Mar 06, 2018
Pancreatitis ( from the Greek "pancreas" - pancreas and the suffix "it", which means inflammation) - inflammation of the pancreas. The term was introduced by the ancient Roman physician Galen in the 2nd century AD: the fleshy consistency of the pancreas resembles soaked meat - hence "pan" - all, all and "kreat" - meat.
What is so dangerous this disease, and why in our time the number of diseases of pancreatitis is growing? The answer lies in the fact that today we consume too much fatty food and alcohol. And sometimes even a single "bust" of alcohol on the background of fatty foods can lead to acute pancreatitis, which ends with a hospital bed. But most often this, of course, happens to people who have long abused alcohol.
The pancreas is often involved in the pathological process in a variety of diseases. And her own diseases are difficult to diagnose, since the organ is very deep: speaking in medical language, in the epigastric and left subcostal area. Nevertheless, there are a number of fairly distinct symptoms, as well as indirect signs, by which it can be understood that everything is not all right with the pancreas.
It can become inflamed after a stomach injury if it was hit with a volleyball or tennis ball, because of a cold, flu and herpes, as well as appendicitis, gastritis, food allergies, overeating and malnutrition with a predominance of fatty and sweet. If you quarrel with the boss, overtired or in a stressed state, the chances of getting sick with pancreatitis sharply increase.
If it is not properly treated, acute pancreatitis can go to chronic. And if the insulin production is disturbed by the cells of the islets of Langerhans, as you already know, diabetes can develop. Much less often there are atrophy of the pancreas, its fatty necrosis, cysts, sclerosis, abscesses. Unfortunately, recently cases of pancreatic cancer have increased all over the world.
Acute pancreatitis is an inflammation of the pancreas, which is based on the process of self-digestion of the gland's own tissue, which proceeds with the increase in the size of the gland, the development of edema and necrosis of the tissues. If earlier this pathology was rare, today pancreatitis has already reached the third place among surgical diseases after appendicitis and cholecystitis. And the chances of each of us to face this disease personally, unfortunately, have increased. Where does this attack come from and what should you do if a sudden attack has twisted you?
Acute pancreatitis develops when, for some reason, the outflow of pancreatic juice is disrupted and the pressure in the pancreatic ducts increases. In the main part of patients, including many women of pre-retirement age, who are overweight, the cause of pancreatitis is cholelithiasis. And for men, a trouble-free "winding key" for pancreatitis is alcohol, which stimulates the gland( despite the fact that the outflow of secretion is disturbed due to the edema of Faterov's nipple).
If you, "pobsochnichach" in the afternoon, eat up in the evening, fried potatoes on sala, like marinated and salted mushrooms and cucumbers, fond of carbonated drinks - you can rest assured: among other things, pancreatitis will choose your victim for you. However, maybe you prefer gastritis? He, too, will not leave you with his attention.
For the sake of justice, it should be noted that not every amateur drink and a good snack is on a hospital bed with an attack of pancreatitis. A certain role is played by the hereditary predisposition to this disease. It happens that the impetus to the development of pancreatitis is the nervous overstrain and stress that cause spasm of the vessels, as well as the muscles at the outlet of the biliary and pancreatic ducts.
Disturbance of normal outflow of pancreatic juice causes ascarids caught in the ducts, various diseases of the duodenum, small and large intestines( peptic ulcer, enteritis, colitis, enterocolitis, diverticula, etc.), accompanied by constipation. Acute pancreatitis can also be caused by physical trauma - a blow to the abdomen or a fall on the abdomen, an unsuccessful operation or diagnostic procedures in the liver, gallbladder and bile ducts. Relatively recently, there was another reason - self-medication, when some lovers to "just in case" use hormonal medications, furosemide, tetracycline and many other drugs uncontrolled.
Well, for every tenth patient, the cause of exacerbation of pancreatitis can not be clarified. Apparently, there is a regularity - where it is thin, there and it is torn. Almost each of us in the body has its weak link - a sick organ, sometimes even a few. And it does not always depend only on us, it will withstand this weak link the next test in the form of nervous stress, hypothermia, infection, and so on. Otherwise how to explain that a person like and not subject to bad habits and gastronomical excesses, and the pancreas, as if going mad, suddenly starts to digest itself?
Science can not answer some questions. But in recent years, scientists have seriously taken up the matter to find out what the role of each of the pancreatic enzymes in the development of acute pancreatitis.
Acute pancreatitis is one of the most difficult diagnosed and at the same time widespread diseases of the digestive system. Specific therapy is practically absent;manifestations of the disease are extremely diverse, and it is difficult to put an accurate diagnosis immediately, even with the help of laboratory tests. In addition, this disease is accompanied by a number of life threatening complications, and clinical course and outcome are unpredictable.
In medical reference books one can read that acute pancreatitis is characterized by a sharp, often girdling pain in the upper half of the abdomen( epigastrium), nausea, multiple vomiting, bloating, drop in blood pressure, general weakness. The pains are so sharp and painful that a person can lose consciousness. However, the pain can be not only paroxysmal, but also long, give back, in the lower back and under the shoulder blade.
One cheerful song of medical students has these words: "Does vomiting and stomach ache? So here's pancreatitis. What does the patient need to do? Cold, hunger and blockade. "Indeed, vomiting and abdominal pain are the main symptoms of pancreatitis. However, vomiting is a symptom not only of acute pancreatitis. For example, with appendicitis, cholecystitis( inflammation of the gallbladder), gastritis can also be vomiting. But with these diseases, the pains are of a different nature, localizing in the corresponding part of the abdomen. Objectively, the disease is confirmed by an increased content of pancreatic enzymes in the blood or urine. This is most accurately indicated by the study of pancreatic elastase.
There are following forms of acute pancreatitis:
interstitial pancreatitis - acute pancreatic edema;
pancreatitis - hemorrhage in the gland tissue;
pancreatonecrosis - gland tight with foci of decay;
acute cholecystopancreatitis - a combination of acute cholecystitis and pancreatitis;
purulent pancreatitis - in the pancreas foci of purulent fusion.
Currently, all researchers recognize the eight main causes of acute pancreatitis.
1. Increased pressure in the bile ducts - bilious hypertension( considered the main cause), which can be based on gallbladder disease;often they are accompanied by a spasm of the sphincter of Oddi. Increase in pressure promotes cholelithiasis.
Pancreatitis of this origin is called "biliary";it is believed that they account for about 70% of all acute pancreatitis. All other pancreatitis is called idiopathic. The category of "idiopathic" includes acute pancreatitis of unclear etiology in the elderly.
2. Stagnant phenomena in the upper parts of the digestive tract( gastritis, duodenitis, stomach and duodenal ulcer, duodenosis) contribute to the deficiency of the Oddi sphincter and the injection of intestinal contents, with enzymes, into the pancreatic duct.
3. Disturbance of metabolism, especially fat metabolism, leads to the activation of enzymes. It's not for nothing that pancreatitis is sometimes called "glutton disease", or "full life" disease. An interesting fact: during the war years, in the Leningrad blockade, there were almost no pancreatitis;they appeared after the breakthrough of the blockade, and, first of all, from the supplyers and the heads of the dining rooms.
4. Blood circulation disorders in the gland, ischemia( lack of tissue supply) of the organ( most often in connection with atherosclerotic changes, hypertension, diabetes, alcoholism) also lead
to the development of acute pancreatitis. In pregnant women, circulatory disorders may be associated with the pressure of the pregnant uterus on the vessels.
5. Enzymes are also promoted by food and chemical poisoning - alcohol, acids, phosphorus, drugs( tetracycline, glucocorticosteroid hormones, immunosuppressants, antibiotics, anticoagulants, estrogens, etc.), helminthic invasions.
6. General and local infection, especially of the abdominal cavity - biliary tract, hepatitis C and B, mumps( mumps).
7. Pancreatic injury - directly with injuries, blunt trauma, as well as surgery( with operations on the duodenum, biliary tract), trauma can also lead to acute pancreatitis.
8. Especially many supporters in recent years have acquired an allergic theory of the origin of acute pancreatitis. It arose on the basis of the fact that many researchers in the serum of patients with acute pancreatitis found antibodies, which speaks of autoaggression, that is, self-devouring of the pancreas.
These are the main reasons for the development of acute pancreatitis. It should be noted that most often there is a combination of several of these reasons. Sometimes it is even difficult to find out which of them was the most important in the onset of the disease.
The variety of forms of acute pancreatitis is caused not only by a variety of causes, but also by a number of other factors. Among them is the individual anatomical structure of the pancreas, and the nature of nutrition, and the general condition of the gland immediately before the influence of the factor that violated its work.
Of possible complications, peritonitis and pancreatic cysts are especially dangerous. In addition, do not forget that acute pancreatitis often becomes chronic.
Warning! When acute pancreatitis requires urgent hospitalization and, possibly, surgical intervention.
Acute pancreatitis in pregnancy - not so rare. The fact is that during pregnancy, the vascular bed of the entire body of a woman is being reconstructed. Therefore, abundant plethora is experienced by all organs and systems of the body( except the brain).As a result, pancreatic tissue edema may occur because of this, the secretion of the secretion along the ducts will be difficult, which sometimes leads to a spasm of the sphincter, and pancreatic juice will begin to flow back. In addition, and the growing fetus squeezes the pancreas.
In pregnancy, as a rule, occurs stone formation, and especially often in many women give birth. And therefore pancreatitis in them is most often just of biliary origin( up to 95% of pancreatitis in pregnant women).Second place is occupied in pregnant women by "metabolic" pancreatitis, which develops as a result of metabolic disturbances in the body, primarily lipid metabolism.
Intensive antibiotic treatment during pregnancy can damage the fetus. Nevertheless, there is no reason to interrupt pregnancy with acute pancreatitis! Another thing is that in a catastrophic situation it is necessary first of all to think about the life and health of the mother. Therefore, intensive therapy is carried out in full.
Generally speaking, with an attack of acute pancreatitis, people usually get to the surgical hospital by an ambulance, because often there is no strength to suffer an attack. Just imagine that you have a wild pain "in the pit of the stomach", which gives to the left hypochondrium or like a hoop squeezes the entire upper half of the trunk. And this state lasts for hours. This starts vomiting - at first, what you ate, and then just mucus and bile. Here you can not get rid of any analgesics, and the hand reaches out to the phone itself.
It should be noted that the main manifestation of acute pancreatitis is an extremely severe pain syndrome, often leading to collapse or shock. A prolonged severe pain wears out a person, often accompanied by fear of death. Pains, as a rule, are localized in the epigastric region, giving to the left costal arch, the left shoulder, the left kidney region. Very often the pain is shrouded in nature.
Sometimes the pain radiates to the right half of the thorax or to the right shoulder, which confuses the patient and his relatives who suspect angina pectoris, myocardial infarction, biliary or renal colic. In most cases, only a doctor can distinguish an attack of acute pancreatitis from a heart attack and other diseases by conducting an appropriate examination. In particular, ultrasound is prescribed, which in acute pancreatitis shows an increase in the pancreas in combination with a change in the shape of its head.
Pain can be associated with diarrhea and vomiting, which do not bring relief, but lead to dehydration of the body, because of which the patient's skin becomes dry, facial features sharpen. Constipation may occur, then the abdomen is swollen - the abdominal muscles become strained, become hard like a board.
Usually, with an acute attack of pancreatitis, blood pressure rises, then it can become, on the contrary, too low. There is a strong palpitation, shortness of breath. To all this, renal failure may be associated, which is established by the analysis of urine, and jaundice.
Often, in the circumference of the navel and on the waist, one can see bluish spots that give the skin a marble shade. Sometimes there are spots of greenish-blue in the inguinal areas. Their occurrence is associated with the penetration of blood from the pancreas under the skin of the abdominal wall.
Keep in mind that the condition of the patient with acute pancreatitis usually deteriorates rapidly, so do not hesitate to call for an ambulance. Fortunately, getting into the hospital does not always mean getting on the operating table, either. Nevertheless, you will ensure the close attention of surgeons in the future.
The diagnosis of pancreatitis is not only based on the clinical picture. Examination of the patient is important, but no less important are the results of blood and urine tests, in which the level of the enzyme amylase increases. Sometimes, with acute pancreatitis, blood sugar levels increase, and sugar can appear in the urine. In patients with acute pancreatitis, not only carbohydrate metabolism is disturbed: a laboratory test reveals certain changes in blood indices. In particular, leukocytosis is always detected, an increase in ESR.In the blood and urine, the activity of amylase, one of the enzymes of pancreatic juice, is increased.
A study of pancreatic juice on the activity of enzymes is also conducted. In the morning on an empty stomach, a duodenal probe is inserted into the duodenum and a liquid that flows through the probe is collected, which consists of gastric and pancreatic juices and bile. A change in the activity of one enzyme indicates a lower degree of pancreatic damage, while a simultaneous change in the activity of all enzymes suggests a more severe course of pancreatitis.
Nowadays it is possible to learn about the condition of various internal organs, including the pancreas, with the help of devices. True, the x-ray of the chest and abdominal organs gives only indirect data on the damage to the pancreas. Ultrasound( ultrasound) and echo- tomography are much more effective. Sometimes they make a computer tomography, in which they determine the size, shape, structure of the pancreas, the relationship with surrounding tissues, the presence of foci of inflammation, stones in the ducts.
There is also densitometry, which makes it possible to judge the density of the organ. With the help of, retrograde pancreato-cholangiography is learned about the state of not only the common biliary, but also the pancreatic duct. There are other methods to find out what condition our pancreas is in and whether it prepares us any tricks. They are quite complex, and only the doctor decides whether the patient should be subjected to such a screening or not.
When the first signs of acute pancreatitis appear, do not get carried away by self-medication. This is not the case to experiment on yourself. Many believe that rinsing the stomach through abundant drinking and inducing artificial vomiting helps get rid of acute pain in the abdomen. This is a delusion, and with acute pancreatitis, such a method will only worsen your condition or the condition of the person you are trying to help. You must refrain altogether from taking any liquid or food. On the area of the upper abdomen should be put not a hot water bottle, but a bubble with cold water or ice.
You can take antispasmodics( nitroglycerin, no-shpu, papaverine).The main treatment is prescribed by a doctor, and if it is timely and correct, a person can recover within a few weeks.
Patient with acute pancreatitis requires very careful and thorough care. He needs a strict bed rest and a hungry diet in the early days of the disease. In order that the stomach does not secrete the digestive juice, the patient is prescribed injections of atropine. And to rest the pancreas itself, put a dropper with trasilol, kontrikalom. In severe pain, it is necessary to inject drugs: morphine, omopon or promedol with atropine, in case of shock - caffeine, cordiamine, mezaton, norepinephrine. If necessary, blood transfusion is performed. Patient obkladyvayut heaters, with flatulence put gas pipe. To avoid infection, which attacks the weakened organism, the patient is injected with antibiotics: penicillin, streptomycin, biomycin, tetracycline and others.
In treatment, much attention is paid to diet and substitution therapy with pancreatic enzymes. Patients are prescribed a strict sparing diet: mucous soups, mashed potatoes, semolina with sugar, jelly. Food should be predominantly carbohydrate, with a sharp restriction of fats and proteins. Then other porridges, boiled vegetables, vegetarian soups, and also boiled meat and fish are introduced into the menu. In the future, a person can in principle have everything, but in very moderate quantities. And then you can live with pancreatitis, however, people in their mass so far do not know how.
If you prefer to "suffer a little" in the hope that everything will pass by itself, and if you overcome pain, you do not call a doctor for a long time, it can end rather badly. In case the disease is started, the pancreatic edema occurs, and it is necessary to do the operation: open the capsule surrounding it, carry out a novocain blockade, and sometimes even drain the most affected areas or ducts of the gland. Therefore pancreatitis, however, like any other disease, it is better not to run.
Many people are worried about the question, are there any consequences of acute pancreatitis? With timely treatment, the colossal pool of pancreas functional capabilities allows it to survive this disease and remain fully functioning as a healthy organ. Although with some forms of acute pancreatitis the prognosis is quite serious.
And not to cloud the clouds in the sky of your health, adhere to a reasonable diet and avoid excessive consumption of alcohol. Of course, there are situations when it is impossible to refuse a glass of vodka or a glass of wine, but it is better that it does not happen too often. Remember that with every excessive libation, the pancreas suffers, and one day it will make you suffer with it.
Chronic pancreatitis is a progressive disease of the pancreas, which is based on the inflammatory process, followed by the development of fibrosis and calcification. At the same time there is a delay in the release of pancreatic enzymes - trypsin and lipase, the connective tissue proliferates and contracts, blood circulation in the gland is disrupted.
There are primary and secondary chronic pancreatitis. Secondary pancreatitis develops on a background of chronic gastritis, cholecystitis, cholelithiasis, enteritis and other diseases of the digestive tract. Chronic, can become and prolonged acute pancreatitis, if it is not treated.
Most often, men aged 30 to 50, who had previous problems with the pancreas, but who did not heed the prescriptions - a strict diet and no alcohol, are at the risk of becoming "chroniclers".Meanwhile, according to medical observations, for the development of chronic pancreatitis, enough to drink half a bottle of wine, 4 bottles of beer or just 5 drops of liquor every day for a couple of years.
But not only excessive libations and malnutrition can contribute to the onset of this disease. And acute pancreatitis does not always grow into chronic pancreatitis.
Until recently, it was believed that children can not have acute pancreatitis. But here, unfortunately, the trend shifts not for the better. More and more often, our children become ill with pancreatitis and doctors of the "fast" are forced to take the children to hospitals with the diagnosis of "acute pancreatitis."That, however, requires mandatory confirmation after taking all the necessary tests. The most informative and early diagnostic tool is a biochemical blood test. An indication of acute pancreatitis is an increase in the activity of the enzyme amylase blood. Somewhat later, the activity of amylase in the urine increases.
The cause of the disease at an early age may be some infectious diseases and allergic conditions, but in most cases the etiological factors remain unexplained. The disease often begins with a general malaise, refusal of food and moving games. The developing clinical picture in many respects depends on the form of acute pancreatitis. Sometimes an attack of acute pancreatitis can be triggered by physical stress during physical education classes or sports classes.
Acute pancreatitis in young children is relatively easy, and symptomatic treatment results in a rapid improvement in general condition. But because of malovyrazhennoy symptoms, the correct diagnosis will put only a special examination.
In older children, the disease begins with acute abdominal pain, initially diffuse, then localized in the upper abdomen or acquiring a shingling nature. At the same time there are multiple vomiting, abundant salivation. The body temperature is normal or subfebrile, the tongue is moist, moderately coated with white coating. The skin is pale. When you feel the front abdominal wall, pain does not appear, the abdomen is soft.
The development of acute pancreatitis in the elderly and elderly is most often promoted by diseases of the digestive system and primarily of the biliary tract. Changes in the pancreas are often characterized by hemorrhages or massive fatty necrosis. In addition, due to the presence of various concomitant pathologies, even mild forms of acute pancreatitis in elderly people often occur with a pronounced impairment of the functions of vital organs and systems, which is accompanied by acute cardiovascular, respiratory, hepatic-renal insufficiency, various types of encephalopathies.
Treatment of acute pancreatitis and elderly patients at home is impossible. It is necessary to conduct medical activities in intensive care units or in intensive care units;while in complex treatment necessarily include cardiovascular and other( according to the doctor) funds.
The main diagnostic method are laboratory tests of blood for diastase and lipase. X-ray is ineffective, but at times it makes it possible to clarify the diagnosis. Recently, a method for determining elastase, the most sensitive for detecting exacerbation, has been developed. Diastase, lipase and elastase are the main enzymes( enzymes) of the pancreas.
Of no small importance is the personal survey of a person. There is a link between the development of an attack of acute pancreatitis and the intake of a large amount of fatty and meat foods in combination with alcohol 1-4 hours before the onset of the first symptoms. The intensity of pain decreases slightly if a person sits down, leaning forward.
Common effects, such as shock and hypoxia, cause pancreatic decay products entering the bloodstream.
Among the causes of chronic pancreatitis, doctors primarily identify the following:
• excessive consumption of alcohol and smoking;
• stones of the gallbladder and bile ducts;
• infection( hepatitis B, parotitis, infectious mononucleosis and others);
• cystic fibrosis;
• hereditary predisposition;
• some drugs( estrogens, corticosteroids, tetracycline, azathioprine, hypothiazide, furosemide, sulfonamides, mercaptopurine and others);
• trauma to the pancreas;
• irregular and poor-quality food( lack of the necessary amount of protein and vitamins in the diet, excess of fatty and spicy food);
• chronic intoxication with lead, mercury, phosphorus, arsenic.
However, sometimes the cause of chronic pancreatitis, as well as acute, can not be established.
Accordingly, the secondary chronic pancreatitis includes:
for diseases of the organs of the gastrointestinal tract( gastric and duodenal ulcer);
duodenosis( organic, functional);
ischemic ischemic syndrome;
However, with all the variety of forms and methods of occurrence, practical doctors are now accustomed to separating chronic pancreatitis, primarily alcohol and biliary. Since most often the development of this pathology occurs exactly as a complication of cholelithiasis or against a background of chronic alcoholism.
I will dwell briefly on the effect of alcohol on the pancreas.
Alcohol has a direct negative effect on the pancreas, since it does not contain enzymes that can break down alcohol. In the liver there are such enzymes, but in the pancreas - no! Therefore, alcohol disrupts transcapillary exchange and exerts a toxic effect on the walls of the blood vessels of the pancreas, which causes severe dystrophic changes in its tissues.
In addition, when the alcohol is consumed, the consistency of secretion is disturbed, protein caps are formed, in which calcium can be retained, - a pancreatitis typical for alcoholics is formed, characterized by the appearance of stones( or protein plugs) in the gland itself. As a result of alcohol intoxication, fat metabolism is sharply disrupted, which sometimes leads to an attack of acute pancreatitis.
Alcohol intoxication, disrupting protein and fat metabolism, causes other pathologies. A single intake of a significant amount of alcohol is accompanied by a rise in the activity of lipase and amylase. And as a result of daily intake of 150-200 ml of alcohol within 2-6 years, alcoholic pancreatitis develops.
Chronic pancreatitis is characterized by pain, eructation, nausea, excrement of undigested food. Possible abundant pancreatic stool( often diarrhea).The person is very thin. In many respects, the symptomatology resembles acute pancreatitis, but in a more relaxed form. Pains, usually strong, girdling, giving in the shoulder, under the shoulder blades, in the lower back, are accompanied by dyspeptic disorders.
The defeat of the pancreas leads to the emergence of endocrine pancreatic insufficiency and to the development of diabetes mellitus.
As you can see, the symptoms of chronic pancreatitis differ little from acute symptoms, except that their manifestations are more eroded.
On exacerbation should be hunger for 1-2 days. Then use diet No. 5p and duspatalin.
Duspatalin. The synonym is meweberine. Has a relaxing effect on the smooth muscles of the gastrointestinal tract. Relieves spasms and pain syndromes with irritated bowel symptoms. The drug in capsules, without chewing, drink it with water.
To relieve pain, use antispasmodics - no-spa, baralgin, papaverine in combination with platyphylline. A person suffering from pancreatitis, in a situation where he knows that he will have to break a diet, time-consuming spasmolytic drugs will help to avoid an attack.
It is better not to use analgesics. The fact that there are diseases whose symptoms are similar to the symptoms of pancreatitis( the same appendicitis).After all, in the first hours, pain with appendicitis will not necessarily be in the right iliac region, it may be epigmoid, and give to the left. A person will think that he has an exacerbation of pancreatitis, but in fact it is appendicitis. Accepted analgesics can lubricate the picture, antispasmodics - no: from no-shpah manifestations of appendicitis will not disappear.
Pancreatitis is greatly assisted by enzyme replacement drugs - pancitrat, creon, etc. These drugs are especially good when a person knows that they have to violate a diet. As a rule, they are used either immediately before meals, or during, or immediately after meals.
If chronic pancreatitis occurs with an external secretory insufficiency of the pancreas, which manifests itself in diarrhea, enzyme-replacement drugs are taken from time to time, rather long( a month or two).But taking breaks in their reception is useful, otherwise the pancreas completely ceases to work. Since not everyone knows the difference in the characteristics of the reception, it is better to consult a doctor.
If it is a question of pancreatitis against a background of chronic cholecystitis or dyskinesia of bile ducts, but without formed gallstones, sometimes cholagogue preparations are prescribed. As a rule, these are herbal preparations, there are a lot of them, but they can be consumed only if it is known that there are no stones in the gall bladder.
It can be both herbal preparations and tablets( to whom it is convenient).Of the tablets, you can call a flamen( extract from an immortelle), hofitol( extract from artichokes, it also has a hepatoprotective property, which in the modern world is also important), hepabene. The composition of plant cholagogue can include peppermint, corn stigmas, immortelle, tansy, hips.
Chronic pancreatitis is still a complex problem in clinical surgery. Despite the myriad of studies devoted directly to this problem, the mechanism of the development of the disease is still largely unclear. Also, there is still no consensus among experts in understanding the relationship and differences between acute and chronic pancreatitis.
American surgeon Spiro in 1994 identified chronic pancreatitis as repeated attacks of pancreatic inflammation leading to progressive anatomical and functional organ damage. At the same time, there is no morphological or functional restoration, since after each attack foci of fibrosis form and, as a result, functional pancreatic insufficiency develops. This is one of the main differences between chronic pancreatitis and acute - if acute pancreatitis is curable in the early stages, then chronic pancreatitis does not lend itself to definitive cure.
The basis of chronic pancreatitis is the development of an inflammatory-sclerotic process leading to a progressive decrease in the functions of external and internal secretion. There is a consolidation of the pancreatic parenchyma due to proliferation of connective tissue, the appearance of scars, pseudocysts and stones.
As a result, chronic pancreatitis of any origin can result in fibrosis of the pancreatic parenchyma, and this pathological process is irreversible. Therefore, in the treatment of chronic pancreatitis, first of all, they seek to eliminate pain syndrome and restore the basic functions of the pancreas. Therefore, the concept of "recovery" in connection with chronic pancreatitis should be considered conditional, since there are always symptoms arising from inflammation and fibrosis of the pancreas.
What about the relationship between acute and chronic pancreatitis? Recently, the opinion has become increasingly prevalent that both diseases can be designated as a single inflammatory process in the pancreas, proceeding in phases and leading to destructive changes in the organ, depending on the duration of the course. Thus, any pancreatitis( acute) that is not healed at the first stage of the transition turns into a chronic form.
There are primary and secondary chronic pancreatitis.
The primary is chronic pancreatitis, which develops in the pancreas proper and at the very beginning of its occurrence is not associated with the pathology of other organs. The main causes of the development of primary chronic pancreatitis are trauma, allergy, narrowing of the bile duct, chronic alcoholism, circulatory disorders, attacks of acute pancreatitis. It can also develop under the influence of prolonged intoxication.
Thus, the following types can be classified as primary chronic pancreatitis:
traumatic( including postoperative);
In the development of the second form of the disease, the leading role is played by diseases of the biliary system, gastrointestinal tract, vascular and endocrine systems, especially cholelithiasis and cirrhosis. Provoke a secondary chronic pancreatitis can also peptic ulcer of the stomach and duodenum.
In addition to taking medications, chronic pancreatitis requires adherence to a diet.
Do not eat the following foods and dishes: rye and fresh bread, buns, puff pastry;
soups on strong meat and fish broth, on a decoction of mushrooms and vegetables, borscht, all cold soups;
fatty meats, smoked meat, sausages, canned food, brains, kidneys, liver;
all fatty fish, as well as smoked and salted fish, caviar;
fried or hard-boiled eggs;
crumbly porridge;pearl, barley, corn, millet;
vegetables( cabbage, eggplant, radish, radish, turnip, garlic, spinach, sorrel, sweet pepper), mushrooms;
uncooked raw fruits, berries, grapes, dates, figs;
sweet confectionery, chocolate, pancakes, jam, sweets;
all spices, tomato sauce;
coffee, cocoa, cold fizzy drinks, grape juice.
Limit the intake of butter - no more than 30 grams per day.
The onset of chronic pancreatitis differs little from an attack in pancreatitis acute. There is still the same severe pain in the upper abdomen or hypochondrium. If the head of the pancreas is inflamed, the pain manifests itself usually in the epigastric region( above the navel, under the thorax itself).If the body of the gland is involved in the inflammatory process, it moves slightly to the left, and when the pancreatic tail is affected, people usually complain of pain under the left rib. Sometimes the pain is given back, the heart area, sometimes have a girdling character.
Usually the pain appears after taking alcohol, fatty or spicy food. Sometimes it concentrates on the left - where the rib connects to the spine. And sometimes, instead of pain, a person feels "wolfish appetite" - the so-called pain equivalent.
The patient complains of nausea, the stomach swells, diarrhea begins, and the feces have a disgusting smell, they show particles of undigested food, a greasy shine appears. However, a violation of the stool( alternating diarrhea with constipation) occurs in more severe cases, in the lungs the stool remains normal.
Usually, when an exacerbation of chronic pancreatitis disappears appetite, a person begins to feel disgust for fat and acute, the mouth accumulates a lot of saliva, you have to spit constantly, there is a belch. Sometimes the patient may experience mechanical jaundice. Sometimes diabetes mellitus joins.
Quite often, patients with chronic pancreatitis develop neuropsychiatric disorders. A person experiences anxiety, is irritable, overly excited, does not sleep well at night. Sometimes relatives of the patient pay attention to the doctor that he is constantly in a state of depression. Why is all this happening?
In such cases, physicians talk about the so-called enzyme toxemia, which is directly related to the weakening of the pancreas. When the blood in chronic pancreatitis permanently increases the content of certain enzymes, the pathological changes of nerve cells that lead to a disruption of their function begin. In addition, it is quite obvious that the constant pain that occurs in both acute and chronic pancreatitis, irritates the sick person.
There are times when the symptoms that we have told you are not so significant: the pain is easily removed by drugs, the intestinal disorder is insignificant. The patients try not to pay attention to them and, as they can, delay the visit to the doctor. However, remember: if you do not treat chronic pancreatitis, pancreatic cancer can develop.
What if you observe similar symptoms and do not show any abnormalities? First of all, you need a comprehensive examination to establish an accurate diagnosis. The fact is that in the first two to three years of chronic pancreatitis, many laboratory and instrumental indices can be within normal limits.
First of all, a blood test is needed. During the exacerbation of chronic pancreatitis, the number of leukocytes and the rate of erythrocyte sedimentation( ESR) increase in the blood, the content of the enzyme amylase increases. Amylase appears in the urine. Even with the rapid disappearance of pain, the blood reacts sensitively to the exacerbation of the disease, and the doctor looks at the ratio of various enzymes in it.
If the pancreas is not in order, an ultrasound examination( ultrasound) determines the increase in the entire gland or some part of it, and the contours become uneven. Echography is usually repeated, because at the beginning of the disease the pancreas can not vary in size.
In case of exacerbation of chronic pancreatitis, a computer tomography is prescribed, which helps to determine the size of the pancreas, as well as to detect foci of the disease in it, the presence of stones in the ducts. Such a study as densitometry allows one to judge the density of an organ. Sometimes a doctor prescribes retrograde pancreato cholangiography to find out what state is not only common bile, but also pancreatic duct. They also scan the pancreas. However, in what kind of examination you need - it's up to the doctor.
If the diagnosis of chronic pancreatitis is confirmed and you are offered to receive medical treatment in the hospital, do not refuse, especially if there is an increase in temperature. First of all, you need to remove the pain. For this, baralgin can be administered intramuscularly or, in severe cases, intravenously. Well help no-spawn, papaverine. If the pain does not recede, appoint promedol. To relieve pain, and also protect the gland tissue, intravenous injections of delargin are used. If the cardiovascular system reacts to severe pains, then it is supported by injections of camphor, cordiamine, caffeine and other medications.
In order that the pancreas can rest a little, prescribe enzyme preparations counter, gordoks, trasilol. However, in some people, these drugs can cause an allergic reaction.
As substitutes use panzinorm, festal, digestal, katazim-forte and other drugs. With the development of intestinal dysbiosis, appropriate treatment is performed, for example, a bifikol is administered 5 doses 2 times a day, in cycles during the month.
For neuropsychiatric disorders, which often occur in patients, various sedatives are recommended. If the patient experiences an increased sense of anxiety, he is usually prescribed a tranquilizer tofisopam( grandaxin).Irritability and insomnia recede before such a drug as phenazepam, but it is prescribed only with a healthy liver. To remove depression, there are also special medications prescribed by a psychiatrist.
During the exacerbation of chronic pancreatitis pancreas requires functional rest. Therefore, the patient is assigned bed rest and fasting for 2-3 days. It is allowed to drink mineral water without gas, not strong herbal tea. Recommend 1-2 glasses of broth of dogrose a day. The total amount of liquid should be about 2 liters, you should drink 200-300 ml 5-6 times a day.
To reduce the secretory function of the stomach apply mineral waters such as "Borjomi", "Polyana Kvasova."Water is consumed at room temperature 150-200 ml 3 times a day for 1 hour before meals for 10 days;all spend 2-3 courses at intervals of 20 days.
When the doctor allows you to start eating, do not attack the food. Eat small portions 5-6 times a day, and after meals rest for half an hour.
When an attack, as doctors say, is stopped, the patient is given physiotherapy procedures - inductothermy and ultrahigh-frequency microwaves, magnetotherapy. Electrophoresis with novocaine on the pancreas is indicated only for severe pain. We need exercises in therapeutic gymnastics. At the same time, special attention is paid to the patient breathing his stomach. Very good course of easy massage of the abdomen and thoracic spine.
Surgical treatment for chronic pancreatitis is rare. In cases of severe pancreatitis, when pain can not be removed by any means, surgeons conduct a sympathectomy to the patient - they cut the nerves that transmit the pain impulse.
Sometimes when exacerbation of chronic pancreatitis, if the pain and other symptoms are not very pronounced, you can do without a hospital. Help the sick iron, unload it, let it work quietly for your benefit, and it will not bother you anymore. To do this, you just need to follow the recommendations of the treating doctor punctually.
Chronic pancreatitis often proceeds secretly. With easy flow and during remission( temporary recovery, when nothing disturbs you), it may not appear. Neither analyzes, nor examinations with the help of devices will show anything. A person begins to consider himself completely healthy, and with chronic pancreatitis do not do this.
But if you are careful not to break the diet, it may well be that your pancreas will quietly perform its duties and will not bother you more. Many thousands of patients with chronic pancreatitis do just that, and their illness does not cause them much trouble.
When the disease recedes, it is very good to go to a sanatorium to consolidate success there. Recommended resorts with drinking mineral waters and medicinal mud - Essentuki, Borjomi, Zheleznovodsk, Truskavets. If the exacerbation recurs, then repeated treatment in the hospital is indicated. Patients can be withdrawn from dispensary observation only in the absence of exacerbation for 5 years.
Operation is an extreme measure in the treatment of pancreatitis. Surgical intervention is shown in the complicated forms of chronic pancreatitis( cyst, fistula, jaundice), ineffectiveness of conservative therapy, persistent pain syndrome and in some other cases.
Direct interventions on the pancreas are performed with constrictions and stones of the Virung duct, suspected cancer, irreversible fibrotic changes in the parenchyma of the gland, the formation of stones.
In cholelithiasis, an operation is performed in order to restore the outflow of bile and pancreatic juice. Of course, in cases with this pathology, there are conditions in which it is not necessary to operate. If the disease is completely asymptomatic, that is, it is regarded only as kamnenositelstvo, the person feels well, and should not be touched.
Most often, cholelithiasis makes itself felt and, as a rule, becomes heavier from an attack to an attack. If a person already had seizures and, assessing his condition, surgeons insist on surgery, this is correct, because removing the bladder filled with stones( stones) frees the person from complications in the form of chronic pancreatitis. The longer the delay in resolving the issue of cholelithiasis, the worse the pancreas will be.
The operations on the stomach and duodenum with chronic pancreatitis are made for excision of ulcers, diverticula, suppression of the acid-forming function of the stomach, elimination of duodenosis, improvement of the passage of bile and pancreatic juice.
With gastric ulcers penetrating the pancreas, resection of the stomach is indicated.
With duodenal ulcer penetrating the pancreas head and complicated by secondary pancreatitis, gastric surgery or gastrectomy is effective.
However, it is also necessary to take into account the fact that surgical intervention is also not an exhaustive tool in the fight against chronic pancreatitis. Unfortunately, even after eliminating the cause, chronic pancreatitis may remain.
A very important point is recovery after surgery. First of all, I must say that after the operation on the pancreas a long-term hunger diet is not needed. Therefore, the diet is prescribed in any phase of the disease, excluding the day of surgery plus one or two days after it, necessarily after the appearance of peristalsis and the escape of gases, naturally - in the absence of vomiting.
Food should be not only sparing, but also high-calorie - for the fastest compensation of metabolic disorders. For this purpose yogurt, ryazhenka, boiled meat and fish, fruit juices, soft-boiled egg, butter, cream, cottage cheese, honey, cheese are most suitable. To stimulate the appetite will help herring, broth, caviar. The main principle of nutrition - high caloric content with a small amount of food, which should be taken in small portions every 2-3 hours.
The food must necessarily be excluded: alcohol, smoked products, spicy seasonings, strong coffee, "heavy" fats.
In addition, for the fastest restoration of normal operation of the gastrointestinal tract, it is necessary to drink mineral water, both before and after meals. In the purulent phase( in the absence of ulcers and hypersecretion of the stomach), preference is given to gently stimulating the motility of the gastrointestinal tract to Essentuki No. 4 and No. 20, and their analogues( excluding No. 17).
Pancreatic necrosis is a formidable complication of pancreatitis
The insidiousness of acute pancreatitis consists in the fact that it often gives a picture of a false favorable course of the disease even when a life-threatening complication develops-necrosis of pancreatic tissue( pancreatic necrosis).
As a rule, pancreatic necrosis develops due to pancreatitis. You already know that in this disease the mechanisms of protection are violated and the pancreas begins to digest itself. As a consequence, necrosis of its individual parts occurs. For the presence of dead tissues, the body reacts with inflammation, which contributes to the gradual melting and resorption of small foci of necrosis.
If large foci of necrosis( sequestration) are formed, they can not dissolve by themselves. Sequesters are gradually separated from living surrounding tissues. If the disease is not treated, then microbes penetrate into the areas of necrosis, and then a severe purulent complication develops-an abscess of the pancreas. This can lead to extremely life-threatening bleeding and fistulas of the stomach, duodenum, thick and thin intestines. Further, sepsis may develop - a common microbial damage to the body.
How does pancreatic necrosis develop? It happens that the disappearance of sharp pain in the abdomen and excruciating vomiting, normal body temperature in the first days of the disease, relatively favorable indicators of the cardiovascular system and respiratory organs soothe the patient. It seems to him that the danger has passed, and he is already reluctant to agree to intensive therapy.
The appearance of a noticeable swelling in the upper abdomen, that is, an inflammatory infiltrate in the pancreas, is also of little concern to the patient, since this infiltrate is not very painful when the fingers are pressed on him( palpation).However, soon the temperature rises, and this is already a sure sign that the patient develops widespread necrosis of the pancreas. The presence of an infiltrate is also confirmed with the help of ultrasound or computed tomography.
Treatment in this phase requires a long time. The patient should prepare for the fact that he will be in the hospital for 3-4 months or more, and during this period he can make several operations for the phased removal of dead tissue from the pancreas.
Pancreatonecrosis is treated only in a hospital environment, primarily because it requires the intervention of many doctors: an endocrinologist, a therapist, and if necessary, an intensive care team. For proper diagnosis and more successful treatment, the participation of specialists in echo- tomography and endoscopy is necessary.
Usually patients with pancreatic necrosis enter the hospital in the phase of toxemia. If the level of amylase is increased in the blood and urine of the patient, the work of the gland( pancreatic secretion) is blocked with the help of medications. Usually, the drug 5-fluorouracil is intraarterially administered.
In order to reduce pancreatic secretion, reduce the acidity of gastric juice. For this purpose, for example, cimetidine and atropine are used.
Further, doctors are taking steps to restore the out-cut outflow of the secretion of the pancreas. For this purpose, special surgery is performed when the sphincter of the papilla is dissected( endoscopic papillosphincterotomy).After this, the level of enzymes in the blood and urine decreases, and the patient's well-being improves.
In pancreatic necrosis, detoxification is also carried out, that is, excess enzymes and cytotoxins are excreted from the body. This is achieved with the help of forced diuresis: intravenously or intraarterially, but special drugs are administered that cause abundant and frequent discharge of urine. The duration of forced diuresis can reach a week.
If a patient with pancreatic necrosis in the abdominal cavity discovers a fluid with an admixture of blood, laparoscopic dialysis is prescribed. It is carried out with the help of drains, through which the liquid is pumped out and a solution consisting of novocaine, sodium chloride and antibiotics is injected. As soon as the fluid flowing from the abdominal cavity becomes transparent, and the level of amylase in it decreases, the procedure is terminated. In cases of increasing intoxication and acute pancreatitis complicated by jaundice, hemosorption, or purification of blood, is carried out.
With the correct treatment, the phase of the toxemia of pancreatic necrosis results in the patient recovering. However, it also happens that the stage of infiltration and purulent complications develops. Then the patients are prescribed broad-spectrum antibiotics, which are injected through the femoral arteries. Usually after this infiltrate dissolves.
If the positive effect of medical procedures does not occur, the patient is prepared for surgery, during which dead pancreas tissue is removed.
The prognosis of the disease depends on how seriously the pancreas is seriously affected and if the treatment is started in time.