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What is Pancreas Divisum
Pancreas division is a common congenital anomaly that is present during birth occurring within the pancreatic duct(s).
The pancreas is a deep seated organ located behind the stomach.
One of its functions is to create enzymes that are critical for the digestion of food in the intestine.
The digestive enzymes, in the form of a digestive fluid, drain from the pancreas via the pancreatic duct into the duodenum which is the smallest intestine, and where it helps assist in food digestion.
What Causes pancreas Divisum?
The human embryo begins life with a pancreas that is separated into two portions; each portion has its duct, which is the ventral duct and the dorsal duct. The two parts of the pancreas will fuse over time during the growth of most embryos; the ventral and dorsal ducts will combine and form one main pancreatic duct. The main pancreatic duct will combine with the common bile duct ( the duct that drains bile from the gallbladder and the liver ) to create a common bile and pancreatic duct which empties into the duodenum through the major papilla.
In some embryos, the dorsal and the ventral ducts fail to fuse. Failure of the ventral and the dorsal pancreatic ducts to connect is called pancreas division because the pancreas is emptied by divided ducts. In pancreas division, the ventral duct drains into the major papilla while the dorsal duct drains into a separate minor papilla.
What are some of the symptoms of pancreas Divisum
Most children born with pancreas divsium will have no symptoms throughout life, In many cases, it will remain undiagnosed, and will not need treatment. There is a small number of people with pancreas divisum who will undergo repeated episodes of pancreatitis. Pancreatitis is a swelling of the pancreas that can cause abdominal pain as well as more severe complications. Some patients with pancreas divsium can develop chronic abdominal pain without pancreatitis.
Doctors are not clear how pancreas divisum causes abdominal pain and pancreatitis. One thought is that the minor papilla is too narrow to adequately drain the digestive fluids in the dorsal area of the pancreas. The backup of the digestive fluids elevates the pressure within the minor duct that triggers abdominal pain and pancreatitis. Other doctors believe that there must be additional factors above and beyond the anatomic anomaly of pancreas division that increases the risk of certain individuals in the population of patients to develop pancreatitis. Research continues to determine the specific relationship.
Most sufferers with pancreas divisum persist to be asymptomatic, and therefore the prognosis is exceptional. For those patients with symptoms of pancreatitis, the prognosis is no different from that of the natural population who exhibit pancreatitis. Even after therapy, pancreatitis may recur. It is essential to remember that there is no clear evidence to support a causal relationship between pancreas divisum and parties.
More About ERCP or Endoscopic Retrograde Cholangial-Pancreatography)
- ERCP is a diagnostic procedure devised to examine diseases of the liver, gallbladder & pancreas, bile ducts, the duodenum (first portion of the small intestines); the papilla of Vater, small nipple-like portion with openings leading to the bile ducts and the pancreatic duct
- ERCP is completed under intravenous sedation, normally without general anesthesia.
- ERCP is an irritating but not painful procedure; There is the low incidence of complications.
- ERCP can provide valuable information that cannot be obtained by other diagnostic examinations such as CT scan, MIR or abdominal ultrasound.
- The frequently therapeutic measure can be performed at the time of ERCP to remove stones, in the bile ducts or relieve obstructive of bile ducts.
What Can You Expect Before and After an ERCP procedure?
The sufferer will be presented medications by a vein to cause relaxation and drowsiness. The patient will be supplied some local anesthetic to reduce the gag reflex. Some doctors do not apply local anesthetic and favor to proffer the patients via further intravenous medications for sedation. This also goes for those patients who have a history of allergy to Xylocaine or cannot endure the bitter taste of the local anesthetic and the paralysis sensation in the throat. While the patient is lying on the left side on the X-ray table, the intravenous medicine is given, and then the instrument is entered gently through the mouth into the duodenum. The device advances through the food pipe and not the air pipe. It does not conflict with the breathing and gagging is usually blocked or reduced by the medication.
When the patient is in a semi-conscious state, they can, however, follow instructions such as adjusting the body position on the X-ray table. Once the device has been advanced into the abdomen, there is minimal discomfort except for the foreign body sensation in the throat. The procedure can take as long as fifteen minutes to one hour, depending on the experience of the physician, what needs to be achieved, and the anatomy or deformities in that area. ERCP also may be conducted under light, general anesthesia.
After the procedure, patients should be evaluated in the rehabilitation area until most of the effects from the medications have diminished. This usually takes one to two hours. The patient may feel bloated or somewhat nauseated from the medications or the procedure. Very rarely patient experiences are vomiting and can have occasions of a belch or pass gas through the rectum. Upon hospital discharge, the patient should be driven home by a companion and is encouraged to stay home for the rest of the day. The patient can continue usual activity the next day. Even though the physician may explain the findings to the patient or companion after the procedure, it is still necessary to follow-up with the physician after the procedure to ensure that the patient understands the results of the examination.