PANCREAS, CANCER OF
PANIC DISORDER
P
pancreas, cancer of A cancerous tumour
of the exocrine tissue of the
pancreas.
The cause is unknown, but smoking and
a high intake of fats or alcohol may be
contributing factors. Symptoms include
upper abdominal pain, loss of appetite,
weight loss, and
jaundice.
There may also
be indigestion, nausea, vomiting, diar-
rhoea, and tiredness. In many cases,
symptoms do not appear until the can-
cer has spread to other parts of the body.
Diagnosis usually requires
ultrasound
scanning, CT scanning
or
MRI
of the
upper abdomen, or
ERCP
. In early stages,
pancreatectomy, radiotherapy
and
anti-
cancer drugs
may provide a cure. In
later stages, little can be done apart
from provision of
palliative treatment
.
pancreatectomy Removal of all or part
of the
pancreas.
Pancreatectomy may be
performed to treat
pancreatitis
or local-
ized cancer of the pancreas (see
pancreas,
cancer of
). Rarely, it is performed to treat
insulinomas
. Pancreatectomy may lead
to
diabetes mellitus
and
malabsorption
.
pancreatin An oral preparation of pan-
creatic
enzymes
required for digestion.
It is used to prevent
malabsorption
, and
it may be needed after
pancreatectomy
or by people with pancreatic disorders.
pancreatitis Inflammation of the
pan-
creas
, which may be acute or
chronic
.
The main causes of acute pancreatitis are
alcohol abuse and
gallstones
. Less com-
mon causes are injury, viral infections,
surgery on the
biliary system,
or certain
drugs. Chronic pancreatitis is usually due
to alcohol abuse. Rarer causes include
hyperlipidaemias
,
haemochromatosis
, and
severe acute pancreatitis. Chronic pan-
creatitis leads to permanent damage.
Acute pancreatitis is less damaging but
there may be recurrences.
Symptoms of acute pancreatitis are a
sudden attack of severe upper abdomi-
nal pain, which may spread to the back,
often with nausea and vomiting. Move-
ment often makes the pain worse. The
attack usually lasts about 48 hours.
Chronic pancreatitis usually has the
same symptoms, although the pain may
last from a few hours to several days,
and attacks become more frequent. If
there is no pain, the principal signs may
be
malabsorption
or
diabetes mellitus
.
Severe acute pancreatitis may lead to
hypotension
,
heart failure
,
kidney failure
,
respiratory failure
,
cysts
, and
ascites
.
Chronic pancreatitis may also lead to
the development of ascites and cysts,
as well as
bile duct obstruction
and dia-
betes mellitus.
A diagnosis may be made by
blood
tests
, abdominal
X-rays
,
ultrasound scan-
ning
,
CT scanning
,
MRI
, or
ERCP
. Acute
pancreatitis is treated with
intravenous
infusion
of fluids and salts and opioid
analgesic drugs.
In some cases, the gut
may be washed out with sterile fluid, or
a
pancreatectomy
may be performed and
any gallstones that are present removed.
Treatment for the chronic form is with
painkillers,
insulin, pancreatin,
and, in
some cases,
pancreatectomy
.
pancreatography Imaging of the pan-
creas or its ducts using
CT scanning
,
MRI, ultrasound scanning, X-rays
(follow-
ing injection of a radiopaque contrast
medium into the pancreatic ducts dur-
ing exploratory surgery), or with
ERCP
.
pandemic A medical term applied to a
disease that occurs over a large geo-
graphical area and that affects a high
proportion of the population; a wide-
spread epidemic.
panic attack A brief period of acute
anxiety
, often dominated by an intense
fear of dying or losing one's reason. At-
tacks are unpredictable at first, but tend
to become associated with specific situ-
ations, such as a cramped lift.
Symptoms (a sense of breathing diffi-
culty, chest pains,
palpitations,
feeling
light-headed, dizziness, sweating, trem-
bling, and faintness) begin suddenly.
Hyperventilation
often occurs, causing a
pins-and-needles
feeling, and feelings of
depersonalization
and
derealization
. The
attacks end quickly.
Panic attacks are generally a feature of
an
anxiety disorder
,
agoraphobia
, or
other
phobias.
In some cases, such
attacks are part of a
somatization disor-
der
or
schizophrenia. Behaviour therapy
and relaxation exercises may be used in
treatment of this condition.
panic disorder A type of
anxiety
disor-
der, characterized by recurrent
panic
attacks
of intense anxiety and distress-
ing physical symptoms.
432
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