jinavie:

(Learn more about the organs of the human bodies in other posts in the Viscera series here: http://jinavie.tumblr.com/tagged/viscera/chrono)

The pancreas is probably the most central organ in the human body. It is situated just under the liver and stomach, surrounded by the duodenum (first part of small intestine) and lies in front of the aorta. It is shaped like a fish and thus is divided into parts named the head, neck, body and tail. The head of the pancreas tucks into the loop of duodenum and drains its contents via the pancreatic duct, which joins with the common bile duct (from the liver and gallbladder).

The function of the pancreas is divided into two functions: exocrine and endocrine.

An exocrine gland is an organ that excretes its products out of the body (including the intestines), such as the salivary or tear glands. The exocrine function of the pancreas is the production and secretion of digestive enzymes that break down proteins, fats and carbohydrates in the small intestine. Because of this, injury to the pancreas often causes a leak of this digestive juice, causing the body to self-digest the pancreas (leading to pancreatitis) and surrounding organs. 

An endocrine gland is the opposite in that it secretes its contents into the bloodstream. These glands typically produce hormones, such as the thyroid, ovaries and adrenal glands. The pancreas’ endocrine function is related to an extremely common yet deadly disease: diabetes. Within the pancreas, there are millions of cells that cluster into groups called islets of Langerhans. There are various types of cells, but the most common are the alpha-islet cells that secrete glucagon and beta-islet cells that secrete insulin. Insulin acts to lower blood sugar (glucose) levels by promoting storage and use of glucose after a meal. Glucagon acts to increase blood glucose by promoting the breakdown of glucose storage units (glycogen) and the production of more glucose by the liver. Diabetes occurs when beta-islet cells fail to produce insulin because they are destroyed by the immune system (type 1 diabetes mellitus) or become desensitised by chronically elevated blood glucose levels (type 2 diabetes mellitus).

Another important disease concerning the pancreas is pancreatic cancer. Pancreatic cancer is notorious for its deadliness as it carries a 5-year mortality rate of over 95%. This is because it usually remains hidden - without any symptoms - until it as grown substantially and spread to other organs. However, this prognosis only applies to the most common type of pancreatic cancer involving exocrine cells (adenocarcinoma). There are far rarer cancers of the pancreas that involve the endocrine cells (e.g. insulinoma), which tend to have extremely good prognoses and are usually curable. 

Steve Jobs (founder of Apple Inc.) had this kind of pancreatic cancer - an islet cell neuroendocrine tumour. Despite his excellent chance of cure with chemotherapy and surgery, he refused treatment for nine months and instead relied on alternative medicine for cure. However, his disease worsened and he finally resorted to having surgery. By this stage, his disease had spread to the liver due to the nine-month delay in treatment. Spreading of cancer is called metastasis and is often an indication that the cancer is no longer curable. Jobs went against his doctors’ advice and opted for a liver transplant in the hopes of curing his cancer. Organ transplant involves suppressing the patient’s immune system (which also keeps cancers in check) to prevent rejection of the donor organ, which is why oncologists advise against transplants in cancer patients. Jobs’ condition deteriorated quickly after his liver transplant and his decisions ultimately led to his demise. 

I feel sad cause I feel like I’m neglecting all of you. But being preggo is a lot of work, and then working on top of being preggo is a lot of work. I’ll try and get the queue loaded up here shortly. Meanwhile, I hope everyone is staying healthy and everyone’s pancreas has been behaving!

madeofgoldx:

I NAMED HIM PANCRY. Got treat him nice, ya know? Maybe he’ll decide to work.

Alright, so I went in for an ERCP. My whole process has been a bit rushed and so I’m adding that to some of my confusion. I feel great now so I’m thankful, but for those who aren’t sure going in, here’s my walk through, along with a few links at the bottom that are pretty helpful. Some of this may be repeat for a few of my followers, but I figured one big summary is good!

When my ERCP was scheduled it was through a long frustrating process. I’ve touched on my pancreatitis attack, and implied that I am not overly happy with my care received on my follow ups. (I only had 1 apt). I went for my physical to make sure I was “Healthy and ok to conceive and carry a baby”, and I was given the thumbs up. They didn’t even find the cyst until 2 months into my pregnancy, despite me voicing the discomfort, hardness, and growing of my tummy. After being told “The cyst isn’t really a big deal, they probably won’t even drain it after”, I finally listened to some friends and family and we asked for a closer look. After that, we were referred to a perenatal specialist as we were concerned for baby. He took one look at my ultrasound and told me he was calling “Colorado’s Pancreas guy”.

Long story short, this phone call was made the day before Thanksgiving, and my ERCP was scheduled for December 17th. Within that time, it was made clear to all parties that I was in big need of the procedure, and was pregnant.

I had been told by a friend who has unfortunately had to deal with this surgery multiple times, that this procedure would be a great deal of pain, that I would be out for a week or so, but that I was in good hands with my particular Dr. (we happened to have the same one now!), and that he was very informative. Unfortunately what I was reading on the internet/heard from the head nurse when scheduling my apt, was completely different! I’d read that I’d be out for weeks, that I’d be in agonizing pain for weeks! Some said I’d not feel a thing. Some said I’d only be moderately uncomfortable, but able to work the next day. The nurse in fact said I could go back to work the next day. I was told by my Dr. that I should not be in any pain following the procedure, and if I was we needed to stay. Well here is my personal experience. I hope someone walks away with this info and finds it useful!

I was not allowed to drink or eat past midnight. I arrived at the hospital at 6am, was in a group of 4 or 5 other patients being admitted for various other gastro-intestinal surgeries or procedures. Once I was checked in, I was taken back to the prep area.

My IV was started, at which point the nurses, anesthesiologist and their team came and spoke with me about the risks/entire process. Then the OB on call came and spoke to me about the risks/entire process, letting me know what they’d be doing to monitor baby. Then the Drs came to speak with me about the process, and what to expect.

I was told that after I was put under completely, they would use a mouth guard to protect my teeth and tongue, and would then slide the scope down my throat to my stomach. I was told a minimal amount of radiation for xrays would be used, along with ultrasounds and other means to gather information about the size and location of the cyst, but that those things using radiation in my case would be used at a minimum due to my fetus. I was informed about any minor ouchies I may acquire due to scopes, guards etc being put in my mouth…(none of which I experienced), and the general process from start to finish.

When I entered the OR, I was talked through the process as well as any learning Nurses/Drs (It is a university hospital) and when it came down to anesthesia time, I was told “Alright be ready for the unpleasant burning feeling in your hand.” That’s the anesthesia part. It’s very uncomfortable, it feels like a very hot wash over your arm, but it’s very very fast, only 5o 10 seconds, I felt it reach my head but was immediately under after that.

During my surgery they removed almost 3 liters of fluid from the cyst, and then placed 3 stents between the duodenum and the cyst so that any remaining fluid could drain on it’s own.

The next thing I remember vaguely is them removing the scopes/tubes from my throat. You have to be “sort of awake” for them to do this as they use your gag reflex to help expel the instruments. I was not awake enough to be really uncomfortable though, and it’s a very fast process. Once I was up and not so groggy, I started to throw up.

It’s not necessarily normal to throw up after this procedure, but because I had SO MUCH fluid in my stomach from the cyst, some of which had old blood in it from an internal damage or rupture of some sort, I was vomiting intermittently. The general consensus of nurses and drs involved was that I was nauseous and vomiting from the blood. So they chose to keep me overnight. Normally I would have been released a few hours after recovery.

I was a bit shaky on my feet afterwards, just from the anesthesia and recovery. But was was REALLy awesome was that my tummy was soft again. Not rock hard from the giant balloon in my gut. I felt pretty dang good immediately after my surgery. I was not in pain…I felt…awkwardly tender but did not hurt.

Please keep in mind I was only able to utilize Tylenol for pain relief, because I am pregnant any narcotics  (the good stuff!!) couldn’t be used! I was informed later by the attending nurse that when people come in for recovery from an ERCP, they’re pretty doped up. So you should have some good pain meds on board.

I did not get sore until later that evening. I really feel as though I am a bit of a different case, as my cyst was so big, that when it was removed all my guts relaxed back down and moved a WHOLE lot. All that soft and connecting tissue moved a whole lot. By day 2 I felt like my guts had been scrambled. I was not in excruciating pain, but I was very uncomfortable. Day 3 was as much pain, but in a different place, day 4 was much of the same.

I had asked for 3 days off from work, so I would in theory go back to work Thursday evening (surgery was monday morning). As of weds afternoon I had called to ask for thursday evening off. I also attempted to get up and be out and about starting weds. This was a terrible idea. I don’t consider myself to be a weenie by any stretch of the imagination, but getting up too soon was not a good idea. I tried to go out to just do some holiday shopping in my PJs, and after making one stop at the grocery store I was sweaty, panting, and in a ton of pain. I made the mistake AGAIN (glutton for punishment) Thursday, but managed to stay out a bit longer and get more done before needing a nap. It really takes it out of you!!

However, when I woke up Friday morning, the difference was huge. I still hurt, but not in a way that I couldn’t function. I ended up going back to work that evening, and was no worse for wear because of it.

So a total of 5ish days was about how long it took me to recover. I still “felt it” the weekend following the surgery, but I was not in any huge amount of pain.

So. 5 days, I slept in a recliner for about a week. (just easier to get in and out), and am now back in bed and doing just great!

If anyone has any questions for me, as always my ask is wide open. Anyway, here’s a few links for you!

National Digestive Diseases
Information Clearinghouse (NDDIC)

Post ERCP

Okay. lol, it seems like so much longer then 2 weeks since I posted last!

Anyway, here’s my update! (all really good!) It’s a little gross in places, so just be forewarned.

So I went in for my Surgery on December 17th. Went in at a bright and chirpy 6am!

I was almost immediately in surgery, after prepping me and speaking with me, I was probably in the ER room and ready for anesthesia by 830? The surgery itself was relatively fast. Only about an hour and 45 minutes. Here’s how things went!

My surgery took a smidge longer then normal, due to the size of my cyst. Once in, they ended up draining almost 3 liters of fluid. That is A LOT of fluid! From the time I was weighed before my surgery, to the time immediately following, I lost a total of 12 lbs. Since the surgery I lost another 4. They placed 3 stents (the normal going quantity is 1) between my duodenum and the cyst, and I continued to vomit almost another half liter of fluid following my procedure. Normally I would have been released from the hospital immediately, but because I couldn’t stop throwing up (understandably) they kept me until the following morning.

I want to go into detail a little bit about the surgery, because I was VERY confused and a bit misinformed about the whole process. I couldn’t get a straight answer from anyone…the internet gave me 5 different outcomes…my doctors/nurses words were different then that of people I’d spoken to regarding recovery. So I’m throwing this out there incase any of you have to go through the same procedure. I’m going to make a different post about it though, so the details don’t get all caught up!

But I just wanted to say…Everything else is great. I feel fantastic, for the first time in a really long time. I can eat a real sized meal without being uncomfortable or sick. I can SLEEP ON MY TUMMY!! I don’t have massive discomfort for no real good reason. It’s fabulous. Baby is doing really well, we’re almost 21 weeks now. We found out that we’re having a little girl. She’s so far healthy and happy and active!

Thanks to everyone for your well wishes and now that all is back to normal, I’ll be back on the hunt for more pancreas stuff for the blog!

Hope everyone had a safe, and alcohol free NYE!