Causes and Symptoms (Magill’s Medical Guide, Sixth Edition)
Linked to the small intestines by the pancreatic duct, the pancreas contributes the enzymes necessary to digestion. When the pancreas is damaged or its duct is blocked, the enzymes may begin to digest the pancreatic tissue itself, a process called autodigestion. Inflammation ensues, resulting in acute pancreatitis. Although there may be complications, most cases are self-correcting once the damaging agent is eliminated, and the pancreatitis does not recur. With continuing damage to the pancreas, however, the disease may become self-perpetuating and either break out periodically in attacks that mimic the acute form or cause few symptoms until much of the pancreas has been destroyed, a chronic form of pancreatitis that is difficult to treat. Either form can be fatal. Acute pancreatitis causes death in less than 5 percent of cases and generally does so because of complications, such as extensive tissue destruction and hemorrhage or infection. Complications from chronic pancreatitis can be fatal in as many as 50 percent of cases.
Medical science has not yet uncovered the exact biochemical processes responsible for pancreatitis. Although a variety of damaging agents are known to lead to the disease, in as many as 30 percent of cases no clear cause is detectable; doctors call these cases idiopathic pancreatitis. Of detectable causes, alcoholism and biliary tract disease account for about 80 percent of both acute and chronic...
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Treatment and Therapy (Magill’s Medical Guide, Sixth Edition)
The treatment for pancreatitis depends on its cause. If the problem is abuse of alcohol or other drugs, physicians usually let an attack of acute pancreatitis run its course while the patient abstains from the offending substance. Nevertheless, even mild attacks frequently require hospitalization because painkillers and intravenous hydration therapy are needed. If gallstones are thought to be the problem, plans are made to remove them by surgery. Patients with severe acute pancreatitis are sent to the hospital’s intensive care unit, since they urgently need supportive treatment to stay alive. There doctors insert a tube through the patient’s nose and into the stomach to suck out excess gastric fluids and relieve pressure on the pancreas. They may give antibiotics if there is evidence of infection. Extra oxygen or mechanical assistance may be needed to support breathing. Surgery may rarely be called for even in pancreatitis not caused by gallstones in order to cut away dead, infected tissue or drain fluid accumulations known as pseudocysts. Following an attack and treatment, a patient may require intravenous nourishment for weeks before the pancreas is ready to resume its full function.
Continued alcohol abuse will generally spur recurrent bouts of pancreatitis. Sometimes, however, the alcohol (or, rarely, slowly developing biliary tract disease) causes more subtle, gradual impairment of pancreatic function with few...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Büchler, M. W., et al., eds. Acute Pancreatitis: Novel Concepts in Biology and Therapy. Boston: Blackwell Science, 1999. Covers the pathophysiology and repair mechanisms, diagnosis, and treatment options of pancreatitis.
Feldman, Mark, Lawrence S. Friedman, and Lawrence J. Brandt, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 2 vols. Philadelphia: Saunders/Elsevier, 2010. A comprehensive textbook of gastrointestinal diseases and physiology. Contains information on pancreatic disorders.
Kronenberg, Henry M., et al., eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia: Saunders/Elsevier, 2008. Text that covers the spectrum of information related to the endocrine system, including diabetes, endocrinology and aging, kidney stones, and endocrine hypertension.
Levine, Joel S., ed. Decision Making in Gastroenterology. 2d ed. Philadelphia: B. C. Decker, 1992. This text for physicians contains detailed information about the symptoms and development of cancers. Accompanying charts explain the sequence of examination, testing, and treatment, and dedicated laypersons can glean much of value from them.
Munoz, Abilio, and David A. Katerndahl. “Diagnosis and Management of Acute Pancreatitis.” American Family Physician 62, no. 1 (July 1, 2000): 164-174. Acute pancreatitis usually occurs as...
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Pancreatitis (Salem Health: Cancer)
Related conditions: Diabetes mellitus, alcoholism, pancreatic cancer, gallstones
Definition: Pancreatitis, inflammation of the pancreas, appears in acute and chronic forms. Acute pancreatitis comes on suddenly and typically resolves quickly, but it may be severe and life-threatening. Chronic pancreatitis slowly destroys the pancreas.
Risk factors: Alcohol abuse, trauma, high lipid or calcium levels are all associatted with pancreatitis.
Etiology and the disease process: The pancreas is a glandular organ that lies behind the stomach. It produces hormones and digestive enzymes. Specialized pancreatic cells produce the hormones glucagon and insulin. Glucagon stimulates the liver to convert stored glycogen into glucose, raising blood glucose (sugar) levels. As blood glucose levels rise, the pancreas responds by secreting insulin. Insulin helps transport glucose into the body’s cells, where it is used for energy. Other cells located throughout the pancreas secrete digestive enzymes. These enzymes are secreted in fluid that travels from the pancreas through the pancreatic duct to the duodenum (portion of the small intestine), where they become activated and aid digestion.
In pancreatitis, the flow of pancreatic enzymes becomes obstructed by gallstones or spasm and edema at the ampulla of Vater, the area where the pancreatic and liver ducts enter the...
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Risk Factors (Genetics & Inherited Conditions)
Pancreatitis is often caused by gallstones that block the pancreatic duct and prevent enzymes from flowing out of the pancreas. Other factors are heavy use of alcohol, trauma, certain medications, and genetic abnormalities of the pancreas. Men are affected by pancreatitis more than women. Chronic pancreatitis usually affects people sometime in their thirties or forties.
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Etiology and Genetics (Genetics & Inherited Conditions)
Two major gene mutations, known as R122H and N29I, to the cationic tryspinogen gene (PRSS1) are associated with hereditary pancreatitis. Family members may carry one, but usually not more than one, mutation. However, even families with a strong history of pancreatitis have none of the known mutations, so scientists believe that other gene mutations for this disease exist. Hereditary pancreatitis follows an autosomal dominant inheritance pattern. It is a possible diagnosis if a person has two or more family members in one generation with pancreatitis and has pancreatic problems before they are thirty; however, most often this condition is not diagnosed for several years as the symptoms (abdominal pain and diarrhea) come and go seemingly in a random fashion.
Some disorders of the pancreas are hereditary, such as a genetic abnormality in structure. For example, pancreas divisum is an inherited condition where two pancreatic ducts form rather than one. Another inherited disorder is a genetic mutation that causes pancreatic enzymes to become active when they are produced. Other hereditary conditions are related to pancreatitis, but the reasons for the relationship are unclear. Hereditary conditions that seem to be related to pancreatitis include cystic fibrosis, certain autoimmune conditions, porphyria, hypercalcemia (high levels of calcium in the blood, which may be related to gallstone production), and...
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Symptoms (Genetics & Inherited Conditions)
Abdominal pain, either acute or chronic, is the main symptom of pancreatitis. Pain may extend into the back or be worse after eating. A distended abdomen, nausea, oily stool, or fever may also be present. Weight loss (from malabsorption) may be a symptom. In severe cases, bleeding and infection may be symptoms.
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Screening and Diagnosis (Genetics & Inherited Conditions)
Genetic testing may help diagnose hereditary pancreatitis. When symptoms are present, a blood test for amylase and lipase, the enzymes normally found in the pancreas, is usually the first test to determine pancreatitis. Ultrasound, CT, and MRI testing may also be helpful. Blood, urine, and stool tests may be used to confirm diagnosis and monitor treatment. Glucose tolerance testing can help determine whether the pancreas is still releasing insulin.
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Treatment and Therapy (Genetics & Inherited Conditions)
No cure currently exists for pancreatitis. Pain relief is generally the first step. In acute cases, one may be hospitalized to receive narcotics and possibly intravenous or tube-feeding to give the pancreas time to rest and heal. Once the acute symptoms are under control, treatment of the underlying cause can begin. Treatment may involve surgery to remove any gallstones blocking the pancreatic duct or draining any cysts or removing any scar tissue that may be present. Other strategies include sphincterotomy, an enlargement of the sphincter muscle that keeps the pancreatic duct closed, or placing a stent, a small piece of material that keeps the duct open. Replacement of pancreatic enzymes may be necessary in cases where the pancreas has impaired function. Removing the pancreas is not generally recommended, as this procedure results in a type of diabetes that is extremely difficult to manage. However, autologous islet cell transplantation is a therapy that may be helpful for patients with hereditary pancreatitis.
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Prevention and Outcomes (Genetics & Inherited Conditions)
Heavy alcohol use is a prime risk factor for developing pancreatitis; avoiding alcohol is the best way to avoid this disease. Outcomes are better for patients who make dietary and lifestyle changes, such as not smoking or drinking alcohol, drinking more water, and eating a low-fat, healthy diet. Management of this condition may involve treatment for alcohol or tobacco addiction. Some alternative therapies, such as acupuncture or meditation, may help manage the pain associated with this condition. Keeping the pancreas active producing enzymes and releasing insulin is important; otherwise, it may begin to calcify or die and portions may need to be removed surgically. In advanced stages, malabsorption, diabetes, impairment of lung function, and kidney failure can occur. Long-term damage to the pancreas is also a risk factor for pancreatic cancer.
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Further Reading (Genetics & Inherited Conditions)
Buechler, M. W., et al. Chronic Pancreatitis. New York: Wiley-Blackwell, 2002.
Etemad, B., and D. C. Whitcomb. “Chronic Pancreatitis: Diagnosis, Classification, and New Genetic Developments.” Gastroenterology 120 (2001): 682-707.
Forsmark, C. E., ed. Pancreatitis and Its Complications (Clinical Gastroenterology). Totowa. N.J.: Humana Press, 2004.
Howard, J. M., and W. Hess. History of the Pancreas: Mysteries of a Hidden Organ. New York: Springer, 2002.
John, C. D., and C. W. Imrie, eds. Pancreatic Disease. New York: Springer, 2004.
Neoptolemos, J. P., and S. B. Manoop. Diseases of the Pancreas and Biliary Tract. Abingdon, Oxfordshire, England: Health Press, 2006.
Parker, James, ed. The Official Patient’s Sourcebook on Pancreatitis: A Revised and Updated Directory for the Internet Age. San Diego: Icon Health, 2002.
Whitcomb, D. C. “Hereditary Pancreatitis: New Insights into Acute and Chronic Pancreatitis.” Gut 45 (1999): 317-322.
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Web Sites of Interest (Genetics & Inherited Conditions)
American Pancreatic Association. http://www.american-pancreatic-association.org
National Pancreas Foundation. http://www.pancreasfoundation.org
Pancreatitis Association. http://pancassociation.org
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Pancreatitis (Encyclopedia of Medicine)
Pancreatitis is an inflammation of the pancreas, an organ that is important in digestion. Pancreatitis can be acute (beginning suddenly, usually with the patient recovering fully) or chronic (progressing slowly with continued, permanent injury to the pancreas).
The pancreas is located in the midline of the back of the abdomen, closely associated with the liver, stomach, and duodenum (the first part of the small intestine). The pancreas is considered a gland. A gland is an organ whose primary function is to produce chemicals that pass either into the main blood circulation (called an endocrine function), or pass into another organ (called an exocrine function). The pancreas is unusual because it has both endocrine and exocrine functions. Its endocrine function produces three hormones. Two of these hormones, insulin and glucagon, are central to the processing of sugars in the diet (carbohydrate metabolism or breakdown). The third hormone produced by the endocrine cells of the pancreas affects gastrointestinal functioning. This hormone is called vasoactive intestinal polypeptide (VIP). The pancreas' exocrine function produces a variety of digestive enzymes (trypsin, chymotrypsin, lipase, and amylase, among others). These enzymes are passed into the duodenum through a channel called the pancreatic duct. In the...
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Pancreatitis (Encyclopedia of Alternative Medicine)
Pancreatitis is an inflammation of the pancreas, an organ that is important in digestion. Pancreatitis can be acute, beginning suddenly, usually with the patient recovering fully; or chronic, progressing slowly with permanent injury to the pancreas.
The pancreas is located in the midline of the back of the abdomen, closely associated with the liver, stomach, and duodenum, the first part of the small intestine. The pancreas is considered a gland. A gland is an organ whose primary function is to produce chemicals that pass either into the main blood circulation (called an endocrine function), or pass into another organ (called an exocrine function). The pancreas is unusual because it has both endocrine and exocrine functions. Its endocrine function produces three hormones. Two of these hormones, insulin and glucagon, are central to the processing of sugars in the diet (carbohydrate metabolism or breakdown). The third hormone produced by the endocrine cells of the pancreas affects gastrointestinal functioning. This hormone is called vasoactive intestinal polypeptide (VIP). The pancreas's exocrine function produces a variety of digestive enzymes (trypsin, chymotrypsin, lipase, and amylase, among others). These enzymes are passed into the duodenum through a channel called the pancreatic duct. In the...
(The entire section is 2894 words.)
Pancreatitis (Encyclopedia of Nursing & Allied Health)
Pancreatitis is an inflammation of the pancreas, an organ that is important in digestion. In pancreatitis, normal digestive enzymes act abnormally to break down the pancreas itself.
The pancreas is a complex organ with many critical functions for normal digestion and regulation of blood sugar. When inflamed, as in pancreatitis, several potent enzymes are inappropriately activated within the organ itself. In acute pancreatitis, inflammation is sudden and causes symptoms. In almost 90% of acute cases, the symptoms disappear within one week after treatment, and the pancreas returns to its normal function. With chronic pancreatitis, damage to the pancreas occurs over longer periods of time. Symptoms may be persistent or sporadic, as the pancreas is slowly but permanently impaired. More than 90% of pancreatic tissue will be destroyed before serious symptoms begin. Late signs of chronic pancreatitis include diabetes mellitus and mal-absorption syndromes in which nutrients are poorly absorbed from the digestive tract.
Causes and symptoms
There are a number of causes of acute pancreatitis, the most common of which are gallstones and alcoholism. These two diseases are responsible for more than 80% of all hospitalizations for acute pancreatitis. Gallstones may obstruct normal drainage from the pancreas into the small intestine, resulting in a backup of normal pancreatic secretions and inflammation of the pancreas until the obstruction is relieved.
The mechanism by which alcohol inflames the pancreas is not so well understood. It is thought that alcohol causes proteins to collect and result in obstruction and calcification of the pancreas.
Other factors in the development of acute pancreatitis include:
- certain drugs, including estrogens, sulfonamides, and diuretics
- structural problems of the pancreatic duct and common bile duct
- injury to the abdomen
- abnormally high levels of circulating fats in the bloodstream
- high blood levels of calcium
- complications from kidney failure or transplant
- a hereditary tendency toward pancreatitis
- various forms of vasculitis (inflamed blood vessels)
In pancreatitis, enzymes become prematurely activated so that they actually begin their digestive functions within the pancreas. The pancreas, in essence, begins digesting itself. Digestion of the blood vessels in the pancreas results in bleeding. Other active pancreatic chemicals cause blood vessels to become leaky, and fluid begins seeping into the abdominal cavity. The activated enzymes also gain access to the bloodstream through leaky, eroded blood vessels, and begin circulating throughout the body.
Pain is a major symptom in acute pancreatitis, and it is usually quite intense and steady, located in the upper abdomen, and radiating to the patient's back. Nausea and vomiting and abdominal swelling are also common symptoms. A patient will often have a slight fever, with an increased heart rate and low blood pressure.
Patients with acute pancreatitis are at risk of complications related to shock, a very serious syndrome that occurs when the blood pressure is too low to get adequate circulation to critical organs. Without adequate blood pressure, organs are deprived of oxygen, nutrients, and waste removal and may not function well. Kidney, respiratory, and heart failure are serious possible outcomes of shock.
Even if shock does not occur, circulating pancreatic enzymes and related toxins can cause damage to the heart, lungs, kidneys, lining of the gastrointestinal tract, liver, eyes, bones, and skin. As the pancreatic enzymes affect blood vessels, the risk of blood clots increases. When blood flow is blocked by clotting, the supply of oxygen is further decreased to various organs and additional damage done.
Other serious complications of acute pancreatitis include pancreatic necrosis, abcess, and pseudocyst formation. Pancreatic necrosis occurs when a significant portion of the pancreas is permanently damaged during an acute attack. Pancreatic necrosis has an increased risk of death and an increased chance of pancreatic infection. A pancreatic abscess is a local collection of pus that may develop several weeks after the illness subsides. Another late complication of pancreatitis, occurring several weeks after the illness begins, is called a pancreatic pseudocyst, which occurs when dead pancreatic tissue, blood, white blood cells, enzymes, and fluid leaked from the circulatory system accumulate. Pseudocysts cause recurrent abdominal pain and also press on other nearby structures in the gastrointestinal tract, causing disruption of function. Pseudocysts are life threatening when they become infected (abscess) and rupture. Simple rupture of a pseudocyst causes death 14% of the time, but rupture complicated by bleeding causes death 60% of the time.
In very severe cases of pancreatitis, called necrotizing pancreatitis, the pancreatic tissue begins to die, and bleeding increases. Due to the bleeding into the abdomen, two distinctive signs may be noted in patients with necrotizing pancreatitis. Turner's sign is a reddish-purple or greenish-brown color to the area between the ribs and the hip (flank). Cullen's sign is a bluish color around the navel.
Alcohol abuse is the cause of tissue damage in 80% of cases of chronic pancreatitis. Tissue damage occurs more slowly, and many digestive functions become disturbed. The quantity of hormones and enzymes normally produced by the pancreas begins to decrease, resulting in the inability to appropriately digest food. Fat digestion, in particular, is impaired. A patient's stools become greasy as fats are passed out of the body. The inability to digest and use proteins results in smaller muscles (wasting)
Abscess pocket of infection; pus.
Acutef short and sharp course; illnesses that appear quickly and can be serious or life-threatening.
Chronicf long duration and slow progression; illnesses that develop slowly over time, and do not end.
Diabetes disease characterized by an inability to regulate blood sugar levels in the blood.
Endocrine system of organs that produces chemicals that go into the bloodstream to affect the function of other organs from a distance.
Enzyme chemical that speeds up or makes a particular chemical reaction more efficient.
Exocrine system of organs that produces chemicals that go through a duct (or tube) to affect the functioning of other organs.
Gland collection of tissue that produces chemicals needed for use outside of the gland itself.
Hormone chemical produced in one part of the body that travels to another part of the body in order to exert an effect.
and weakness. The inability to digest and use the nutrients in food leads to malnutrition, vitamin deficiencies, and a generally weakened condition. As the disease progresses, permanent injury to the pancreas can lead to diabetes.
Diagnosis of pancreatitis, whether acute or chronic, is not simple. History and physical exam are very important, as well as imaging studies and laboratory tests. Levels of amylase and lipase that are three times above the upper limit of normal are very predictive of acute pancreatitis. Other abnormalities in the blood may also point to pancreatitis, including increased white blood cells, changes due to dehydration from fluid loss, and abnormalities in the blood concentration of calcium, magnesium, sodium, potassium, bicarbonate, and glucose.
X rays or ultrasound examination of the abdomen may reveal gallstones, possibly responsible for blocking the pancreatic duct. The gastrointestinal tract will show signs of inactivity (ileus) due to the presence of pancreatitis. Chest x rays may reveal abnormalities due to shallow breathing or due to lung complications from the circulating pancreatic enzyme irritants. Computed tomography (CT) scans of the abdomen may reveal the inflammation and fluid accumulation of pancreatitis.
In the case of chronic pancreatitis, lipase and amylase levels will no longer be elevated. However, blood tests will reveal the loss of pancreatic function that occurs over time. Blood sugar (glucose) levels will rise, eventually reaching the levels consistent with diabetes. The levels of various pancreatic enzymes will fall, as the organ is increasingly destroyed and replaced by nonfunctioning scar tissue. Calcification of the pancreas can also be seen on x rays. Endoscopic retrograde cholangiopancreatography (ERCP) may be used to diagnose chronic pancreatitis in unclear cases. In this procedure, the physician uses a medical instrument fitted with a fiber-optic camera to inspect the pancreas.
Treatment of acute pancreatitis involves replacing lost fluids intravenously (in a vein). These IV solutions need to contain appropriate amounts of salts, sugars, and sometimes even proteins, in order to correct the patient's disturbances in blood chemistry. Pain is treated with a variety of medications, chiefly meperidine. To decrease pancreatic function, the patient is not allowed to eat. A thin, flexible tube (nasogastric tube) may be inserted through the patient's nose and down into the stomach. The nasogastric tube can empty the stomach of fluid and air that may accumulate due to the inactivity of the gastrointestinal tract.
The patient will need careful monitoring in order to identify complications that may develop. Infections will require antibiotics through the IV. Severe necrotizing pancreatitis may require surgery to remove part of the dying pancreas, especially if infection has begun. A pancreatic abscess can be drained by a needle inserted through the abdomen and into the collection of pus (per-cutaneous needle aspiration). An abscess may also require surgical removal. In 250% of cases, pancreatic pseudocysts may shrink on their own or continue to expand, requiring needle aspiration or surgery. Surgery may be necessary for the removal of gallstones.
Because chronic pancreatitis often includes repeated flares of acute pancreatitis, the same kinds of basic treatment are necessary. Treatment of chronic pancreatitis caused by alcohol consumption requires that the patient stop drinking alcohol entirely. A low-protein and low-fat diet is prescribed. As chronic pancreatitis continues and insulin levels drop, a patient may require insulin injections to be able to process sugars in the diet. Pancreatic enzymes can be replaced with oral medications. As the pancreas is progressively destroyed, some patients stop feeling the abdominal pain that was initially so severe. Others continue to have constant abdominal pain, and may require a surgical procedure for relief.
When necrosis and bleeding are present, as many as 50% of patients with pancreatitis may die.
Ranson's criteria can help determine the severity of the disease. The first five categories are evaluated when the patient is admitted to the hospital, including:
- age over 55 years
- blood sugar level over 200 mg/dl
- serum lactic dehydrogenase over 350 IU/L
- AST over 250 μ (a measure of liver function, as well as a gauge of damage to the heart, muscle, brain, and kidney)
- white blood count over 16,000 μL
The following six of Ranson's criteria are reviewed 48 hours after the patient's admission to the hospital, including:
- greater than 10% decrease in hematocrit (a measure of red blood cell volume)
- increase in BUN (blood urea nitrogen, an indicator of kidney function) greater than 5 mg/dL
- blood calcium less than 8 mg/dL
- PaO2 (a measure of oxygen in the blood) less than 60 mm Hg
- base deficit greater than 4 mEg/L (a measure of change in the normal acidity of the blood)
- fluid sequestration greater than 13 pt (6 l) (an estimation of the quantity of fluid that has leaked out of the blood circulation and into other body spaces)
Once it is determined how many of Ranson's signs are present in the patient, the physician can better predict the risk of death. A patient with less than three positive Ranson's signs has less than a 5% chance of dying. A patient with three to four positive Ranson's signs has a 150% chance of death.
The results of a CT scan can also be used to predict the severity of pancreatitis. Slight swelling of the pancreas indicates mild illness. Significant swelling, especially with evidence of destruction of the pancreas and/or fluid build-up in the abdominal cavity, indicates more severe illness and a worse prognosis.
Health care team roles
The physician will make a full physical examination of the patient to determine which tests are necessary. Radiation technologists will perform imaging studies and clinical laboratory technicians will perform the laboratory tests. Nurses have an active supportive role throughout the patient's illness.
Alcoholism is essentially the only preventable cause of pancreatitis. Patients with chronic pancreatitis must stop drinking alcohol entirely. The drugs that may cause pancreatitis should also be avoided when possible.
Izenberg, Neil, ed. Human Disease and Conditions. New York: Charles Scribner's Sons, 2000, pp.643-644.
Toskes, Phillip P., and Norton J. Greenberger. "Disorders of the Pancreas." In Harrison's Principles of Internal Medicine, edited by E. Braunwald, et al. New York: McGraw-Hill, 2001, pp.1788-1803.
Munos, Abilio, and David A. Katerndahl. "Diagnosis and Management of Acute Pancreatitis." American Family Physician 62 (July 2000): 164-73.
National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570.
National Institute of Diabetes and Digestive and Kidney Diseases. <<a href="http://www.niddk.nih.gov/health/digest/pubs/pancreas/pancreas.htm">http://www.niddk.nih.gov/health/digest/pubs/pancreas/pancre... >.
The National Pancreas Foundation. <<a href="http://www.pancreasfoundation.org/diseases.html">http://www.pancreasfoundation.org/diseases.html>.
Erika J. Norris