- thanks were premature I think

[Guest guest]

It seems as if there is the same confusion in the surgical

literature. There are several references to small duct disease

being a main pancreatic duct less than 3mm in diameter. But

then there are a few references that refer to the " small duct entity "

that is similar to how I was trying to explain it. That is, that

because no visible abnormalities are seen in the major ducts it

is assumed that there is something going on in the small ducts:

hypertension, cell destruction etc. It seems that if you go with

this point of view, surgical options are to remove the head of the

pancreas where it is assumed the pain mechanism is going on.

If it is large duct disease (dilated ducts etc) then they seem to

recommend the type of surgery where they fillet open the

pancreas and connect the duct lengthwise (?) to the duodenum

so that drainage occurs along the duct rather than through the

tiny sphincter. The removal of the head part, I think, it is assumed

that they are removing the area that is causing the pain - all

those tiny ducts that may be blocked. Like you said, there is no

way that they can reconnect or ream out those tiny ducts so they

just remove the whole kit and kaboodle thinking that this is a way

to remove " obstruction " and stop the pain. The large ducts

though, can be treated it is thought, by re-establishing drainage

by surgically altering the flow or by using stents to bypass the

blockage.

So I guess how it is defined depends on the context of the paper

that a person is reading (?).

In general though, it seems as if the prevailing definitions is that

large duct disease is a dilated major (> 8mm) duct and small

duct disease is a small major duct (<3mm). I need to figure out

if the different definitions is due to older papers versus more

up-to-date versions or if this is just a matter of personal

philosphy as so much of pancreas issues seem to be (or me

just mis-interpreting the literature - which can happen, but I

swear that I read it almost exactly the way I explained it, but now I

cannot find where I read that!)

I like the plan that you mentioned about getting your certification.

Hopefully they will still allow you to register. Sometimes they do

for those types of tests - just maybe they charge you a late fee.

Most of those type of things are done now at " testing centers "

that use computers as the modality. Most of the " boards " now

are done that way (if not all) so the residents and fellows don't

have to travel to on-site or regional centers. My husband was

able to just go to a local shopping mall that had a testing center

there (for his cyto certification). They had a gamut of students -

from EMTs to Fellows taking boards from what I understand. So

I would think it wouldn't be too difficult to add you in (I hope).

Is there a way you can delete that post I made? I am concerned

now that I may just have muddied the waters even more than

they should be......not that it isn't good to have a discussion but I

sure hate to mislead anyone if their doctor defines small duct

disease in the way I just presented........

Laurie