The diagnosis as well as management of pancreatic cystic lesions is a general problem. Nearly 1% of the patients in the chief medical centers have been observed to have pancreatic cystic lesions on cross sectional imaging. It has also been observed that a quarter of all pancreas scanned in an autopsy series contain pancreatic cysts. Earlier, these cystic lesions were regarded benign but with increasing evidence made available from the cystic lesions, they are regarded as origin of pancreatic malignancies.


Information on asymptomatic neoplastic pancreatic cysts
The most vital medical tools that are used in the diagnosis and management of pancreatic cystic lesions include the endoscopic ultrasound and cross sectional imaging. These are used to distinguish non-mucinous cysts from mucinous cysts. The identification of pancreatic cysts creates a lot of anxiety for the clinicians as well as the patients related to the probable presence of a fatal tumor. The findings of a macro cystic lesion that enclose viscous fluid loaded in cea are helpful in the analysis of a mucinous lesion. 


The most common pancreatic cysts are the non-neoplastic inflammatory pseudo cysts, and they can be detected easily by imaging. The identification of pancreatic irregularity with probable association with malignant cells is a vital source of referral for the specialist. The set of guidelines that have been proposed for the management and diagnosis of patients with asymptomatic neoplastic pancreatic cysts are based specifically on the analysis of the quality of the data. It is also designed to address the most important and frequent clinical scenarios. The diagnostic suggestions are provided based on the clinical problem as well as the risk of malignancy.


Imperative guidelines to follow
To achieve accurate diagnosis of asymptomatic neoplastic pancreatic cysts is indeed a great challenge. It is all the more important to find the reproducible methods that can be used to stratify threat of cancer for the patients. The main guidelines include a two year screening interval of cysts that can be of any size as well as stopping observation after 5 years, in case there is no change. The new guidelines, for the most part, recommend surgery if more than one concerning feature is confirmed on the mri by use of endoscopic ultrasound. The new guidelines even suggest discontinuation of inspection after the surgery if no dysplasia or invasive cancer is identified. The guidelines have mainly been developed by use of grading of recomendations assessment, development and evaluation.

Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

Pancreas is a small organ that is located in the lower part of the stomach. It lies just behind the abdomen. It functions by producing the insulin hormone which is responsible for regulating blood sugar level in the body and breaking down food into glucagon which is stored in the body. This glucagon is converted into glucose which is used by the body for energy and other purposes. Therefore, pancreatic transplant is done in patients with a malfunctioning pancreas.

Why is pancreatic transplant required?
Patients suffering from type I diabetes usually undergo a pancreatic transplant. Type I diabetes is characterized by the inability of the pancreas to produce insulin, thereby leading to low blood sugar level. This type of diabetes occurs due to the malfunction of pancreatic beta cells whose primary role is to produce insulin. These beta cells make up around 65 to 80 percent of the cells found in the pancreatic islets. They typically malfunction when the body's immune system begins to attack and destroy the pancreatic beta cells. Therefore, type I diabetes is an autoimmune disorder. Patients with type I diabetes require insulin injections that might cause severe reactions. People dependent on insulin are prone to the development of diabetic retinopathy and diabetic nephropathy.

People with type II diabetes generally do not need pancreatic transplant because this type of diabetes occurs due to low production of insulin or lack of insulin resistance. Here is a list of the probable reasons why pancreatic transplant is required:

People who have type I diabetes but are not cured by standard treatment
Severe reactions to insulin injections
Low blood sugar
Kidney damage
Hypoglycemia unawareness
A pancreatic transplant can be of three types. They are:

Pancreas transplant only- People with type I diabetes and normally functioning kidneys require only a pancreatic transplant.
Pancreas and kidney transplant- Type I diabetes, in rare cases, leads to end-stage renal disease (ESRD) or end-stage kidney disease where one or both the kidneys are damaged. In such cases, pancreas and kidney are transplanted simultaneously to disable the dependence on insulin injection. This type of surgery may also be required when the pancreas and the kidneys come from the same donor.
Pancreas-after-kidney transplant- In some cases of type I diabetes, your doctor will recommend kidney transplant first followed by pancreatic transplant. It must be remembered that pancreatic transplant should be done by taking into consideration the side-effects caused by the anti-rejection injections administered after the procedure is performed. It may cause bone thinning, high cholesterol and high blood pressure in a patient s body. As the anti-rejection injections work by suppressing the immune system, the body s defense mechanism against infections and other diseases becomes ineffective to a considerable extent.
A pancreatic transplant is a serious procedure that requires a lot of deliberations and consultations with your doctor and should only be opted for when the benefits outweigh the side effects from the anti-rejection medications.

Pancreatic Transplant - When Is It Required?

The inflammation of your pancreas over a short period of time indicates acute pancreatitis, which is a serious health condition. You may experience symptoms such as severe abdomen pain all of a sudden, diarrhoea and feeling of being sick. Acute pancreatitis occurs when there are some problems with certain enzymes in the pancreas. This condition is often associated with gallstones and alcohol consumption.


Treatment
Acute pancreatitis can be cured in a hospital, where you will get monitored for signs of serious issues. In some cases, supportive things like oxygen and fluids are required. Here are the various ways by which the condition can be treated:


1. Fluids: The body may get dehydrated during acute pancreatitis. Fluids are provided via a tube connected to one of the veins of the patient. This is known as intravenous or IV fluid. These fluids may help in the prevention of a problem called hypovolemic shock, which occurs when the amount of blood in your body gets lowered due to a drop in fluids. 
2. Nutrition: Diet is usually not restricted for people with acute pancreatitis, but some patients are recommended not to consume solid food for some time. Attempting to digest solid food may cause a strain on the pancreas. You may need to avoid solid food for some days. You should use a feeding tube to get essential nutrients. This process is called enteral feeding and it may involve the insertion of a tube into your stomach via the nose. 
3. Oxygen: For ensuring sufficient oxygen supply to your vital organs, you will be supplied with oxygen through the tubes on your nose. The tube may be removed when your condition improves. In some cases, ventilation equipment may be required for assistance to breathe.
4. Painkillers: Acute pancreatitis causes severe abdominal pain and strong painkillers such as morphine may be given to the patient. These may make the patient feel drowsy. 


Treatment of underlying cause
After controlling the symptoms, the underlying cause must be treated. They are as follows:
1. Gallstone: When pancreatitis occurs because of a gallstone, you may require a process known as endoscopic retrograde cholangiopancreatography or ERCP. The gallbladder may have to be removed, if necessary. 


2. Alcohol consumption: After getting treated for acute pancreatitis and you have recovered from this condition, you should try to avoid alcohol completely. Alcohol may spoil your recovery and the condition might reoccur or the symptoms may reappear. For freedom from alcohol, you may try counselling, joining self-help groups such as Alcoholics Anonymous (AA) or take a medicine which reduces your craving for alcohol. 


It is recommended that you visit a doctor immediately after experiencing any slight or severe symptoms of acute pancreatitis. This will help in early diagnosis and the chances of the symptoms getting worse are prevented.

Acute Pancreatitis - Can it be Cured?

Enlarged pancreas can result beacuse of factors such as: 

An abscess in your pancreas: This refers to a dangerous formation inside the pancreas. Neglecting its occurrence can also turn out to be fatal. An abscess is a cavity containing pus that further infects the rest of the organ. Presence of harmful bacteria in the pancreas leads to such a case.
A cyst in the lining of your pancreas: Epithelial cysts in the pancreas can also cause the organ to swell up. Such cysts are mostly benign but they are accompanied by disabling pain.
Pancreatitis is one disease with an array of threats: Highly active enzymes within the organ can make its tissues wear down thus, affecting the size of your pancreas. If you are an alcoholic, you are more prone to develop this condition. It could also be contracted due to an excess of calcium or fats in the blood.
Cancer of the pancreas is dreadful too: Due to the unanticipated growth of cancer cells in the pancreas, the organ grows bigger. A person suffers from excruciating pain under the influence of this condition.
Pseudocysts in the pancreas can have serious ill effects: When benign cysts become unmanageably harmful, they result into pseudocysts. The cysts contain remains of your tissues and other damaging fluids that can increase the size of the pancreas.
An enlarged pancreas surfaces in the form of these symptoms:

The kind of stool you pass indicates a lot about your health. Oily poop can be indicative of an enlarged pancreas. Persisting diarrhea can also be a symptom of pancreatic ailments.
You may even experience an accelerated pulse rate.
You may feel feverish continually. Bouts of fever can impede your free movement and general health.
Health issues with your pancreas can make you suffer from jaundice. It could be a one- time affair or it could reappear from time to time.
Constant queasiness could hint at some underlying problem in your pancreas.
You may even lose more than a few pounds over a short span of time. Such a thing should not be taken lightly as it not only makes you look sick but also degrades your immunity.

Enlarged Pancreas - 5 Factors Behind It 

Problems are pancreas are common and are treated by gastroenterologists. There are two common pancreas problems -

1. Acute Pancreatitis: Sudden Inflammation of the pancreas is known as acute pancreatitis. It is usually due to Alcohol, gall stones, trauma, metabolic causes such as hypertriglyceridemia, and congenital causes such as Pancreas divisum. The patient presents with severe upper abdominal pain and vomiting. Patients require admission for IV fluids and analgesics. Nearly all patients recover from the pain and start eating within 3 to 4 days. Few patients with severe pancreatitis may develop kidney failure, respiratory failure or GI bleeding. Such patients require longer hospitalisation stay and critical care management. Recovery is usually uneventful but few patients develop peripancreatic fluid collection known as Pseudocyst or walled-off pancreatic necrosis(WOPN). In such cases, the patient requires additional treatment of fluid collection and requires internal drainage by Cystogastrostomy which is done by Endosonography (EUS) by a gastroenterologist. Some patients require ERCP (Endoscopic retrograde cholangiopancreatography) for evaluation of pancreatic ductal leak. EUS and ERCP are advanced endoscopic procedures done by a few gastroenterologists who are specially trained in such procedures.

2. Chronic pancreatitis: Long term irreversible damage to the pancreas is called chronic pancreatitis. It is usually due to Alcohol intake. It presents with upper abdominal pain, Diabetes mellitus and fat in stools (steatorrhea). The small duct in the pancreas called main pancreatic duct can have hard calcifications also known as stones, which obstruct the flow of pancreatic juice and cause severe abdominal pain. Treatment of chronic pancreatitis includes stopping alcohol intake to prevent further damage to the pancreas, medicines for pain, Pancreatic enzyme replacement therapy (PERT) and Endoscopy for those who do not respond to medical treatment. Endoscopy includes ERCP and plastic stenting to establish a flow of obstructed pancreatic duct and Endosonography (EUS) guided Celiac plexus block for decreasing pain. Patients who develop fluid collection such as Pseudocyst require internal drainage by Cystogastrostomy which is done by Endosonography (EUS)

In Brief About Types Of Pancreatic Disorders!

The pancreas is a gland located in the abdominal region that performs two main functions for the body: produces digestive juices and the hormone insulin which regulates the blood sugar levels. The part which produces the digestive juices is exocrine and the insulin-producing part is the endocrine portion. Pancreatic cancer, which is an uncontrolled growth of the pancreas cells, often starts in the exocrine portion and is known as the pancreatic adenocarcinoma. The one which develops in the endocrine portion is known as neuroendocrine cancer or islet cell tumors.

Risk factors
Though not clearly established, the following factors are believed to up the risk of pancreatic cancer.

Smoking
Family history
Prolonged uncontrolled diabetes
Pancreatic conditions like inherited pancreatitis
Chronic inflammation of the pancreas
Symptoms
A pancreatic condition is of insidious onset, and the exact period of onset cannot be determined. The symptoms also are nonspecific abdominal symptoms, which do not pinpoint the pancreas per se.

Jaundice, which includes yellowing of the skin and whites of the white. This is because the growth of the pancreas puts pressure on the liver and bile ducts, and so hampers bile flow.
Weight loss, which was unintended. This is due to a bloated feeling plus inability to digest the foods.
Severe pain, which can be difficult and may even require regular injections to control.
Fluctuating sugar levels, which is unexplained.
Onset of diabetes, which is associated with weight loss and jaundice.
Increased tendency for blood clots.
Loss of appetite.
Bowel obstruction due to blockage of the growing pancreas.
Diagnosis
The above symptoms could lead to a further investigation that includes a few important tests, like the following.

Blood tests
Insulin levels
CT scan
Ultrasound
MRI
Laparoscopy, both to look for the extent of the disease and to do a biopsy, which can be used for confirming the type of cancer
Percutaneous transhepatic cholangiography: A dye is injected into the pancreas to study the spread of the dye, which will also help identify the diseased portion.
Treatment
Pancreatic cancer is very aggressive, usually not detected early, and has a very poor prognosis. So, if there is a family history or one has a prolonged pancreatic condition, it is advisable to go for annual screening to help with early detection and intervention. Once identified, treatment would include a combination of the three modalities   surgery, radiation, and chemotherapy. Surgery often may be followed by chemotherapy and/or radiation.

Prognosis
The prognosis for pancreatic cancer is very poor. Only about 25% of patients diagnosed with pancreatic cancer live past the first year. Early detection of risk factor remains the best way to improve prognosis. In case you have a concern or query you can always consult an expert & get answers to your questions!

Pancreatic Cancer - 8 Common Signs You Must Be Aware Of!

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