small duct disease vs large duct disease

[Guest guest]

I haven't read all the posts that are discussing this but from what

I have read I am getting the impression that maybe there is

some confusion about what small duct disease is.

What I have learned over the past couple of years from reading

up on this, " small duct disease " is the term that surgeons,

radiologists and GI docs use to describe the condition of the

pancreas in which no changes are grossly visible on radiology

(MRCP, CT or US) or ERCP, but that the symptoms of the

patients point towards there being a problem with the pancreas -

especially if the symptoms are being supported by laboratory

signs. In addition, I think, when small ducts are visible on

imaging studies, this indicates small duct disease too because

a normal pancreas does not show the smaller ducts (I think it is

only the two major ducts along with maybe one side branch that

can be visualized in a healthy pancreas) This is a phrase that is

used to differentiate between " large duct " disease - which

usually means that the large ducts have some visible

abnormalities like strictures, dilatations, stones, pseudocysts,

etc.

You will see these phrases used in surgical manuals / papers

because it will direct the surgeon towards the appropriate

procedure to recommend. Large duct disease has one

preferential procedure and small duct disease another.

Supposedly there are better outcomes if the surgeon and the

patient know ahead of time which category the pancreas fits into.

But like most things in medicine, it is not cut and dried.

The fact that people here are talking about having a small duct or

tight / occluded sphincter (with strictures, dilatation seen

downstream) may actually put you into the " large duct disease "

category. Small duct disease is when there is something wrong

with the small ducts that drain the " meat " of the pancreas....the

tissue that seems solid when you look at your radiology films.

The two ducts that are visible on the films are the large ducts

and anything that is abnormal with them is large duct disease

and anything that is abnormal in the area of the pancreas that

has the small ducts that cannot be visualized is small duct

disease. The fact that people have small, large ducts is large

duct disease not small duct disease. You can have small large

ducts and large small ducts but that is not how large and small

duct disease is medically defined. Are you thoroughly confused

now? LOL

I only mention this, not to be a perfectionist, but so when you

read up on any surgical websites about procedures that are

availbable for various conditions of the pancreas, you will be

thinking along the same lines as the surgeons, etc.

If anyone would like, I can find the exact definitions of these

phrases and post them here or email them to you.

Laurie