Diabetes which was earlier called a lazy person's disease does not live up to the name anymore. Owing to the sedentary lifestyle and bad eating habits, diabetes has become an epidemic in the recent years.
As as we all know, diabetes is a condition characterized by an increased concentration of blood glucose level. If not managed and treated on time, the condition can prove to be life threatening. Diabetes is known to trigger a host of health complications and disorders including cancer. In fact, research has established that there is a link between diabetes and pancreatic cancer. The report suggests that people with chronic diabetes for more than 5 years stand at an increased risk of suffering from pancreatic cancer. In some patients, diabetes may be one of the symptoms associated with pancreatic cancer. Whether diabetes triggered pancreatic cancer or was it the precancerous cells that caused the diabetes is difficult to explain.

The pancreas is an important organ involved in the production and secretion of many important hormones including the insulin (by the Beta cells of the pancreas). A diseased condition, such as pancreatic cancer may bring about changes, affecting the proper functioning of the pancreas. This, in turn, may interfere with the production of insulin. Decreased production of insulin or insulin resistance may result in elevated concentrations of glucose in the blood, a condition that will eventually give rise to Diabetes.

According to another published article (NCBI), in many patients with pancreatic cancer, diabetes was detected almost simultaneously along with cancer or 2 years prior to the diagnosis of cancer. These findings indicate the fact that both diabetes and pancreatic cancer not only occurred concomitantly but were also correlated.

Another experiment suggested that in people with Type-2 diabetes, the pancreas was for long subjected to a condition termed as hyperinsulinemia (increased level of insulin in the blood as compared to the blood glucose level). The experiment shows that insulin does have a role to play in establishing a relationship between diabetes and pancreatic cancer.

Managing Diabetes and Pancreatic Cancer
The conditions of diabetes and pancreatic cancer should be managed well to avoid further complications.

The diet plays a significant role in the proper management. The diet should be well balanced with all the essential nutrients. Include more fruits and vegetables in the diet. Berries such as raspberries, blackberries can go a long way to regularize the blood glucose level. Opt for whole grain cereals and food items. Avoid foods rich in fats and carbohydrates.
A healthy body weight can work wonders, both in the case of diabetes and pancreatic cancer. If you are a couch potato, give up the habit at the earliest. Indulge in more physical activities (not necessarily rigorous or strenuous) such as exercise, jogging, morning walk. In addition to keeping your weight in check, these physical activities are excellent stress busters.
The unhealthy lifestyle habits such as drinking, smoking, substance abuse can harm your body beyond imagination. Give up these unhealthy habits as early as you can.
There may be a strong connection between pancreatic cancer and diabetes. However, to avoid one affecting the other, one should take care of themselves and manage the conditions well.

Pancreatic Cancer - Are Diabetic Patients At A Higher Risk?

The inflammation of your pancreas over a short period of time indicates acute pancreatitis, which is a serious health condition. You may experience symptoms such as severe abdomen pain all of a sudden, diarrhoea and feeling of being sick. Acute pancreatitis occurs when there are some problems with certain enzymes in the pancreas. This condition is often associated with gallstones and alcohol consumption.


Treatment
Acute pancreatitis can be cured in a hospital, where you will get monitored for signs of serious issues. In some cases, supportive things like oxygen and fluids are required. Here are the various ways by which the condition can be treated:


1. Fluids: The body may get dehydrated during acute pancreatitis. Fluids are provided via a tube connected to one of the veins of the patient. This is known as intravenous or IV fluid. These fluids may help in the prevention of a problem called hypovolemic shock, which occurs when the amount of blood in your body gets lowered due to a drop in fluids. 
2. Nutrition: Diet is usually not restricted for people with acute pancreatitis, but some patients are recommended not to consume solid food for some time. Attempting to digest solid food may cause a strain on the pancreas. You may need to avoid solid food for some days. You should use a feeding tube to get essential nutrients. This process is called enteral feeding and it may involve the insertion of a tube into your stomach via the nose. 
3. Oxygen: For ensuring sufficient oxygen supply to your vital organs, you will be supplied with oxygen through the tubes on your nose. The tube may be removed when your condition improves. In some cases, ventilation equipment may be required for assistance to breathe.
4. Painkillers: Acute pancreatitis causes severe abdominal pain and strong painkillers such as morphine may be given to the patient. These may make the patient feel drowsy. 


Treatment of underlying cause
After controlling the symptoms, the underlying cause must be treated. They are as follows:
1. Gallstone: When pancreatitis occurs because of a gallstone, you may require a process known as endoscopic retrograde cholangiopancreatography or ERCP. The gallbladder may have to be removed, if necessary. 


2. Alcohol consumption: After getting treated for acute pancreatitis and you have recovered from this condition, you should try to avoid alcohol completely. Alcohol may spoil your recovery and the condition might reoccur or the symptoms may reappear. For freedom from alcohol, you may try counselling, joining self-help groups such as Alcoholics Anonymous (AA) or take a medicine which reduces your craving for alcohol. 


It is recommended that you visit a doctor immediately after experiencing any slight or severe symptoms of acute pancreatitis. This will help in early diagnosis and the chances of the symptoms getting worse are prevented.

Acute Pancreatitis - Can it be Cured?

An inflammation of the pancreas is known as pancreatitis. The pancreas is an organ that produces digestive enzymes. Pancreatitis might start any day and continue for long period and it requires immediate medical attention. It is of two types- acute pancreatitis and chronic pancreatitis. Although the treatment usually requires hospitalization, pancreatitis can be easily stabilized and the underlying cause can be treated thereafter.

Causes
Pancreatitis may be caused due to various reasons:
1. Gall bladder stone: The pancreatic duct lies next to the bile duct. The gallstones enter the small intestine after passing through the common bile duct. Often the stones that remain in the common bile duct have a negative effect on the pancreas, which causes a hindrance to the normal flow of the pancreatic fluids, causing pancreatitis. Also a back flow of the bile into the pancreas can cause pancreatitis. 
2. Alcohol: Long time alcohol use also causes pancreatitis. Alcohol can damage the pancreas tremendously causing it to get inflamed.
3. Other causes: Hereditary disorders in the pancreas, cystic fibrosis, high level of triglycerides, and a few medicines may also cause pancreatitis.

Symptoms: 
1. The first symptom of pancreatitis is abdominal pain: The pain may be sudden or gradually increasing, but is usually aggravated after eating. It is severe and constant, and may continue for a few days. If you are suffering from pancreatitis, you will feel very sick after a sudden attack and you might require medical assistance immediately.
2. Swollen abdomen: Pancreatitis may cause your abdominal area to swell up and become tender.
3. Nausea: If your abdomen suddenly starts paining due to the onset of pancreatitis, you tend to feel extremely nauseous. You might end up vomiting and may also have violent heaves.
4. Fever: The inflammation will cause you to run a temperature, along with a searing pain in your stomach, which will make you feel extremely uncomfortable.
5. Rapid pulse: Pancreatitis affects the rate, at which the heart beats, causing a rapid increase in the pulse rate.

Causes and Symptoms of Pancreatitis

Pancreatic cancer is an aggressive form of cancer. The disease shows no early symptoms and often spreads to other organs long before it is properly diagnosed. Due to such poor prognosis, only around 6% of the pancreatic cancer patients are healthy and alive 5 years after the first diagnosis.

One of the most common surgeries to remove tumours from the pancreas is Pancreaticoduodenectomy, that is commonly called Whipples surgery. The primary aim of the procedure is to cure cancers or disorders that are identified in the pancreas, bile duct or the duodenum. Here, the tumour is removed to prevent it from spreading to other organs, thus improving the life expectancy of the patient. 

Whipple's Procedure

Before the surgery, an intravenous line will be injected to your arm, to provide you with the necessary medication. Medicines may be passed through this line to soothe your nerves. A spinal injection or an epidural catheter may be placed. This helps you to recover painlessly after the surgery.

The surgery can be carried out in different ways  

Open surgery

Here, the surgeon makes a small incision in your abdomen to access the pancreas and other organs. This is the most common method. This is a complicated operation where the tip of the pancreas, the gallbladder, the bile duct and the initial portion of the small intestine are removed. It is performed to treat cancers that are present on the head of the pancreas. 

Laparoscopic surgery

Here several small incisions are made in your abdomen to insert a camera that transmits the live video of the abdomen to a monitor. According to the live feed, the surgeon performs the operation by using surgical tools. It is a common form of minimally invasive surgery.

Robotic operation

This is another type of minimally invasive surgery where the surgical tools are attached to a special robot. Here, the doctor uses a console to control the robot to perform the surgery. This is used because surgical robots can reach and operate in spaces and corners where the human hands may not reach during surgery.

 The Whipples surgery can take 4 to 12 hours depending upon the approach being used and the complexity of the process. During the surgery, you will be given general anaesthesia, so you will be asleep.

In some cases, a part of your stomach or nearby lymph nodes may be removed to treat the cancer growths. After the process, the doctor will reconnect the other organs so that you can digest food normally.

After the procedure, you may face problems while emptying your bowels. The condition improves around 7 to 10 days after the surgery. Most patients are able to return back to their normal life usually around 6 weeks after the procedure.

It is recommended that you follow the doctor s instructions after the surgery and stick to the diet prescribed. Additionally, keep the incision protected from sunlight and remove the bandages only after consulting the doctors. 

 

 

Whipples Surgery & Pancreatic Cancer - Know About Them!

Problems are pancreas are common and are treated by gastroenterologists. There are two common pancreas problems -

1. Acute Pancreatitis: Sudden Inflammation of the pancreas is known as acute pancreatitis. It is usually due to Alcohol, gall stones, trauma, metabolic causes such as hypertriglyceridemia, and congenital causes such as Pancreas divisum. The patient presents with severe upper abdominal pain and vomiting. Patients require admission for IV fluids and analgesics. Nearly all patients recover from the pain and start eating within 3 to 4 days. Few patients with severe pancreatitis may develop kidney failure, respiratory failure or GI bleeding. Such patients require longer hospitalisation stay and critical care management. Recovery is usually uneventful but few patients develop peripancreatic fluid collection known as Pseudocyst or walled-off pancreatic necrosis(WOPN). In such cases, the patient requires additional treatment of fluid collection and requires internal drainage by Cystogastrostomy which is done by Endosonography (EUS) by a gastroenterologist. Some patients require ERCP (Endoscopic retrograde cholangiopancreatography) for evaluation of pancreatic ductal leak. EUS and ERCP are advanced endoscopic procedures done by a few gastroenterologists who are specially trained in such procedures.

2. Chronic pancreatitis: Long term irreversible damage to the pancreas is called chronic pancreatitis. It is usually due to Alcohol intake. It presents with upper abdominal pain, Diabetes mellitus and fat in stools (steatorrhea). The small duct in the pancreas called main pancreatic duct can have hard calcifications also known as stones, which obstruct the flow of pancreatic juice and cause severe abdominal pain. Treatment of chronic pancreatitis includes stopping alcohol intake to prevent further damage to the pancreas, medicines for pain, Pancreatic enzyme replacement therapy (PERT) and Endoscopy for those who do not respond to medical treatment. Endoscopy includes ERCP and plastic stenting to establish a flow of obstructed pancreatic duct and Endosonography (EUS) guided Celiac plexus block for decreasing pain. Patients who develop fluid collection such as Pseudocyst require internal drainage by Cystogastrostomy which is done by Endosonography (EUS)

In Brief About Types Of Pancreatic Disorders!

Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.

This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.

This is inserted through the patient s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.

ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:

  Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.

  Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.

  Persistent upper abdominal pain

  Unexplained weight loss and loss of appetite

  Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater

ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient s needs.

Endoscopic Retrograde Cholangiopancreatography - Procedure and Results

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