Pancreas

The pancreas, also called the hidden organ, can often act silently. To learn more about the pancreas pathogens, the first signs of the disease and its trajectory, we discussed with Prof. Univ. Daniel Cochior, primary surgeon. What is happening doctor? . Generally, how do we know we have pancreatic problems? .

Univ. Daniel Cochior: Except for acute pancreatitis, which, for whatever reason, has a loud onset with atrophic abdominal pain, most signs and symptoms of pancreatic disease are not specific, that is, they may also be encountered in other conditions. CSID: What are the symptoms? . Univ. Daniel Cochior: A series of events can be considered as a first alarm signal and requires a doctor's presentation: The jelly - yellowing of the eyes and skin; .

So this would be an indicator, the suspicious cases being those of sudden diabetes installed in people who do not have this disease in their family history. Installing anorexia (lack of appetite); . Pancreas is the main organ involved in the digestion of lipids by the produced lipase, so the lack of this enzyme will lead to the elimination of undigested fats in the body and liposoluble vitamin deficiencies (which require lipids to be absorbed from the intestine); . Univ. Daniel Cochior: Although it is a vital organ, little is discussed about its affections, compared to the pathology of other organs: heart, liver, brain, kidney, genitals.

Pancreas is an organ of endocrine and exocrine secretion. Affecting any function can cause important imbalances, sometimes with systemic manifestations that put the patient's life at risk. The most common pathologies, not necessarily in the order of severity at one time, are: diabetes mellitus, chronic pancreatitis, acute pancreatitis, pancreatic tumors (benign and malignant), cystic fibrosis (mucoviscidosis), exocrine pancreatic insufficiency. With regard to this last aspect, I emphasize that the pancreas is the main organ involved in the digestion of lipids by the produced lipase, so that the lack or insufficient secretion of this enzyme causes the elimination of undigested fats from the body (persistent steatores), liposoluble vitamin deficiencies, avitaminoses . On the other hand, damage to the pancreas may appear as an evolving complication of diseases of neighboring organs, eg gastric ulcer or post-penetrating penetrant in the pancreas.

Large surgical interventions for the pathology of other organs are risk factors - for example acute pancreatitis after gastric resections. Randomized clinical trials have been and are being conducted for each disease, and although numerous treatments have been reported, there are still many non-lethal aspects related to causes, pathophysiological mechanisms or therapeutic management. CSID: What complications may exist? . Univ. Daniel Cochior: Depending on pancreatic disease, complications vary from exocrine pancreatic insufficiency (for example, insufficient lipase) or endocrine (diabetes) to glandular necrosis with multiple organ dysfunction (affecting other devices and systems: liver, kidney .

In diseases of the pancreas, most complications are characterized as invalidating, with a significant impairment of the quality of life for survivors. CSID: What analyzes are recommended? . Univ. Daniel Cochior: In addition to the usual analyzes, depending on the pancreatic disease, laboratory analyzes are somewhat specific. For example: In acute pancreatitis, lipaseemia gives information about the existence of the liver (alkaline phosphatase, transaminases, bilirubin), and other tests, such as leukocytosis, inflammatory tests, tests specific to other organs, provide data on the systemic extent of the disease.

Pancreatic diseases are, for the most part, life-threatening or high-morbidity conditions, so patients should see their doctor as soon as possible, from the first signs of onset of the disease. In addition to laboratory analyzes, we have a whole arsenal of paraclinical investigations - photographic, helical CT with contrast substance, contrast-matrix NMR or PET-CT in neoplastic disease. CSID: What can be the treatment? . Univ. Daniel Cochior: The treatment addresses not only pancreatic disease but also associated co-morbidities, ie other pre-existing conditions.

Treatment can only be medical or surgical. It may range from endoscopic interventions, interventional radiology, minimally-invasive or classical surgery. CSID: When Is Surgery Needed? . Univ. Daniel Cochior: It's hard to talk about pancreatic affections in general.

Each condition has its peculiarities, causes, physiopathological mechanisms and specific treatments. Therefore, there is no universal principle to apply, neither from the point of view of tactics nor from the point of view of surgical technique. In order for surgery on the pancreas to be successful, it is necessary to fulfill some conditions: the surgical indication is correct, the operative moment is well-chosen, the operator unit has adequate equipment for the proposed purpose and the surgeon is well trained in such interventions. Surgical techniques differ depending on the pancreatic disease itself and the patient (age, pre-existing conditions). On the other hand, pancreatic surgery involves a multidisciplinary team consisting of surgeon, anesthetist, endoscopist, ultrasound, interventionist radiologist, gastroenterologist, anatomopathologist.

Therefore, it is imperative that such pathology be concentrated in centers of excellence with experienced specialists in each listed specialty. .