Focal Pancreatitis
At times acute pancreatitis involves only a portion of the pancreas, with such focal pancreatitis then evolving into chronic changes limited to a segment of the pancreas. A separate description here of focal pancreatitis is not meant to imply that it is a separate disease entity; rather, its importance lies in its mimicry of pancreatic cancer. An annular pancreas, with pancreatitis limited to the annular portion, has already been discussed. Some descending duodenal stenoses are secondary to focal pancreatitis in the annular segment. A history of acute or chronic pancreatitis is often lacking in those with focal pancreatitis. Most often focal pancreatitis involves the pancreatic head. Computed tomography shows focal pancreatitis to be hypodense and US reveals hypoechoic tumors. It tends to be hypervascular at angiography.
Groove Pancreatitis One form of segmental chronic pancreatitis is called “groove pancreatitis.” The groove is located between the pancreatic head, the duodenum, and the common bile duct. Why focal pancreatitis should develop preferentially in this location is puzzling, although this region of the pancreas is drained by the duct of Santorini, and obstruction of this duct or aberrant ducts may play a role. Relation of this entity to focal annular pancreatitis is conjecture. A typical appearance is a tumor simulating a pancreatic head carcinoma; differentiation between the two entities is difficult at best, and some of these patients undergo resection. Some develop a duodenal stricture. Magnetic resonance imaging in five patients revealed a sheet-like tumor between the pancreatic head and duodenum; these tumors were hypointense relative to the pancreas on T1- and iso- to slightly hyperintense on T2-weighted images and had delayed contrast enhancement. Histology revealed fibrosis.
Inflammatory Pseudotumor
A number of pancreatic inflammatory pseudotumors have been described. Whether these should be considered a type of focal pancreatitis or as a separate entity is not clear. Computed tomography detects an inflammatory pseudotumor of the pancreas simply as a large tumor; histology shows a mixed infiltrate of spindle cells, lymphocytes, histiocytes, and plasma cells.
Groove Pancreatitis One form of segmental chronic pancreatitis is called “groove pancreatitis.” The groove is located between the pancreatic head, the duodenum, and the common bile duct. Why focal pancreatitis should develop preferentially in this location is puzzling, although this region of the pancreas is drained by the duct of Santorini, and obstruction of this duct or aberrant ducts may play a role. Relation of this entity to focal annular pancreatitis is conjecture. A typical appearance is a tumor simulating a pancreatic head carcinoma; differentiation between the two entities is difficult at best, and some of these patients undergo resection. Some develop a duodenal stricture. Magnetic resonance imaging in five patients revealed a sheet-like tumor between the pancreatic head and duodenum; these tumors were hypointense relative to the pancreas on T1- and iso- to slightly hyperintense on T2-weighted images and had delayed contrast enhancement. Histology revealed fibrosis.
Inflammatory Pseudotumor
A number of pancreatic inflammatory pseudotumors have been described. Whether these should be considered a type of focal pancreatitis or as a separate entity is not clear. Computed tomography detects an inflammatory pseudotumor of the pancreas simply as a large tumor; histology shows a mixed infiltrate of spindle cells, lymphocytes, histiocytes, and plasma cells.
Hi,
ReplyDeleteTook Onglyza off and on for a year. I have an enlarged adrenal gland. Still I await the outcome of that CT, but I know that much. Will find out more.
I had the CT because of chronic pancreatic pain that started out as "attacks" from a couple of times a month to finally after 3 months of use without interruption, "attacks" 2-3 times a week. My PA put Onglyza on my allergies list.
In the meantime, I lost almost 50 lbs in 5 months due to illness. Loss of appetite, pancreatic pain, chronic diarrhea, then eventually, inability to move my bowels. Severe back pain from the pancreas, and severe chest pain sent me to the ER where I was worked up for cardiac pain. I was cardiac cleared, but told my amylase was very low.
Still seeking a diagnosis, but I lay the blame squarely on Onglyza. I'd had pancreatic issues in the past, and argued with the PA that prescribed it, she was calling me non-compliant, and I feared repercussion from my insurance company.
I even took an article about the dangers of Onglyza, particularly in patients with a history, and she made me feel foolish.
I wish I had listened to my instincts, I fear not only damage to my pancreas that is irreversible, but also severe damage to my left kidney, though I have bilateral kidney pain.
I was off all diabetes meds, and control sugars strictly low to no carb. I can barely eat anymore, I have severe anorexia.
I would warn anyone taking Onglyza to consider a change and try Dr Itua Herbal Medicine, and anyone considering taking it, to select a different avenue. I have been suffering severely for about 9 months, but the past 7 months have been good with the help of Dr Itua herbal medicine which I took for 4 weeks.
I have been off Onglyza now, for 7 months, and simply 100% improvement with the help of Dr Itua. I had none of these issues except a history of pancreatitis in my distant past.
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