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

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!

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!

A pancreatic transplantation or pancreas transplantation refers to the surgical procedure, which involves replacing a dysfunctional pancreas with a healthy one.  The donor of the pancreas is usually a deceased person. Pancreas is an important organ of the body as it produces several important hormones, which play a significant role of regulating our body cycles. Pancreas transplantation is usually performed for the treatment of type 1 diabetes which is linked to the inability of the pancreas to produce the insulin hormone.

A pancreatic transplant is considered as one of the potential cures for type 1 diabetes. However it is not considered to be a standard treatment due to complications, such as:

Rejection of graft by the recipient body or similar complications
The medications which are given to prevent the rejection can have serious side effects too
Certain complications like blood clots or infections can occur following the procedure
Failure to control the blood sugar levels and rejection of the graft or complete pancreatic failure are Common complications that occur after a pancreas transplant.
These are the primary reasons why pancreas transplant is often considered to be one of the last measures of treating diabetes. Nevertheless, there are certain conditions where a pancreas transplant is worth considering. Some of the conditions include diabetes which cannot be controlled with the usual treatment procedure, chronic poor blood sugar control, insulin reactions which turns chronic or a serious kidney disease.

Certain medications are also prescribed for anti rejection purposes. These medications need to be taken after the operation for the rest of your life to prevent rejection of the donor graft. These medications can have a few adverse side effects. Some of the side effects include hypertension, thinning of your bones, unwanted weight gain and a rise in your cholesterol levels. Swollen gums or acne are also observed in several cases.  

Often a pancreas transplant is carried out along with a kidney transplant, especially if you have a serious kidney condition. It helps to provide a healthy kidney and a pancreas and also reduces a risk of kidney damage caused due to diabetes later in the future.

Know More About Pancreatic Transplantation!

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!

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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