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n. inflammation of the pancreas. Acute pancreatitis is a sudden illness in which the patient experiences severe pain in the upper abdomen and back, with shock; its cause is not always discovered, but it may be associated with gallstones or alcoholism. It may be mistaken for a perforated peptic ulcer but differs from this condition in that the level of the enzyme amylase in the blood is raised. The main complication is the formation of a pseudocyst. Treatment consists of intravenous feeding (no food or drink should be given by mouth), antibiotics, and antimuscarinic drugs. Relapsing pancreatitis, in which the above symptoms are recurrent and less severe, may be associated with gallstones or alcoholism; prevention is by removal of gallstones and avoidance of alcohol and fat. Operations may be done to improve drainage of the pancreatic duct. Chronic pancreatitis may produce symptoms similar to relapsing pancreatitis or may be painless; it can lead to pancreatic failure causing malabsorption and diabetes mellitus. The pancreas often becomes calcified, producing visible shadowing on X-rays. The malabsorption is treated by a low-fat diet with pancreatic enzyme supplements, and the diabetes with insulin. Autoimmune pancreatitis is a recently described condition in which an autoimmune process leads to inflammation and swelling of the pancreas. Although abdominal pain is minimal or absent, jaundice is usually present. Radiologically it is characterized by diffuse ‘sausage-shaped’ enlargement of the pancreas and narrowing of the main pancreatic duct. The presence of raised serum IgG4 is a serological marker. Treatment involves immunosuppressant agents (e.g. corticosteroids or azathioprine). There is an association with other autoimmune disorders.

Subjects: Medicine and Health.

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