pancreas, cancer ofA 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 scanningor MRIof the
upper abdomen, or ERCP. In early stages,
pancreatectomy, radiotherapyand anti-
cancer drugs may provide a cure. In
later stages, little can be done apart
from provision of palliative treatment.
pancreatectomyRemoval of all or part
of the pancreas. Pancreatectomy may be
performed to treat pancreatitisor local-
ized cancer of the pancreas (see pancreas,
cancer of). Rarely, it is performed to treat
insulinomas. Pancreatectomy may lead
to diabetes mellitusand malabsorption.
pancreatinAn oral preparation of pan-
creatic enzymesrequired for digestion.
It is used to prevent malabsorption, and
it may be needed after pancreatectomy
or by people with pancreatic disorders.
pancreatitisInflammation 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 malabsorptionor 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 obstructionand 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 pancreatectomymay be performed and
any gallstones that are present removed.
Treatment for the chronic form is with
painkillers, insulin, pancreatin, and, in
some cases, pancreatectomy.
pancreatographyImaging 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.
pandemicA 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 attackA 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.
Hyperventilationoften occurs, causing a
pins-and-needlesfeeling, and feelings of
depersonalizationand 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-
deror schizophrenia. Behaviour therapy
and relaxation exercises may be used in
treatment of this condition.
panic disorderA type of anxietydisor-
der, characterized by recurrent panic
attacksof intense anxiety and distress-
ing physical symptoms.PANCREAS, CANCER OF PANIC DISORDERP