
t h a t
o c c u r s
o v e r
a
l a r g e
g e o -
g r a p h i c a l
a r e a a n d t h a t a f f e c t s a h i g h
p r o p o r t i o n o f t h e p o p u l a t i o n ; a w i d e -
s p r e a d
e p id e m ic
.
p a n e n c e p h a litis
S e e
s u b a c u t e s c le r o s in g p a n e n c e p h a lit is
.
p a n ic a tta c k
A
b r i e f p e r i o d
o f a c u t e
a n xiety,
o f t e n
d o m i n a t e d b y a n i n t e n s e f e a r o f d y i n g o r
l o s i n g o n e ’s r e a s o n . A l t h o u g h u n p l e a s a n t
a n d
f r i g h t e n i n g ,
p a n i c
a t t a c k s
u s u a l l y
l a s t f o r
o n l y a f e w m i n u t e s ,
c a u s e n o
p h y s i c a l h a r m , a n d a r e r a r e l y a s s o c i a t e d
w i t h a n y s e r i o u s p h y s i c a l i l l n e s s .
P a n i c a t t a c k s a r e g e n e r a l l y a f e a t u r e o f
a n
a n x ie ty d is o rd e r, a g o ra p h o b ia ,
o r o t h e r
p h o b ia s .
I n s o m e
c a s e s ,
h o w e v e r ,
s u c h
a t t a c k s a r e a s s o c i a t e d w i t h a
s o m a tiz a tio n
d is o r d e r
o r
s c h iz o p h re n ia .
A t t a c k s a r e u n p r e d i c t a b l e a t f i r s t , b u t
t e n d t o b e c o m e a s s o c i a t e d w i t h s p e c i f i c
s i t u a t i o n s , s u c h a s b e i n g i n a c r a m p e d
l i f t .
S y m p t o m s
b e g i n
s u d d e n l y .
T h e y
i n c l u d e a s e n s e o f b r e a t h i n g
d i f f i c u l t y ,
c h e s t
p a i n s ,
p a lp it a tio n s ,
f e e l i n g
l i g h t -
h e a d e d , d i z z i n e s s , s w e a t i n g , t r e m b l i n g ,
a n d f a i n t n e s s .
H y p e rv e n tila tio n
o f t e n a l s o
o c c u r s . T h i s c o n d i t i o n r e s u l t s i n c a r b o n
d i o x i d e l e v e l s i n t h e b l o o d
b e c o m i n g
a b n o r m a l l y l o w , w h i c h l e a d s t o a
p in s -
a n d - n e e d le s
s e n s a t i o n
a n d
f e e l i n g s
o f
d e p e rs o n a liz a tio n
a n d
d e re a liz a tio n .
T h e
a t t a c k s e n d q u i c k l y .
T h e
s y m p t o m s
o f
h y p e r v e n t i l a t i o n
m a y b e r e l i e v e d q u i c k l y b y c o v e r i n g t h e
m o u t h a n d n o s e w i t h a s m a l l p a p e r b a g
a n d b r e a t h i n g
i n t o
t h e
b a g
f o r a f e w
m
i n u t e s ; t h i s
m e a s u r e
r e s t o r e s
c a r b o n
P
585
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