The pancreatic gland is an organ in which several serious diseases can occur.
The operations in the pancreas are generally considered the most challenging in all surgeries.
Because surgical access is difficult and the gland is closely related in many vital structures such as the bile duct and the gallbladder.
In addition, it is close to the main blood vessels that carry blood from the upper intestine to the mesenteric artery and veins.
Due to its location, hidden from view and difficult to see, even by modern scanning techniques, diseases of the pancreas often manifest late.
The most common condition of the pancreas is acute pancreatitis. This is an inflammatory condition with two main causes: alcohol and gallstones.
The presentation of acute pancreatitis is with intense pain in the upper part of the abdomen; Severe dehydration, nausea and vomiting are common.
The abdomen is very sensitive and the pain severe enough. The diagnosis is made in clinical history and examination.
Confirmation is by blood test (elevated serum amylase or lipase) and CT or ultrasound imaging, which will show a swollen pancreas and possibly collections of fluids around the gland.
Chronic pancreatitis does not refer to the severity of the condition, but to the fact that the pancreas gland shows changes in its structure, this is reviewed and examined by computerized tomography.
Scarring and fibrosis, usually after attacks of acute pancreatitis, is present. Such structural changes are permanent and hence it is called chronic.
Chronic pancreatitis increases the risk of developing pancreatic cancer by approximately 20%.
Sixty to ninety percent of cases of chronic pancreatitis in men have a history of high prolonged alcohol intake, while in women this figure is unknown.
It is said that chronic pancreatitis is related to the duration and amount of alcohol consumption. An intake of more than 80g / day for six to twelve years considerably increases the risk.
Only about 10 percent of patients with acute alcoholism progress to chronic, hence the relationship is far from complete and other factors that should be important in the etiology of chronic pancreatitis.
Management of chronic pancreatitis
The focus is on limiting any aggravating factors such as alcohol, relieving the activity of the pancreas. The administration of pancreatic enzyme and supplements.
The pain is managed by analgesics according to its severity. Special techniques of pain control such as celiac axis neurolysis (destruction of the nerves that bring the sensation of pain from the pancreas to the brain). They are difficult to perform, can not be repeated and the effect of short duration, usually only a few months.
There are several operations for the treatment of chronic pancreatitis and none is uniformly effective or satisfactory.
Sometimes referred to as the silent killer because the diagnosis is usually not evident until late in the disease, it is an uncommon cancer with an incidence of about 1/100 000 (6000 cases) per year in the United Kingdom).
When we talk about pancreatic cancer we usually refer to adenocarcinoma of the pancreas, which arises from the ducts of the pancreas. Other types of cancer can occur, but they are very rare.
Ductal adenocarcinoma of the pancreas is about to be as common in men as women and the average age of diagnosis is in late 60s.
Family history is a known risk factor, although the causative genes have not yet been identified.
Hereditary breast, ovarian and familial pancreatitis cancer are other hereditary syndromes for which there are recognized identifiers that are associated with an increased risk of pancreatic cancer.
Environmental factors such as obesity, smoking (active or passive) and diabetes are risk factors. The onset of diabetes in middle age should alert the doctor to the possibility of pancreatic cancer.
Signs and symptoms of pancreatic cancer
The most common presentation is with jaundice (80%). In jaundice the white of the eyes turns yellow, followed by the skin.
The urine is usually rust-colored and looks like soft clay. These changes occur because the bile duct is crushed by pancreatic cancer and the bile can not leave the liver.
It is filtered in the blood, giving rise to the clinical picture described. Careful research almost always reveals that the patient had been experiencing vague and often ignored symptoms for several months.
These include weight loss, discomfort in the epigastrium , nausea, indigestion, especially of fatty foods, and pale, pale stools.
Back pain (like a throbbing pain between the shoulder blades) is not uncommon and usually a sign that the cancer is large and probably unresectable.
A cancer with jaundice is usually found in the head of the pancreas.