PANCREAS AND DISEASES OF THE PANCREAS

[Lux]

The pancreas (to be) _____  an organ in the digestive and endocrine system. It (to serve) _______ two major functions: exocrine (producing pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including insulin).

Anatomy
In humans, the pancreas (to be) ____ a 15-25 cm (6-10 inch) organ in the abdomen. It (to locate) _____________ posterior to the stomach and in close association with the duodenum.
It(to describe) _____ often ___________ as having three regions: a head, body and tail.
The pancreatic duct (to empty) ___________ into the second part of the duodenum. The common bile duct commonly (to join) ___________ the pancreatic duct at or near this point.
The pancreas (to supply) _________________ by the pancreaticoduodenal arteries.
Venous drainage [‘dreinidz] (to be) ______ via the pancreaticoduodenal veins which (to end up) _________ in the portal vein.

Acute pancreatitis (to be) _____ rapidly-onset inflammation of the pancreas. Depending on its severity, it can (to have) ___________ severe complications and high mortality despite treatment. While mild cases (to treat) _______often successfully _______________ with conservative measures or laparoscopy, severe cases (to require) _______________ invasive surgery (often more than one intervention.

Common symptoms (to include) _______________________:
•   Severe abdominal pain often radiating through to the back.
•   Nausea, vomiting, diarrhea and loss of appetite.
•   Fever
•   Shock, hemodynamic instability
Recovery may (to follow) _________________by development of pancreatic pseudocyst, pancreatic dysfunction or diabetes mellitus.
Common causes of pancreatitis spells may (to be) ______:
gallstones, alcohol, trauma, steroids, mumps and other viruses, autoimmune diseases, snake bites, hypercalcemia, hyperlipidemia/hypertriglyceridemia and hypothermia, drugs, duodenal ulcers
Less common causes (to include)
long common duct, carcinoma of the head of pancreas, and other cancer, ischemia from bypass surgery, fatty necrosis, pregnancy, infections other than mumps, including varicella zoster, repeated marathon running.
The most common demographic causes of pancreatitis, (to be) _____ as follows :
Western countries - chronic alcoholism and gallstones accounting for more than 85% of all cases
Eastern countries - gallstones
Children - trauma
Adolescents and young adults - mumps

Investigations may (to include):
Blood Investigations - Full blood count, Renal function tests, Liver Function, serum calcium, serum amylase and lipase, Arterial blood gas
Imaging - Chest Xray, Abdominal Xrays and CT abdomen

Treatment
In the management of acute pancreatitis, the treatment (to be) _____to stop feeding the patient, giving him or her nothing by mouth, giving intravenous fluids to prevent dehydration, and sufficient pain control.
SSurgery (to indicate) __________________ for (i) infected pancreatic necrosis and (ii) diagnostic uncertainty and (iii)complications. The most common cause of death in acute pancreatitis (to be) ______ secondary infection.

Complications may (to include)
•   multiple organ dysfunction syndrome, hypocalcemia, hyperglycemia and insulin dependent diabetes mellitus; pancreatic pseudocyst and phlegmon / abscess formation, splenic artery pseudoaneurysms, hemorrhage from erosions into splenic artery and vein, thrombosis of the splenic vein, superior mesenteric vein and portal veins, duodenal obstruction, common bile duct obstruction, progression to chronic pancreatitis
Epidemiology
Annual incidence in the U.S. is 17 per 100,000 population.
Prevalence in the US is 80,000 cases per year.
Pancreatic cancer (to be) ____a malignant tumour within the pancreatic gland. Each year about 32,000 individuals in the United States (to diagnose) _______________ with this condition, and more than 60,000 in Europe. Depending on the extent of the tumour at the time of diagnosis, the prognosis (to regard) _____ generally _______________ as poor, with few victims still alive 5 years after diagnosis, and complete remission still extremely rare.

About 95 percent of pancreatic tumors (to be) ______ adenocarcinomas. The remaining 5 percent (to include) ______________ other tumors of the exocrine pancreas.
Early diagnosis of pancreatic cancer (to be) ____ difficult because the symptoms (to be) _____ so non-specific and varied. Common symptoms (to include) _____________ abdominal pain, loss of appetite, significant weight loss and painless jaundice. All of these symptoms can (to  blame) ______________ on other causes. Therefore, diagnosis of pancreatic cancer (to be) _____ often late-stage in its development.
Risk factors for pancreatic cancer (to include) _________________:
Age
Gingivitis
Male gender
African ethnicity
Smoking
Diets high in meat
Obesity
Diabetes
Chronic pancreatitis has been linked, but is not known to be causal.
Occupational exposure to certain pesticides, dyes, and chemicals related to gasoline
Family history
Helicobacter pylori infection

Pancreatic cancer (to discover) _____ usually _______________ during the course of the evaluation of aforementioned symptoms. Liver function tests may (to show) __________ a combination of results indicative of bile duct obstruction  Imaging studies, such as ultrasound or abdominal CT may (to use) ______________ to identify tumors. Endoscopic ultrasound (EUS) (to be) ______ another procedure that can (to help) ________________ visualize the tumor and obtain tissue to establish the diagnosis.

Treatment of pancreatic cancer (to depend) ______________ on the stage of the cancer. Recent advances (to make) _____________________resection (surgical removal) of tumors that (to be) ________ previously unresectable due to blood vessel involvement possible.
Patients diagnosed with pancreatic cancer typically (to have) ________________ a poor prognosis partly because the cancer usually (to cause) _______________ no symptoms early on, leading to metastatic disease at time of diagnosis. Median survival from diagnosis (to be) _____ around 3 to 6 months; 5-year survival (to be) ______ much less than 5%. . With 32,180 new diagnoses in the United States every year, and 31,800 deaths, mortality (tp approach) ________________ 99%, giving pancreatic cancer the #1 fatality rate of all cancers and the #4 cancer killer in the United States amongst both men and women.
Pancreatic cancer occasionally may (to result) _______________ in diabetes.
Prevention of pancreatic cancer (to consist) ________________ of avoiding risk factors when possible. Cigarette smoking (to consider) ___________________________ to be the most significant and avoidable risk factor for pancreatic cancer. Maintaining a healthy weight and exercising may (to be) _____ helpful. Additionally, increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake (to recommend) __________________________.

In September 2006, a long term study (to conclude) _______________ that taking Vitamin D can substantially (to cut) _________________ the risk of pancreatic cancer (as well as other cancers) by up to 50%.