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

Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.

This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.

This is inserted through the patient s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.

ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:

  Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.

  Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.

  Persistent upper abdominal pain

  Unexplained weight loss and loss of appetite

  Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater

ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient s needs.

Endoscopic Retrograde Cholangiopancreatography - Procedure and Results

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?

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!

Chronic pancreatitis refers to an inflammation of the pancreas   the organ that creates enzymes and hormones to manage blood sugar levels and aids in digestion. The condition either does not heal completely and keeps coming back, or persists for months or years at a stretch.

Chronic pancreatitis is a serious, debilitating condition, which can potentially lead to permanent damage and scarring of the organ. The following are the consequences-

  Formation of cysts and calcium stones in the pancreas
  Blockage of the gastrointestinal tract
  Malnutrition
  Diabetes

The condition is most likely to develop between the ages of 30 and 40 and is commonly observed in men than in women.

Causes of Chronic Pancreatitis:

A number of factors are responsible for long-term pancreatitis. The most common ones include-

  Alcohol abuse   Reportedly, 70% of all cases regarding the condition is related to alcohol consumption
  Autoimmune diseases   When your body attacks the healthy tissues and cells mistakenly
  Genetics
  A constrict pancreatic duct   The tube that carries enzymes to the small intestine from the pancreas
  A blockage of the pancreatic duct by stones
  Cystic fibrosis   A hereditary disorder that causes mucus to build up in the lungs
  Hypercalcemia   When the level of calcium in the bloodstream increases abnormally
  Hypertriglyceridemia   When the level of triglycerides in the blood rises up

Warning Signs of Chronic Pancreatitis:

Symptoms of chronic pancreatitis do not show up at the early stages. They become more evident when inflammation aggravates. However, you should look out for the following signs-

  Severe abdominal pain   Usually in the upper portion
  Loose stool that appears pale and does not flush away easily
  Vomiting and nausea
  Unintentional weight loss
  Fatigue
  Excessive thirst
  Shortness of breath
  Diarrhoea
  Jaundice
  Pancreatic fluids inside the stomach
  Intestinal blockage
  Internal bleeding

The above symptoms vary based on the severity of the condition. Painful episodes may last for days. For some people, drinking and eating seem difficult because that makes the pain worse. With the progression of persistent pancreatitis, the pain becomes constant. Seeking treatment at the earliest is necessary for the condition to heal.

Diagnosis and Treatment:

A blood test alone is not sufficient to detect the changes in your pancreas in the initial stages. An imaging test is the most reliable method to confirm the diagnosis. Your doctor may recommend the following tools-

  CT Scan
  X-ray
  Ultrasound
  MRI Scan

The objective of the treatment is to reduce pain and improve the functioning of your digestive system. The damage to the pancreas cannot be cured, but your doctor will prescribe necessary measures to manage the symptoms of the condition.

The primary treatment methods include endoscopic therapy, medications, and surgery.

  Medication - Pain killers, insulin steroids, and artificial digestive enzymes may be taken as per the doctor s recommendation
  Endoscopy - The procedure involves inserting a flexible, long tube (known as an endoscope) through the mouth. It allows the doctor to look at the pancreatic stones formed inside. He/she then removes the stones, places stents to improve the flow, and seals the leakage.
  Surgery - The last resort is surgery. The doctor will recommend it only if medications and endoscopy therapy have failed to rectify the painful symptoms. Removing a portion of the diseased pancreas can offer relief. Surgery may also be performed to drain cysts and to unblock or widen the pancreatic duct.

The outlook depends on the underlying causes and the seriousness of the disease. However, immediate treatment and diagnosis can improve the outlook. Consult a doctor as soon as you encounter the above symptoms of pancreatitis.

Chronic Pancreatitis - Everything You Should Be Knowing!

Pancreas Transplant is a surgical procedure where the damaged pancreas is taken out of the body of the patient and transplanted with the healthy ones from the donor s body.
The pancreas is located in the middle part of the body that helps in the secretion of insulin in the body. Insulin helps in the absorption of sugar in the body and helps in maintaining glucose level. If the pancreas is not producing insulin in sufficient quantity than the patient is likely to suffer type 1 diabetes.

Most of the pancreas transplants are done to cure the extreme conditions of type 1 diabetes. However, the transplants are done only in case of severe diabetic conditions because the pancreas transplant has serious side effects and not always pleasant after surgery recovery.

Why is the Pancreas Transplant Done?
There are several reasons for doctors choosing for pancreas transplantation. One of the most reason is the type of diabetes. However, they are also performed along with the kidney transplantation, when damage to the kidney is done by diabetes.

Following reasons are worth considering for pancreas transplantation:
  Extreme and severe type 1 diabetes
  Kidney damage
  Type 2 diabetes due to a lower level of insulin usage in the body
  Poor blood sugar level

Types of Pancreas Transplantations-

  Pancreas Transplant Alone: The pancreas transplantation is done solely for the diabetic patient whose kidney is unaffected and does not require any surgery along with pancreas transplant.

  Pancreas Transplantation Along with Kidney Transplant: This kind of surgery is done by the doctors when the patient has weak kidney and damaged pancreas. In such a scenario, only kidney transplantation is not sufficient and requires new pancreas for overall development.

  Pancreas-after-kidney Transplantation: For patients who have been waiting long enough for a donor for pancreas and kidney both, this is a better solution. Since the waiting list to get, such donor is long and not probable. Doctors prioritize and perform kidney transplantation first since the condition for kidney transplantation is rather severe and affected. Then after pancreas transplantation is done when a suitable donor is found.

  Pancreatic Islet Cell Transplant: Pancreatic islet cells are responsible for producing insulin into the body. So, doctors perform surgery on the patient and inject the pancreatic islet cells from donor s pancreas to the patient under operation.

Complications of the Procedure-
Some of the common complications of the procedure are:

  Blood clots
  Bleeding
  Infection
  Excess sugar in the blood
  Failure of the donated pancreas
  Transplant rejection
  Urinary tract complications

Conclusion-
Pancreas Transplant is done when the patient is severely diabetic and is not curable with only medication. The doctors suggest the post-surgery rest. The patient is required to be hospitalized for one week at least and keep strict follow-up routine to look after the effects of transplantation.

Pancreas Transplant - When Is It Required?

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