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!

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

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

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 

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?

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!

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