Posted on September 15, 2017February 17, 2023 by Ashley Davidoff

Pancreas – Hermit of the Abdomen

Ashley Davidoff MD

O’ Dear pancreas

You have been called the hermit of the abdomen
By whom I do not know
But in your dark and hidden way, you have
spoken without a word
from the gurgling depths of the abdomen
Yes – you have earned this lonely title
and a coin should be tossed
to the person who coined the phrase

But it took a long time to understand who this hermit was – and what he was doing in the darkness of the abdomen

From the day of antiquity
You have been looked upon by many
Herophilus, the father of anatomy had the first incisive insights into you
As he was one of very few who had the guts to explore the guts in open fashion

Aristotle at the same time seemed to have known something about you
But then you lay unharmed and unexplored for almost 500 years
Until Rufus mistook you for a piece of meat –
You must have laughed at the “pan kreas” thing
How wrong he was – you evasive little trickster

And then the Talmud – always seeming to be right
Thought you were the finger of the liver –
Little did they know how independant you were

While Vesalius was up to your “hide and seek” game
The magical eyes of da Vinci missed you completely
Even though he saw the serpiginous splenic artery snake right above you

Your ducts seemed to have intrigued the next generation, Wharton, Wirsung, and de Graaf
As you sustained the pain of the quill penetrating your inner gut
(I forget you were already dead but it must of hurt just watching!)

A little later it was that man called Vater and the little Italian Santorini found your minor duct and your nipple
And so by this time we had a good understanding of you in your nakedness
But of course, as said – you were dead

And so young Bernard explored your factories, and got a sense of your canine workings,
But you were able to hold on to your sweet secret for just a little longer
Until the Langerhans found the family jewels in the famous 2% of your population-
The islets – those beautiful eyelits – governess of all things sweet in the body

Eberle Bernard Danilevsky, and Kuhne joined up across the world to expose your antacid and enigmatic enzymatic brew
And once again your wonderful workings for a better world were exposed –
And we knew then, that you were the quiet and effective type –
A hermit who did good
But did not want the limelight

To see you as you lived and breathed in the flesh
was the mission of Wilhelm the X-Ray man
who crusaded the path to visualise 40,000 Angstroms under the skin

abdomen, pancreas, liver, gallbladder, kidneys, CT scan, Art in Anatomy, Ashley Davidoff MD

And then there was a slew of heroes who learned to slew your sickened parts – including the famous Whipple who was able to Whipple you in an inimitable way

And then a bone guy – for God’s sakes – a bone guy! – called Banting and his student Best
Exposed the insular chemistry of you insulin that had given you the power over the sweet
Never mind – in the end it was for the good of all –
And a new era was borne

And so we try to understand your form as our scans explore you as you live and breathe
And we stare in awe at your odd shape – why oh why did you choose that shape?
What are you supposed to look like? – we have no clue
And we are happy – so happy for you that you are well nourished by a double blood supply
And we wonder why you have no skin – we thought all the organs had a skin
Except for your tail – almost a foreskin

And you are off axis on two planes – what is that all about? – kinda crooked

And your twin origins and the intimacy with the duodenum, of the ventral twin
And the strange fusion of the Wirsung guy excluding the little Italian Santorini
It seems to me that your matrimonial fusion with Wirsung and the bile duct has led to more problems than the merger was worth
It does not seem in the long run, to have been a marriage made in heaven
What was that all about? Is there a grand plan to come?

And so we try to understand your diseases
And in some way we understand that the guy glugging down the bottle
Could be punished by your reaction
But why Oh why are you so nasty to those whose misfortune it is to have stones roll down and get no satisfaction.. down the green vile bile route
Have you not learned to live with the green secretion by now
And did you not know that by reacting the way you do, that you are cutting off your nose to spite you head?

While type 2 seems remote from you
We don’t know about this Type 1 business
Why are you made to suffer so much at the hands of your own body on your own body?
We feel sorry for you – to have your own buddies reject you – must be awful
And then to see so many young ones suffer because you don’t work
And we once again see and understand what power you control from that deep dark hermit home of yours

And the cancer thing … so silently it creeps on you causing your collagen to counter
And only making things worse as it strangles nerve, blood vessel, and your spouse duct – the green one, – without regard

And then I think of you in your prime and in your happiness
When you are with you two buddies – the splenic vein and the renal vein
And you all look so much alike, and happy swimming in that deep ocean where you hide
And I wish this was forever

Posted on August 29, 2016February 17, 2023 by Ashley Davidoff

Pain – Art and Science

Pain

Pain is an unpleasant sensation originating from our physical and or emotional environments.

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Faces of Pain

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Extreme Physical Pain

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Extreme Emotional Pain

Physical Pain

Pain is a symptom and as such reflects a derangement of either the external or internal environment.

All sensations start by stimulating a receptor of a nerve that conducts the impulse to the spinal cord where low level control and discrimination occurs, and transfers the stimulus to the brain, where higher centers process the stimulus and react to it. The structures in the brain include the thalamus, somatosensory cortex, limbic system, and autonomic systems and they are involved in perception, localization and integration. They send out a stimulus with instructions of how to react which is executed by muscle contraction or tissue secretion.

Functionally, pain is protective. The physiology and pathophysiology relate to changing the mechanical stimulus into an electrical impulse, and then through a series of complex synapses the stimulus is transmitted with the intent of protecting the person from further damage.

The causes of pain are innumerable and exist within the full spectrum of human diseases. Pain may result from pain receptors sensitive to pain, (pricking, cutting, tearing) extreme temperatures, pressure, or aberrant chemical environments. A myriad of processes then occur in response to tissue injury causing either irritation of a somatic nerve or distension and pressure on a visceral sensory nerve. Inflammation is one of the most common of these injurious processes that is classically and universally expressed with pain – a concept first described by the second century philosopher Celsus.

The result of a pain impulse is usually withdrawal from the insulting stimulus, resting of the injured part, or seeking the help of a medical practitioner if the pain is unbearable and arises from an internal disorder.

Diagnosis of pain disorders should proceed with careful history taking and clinical examination, followed by appropriate laboratory tests, and imaging if necessary.

Pain is a very common symptom and most instances are treated with an analgesic or antiinflammatory agent. For more serious pains, treatment is directed at the cause of the pain.

Classification

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The table explores the variety of ways of classifying pain. The left hand column reveals the classification based on functionality, origin, mode of stimulation, pathological causes and relationship of pain to chronicity. As for functionality it may be adaptive or nonadaptive. The pain may originate from somatic or visceral nociceptors, may originate from damaged nerves in which case it is called neuropathic, or it may be psychogenic. The causes are usually via the inflammatory process but may result from any of the disease listed.

Structural Basis of Pain

A pain impulse is initiated by sensory receptors called nociceptors which are located in almost all the tissues. A noxious stimulus say from a hand touching a hot stove is then transmitted by sensory nerves to the spinal cord where a direct spinal reflex causes immediate withdrawal from the source. Additionally the stimulus is modified in the spinal cord by a variety of influences from other sources and is then transmitted via the midbrain and reticular activating system to the cortex. Finally, the stimulus reaches the brain’s somatosensory area where it is perceived and localized with additional extension to other areas of the cortex for the provision of a variety of protective reactions to the stimulus.

We will now expand the detail of the structural pathway described above.

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Pain from the Joints

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Pain from Sinuses

The Sensory Pain Receptors – Nociceptors

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Nociceptor

A pain impulse is initiated by sensory receptors called nociceptors which are located in almost all the tissues. They are tree like branching structures.

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Types of Receptors Subtending the A delta Fibers and C Fibers

The diagram shows sensory stimuli including sharp pressure, extreme heat and cold as well as chemical, stimulating the free nerve endings of the nociceptors that are linked to the myelinated A delta fiber , and non myelinated C fiber. The myelinated fiber will conduct the impulse between 3 and 15 times faster than the non myelinated fiber.

These specialized receptors vary in structure and number throughout the tissue and viscera of the body. There are external nociceptors that are situated in the skin and cornea with higher concentrations in the coverings of the body including the skin, pleura, pericardium, peritoneum and periosteum. Internal nociceptors are found in muscles, joints, around blood vessels, and within the mucosa of some organs including the urinary bladder, genitourinary tract, and the gastrointestinal tract. There are nociceptors in varying concentrations in almost every organ in the body, but interestingly there are none in the brain substance itself .

First Order of Transmitting Sensory Fibers

The first order of nerve fibers transport the stimulus from the nociceptor to the dorsal root ganglion

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The sensory receptors of the nociceptors are found in the tissues peripherally and are connected by a long fiber that transmits the impulse to the ganglion cell that lies in the dorsal ganglion in the neural canal alongside the spinal cord. This diagram shows the three types of receptors and fibers that transmit impulses related directly and indirectly to pain . The upper fiber is called the C fiber and it is non myelinated, consists of the receptors in the top left hand corner that when stimulated transmit the impulse via a long afferent neuron to the cell body lying alongside the spinal column. This fiber is relatively thin, measuring between .4 to 1.2 micrometers, and conducts the impulse at about 2m/s. The second neuron is the A delta fiber and it responds to the pricking or sharp sensation that is first felt and reacted to. It is weakly myelinated and is about 2-6 micro meters thick, and conducts the stimulus with a velocity of between 15-30 meters per second. The last fiber is the A beta fiber and it is responsible for the pressure component which indirectly affects response to pain by affecting the gate mechanism of pain. It is greater than 10 microns thick due to heavier myelination and conducts impulses at 30-100 meters per second

The Dorsal Root Ganglia

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The Dorsal Root Ganglion of the Afferent Neurons

The dorsal root ganglion is a focal accumulation of the first order nerve cells of the sensory component of the peripheral nerve. (orange) It is situated in the neural foramen of the vertebral body. The central process emanates from the ganglion cell and ends in the dorsal horn.

2^nd Order of Neurons

The second order sensory fibers are those fibers in the spinal cord. They first cross to the contralateral side of the spinal cord and then connect to the thalamus via the spinothalamic tract.

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Second Order Neurons – Cross Over in the Spinal Cord and 3rd order are Found in the Spinothalamic Tract

The spinothalamic tract is the major sensory ascending pathway of 2nd order neurons and serves as the major pathway for pain, temperature, itch and crude touch. Within its construct, the spinothalamic tract has three merging bands of specialized fibers that conduct pain impulses. The anterior spinothalamic tract carries pain signals initiated by touch while the lateral spinothalamic tract carries slow and fast fibers for pain and temperature sensations. The anterolateral spinothalamic pathway, located in the anterolateral white column pathway in the anterior half of the lateral funiculus conducts a variety of somatic pain signals.

3rd Order of Neurons – Connect the Thalamus with the Sensory Cortex

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The Three Orders of Neurons

Second Order Neurons From the Spinal Cord to the Brain and Perception of the Pain The Three Orders of Neurons

The stimulus is first converted into an electrical impulse which is taken by a first order sensory nerve (orange) to the spinal cord (dorsal root ). The second order neurons (blue) first transport the stimulus to the contralateral spinothalamic tract which in turn transports the impulse to the thalamus,. The third order neurons (pink) transport the impulse to the somatosensory cortex.

Role of the Thalamus

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Thalamus – Relay Station to the Cortex in the Pain Pathway
The thalamus (T) is the gateway to the cerebral cortex. It is a paired organ and represents the main part of the diencephalon and subserves both motor and sensory function. It is structurally and functionally situated between the cortex and the midbrain. The thalamus has specific nuclei with diffuse projections to and from multiple regions of cerebral cortex. The thalamus functions as a translator for the cerebral cortex. It processes sensory and motor information and mediates the autonomic nervous system regulating sleep and arousal. The thalamus also contains reciprocal connections to the cortex that are involved in consciousness. It may also play a role in vestibular function. The thalamus translates pain signals of the 2nd order neurons and gives rise to the third order neurons that extend to the cortex. Awareness and localization of the pain is then achieved at the level of the cortex. The thalamus however is not merely a relay station for nociception but also plays a role in processing the stimulus. Axons terminating in the lateral thalamus mediate discriminative aspects of pain (somatosensory cortex) including the originating body part. The fibers ending in the medial thalamus mediate the motivational and affective aspects relating for example to the emotional and memory of pain. These third order neurons travel to the prefrontal cortex, insular and cingulate gyrus which contribute to the emotion and memorization of pain experiences.

The Homunculus Man and Localization of the Pain

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HOMUNCULUS MAN and Localization of Sensation in the Somatosensory Cortex of the Parietal Lobe

The homunculus man (literally the “little man”) is the distorted figure drawn to reflect the concept of size of organ paralleling the size of the sensory innervation. The diagram reflects the relative functional sensory space each body part occupies in the somatosensory cortex. Those structures with a high density of sensory receptors are represented by a larger size, while those with a lesser concentration of sensory apparatus are shown as being “smaller” in size. Hence the mouth lips, hands feet and genitalia have a relatively large representation. Nerve fibers from the spinothalamic tract in the spinal cord (blue line) are relayed to the thalamus (orange) which filters and then distributes the sensation to the somatosensory cortex.

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The Somatosensory Cortex in the Parietal Lobe – Home of the Sensory Homunculus

The somatosensory cortex in the parietal lobe is the location of the the main sensory receptive area for all the senses including pain. It receives the stimuli from the thalamus and then integrates the information with other parts of the brain that will modify the perception of the sensation

The function of the somatosensory cortex is that of a higher processing center for touch, temperature, pain, and proprioception serving to amplify awareness of the sensations enabled by the thalamus. Sensation from the left side of the body are processed in the right somatosensory cortex and similarly those from the right side are processed on the left. The higher function of the somatosensory cortex allows us to localize the pain to a specific site, perceive the character and intensity of the stimulus, and sometimes helps identify the shape of the originating object.

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The Higher Multicentric Levels of Pain Perception and Reaction

The somatosensory cortex relays impulses to other cerebral areas of perception that modulate the reaction to the pain It forward the pain signals via the white matter to other centers in the cortex to enable integration with visual and auditory input, and with other higher cortical functions such as emotion and memory for example. The full experience is then “seen” by the brain enabling the consequent reaction to be as discriminating and prudent relative to the nature and experience of the person. The difference between the reaction of an infant, child and an adult to the “shot at the doctors” speaks volumes about this latter function.

Emotional Pain

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Pain of Poverty

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Pain of Addiction

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Pain of Loneliness

Pain .. Pain go away! – and please leave us alone!

Posted on April 29, 2016February 17, 2023 by Ashley Davidoff

Anatomy of the Liver, Alcohol, and Addiction

The Liver – Just Another Normal Miracle of the Body

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The liver is the largest gland in the body and is central to many metabolic functions. It is known as the body’s “metabolic warehouse.”

The liver serves several important functions. It is integral to the digestive system, producing both internal and external secretions. The external secretion, bile, aids in the digestive process, while internal secretions are responsible for the metabolism of both nitrogenous and carbohydrate materials absorbed from the intestine.

Some of the liver’s functions take milliseconds and others take days and sometimes weeks. It secretes bile in order to alter toxic substances chemically (e.g. converts ammonia to urea), converts glucose to glycogen, and can produce glucose from breaking down certain proteins. The liver also synthesizes triglycerides and cholesterol, breaks down fatty acids and produces plasma proteins necessary for the clotting of blood such as clotting factors I, III, V, VII, IX and XI. Nearly 30% of the blood pumped by the heart passes through the liver each minute.

One of the unique structural features of the liver is its dual blood supply. It is supplied both by an artery (hepatic artery) and a vein (yes a vein!) – the portal vein. The portal vein drains the gastrointestinal tract of digested metabolic products and transports the nutrients to the liver for processing.

Four to five thousand years ago, the sheep’s liver held godly powers in the Babylonian culture. The Babylonians, and many cultures thereafter, believed that since the liver was the largest organ, it certainly must be the organ of most importance.

The Cells

Hepatocytes are the major cellular component of the liver, comprising approximately 70% by volume. Structurally they are characterised by their large size and the absence of a basement membrane. Functionally they are characterised by their remarkable metabolic and regenerative capability. Kupffer cells are found within the space of Disse and they act as macrophages of the liver, identifying and removing substances and organisms toxic to the body.

The Cells

The AiA rendering of cells in the round provide an image that is reminiscent of craters on the moon surface. The thought process behind the image is the formation of tissues from cells. The building of the whole from the parts starts with the cell and progresses to the tissue and finally the organ. In this instance, groups of liver cells are artistically combined to form a tissue and an imaginary spherical organ.

Cellular Organization

Organization of the Liver Cells in Cords Along the Rivers of Blood Flow

The liver is a compound tubular serous gland. The cells are arranged in plates or cords alongside rivulets of a capillary network called sinusoids. The spaces of Disse are spaces below the lining of the Kupffer cells. The plates and cords are lined by the sinusoids which are the channels which carry blood to the liver. Just below the sinusoids, between the wall of the sinusoid and the capsule of the liver there is a space called the space of Disse which carries the lymphatic fluid of the liver.

Organization of the Liver Cells in Cords in the Liver Lobule

The cells of the liver are organized in cords and plates and are organized like spokes of a wheel around the central vein. The periphery of the lobule contains groups of portal triads consisting of portal vein (dark blue), hepatic artery (red) and bile duct (green).

The structural liver unit is called a lobule. Cellular plates branch and anastomose alongside and in parallel with the sinusoids. Each lobule measures 1-2mm and is shaped like a hexagon. A central venule lies at the center of the lobule and is the destination of the sinusoids, which carry both hepatic arteriole as well as portal venous blood. At the periphery of the lobules are sets of portal triads consisting of portal vein, bile duct and hepatic artery. The biliary system collects bile from the liver and evolves into an independent network terminating in the common bile duct which empties bile, into the duodenum. The hepatic artery and portal vein supply the liver with metabolic substrates via the sinusoids, and also collect metabolic products produced by the liver to transport to the rest of the body.

Anatomy of the Liver in a Nutshell–

From its Embryonic Beginnings to Full Member of the Society of the Body

Pleasure

Alcohol – Drink of the Gods in Moderation and Poison of the Devil in Excess

Anatomy of the Initial Positive Effects of Alcohol

“Drink because you are happy, but never because you are miserable.”
― G.K. Chesterton,

Social Drinking: The Prostate Having a Drink with the Uterus

The uterus and prostate are out on a date and sharing a cocktail The uterus approximates a rectangular shape as does the prostate, accounting for their fascination with each other and their similarity with the shape of the wine glass. The uterus is accompanied by the ovaries and the vagina which forms the stem of the wine glass. The prostate is accompanied by the Seminal vesicles and Cowper’s glands and the urethra which acts as the stem of the wine glass. The male secretion seen in the urethra consists of a mixture of sperm, prostatic secretions, and seminal vesicle secretions.

Social drinking to celebrate an event is a wonderful means to enable people to open up to each other

As G.K. Chesterton wrote – “Drink because you are happy, but never because you are miserable.”

William Shakespeare, in Othello, on the other hand wrote – “I would not put a thief in my mouth to steal my brains.”

Most cultures favor the use of alcohol in celebration of events, and the positive effects of alcohol when used judiciously is to promote a pleasurable feeling via the nucleus accumbens, and to reduce stressful feelings (often social interactions) by reducing inhibitions by acting on the amygdala

Anatomy of the Feeling of Pleasure and the Nucleus Accumbens

The nucleus accumbens is one of the most primitive part of the brain. It is part of the basal part of the forebrain. It is a paired structure. Alcohol promotes pleasure by stimulating the nucleus accumbens.

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The Nucleus Accumbens

The coronal section of the brain shows the nucleus accumbens (ringed red) opposite its partner at the base of the brain. It lies just inferior to the internal capsule and frontal horns, near the hypoyhalamus

Courtesy Department of Anatomy and Neurobiology at Boston University School of Medicine Dr. Jennifer Luebke , and Dr. Douglas Rosene

Artistic Rendition of the Nucleus Accumbens on a sagittal T1 Weighted MRI

The nucleus accumbens, which is the site enabling the sensation of pleasure is shown as a red dot at the base of brain near the hypothalamus.

Stress

Anatomy of Stress and the Amygdala

The amygdalae are paired structures that are part of the limbic system that play an important part in emotional reactions including the reactions to stress. Alcohol reduces the uncomfortable emotion of stress and distress. Stress, in general is healthy, while distress on the other hand is not. The distinction between the two is not always obvious. Social situations are often stressful since in general people are “forced”into a position with “new” people they do not know too well. Using alcohol in such a social situation disinhibits the individuals, reduces the feeling of stress and promotes a sense of social confidence.. The origin of the physiology is in the amygdala.

Amygdala of the Forebrain in Sagittal Projection

The amygdala (red arrow)is a nucleus that is part of the limbic system. It is a paired structure. They are located deep in the temporal lobes and participate in emotional reactions, memory, and decision making.

Peer Pressure

Stressful social situations are particularly prominent in adolescence when peer pressure is pervasive. The college experience with new adventures of socialization, combined with freedom from the constraints of paternal disciplines are ripe for the use of substance abuse.

Peer Pressure

The scene: Party night – adolescent on the right, different innocent, alone and anxious. The in- crowd on the left are homogenous, powerful in number and stature, and encourage the newcomer to join in and be “one of us” – perhaps drink or smoke – and this is how it starts.
Educate, support, and love your children – Promote confidence in themselves so when they are confronted they can just say “no!”

Loneliness

Loneliness

Alone and bored, some turn to alcohol to provide relief. It is a short term, and short sighted relief to the problem

Early Addiction

Every form of addiction is bad, no matter whether the narcotic be alcohol or morphine or idealism.

Carl Jung

The signs of early addiction

There are a few early warning signs that are forebears of early addiction as they start to surface.

They include; drinking alone, hiding and lying about the habit, blacking out, neglecting responsibility, deteriorating relationships, drinking in dangerous circumstances (eg before driving) and inability to quit.

Too Much of a Good Thing- can make your life tipsy turvy and turn you upside down –

shows bottles of alcohol in different positions and personify the state of inebriation. Alcoholic intoxication is a form of poisoning, and can make your life tipsy turvy and turn you upside down. The art piece expresses the uncontrolled situation of inebriation. When the liver cannot metabolize the alcohol due to excess in the blood stream drunkenness ensues. At lower blood levels there is a sensation of elation and lack of social reserve. With higher levels of alcohol in the blood, cerebral and cerebellar dysfunction ensues with ataxia, imbalance and muscle incoordination. Forebrain impairment includes disability to make appropriate decisions. Coma and death can ensue when blood levels are extremely high.

Drunk Man in the Town Square

A drunk man in the town plaza is toying with the idea of another swig. His indifference to his environment, and lack of judgement suggests he is inebriated. However his body language with an outstretched arm holding the bottle and the other hand pointed in another direction may suggest, at least idealistically, symbolically and hopefully subconsciously, that he realises he could go one of two ways “Decision time” he says to himself – “on the one hand I could take a swig .. Yet on the other I may take a different and more healthful course” Which way do you think he would go? (Photograph modified to enable anonymity)

Cirrhosis

Normal Liver and Cirrhosis

The left sided image shows the CT scan of a normal liver. The liver is the biggest structure that you can appreciate on the CT scan and is triangular in shape. The scan on the right shows a liver with cirrhosis. Alcohol pickles and scars the liver making it look like a knobby shrunken prune. The first image reflects healthy and romantic enjoyment of two people enjoying a beer at sunset. The colorful sunset transposes int a black and white background providing the mood of a lonely alcoholic. The alcoholic drinks in loneliness and in excess, until finally the person and the the bottle do not remain upright symbolically reflecting physical and psychosocial failure.

The Failing Liver

Normal Liver and Cirrhosis and Ascites

The AiA rendering shows a normal liver on the left, and a person with cirrhosis on the right evidenced by a shrunken, knobbly and pickled liver, jaundice of the skin and a distended abdomen caused by the accumulation of litres of fluid (ascites). In the long run, the addiction results in much suffering, a miserable existence, and immediately life threatening hemorrhagic episodes.

Alcoholism and Ascites

(Photograph modified to enable anonymity)

Liver Cancer

Liver Cancer

Liver cancer, frequently arises as a complication of cirrhosis and most particularly from alcoholic cirrhosis. The AiA rendering of the liver shows the inner workings of the organ, now inhibited by the large yellow cancer preventing the clockwork function of the liver. The liver starts to fail as a result of the cirrhosis so that the synthesis of biochemical products that keep the body going are no longer produced to the degree which they are needed.

Wasting of Body and Life

The collage shows normal healthy liver cells (top left) with a healthy appearing torso (CT scan reconstruction bottom left). The top right image reflect cancerous hepatic cells where the nuclear to cytoplasmic ratio is too large meaning that the the nuclei are too big and the cytoplasm too scanty. This finding is one of the typical findings in cancer. An emaciated torso (bottom right) is seen in contrast to the healthy counterpart.

Artistically the stark reality of health and disease is exposed. This terrible disease stares at us in stark graphic reality.

Philosophically – the cancer cell is like a rebel in the community, who only has selfish interests and contributes nothing to the welfare of the community. As a result the whole community of the body eventually fails, and hence the emaciation of the body.

Lessons? Kick the Habit Early or Kick the Bucket

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ART IN ANATOMY

Category: Addiction

Pancreas – Hermit of the Abdomen

Pancreas – Hermit of the Abdomen

Pain – Art and Science