Dariusz Litera
Pancreatic diseases pose an increasingly serious health challenge.
increasing incidence of these diseases and, unfortunately, high mortality rates. In Poland
There's an increase in the incidence of acute pancreatitis and pancreatic cancer. This highlights the need for increased patient awareness and early diagnosis. Are you concerned you might be experiencing symptoms related to pancreatic disease? Find out what your doctor has to say. Today, your doctor is surgical specialist Dr. Adam Kuźmiński. Hello, doctor.

Dr. Adam Kuźmiński
Good morning.

Dariusz Litera
This is a difficult topic because the pancreas is not as popular in terms of easy treatments as, for example, the gallbladder.

Dr. Adam Kuźmiński
Unfortunately, it's a tail in the treatment rankings. Although the pancreas also has a tail. This is the tail of our treatment, the tail of our diagnostics. And this is mainly due to the fact that the symptoms this organ can produce are extremely nonspecific. Sometimes we ignore them because they pass. When they appear, we treat them with home remedies.

Dariusz Litera
We can't connect what caused it.

Dr. Adam Kuźmiński

This is true, and when we start to diagnose seriously, it turns out that the cancer process, for example, is already so advanced that we are unable to do anything.

Dariusz Litera
And hence the high mortality rate?

Dr. Adam Kuźmiński
Mainly because of this, although pancreatic cancer in general is, if I may say so, extremely poorly treated. Because we can't really find the right tumor markers. We can't diagnose this cancer quickly. Pancreatic cancer metastasizes very quickly. It's very, very difficult to treat.

Dariusz Litera
But before we return to this difficult and deadly cancer, let us start with pancreatitis, especially acute pancreatitis, which is also a deadly disease.

Dr. Adam Kuźmiński
Acute pancreatitis is a condition that can progress in two ways. One type of acute pancreatitis is called the edematous type, and we don't particularly fear it. After a proper diet, hydration, painkillers, antispasmodics, a hospital stay, and observation, the patient returns home with no significant side effects. The second type is called hemorrhagic pancreatitis. Here, the organ self-digests, and this is unfortunately associated with a very high mortality rate. The worst part of all this? We have absolutely no idea which direction this inflammation will take. Whether it will be the edematous or hemorrhagic form.

Dariusz Litera
So we're constantly monitoring the patient. And here's where it's important to explain to our listeners that these pancreatic diseases are so virulent that they produce very virulent substances, substances that must be digested.

Dr. Adam Kuźmiński
Digestive enzymes are so essential for digestion. In addition, the pancreas is responsible for regulating our blood glucose levels, meaning insulin production.

Dariusz Litera
So if it digests itself, the result, if we survive the moment when it digests itself, will be that we will have diabetes.

Dr. Adam Kuźmiński
Type 1 diabetes, i.e. diabetes associated with a lack of insulin.

Dariusz Litera
And the need to administer insulin for the rest of your life.

Dr. Adam Kuźmiński
Yes. Both insulin and digestive enzyme replacement are necessary.

Dariusz Litera
But speaking of the pancreas and acute pancreatitis, what is the most common cause of this inflammation?

Dr. Adam Kuźmiński
Two things. First, cholelithiasis, or gallstones, is the most common cause. But right behind it, unfortunately, is alcohol consumption. Besides that, we can also talk about high triglyceride levels, which are changes related to fat metabolism. These are the most important causes of acute pancreatitis.

Dariusz Litera
Is there any medicine for acute pancreatitis?

Dr. Adam Kuźmiński
No. It doesn't. It's symptomatic treatment, involving only the administration of antibiotics, painkillers, and antispasmodics. Moreover, the administration of antibiotics is also highly controversial. Some surgeons don't administer antibiotics, others do. Some wait until reinfection sets in before administering antibiotics. So it depends on the experience of the medical center.

Dariusz Litera
So: we hydrate, strictly follow a diet, and observe. That's it. Does it go away after how many days?

Dr. Adam Kuźmiński
Oh, it varies greatly. Usually, by about a week, the situation has become clearer, meaning the patient is either getting closer to home or not.

Dariusz Litera
Does the pancreas regenerate after such inflammation?

Dr. Adam Kuźmiński
No. The pancreas becomes fibrotic after several such inflammations. Fibrosis develops there, which unfortunately also impairs the function of this organ. Therefore, after several inflammations of the pancreas, we may experience problems with blood glucose levels. Digestive problems, i.e., related to the secretion of insulin and digestive enzymes.

Dariusz Litera
And that was acute pancreatitis. Now let's move on to chronic pancreatitis.

Dr. Adam Kuźmiński
This condition is primarily associated with the presence of gallstones, similar to acute inflammation, and alcohol consumption, although alcohol consumption is a primary cause. These patients have a very characteristic appearance, often being very emaciated. This is associated with constant abdominal pain and the inability to eat. The pain is intense and intense. These patients truly suffer. Pain management options are also very limited. Patients most often end up on opioid medications. There are surgical methods for pancreatic denervation, but these are very advanced.

Dariusz Litera
What percentage of patients coming to your office are those with pancreatic problems? Is that a lot?

Dr. Adam Kuźmiński

This represents a small percentage of patients. I think this is because people don't realize they have pancreatic disease, that the symptoms they experience are actually pancreatitis or at least irritation of this organ.

Dariusz Litera
So what are the symptoms besides abdominal pain?

Dr. Adam Kuźmiński
Abdominal pain is the first thing. Other symptoms include indigestion. If we have inflammation, fever, nausea, and sometimes vomiting. Any pain associated with vomiting or nausea should be a red flag that something is wrong. This is most often related to inflammation of the organ. We test amylase and diastase levels, and that tells us what the enzyme status is. Then there are inflammatory factors, namely CRP. A normal white blood cell count, or a normal blood count, also tells us a lot.

Dariusz Litera
So, will the blood test show any inflammation? If we connect it to these pains?

Dr. Adam Kuźmiński
Yes, there will be a high probability that it will involve the pancreas.

Dariusz Litera
Is there any progress or breakthrough in medicine on the horizon that will help us look towards the pancreas with greater optimism?

Dr. Adam Kuźmiński
Yes, there's been significant progress, and it's actually related to the diagnosis of this organ. Besides traditional ultrasound, we also have endoscopic ultrasound. There are things we can't see through the skin. The location of this organ is very tricky. The pancreas is located very deep, obscured on one side by the intestines, which contain a lot of gas and obscure the organ in ultrasound. So the introduction of endoscopic ultrasound was a breakthrough. We also have computed tomography and magnetic resonance imaging. CT is the examination of choice in cases of acute pancreatitis, and later in monitoring necrotic changes in this organ. This is all related to CT.

Dariusz Litera
And then doctors have a better picture of what's going on inside.

Dr. Adam Kuźmiński
Yes, especially since, unfortunately, in most cases, we can only observe what's happening. Observation is the only way, and our medical resources are very, very limited. We can't really influence the course of this disease. That's very difficult to do.

Dariusz Litera
And in this case, also when it comes to chronic pancreatitis, there is no miracle pill or miracle injection that will make the pancreas healthy.

Dr. Adam Kuźmiński
Unfortunately, such things don't exist. In these cases, complete fibrosis of the organ is most often the result, requiring full supplementation of both pancreatic enzymes and insulin.

Dariusz Litera
As long as it doesn't progress to what could be the worst in this case, which is pancreatic cancer.

Dr. Adam Kuźmiński
Yes, this is something that unfortunately happens very often.

Dariusz Litera
Are these things related?

Dr. Adam Kuźmiński
Yes, this is one sequence of events.

Dariusz Litera

So we start with one case of acute pancreatitis, then…

Dr. Adam Kuźmiński
Chronic inflammation and pancreatic cancer. This isn't always the case, but it's a very possible path.

Dariusz Litera
Is there any treatment path for pancreatic cancer that offers hope for a cure?

Dr. Adam Kuźmiński
We're constantly trying to find this path, just as we're trying to find specific markers associated with pancreatic cancer. Various chemotherapy regimens exist, but they don't produce any spectacular results. Indeed, it's possible to melt the tumor mass, usually to the point where it can be surgically treated. The Whipple procedure itself is a relatively old procedure in terms of its origins. It's a surgical canon. Modern surgery, both laparoscopic and open, offers a much wider range of possible procedures involving both the body and tail of the pancreas.

Dariusz Litera
Why is this organ so difficult to operate on?

Dr. Adam Kuźmiński
The highly unusual blood supply to this organ, and its location itself, are actually the biggest problem in all of this, as its function is the passage of the bile ducts through it. Within the pancreas, we have the opening of these bile ducts, so everything must be reconstructed, in addition to the subsequent resection surgery. We also have to perform reconstructive surgery. These procedures are extremely lengthy and arduous. After removing the organ, we need to reconstruct the ducts that pass through the pancreas, bypassing the removed organ.

Dariusz Litera
So that everything is tight enough to prevent another fire from occurring.

Dr. Adam Kuźmiński
There will be no further inflammation, because this organ will not be there, but there will be peritonitis, for example.

Dariusz Litera
And diffuse disease. Doctor, since we already know that this pancreas is not benign when it comes to the diseases that appear there, is there anything each of us can do to help the pancreas on a daily basis?

Dr. Adam Kuźmiński
Yes, we must take care of certain things, we must watch our weight, we must maintain a proper diet. Unfortunately, the main cause is alcohol, which we should limit. If not, quit. Don't smoke. These are all nicotine-dependent cancers, meaning nicotine very often induces cancer.

Dariusz Litera
And here a very important thing is not only lung cancer.

Dr. Adam Kuźmiński
Not a lot of different cancers. Nicotine has a systemic effect.

Dariusz Litera
Or even cancer of the urinary bladder and urinary tract in general.

Dr. Adam Kuźmiński
This is all related to the presence of nicotine in our blood.

Dariusz Litera
We're giving up these stimulants. And are we adding anything to our diet to help our pancreas function better?
work?

Dr. Adam Kuźmiński
There are no such things. The point is to maintain a varied diet, to avoid monotony, to avoid falling into one-size-fits-all diets. The food we eat should be varied. We eat little and often.

Dariusz Litera
He said in the podcast: What does your doctor, surgical specialist Dr. Adam Kuźmiński, say about this? Doctor, thank you very much for our meetings. Now we know that if any abdominal pain occurs, we of course consult a specialist.

Dr. Adam Kuźmiński
Thank you very much.