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CHAPTER 21 Diseases of the pancreas
Tyler M. Berzin and Awais Ahmed
Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
The ageing pancreas
The pancreas has considerable functional reserve, so any anatomical changes associated with age have little, if any, effect on pancreatic function. Morphological changes, however, do occur as part of the ageing process. Ectasia of the main pancreatic duct and pancreatic atrophy can sometimes be noted, both of which can cause confusion in the interpretation of cross‐sectional imaging. Ageing may also be associated with impaired pancreatic blood supply due to atherosclerosis, although the implications of this remain unclear.
Pancreatic function studies have been carried out on elderly patients and compared with those on younger patients. The volume of pancreatic secretion falls in the elderly, as do the outputs of lipase, trypsin, and phospholipase.1 However, there does not appear to be a corresponding fall in fat absorption.
Inflammatory diseases of the pancreas
Acute pancreatitis
In the United States, the incidence of acute pancreatitis increased from 65 to 81 per 100,000 adults annually between 2001 and 2014. In the hospital, case fatalities have decreased from 1.68 to 0.69%, but mortality rates were higher in persons older than 65.2
Although alcohol abuse is a major cause of acute pancreatitis in adults, it is somewhat less common as a cause in the elderly. Acute pancreatitis, however, occurs with increasing frequency in the elderly because of an increased prevalence of gallstones and biliary sludge. In addition to alcohol and gallstones, other predisposing factors for acute pancreatitis in the elderly include hypercalcemia (usually due to hyperparathyroidism), hypertriglyceridemia, and obstruction to pancreatic flow caused by a pancreatic tumour. Acute pancreatitis occurs in some patients following