Biliary and Pancreatic Pathologies PDF

# **Nutricional** - The choice between enteral or parenteral nutrition will depend on several factors, including the type of fistula and the patient's nutritional status. - Whenever possible, the enteral route should be used. - If nutritional requirements cannot be met through this route or in case...

# **Nutricional** - The choice between enteral or parenteral nutrition will depend on several factors, including the type of fistula and the patient's nutritional status. - Whenever possible, the enteral route should be used. - If nutritional requirements cannot be met through this route or in cases of high-output fistulas, parenteral nutrition should be chosen. ## **High-output Fistulas** - Parenteral nutrition is recommended. ## **Low-output Fistulas** - **Proximal location:** Nasojejunal tube (SNY). - **Distal location:** Nasogastric tube (SNG) or adapted oral route. # **Pathologies of the Biliary and Pancreatic Ducts** ## **Anatomy of the Intrahepatic Biliary Ducts** - Hepatocytes are grouped together to form hepatic lobules, which in turn form lobes. - In the lobules, hepatocytes function as channels called bile canaliculi, which enlarge and give rise to bile ducts. - The portal triad is formed by the hepatic ducts, the portal vein, and the hepatic artery. - These bile ducts branch out, forming the intrahepatic ducts. - Bile is stored in the gallbladder, which connects to the cystic duct and then passes through the Sphincter of Lutkens. - When it reaches the duodenum, bile passes through the Sphincter of Oddi, located at the opening of the common bile duct. ## **Biliary Physiology** - The physiology of the biliary ducts involves a complex process that starts in the hepatocytes and ends with the secretion of bile into the duodenum. - Bile is a watery fluid secreted by the liver and plays a crucial role in the digestion of fats. - While water is its most abundant component (95%, from a functional standpoint, the most important elements are bile acids and salts. - These molecules act as surfactants, helping to emulsify and digest fats in the intestine. ## **Bile Composition** - The composition of bile can vary depending on health status and diet. - For example, foods rich in fats and proteins stimulate the production of hepatic bile, while carbohydrates reduce it. - It's important to differentiate between bile produced by the liver and bile stored in the gallbladder, as the latter becomes concentrated during periods when digestion is not taking place. - Bile components include, in addition to water, bile salts (0.7%), bilirubin (0.2%), lipids (0.51%), electrolytes, and proteins such as albumin. - Lipids include cholesterol, lecithin, and phospholipids, which play an essential role in fat digestion. - Bile is responsible for the excretion of cholesterol and fat-soluble substances, including certain vitamins (D, B12, and folic acid), estrogens, thyroid hormones, and medications. - Bile acids are synthesized in the liver from cholesterol, forming primary bile acids (cholic acid and chenodeoxycholic acid). - In the intestine, the intestinal flora transforms these acids into secondary bile acids (lithocholic acid and deoxycholic acid), which are then reabsorbed and return to the liver through the enterohepatic circulation, allowing for their recycling. - In the liver, bile acids are conjugated with the amino acids glycine or taurine, forming conjugated bile acids such as taurocholic acid or glycocholic acid. - These conjugated bile acids are dissolved in bile in the form of bile salts, Which are fundamental for digestion. - Bile circulates from the liver through small intrahepatic bile ducts, which join to form the right and left hepatic ducts. - These join to form the common hepatic duct, which when joined by the cystic duct (which connects to the gallbladder) forms the common bile duct. - The latter empties into the second part of the duodenum through the Ampulla of Vater, shared with the pancreatic duct. - Any obstruction in this area, such as caused by gallstones, can lead to pancreatitis and gallstones. - The emptying of the gallbladder is regulated by the hormone cholecystokinin (CCK), which stimulates gallbladder contraction and relaxation of the Sphincter of Oddi, allowing bile to pass into the intestine. - During periods when digestion is not taking place, the gallbladder can empty between 20 and 30% of its contents. # **Cholestasis** - Cholestasis is a medical condition involving decreased bile flow from the liver to the intestine. - This causes the buildup of substances that are usually excreted through bile, such as bilirubin, cholesterol, and bile acids. - The buildup of these substances in the blood can lead to various symptoms and health problems. - Cholestasis can occur intrahepatically (inside the liver) or extrahepatically (outside the liver). ## **Intrahepatic Cholestasis** - Occurs when there is a problem directly in the liver affecting the smaller bile ducts (bile canaliculi). - Examples include: - **Primary Biliary Cirrhosis:** An autoimmune disease that destroys intrahepatic bile ducts, hindering proper bile flow. - **Primary Sclerosing Cholangitis:** Inflammation and scarring of bile ducts inside and outside the liver that narrows or blocks these ducts, obstructing bile flow. - **Consequences:** Trapped bile inside the liver damages liver cells (hepatocytes), causes buildup of substances in the blood, and progressive liver damage. ## **Extrahepatic Cholestasis** - Occurs when there is a blockage in the main biliary ducts outside the liver that transport bile to the intestine. - Examples include: - **Gallstones:** Block the common bile duct (the duct transporting bile from the gallbladder to the intestine). - **Neoplasias:** Tumors that grow in the biliary ducts or nearby areas and obstruct bile flow. - **Stricture of the Common Bile Duct:** Narrowing of this duct due to inflammation or scarring. - **Consequences:** Bile is unable to reach the intestine, accumulating in the biliary system and backing up to the liver and blood. - Cholestasis causes a range of systemic effects due to the buildup of substances usually eliminated through bile. - One of the most significant effects is the buildup of bilirubin, which occurs when the liver cannot eliminate it properly, causing it to accumulate in the blood. - This leads to jaundice, a yellowish coloration of the skin and eyes. - Cholesterol also accumulates because bile is the main route for its elimination. - When this happens, cholesterol builds up in the blood and forms deposits on the skin called xanthomas. - Furthermore, elevated blood lipids (hyperlipidemia) increase the risk of cardiovascular problems. - Bile acids, which are essential for fat digestion, also accumulate in the blood in cholestasis. - This accumulation causes pruritus (intense itching of the skin). - The absence of bile in the intestine also hinders fat digestion and the absorption of fat-soluble vitamins, such as vitamins A, D, E, and K. - This can cause fatty stools (steatorrhea) and deficiencies in these vitamins. - Another important effect is elevated liver enzymes, especially alkaline phosphatase, which is an enzyme associated with the biliary ducts. - Elevated alkaline phosphatase levels in the blood indicate damage or blockage in the biliary ducts. - The combined effects highlight how cholestasis affects the body on multiple levels. ## **Manifestations of Cholestasis** - **Jaundice:** Yellowish discoloration of the skin and mucous membranes due to bilirubin buildup. - **Pruritus (itching):** Related to the buildup of bile acids in the blood. - **Xanthomas:** Small yellowish bumps on the skin resulting from cholesterol deposits. - **Hypercholesterolemia:** Elevated blood cholesterol levels due to the liver's inability to excrete it through bile. - **Digestive problems:** Particularly related to malabsorption of fats and fat-soluble vitamins, leading to fatty stools (steatorrhea) and nutritional deficiencies. ## **Treatment of Cholestasis** - **Treatment depends on the underlying cause.** - If the cause is extrahepatic cholestasis, treatment might involve removing the obstruction (for example, surgery to remove gallstones or tumors). - In the case of intrahepatic cholestasis, treatment focuses on managing the cause of liver damage. - **Difenhydramine can help with pruritus.** # **Cholelithiasis** - Cholelithiasis is the presence of gallstones (stones) in the gallbladder. - **Origin:** Gallstone formation is due to gallbladder dysmotility, supersaturation of bile, and cholesterol nucleation (precipitation of substances contained in bile). - **Association with diseases:** Cholelithiasis is often linked to conditions like obesity, Type 2 diabetes, dyslipidemia, and insulin resistance. ## **Risk factors for Cholelithiasis** - **Non-Modifiable Risk Factors:** - **Age:** Higher incidence in older individuals. - **Gender:** More prevalent in women. - **Genetics:** Family history increases risk. - **Modifiable Risk Factors:** - **Diet:** - Excessive calorie and carbohydrate intake. - Low fiber intake (high carbohydrate intake lowers CCK activity). - High fat intake. - **Weight:** - Obesity: increases bile secretion of cholesterol and alters gallbladder motility. - Rapid weight loss. - Abdominal visceral fat distribution. - **Metabolic Disorders:** - Dyslipidemia (especially hypertriglyceridemia): affects bile composition and emptying. - Insulin resistance (IR): increases bile secretion of cholesterol and alters gallbladder motility - Type 2 diabetes: Affects gallbladder motility. - **Other Factors:** - Parenteral nutrition. - Cirrhosis. - Chronic Alcoholism. - Gastric surgery and intestinal interventions. - These factors are closely linked to the metabolic syndrome, which can also lead to complications such as gallstones and non-alcoholic fatty liver disease. # **Cholelithiasis Pathophysiology** - **Gallbladder Dysmotility:** The gallbladder is responsible for storing and releasing bile in response to food. - In the case of gallbladder dysmotility, the gallbladder does not empty properly, promoting the accumulation and prolonged concentration of bile. - This creates an environment conducive to gallstone formation, which can be affected by factors such as obesity, Type 2 diabetes, and the metabolic syndrome, which impact gallbladder motility. - **Bile Oversaturation:** In a normal state, bile consists of cholesterol, bile salts, phospholipids, and water, among other components. - When there is an excessive amount of cholesterol in bile (hypersecretion), the excess cannot remain in solution, leading to cholesterol precipitation. - Factors contributing to bile oversaturation include obesity, a high-fat diet, dyslipidemia (especially hypertriglyceridemia), and insulin resistance, which increase bile secretion of cholesterol. - **Cholesterol Nucleation:** Nucleation is the initial step in gallstone formation. - Once cholesterol precipitates, it forms crystals that clump together and grow, transforming into gallstones. - This process is facilitated by the lack of nucleation inhibitors, which normally prevent cholesterol from forming crystals. - Insufficient production of bile acids, normally responsible for keeping cholesterol in solution, can also contribute to gallstone formation. # **Gallstones** - **Cholesterol Stones:** The most common type, usually yellow. They form when there's an excess of cholesterol in bile. - **Pigment Stones:** Composed of bilirubin, more common in individuals with conditions causing hemolysis (red blood cell breakdown), such as sickle cell disease or cirrhosis. ## **Clinical Manifestations of Cholelithiasis** - **Asymptomatic Gallstones:** Most individuals with gallstones are asymptomatic. These stones may remain in the gallbladder without causing significant problems and can pass through the digestive system unnoticed. - **Symptomatic Gallstones:** Approximately 20% of individuals experience symptoms, including serious complications in a small percentage (0.7%-2%). - **Biliary Colic:** The most characteristic symptom. The pain is typically abrupt and severe, reaching peak intensity within 30 to 60 minutes. - It is usually located in the right upper quadrant of the abdomen or epigastrium, and may radiate to the back, right shoulder, or between the shoulder blades. - This pain is caused by temporary blockage of the cystic duct or common bile duct by a gallstone. - **Other Nonspecific Symptoms:** Some individuals may experience indigestion, a feeling of fullness, abdominal heaviness, belching, abdominal distention, and nausea, which are less specific but can be associated with gallstones. ## **Diagnosis of Cholelithiasis** - **Abdominal Ultrasound:** The gold standard for imaging gallstones due to its accuracy in visualizing gallstones in the gallbladder. - **Cholescintigraphy or Gallbladder Scintigraphy:** Uses radioactive material (technetium-99m) injected intravenously. - The liver takes up the material and secretes it through the biliary system, allowing for images of the liver and gallbladder. - Useful in more complex cases and when there is a concern for bile duct obstruction. - **CT Scan:** Can reveal gallbladder wall thickening and fluid, but it is less accurate than ultrasound for detecting gallstones. ## **Treatment of Cholelithiasis** - **Surgical:** - **Laparoscopic Cholecystectomy:** Gold standard for symptomatic patients. - It involves removing the gallbladder through small incisions in the abdomen using a laparoscope and instruments. - This approach minimizes surgical trauma and leads to faster recovery. - **Open Cholecystectomy:** A more complex procedure performed through a larger incision in the right subcostal area. - Offers better exploration of the extrahepatic biliary system during the surgery. - **Non-Surgical:** - **Dietary Therapy:** Can help manage cholelithiasis in some cases, but it is not a replacement for medical or surgical treatment. - A low-fat and moderate-fiber diet can help prevent episodes of biliary colic. - **Antiemetics:** Medications such as Buscopan or Sertal can be used to relieve pain caused by gallbladder spasms. # **Complications of Cholelithiasis** ## **Cholecystitis** - Inflammation of the gallbladder, typically caused by a gallstone obstruction. - Can be acute or chronic. ### **Acute Cholecystitis** - **Causes:** - **Litiasis Cholecystitis:** The most common cause (85-90% of cases), due to the presence of gallstones. - **Acalculous Cholecystitis:** Accounts for the remaining 10-15% of cases, and can be caused by: - Septicemia. - Severe trauma. - Gallbladder infection. - **Pathophysiology:** When a gallstone blocks the cystic duct, phospholipase is released by the biliary epithelium, causing lecithin hydrolysis and the release of lysolecithin, which damages cell membranes. - The loss of the protective mucus lining leaves epithelial cells vulnerable to bile salt damage. ### **Clinical Manifestations of Acute Cholecystitis** - **Pain:** Usually severe, constant, and located in the right upper quadrant of the abdomen or epigastrium. It may radiate to the back, right shoulder, or between the shoulder blades. - **Other symptoms:** Low-grade fever, loss of appetite, nausea, and vomiting. - Individuals with lithiasis cholecystitis often have previous episodes of biliary colic, which can make it easier to diagnose. - Pain may be sudden and require urgent surgical intervention. - Without treatment, an acute cholecystitis episode can last for 7 to 10 days, and recurrences are common. - In acalculous cholecystitis, symptoms can be subtler, particularly in conjunction with underlying conditions, making early diagnosis difficult. ### **Diagnosis of Acute Cholecystitis** - **Ultrasound:** The most common method, helps detect gallstones, gallbladder wall thickening, and fluid around the gallbladder. - **Cholescintigraphy (Nuclear Scan):** Uses a radioactive agent to assess gallbladder function. - It is very accurate for detecting acute cholecystitis. - **CT scan:** Can also demonstrate gallbladder wall thickening and fluid, but it is less accurate than ultrasound for identifying gallstones. ### **Treatment of Acute Cholecystitis** - **Cholecystectomy:** Surgical removal of the gallbladder is the typical treatment for acute cholecystitis. - **Laparoscopic Cholecystectomy:** The preferred approach, involving small abdominal incisions and is associated with shorter hospital stay and faster recovery. - **Open Cholecystectomy:** A more invasive procedure, performed through a larger incision in the abdomen, which may be needed in complex cases. - **Dietary Therapy:** A low-fat diet may be helpful in some cases, but it is not a replacement for medical or surgical treatment. - **Antiemetics:** Medications, such as Buscopan or Sertal, can be used to alleviate the pain associated with gallbladder spasms. ## **Chronic Cholecystitis** - Results from repeated episodes of acute cholecystitis or chronic irritation of the gallbladder, most often due to the presence of gallstones. - **Characteristics:** - Chronic inflammation: Characterized by varying degrees of inflammation and almost always associated with gallstones. - Episodes of acute exacerbations: May occur. - Association with choledocholithiasis (gallstones in the common bile duct) and pancreatitis, though rarely with gallbladder cancer. ### **Clinical Manifestations of Chronic Cholecystitis** - **Vague symptoms:** Indigestion, belching, and discomfort. - **Chronic pain:** Can happen due to bile flow obstruction caused by gallstones. The pain may be less intense but persistent. - **Gallbladder size:** May be normal, enlarged, or reduced in chronic cholecystitis, and gallstones are often present. ### **Diagnosis and Treatment of Chronic Cholecystitis** - **Diagnosis:** Similar to acute cholecystitis, and involves ultrasound, cholescintigraphy, and CT Scan. - **Treatment:** Cholecystectomy is often recommended to relieve symptoms and prevent complications. ## **Pancreatitis** - Inflammation of the pancreas, typically caused by a blockage of the pancreatic duct by gallstones, leading to a buildup of pancreatic juices and inflammation of the pancreas. ### **Acute Pancreatitis** - **Causes:** - **Gallstones:** The most common cause, blocking the pancreatic duct, leading to a buildup of digestive enzymes and inflammation. - **Alcohol Abuse:** Can also cause acute pancreatitis due to the release of toxic metabolites, such as acetaldehyde which obstructs the pancreatic duct and leads to inflammation. - **Other Causes:** - **Choledocholithiasis (Gallstones in the common bile duct):** The blockage of this duct by gallstones, as with gallstones in the gallbladder, leads to a buildup of enzymes and inflammation. - **Hypercalcemia:** Can lead to calcium deposits in the pancreatic ducts, obstructing the flow and activating enzymes prematurely. - **Pancreatic Tumors:** Can compress or obstruct the flow of pancreatic juice. - **Autoimmune Pancreatitis:** Occurs when the immune system mistakenly attacks pancreatic tissue. - **Congenital Structural Duodenal Abnormalities:** Can alter pancreatic juice flow. - **Idiopathic Pancreatitis:** When no clear cause can be identified, although this may be more common in tropical regions. - **Viral Infections:** Such as mumps, can trigger pancreatitis. - **Lupus Erythematosus:** Can also cause pancreatitis. - **Toxic Exposures:** Certain drugs, such as certain medications, can lead to pancreatitis. - **Genetic Mutations:** Mutations in specific genes, such as the cationic trypsinogen gene and the serine peptidase inhibitor Kazal type 1 (SPINK1) gene, have been linked to increased risk of pancreatitis. - **Pathophysiology:** The process begins with the premature activation of trypsin, triggered by pancreatic juice reflux. - This activation triggers a cascade of events, involving the activation of other digestive enzymes, ultimately leading to pancreatic tissue autodigestion and inflammation. - The resulting inflammatory response can become severe, spreading beyond the pancreas and leading to systemic inflammatory response syndrome (SIRS) and organ failure. ### **Clinical Manifestations of Acute Pancreatitis** - **Pain:** Intense, often in the epigastrium or periumbilical region, radiating to the back. - **Nausea and Vomiting:** Commonly reported. - **Abdominal Distention:** Caused by inflammation and fluid buildup. - **Fever:** Possible indicator of infection. - **Paralysis of the Bowel (Ileus):** Due to inflammation and pressure on the bowel. This can lead to constipation and a lack of gas passage. ### **Diagnosis of Acute Pancreatitis** - **Blood Tests:** Elevation of pancreatic enzymes, including amylase and lipase. - **Imaging:** - **Ultrasound:** May show inflammation and fluid buildup. - **CT Scan:** More sensitive than ultrasound for detecting inflammation and necrosis. - **MRI:** Can assess inflammation and necrosis. - **Endoscopy:** Could be used to look for the cause of obstruction. ### **Classification of Acute Pancreatitis** - **Mild Acute Pancreatitis:** Resolves within a few days without complications. - Although local damage may occur, such as necrosis or fluid collections, these don't affect the patient's overall condition. - Fluid collections can occur due to the intense inflammatory response and "sequester" fluid from circulation and surrounding organs into the abdominal space. - This localized collection may trigger mild SIRS. - Mild acute pancreatitis accounts for about 80% of cases. - The majority of patients recover without organ failure or long-term complications. - Management focuses on symptom relief, monitoring, and avoiding invasive interventions unless complications arise. - **Severe Acute Pancreatitis:** Progressively worsens, leading to pancreatic tissue necrosis, SIRS, and potentially organ failure. - It is more dangerous, with complications including infections, abscesses, and organ failure. - Pancreatic necrosis can become a source of infections, which can cause serious complications if untreated. - Early identification is key to prompt and aggressive treatment to prevent death. - The outcome depends on how quickly complications are addressed, the severity of the disease, and the individual's response to treatment. ### **Treatment of Acute Pancreatitis** - **Hospitalization:** Typically required for patients with intense pain, persistent vomiting, dehydration, or signs of severe acute pancreatitis. - **Pain Control:** Meperidine is often preferred over morphine for pain relief, as morphine can cause spasms in the sphincter of the pancreatic duct, worsening the condition. - **Pancreatic Rest:** Patients should temporarily abstain from food and oral fluids to minimize pancreatic stimulation. - **Intravenous Hydration:** Essential to replenish fluid and electrolyte losses, correct low blood pressure, and prevent shock. - **Supportive Care:** Includes monitoring vital signs, managing blood sugar levels, and addressing any potential complications. - **Antibiotics:** May be used if an infection is suspected. - **Other Potential Treatments:** Depending on the cause and severity of the pancreatitis, other therapies might include: - **Endoscopic Retrograde Cholangiopancreatography (ERCP):** For gallstones: to remove gallstones from the common bile duct. - **Surgery:** To drain fluid collections or remove damaged pancreatic tissue. - **Prognosis:** The outlook for acute pancreatitis depends on the severity of the disease, the presence of complications, and the overall health of the individual. ### **Complications of Acute Pancreatitis** - **Fluid Collections and Infections:** Fluid accumulation in the abdomen is common in acute pancreatitis. - These collections may become infected, causing pancreatic abscesses that require urgent medical attention. - **Necrotizing Pancreatitis:** Necrosis of pancreatic tissue can occur, potentially leading to infection and complications such as sepsis. - **Pseudo-Cysts:** Fluid filled sacs formed by inflammation can persist or cause symptoms, requiring surgical drainage - **Acute Respiratory Distress Syndrome (ARDS):** Caused by system-wide inflammation, complicating pancreatitis due to fluid buildup in the lungs, requiring breathing support. - **Chronic Pancreatitis:** Chronic inflammation and scarring of the pancreas can lead to irreversible damage, resulting in a loss of both exocrine and endocrine functions. - **Organ Failure:** Pancreatitis can affect other organs, sometimes leading to multi-organ dysfunction, which is a major contributor to mortality. - **Cancer of the Pancreas:** Those with a history of chronic pancreatitis are at higher risk for pancreatic cancer ### **Etiology of Chronic Pancreatitis** - **Toxic-Metabolic:** Alcohol abuse and smoking are two major risk factors. - **Idiopathic:** An unknown cause is the most common, especially in tropical regions, with quicker onset and more aggressive course. - **Genetic:** Mutations in genes, such as the cationic trypsinogen gene and the SPINK1 gene, are associated with increased risk. - **Autoimmune:** Pancreatitis can be autoimmune (triggered by the immune system). - **Recurrent:** Repeated episodes of acute pancreatitis can lead to chronic pancreatitis due to recurrent attacks. - **Obstructive:** Caused by blockages in the pancreatic duct, often from pancreatic tumors or strictures. ### **Clinical Manifestations of Chronic Pancreatitis** - **Recurrent Abdominal pain:** Usually less severe than the acute form, though may worsen with alcohol or fatty foods. - **Weight loss:** Caused by malabsorption of nutrients, resulting in inadequate calorie intake. - **Exocrine Pancreatic Insufficiency:** The inability to digest food properly, leading to fatty stools (steatorrhea) and malabsorption of other nutrients as well. - **Other Complications:** May include diabetes, osteoporosis due to poor calcium absorption, and vitamin deficiencies. ### **Diagnosis of Chronic Pancreatitis** - Based on clinical manifestations, nutritional status, laboratory tests (such as amylase, lipase, and fasting blood sugar), and imaging (such as CT scan or MRI). - **Endoscopic Retrograde Cholangiopancreatography (ERCP):** Can help identify structural problems in the pancreas and biliary tree. - **Biopsy:** A tissue sample from the pancreas can confirm the diagnosis. ### **Treatment of Chronic Pancreatitis** - **Pain Control:** Pain medication is essential. - **Pancreatic Enzyme Replacement Therapy (PERT):** Provides enzymes to assist with digestion. - **Dietary Management:** A low-fat, high-protein diet with manageable fiber is recommended. - **Diabetes Management:** If diabetes develops, blood sugar levels must be closely monitored and controlled. - **Surgery:** In cases with severe complications or obstructions, surgery may be necessary to drain fluid collections, remove damaged tissue, or relieve obstructions. - **Prognosis:** The prognosis of chronic pancreatitis is generally poor. - It is a progressive disease, and death often results from complications such as infection, sepsis, or organ failure. # **Cancer of the Pancreas** - One of the most aggressive and deadly cancers with a poor prognosis. - It is typically an adenocarcinoma, originating from cells lining the pancreatic ducts with the head of the pancreas being the most common location. - **Risk Factors:** - **Chronic pancreatitis:** A significant risk factor. - **Diabetes:** Also associated with increased risk. - **Smoking:** The strongest risk factor. - **Age:** Risk increases with age. - **Genetics:** Family history and certain genetic mutations increase risk. - **Symptoms:** Symptoms are often subtle and appear in later stages. - **Weight loss:** A common early symptom. - **Upper abdominal pain:** Can be constant and radiate to the back. - **Jaundice:** Often due to blockage of the bile duct in the head of the pancreas, leading to yellowish discoloration of the skin and eyes. - **Other symptoms:** May include fatigue, nausea, vomiting, and a loss of appetite. - **Diagnosis:** Difficult to diagnose early due to lack of specific symptoms. - **Blood tests:** May show elevated liver enzymes and pancreatic cancer markers, such as CA 19-9. - **Imaging:** Usually performed as a combination of ultrasound, CT scans, and MRI scans. - **Biopsy:** A tissue sample from the pancreas is needed to confirm the diagnosis. - **Treatment:** Treatment options depend on the stage of the cancer and the overall health of the individual. - **Surgery:** The only potentially curative treatment for pancreatic cancer, but only possible in a small percentage of cases. - **Chemotherapy:** Used to shrink the tumor or slow its growth. - **Radiation therapy:** **In some instances to help control pain. - **Palliative care:** If cancer is advanced, the goal is to manage symptoms and improve quality of life rather than cure the disease. - **Prognosis:** Prognosis for pancreatic cancer is generally poor. - The 5-year survival rate is less than 10%, and the overall survival rate is even lower. - Early detection and treatment are crucial for improving the chances of survival.