Pancreatitis - Causes, symptoms and treatment. MF.

Pancreatitis is a progressive disease of the pancreas, which is based on an inflammatory process that leads to its damage and changes in external and intrasecretory functions, leading to serious metabolic disorders.

1 - esophagus;
2 - stomach;
3 - duodenum;
4 - small intestine;
5 - large intestine;
6 - liver;
7 - gallbladder;
8 - spleen;
9 - pancreas

The pancreas is the organ of the digestive system, which provides an effective process of digesting food and regulating carbohydrate metabolism in the body. It produces pancreatic juice( exocrine function) and synthesizes hormones( intrasecretory function), in particular, insulin, the main hormone responsible for maintaining normal blood glucose levels. Pancreatic juice contains a unique set of enzymes( protease, lipase, amylase) - substances that break down the main components of food: proteins, fats, carbohydrates. The hormone insulin regulates the metabolism of carbohydrates. Thanks to the pancreas, the processes of normal digestion, the digestion of food, and the nutrition of tissues and organs are provided.

The incidence of pancreatitis and other pancreatic diseases is increasing worldwide. First of all, this is due to irrational nutrition, alcohol abuse, deterioration of the ecological situation. There are acute and chronic pancreatitis.

The main causes of pancreatitis:

- alcohol abuse;
- the constant use of a large amount of fatty, fried, smoked, spicy food;
- obesity;
- pathology of the hepatobiliary system( cholelithiasis, cholecystitis, hepatitis);
- diseases of the stomach and duodenum( peptic ulcer, gastritis, tumors);
- viral infections( epidemic parotitis, hepatitis B);
- endocrine diseases( hyperparathyroidism);
- pancreatic injury, including surgery;
- smoking;
- severe food allergy;
- taking medications( tetracyclines, sulfonamides, cytostatics);
- cystic fibrosis;
- hereditary pancreatitis.

Chronic pancreatitis can occur for a number of reasons, this is in the article "Chronic pancreatitis."

Symptoms of pancreatitis.

Constipation, abdominal distention, digestive distress, heaviness after eating, stomach discomfort are the first bells in which it is necessary to pay attention to the stomach and pancreas.

Symptoms of acute pancreatitis

In acute pancreatitis, there is a violation of free outflow of pancreatic juice leading to self-digestion of the gland by its own enzymes. This disease is characterized by a sharp pain syndrome. Pain in acute pancreatitis occurs in the left side of the abdomen, after a while acquires a shingling character, accompanied by nausea, vomiting. Due to intoxication, dehydration( frequent vomiting), the condition of patients can quickly become severe: blood pressure drops, consciousness is disturbed. Collapse and shock may develop. This disease is referred to as urgent conditions in surgery, and it requires an urgent examination of the surgeon and hospitalization in a surgical hospital.

Detailed symptoms of acute pancreatitis & gt; & gt;

At the same time, an easy attack patient can "endure", which, of course, should not be done, because without treatment, he can go on to chronic pancreatitis, which is incurable.

Symptoms of chronic pancreatitis

During the chronic pancreatitis, two periods are distinguished: the initial period and the period of pronounced pancreatic damage. In the initial period( lasts about 10 years), the main symptom is pain syndrome. The pain is localized mainly in the upper and middle part of the abdomen, the left side of the chest, in the heart area( as in ischemic heart disease) in the left lumbar region( resembles renal colic), can spread along the circumference of the body, girdle, decrease in sitting position,tilting the body forward, often occurs 15-20 minutes after eating. An attack in a patient with chronic pancreatitis is classified as acute pancreatitis.

Provoke excessive, fatty, fried, smoked food, alcohol and carbonated drinks, chocolate, coffee, cocoa. Pain in pancreatitis is accompanied by dyspepsia - prolonged nausea, vomiting, not bringing relief, bloating, loosening of the stool. Dyspeptic symptoms are not always observed and have a concomitant nature, they are easily eliminated during treatment. The external secretory function of the pancreas, as a rule, remains intact.

With prolonged existence of chronic pancreatitis, the pancreatic tissue is restructured, its ability to produce enzymes and hormones decreases, secretory deficiency is formed. Pain becomes less pronounced, and more often can be absent. In the clinical picture, dyspeptic syndrome prevails, exocrine pancreatic insufficiency develops, manifested by malabsorption syndromes and maldigestions.

Maldegestia is a violation of digestion of food to the necessary components for absorption. Malabsorption of is a violation of the very mechanism of absorption in the small intestine. The leading symptom is a mushy stool 2-3 times a day and more often, "a large pancreatic chair"( plentiful, fetid, fatty).Characteristic bloating as a result of the accumulation of gases in the intestine. There is a loss of body weight. There are signs of hypovitaminosis: decreased vision in twilight, a violation of pigmentation( lack of vitamin A), bleeding gums( lack of vitamins K and C), conjunctivitis, stomatitis, skin itching( lack of B vitamins), anemia( hypovitaminosis B12 and folic acid).Violation of calcium absorption leads to convulsions, pain in the bones( osteoporosis).Endocrine insufficiency of the pancreas develops. Appears episodes of hypoglycemia( lowering blood sugar) with a characteristic weakness, neuro-psychic excitement, cold sweat, trembling in the body. In the future develops pancreatogenic diabetes mellitus. There is dryness of the skin, thirst.

One of the most common combinations in the practice of a gastroenterologist is the combination of chronic pancreatitis and gastroesophageal reflux disease( GERD), and this also imposes its symptoms, and often this combination occurs against obesity.

First aid for suspected acute pancreatitis

If a pancreatitis attack is suspected as first aid, rest, sitting with knees pressed to the chest, severe fasting with taking a quarter of a glass of water every 30 minutes - an hour, putting the back of the pancreasa bubble with ice. Superficial breathing will help ease the attack.

Anesthetics and anti-inflammatory drugs can not be taken, this greatly complicates the diagnosis. Enzyme preparations are also contraindicated. Easier to the patient's condition will help 0.8 mg but the spines or drotaverina hydrochloride in a similar dosage, if possible, it is better to make an intramuscular injection of a solution of papaverine 2 ml, you can replace the drug with a solution but the spines. And nitroglycerin under the tongue, well, suddenly it's not pancreatitis, but myocardial infarction.

Diagnosis of pancreatitis.

If you have pain in your abdomen, call a doctor. Acute pancreatitis can be confused with other life-threatening diseases, and even in severe conditions it is deadly dangerous.

Instrumental confirmation of pathological changes in the pancreas:

1. Transabdominal ultrasound( ultrasound).It determines the increase in the size of the pancreas, calcifications in the tissues, fuzziness and unevenness of the contours, heterogeneity of the structure, changes in echogenicity, the presence of cysts, and expansion of the ducts. The sensitivity of ultrasound in the diagnosis of pancreatitis is 80-85%.Therefore, in all cases, sonographic changes should be compared with laboratory data, since ultrasound results are not specific enough.

2. Computed tomography( CT) and magnetic resonance imaging( MRI) - reveal an increase in the pancreas, detect calcification, pseudocysts, determine the dilations of the ducts, identify lesions of neighboring organs, malignant neoplasms.

3. ERCPH - endoscopic retrograde cholangiopancreatography. Currently, he plays one of the leading roles in the diagnosis of pancreatitis. The sensitivity of this method is 93-100%.

Laboratory diagnosis of pancreatitis.

1. Definition of fecal pancreatic elastase -1.This method determines only human elastase, so the test results are not affected by the substitution of enzyme therapy. It is the "gold standard" for the diagnosis of chronic pancreatitis.
2. General blood test - signs of inflammation, anemia appear.
3. Alpha-amylase of blood and urine - with exacerbation increases. But the sensitivity of the test does not exceed 30%.
4. Sugar level in the blood - to identify diabetes.
5. The general analysis of urine - spend for exclusion of diseases of kidneys.
6. ECG and Echocardiography - to exclude heart disease.

In the diagnosis of pancreatitis, the leading role belongs to a specialist - a physician or a gastroenterologist. Only they are able to choose the methods of diagnosis, their sequence in each individual patient, in order to establish a correct diagnosis quickly, accurately and with minimal costs.

Consultation of specialists:

1. Gastroenterologist, for choosing the tactics of treatment.
2. Surgeon, with a long-term pain syndrome, the development of complications.
3. An endocrinologist, with the development of diabetes mellitus.
4. A cardiologist, to exclude the pathology of the cardiovascular system.

Treatment of pancreatitis.

The causes of pancreatitis are diverse and in a number of cases, when they are eliminated, the symptoms and inflammation decrease.

It is necessary to refuse the use of alcohol, observe a diet with a low content of animal fats, exclude the use of medications that can have a damaging effect on the pancreas, it is extremely important to treat diseases of the gastrointestinal tract, food allergies.

The main goal of the treatment is the elimination of pain, correction of pancreatic function disorders, prevention and treatment of complications.

For non-pain syndrome use non-narcotic and narcotic analgesics. The dose of analgesics is selected by the doctor, starting with the lowest effective dose. Apply myotropic antispasmodics( mebeverin, no-spa, spazmolgon).

Pancreatic enzymes with a sufficient lipase content of not less than 10 000 thousand units are used to relieve pain.(Creon, panzinorm) in combination with proton pump inhibitors( PPI - omeprazole, pantoprazole, rabeprazole, esomeprazole) both for the protection of enzymes from destruction by gastric juice and for the physiological dormancy of the pancreas. These drugs are shown only with moderate exacerbation of chronic pancreatitis. The choice of the drug, its dosage, the frequency of reception is performed only by the doctor.

In the absence of the effect of conservative treatment, an operative correction of the disease is performed. Operative treatment helps to prolong the life of these patients and improve its quality.

More on the treatment of acute pancreatitis & gt; & gt;

Replacement polyenzymatic therapy is performed with the development of exocrine insufficiency. Indication for its conduct is progressive weight loss, persistent diarrhea( frequent loose stools) syndrome. Its purpose is to ensure sufficient activity of lipase in the duodenum. With a properly selected dose of the enzyme drug, the patient notes an increase in body weight, normalization of the stool, a reduction in the symptoms of pain, bloating.

The use of polyenzymatic preparations of pancreatin, especially in traditional doses and enzymatic preparations of plant origin, is practically useless. Polyfermentative therapy is prescribed depending on the level of exocrine insufficiency, according to the data of the elastase test. With the development of pancreatogenic diabetes mellitus - compliance with diet and observation of the endocrinologist. Only the specialist - therapist or gastroenterologist - can select the necessary treatment plan, using an individual approach in each individual case.

Pretty well proven treatment of chronic pancreatitis with phytotherapy. About herbs and medical supplies, as well as how to brew them and what doses to take in the article Treatment of pancreatitis with herbs & gt; & gt;

Diet for pancreatitis.

In acute pancreatitis, food intake is contraindicated until your doctor has specifically instructed you.

The main principle of diet therapy during the recovery period and in chronic pancreatitis is eating food that spares the stomach, pancreas and liver.

During the period of exacerbation of chronic pancreatitis, in the first 1-2 days, hunger is prescribed. Only the intake of a liquid is allowed 1.0-1.5 liters per day( 200ml 5-6 times a day).This is an alkaline mineral water without a gas of room temperature, a broth of dogrose( 1-2 cups), a weak tea. As the general condition of the patient improves, the patient is initially transferred to a limited, and then to a full-fledged diet. With the expansion of the diet, the principle of gradualness is strictly observed, both in terms of the volume and caloric content of the diet, and with regard to the inclusion of certain dishes and food products in it. There is a need to slowly, chewing food, 5 times a day. Modern approaches in diet therapy do not provide for the exclusion of any products from the diet. An exception or a significant restriction( especially during the exacerbation) of individually intolerable foods and products that cause deterioration of the course of the disease.

Food category	Foods unfavorable for patients with chronic pancreatitis
Bakery products	Fresh bread, cookies, dough products, fried pies, pancakes, pizza
Groats, porridges	Millet, pearl barley, corn cereals, legumes
Meat, meatproducts	Fatty meats: lamb, pork, duck, offal;sausages, canned food.
First courses	Fat broths and soups, borscht, based on them
Sauces and seasonings	Tomato sauces and sauces, fries.
Fats	Margarine, chicken, goose, mutton, pork fat.
Drinks	Strong tea and coffee, juices( orange, grapefruit, apple, grape, pomegranate), carbonated drinks, alcohol.

Rehabilitation.

Patients are recommended to adhere to the regime of work and rest during the period of remission. Smoking and alcohol use are prohibited. Sanatorium treatment - only with persistent remission and no symptoms. Balneological resorts with hydrocarbonate waters of small and medium mineralization are shown. These are Yessentuki, Truskavets, Morshin, Zheleznovodsk, Borjomi. It is extremely cautious to apply to physiotherapeutic procedures, to conduct them only with persistent remission.

In acute pancreatitis, temporary disability is often delayed. It depends not so much on the patient's well-being as on the complete disappearance of pathological local( palpatory, sonographic, etc.) and laboratory symptoms. In some cases, subsequent temporary or permanent employment through the WCC is required. Contraindicated work associated with significant physical stress, shaking the body, traumatizing the abdomen, contact with poisons, and work that prevents compliance with the diet regime.

In severe, protracted, acute pancreatitis without operative treatment, long-term disability occurs, leading to disability of Group III or II.

Complications of pancreatitis:

1. Pancreatonecrosis.
2. Pancreatic cancer.
3. Mechanical jaundice.
4. Pancreatic coma.
5. Cysts and pseudocysts of the pancreas.
6. Pancreatic abscess.
7. Reactive hepatitis.
8. Reactive pleurisy.

In case of complications, the habitual character of the disease changes: the character, localization and intensity of pain changes, it can become permanent. The development of complications in chronic pancreatitis can occur in any period of the disease and requires an immediate examination of the doctor and hospitalization in a surgical hospital, since many complications pose a direct threat to the life of the patient.

Prevention of pancreatitis.

The goal of prevention is to stop the progression of inflammation, to prevent the development of complications. The patient is under the supervision of a therapist. At least twice a year, there is a dispensary examination, the necessary amount of research is set by the doctor, depending on the severity of the disease. Modification of the way of life. The risk of complications, and especially of pancreatic cancer, in those who drink alcohol is 1.6 times higher than those who refused to take it.

Doctor's consultation on pancreatitis:

Question: Is it possible to develop pancreatitis in obesity?
Answer: Obviously, obesity contributes to the development of chronic pancreatitis. Pancreatitis, developed in a patient with obesity, often occurs with the development of complications. This patient needs to gradually reduce body weight.

Question: Is it possible to take enzyme preparations containing bile acids( festal) in a patient suffering from chronic pancreatitis?
Answer: Enzymatic preparations containing bile acids can not be prescribed, since bile acids intensify intestinal motility, cause diarrhea( diarrhea), aggravating the patient's condition.

Question: Is it possible for a patient suffering from chronic pancreatitis to take cholagogue preparations, herbs, to conduct blind duodenal sounding, to cleanse the intestines?
Answer: We can not predict whether bile acids will enter the pancreatic duct, which can lead to an exacerbation of pancreatitis. The attending physician should prohibit the patient from carrying out such manipulations.

Doctor therapist Irina Vostrykova