Pancreatitis and Vitamin D

deficiency
Muhammad Asif Shaheen
Lecturer Pathology
KEMU, Lahore
Pancreatitis
• Pancreatitis is inflammation in the pancreas. The pancreas is a long,
flat gland that sits tucked behind the stomach in the upper abdomen.
The pancreas produces enzymes that help digestion and hormones
that help regulate the way your body processes sugar (glucose).
• Pancreatitis can occur as acute pancreatitis — meaning it appears
suddenly and lasts for days. Or pancreatitis can occur as chronic
pancreatitis, which is pancreatitis that occurs over many years.
• Mild cases of pancreatitis may go away without treatment, but severe
cases can cause life-threatening complications.
Symptoms

• Signs and symptoms of pancreatitis may vary, depending on which type you experience.
• Acute pancreatitis signs and symptoms include:
• Upper abdominal pain
• Abdominal pain that radiates to your back
• Abdominal pain that feels worse after eating
• Fever
• Rapid pulse
• Nausea
• Vomiting
• Tenderness when touching the abdomen
• Chronic pancreatitis signs and symptoms include:
• Upper abdominal pain
• Losing weight without trying
• Oily, smelly stools (steatorrhea)
 Causes
• Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the
cells of your pancreas and causing inflammation. With repeated bouts of acute pancreatitis, damage to
the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing
loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.
• Conditions that can lead to pancreatitis include:
• Abdominal surgery
• Alcoholism
• Certain medications
• Cystic fibrosis
• Gallstones
• High triglyceride levels in the blood (hypertriglyceridemia)
• Infection
• Injury to the abdomen
• Obesity
• Pancreatic cancer
Diagnosis
• Tests and procedures used to diagnose pancreatitis include:
• Blood tests to look for elevated levels of pancreatic enzymes
• Stool tests in chronic pancreatitis to measure levels of fat that could suggest your
digestive system isn't absorbing nutrients adequately
• Computerized tomography (CT) scan to look for gallstones and assess the extent of
pancreas inflammation
• Abdominal ultrasound to look for gallstones and pancreas inflammation
• Endoscopic ultrasound to look for inflammation and blockages in the pancreatic
duct or bile duct
• Magnetic resonance imaging (MRI) to look for abnormalities in the gallbladder,
pancreas and ducts
Biochemical Markers-Amylase
• This test measures the level of the enzyme amylase in your blood.
• About 40% of the amylase in your body is made by your pancreas. The
rest comes from your salivary glands. Amalyse helps digest
carbohydrates in your food. This test is used to find out if you have a
condition that affects your pancreas or salivary glands. If you have a
pancreatic disorder, your amylase levels are usually higher than
normal. High levels can also be caused by an infection, cancer, or even
alcohol or medicines you are taking.
• The normal range for adults for amylase in a blood sample is 30 to
110 units per liter (U/L).
• Hyperamylasemia (High Blood Amylase Level)
• Causes of Hyperamylasemia:
• Pancreatitis - also known as inflammation of the pancreas. This can cause
amylase and lipase levels to be increased up to 3 times the normal limit. Both
values should be increased, in order to carry the diagnosis of pancreatitis.
• Tumors - Amylase enzyme levels may be increased in some pancreas, salivary,
prostate, lung and ovarian tumors.
• Gall bladder infection - Inflammation of the gall bladder (cholecystitis), may
cause increased amylase levels, causing hyperamylasemia.
• Kidney failure can result in hyperamylasemia.
Lipase Test
• Lipase is an enzyme primarily produced by the pancreas to help digest
dietary fats. This test measures the amount of lipase in the blood.
• Lipase is usually present in the blood in small quantities. When cells in
the pancreas are injured, increased amounts of lipase enter the blood
and result in higher concentrations in the blood. This can occur in
conditions such as pancreatitis, or when the pancreatic duct is
blocked by a gallstone or, in rare cases, by a pancreatic tumor.
Hyperlipasemia (High Blood Lipase Level)
• A high lipase level in the blood may indicate the presence of a condition affecting the
pancreas.
• In acute pancreatitis, lipase levels are frequently very high, often 3 to 10 times higher
than the highest reference value (often called the upper limit of normal). Lipase
concentrations typically rise within 3 to 6 hours of an acute pancreatic attack, peak at
24 hours, and remain elevated for up to 8 to 14 days. Lipase levels cannot be used to
determine the severity of an acute pancreatic attack.
• Lipase levels may also be increased with pancreatic duct obstruction, pancreatic cancer,
and other pancreatic diseases, as well as with gallbladder inflammation or kidney disease
.
• A low level of lipase in the blood may indicate permanent damage to the lipase-
producing cells in the pancreas. This can occur in chronic diseases that affect the
pancreas, such as cystic fibrosis.
• The normal range for adults upto 160 U/L. 
Vitamin D
• Vitamin D is a group of fat-soluble steroids responsible for increasing intestinal
absorption of calcium, magnesium, and phosphate, and multiple other
biological effects. In humans, the most important compounds in this group are
vitamin D3 (also known as cholecalciferol) and vitamin D2 (ergocalciferol).
• The major natural source of the vitamin is synthesis of cholecalciferol in the
lower layers of skin epidermis through a chemical reaction that is dependent
on sun exposure (specifically UVB radiation).
• Cholecalciferol and ergocalciferol can be ingested from the diet and from
supplements.
• Only a few foods, such as the flesh of fatty fish, naturally contain significant
amounts of vitamin D
Vitamin D deficiency
• Vitamin D deficiency, or hypovitaminosis D is defined as a vitamin D
 level that is below normal. It most commonly occurs in people when
they have inadequate sunlight exposure (in particular sunlight with
adequate ultraviolet B rays).
• Vitamin D deficiency can also be caused by inadequate nutritional
intake of vitamin D, disorders limiting vitamin D absorption, and
conditions impairing vitamin D conversion into active metabolites—
including certain liver, kidney, and hereditary disorders.
Pathophysiology
• Vitamin D deficiencies are often caused by decreased exposure of the
skin to sunlight. People with a darker pigment of skin or increased
amounts of melanin in their skin may have decreased production of
vitamin D.[1] Melanin absorbs ultraviolet B radiation from the sun and
reduces vitamin D production.[1] Sunscreen can also reduce vitamin D
production.[1] Medications may speed up the metabolism of vitamin D,
causing a deficiency.[1] Some types of liver diseases and kidney diseases
 can decrease vitamin D production leading to a deficiency.[1] The liver is
required to transform vitamin D into 25-hydroxyvitamin D. This is an
inactive metabolite of vitamin D but is a necessary precursor (building
block) to create the active form of vitamin D.[14]
• In liver disease, the 25-hydroxyvitamin D may not be formed, leading to a vitamin D
deficiency.[14] The kidneys are responsible for converting 25-hydroxyvitamin D to 1,25-
hydroxyvitamin D.[14] This is the active form of vitamin D in the body. Kidney disease
often prevents 1,25-hydroxyvitamin D from being formed, leading to a vitamin D
deficiency.[14] Intestinal conditions that result in malabsorption of nutrients may also
contribute to vitamin D deficiency by decreasing the amount of vitamin D absorbed
via diet.[14] In addition, a vitamin D deficiency may lead to decreased absorption of
calcium by the intestines, resulting in increased production of osteoclasts that may
break down a person's bone matrix.[15] In states of hypocalcemia, calcium will leave
the bones and may give rise to secondary hyperparathyroidism, which is a response
by the body to increase serum calcium levels.[15] The body does this by increasing
uptake of calcium by the kidneys and continuing to take calcium away from the bones.
[15]
 If prolonged, this may lead to osteoporosis in adults and rickets in children.
Classification
• Vitamin D deficiency is typically diagnosed by measuring the
concentration of the 25-hydroxyvitamin D in the blood, which is the
most accurate measure of stores of vitamin D in the body.[4][5] 1 ng/mL
is equivalent to 2.5 nmol/L.
• Severe deficiency: <12 ng/mL = <30 nmol/L[5]
• Deficiency: <20 ng/mL = <50 nmol/L
• Insufficient: 20–29 ng/mL = 50–75 nmol/L
• Normal: 30–100 ng/mL = 75–250 nmol/L
Osteomalacia 
• Osteomalacia is a disease characterized by the softening of the bones
 caused by impaired bone metabolism primarily due to inadequate
levels of available phosphate, calcium, and vitamin D, or because of 
resorption of calcium. The impairment of bone metabolism causes
inadequate bone mineralization. Osteomalacia in children is known
as rickets, and because of this, use of the term "osteomalacia" is often
restricted to the milder, adult form of the disease. Signs and
symptoms can include diffuse body pains, muscle weakness, and
fragility of the bones. In addition to low systemic levels of circulating
mineral ions necessary for bone and tooth mineralization
Rickets
• Rickets is a condition that results in weak or soft bones in
children.Symptoms include bowed legs, stunted growth, bone pain,
large forehead, and trouble sleeping. Complications may include 
bone fractures, muscle spasms, an abnormally curved spine, or 
intellectual disability
Fasciculation
• A fasciculation, or muscle twitch, is a small, local, involuntary 
muscle contraction and relaxation which may be visible under the
skin. Deeper areas can be detected by electromyography (EMG)
testing, though they can happen in any skeletal muscle in the body.
Periodontitis
• Periodontal disease, also known as gum disease, is a set of
inflammatory conditions affecting the tissues surrounding the teeth.In
its early stage, called gingivitis, the gums become swollen, red, and
may bleed. In its more serious form, called periodontitis, the gums
can pull away from the tooth, bone can be lost, and the teeth may
loosen or fall out. Bad breath may also occur.