Pancreatic atrophy is a decrease in the volume of the organ, manifested by the insufficiency of the external secretory (production of digestive enzymes, bicarbonate) and intrasecretory (synthesis of insulin, glucagon) functions. The most common causes of pathology are chronic pancreatitis, diabetes mellitus, somatic diseases with severe exhaustion, as well as cirrhosis of the liver, impaired blood supply, compression by a tumor. Diagnosis is based on laboratory data revealing enzyme deficiency and low insulin levels, ultrasound of the pancreas, biopsy results. Treatment consists in the appointment of substitution therapy: enzyme preparations, insulin; restoration of intestinal flora; correction of nutrient deficiency.
ICD 10
K86.8 Other specified diseases of the pancreas
Meaning
Pancreatic atrophy is a condition characterized by a decrease in the size of the organ, compaction of its structure and insufficiency of functions. This process can develop due to physiological age-related changes, as well as diseases accompanied by damage to the parenchyma, compression, impaired blood supply, with long-term debilitating diseases. At the same time, the weight of the gland, which normally is about 80-90 g, decreases to 30-40 and below.
Causes of pancreatic atrophy
Pancreatic atrophy can be physiological, developing as a result of natural aging processes of the body. It accompanies severe debilitating diseases (cachectic form). Also, atrophy is the outcome of all forms of chronic pancreatitis, while a significant part of the stroma is replaced by fibrous tissue, which is accompanied by the progression of endocrine and exocrine insufficiency.
A peculiar type of atrophy is lipomatosis, in which most of the parenchyma of the organ is replaced by adipose tissue. A separate place is occupied by pancreatic atrophy in diabetes mellitus. More rare cases of the disease in gastroenterology include atrophy of the gland with cirrhosis of the liver, systemic scleroderma, compression by a tumor, overlap of the excretory ducts with concretions.
Pathanatomy
This pathology is accompanied by a significant decrease in the size of the gland – up to 20-18 g, the consistency is significantly compacted, the surface of the organ is bumpy, the capsule is fused with the surrounding adipose tissue, as well as neighboring organs. The structure of the pancreas changes, excessive development of connective tissue is characteristic, which can proliferate around the lobules (perilobular sclerosis) or diffusely (intralobular sclerosis). At the microscopic level, the lesion is characterized by diffuse proliferation of fibrous tissue (intraacinous sclerosis), death of glandular parenchyma cells.
In lipomatosis, despite the fact that this condition is characterized by the preservation or even an increase in the size of the organ (pseudohypertrophy), most of it is replaced by adipose tissue, in which there are separate glandular areas. According to the observations of specialists in the field of clinical gastroenterology and endocrinology, in most cases with this pathology, the insular apparatus and the endocrine function of the organ are preserved.
Pancreatic atrophy symptoms
The clinical picture of pancreatic atrophy is determined by the cause of its development (diabetes mellitus, chronic pancreatitis and others). However, in any case, the characteristic symptoms are exocrine and endocrine insufficiency. Exocrine (external secretory) insufficiency of the gland is characterized by reduced production of digestive enzymes, as well as bicarbonates and other electrolytes that neutralize the contents of the stomach, providing a favorable environment for the action of pancreatic enzymes. Typical symptoms are relaxation of the stool, loss of appetite, weight loss.
An early symptom of insufficiency of external secretory function is steatorrhea (increased excretion of fats with feces). This sign develops with a decrease in secretion by 10% of the norm. Weight loss occurs due to impaired digestion of food, absorption of substances in the intestine, loss of appetite. With a long-term pathology, signs of vitamin deficiency develop.
Endocrine (intersecretory) insufficiency is manifested by disorders of carbohydrate metabolism, proceeding according to the type of hyperglycemic syndrome. At the same time, only half of the patients develop symptoms of diabetes mellitus. This is due to the fact that insulin-producing cells have the ability to be preserved better in pathology in comparison with acinar cells. Insulin and glucagon deficiency develops. The patient may be disturbed by pronounced weakness, dizziness, thirst.
Diagnostics
When examining a patient with pancreatic atrophy, a body weight deficit is determined. The skin is dry, flaky. With a decrease in the size of the gland, it is not possible to palpate it. If the cause of the condition was pancreatitis, soreness during probing is possible. The diagnostic algorithm includes:
- Analyzes. During biochemical blood tests, a decrease in the activity of pancreatic enzymes is determined. Characteristic symptoms are steatorrhea detected during the coprogram (detection of more than 9% of fat from daily intake in feces) and creatorrhea (high content of muscle fibers in feces). An increase in blood glucose is often diagnosed, which is a reason for consultation with an endocrinologist or diabetologist.
- Visualization techniques. Ultrasound of the pancreas determines a decrease in its size, compaction of the structure, increased echogenicity, uneven contours. For a more detailed visualization of the organ, to find out the cause of atrophy, an MRI of the pancreas is performed. In order to assess the state of the ductal system, changes in which are characteristic of chronic pancreatitis, ERCP – endoscopic retrograde cholangiopancreatography (contrast X-ray examination) is indicated. With its help, it is possible to detect narrowing of the main pancreatic duct, unevenness of the walls, tortuosity. To exclude neoplasms of the pancreas, angiography is performed.
- A biopsy. An important diagnostic method is a pancreatic biopsy. When examining the biopsy, the degree of fibrosis and destruction of parenchyma, the degree of damage to glandular elements, islets of Langerhans (insulin-producing zones) are evaluated. In the case of lipomatosis, fatty degeneration of the organ is detected. Conducting a biopsy allows you to assess the prognosis of the disease.
Pancreatic atrophy treatment
Conservative treatment
In case of pancreatic atrophy, diet therapy is necessarily prescribed. The food should be with a minimum fat content. Sufficient attention should be paid to protein-energy deficiency, correction of hypovitaminosis. A mandatory measure is complete cessation of smoking, since nicotine disrupts the production of bicarbonates by the pancreas, as a result of which the acidity of the contents of the duodenum increases significantly.
The main direction of therapy for this pathology is the replacement of exocrine and endocrine secretion of the pancreas. To compensate for the disturbed processes of oral digestion, a gastroenterologist prescribes enzyme preparations. To achieve a clinical effect, the drugs must have high lipase activity, be resistant to the action of gastric juice, provide rapid release of enzymes in the small intestine and actively promote oral digestion of food. Microgranule-shaped enzymes meet these requirements.
Since it is the lipase of all pancreatic enzymes that loses activity the fastest, the correction is made taking into account its concentration in the drug and the severity of steatorrhea. The effectiveness of treatment is assessed by the content of elastase in feces and the degree of reduction of steatorrhea. The action of enzyme preparations is also aimed at eliminating pain syndrome, reducing secondary enteritis, creating conditions for normalization of intestinal microbiocenosis, improving carbohydrate metabolism.
Correction of endocrine insufficiency is carried out with the help of insulin therapy. With pancreatic atrophy, the islets of Langerhans are partially preserved, so insulin is produced in the body, but in small quantities. The dosage and administration of insulin are determined individually depending on the course of pathology, etiological factor and data from daily monitoring of blood glucose levels. The appointment of enzyme preparations significantly improves the function of the pancreas as a whole and carbohydrate metabolism, including. Therefore, the insulin therapy regimen is determined depending on the dosage and effectiveness of enzyme replacement therapy.
An important condition for the effective correction of digestive functions is the normalization of intestinal microbiocenosis, since favorable conditions for colonization of pathogenic flora are created against the background of enzyme intake. Probiotics and prebiotics are used. Vitamin therapy by injection is prescribed, as well as preparations of magnesium, zinc, copper.
Surgical treatment
Surgical treatment of this pathology is carried out in specialized centers. Langerhans islets are transplanted with subsequent removal of the gland and replacement enzymatic therapy. However, since atrophy is often a consequence of severe diseases with a pronounced violation of the general condition of the patient, such treatment is rarely carried out.
Prognosis and prevention
The prognosis for pancreatic atrophy is determined by the degree of damage to the exocrine and endocrine structures of the organ. Since the insulin apparatus is partially preserved, residual insulin synthesis is also observed. Because of this, ketoacidosis rarely develops, but hypoglycemic conditions often occur. Determination of the etiology of the disease, elimination of the underlying pathology, timely initiation of treatment can achieve good results.
Prevention consists in the timely treatment of diseases that can cause pancreatic atrophy. In the presence of chronic pancreatitis, complete abstinence from alcohol, diet, maintaining a sufficient level of enzymatic activity of the gland is mandatory.
