What do you think this is?” a surgical registrar once asked me. we were standing over the blue-draped abdomen of a 60-year-old man, peering into the hole the registrar had made. The brown bulk of the liver was obvious – it is massive, relative to everything else, with a clearly defined bottom edge, like the hull of a boat. I could see the gall bladder, clinging to the liver’s underside like a greenish blob of sea anemone. The surgeon had worked her way deeper towards the spine and was poking at a knobbly piece of tissue with her forceps. “Think of the pictures you’ve seen in books: think what is related to what.”

Looking for a landmark, I finally saw a bit of the duodenum, the first part of the gut, which curves in the shape of a C. The unidentified organ had one end buried in the curve. It was the pancreas. in anatomical drawings the pancreas looks weightless: an elegant plume like the feather sticking out of a cavalier’s hat, with its broad end (the “head”) nestled against the duodenum and its “tail” pointing across the top of the abdomen towards the spleen. you could see how its name is derived from the Greek words meaning “all flesh”; it is lumpy and blobby, unlovely but essential.

The pancreas has several functions. It is both an endocrine gland (producing hormones that are secreted into the internal environment: the pancreas secretes insulin and glucagon into the bloodstream), and an exocrine gland (producing substances released into the exterior; the pancreas makes enzymes to help us digest our food and secretes them into the gut, and so, eventually, the outside world). when the endocrine cells malfunction, diabetes results: a common, harmful but treatable illness. For some reason, the other serious diseases affecting the pancreas have a much lower profile. Pancreatic cancer, like the other so-called “silent” cancers (ovarian is another), tends to present late, which accounts for its poor prognosis. A small tumour in the pancreas is rarely painful or disruptive, especially if it grows in the tail. By the time it has grown large enough to cause symptoms, such as nausea, weight loss, pain or jaundice (from a tumour blocking the common bile duct), it has often invaded nearby structures, or spread elsewhere in the body – as happened to the actor Patrick Swayze. Once it has spread, the disease is inoperable.

Pancreatic cancer is a very nasty disease, but it actually kills fewer people than a less well-known illness, pancreatitis – inflammation of the pancreas. At its most severe, acute pancreatitis has a mortality rate of 10 per cent. (You can also get a lingering, chronic form of the disease, which is painful and difficult to treat, but less immediately dangerous.) Many things can provoke an acute (or sudden) inflammation of the pancreas, but the most common are excessive alcohol and gallstones (if you are a medical student these sensible causes unfortunately desert you and you will only be able to summon up “scorpion venom” – true, but unhelpful in a British context).

Alcohol acts as an irritant (a single binge can be enough to trigger a severe episode), and gallstones can fall out of the gallbladder and block the common bile duct, obstructing the drainage route from the pancreas to the gut. whatever the trigger, the results are the same. instead of pouring its enzymes into the small bowel to help process food, the pancreas sequesters them instead, digesting itself. as the students inevitably ask, “you mean it eats itself?” It does, with life-threatening consequences.

Sophie Harrison is a hospital doctor in South Yorkshire

When 6-year-old Angela Bushi’s organs started to fail, her family feared they would lose her – just as they had lost her 18-month-old sister Alicia to liver failure a few months earlier.

“When you see your children in this situation, and there’s nothing you can do, it is so hard,” said Angela’s mom, Valbona Bushi.  “We went through a lot.”

But today, Angela’s organs are functioning better than ever.  thanks to a team of geneticists and surgeons at Holtz Children’s Hospital and the University of Miami Miller School of Medicine/Jackson Memorial Hospital, her life was saved after she underwent a combined liver, pancreas, and kidney transplant – the first ever quadruple transplant of its kind performed on a child.

Initially born healthy, Angela developed type 1 diabetes when she was just a year old.  Four years later, she became even sicker, developing flu-like symptoms, which  eventually turned into fatal liver failure.

“This was kind of an unusual combination of acute liver failure and diabetes,” said Dr. Olaf Bodamer, director of the pediatric genetics program at Holtz Children’s Hospital, who eventually diagnosed Angela.  “We knew that her sister had died under similar circumstances, so we assumed that her condition was genetic.  When you go to the medical literature, the list of syndromes that came up to explain her condition was very small.”

Bodamer finally discovered the culprit – Wilcott-Rallison Syndrome (WRS), an extremely rare disease with only 60 known cases in medical literature worldwide.  Those with WRS have a multitude of health problems, including diabetes, liver and/or kidney failure, bone and growth problems, repeated infections and intellectual impairment.

And for the majority of children with WRS, the condition is typically fatal.

After finally diagnosing Angela with WRS, surgeons knew that if they were going to save her life, transplanting just one organ wasn’t going to cut it.

“The risk to her life was from three (different) organs – the liver, pancreas, and kidneys,” said Dr. Andreas Tzakis, chief of the liver/GI transplant program at UM’s Miller School of Medicine and Jackson Memorial Hospital, and one of the transplant surgeons who operated on Angela.  “If there was to be a solution, we knew we’d have to combine these (three different types of) organs into one transplant.  We had several consultations within the team, outside the team, and the parents; and collectively, we decided the transplant was the way to go.”

Angela was placed on a transplant list, and on December 29, 2011, she received the ground-breaking quadruple transplant.  Because of Angela’s small size and the combination of the organs needed, Angela’s new liver, pancreas, and kidneys all came from a single donor.  the organs were left in a “block,” almost as if they were all one organ.  

The surgery was the first to ever be performed on a child – and the first to be used to treat WRS.  Liver transplants had previously been considered to treat the disease, but surgeons never followed through with them for fear of complications with other organs.  but because the surgeons transplanted all the organs at once, the complications were minimized as much as possible.

Initially, Angela started to reject the organs – but the doctors were prepared and treated the issue with anti-rejection meds, and she has since fully recovered. she was discharged from Holtz at the end of February.

Angela no longer needs insulin treatment, and the only evidence of her innovative surgery is a slightly protruding belly, which houses two pancreases, a new liver and four kidneys.

The surgeons hope Angela’s story will not be the only one of its kind and that more transplants like hers can be done in the future.

“The surgery itself might benefit other children who might need this combination,” Tzakis said.  “It might give hope to children with this syndrome – that there might be at least one solution that can prolong their life.  For the first time, we have a sense of enjoyment about this whole process.   Seeing the child looking well and the family being relieved, this is the first time I feel joy for having done this procedure.”

The Bushi family, who live in Jacksonville, Fla., are also joyous to have Angela back home and feeling better.  they said they look forward to seeing Angela live a long and healthy life.

“She’s a normal child again, and we can do everything like normal parents,” Valbona said.  “She even wants to be a doctor when she grows up.”

1. What kind of diabetes?

2. how can it be reversed?

Great questions! Diabetes in cats is different than in humans. in humans there is type I (where the body is not producing enough insulin) and type II (“non- insulin dependent,” often caused by obesity, which can be controlled). Diabetic cats are not classified as type I or II; they are borderline diabetics. If we were going to classify diabetic cats capable of remission they are most closely related to type II diabetics.

Cats can go into remission and stay there for various periods of time. Sadly, with time, stress, diseases or weight gain will cause the pancreas to eventually give out, and the cat will become diabetic again (similar to type I). The goal of therapy is to reverse the symptoms of diabetes, including increased thirst, excess urination and weight loss, by lowering the blood sugar levels closer to that found in “normal” cats.

How can they go into remission?

Diabetics have high blood glucose levels, which negatively affect the beta cells in the pancreas. Insulin allows these cells time to recover and start working again properly. But cats that are overweight are resistant to insulin. therefore, it is important to put your diabetic cat on a weight-loss diet to allow the insulin to start working more efficiently. a low carb and high protein diet is thought to prevent spikes in blood glucose levels so the cat produces less simple sugar. Carbohydrates readily convert to simple sugars and raise blood glucose levels. High-protein and high-fat diets, on the other hand, are less likely to raise the cat’s blood glucose level than a diet consisting of carbohydrates.

Some fortunate cats are transient diabetics and no longer require insulin treatment after initial therapy. this type of diabetes is typically caused by drugs or other diseases. If the pet’s underlying disease is cured (often related to pancreatic diseases), or particular medications are discontinued, the transient diabetic cat can become a non-diabetic.

Unfortunately, diabetes in cats is very complicated and there is still a lot that is unknown. Fortunately, diabetes is on the forefront of numerous research projects.

Alia Kroos is a veterinary nurse at Adobe Animal Hospital in Los Altos. Visit adobe-animal.com.

Send in your questions

If you have questions about pets, The Daily News would like to answer them, with help from experts at Adobe Animal Hospital in Los Altos and other Peninsula vets. Just write to us at petpointers@dailynewsgroup.com.

Grisha Balasanyan16:23, November 24, 2011

Lilit should be entering the fifth grade but she’s been left back.

Her medical condition is such that the young girl hardly attends class. Lilit is given to long coughing bouts.

The girl doesn’t seem to mind that much given that she won’t be surrounded by the same classmates that used to make fun of her.

At first, parents and even some teachers thought Lilit suffered from tuberculosis. Recently, physicians have diagnosed something more alarming – cystic fibrosis (mucoviscidosis).

It’s a recessive multi-system genetic disease characterized by abnormal transport of chloride and sodium across epithelium, leading to thick, viscous secretions in the lungs, pancreas, liver, and intestine.

The hallmark symptoms of cystic fibrosis are salty tasting skin poor growth and poor weight gain despite a normal food intake, accumulation of thick, sticky mucus, frequent chest infections and coughing or shortness of breath.

For the past three years Lilit has spent most of her days in hospital under the car of doctors.

Lilit’s aunt, Narineh Sargsyan, says the illness is incurable and that now they are simply trying to prolong the girl’s life expectancy.

When we visited Lilit, one of her coughing spells acted up. Family members were afraid because there was a lot of mucous coming up and the girl was having trouble breathing.

When doctors diagnosed CF and they registered Lilit as “disabled”, they advised the family to purchase a special piece of medical equipment. Medicine would be filled into the unit and Lilit would breathe it in. It’s the only way to bring the girl back to a conscious state in a short time.

But Narineh says the unit must be special ordered and that it costs 60,000 AMD ($170). the family was despondent since they couldn’t afford the life-saving unit but a kindhearted nurse, Satik Arturovna, gave the unit to the family free of charge. she realized that the child couldn’t get by without it.

Lilit uses the unit to breath 2-3 times daily and takes a regimen of medicines and nutritional supplements.

Lilit is starting to lose weight – a bad sign.

A t first, the doctors wanted to operate but decided to hold off till Lilit got older and the illness progressed. They aren’t sure if Lilit will make it to her twentieth birthday.

Lilit and her family live in the Sipanik village in Ararat Marz. the family can’t make ends meet let alone pay for Lilit’s medical care.

Lilit’s mother Karineh told us that her other child Benik is ill as well due to the dampness in the trailer they call home. Doctors have diagnosed that the boy has kidney nephritis.

Hetq covered the story of Lilit last year but there was no response from the government. the only form of assistance came from the Diakonia charitable organization in the form of periodic food packages.

This year Lilit sat down and wrote a letter to Armenia’s first Lady Rita Sargsyan. but the letter was addressed to the Ararat Regional Authority. Edik Barseghyan, the Regional Governor, responded that his office had financially assisted the young girl.

The assistance Barseghyan mentions amounted to 20,000 AMD ($60) and was used to but Lilit a school uniform this September.

Lilit’s aunt wrote a second letter to first Lady Rita Sargsyan. she included a picture of the girl breathing with the assistance of the medical device.

A few days ago the family received a reply stating that the first Lady wouldn’t be able to help until February 2012.

Once, the family wrote to the Catholicos saying, “if you refuse to help this girl remember that every day the church bells chime Lilit has held out her hand to you for help.”

The family received no answer from the church.

The Red Cross office in Armenia told the family that it only assists those with HIV/AIDS.

Prosperous Armenia Party (PAP) MP Tigran Stepanyan is the legislative representative for the village of Sipanik. Narineh says she wrote to the PAP office in Masis but that her request for assistance was turned down. MP Stepanyan is aware of the girl’s medical condition but said he doesn’t deal with such matters.

Narineh also wrote to the Gagik Tsarukyan Foundation, but says they never answered.

Lilit’s mother says that received 25,000 AMD from the village municipality bad they spent it on school supplies.

Narineh has lost all hope. she says that there is no one coming forth to help Lilit.

“Lilit has lost her health but she at least be afforded the chance to have a happy childhood. We draw strength from God and will never give up seeking assistance. there is no one else to rely on. the elections are coming and at least the candidates will be doling out 5,000 Drams for votes,” Narineh laments.

The young girl can’t even watch her favorite cartoons. the TV is tiny and old. the family is forced to burn wood to keep the trailer they live in warm. They collect wood from the streets and even burn discarded clothes found in the trash.

Karineh says that when the fire goes out even water in the house freezes.

When it was time for us to leave, Lilit showed us a picture of a house she painted. the house has two doors,

She said that one of the doors was for her Aunt Narineh and her cousins.

Lilit told us that she cannot imagine living without them.

I had Pancreatitis about 4 months ago and I've noticed something different since I had it. it seems like most foods I eat now give me painful diarrhea or oily loose stool. I drink plenty of water a day and only eat about 2 meals a day. I haven't seen a doctor yet about this yet. I just read stories about people with Pancreatic cancer having similar symptoms. do you think my pancreas could be somewhat damaged from my Pancreatitis attacks?

Sounds like you have developed low levels of pancreatic enzymes, which cause you to be unable to adequately absorb fat and thus have loose oily (fatty) stools. it may improve as your pancrease recovers, but even if not, there are prescription pancreatic enzyme replacement pils that should take care of the problem (pancrease). Definately call you doctor for evaluation.

I have had stomach problems for the last couple of years. my doctor's tell me I IBS. However, lately I have had a dull ache under my left rib. I am not sure if this may be my pancreas or my stomach. I have considered an ulcer because I have symptoms like upset stomach. Has anyone else had this problem?

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What is Cystic Fibrosis?

Cystic Fibrosis is a average genetic ailment that affects many organs of the body. the most average organs affected are the lungs, sinus and pancreas. Other organs that are also affected are; liver and gallbladder, intestines, reproductive organs in men and women. Cystic Fibrosis also affects the difficulty glands. This means the inadequate gene interferes with the body's ability to carry water and salt to and from cells, which means that people who suffer from Cystic Fibrosis altogether have bristly and sticky secretion. This is not so good since it clogs up many organs of the body. In non-CF people, the secretions are thin and watery, which is normal.

How organs are affect

Respiratory System:

Cystic Fibrosis affects ones breathing and the alibi for this is because emanation in the airway becomes bristly and blocks the airways, which makes this difficult for most CF patients to breath.  Normal emanation in the airway is altogether thin which makes it easier for emanation to pass through and be cleared. Because of this reason, lung infections are very average is CF patients. Pseudomonas Aeruginosa (PA) is the most average bacteria that beget lung infections. Sinus difficulty may also occur due to respiratory infections of CF patients, which mean that CF patients have a higher risk of sinus infections. the alibi for sinus infections is due to nasal polys, which are non-cancerous tumours in the liner of the nasal passage. when this happens, altogether surgery is required. I have had 18 surgeries in my life due to this reason.

Digestive System:

Cystic Fibrosis affects the digestive system due to lack of enzymes in the pancreas. This means that not adequate nutrients can be digested. Patients with CF must take enzymes in order to absorb all the nutrients taken in by food. Lack of enzymes in the body causes many CF patients to be under weight. In CF, many patients lack the assimilation of fats and proteins, so when this happens, higher intake of fat and proteins from food are required. Sticky emanation is alternative issue why people in CF lack assimilation because of abnormal bristly secretion, this blocks the ducts or passageways to the pancreas preventing healthy digestive juices from toward the inside the intestines, making it almost not possible to digest proteins and fats.

Prevention is the best medication for cystic fibrosis. Although, nowadays there is no known cure there are natural supplements for cystic fibrosis. Natural dietetic supplements afford your digestive system the proper enzymes needed to process food and abate the intensity of cystic fibrosis. (hellolife.net/explore/digestive-enzymes/how-cystic-fibrosis-affects-your-digestive-system/)

Reproductive System:

Cystic Fibrosis affects the reproductive system due to the sticky emanation in the sexual organs. For men, this may beget obstruction of the sperm canal. For women, this may beget infertility or a abate in fertility, yet it is not not possible for a woman with CF to get pregnant.  Many women who have cystic fibrosis have successful pregnancies, but they need attached monitoring because of their dietetic status and the addition crick on their lungs.

Symptoms of Cystic Fibrosis

There are many symptoms that are associated with CF, but vary from person to person. Below are the lists of symptoms:

-chronic cough -coughing up blood -collapsed lung -clubbing (rounding and enlargement of the fingers and toes) -heart enlargement -nasal polyps (fleshy growths in the nose) -sinusitis (inflamed nasal sinuses) -delayed sexual development -absence or stopping of menstruation -irregular menstrual periods -inflammation of the cervix -infertility or sterility -salty tasting skin -bowel obstruction -frequent wheezing or pneumonia -abdominal swelling -vomiting -dehydration -pneumothorax (rupture of lung tissue and trapping of air between the lung and bureau wall) -Liver and gallbladder problems -Gassiness

Who is altogether affected by Cystic Fibrosis and how it is diagnosed?

Did you know that it is most average for Caucasians to be diagnosed with cystic fibrosis? it is said that 1 out of all 3600 children in Canada are diagnosed with cystic fibrosis. 1 in 25 people are carriers of this gene, which means they do not have CF, but because they carry this gene they can pass it on to their children.  it is said that in the United States, Cystic Fibrosis is the number 1 killer amongst children and adults. Here is anything I had base on what happens when two people are a carrier of Cystic Fibrosis. 

When two people who carry the CF gene have a child, there is:

a 25% chance that the babe will be born with cystic fibrosis; a 50% chance that the babe will not have CF, but will be a carrier; a 25% chance that the babe will not have CF, and will not be a carrier.

How is CF diagnosed?

Cystic Fibrosis is diagnosed by performing what is called a "sweat test". In CF, many patients lose salt through sweat, but CF patients tend to lose more salt then a non-CF person. when a difficulty test is performed, if high salt bank occurs, then the attending of Cystic Fibrosis is there.

What is the standard life span of Cystic Fibrosis today?

Today the standard life span of Cystic Fibrosis is 30 days old. This has accretion a lot in the past decade. In the past, the life expectation of CF was 18 days old. Now due to the accretion in treatments and amplified medication, people with CF are also days into their 40's.

-Treatments used to delicacy Cystic Fibrosis

Many treatments are used nowadays to delicacy this fatal disease, such as

-Chest physiotherapy -Pancreatic enzyme replacement -Antibiotics -Nutritional therapy -Pulmonary therapy

Many illnesses that are present in the world today can be unavoidable for some, because of their inherited qualities. Though there are various types, one of the most common and deadly is Cystic Fibrosis.

Cystic Fibrosis, or CF, causes thick mucus to build up in the lungs, digestive tract, and sometimes other organs within the body. the buildup is created because of a defective inherited gene, and the mucus collects in the lung passages and in an organ that helps to break down food, the pancreas.

Because the disease is brought on by heredity, unfortunately, many do not have a chance in avoiding it and it is inborn. There are many Americans that carry the gene that is responsible for CF but do not realize it because they do not experience symptoms, themselves.

Individuals that suffer from the disease must inherit two defective Cystic Fibrosis genes, one from each parent. it has been estimated that one in every twenty-nine Americans of Northern or Central European descent have this specific gene that could potentially cause the disorder in future children.

Most individuals that suffer from CF are diagnosed by the age of two, because the symptoms are present in infancy; however, there are some that may not be diagnosed until the age of eighteen because their condition is milder. it can sometimes be difficult to determine the disease in infants, especially because there are so many different degrees of seriousness and more than a thousand various mutations of the gene that causes Cystic Fibrosis.

Some tell-tale signs may be delayed growth, a lack of bowel movement in the first day or two after birth, salty-tasting skin, and an inability to gain weight during childhood. Other symptoms that relate specifically to the disease are belly pain, nausea, bloating, coughing or increased sinus blockage, fatigue, and recurring episodes of the sickness pneumonia.

Probably the best and most effective way to determine whether or not an infant or child suffers from the disease is to have a blood test performed. if any of these symptoms are manifested at any time within the first few years of birth, it is best to take the child into a physician for a health evaluation or testing.

Other tests that may be used to diagnose the condition are a fecal fat test, secretin stimulation test, or a CT scan. Having a child that suffers from the aforementioned symptoms can be hard for adults, as well, especially when they are unsure about what is wrong.

Unfortunately, there really is no way to prevent Cystic Fibrosis, seeing that it is inherited from the parents and nothing can really be done about their genetic makeup. Those that are worried that they may be carriers of the gene or have a family history of CF may want to be screened or tested.

There is usually around a sixty to ninety percent success rate, depending on the type of screening method that is used. Children that do suffer from CF should be able to live a pretty normal childhood, including going to school and participating in sports and physical activity.

The sooner the disease is diagnosed, the sooner your physician will be able to create a treatment plan. This usually means a higher life expectancy and an easier time overall for your child.

It is usually vital to maintain a good schedule of monitoring with your doctor to make sure that the individual affected is experiencing somewhat proper functioning of the lungs and digestive tract. There are a number of Cystic Fibrosis focused clinics where you can possibly receive treatment; those that are interested in these types of medical establishments should contact their doctor or insurance company.

As far as medications go, many prescribe antibiotics to prevent and treat infections, medications that are inhaled and open airways, vaccines, oxygen therapy, and sometimes a lung transplant, if necessary and available. Parents can possibly help reduce the amount of symptoms that their child experiences by making small lifestyle changes.

These include avoiding dust, mildew, smoke, and cleaning fumes within the home, performing chest percussions/postural drainage, making sure the child gets enough exercise, and drinking enough fluids. unfortunately, this disease can weaken the lungs and body so much that there is usually not a very long life expectancy for those that suffer with from the disease.

Children may be able to live normal lives, but as they age and enter into adulthood conditions usually worsen. As they get older, the lungs have to work harder to provide the body with necessary oxygen, and this can weaken and wear out this organ and the airways.

Often, individuals become disabled and may eventually die due to lung complications. the life expectancy for someone suffering from Cystic Fibrosis is around thirty-five years, but this number can be larger or smaller depending upon the severity and the lung health.

Individuals who suffer or parents who have children with CF can find help and assistance through support groups. Though this disease does not provide a positive prognosis, patients can still live full lives.

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Dog pancreas produces hormones and digestive enzymes too. Pancreatic cancer is a very serious medical condition in dogs. Usually fatal. symptoms do not appear until the cancer is already well under way.

This will cause the disease to develop tumors of the pancreas. This usually causes the blood in the stool of the dog. Other common symptoms are lethargy, vomiting, diarrhea and loss of appetite. Neurologicalsigns may be present, and seizures and loss of coordination.

Pancreatic cancer in dogs an owner

if your dog displays these symptoms, should be a veterinarian as soon as possible. as stated in the notice of one thing and seek treatment before the disease is usually advanced. In order to diagnose this disease, veterinary, and blood tests, pancreatic enzymes will have to do is to check the damage.

Unfortunately, cancer, pancreasdogs are usually difficult to treat. It is one of the basic methods of surgical treatment. disease has already spread to other parts of the body, however, surgery has no effect. Tumors can cause intestinal obstruction as they grow. This requires that gastrointestinal bypass surgery.

In addition to surgery, radiation therapy and veterinary prescription drugs may choose to give. Most dogs will not rest the pancreas and the food is notto secrete digestive enzymes. without food, dog food and vitamins must be given by IV.

very poor prognosis for pancreatic cancer in dogs. After showing symptoms of the disease, most dogs would not live more than a year.

Pancreatic cancer in dogs an owner