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

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!

It is a known and proven fact that eating while consuming alcohol is necessary. One tends to grow hungrier, the more he or she drinks alcohol. This is because alcohol has the attribute to stimulate one s appetite in such a way that one would have you craving for food that is rich in salt and high in fibre. Consuming only alcohol ignoring the hunger would lead to several diseases like pancreatitis and issues with the liver.

Though the appetite of an individual during alcohol consumption tends to incline towards snacks like pizza, french fries, nuts and cheese cubes, it is wise to opt for healthier food choices. Salty food can worsen the dehydration effects of the body. And as the body tends to be dehydrated during drinking, it is better to avoid salty food. High-fibre food items are not good for the health either. It delays the digestion process, which is not a good sign for the body. Also, it is also not advisable to eat food in large portions before going to bed, especially after alcohol intake.

There is a variety of healthy food that one can eat along with alcohol

Soup: A clear soup, like chicken clear soup or vegetable clear soup, which has a broth-like texture, is a healthy choice. Creamy soup with cream of chicken or cream of mushroom should be avoided as it would make one heavy, thus delaying the digestion process.
Rice: Plain rice is said to be one of the best food that is easy to digest, paired up with a light vegetable dish. It is very nutritious as well.
Chicken sandwich: Grilled chicken sandwich without cheese and mayo is a healthy food tip as it contains sodium.
Popcorn: Popcorn does not contain fat, neither is it high-fibre. It is the best low-calorie food to go along with alcohol and it tastes really good too.
Wheat crackers: Wheat crackers contain whole grains. It is full of complex carbohydrates, which help the alcohol to absorb easily. It also consists of Vitamin B, which like potassium, gets reduced with the consumption of alcohol.
Banana: It is rich in potassium. Though an individual would never have a banana along with alcohol, it is healthy as the level of potassium should be taken care of while drinking alcohol.
Wheat bread: Wheat bread toast can be consumed with alcohol without butter or cheese. It is an alternative to wheat crackers for those who do not prefer it.
Oats: Cooked food is easy to digest with alcohol, so a pot of cooked oatmeal can be a healthy accompaniment. It can be spiced up a bit to add flavour.
Salad: Salad is refreshing and healthy at the same time. It can be bland, but it is better to have healthy salad as an accompaniment than having salty food with alcohol.
Milk cereal: Cereal, especially whole grain cooked with low-fat milk, is healthy.
By being aware of the right eatables, the ill effects of alcohol can be mitigated to a large extent.

Alcohol - 10 Healthy Foods that You Can Eat With It!

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

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?

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