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

Pancreatic cancer is an aggressive form of cancer. The disease shows no early symptoms and often spreads to other organs long before it is properly diagnosed. Due to such poor prognosis, only around 6% of the pancreatic cancer patients are healthy and alive 5 years after the first diagnosis.

One of the most common surgeries to remove tumours from the pancreas is Pancreaticoduodenectomy, that is commonly called Whipples surgery. The primary aim of the procedure is to cure cancers or disorders that are identified in the pancreas, bile duct or the duodenum. Here, the tumour is removed to prevent it from spreading to other organs, thus improving the life expectancy of the patient. 

Whipple's Procedure

Before the surgery, an intravenous line will be injected to your arm, to provide you with the necessary medication. Medicines may be passed through this line to soothe your nerves. A spinal injection or an epidural catheter may be placed. This helps you to recover painlessly after the surgery.

The surgery can be carried out in different ways  

Open surgery

Here, the surgeon makes a small incision in your abdomen to access the pancreas and other organs. This is the most common method. This is a complicated operation where the tip of the pancreas, the gallbladder, the bile duct and the initial portion of the small intestine are removed. It is performed to treat cancers that are present on the head of the pancreas. 

Laparoscopic surgery

Here several small incisions are made in your abdomen to insert a camera that transmits the live video of the abdomen to a monitor. According to the live feed, the surgeon performs the operation by using surgical tools. It is a common form of minimally invasive surgery.

Robotic operation

This is another type of minimally invasive surgery where the surgical tools are attached to a special robot. Here, the doctor uses a console to control the robot to perform the surgery. This is used because surgical robots can reach and operate in spaces and corners where the human hands may not reach during surgery.

 The Whipples surgery can take 4 to 12 hours depending upon the approach being used and the complexity of the process. During the surgery, you will be given general anaesthesia, so you will be asleep.

In some cases, a part of your stomach or nearby lymph nodes may be removed to treat the cancer growths. After the process, the doctor will reconnect the other organs so that you can digest food normally.

After the procedure, you may face problems while emptying your bowels. The condition improves around 7 to 10 days after the surgery. Most patients are able to return back to their normal life usually around 6 weeks after the procedure.

It is recommended that you follow the doctor s instructions after the surgery and stick to the diet prescribed. Additionally, keep the incision protected from sunlight and remove the bandages only after consulting the doctors. 

 

 

Whipples Surgery & Pancreatic Cancer - Know About Them!

An inflammation of the pancreas is known as pancreatitis. The pancreas is an organ that produces digestive enzymes. Pancreatitis might start any day and continue for long period and it requires immediate medical attention. It is of two types- acute pancreatitis and chronic pancreatitis. Although the treatment usually requires hospitalization, pancreatitis can be easily stabilized and the underlying cause can be treated thereafter.

Causes
Pancreatitis may be caused due to various reasons:
1. Gall bladder stone: The pancreatic duct lies next to the bile duct. The gallstones enter the small intestine after passing through the common bile duct. Often the stones that remain in the common bile duct have a negative effect on the pancreas, which causes a hindrance to the normal flow of the pancreatic fluids, causing pancreatitis. Also a back flow of the bile into the pancreas can cause pancreatitis. 
2. Alcohol: Long time alcohol use also causes pancreatitis. Alcohol can damage the pancreas tremendously causing it to get inflamed.
3. Other causes: Hereditary disorders in the pancreas, cystic fibrosis, high level of triglycerides, and a few medicines may also cause pancreatitis.

Symptoms: 
1. The first symptom of pancreatitis is abdominal pain: The pain may be sudden or gradually increasing, but is usually aggravated after eating. It is severe and constant, and may continue for a few days. If you are suffering from pancreatitis, you will feel very sick after a sudden attack and you might require medical assistance immediately.
2. Swollen abdomen: Pancreatitis may cause your abdominal area to swell up and become tender.
3. Nausea: If your abdomen suddenly starts paining due to the onset of pancreatitis, you tend to feel extremely nauseous. You might end up vomiting and may also have violent heaves.
4. Fever: The inflammation will cause you to run a temperature, along with a searing pain in your stomach, which will make you feel extremely uncomfortable.
5. Rapid pulse: Pancreatitis affects the rate, at which the heart beats, causing a rapid increase in the pulse rate.

Causes and Symptoms of Pancreatitis

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?

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!

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