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Can Pancreas Burst?

5 Warning Signs Your Pancreas Is In Trouble

5 Warning Signs Your Pancreas Is In Trouble

5 Warning Signs Your Pancreas Is In Trouble Quick, say the first thing that pops into your head when you read the word "pancreas." If you said "cancer," you're not alone. Most people only think about their pancreas when they hear about pancreatic cancerwhich is the deadliest form of cancer in terms of 5-year survival rates. "Part of the reason survival rates are so low is that identifying pancreatic cancer early is difficult," says Andrew Hendifar, MD, codirector of pancreas oncology at Cedars-Sinai Medical Center in Los Angeles. Early detection is also tough when it comes to non-cancer pancreas problems, says Ted Epperly, MD , president of Family Medicine Residency of Idaho. Tucked deep in your abdomen, your pancreas is a long, flat organ that produces enzymes and hormones that aid in digestion. While symptoms of pancreas issues can be persnickety, both Epperly and Hendifar say there are a handful of warning signs that warrant a call to your doctor. Here are 5 of them. (Want to pick up some healthier habits? Sign up to get healthy living tips delivered straight to your inbox !) If you notice your stool is light colored and floating, that's a sign of poor nutrient absorption. (Here are 7 things your poop says about your health .) "The enzymes your pancreas produces help you digest fats in your diet," Hendifar explains. Along with breaking down fats, your pancreas helps your body absorb fat-soluble vitamins like A, E, and K, he says. When pancreatic disease messes with your organ's ability to properly manufacture those enzymes, the result is feces that looks paler and is less dense. You may also notice your poop is oily or greasy. "The toilet water will have a film that looks like oil," Hendifar says. That's the dietary fat your body failed to break down, he explains. I Continue reading >>

Acute Pancreatitis Symptoms, Treatment & Causes Merck Manuals - Digestive Disorders - Merck Manuals Consumer Version

Acute Pancreatitis Symptoms, Treatment & Causes Merck Manuals - Digestive Disorders - Merck Manuals Consumer Version

Almost everyone with acute pancreatitis has severe abdominal pain in the upper abdomen. The pain penetrates to the back in about 50% of people. When acute pancreatitis is caused by gallstones, the pain usually starts suddenly and reaches its maximum intensity in minutes. When pancreatitis is caused by alcohol, pain typically develops over a few days. Whatever the cause, the pain then remains steady and severe, has a penetrating quality, and may persist for days. Coughing, vigorous movement, and deep breathing may worsen the pain. Sitting upright and leaning forward may provide some relief. Most people feel nauseated and have to vomit, sometimes to the point of dry heaves (retching without producing any vomit). Often, even large doses of an injected opioid analgesic do not relieve pain completely. Some people, especially those who develop acute pancreatitis because of heavy alcohol use, may never develop any symptoms other than moderate to severe pain. Other people feel terrible. They look sick and are sweaty and have a fast pulse (100 to 140 beats a minute) and shallow, rapid breathing. Rapid breathing may also occur if people have inflammation of the lungs, areas of collapsed lung tissue ( atelectasis ), or accumulation of fluid in the chest cavity ( pleural effusion ). These conditions may decrease the amount of lung tissue available to transfer oxygen from the air to the blood and can lower the oxygen levels in the blood. At first, body temperature may be normal, but it may increase in a few hours to between 100 F and 101 F (37.7 C and 38.3 C). Blood pressure is usually low and tends to fall when the person stands, causing lightheadedness. Occasionally, the whites of the eyes (sclera) become yellowish. Damage to the pancreas may permit activated enzymes and toxins s Continue reading >>

Internet Scientific Publications

Internet Scientific Publications

Fig 1 Rupture of pancreas near tail region with anechoic collection in lesser sac Fig 2 Rupture of pancreas near tail region with anechoic collection in lesser sac, splenic vessels appear normal Contrast enhanced CT of abdomen was performed which clearly showed fracture of body of pancreas near tail with a hypodense large collection in lesser sac (Fig 3). Splenic vessels appeared normal (Fig 4). Mild ascites was also detected on CT scan. Other intra-abdominal organs were normal. We diagnosed a post-traumatic pancreatic rupture, type III with ascites. The patient was operated and imaging findings were confirmed. Fig 3 CECT shows fracture of pancreas distal body near tail with large hypodense collection in lesser sac Fig 4 - CECT shows fracture of the pancreas at distal body near tail with large hypodense collection in lesser sac, splenic vessels appear normal Pancreatic injury is a rare complication in patient with single or multiple injuries, either with blunt or penetrating abdominal trauma (4). The deep, central and retroperitoneal location of the pancreas usually protects it from injury, but this anatomical location is also responsible for the diagnostic challenge (5). Pancreatic injury can range from minor contusions, hematoma to major lacerations or fractures or rupture with associated duct injury according to severity as described in table 1 (6). Abdominal radiograph may show retroperitoneal air due to rupture of duodenum. However in our patient this finding was not present. Laboratory investigations like serum amylase and lipase levels are important for pancreatic parenchymal injury. Initial serum amylase levels carry a low sensitivity for the prediction of injury. However, persistently elevated or rising serum or urinary amylase levels are more reliable indicat Continue reading >>

Pancreatitis

Pancreatitis

Pancreatitis is inflammation of the pancreas.[1] The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones.[1] There are two main types, acute pancreatitis and chronic pancreatitis.[1] Signs and symptoms of pancreatitis include pain in the upper abdomen, nausea and vomiting.[1] The pain often goes into the back and is usually severe.[1] In acute pancreatitis a fever may occur and symptoms typically resolve in a few days.[1] In chronic pancreatitis weight loss, fatty stool, and diarrhea may occur.[1] Complications may include infection, bleeding, diabetes mellitus, or problems with other organs.[1] The most common causes of acute pancreatitis are gallstones and heavy alcohol use.[1] Other causes include direct trauma, certain medications, infections such as mumps, and tumors among others.[1] Chronic pancreatitis may develop as a result of acute pancreatitis.[1] It is most commonly due to many years of heavy alcohol use.[1] Other causes include high levels of blood fats, high blood calcium, some medications, and certain genetic disorders such as cystic fibrosis among others.[1] Smoking increases the risk of both acute and chronic pancreatitis.[2][3] Diagnosis of acute pancreatitis is based on a threefold increase in the blood of either amylase or lipase.[1] In chronic pancreatitis these tests may be normal.[1] Medical imaging such as ultrasound and CT scan may also be useful.[1] Acute pancreatitis is usually treated with intravenous fluids, pain medication, and sometimes antibiotics.[1] Typically no eating or drinking is allowed and a tube may be placed into the stomach.[1] A procedure known as an endoscopic retrograde cholangiopancreatography (ERCP) may be done to open the pancreatic duct if blocked.[1] In those with gallst Continue reading >>

Pancreas & Cysts | Cleveland Clinic

Pancreas & Cysts | Cleveland Clinic

Overview Diagnosis and Tests Management and Treatment Outlook / Prognosis Your pancreas is a 6-inch gland located below your liver, between your stomach and your spine. The pancreas is made up of 3 parts: a "head" that is tucked into the duodenum (the upper part of the small intestine); a flattened, longer "body;" and a "tail" that is connected to the spleen. Your pancreas makes potent digestive enzymes and hormones that help manage blood glucose (blood sugar). Normally, these enzymes and hormones do not become active until they exit the pancreas and enter other parts of the body. Your pancreas also produces bicarbonates that neutralize stomach acids. Small ducts (tubes) move these fluids into a larger pancreatic duct, down into the duodenum. The common bile duct also carries bile (a substance that breaks down fats) from your liver and gall bladder through the head of the pancreas into your small intestine. An inflammation of the pancreas is called pancreatitis . Pancreatitis can either be acute (a sudden, sharp, and/or severe attack) or chronic (recurring and/or lasting for a long period of time). When the pancreas is inflamed, digestive enzymes become activated while still inside the pancreas, which can cause the pancreas to begin "digesting" its own tissues. The two most common causes of pancreatitis are gallstones (bile that has hardened into little pebble-like masses) and chronic, heavy alcohol use . Pancreatitis can also result from certain diseases or injury. Pancreatic pseudocysts can develop as a serious complication of pancreatitis. A pancreatic cyst is a closed sac lined with epithelium and located on or in your pancreas. Pancreatic cysts contain fluid. They can range from benign pseudocysts (see below) to malignant cysts (cancerous and spreading). There are Continue reading >>

Symptoms Of Pancreatic Cancer

Symptoms Of Pancreatic Cancer

Pancreatic cancer is known as a "silent disease" because identifiable symptoms are not usually present in the early stages of the disease. Many symptoms of pancreatic cancer are mild at first, so patients may often be unaware of the potential seriousness of them. Due in large part to the position of the pancreas deep in the abdomen, a pancreatic tumor can grow for years before causing pressure, pain, or other signs of illness. This can make it difficult for a patient or doctor to recognize a problem. There are several symptoms commonly associated with pancreatic cancer. However, other medical conditions can cause these, or similar symptoms. Having one or any combination of these symptoms does not always mean you have pancreatic cancer. If you are experiencing any of these symptoms, you should consult your doctor to discuss possible diagnoses. Jaundice Jaundice is identified primarily by your skin and the white of your eyes becoming yellow or greenish yellow. Dark urine and light or clay-colored stools can also be associated with jaundice. Jaundice occurs when bilirubin, a component of bile, builds up in your blood. Bilirubin is created in the liver as a breakdown product of worn-out red blood cells and is typically eliminated from the body when bile is released from the gallbladder. Bile travels from the gallbladder through the common bile duct and passes through the pancreas just before emptying into the duodenum. However, when the bile duct becomes blocked - for any reason - jaundice can occur. Deep-felt itching often accompanies obstructive jaundice. This is a condition known as pruritis. In Pancreatic Cancer: Jaundice typically occurs in pancreatic cancer when a tumor in the head of the pancreas first narrows, then obstructs the common bile duct, blocking the flow o Continue reading >>

Pancreatic Cysts: Symptoms, Causes & Management

Pancreatic Cysts: Symptoms, Causes & Management

What is the treatment for pancreatic cysts? The pancreas is an organ approximately six inches long that is located in the abdomen behind the stomach and in front of the spine and aorta . The pancreas is divided into three regions: the head, the body, and the tail. The head of the pancreas is located on the right side of the abdomen adjacent to the duodenum. The tail is on the left side of the abdomen, and the body lies between the head and the tail. There are two functional parts to the pancreas, referred to as the exocrine and endocrine parts. The majority of the cells of the pancreas produce digestive juices which contain the enzymes necessary for digesting food in the intestine. The enzymes are secreted into smaller collecting ducts within the pancreas (side branches). The side branches empty into a larger duct, the main pancreatic duct, which empties into the intestine through the papilla of Vater in the duodenum. During passage through the ducts, bicarbonate is added to the digestive enzymes to make the pancreatic secretion alkaline. The cells and ducts producing the digestive juices comprise the exocrine part of the pancreas. Just before the main pancreatic duct enters the duodenum, it usually merges with the common bile duct that collects bile (a fluid that helps to digest fat) produced by the liver . The common bile duct usually joins the pancreatic duct in the head of the pancreas. The union of these two ducts forms the ampulla of Vater which drains both the bile and pancreatic fluid into the duodenum through the papilla of Vater. Buried within the tissue of the pancreas, primarily in the head, are small collections of cells, termed the Islets of Langerhans. The cells of the Islets produce several hormones, for example, insulin , glucagon, and somatostatin; th Continue reading >>

What Is A Pancreatic Cyst?

What Is A Pancreatic Cyst?

Pancreatic cysts often cause no symptoms, though they can be serious enough to require surgery. Sign Up for Our Digestive Health Newsletter Thanks for signing up! You might also like these other newsletters: Sign up for more FREE Everyday Health newsletters . There are 20 different types of pancreatic cysts some benign and some malignant and most are discovered through imaging tests conducted for other reasons. Thepancreasis an approximately 6-inch gland located in the upper left area of the abdomen, behind the stomach. Its main functions are to produce digestive enzymes to break down food in the small intestine, and to secrete hormones (insulin and glucagon) to control blood sugar levels. Pancreatic cysts can develop on or in this organ. These cysts are either closed sacs, lined with epithelial tissue that contain fluid, or theyre marked by nonepithelial tissue, in which case they're called pseudocysts. Some cysts are caused by pancreatitis , which is an inflammation of the pancreas. But most pancreatic cysts don't have a detectable cause and are discovered through imaging tests conducted for other reasons. They can sometimes but very rarely develop in children who experience trauma in the abdominal region from a sports or other injury. There are 20 different types of pancreatic cysts. Some are benign (noncancerous) and some aremalignant (cancerous). According to Memorial Sloan Kettering Cancer Center, these four are among the most common types: ( 1 ) PseudocystsThese are often a result of pancreatitis. Serous CystadenomasAlmost all of these are benign. IntraductalPapillary MucinousNeoplasms IPMSare the mostcommon type of precancerous cysts. MucinousCystic Neoplasms (MCN)Twenty-five percent of MCNs can be cancerous, and they develop mainly in women. ( 2 ) RELATED: Rar Continue reading >>

Acute Pancreatitis - Complications - Nhs.uk

Acute Pancreatitis - Complications - Nhs.uk

Although most people with acute pancreatitis recover without experiencing further problems, severe casescan have serious complications. Pseudocysts are sacs of fluid that can develop on the surface of the pancreas. They're a common complication of acute pancreatitis, thought to affect around 1 in 20 people with the condition. Pseudocysts usually develop four weeks after the symptoms of acute pancreatitis start. In many cases, they don't cause any symptoms and are only detected during a computerised tomography (CT) scan . However, in some people, pseudocysts can cause bloating, indigestion and a dull abdominal (tummy) pain. If the pseudocysts are small and not causing any symptoms, there may be no need for further treatment, as they usually go away on their own. Treatment is usually recommended if you're experiencing symptoms or ifthe pseudocysts are large. Larger pseudocysts are at risk of bursting, which could cause internal bleeding or trigger an infection. Pseudocysts can be treated by draining the fluid out of the cyst by inserting a needle intoit through your skin. This can also be done by carrying out an endoscopy , wherea thin, flexible tube called an endoscope is passed down your throat, and tiny tools are used to drain away the fluid. In aroundone in threesevere cases of acute pancreatitis,a serious complication called infected pancreatic necrosis occurs. In infected pancreatic necrosis, high levels of inflammation cause an interruption to the blood supply of your pancreas. Without a consistent supply of blood, some of the tissue of your pancreas will die. Necrosis is the medical term for the death of tissue. The dead tissue is extremely vulnerable to infection from bacteria. Once an infection has occurred, it can quickly spread into the blood ( blood poisonin Continue reading >>

Enlarged Pancreas: Causes, Symptoms, And Treatments

Enlarged Pancreas: Causes, Symptoms, And Treatments

Enlarged Pancreas: Causes, Symptoms, and Treatments An enlarged pancreas can occur for many reasons. The pancreas is a gland that sits behind your stomach in the upper abdomen and helps with digestion. It produces enzymes that are secreted into the small intestine, digesting protein, fat, and carbohydrates. The pancreas also produces insulin to help regulate blood sugar (glucose), the body's main source of energy. An enlarged pancreas may mean nothing. You may simply have a pancreas that is larger than normal. Or, it can be because of an anatomic abnormality. But other causes of an enlarged pancreas may include the following: Pancreatitis occurs when digestive enzymes become active inside the pancreas, attacking and damaging its tissues. This can cause an enlarged pancreas. Acute pancreatitis is inflammation that occurs suddenly in the pancreas. It can be very serious, even life-threatening. But it usually goes away within a few days of treatment. Gallstones and alcohol are common causes of acute pancreatitis. Other causes include high levels of fats in the blood , certain drugs, certain medical procedures, and some infections. Chronic pancreatitis is inflammation that gets worse over time and leads to permanent damage in the pancreas. Heavy alcohol use is the most common cause. Other causes include heredity, cystic fibrosis , high levels of calcium or fats in the blood , certain medications , and some autoimmune conditions. Pancreatic pseudocyst is an accumulation of fluid and tissue debris in the pancreas, which can occur after a case of pancreatitis. Cystadenoma is a tumor that is usually benign. Abscess is a pus-filled cavity, usually caused by a bacterial infection . A pancreatic pseudocyst that becomes infected can become an abscess. Pancreatic cancer is an abnor Continue reading >>

Acute Pancreatitis In Children

Acute Pancreatitis In Children

Home Patient Information Children/Pediatric Acute Pancreatitis in Children Many cases of acute pancreatitis occur in children who have a separate illness. Some of these illnesses affect multiple organs and can make your child sick enough to require care in an Intensive Care Unit. Other common causes of acute pancreatitis in children include physical injury, certain medications, gallstones, or problems in the anatomy of the ducts (tubes) in the liver or pancreas. Bicycle handle-bar injuries or blunt trauma to the mid-upper abdomen can cause pancreatitis. Common medications that are associated with pancreatitis include anti-seizure medications, chemotherapy agents and certain antibiotics.In up to 35% of children with acute pancreatitis, a cause will not be identified. Common symptoms include abdominal pain, nausea, and vomiting. However, not every patient with pancreatitis will have all of these symptoms. Pancreatitis symptoms are nonspecific and can easily be confused with signs of another disease. They also vary depending on your childs age and developmental level; for instance, non-verbal infants may present with increased crying. There is no single test to diagnose pancreatitis. The diagnosis is clinical and depends on the presence of symptoms consistent with acute pancreatitis, abnormal blood tests, or radiographic images showing inflammation in the pancreas. A diagnosis of acute pancreatitis can be made if two or more of these criteria are fulfilled. Amylase and lipase are the most commonly measured blood tests. Both are enzymes which are made by the pancreas to aid digestion of foods. When the pancreas is injured or inflamed, the blood levels of both amylase and lipase can rise above normal. Since other conditions can also raise these enzyme levels, they are not s Continue reading >>

Acute Pancreatitis: Symptoms, Treatment, Causes, And Complications

Acute Pancreatitis: Symptoms, Treatment, Causes, And Complications

Acute pancreatitis is an inflammation of the pancreas. It is painful, develops quickly, and it can, in some cases, be fatal. Some mild cases resolve without treatment, but severe, acute pancreatitis can trigger potentially fatal complications. The mortality rate ranges from less than 5 percent to over 30 percent , depending on how severe the condition is and if it has reached other organs beyond the pancreas. Acute pancreatitis is estimated to affect between 4.5 and 35 in every 100,000 individuals per year. However, this figure may not include the many mild cases that resolve without medical evaluation or treatment. Every year, there are 275,000 hospitalizations for acute pancreatitis in the United States. The pancreas is a long, flat gland located behind the stomach in the upper abdomen. It produces digestive enzymes and hormones, which regulate how the body processes glucose, for instance, insulin . The most common cause of pancreatitis is gallstones , but a rise in alcohol misuse is linked to an increase in incidence. Alcohol now accounts for around 30 percent of cases. Acute pancreatitis starts suddenly, but chronic pancreatitis is recurring or persistent. This article will focus on acute pancreatitis. Here are some key points about acute pancreatitis. More detail is in the main article. Pancreatitis is split into acute and chronic types. The pancreas carries out many tasks, including the production of digestive enzymes. Symptoms include pain in the center of the upper abdomen, vomiting, and diarrhea . The most common causes of acute pancreatitis are gallstones and alcohol abuse. Sharp and sudden abdominal pain can be a sign of pancreatitis. Typically, the patient will experience a sudden onset of pain in the center of the upper abdomen, below the breastbone (stern Continue reading >>

Spontaneous Rupture Of Pancreatic Pseudocyst: Report Of Two Cases

Spontaneous Rupture Of Pancreatic Pseudocyst: Report Of Two Cases

Spontaneous Rupture of Pancreatic Pseudocyst: Report of Two Cases Surgery Department, Cirurgia B, Hospital Prof. Dr. Fernando Fonseca, 2720-276 Amadora, Portugal Received 28 January 2016; Accepted 2 March 2016 Copyright 2016 Ricardo Rocha et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Pancreatic pseudocysts are a common complication of acute pancreatitis. Pancreatic pseudocysts natural history ranges between its spontaneous regression and the settlement of serious complications if untreated, such as splenic complications, hemorrhage, infection, biliary complications, portal hypertension, and rupture. The rupture of a pancreatic pseudocyst to the peritoneal cavity is a dangerous complication leading to severe peritonitis and septic conditions. It requires emergent surgical exploration that is often of great technical difficulty and with important morbidity and mortality. Case Study. We present two cases of spontaneous rupture of pancreatic pseudocysts, managed differently according to the local and systemic conditions. Conclusion. The best surgical choice is the internal drainage of the cyst to the GI tract; however, in some conditions, the external drainage is the only choice available. Pancreatic pseudocysts are a common clinical problem after acute pancreatitis, with an estimated prevalence of 6 to 18.5%. In chronic pancreatitis its prevalence is higher, ranging from 20 to 40% [ 1 ]. Pseudocyst of the pancreas is an encapsulated collection of fluid with a well-defined inflammatory wall usually outside the pancreas with minimal or no necrosis, usually occurring more than 4 weeks af Continue reading >>

Uncomplicated Spontaneous Rupture Of The Pancreatic Pseudocyst Into The Gut Ct Documentation: A Series Of Two Cases

Uncomplicated Spontaneous Rupture Of The Pancreatic Pseudocyst Into The Gut Ct Documentation: A Series Of Two Cases

Uncomplicated Spontaneous Rupture of the Pancreatic Pseudocyst into the Gut CT Documentation: A Series of Two Cases Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India Address for correspondence: Dr. Mohammed F. Mir, Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Soura, GPO Post Bag No. 27, Srinagar - 190 011, Kashmir, India. E-mail: [email protected]_qoorafrim Received 2008 Sep 1; Accepted 2008 Sep 23. Copyright Saudi Journal of Gastroenterology This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present herein two cases of uncomplicated spontaneous rupture of a pancreatic pseudocyst into the stomach with complete resolution. Keywords: Pancreatic pseudocyst, spontaneous rupture, computed tomography Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, whenever it occurs, is associated with life-threatening bleeding. We present a series of two cases of uncomplicated spontaneous rupture of a pancreatic pseudocyst into the stomach with complete resolution. A 44-year-old nonalcoholic male presented with an epigastric mass and postprandial fullness. The patient had been treated as acute pancreatitis by conservative management 2 months earlier. Contrast enhanced computed Continue reading >>

Pancreatic Pseudocyst

Pancreatic Pseudocyst

A pancreatic pseudocyst is a collection of tissue and fluids that forms on an organ located behind your stomach called the pancreas. Its usually the result of a hard blow to your abdomen or pancreatitis, which is an inflammation of the pancreas. Pseudo means false. A pseudocyst looks like a cyst but is made from different kinds of tissue than a true cyst. A true cyst is more likely to be cancerous than a pseudocyst. A pancreatic pseudocyst isnt usually dangerous unless it ruptures. A ruptured pancreatic pseudocyst is a life-threatening condition. See your doctor immediately if you have any of the following symptoms: You should pay even closer attention to these symptoms if you or anyone in your family has had pancreatitis. Pancreatic pseudocysts most often follow a bout of pancreatitis. Pancreatitis is a serious and painful condition. Pancreatic enzymes, which help you digest fats and sugars, overreact and begin to digest the tissues of the pancreas itself. This can cause swelling, bleeding, and damage to the tissues and blood vessels in the pancreas. Cysts typically form when the ducts that carry pancreatic juices to the intestine become blocked. Pancreatitis can be either acute or chronic. Acute pancreatitis starts suddenly, and it can go away with or without treatment. Chronic pancreatitis resists treatment. While pancreatitis may be a complication of surgery or due to certain autoimmune disorders, alcoholism is the most common cause of both acute and chronic pancreatitis. Additionally, alcoholism can raise the level of certain fats, or triglycerides, in your bloodstream. Your pancreas helps your body digest fats, but having too much fat to process can damage it. Pancreatitis can also be due to gallstones. These are pebble-like deposits that develop in the gallbladd Continue reading >>

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