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A. General Questions
1. What are the functions of the pancreas?
The pancreas has 2 entirely different functions. One is the so called exocrine (non-endocrine) function which produces digestive enzymes the other is the so called endocrine function which produces hormones. The most significant hormone produced by the pancreas is insulin. Insulin is the most important hormone for regulating the blood sugar level.
2. Is the pancreas a vital organ?
This question must basically be answered with “yes”. Especially insulin which regulates the blood sugar level is essential for life. And without the digestive enzymes humans would not be able to absorb nutrition. A lack of insulin-producing cells, due to, for example, the dying of or surgical removal of pancreas tissue, can be treated with insulin injections. In cases of insufficient production of digestive enzymes, these can be easily taken with each meal in the form of capsules, making normal nutrition possible.
3. How do I notice if something is not OK with my pancreas? Are there clear symptoms, which point to a disease of the pancreas?
There are several pancreas diseases of the pancreas and not each one shows the same symptoms. Pancreatic inflammations are usually quite painful – typically with abdominal pains which may also radiate to the back - combined with a general sick feeling. Pancreatic tumors cause hardly any symptoms especially at an early stage. As the bile duct runs through the pancreatic head, an inflammatory- or tumor-caused swelling in this area can result in bile congestion leading to a yellow coloring of the eyes and / or skin. Having these symptoms one should always immediately consult a doctor.
In cases of severe abdominal pains, the doctor can find out if the pancreas is involved by drawing blood. If a tumor is suspected x-rays will also be necessary.
4. What are the most common diseases of the pancreas?
There are 3 groups of diseases of the pancreas: acute pancreatitis, chronic pancreatitis and pancreatic tumors. In the last group one must differentiate between malignant or benign tumors. Today we know that there are different types of malignant tumors, each having their own growth behavior and prognosis.
5. Is there a particular way of life which contributes towards acquiring diseases of the pancreas?
It is known that heavy alcohol use can lead to both acute pancreatitis and chronic pancreatitis. Patients who have acquired chronic pancreatitis as a result of heavy alcohol use should avoid alcohol entirely. It is also known today that smoking can play a role in acquiring pancreatic cancer.
6. What is special about the Pancreas Center Bern at the Inselspital?
Being a university clinic, the Inselspital has all necessary specialty fields at its disposal including gastro (stomach)-intestine diseases (Gastroenterology), abdominal surgery (Visceral Surgery), and the treatment of cancer (Oncology). In particular, research has been conducted with great interest at the Clinic for Visceral Surgery since 1993, in both basic principles and patient care as well as in diseases of the pancreas. A lot of experience has been gained from our center as well as from several members of staff who have been to renowned centers abroad. A foundation has been established for anyone who would like to support this research.
Coordination between the individual disciplines is very well organized at the Inselspital. Various treatment methods are put to practice according to what is best for the patient, without any unnecessary competition among the disciplines. In this manner the Pancreas Center in the Inselspital can offer treatment in accordance with the newest international guidelines.
7. Who pays for the surgery if I live or work in Switzerland?
Pancreas surgery is paid for by the health insurance .
8. Do you accept foreign patients?
Being a center we regularly have foreign patients. If needed we have translators available so that foreign patients and their families can be kept informed.
9. How can I make an appointment at the Pancreas Center?
The simplest way is by email. Use the link on our homepage or the homepage of the Clinic for Visceral Surgery (www.chirurgiebern.ch).
B. Chronic Pancreatitis
10. What is chronic pancreatitis?
Chronic pancreatitis is when the pancreas, due to a chronic inflammation, shows a changed structure. The symptoms are pain and the restriction of endocrine and exocrine functions. The degree of this restriction can vary.
11. What must I do when my doctor tells me that I have chronic pancreatitis?
The most important thing is to prevent any further damage to the pancreas. This would foremost mean complete alcohol abstinence. In addition continuous medical care by your doctor is necessary so that the insufficient endocrine and / or exocrine functions can be treated.
12. How is chronic pancreatitis usually treated?
Insufficient endocrine function can be treated with insulin or tablets to regulate blood sugar levels. Insufficient exocrine function is treated with digestive enzyme capsules. Chronic pain can be more difficult to treat. If simple pain killers are not effective, your doctor will need to collaborate with a specialist at the Pancreas Center.
C. Acute Pancreatitis
13. What is acute pancreatitis?
Acute pancreatitis is an acute inflammation of the pancreas. In 80-85% of the cases, acute pancreatitis is mild and heals fully in a few days. However, a very severe and life-threatening inflammation can develop requiring hospitalization in an intensive care unit and in some cases surgery.
14. What must I do if a doctor says I have acute pancreatitis?
As it is difficult to determine in the early stages whether it is a mild or severe form, acute pancreatitis should, when possible, be treated in a hospital. The most common causes of acute pancreatitis are gallstones and heavy alcohol use. If gallstones are diagnosed, the gallbladder including the stones should be removed. When this is done, depends upon the severity of the pancreatitis. If heavy alcohol use is the cause, total alcohol abstinence is strongly recommended.
15. How is acute pancreatitis normally treated?
Acute pancreatitis should be treated in a hospital. In the early stages, the patient should neither eat nor drink and will receive fluids and nutrition through a vein (intravenously). Additionally, pain killers are prescribed. Depending on the severity further measures such as the use of a catheter in a large vessel as well as in the bladder. For diagnostic purposes an ultrasound or, in certain cases, a computerized tomography (CT) scan of the abdomen may be required.
16. Our pediatrician diagnosed my daughter with acute pancreatitis following mumps.
Pancreatitis as a complication of mumps is generally mild and it is not necessary to hospitalize these children.
D. Pancreatic tumors
17. What is a pancreatic carcinoma?
Carcinoma is the term for a malignant tumor, which in layman language is called cancer. It is known today that there are various groups of pancreatic carcinoma, which have different approaches to treatment.
18.
Is there a method for detecting pancreatic cancer at an early stage?
Unfortunately not yet. However, numerous research groups, including our group, are trying to solve this problem.
19. What kind of pancreas tumors are there? Are they all malignant?
Whereas in the past only a vague distinction was made between benign and malignant tumors, today the various kinds of tumors are highly differentiated. Unfortunately, the majority of tumors fall into the malignant category, affecting pancreas tissue which is responsible for the exocrine function. Endocrine tumors can also be either benign or malignant. Benign tumors which produce hormones – especially those which produce insulin- must be treated as the overproduction of insulin can lead to blood sugar levels being dangerously low.
20. What methods of therapy are there for pancreatic cancer? Is surgery always required of are there other therapies?
The treatment of pancreatic cancer should always be carried out by a team of experienced oncologists and surgeons. Whether the treatment consists of chemotherapy or surgery depends primarily upon the tumor stage as well as the tumor type. Generally, for patients with localized pancreatic cancer, one should aim at the complete surgical removal performed at a large center by an experienced team. Combined treatments with chemotherapy and, in individual cases, with radiation therapy, should be controlled at a center in relatively short intervals for the quality of their effectiveness.
21. How high are the risks of pancreas surgery?
Pancreas operations are stressful for the body, and should only be performed at centers where the performing surgeons as well as all others involved in the patient’s treatment such as anesthetists and nurses are experienced. During the operation, a loop of the small intestine is sewn onto the pancreas. The risk of there being a leak in the area of the suture (seam) lies between 2 and 15%, and, in most cases, can be treated without further surgery. Further risks include temporary disturbances in stomach emptying (harmless but annoying), or any complications associated with a hospital stay but not directly related to the operation such as pneumonia, thrombosis or urinary tract infections.
The risk of dying due to a pancreas operation lies internationally under 5%. There are many centers where a series of over 100 operations have been performed without any cases of death due to the operation.
22. Is the entire pancreas always removed in pancreatic cancer operations?
The complete removal of the pancreas is the exception. Only very few tumors grow along the pancreas ducts inside the pancreas thusly attacking the entire organ, without also producing metastases (secondary malignant growths in a different part of the body).
23. Can I live without a pancreas?
You can live very well without a pancreas. It, however, requires that you check your blood sugar level regularly and use insulin accordingly as well as taking digestive enzymes with each meal.
24. How will my life be after a partial or total removal of my pancreas? What must I take into consideration? Does it always result in diabetes?
Generally, following a partial removal of the pancreas, you will be able to lead a normal life. Depending upon the functional condition and size of the remaining pancreas is may be necessary to support the exocrine or endocrine functions. The occurrence of diabetes is more likely in cases of long-term previous pancreas disease and in cases of removal of the left side section of the pancreas (which is removed much less often than the right side).
25. Are diabetics more susceptible to pancreatitis?
This question can be answered with “no”.
26. Do you recommend getting a second opinion from another specialist before undergoing stressful surgery?
It is important that surgery is performed by a team of experienced surgeons. In cases where borderline decisions have to be made, such as whether surgery is still a promising option or not or whether more major surgery is required, a second opinion could be of help.
E. Transplantation
27. Can a pancreas be transplanted
It would be possible to transplant the entire pancreas. This could be considered in cases of diabetics who are dependant on insulin and who, due to their diabetes, require a kidney transplant. However, most recent data show that islet cell transplantation is more beneficial than transplanting the entire organ.
28. Do you offer transplants at the Pancreas Center Berne?
Pancreas transplants are offered at the Pancreas Center Berne. However islet cell transplantation is performed in collaboration with the Center at the University of Geneva.
29. What should I look for when selecting a specialist and / or hospital?
Pancreas surgery including oncology care of pancreas patients should be carried out by a team of doctors who are well versed in all aspects of these diseases. It is known in medical literature that centers which have seen a higher number of such patients achieve better results than centers which have seen less, although in individual cases smaller hospitals have performed operations well.
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