Friday, May 04, 2007

More on acute pancreatitis

Surgeonsblog is the blog of a "mostly retired general surgeon," Sid Schwab, who shares stories of past experiences with surgery, patients, families, and the healthcare system, full of interesting and informative anecdotes from a surgeon's perspective.

A couple of Surgeonsblog posts relevant to this month's Journal of the Medical Library Association case study, "Using the literature to evaluate diagnostic tests: amylase or lipase for diagnosing acute pancreatitis?":

- Surgeons and Sweetbreads: an in-depth (and consideration of the anatomy of pancreas and surgical intervention in the patient with acute pancreatitis:
The good news is most of us will never have a reason to find out. The bad news is we all walk around with a self-destruct button in us, and I'm not getting all Freudian here. Of all the vital organs, there's only one that can -- sometimes with only the slightest of provocations -- turn on us and literally become our worst nightmare: it can eat us alive, from the inside. All the while, doing only what it thinks it's supposed to do.
- and a follow-up post, Pancreas stuff, #2:

It's that combination of highly unfortunate location and the power of self-digestion that turns the upper abdomen into a seething and distorted mess. Imagine a nicely-tended garden overtaken by sewage. Think of trying to find your way through a mine-field, knowing a misstep could cause death, while wearing size twenty shoes, and blindfolded. Compare being required to reach into a shallow pan of water to find by feel a couple of well-defined objects, with groping into hot mush, mittened and scared...

...Tucked behind the stomach and colon, that space is clean and quiet, opens sort of magically; and its backside is -- ideally -- that pink and normally-firmer-than-normal organ, the pancreas. There for your viewing pleasure. With acute pancreatitis, not only is that space completely obliterated, it's filled with indistinguishable stinky goo, and the edges of the stomach and colon -- out of which you'd dearly like to stay -- are absolutely undecipherable, unrecognizable, and half-digested. Not good.



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