Posted in Psychology & Medicine

Viscera: Pancreas

(Learn more about the organs of the human bodies in other posts in the Viscera series here:

The pancreas is probably the most central organ in the human body. It is situated just under the liver and stomach, surrounded by the duodenum (first part of small intestine) and lies in front of the aorta. It is shaped like a fish and thus is divided into parts named the head, neck, body and tail. The head of the pancreas tucks into the loop of duodenum and drains its contents via the pancreatic duct, which joins with the common bile duct (from the liver and gallbladder).


The function of the pancreas is divided into two functions: exocrine and endocrine.

An exocrine gland is an organ that excretes its products out of the body (including the intestines), such as the salivary or tear glands. The exocrine function of the pancreas is the production and secretion of digestive enzymes that break down proteins, fats and carbohydrates in the small intestine. Because of this, injury to the pancreas often causes a leak of this digestive juice, causing the body to self-digest the pancreas (leading to pancreatitis) and surrounding organs.

An endocrine gland is the opposite in that it secretes its contents into the bloodstream. These glands typically produce hormones, such as the thyroid, ovaries and adrenal glands. The pancreas’ endocrine function is related to an extremely common yet deadly disease: diabetes. Within the pancreas, there are millions of cells that cluster into groups called islets of Langerhans. There are various types of cells, but the most common are the alpha-islet cells that secrete glucagon and beta-islet cells that secrete insulin. Insulin acts to lower blood sugar (glucose) levels by promoting storage and use of glucose after a meal. Glucagon acts to increase blood glucose by promoting the breakdown of glucose storage units (glycogen) and the production of more glucose by the liver. Diabetes occurs when beta-islet cells fail to produce insulin because they are destroyed by the immune system (type 1 diabetes mellitus) or become desensitised by chronically elevated blood glucose levels (type 2 diabetes mellitus).

Another important disease concerning the pancreas is pancreatic cancer. Pancreatic cancer is notorious for its deadliness as it carries a 5-year mortality rate of over 95%. This is because it usually remains hidden – without any symptoms – until it as grown substantially and spread to other organs. However, this prognosis only applies to the most common type of pancreatic cancer involving exocrine cells (adenocarcinoma). There are far rarer cancers of the pancreas that involve the endocrine cells (e.g. insulinoma), which tend to have extremely good prognoses and are usually curable.

Steve Jobs (founder of Apple Inc.) had this kind of pancreatic cancer – an islet cell neuroendocrine tumour. Despite his excellent chance of cure with chemotherapy and surgery, he refused treatment for nine months and instead relied on alternative medicine for cure. However, his disease worsened and he finally resorted to having surgery. By this stage, his disease had spread to the liver due to the nine-month delay in treatment. Spreading of cancer is called metastasis and is often an indication that the cancer is no longer curable. Jobs went against his doctors’ advice and opted for a liver transplant in the hopes of curing his cancer. Organ transplant involves suppressing the patient’s immune system (which also keeps cancers in check) to prevent rejection of the donor organ, which is why oncologists advise against transplants in cancer patients. Jobs’ condition deteriorated quickly after his liver transplant and his decisions ultimately led to his demise.


Posted in Psychology & Medicine

Viscera: Liver

(Learn more about the organs of the human bodies in other posts in the Viscera series here:

The liver is the second largest organ (next to the skin) in the human body, weighing about 1.4~1.6kg. It is found tucked under the right side of the ribcage, underneath the 5th to 10th rib in height and almost spanning the entire width of the trunk. When enlarged, the liver grows downward and can be felt in an abdominal exam (sometimes it is so large that it covers most of the abdomen).

It is a vital organ with many life-sustaining functions (hence “liver”) such as building various proteins, breaking down toxins, storing sugars in the form of glycogen, decomposing red blood cells and producing bile. The liver metabolises (breaks down) a large proportion of medications and drugs as it treats them as “toxins”. For example, the enzyme alcohol dehydrogenase breaks down alcohols into acetaldehyde, which causes hangovers and liver damage. Many Asians have a variant of this enzyme that is extremely efficient, causing a massive build-up of acetaldehyde when they drink alcohol. This is responsible for the so-called “Asian flush”.

Liver disease is associated a myriad of symptoms. The classic sign of jaundice (yellow skin and whites of eyes) is caused by obstruction of bile flow. Because of its location, pain in the right upper quadrant of the abdomen is commonly seen. As the liver is involved in synthesising various proteins, signs such as ascites (fluid in the abdomen) or bleeding may occur when the liver is damaged. A syndrome called portal hypertension is commonly seen in chronic liver disease such as cirrhosis as a major vein to the liver is blocked. This can cause an enlarged spleen, oesophageal varices that can bleed, ascites and prominent veins radiating from the belly button (caput medusae).

An interesting property of the liver is that it can regenerate at an amazing rate. A liver will regenerate to its original size even when a half of it is cut out (this is how live donor liver transplants work). What is more interesting is that the ancient Greeks probably knew of this fact as well. In Greek mythology, the gods punish Prometheus for bringing fire to humans by chaining him to a mountain and commanding an eagle to peck out his liver. The liver would then regenerate overnight and the eagle would return every morning to eviscerate him, causing him eternal anguish.


Posted in Psychology & Medicine

Skin Colour

The world is full of people of all creed and races and it is a common fact that people from certain races have different skin colours to people from other races. But other than the range of normal skin colours, there are certain skin colours that can occur with specific medical conditions.

The most common reason for a change in skin colour is a suntan, which damages the skin and causes darkening of the skin (hyperpigmentation). However, some diseases are also known to cause hyperpigmentation, such as Addison’s disease or haemochromatosis.

The converse is lightening of the skin (hypopigmentation) and can happen with diseases such as leprosy, vitiligo or albinism. Alternatively, people can look pale when they are anaemic or extremely frightened, triggering a sympathetic nervous response, shutting down blood circulation to the face and extremities.

It is common to see red skin with flushing, sunburns, skin infections or numerous dermatological conditions such as rashes. Occasionally, these rashes may be associated with serious diseases such as lupus or Crohn’s disease.

Cyanosis (literally “blueness” in Latin) causes the skin to bluish-purple and it is due to the lack of oxygen in the blood. This could be caused by any number of reasons that causes hypoxia. For example, babies can be born with a heart defect that causes mixing of oxygenated and deoxygenated blood, leading to something called “blue baby syndrome”.

Liver dysfunction can present as jaundice, which is yellowing of skin and the white of the eyes due to a build-up of bilirubin.

Some stranger skin changes can be caused by certain chemicals. Carrots contain beta-carotene (which gives carrots their orange colour) and excess consumption can cause carotenosis (or carotenodermia), a yellowing of the skin. Eating too many tomatoes causes a similar condition called lycopenodermia, which presents as reddened skin (lycopene gives tomatoes their red colour). A combination of the two produces a distinctively orange colour. Both conditions are harmless and disappear after reducing the amount of carrots and tomatoes eaten.

Even stranger still is a condition called argyria, which can be caused by exposure to silver, either through medications especially alternative medicine), mining or contamination of the water supply. Silver causes skin to turn a deep blue colour and the pigmentation is irreversible. Similarly, copper can turn skin green and gold can turn skin grey.