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Pleural Effusion

Management Team

Pleural Effusion

Overview

Pleural effusion is the accumulation of excess fluid between the layers of the pleura, the thin membranes that line the lungs and the inside of the chest cavity.

Pleural effusion can be caused by various conditions, which can be broadly classified into transudative and exudative effusions:

Transudative Effusions:

  • Heart failure: Increased pressure in the heart and blood vessels
  • Cirrhosis: Reduced plasma oncotic pressure due to low albumin levels
  • Nephrotic syndrome: Low protein levels in the blood

Exudative Effusions:

  • Infections: Such as pneumonia or tuberculosis
  • Malignancies: Lung cancer, metastatic cancers
  • Pulmonary embolism: Blood clot in the lungs
  • Inflammatory conditions: Rheumatoid arthritis, lupus
  • Trauma: Injury to the chest

  • Dyspnoea (shortness of breath)
  • Chest pain: Often sharp and may worsen with deep breaths
  • Cough: Often dry may be productive
  • Fever: If the effusion is due to an infection
  • Hiccups: Due to irritation of the diaphragm

Clinical Examination: Decreased breath sounds, dullness to percussion and reduced tactile fremitus.

Imaging Studies:

  • Chest X-ray: Can show fluid in the pleural space.
  • Ultrasound: More sensitive for detecting small effusions and guiding thoracentesis.
  • CT Scan: Provides detailed images and helps identify the underlying cause.

Thoracentesis: Involves inserting a needle into the pleural space to withdraw the pleural fluid, which is then histopathologically analysed to determine the cause of the effusion and provide symptomatic relief to the patient.

  • Antibiotics: For bacterial infections.
  • Diuretics: For heart failure.
  • Chemotherapy/Radiation: For malignancies.
  • Antitubercular treatment: For TB.
  • Pleurodesis: A procedure to adhere the pleural layers together, preventing fluid reaccumulation. Often used in recurrent effusions, particularly due to malignancies.
  • Surgery
  • Pleurectomy: Removal of part of the pleura.
  • Indwelling Pleural Catheter: For periodic drainage of the pleural fluid.
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Pneumothorax

Management Team

Pneumothorax

Overview

A pneumothorax occurs when air enters the space between the lung and the chest wall, causing partial or complete lung collapse.

Pneumothorax can result from trauma/chest injury, such as a rib fracture; it can also occur spontaneously, particularly in individuals with underlying lung conditions like emphysema, COPD, pneumonia, or cystic fibrosis.

Symptoms include sudden chest pain, difficulty in breathing, and cyanosis.

Diagnosis involves a physical examination, chest X-ray, or CT to confirm the size and severity of the pneumothorax.

Small pneumothorax may resolve on their own, but larger or symptomatic ones may require treatment. Options include observation with supplemental oxygen to promote the reabsorption of trapped air, or chest tube insertion to remove air and allow the lung to re-expand. Surgery may be necessary for recurring or severe cases to prevent future episodes and complications such as tension pneumothorax, where trapped air increases the pressure within the chest cavity, potentially compressing the heart and lungs.

Treatment modalities for pneumothorax include:

  • Needle Aspiration: Inserting a needle into the chest cavity to remove excess air, similar to chest tube insertion but less invasive.
  • Pleurodesis: Creating inflammation and scar tissue in the pleural space (a thin space between the visceral and parietal pleura that lines the lungs and the chest wall respectively) using chemicals or talc to seal off the space and prevent recurrence.
  • Video-Assisted Thoracoscopic Surgery (VATS): Minimally invasive lung surgery using a small camera and instruments to view and treat the pneumothorax by removing blebs or sealing air leaks.
  • Lung Reinflation Techniques: Methods like high-flow oxygen therapy to reinflate the collapsed lung without surgery.
  • Preventive Measures: Preventive strategies, such as smoking cessation and avoiding activities that risk chest trauma are crucial for individuals prone to recurrent pneumothorax.

The choice of treatment depends on pneumothorax size, symptoms, and the patient's overall health.

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Pre-diabetes

Management Team

Pre-diabetes

Overview

Prediabetes is a condition where blood sugar levels are elevated but not yet enough to get a diagnosis of diabetes. It significantly raises the likelihood of developing type 2 diabetes, heart disease, and stroke.

Often do not show up easily

This condition can be detected through blood tests like fasting glucose or HbA1c testing.

  • Effective management of Prediabetes entails lifestyle changes involving maintaining a healthy and balanced diet, adequate and regular physical activity, and reducing body weight to decrease the risk of progression to diabetes.
  • Regular monitoring and early intervention can prevent or prolong the onset of type 2 diabetes and its related complications, improving long-term health outcomes.
  • If you have any worries about diabetes or observe signs or symptoms of type 2 diabetes, it is advisable to get an endocrine consultation. Inquire about blood sugar screening if you think you have any diabetes-related risk factors to stay proactive about your health and well-being.
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Periodic Paralysis

Management Team

Periodic Paralysis

Overview

Periodic paralysis is a group of disorders with episodic muscle weakness. The dysfunction of ion channels interferes with muscle depolarization and in turn causes muscle weakness. Correction of these electrolytes causes rapid correction of muscle weakness.

Caused due to dysfunction of ion channels leading to hypo or hyperkalaemia.

This shows autosomal dominant inheritance and is caused by CACNA1/ SCNA gene mutation

  • Recurrent paralysis lasting hours to days
  • Low potassium levels
  • Muscle cramps/ spasms
  • Precipitated by high carbohydrate diet, stress, and alcohol consumption among others
  • Symptoms vary in severity and frequency

 It is similar to hypokalaemia periodic paralysis, except that it gets precipitated by raised potassium levels (hyperkalaemia) and is treated by potassium lowering agents such as diuretics.

Risk factors for periodic paralysis include:

  • Abnormal Potassium levels
  • Age of onset: the first paralytic attack usually occurs between the ages of two and 30,
  • Female sex
  • Individuals of Asian or Hispanic descent
  • Abnormal thyroid hormone levels
  • Certain medications
  • Eating potassium-rich foods, high-carbohydrate meals, or skipping meals
  • Resting after exercise can trigger attacks.
  • Stress
  • Pregnancy
  • Exposure to extreme temperature
  • Viral illness

  • Low potassium levels
  • ECG changes due to hypokalaemia
  • NCV may show axonal neuropathy
  • Genetic testing

Neurologist

  • Correction of potassium levels
  • Physiotherapy
  • Muscle strengthening on a regular basis
  • Dietary and lifestyle regulation
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Pancreas Cancer

Management Team

Pancreas Cancer

Overview

Pancreas cancer occurs when certain cells within the pancreas, grow and spread forming a malignant tumour. Pancreas is located deeply within the abdominal cavity and in the vicinity of major and vital blood vessels supplying blood to the liver and intestines.

The exact cause of pancreas cancer is not known. Factors increasing the risk of cancer are:

  • Genetics: Pancreatic cancer
  • Newly diagnosed diabetes
  • Alcohol consumption
  • Smoking tobacco

Cancers of the pancreas can be silent and may not show any defined or specific symptoms. Hence, they are often discovered at an advanced stage. This is especially true for cancers in the body and tail of the pancreas, which can remain silent for a long time. Unlike cancers in the pancreatic head, those in the body and tail of the pancreas do not present with jaundice

  • Jaundice: Jaundice is one of the most common symptoms in the development of pancreatic cancer. It occurs due to obstruction in the bile duct. Most cancers of the pancreas originate in the head region of the pancreas and present as jaundice
  • Unexplained weight loss
  • Nausea
  • Vomiting
  • Recent development of diabetes or worsening of pre-existing diabetes

  • Computed tomography (CT) scan: CT scan will accurately stage the cancer, which will help to define the treatment plan
  • Blood tests for CA 19-9 and CEA (tumour markers)
    Endoscopic retrograde cholangiopancreatography (ERCP)/ endoscopic ultrasound (EUS): These are specialised endoscopic tests done to establish the diagnosis of pancreatic cancer.  In some cases, biliary stenting (stenting of the bile duct) may be required before surgery. While not always necessary, it can help reduce jaundice. Once the jaundice level decreases, a pancreatoduodenectomy (Whipple's procedure) may be performed

Treatment will depend on the stage of the cancer/tumour, which can be accurately obtained using a CT scan. At times, additional investigations, including positron emission tomography (PET) scans and magnetic resonance imaging (MRI), may be required for further information. Accurate mapping of the tumour and its relationship with the neighbouring blood vessels need to be defined, while making treatment decisions. The treatment includes:

  • Surgery: Surgery is the only ideal treatment with a potential for cure. Surgery for pancreas cancer will depend on the location of the tumour within the pancreas.
    • Whipple procedure: This procedure is an operation in which the lower bile duct along with the head of pancreas, a portion of stomach and initial portion of the small intestine (jejunum) is removed to eliminate the tumours located in the head of the pancreas, periampullary region, duodenum (small intestine) and lower bile duct.
    • Distal pancreatectomy: This operation is usually done for tumours located in the body and tail of pancreas (left side of pancreas). The operation also sometimes involves removal of the spleen alongside, although the spleen can be preserved in certain select cases.
  • Chemotherapy: At times, chemotherapy may be required for certain advanced cancers prior to surgery (neoadjuvant chemotherapy). This helps in reducing the size of the tumour to make them smaller for facilitating the complete removal of tumour. Different regimes of chemotherapy are available, which are individualised based on the patient conditions. Following surgery, chemotherapy is given after analysis of the pathology report (adjuvant chemotherapy). This is usually done after complete recovery from the surgery.
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Pregnancy-induced Hypertension

Management Team

Pregnancy-induced Hypertension

Overview

Approximately 10‒12% women experience increased blood pressure during pregnancy (hypertensive disorders of pregnancy), and of these, ~6% are diagnosed with pregnancy-induced hypertension (PIH), also known as gestational or transient hypertension, a condition characterised by hypertension without proteinuria (protein in urine). According to the guidelines proposed by the American College of Obstetricians and Gynaecologists, PIH is defined as the presence of blood pressure greater than or equal to 140/90 mmHg at two separate instances (measured at an interval of at least 4 hours) after 20 weeks of pregnancy (when the previous blood pressure was normal). Though PIH generally subsides by the 6th week after delivery, it is a concerning condition as it can affect placenta development and function, meaning that the foetus may not get adequate nutrients, and both the mother and child are at high risk of developing complications (before labour, during labour, and after delivery). If left unmanaged, PIH can progress to serious conditions like preeclampsia, which can cause organ damage, seizures, and complications for the baby.

Although the exact cause of PIH has not yet been identified, certain risk factors for this condition have been identified:

  • Age: Women over 35 years of age are at moderate risk of developing PIH.
  • First pregnancy: PIH is more common in first-time mothers.
  • Multiple pregnancies: Carrying twins or triplets increases your chances of developing PIH.
  • Pregnancy-related conditions: Having or PIH or preeclampsia during previous pregnancies can increase the risk of developing PIH.
  • Obesity: Being overweight before pregnancy can also contribute to PIH.
  • Pre-existing illness: PIH risk is higher in case of pre-existing illness, such as chronic hypertension, kidney disease, diabetes, or lupus.
  • Family history: A history of PIH or preeclampsia in the family is also a key risk factor.

  • High blood pressure (>140/90 mmHg).
  • Severe headaches that do not go away.
  • Blurred vision or seeing spots.
  • Pain under the ribs (upper abdomen).
  • Sudden swelling of limbs (hands/feet) or face.
  • Fluid retention and subsequently, rapid weight gain.
  • Reduced urine output.
  • Thrombocytopenia (low platelet count).

Hypertensive disorders of pregnancy are diagnosed based on consistently high blood pressure measurements (above 140/90 mmHg) during blood pressure monitoring. Additionally, as weight gain during pregnancy can increase the risk of these hypertensive disorders, frequent weight measurements are used to monitor them However, the diagnosis of PIH is more of an elimination analysis, i.e., the patient does not develop preeclampsia (no protein in urine) and the blood pressure values return to normal by week 6 after delivery. In other words, a diagnosis of PIH is made after ruling out other more hypertensive disorders of pregnancy, such as preeclampsia, chronic hypertension, and the superimposition of the two. One or more of the following routine diagnostic techniques are used to diagnose PIH:

  • Urine tests: Urine samples are checked for the presence of protein to rule out preeclampsia.
  • Oedema assessment: Swelling in both legs (bilateral leg oedema) is indicative of PID.
  • Liver and kidney function tests: These tests are used to rule out preeclampsia.
  • Blood clotting tests: These tests are used to rule out preeclampsia.

If a diagnosis of PID is made, physicians also perform routine tests to monitor foetal health; these include:

  • Ultrasound: This test helps monitor the baby’s development and check for complications.
  • Non-stress test: This test is used to observe the baby’s heart rate and ensure that they are doing well in the womb.
  • Foetal movement counting: This test involves keeping track of the number or frequency of foetal kicks and movements, a change in which indicates foetal stress.
  • Biophysical profile: This test—usually performed after the 28th week of pregnancy—involves combining the nonstress test with ultrasound to observe the foetus.
  • Doppler flow study: This type of ultrasound is used to measure the flow of the baby’s blood through a blood vessel.

PIH treatment is aimed at managing your blood pressure and preventing it from progressing into more dangerous conditions like preeclampsia. Treatment depends on the severity of your condition and how far along you are in your pregnancy.

  • Lifestyle changes: In mild cases, your doctor may recommend more rest, reducing salt intake, and frequent monitoring.
  • Medications: If blood pressure is too high, your doctor may prescribe antihypertensive medications (medications to control the blood pressure). However, if PIH progresses to preeclampsia, magnesium sulphate may be used to prevent seizures.
  • Hospitalisation: In severe cases, your doctor may recommend a hospital stay for close observation and management.
  • Early delivery: If PIH puts you or your baby at risk, early delivery might be the best option, sometimes through labour induction or a caesarean section.

Though PIH cannot be prevented, the below steps help in reducing PIH risk and ensuring a healthier pregnancy:

  • Maintaining a healthy weight: Patients are advised to attain a healthy weight before pregnancy and follow the doctor’s advice for weight gain during pregnancy.
  • Consuming a balanced diet: Diet comprising fruits, vegetables, proteins, grains, and diary with less salt helps to control hypertension.
  • Staying active: Light to moderate exercise can help manage weight and maintain healthy blood pressure levels. 
  • Attending prenatal appointments: Regular check-ups are essential for catching PIH early.
  • Monitoring blood pressure at home: If you are at risk, your doctor may advise you to keep an eye on your blood pressure between appointments.
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Paediatric Diarrhoea

Management Team

Paediatric Diarrhoea

Overview

Paediatric diarrhoea, a common yet potentially dangerous condition, is characterised by frequent, loose, or watery stools, which can lead to dehydration, malnutrition, and even death. It poses a significant health impact on children worldwide. Our hospital has advanced diagnostic imaging and treatment protocols which play an essential role in managing and mitigating the consequences of paediatric diarrhoea.

Paediatric diarrhoea can be triggered by both infectious and non-infectious factors. Infectious agents include viruses, bacteria, and parasites.

  • Viral infections: Viral gastroenteritis, which is often caused by rotavirus and norovirus, is the most common cause of acute diarrhoea in children.
  • Bacterial infections: Pathogens, such as Escherichia coli, Salmonella, and Shigella, can cause severe diarrhoea and are often associated with severe symptoms.
  • Parasitic infections: Amoebiasis and other parasitic infections, though less common, can occur in regions with poor sanitation.
  • Non-infectious causes: The non-infectious causes of paediatric diarrhoea include food allergies, lactose intolerance, inflammatory bowel disease (IBD), and celiac disease.
  • Antibiotic use: Prolonged broad-spectrum antibiotic therapy may cause antibiotic-associated diarrhoea.

The symptoms of diarrhoea vary in severity depending on the cause and extent of dehydration.

  • Frequent loose stools: The primary symptom of diarrhoea is frequent loose stools, which is often accompanied by cramping.
  • Abdominal pain and cramping: Abdominal pain and cramping are common complaints associated with diarrhoea.
  • Fever and vomiting: Fever and vomiting may occur in cases of viral or bacterial infection.
  • Dehydration: Dehydration, a critical concern in paediatric diarrhoea, can manifest as dry mouth, sunken eyes, decreased urination, lethargy, and, in severe cases, shock.

Diagnosis of paediatric diarrhoea in a hospital setting involves a thorough evaluation.

  • Detailed medical history and physical examination: Obtaining a detailed medical history and physical examination, such as assessing stool frequency, consistency, duration, and other associated symptoms is crucial in determining the cause and severity of paediatric diarrhoea.
  • Stool analysis: This includes microscopy, culture, and sensitivity tests for detecting bacterial pathogens, tests for detecting ova and parasites, and stool PCR for identifying viral pathogens.
  • Blood tests: Complete blood count (CBC), electrolytes, renal function tests, and inflammation markers are common tests prescribed to assess the cause of diarrhoea and determine its subsequent treatment.
  • Imaging and endoscopy: Imaging and endoscopy are used in cases of chronic diarrhoea or when an underlying pathology (such as IBD) is suspected.

The management of paediatric diarrhoea focuses on rehydration, managing the underlying cause, and preventing complications.

  • Oral rehydration therapy (ORT): This is the first line of treatment for mild to moderate dehydration. ORT solutions, which contain an appropriate balance of salts and glucose, are highly effective and can be administered at home or in healthcare settings.
  • Intravenous (IV) rehydration: IV rehydration is necessary in cases of severe dehydration or when ORT is not feasible. Tertiary care hospitals are well-equipped to provide IV fluids and monitor critically ill children.

Specific treatments for diarrhoea include:

  • Viral diarrhoea: Viral diarrhoea can generally be managed with supportive care, including hydration and dietary adjustments.
  • Bacterial diarrhoea: Antibiotics are used for certain bacterial infections, but they are used judiciously to avoid resistance and complications.
  • Parasitic infections: Parasitic infections are generally treated with antiparasitic medications.
  • Non-infectious causes: Non-infectious causes are managed according to the underlying condition, such as dietary modifications for lactose intolerance or immunosuppressive therapy for IBD.
  • Nutritional support: Nutritional support is crucial in paediatric diarrhoea management. Continued feeding or breastfeeding is encouraged to maintain nutritional status and promote recovery.

Diarrhoea prevention measures in children focus on reducing exposure to pathogens and improving sanitation.

  • Vaccination: Rotavirus vaccination plays a key role in preventing viral gastroenteritis.
  • Hygiene: Proper handwashing, safe food preparation, and clean drinking water can reduce diarrhoeal illness.
  • Nutritional support: Ensuring adequate nutrition during episodes of diarrhoea helps prevent malnutrition and promotes faster recovery.
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Paediatric Convulsions

Management Team

Paediatric Convulsions

Overview

Paediatric convulsions, also known as seizures, are sudden, uncontrolled electrical disturbances in a child's brain. They can manifest in various forms, ranging from subtle staring spells to dramatic shaking and loss of consciousness. Such events can be alarming for parents and healthcare providers, requiring prompt and effective management. Tertiary care hospitals, such as ours, play a critical role in diagnosing, managing, and treating paediatric convulsions, supported by specialised staff and advanced medical technology.

Causes of paediatric seizures can vary and include the following:

  • Febrile seizures: These seizures are generally triggered by a rapid increase in the body temperature and are typically caused by infections, such as viral or bacterial infections. These seizures are most common in children between the ages of 6 months and 6 years.
  • Afebrile seizures: These seizures occur without fever and are often caused by underlying conditions, which include the following:
    • Neurological disorders, such as recurrent seizures (epilepsy) or motor disorder (cerebral palsy)
    • Metabolic imbalances, such as low blood sugar (hypoglycaemia), low calcium (hypocalcaemia), or electrolyte imbalances
    • Genetic conditions (a family history of epilepsy or seizure disorders)
    • Brain injuries due to trauma or hypoxia during birth
    • Infections that affect the brain, such as meningitis or encephalitis
    • Structural abnormalities in the brain identified through neuroimaging

  • Family history of epilepsy or seizures
  • Previous febrile seizures
  • Premature birth or low birth weight
  • Developmental delays or neurological impairments
  • Brain infections or trauma
  • Exposure to toxins or drugs

The symptoms of seizures depend on the type of seizure and can range from mild to severe. Seizure symptoms include:

  • Brief episodes of disorientation
  • Periods of unresponsiveness or vacant staring
  • Uncontrollable jerking of the arms and legs
  • Loss of consciousness or awareness
  • Cognitive or emotional changes, including sensations of fear and anxiety, or a sense of déjà vu (where one feels they have experienced the current moment before)

To diagnose epilepsy, a comprehensive evaluation is conducted, which typically includes:

  • Medical history review: This involves an investigation of the detailed family history of epilepsy or seizures to assess potential hereditary factors.
  • Electroencephalogram (EEG): This is a key neurology diagnostic test that measures electrical activity in the brain and helps detect abnormal brain wave patterns linked to epilepsy.
  • Diagnostic imaging: Brain magnetic resonance imaging (MRI) or computed tomography (CT) scans are performed to identify structural abnormalities or lesions in the brain that may contribute to seizures.
  • Blood tests: These tests are performed to detect infections, metabolic imbalances, or genetic conditions that may be the underlying causes of the seizures.
  • Electromyography (EMG) tests: In some cases, EMG may also be used to assess muscle responses, especially in differential diagnosis.

This thorough approach helps guide effective epilepsy management.

Managing childhood epilepsy and seizures requires a multidisciplinary approach in specialised neurology hospitals. Key aspects of epilepsy management and treatment include:

  • Paediatric seizure treatment: Antiepileptic drugs (AEDs) are the first-line therapy with the choice of medication tailored to the type of seizure and the child's overall health.
  • Epilepsy surgery for children: For children with drug-resistant epilepsy, surgery may be considered to remove the brain area causing seizures or mitigate abnormal brain activity.
  • Neonatal seizure management: In newborns, management of seizures involves identifying the underlying cause and administering appropriate medication or supportive therapies.
  • Childhood epilepsy treatment: Along with medication, treatment may include lifestyle changes, dietary interventions (like the ketogenic diet), or neuromodulation techniques (such as vagus nerve stimulation).
  • Long-term epilepsy management: Ongoing care involves regular follow-up, monitoring seizure control, adjusting medications, and assessing cognitive and developmental progress.

Regular follow-up is critical for managing paediatric convulsions. Tertiary care hospitals provide structured follow-up programmes, including routine EEG monitoring, medication adjustments, and ongoing assessment of the child’s developmental and cognitive progress. Support services, such as counselling and educational support for families, are integral to long-term care.

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Pancreatic Cancer

Management Team

Pancreatic Cancer

Overview

Pancreatic cancer occurs when malignant (cancerous) cells form in the tissues of the pancreas, a vital organ in the digestive system that also regulates blood sugar through insulin production. The cancer is often aggressive and has a poor prognosis, primarily because it is frequently diagnosed at later stages.

  • Exocrine pancreatic cancer (most common)
    • Adenocarcinoma: The most common type, accounting for about 95% of cases. It starts in the cells lining the ducts of the pancreas and is known as pancreatic ductal adenocarcinoma (PDAC).
    • Other types:
      1. Acinar cell carcinoma
      2. Squamous cell carcinoma
      3. Undifferentiated carcinoma
      4. Colloid carcinoma (a rare, slower-growing type)
  • Endocrine pancreatic cancer: These cancers develop in the hormone-producing cells of the pancreas (Islets of Langerhans). They are rarer and include:
    • Insulinomas (produce insulin)
    • Glucagonomas (produce glucagon)
    • Gastrinomas (produce gastrin)
    • Non-functional pancreatic neuroendocrine tumours (PNETs)

The exact cause of pancreatic cancer is not fully understood, but it is believed to involve a combination of genetic mutations and environmental factors that lead to uncontrolled cell growth.

  • Age: Most cases occur in individuals over 60 years old.
  • Tobacco use: Smoking increases the risk significantly.
  • Chronic pancreatitis: Long-term inflammation of the pancreas increases the risk.
  • Family history and genetics: Inherited mutations like BRCA1/2, Lynch syndrome, and others increase the risk.
  • Obesity and poor diet: Diets high in fats and red meats and being overweight may contribute.
  • Diabetes: Long-standing type 2 diabetes is linked with an increased risk.
  • Alcohol consumption: Heavy, chronic drinking can increase the risk of pancreatic cancer.
  • Gender: Men have a slightly higher risk than women.
  • Exposure to certain chemicals: Industrial chemicals like pesticides and dyes are linked to a higher risk.

Symptoms may not appear until the cancer is advanced, making early detection difficult. Common symptoms include:

  • Jaundice: Caused due to bile duct obstruction.
  • Abdominal pain: Often localised in the upper abdomen or back.
  • Unexplained weight loss: A significant and unintended weight loss.
  • Loss of appetite: A lack of interest in food.
  • Fatigue: Feeling unusually tired or weak.
  • Nausea and vomiting: Due to blockage or issues with digestion.
  • New-onset diabetes: A sudden diagnosis of diabetes may indicate underlying pancreatic issues.
  • Digestive problems: Difficulty digesting food, often due to poor enzyme production.

  • Imaging tests
    • CT scan: Commonly used to detect pancreatic tumours and evaluate their size and spread.
    • MRI (magnetic resonance imaging): Provides detailed images of the pancreas and surrounding areas.
    • Endoscopic ultrasound (EUS): A specialized ultrasound that uses a probe inserted into the digestive tract to view the pancreas directly.
    • PET scan: Can help identify cancer spread.
    • Endoscopic retrograde cholangiopancreatography (ERCP): Used to evaluate the bile ducts and pancreatic ducts.
  • Biopsy: A sample of pancreatic tissue is taken (often via EUS or ERCP) to confirm cancer presence.
  • Blood tests: Elevated levels of certain substances like CA 19-9 (a tumour marker) may suggest pancreatic cancer, though it’s not definitive.
  • Genetic testing: In some cases, genetic mutations may be detected, aiding in treatment decisions and providing information on familial risks.

Treatment depends on the cancer’s stage, location, and overall health of the patient.

  • Surgical Treatment
    • Whipple procedure (pancreaticoduodenectomy): A common surgery for tumours in the head of the pancreas, which involves removing part of the pancreas, small intestine, bile duct, and gallbladder.
    • Distal pancreatectomy: Removal of the tail or body of the pancreas.
    • Total pancreatectomy: Removal of the entire pancreas, sometimes combined with removal of nearby organs.
  • Chemotherapy: Chemotherapy is often the primary treatment for advanced pancreatic cancer. Drugs like FOLFIRINOX (a combination of fluorouracil, leucovorin, irinotecan, and oxaliplatin) or Gemcitabine are commonly used.
  • Radiation therapy: Used either as the main treatment or in combination with surgery or chemotherapy. It aims to shrink tumours or relieve symptoms.
  • Targeted therapy: Targeted treatments focus on specific genes or proteins involved in cancer growth. For instance, Erlotinib is sometimes used for pancreatic cancer with specific genetic markers.
  • Immunotherapy: While still experimental for pancreatic cancer, immunotherapy is an emerging treatment that may boost the body’s immune system to fight cancer cells.
  • Palliative care: In cases where surgery is not an option or cancer is advanced, palliative care aims to manage symptoms and improve quality of life. This can involve pain management, nutritional support, and alleviating digestive blockages

The prognosis for pancreatic cancer depends on the stage at diagnosis:

  • Early-stage: Surgery may be an option, offering the best chance for survival.
  • Late-stage: The cancer is often not operable, and survival rates are generally low. However, treatments like chemotherapy and radiation may help prolong life and relieve symptoms.
  • 5-year survival rate:
    • Localized (confined to the pancreas): ~40%
    • Regional (spread to nearby tissues): ~13%
    • Distant (metastasized): ~3%

While there is no guaranteed way to prevent pancreatic cancer, some steps can help lower the risk:

  • Quit smoking and avoid tobacco products.
  • Maintain a healthy weight and engage in regular physical activity.
  • Limit alcohol consumption.
  • Eat a balanced diet rich in fruits, vegetables, and whole grains.
  • Manage diabetes and other risk conditions carefully.
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Pancreatic Fibrosis

Management Team

Pancreatic Fibrosis

Overview

Pancreatic fibrosis is characterised by the accumulation of fibrous tissue in the pancreas, leading to a reduction in its ability to function properly. This condition is often a result of chronic inflammation and damage to the pancreatic cells, disrupting the normal structure and function of the pancreas.

  • Cystic fibrosis-related pancreatic fibrosis: This is the most common cause of pancreatic fibrosis in children and young adults. It results from cystic fibrosis, a genetic disorder that causes thick and sticky mucus to build up in various organs, including the pancreas. The mucus can obstruct ducts in the pancreas, leading to fibrosis.
  • Chronic pancreatitis-related fibrosis: Chronic inflammation of the pancreas (chronic pancreatitis) is a major cause of pancreatic fibrosis. This can result from repeated episodes of acute pancreatitis or prolonged damage from alcohol use, gallstones, or other factors.
  • Fibrosis due to pancreatic cancer: Tumours or cancers of the pancreas can lead to fibrosis, both as a result of tumour growth and the body's response to the tumour. In this case, fibrosis can contribute to impaired pancreatic function.
  • Autoimmune pancreatitis: A rare type of pancreatitis in which the body’s immune system mistakenly attacks the pancreas, causing inflammation and fibrosis.

  • Chronic pancreatitis:Long-term inflammation of the pancreas caused by alcohol abuse, gallstones, high triglycerides, or autoimmune diseases.
  • Genetic disorders:
    • Cystic fibrosis: A genetic condition that leads to thick mucus buildup in the pancreas.
    • Hereditary pancreatitis: A rare genetic condition that increases the risk of recurrent pancreatitis and fibrosis.
  • Pancreatic cancer:
    • Pancreatic cancer can lead to the formation of fibrous tissue as part of the tumour's progression.
  • Metabolic disorders:
    • Conditions such as high cholesterol, high blood sugar (diabetes), and hypercalcemia can increase the risk.
  • Infections and trauma:
    • Certain infections or injury to the pancreas can lead to fibrotic changes.
  • Smoking and alcohol abuse:
    • Smoking and excessive alcohol consumption are major risk factors for developing chronic pancreatitis and fibrosis.

Symptoms of pancreatic fibrosis are often linked to the underlying cause (e.g., chronic pancreatitis or cystic fibrosis), but the fibrotic changes themselves can result in the following:

  • Abdominal pain: Persistent or episodic abdominal pain, often in the upper abdomen or back.
  • Digestive problems: Difficulty digesting food, leading to bloating, diarrhea, or fatty stools (steatorrhea) due to malabsorption of nutrients.
  • Unexplained weight loss: Due to malabsorption of nutrients and insufficient pancreatic enzymes.
  • Jaundice: Typically caused by a blockage in the bile ducts.
  • Nausea and vomiting: These symptoms may occur, especially during acute episodes of pancreatic inflammation.
  • Diabetes: As fibrosis progresses, insulin production in the pancreas can decrease, leading to diabetes.

  • Blood tests:
    • Elevated levels of certain enzymes (e.g., amylase, lipase) can indicate pancreatic inflammation.
    • Blood glucose levels may be elevated if diabetes develops.
  • Imaging tests:
    • CT Scan (Computed Tomography): Provides detailed images of the pancreas and can show changes consistent with fibrosis.
    • MRI (Magnetic Resonance Imaging): Used to assess the pancreas and surrounding tissues.
    • Endoscopic Ultrasound (EUS): A highly sensitive method to detect fibrosis and pancreatic duct abnormalities.
    • MRI/CT Cholangiopancreatography: For detailed visualization of pancreatic ducts.
  • Biopsy: In some cases, a biopsy may be needed to confirm the presence of fibrosis.
  • Genetic testing: In cases suspected to be related to cystic fibrosis or hereditary pancreatitis.

Treatment of pancreatic fibrosis primarily focuses on addressing the underlying cause, managing symptoms, and preventing complications. The options include:

  • Managing chronic pancreatitis or cystic fibrosis:
    • Pain Management: Medications like acetaminophen or NSAIDs, and in severe cases, opioids.
    • Pancreatic Enzyme Replacement Therapy (PERT): To help with nutrient digestion and alleviate digestive symptoms.
    • Insulin Therapy: For patients who develop diabetes due to the loss of insulin-producing cells.
  • Alcohol and smoking cessation:Reducing or eliminating alcohol use and smoking, which can worsen fibrosis and inflammation.
  • Surgical interventions:In cases of obstructed ducts or pancreatic cancer, surgery may be necessary to remove parts of the pancreas or treat the underlying cause.
  • Endoscopic treatment:Endoscopic procedures to treat ductal obstructions, pancreatic cysts, or stones.
  • Stem cell and regenerative therapies:Research into regenerative treatments is ongoing, but stem cell therapy and pancreatic islet cell transplants show potential in improving pancreatic function.
  • Supportive Care:Nutritional support through a high-calorie, low-fat diet may be recommended to counteract malnutrition. Vitamins and minerals may be supplemented.
  • Addressing diabetes:If diabetes develops, insulin or other diabetes medications may be prescribed to manage blood sugar levels.
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