Obstruction of the pancreatic duct by tumors from the head of pancreas, destruction of the pancreas by tumor growth, and loss of pancreatic tissue from surgery often lead to pancreatic exocrine insufficiency.
Partial or complete removal of the pancreas is very likely to cause EPI and the patient will need lifelong use of pancreatic enzyme replacement therapy (PERT). EPI has been diagnosed after partial resection of the pancreas including duodenopancreatectomy (Whipple procedure), a procedure that involves removal of the head of the pancreas and the encircling duodenum. The risk of EPI depends upon the type of surgery and extent of pancreatic tissue removed.
Gastric surgical procedures can result in asynchrony between gastric emptying and discharge of bile and pancreatic enzymes.
OBSTRUCTION OF THE BILIARY OR PANCREATIC DUCT:
Descending gall stones, biliary sludge from common bile duct as well as tumors of the pancreas can lead to obstruction of pancreatic duct and ampulla of Vater, leading to pancreatic inflammation/autodigestion.
DIABETES MELLITUS (TYPE I AND TYPE IIIC):
EPI is associated with type I and type IIIC diabetes. Type I diabetes is characterized by chronic inflammation in both the endocrine and exocrine pancreas from autoimmunity against pancreatic islets, leading to insulin deficiency, pancreatic fibrosis, and atrophy. Type IIIC diabetes, or pancreatogenic diabetes, is a form of secondary diabetes that follows the disease of the exocrine pancreas, such as chronic pancreatitis.