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Pancreas
Thepancreasislocatedintheabdomen,tuckedbehindthestomach.Itisshapedsomewhatlikea tadpole-fatatoneendandslenderattheother-andisaround25cminlength.Thepancreashas dualroles;itisanorganofthedigestivesystemandoftheendocrine(hormonal)system.Once foodhasbeenmulchedandpartiallydigestedbythestomach,itispushedintotheduodenum(first partofthesmallintestine).Thepancreasaddsitsowndigestivejuicesandenzymestothefood, viaasmallductattachedtotheduodenum.Thisprocessissaidtobelongtothe'exocrine pancreas'.Thepancreasalsoproducesthehormoneinsulin,whichhelpstocontroltheamountof sugarintheblood.Thisistheroleofthe'endocrinepancreas'. The exocrine pancreas Thepancreashelpstodigestfood,particularlyprotein.Pancreaticjuicescontainenzymesthatonly becomeactivatedoncetheyreachtheduodenum.Thisistopreventtheprotein-digestingenzyme trypsinfrom'eating'theprotein-basedpancreasoritsduct.Otherenzymesproducedbythe pancreasincludeamylase(tobreakdowncarbohydrate)andlipase(tobreakdownfats).The exocrinepancreasalsomakessodiumbicarbonate,whichhelpstoneutralisethestomachacidsin thefood. The endocrine pancreas Thepancreasmakesthehormoneinsulin,whichhelpstocontrolbloodsugarlevels.Insulinis manufacturedbyasmallclumpofpancreaticcellscalledthe'isletsofLangerhans'.Highblood sugarlevelspromptthereleaseofinsulinfromtheisletsofLangerhans,sothatthesugarscan passintocells.Theendocrinepancreasalsomakesglucagon,anotherhormoneinvolvedinthe regulationofbloodsugar. Symptoms of disease Thesymptomsofadiseasedpancreasdependontheunderlyingcause,butmayinclude: Painintheupperabdomen Lossofappetite Yellowingoftheskinandeyes(jaundice) Backpain Bloating Nausea Vomiting Digestiveupsets Passingfoul-smellingandfattyfaeces.

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A range of disorders Someofthedisordersthataffectthepancreasinclude: Acutepancreatitis Chronicpancreatitis Pancreaticcancer Diabetes.

Acute pancreatitis Acutepancreatitisisinflammationofthepancreas.Thisisamedicalemergencyandrequires prompttreatment.Itoccurswhenthepancreassuddenlybecomesinflamed-theenzymescan't leavethepancreasandsocauseirritationandburning.Enzymesmayalsoleechintotheabdominal cavity.Thetwomostcommoncausesforpancreatitisaredrinkingtoomuchalcohol(alcohol inducedpancreatitis)andgallstoneswithinthebiletubes(gallstonepancreatitis).Otherfactors thatmaytriggeracutepancreatitisinclude: Certaindrugs

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Mumps Damageortraumatothepancreas Pancreaticcancer.

Chronic pancreatitis Chronicpancreatitismeansrecurringboutsofinflammation,evenwhenknowntriggers(suchas alcohol)areeliminated.Alcoholicsareatincreasedriskofdevelopingthiscondition.Therelentless inflammationeventuallydamagesordestroyspartsofthepancreas,reducingitsfunction. Symptomsincludedigestiveupsetsandpassingfatty,foul-smellingstools. Pancreatic cancer Pancreaticcancerstartsinthecellsoftheductandspreadsintothebodyofthepancreas.Nearby bloodvesselsandnervesmaybeinvaded.Withouttreatment,thistypeofcancerwillspreadto everyabdominalorganandtootherpartsofthebody,viathelymphaticsystem.Thecausesare unknown,butriskfactorsmayinclude: Cigarettesmoking Chronicpancreatitis Advancingage(over65years).

Diabetes Insomecases,theisletsofLangerhanscan'tproduceenoughinsulin,sobloodsugarlevelsremain high.Inothercases,insulinisproducedbutthebodyisunabletoutiliseit,forreasonsunknown. Complicationsofhighbloodsugarlevelsinclude: Kidneydamage Eyedamage Nervedamage Increasedriskofstroke Increasedriskofheartattack.

Diagnostic methods Diagnosticmethodsdependonthedisorderunderinvestigation,butmayinclude: General tests-suchasbloodtests,physicalexaminationandx-rays. Ultrasound-soundwavesformapictureofthepancreas. Computed tomography (CT) scan-aspecialisedx-raytakesthree-dimensionalpictures ofthepancreas. Magnetic resonance imaging (MRI)-similartoaCTscan,butmagnetismisusedto buildthree-dimensionalpictures. Endoscopy-athintelescopeisinserteddownthethroat.Thisdevicemaybeusedto injectcontrastingdyeintothepancreaticductpriortox-rays. Laparoscopy-thepancreasisexaminedthroughaslenderinstrumentinsertedintothe abdomen. Biopsy-asmalltagofpancreatictissueistakenoutwithaneedleandexaminedina laboratory.

Treatment options Treatmentdependsonthecause,butmayinclude: Acute pancreatitis-hospitalisationinintensivecare;fastingandintravenousfluids; surgerytoremovegallstonesordamagedsectionsofpancreas;lifestylechanges,suchas eliminatingalcohol. Chronic pancreatitis-longtermtreatmentmayincludereducingdietaryfats; supplementingdigestionwithpancreaticenzymetablets;eliminatingalcohol;taking regularinsulininjectionsforreducedendocrinefunction. Pancreatic cancer-surgerytoremovethecancerandassociatedtissue;radiotherapy andchemotherapy. Diabetes-insomecases,diabetescanbemanagedwithacarefullycontrolleddiet.In others,thepersonmayalsoneedtotakeregularmedicationsorinjectionsofinsulin.

Where to get help

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Yourdoctor.

Things to remember

Thepancreashasdualroles;itisanorganofthedigestivesystemandoftheendocrine system. Theexocrinepancreasproducesenzymesthathelptodigestfood,particularlyprotein. Theendocrinepancreasmakesthehormoneinsulin,whichhelpstocontrolbloodsugar levels. Disordersofthepancreasincludeacuteorchronicpancreatitis,pancreaticcancerand diabetes.

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NorthEastValleyDivisionofGeneralPractice

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