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Know your pancreas – Punch Newspapers

The pancreas is an organ within the abdomen that is a member of the digestive system. It is situated at the back of the stomach and lies across the cavity such that its head is located in the right side of the abdomen while its tail is in the left side. The head is big relative to the rest of its body while the tail is its narrow end, thus giving the organ an oblong shape. The head is connected to the first part of the small intestine, called the duodenum, through a small pipe known as the pancreatic duct. With this tube, it is closely related to the tube which brings bile from the gallbladder to that same area of the small intestine. It is also called the bile duct. Both of them work in tandem to secrete their respective products into that part of the small intestine where they are indispensable for the important work of digesting the food we eat.

It is important for the management of the use of sugar in the body and for making energy available to the body following proper digestion. When there are symptoms of digestive problems linked to the pancreas, there will be loss of appetite, abdominal pain, weight loss and the passing of fatty, smelly and big stools.

This organ contains glands that produce certain enzymes that are critical to the digestive process. These enzymes are known as lipase to break down fats; amylase to break down carbohydrates and both trypsin and chymotrypsin for the breakdown of proteins. These enzymes characteristically operate in the neighbourhood of the pancreas which means they are poured into the duodenum where they come into contact with food and commence their unique actions. These are different from certain hormones produced by the pancreas which have the ability of operating in different parts of the body to produce their effects. These substances have profound effects around the body, not just within the intestinal tract like the enzymes and, include insulin, glucagon, gastrin and somatostatin. Insulin helps with the reduction of blood sugar and helps to make it available for the creation of energy essentially in cooperation with glucagon, which helps to raise it. The latter helps with storage of body sugar. Gastrin aids digestion by stimulating certain cells in the stomach to produce acid which is regulated by glucagon.

As a result, it can be appreciated that in the pancreas, there is a check for any action. When there is a disease condition affecting the pancreas, certain changes occur depending on which group of cells is involved. Therefore, when there has been an inflammation of the pancreas, scar tissues develop which leads to the increase in secretion of amylase which can be measured in the blood. If there is beta cell damage, there is a rise in blood sugar levels in keeping with diabetes. When there is damage to the alpha cells, glucagon secretion is affected and can no longer prevent blood sugar from dropping too low. Cells known as delta cells produce somatostatin while gamma cells produce gastrin. Therefore, it can be seen here that alpha, beta, delta and gamma cells in the pancreas secrete different types of hormones for different functions. All of them are located in a specific part of the pancreas known as the islets of Langerhans. This makes the pancreas a truly unique organ judging from the range of functions it conducts around the body. Because of its unique properties, it is somewhat easy to investigate it for many disease conditions with simple blood tests. However, as diseases linked to it become more complex, so too are the tests required and their associated costs.

A physical examination of the abdomen is always the place to begin the examination of the pancreas. When the centre of the abdomen is pressed upon, it is possible to check for lumps and swellings.

Any pain found in association with such an examination usually radiates to the back. The next investigation should be an abdominal ultrasound scan by which any growth within the pancreas can be noted. Such an examination can help show the presence of a cyst or an abscess and can also determine whether the pancreatic duct has a normal caliber or not. If there are stones in the gallbladder, especially if they are blocking the flow of its secretions into the small intestine, they can also be detected. A CT scan (computed tomography scan), can further clarify the nature of such a condition through the elaboration of detailed images that will help show whether there is a fluid collection which may be the case following injuries to the abdomen, or an abscess following an infection. The collection and retention of enzyme collections can form a detectable cyst. With the injection of a contrast medium into the veins, these images are brought into even better relief. Usually, this enhances the accuracy of the diagnosis made.

Now, the MRI (magnetic resonance imaging) is superior in resolution to the CT scan. This can be deployed for an even more specific elucidation of the nature of the organs in that part of the abdomen. Therefore, the gallbladder and pancreas, together with their drainage systems are subjected to detailed examination by this means. The liver and its portal vessels and drainage systems are also part of this exercise. With this tool, a magnetic resonance cholangiopancreatography (MRCP) can be done being that it is a specialised investigation that will look and assess the pancreas, liver and biliary system. Even better than these tools is another piece of equipment called endoscopic retrograde cholangiopancreatography (ERCP). These are names that are jaw-breaking but this week, we found no ways to make them simpler. However, this latter investigative equipment is made up of a system in which a patient is made to swallow a flexible tube containing a series of mirrors and a camera, with which a doctor can gain access into the intestine and look in detail at the head of the pancreas for the purposes of diagnosis and also conduct treatment. Through this means, a biopsy can also be obtained and the tissue harvested examined in a histology laboratory.

Where ERCP is not available, and a biopsy is required to make a diagnosis, this can be done with a long needle through the skin to harvest a small bit of the pancreas for proper examination at a laboratory. This can also be obtained through a small incision made on the skin but the advancement of the needle subsequently can be controlled with the benefit of an ultrasound machine. Such a biopsy can also be done using a CT scan or MRI for accurate direction of the biopsy needle. Blood tests for amylase and lipase levels can show that the pancreas has been injured or become inflamed if they are higher than normal. Elevated blood sugar levels also help to diagnose diabetes but indirectly point at problems with the beta cells of the islets of Langerhans. Finally, it is possible to conduct endoscopic ultrasound investigations in which a scan uses high frequency sound waves to produce detailed visual images of the walls of the intestine and the nearby pancreas, liver, gall bladder and surrounding lymph nodes. While many public hospitals in our country have the trained hands to handle many of these procedures, most of the required equipment are in private healthcare facilities where the doctors from the public institutions use them to advance the care of the people who need those services and can afford them.

Questions and answers

Dear doctor, if I am walking and I mistakenly hit my foot against a stone, I feel the pain at the top of my skull. The pain is sharp as if they hit a hammer on my head. I do not understand what is happening to me anymore but the headache is terrible.  What should I do sir? 0808xxxxxxx

This is an intriguing question but it is possible that the cause is not far to seek. I would advise you to run a basic blood test that must include a blood film for malaria parasites. The cause is likely to be found in those tests and the treatment should then become straight-forward. It is good to start small and if needed, your doctors can request for further tests after these results must have been obtained. Good luck.

Dear doctor, I learnt that taking too much cloves can affect the kidneys and the liver. But I take mine after soaking them for three days in an Eva bottle. It would then look like those roadside herbs that women sell. How much of that do you recommend? Also a plant called small leaf is said to be good for the body. What’s your advice sir?            [email protected]

The truth is I do not know the plant you called small leaf and so I am unable to give you any form of advice about it. As for cloves, it is conventional wisdom that anything you take excess of is bad. It is extreme to soak it for days before being consumed and this concoction could actually harm you as some fermentation is likely to have occurred to it. Cloves are usually chewed or added to hot water or tea and consumed. That means it ought to be taken as fresh as possible. Sometimes, it is also processed into powder and added to boiling meat or soup as an additive just like you might use thyme or turmeric.

Dear doctor, I have a daughter aged eight years with a vaginal discharge which is itchy, according to her. The discharge is off-white to yellow and stains her pants every day. Now, there are small boils both around the vagina and close to the anus. What could these be and what do we do to deal with it? We have been at a house where there were four adults and two other children using just one toilet. Could that be a contributory factor? Please help.        0810xxxxxxx

Well, the toilet is most unlikely to be a contributor. It perhaps has got a lot more to do with her genital hygiene not being good enough. It can be made worse if she is also allowed to bathe on her own and wear soiled and previously used underwear. All of that is beside the point, however, and the most important thing to do is to get her to see a doctor or more specifically a paediatrician for swab tests of the discharge and the attendant treatment.

 Dear doctor, is there anything I can do to deal with my skin which is excessively dry and causes me a lot of itching especially at night? Please help me because I become miserable every night when it is time to sleep especially when it is combined with this insane heat and the general absence of light. 0705xxxxxxx             

There are different types of materials you can use to keep your skin moist. However, you did not disclose your age or your gender which are important in the end in giving you the most useful kind advice you might need. There are soaps you can use which will leave your skin feeling like velvet. After a normal bath, you can then apply a moisturising lotion or cream which will ensure that the skin retains its elasticity and does not lose its suppleness with ease. It is usually beneficial to know if you are being treated currently for any health condition. If not, after using these skin products for several weeks, there ought to be some improvement failing which you should properly see a dermatologist for the best possible advice.

Dear doctor, I am a 24-year-old lady. At first, my vagina started itching me all the time, and then, it began to swell up. I decided to do an online search and I began to think it was a yeast infection. So please help me, doctor. I always read your essays in Sunday PUNCH. Please tell me what to do because the right vulva is very much swollen and also painful to such an extent that I now walk awkwardly. Thank you sir.         0813xxxxxxx      

Well, a visit to the hospital should help solve this problem by first setting out to find out what all this is about. You will get a proper clinical examination of the vagina. Also, swabs will be taken of the discharge your vagina might have. You are not likely to be dealing with a yeast infection alone. And the vaginal swelling may yet be something else. The abnormal manner in which you now walk could be due to a bartholin’s cyst or even an abscess which would require proper attention. Although different micro-organisms acting together can cause this type of problem,  it is important to know which ones they are so that proper treatment can be reached before any further damage occurs. However, you have not mentioned the presence of a discharge so that this could well be an allergy.

 Dear doctor, good day to you. Is there any hospital in Nigeria that dedicates itself to the treatment of the elderly? I have aged parents, now in their late 80s and early 90s, my mother being the younger, and even though they are in fairly good health, they do not remember things or even names. Is this dementia? Please give me some advice. Thank you. 0813xxxxxxx   

At such an advanced age, certain levels of dementia are to be expected. It is a part of the inevitable physical and mental decline that occurs as we age. Going forward, there are certainly hospitals that exist for the treatment of the elderly and for the special conditions that they suffer from. There is such a unit at the UCH (University College Hospital), Ibadan, Oyo State and also at the University of Benin Teaching Hospital, Benin City, Edo State. It helps that the age bracket your parents belong to are also managed in the bigger hospitals where many different experts are to be found in close proximity.

Dear doctor, I am a 52-year-old woman and I live in Abuja. I usually suffer from terrible stomach pain whenever it is in the hot season like this. It has been happening to me since when I was a child and my mother recently reminded me of it when she visited. Normally, I will go to the toilet often after having the pain. Initially, I thought that it was the rice I ate with vegetables but when she reminded me I decided to be calm but is this possible?  Sometimes, I even feel like fainting and the pain will be so much that one would think it is something else like food poisoning.0803xxxxxxx

Well, you can suffer from some strong adverse stimuli depending on your mental constitution. People can experience similar discomfort and vomit or have the urge to use the toilet like you have experienced when they sight human blood as it flows from a wound. Some people can have this kind of reaction when they enter a hospital. Others can do so when they come upon an accident scene or some other scenario where there is human suffering. If intense temperatures make you truly uncomfortable, you can suffer similar effects and throw up or pass stool as well as experience abdominal pain. Sometimes, there can be profound dizziness with sufficient intensity to make one fall. For the record, severe heat can make your stomach churn violently some times and cause you significant pain with consequences like you have described above.

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