Pancreatic Cancer		Enzyme Therapy

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management must include efforts to palliate patients with advanced pancreatic cancer Common problems include biliary obstruction depression pain intestinal obstruction and fatigue

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the patient for the exocrine pancreatic insufficiency It is unusual for a patient with anorexia to have single specific contributing factor when controlled alleviates the anorexia

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issue can be an additional consideration favoring its use over the systemic analgesic therapy However intraspinal drug delivery cannot be provided without a proper team 8 9

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patency than the plastic stent however they are more expensive In a study done by Katsinelos et al Tannenbaum stent were found to be cost effective as compared to metal stents 21

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another reason affecting the selection In addition if a patient is having problems with bloating despite taking the enzymes changing to a different formulation may help few patients

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pain and sometimes referred pain to the right shoulder or neck Pain is usually worrisome for both patient and family Some people would equate the suffering with intolerable pain 1

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lasts up to 5 days Diarrhea 38 may result from sympathetic blockage to the GI tract Abdominal aortic dissection and retroperitoneal hemorrhage are rare complications 5 6

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disease or hepatic metastasis Propoxyphene and meperidine should be used with caution in elderly as its metabolites may build up to cause neurotoxicity and lower the seizure threshold

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The rate of serious complications with ERCP is approximately 11 and 5 10 with PTC Complications related to stent are note mentioned over here

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It is important to recognize the several contributing factors outline above in each patient Treatment is usually difficult and its important to treat the contributing factors 27

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In general it is best to start the antidepressants at a low dose and titrate up as the patient tolerates This approach will help in minimizing side effects and aids in compliance

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Management of depression depends upon attention to adequate pain control use of antidepressants and psychological support 26

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Exercise and activity enhancement has been shown consistently to help in fatigue It increases the functional capacity so that they can perform their activities with reduced effort 28

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examination about 50 of patients have jaundice Occasionally they may have palpable gall bladder Courvoisier s sign Hepatomegaly may be present due to metastatic liver disease

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coated with the chemotherapy agent such as carboplatin has been used in patients with cholangiocarcinoma Antibiotic trials to prevent stent blockage has yielded mixed results 22

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