home Calculators The main causes and symptoms of acute pancreatitis in adults, correct diagnosis and treatment. Treatment for acute pancreatitis: drug therapy and folk remedies

The main causes and symptoms of acute pancreatitis in adults, correct diagnosis and treatment. Treatment for acute pancreatitis: drug therapy and folk remedies

Acute pancreatitis is inflammation of the pancreas. Symptoms of the pathology primarily include unbearable acute pain in the abdominal area. The localization of pain will depend on which part of the gland is inflamed. So, pain can be localized in the epigastric region, in the left or right hypochondrium.

There are options when the pain is girdling in nature. Pancreatitis in chronic form accompanied by symptoms such as loss of appetite, indigestion, acute pain that occurs after drinking alcohol, spicy or fatty foods.

In this article we will look at complications of acute pancreatitis.

Description of the disease

Pancreatitis is a disease that is characterized by the occurrence and development of inflammatory processes affecting the tissue of the pancreas. Pancreatitis can be classified according to the nature of its course into chronic and acute. In this case, pancreatitis in acute form is the third in the ranking of the most common conditions requiring hospital treatment. In first and second place respectively are acute appendicitis And acute cholecystitis. Complications from acute pancreatitis can be very serious.

Statistical data

World statistics show that every year up to 800 people out of a million become ill with a disease such as acute pancreatitis. Men suffer from this type of pancreatitis much more often than women. The age of the patients has a fairly wide range, and this is directly related to the reasons why acute pancreatitis occurred. If acute pancreatitis arose and developed against the background overuse alcohol, then average age patients are 39 years old. If the cause of this disease was cholelithiasis, then the average age of patients is 69 years.

Pathogenesis and etiology of acute pancreatitis

Various factors can contribute to the occurrence of a disease such as acute pancreatitis. Among them:

Cholelithiasis.
Bad eating habits.
Alcohol abuse.
Viral infections, such as Coxsackie virus.
Bacterial infection, such as campylobacter or mycoplasma.
Injury to the pancreas.

Taking medications that contain estrogens, corticosteroids, thiazide diuretics, azathioprine. That is, those medicines, which have a pathological effect on the pancreas. This type of pancreatitis is drug-induced.
Surgical interventions that were aimed at treating other diseases of the pancreas and biliary tract.
Cystic fibrosis.
Genetic predisposition.
A congenital anomaly that affects the development of the pancreas.
Diseases of the gastrointestinal tract inflammatory in nature, including cholecystitis, gastroduodenitis, hepatitis.

Complications acute pancreatitis can be prevented if pathology is detected early.

Provoking factor

In accordance with the most common theory about the causes of pancreatitis, the main factor provoking the development of this disease is considered to be cell damage, which is caused by enzymes that are prematurely activated. If conditions are normal, the pancreas produces enzymes involved in digestion in a reactive state. Their activation occurs directly in digestive tract. In the event that internal pathological factors are present or affect external factors, then the activation of enzymes occurs untimely in the tissues of the pancreas. The consequence of this is the digestion of the tissues of the pancreas itself. As a result, tissue swelling develops and the vessels of the gland parenchyma are damaged. The medical history (acute pancreatitis) is known to all specialists.

If pancreatitis is acute, then such a pathological process can affect tissues located in close proximity to the gland itself, for example, retroperitoneal tissue, omental bursa, peritoneum, omentum, intestinal mesentery, and liver ligaments may be affected. If acute pancreatitis occurs in severe form, then the level of biologically diverse substances in the blood increases sharply. active substances. This leads to severe disturbances in the functioning of the body. Secondary inflammatory processes and dystrophic disorders may occur different organs and tissues, for example, heart, kidneys, lungs, liver.

These manifestations are complications of acute pancreatitis.

Classification of the disease

Acute pancreatitis can be classified according to the severity of its course:

Pancreatitis occurring in mild form, causes minimal damage to tissues and organs. It is expressed mainly by interstitial edema of the pancreas itself. Therapy is quite easy, the prognosis is very favorable, implying a quick and complete recovery.
Acute pancreatitis, which occurs in severe form, causes significant and severe damage to tissues and organs. It is also characteristic local complications, which include tissue necrosis, infection, abscesses, and cysts.

Acute liver failure in severe form may be accompanied by:

Acute accumulation of fluid in the tissues of the gland or in the peripancreatic space, which does not have granulation or fibrous walls.
Acute false cyst, which is an accumulation of pancreatic juice, which is surrounded by a fibrous wall or granulations and occurs as a result of an attack of the disease. The development of such a cyst occurs over four to six weeks.
Pancreatic abscess, which is a collection of pus in the tissues of the pancreas and tissues that are in close proximity to it.
Pancreatic necrosis, leading to tissue infection. A diffuse or limited zone of parenchyma appears, which begins to die. If an infection occurs and purulent pancreatitis begins to develop, the likelihood of death increases significantly.

Below we will tell you more about the history of acute pancreatitis.

Symptoms

TO characteristic symptoms Acute pancreatitis may include:

Pain syndrome. Painful sensations may have epigastric localization, may be observed in the left hypochondrium, be of a girdling nature, and may radiate under left shoulder blade. Pain in acute pancreatitis is pronounced and constant. If the patient is in a supine position, the pain increases significantly. The pain also intensifies after eating spicy, fatty or fried foods, or after drinking alcohol.
Feeling of nausea, vomiting. In this case, vomiting most often occurs indomitable character, contains a large amount of bile, does not bring relief.
Yellowness of the sclera. Most often it is expressed moderately. IN in rare cases possible manifestation of jaundice skin.

In addition, acute pancreatitis may be accompanied by dyspeptic symptoms. These include flatulence, bloating, and heartburn. Manifestations on the skin are possible, for example, hemorrhages located in the navel area, bluish spots on the body.

How is acute liver failure diagnosed in a person?

Diagnosis of the disease

Gastroenterologists carry out the procedure for diagnosing pancreatitis, based on the patient’s complaints and physical examination. The latter allows you to identify specific symptoms.

What tests are done for pancreatitis?

When carrying out the pulse measurement procedure and blood pressure tachycardia and hypotension are detected. To confirm the diagnosis, various lab tests urine and blood, ultrasound of organs located in abdominal cavity, MSCT, MRI of the pancreas.

In case of acute edematous pancreatitis during a blood test general analysis shows signs of an inflammatory process (ESR accelerates, leukocyte levels increase). reveals increased activity of pancreatic enzymes (lipase and amylase). Hypocalcemia and hyperglycemia cannot be excluded. In addition, the level of concentration of enzyme compounds in the patient’s urine should be determined. Possible manifestations of bilirubinemia, increased activity liver enzymes.

Urine biochemistry allows us to determine amylase activity in urine.

It is necessary to conduct a visual examination of the pancreas, as well as organs in the immediate vicinity. Such a study is carried out using CT, ultrasound, MRI. It allows you to detect pathological change parenchyma, cysts, abscesses, stones in the ducts, enlarged glands.

Treatment

If acute pancreatitis is detected, the patient is indicated for hospitalization followed by bed rest. The main goal of treatment is to eliminate pain syndrome, stimulation of self-healing processes, reducing the load that falls on the pancreas.

For treatment therapeutic methods can be attributed:

novocaine and antispasmodic blockade, the main purpose of which is to relieve too severe pain;
use of pancreatic enzyme deactivators (proteolysis inhibitors);
carrying out detoxification therapy;
the use of antibiotic therapy to prevent infectious complications; Most often, drugs are used that have a wide spectrum of action, but in large dosages;
fasting, applying ice to the area where the gland is located in order to create local hyperthermia.

Surgical treatment is prescribed in the following cases:

in the presence of ;
accumulation of fluid around or in the gland;
the occurrence of cysts, necrosis, abscesses.

In acute pancreatitis, endoscopic drainage, cystogastrostomy, and marsupialization of the cyst may be indicated. If necrosis has formed, then, depending on its size, the doctor may prescribe necrectomy or pancreatic resection surgery. Stones can cause surgery on the ducts.

Possible complications

Acute pancreatitis is dangerous due to its possible consequences and complications. If tissue that is inflamed becomes infected, necrosis and abscesses may occur. If you don't carry out timely treatment, then death is possible.

If the disease is severe, it may develop state of shock with pancreatitis and multiple organ failure.

The development of acute pancreatitis can result in the formation of pseudocysts, the rupture of which is fraught with the occurrence of ascites.

Diet for pancreatitis: menu for the week

In case of exacerbation of pancreatitis in the first day or two, you need to follow starvation diet, two glasses of rosehip decoction are allowed, up to 1 liter of alkaline mineral water. IN severe cases nutrition only by intravenous drip.

For pancreatitis, diet No. 5p is indicated, which consists of several options.

Below we give sample menu for a week for pancreatitis of the pancreas.

For breakfast, you can eat steamed meat (chicken or beef). Drink rosehip decoction or weak tea.
For second breakfast, serve oatmeal with milk, washed down with rosehip decoction or infusion.
For lunch - puree soup of carrots and potatoes. You can eat steamed fish. Dried fruits compote.
For an afternoon snack - fruit puree (apple or pear).
Dinner should include a piece of boiled chicken, vegetable stew and weak tea.
Before going to bed, drink a glass of kefir.

It has its own characteristics that distinguish it from other diets. About what is typical for diets for acute pancreatitis, This post will tell you about nutritional features for diseases of the pancreas.
Acute pancreatitis is an inflammation of the pancreas that occurs in an acute form, caused by activation of digestive enzymes.

There are many causes of acute pancreatitis, but most often acute pancreatitis occurs in people who abuse alcohol and people with diseases of the biliary system - chronic cholecystitis, cholelithiasis.

An attack of acute pancreatitis usually occurs suddenly and is manifested by unbearable pain and other symptoms characteristic of of this disease symptoms.

Treatment of acute pancreatitis conservatively:
cleanse the blood of pancreatic enzymes (Contrical, Trasylol, etc. - destroy enzymes that enter the blood)
fasting is prescribed for several days,
then a strict diet - diet No. 5p - the first option,
then a gradual transition to the second version of diet No. 5p.
Pain relief (narcotic or non-narcotic)
If the patient’s condition does not improve, then surgery in order to remove necrotic areas of the gland.

Fast for 2 days(fasting can be prescribed for up to 4 days depending on the severity of the disease.

Fasting for more than two days is carried out in a hospital setting). During this period, the patient is only allowed to drink rosehip decoction, weakly brewed tea and, from which gases have been removed - “Borjomi”, “Essentuki No. 4”, “Essentuki No. 20”, “Smirnovskaya” or “Slavyanovskaya” one glass 4-5 times in a day. In order to eliminate intoxication of the body, nutrition and prevent dehydration, they use parenteral nutrition(i.e. droppers - sodium chloride with 5% glucose).
Since food does not enter the esophagus, therefore gastric and pancreatic juices are not produced, enzymatic activity decreases, which promotes the regeneration of the pancreas.

Diet for acute pancreatitis, starting from day 3.

Day 5 Calorie content increases to 600-800 cal
Fats are excluded. Proteins – 15g. Carbohydrates – up to 200 g.

6-9 days. Calorie content increases to 1000 cal
Fats – 10g. Proteins – 50g. Carbohydrates – up to 250 g.
Breakfast. Dairy-free semolina porridge (or rice), apple (or orange), tea with sugar.
Lunch. Mashed potatoes (or carrots), 50g. Low-fat chicken meat(or lean fish), rosehip decoction with sugar.
Dinner. Vegetable broth, vegetarian - 100-150g, boiled fish (or beef) - 30-40g. with mashed potatoes, grated apple.
Afternoon snack. Low-fat cottage cheese with sugar – 50-60g. Tea with sugar or jam
For the night. Cup boiled water, honey - 1 tablespoon (or a glass of curdled milk)

10-15 day. Calorie content exceeds 1000 cal

Proteins - up to 60 g, fats - 20 g, carbohydrates - 300 g.

Two weeks after the attack- diet for acute pancreatitis:

After suffering an attack of acute pancreatitis, the strictest diet No. 5p must be followed for 6-12 months. Calorie content gradually increases.

Proteins – up to 100 g, fats – up to 40 g, carbohydrates – up to 450 g, the content of water-soluble vitamins increases.

The food is still pureed, without salt.

Table. List of permitted and prohibited foods and dishes. Diet No. 5p - option 2.

pureed oatmeal and rice soup,

vegetable puree,

pureed porridge from cereals: rolled oats, rice, buckwheat,

apple mousse and jelly,

drinks and fruit drinks made from black currants and cranberries.

tea with milk and beet juice.

CAN: vegetarian soups, lean and lean meat, meat dishes, boiled fish, homemade cottage cheese and cottage cheese dishes, cereal and vegetable dishes (porridge, puddings), fruits and berry juices, sugar, jam, honey.

Product	Allowed	Prohibited	Limited use
Bread	Dried or yesterday's wheat 200–300 g per day or in the form of crackers; unsweetened cookies	Rye and fresh bread; products made from butter and puff pastry	Not rich dry biscuits
Soups	Vegetarian pureed with permitted vegetables; pureed cereals (except millet), with vermicelli, ½ serving (250 ml) with the addition butter(5 g) or sour cream (10 g)	Meat, fish soups and broths, mushroom decoctions, milk soups, with millet, cabbage soup, borscht, okroshka, beetroot soup	During the period of remission, soups with weak meat or fish broth 1–2 times a week (if tolerated)
Meat, poultry	Low-fat varieties (beef, veal, rabbit, turkey, chicken) chopped. During the period of remission, perhaps in a piece	Fatty, stringy meats, skin of birds and fish; offal. Sausages, canned food, smoked meats, fried	Lean meat, chicken, rabbit, turkey are allowed boiled in pieces
Fish	Lean cod, perch, pike perch, ice cod, etc., boiled in pieces and chopped (meatballs, dumplings, soufflé, cutlets)	Fatty species (catfish, carp, stellate sturgeon, sturgeon, etc.), fried, smoked, stewed, salted, canned, chum salmon caviar	Jellied fish
Eggs	2 egg white omelettes	Dishes made from whole eggs, especially hard-boiled and fried. Raw eggs	Egg yolks in dishes up to 1 per day
Milk, dairy products	All low fat products. Fresh, non-acidic cottage cheese, calcined or made from kefir - natural and in the form of puddings. One-day fermented milk drinks	Dairy high fat content and with added sugar	Milk if tolerated. Sour cream and cream in dishes. Low-fat and mild cheese (Dutch, Russian)
Vegetables	Potatoes, carrots, cauliflower, beets, zucchini, pumpkin, green peas, young beans, in the form of purees and steam puddings	White cabbage, eggplant, radish, radish, turnip, onion, garlic, sorrel, spinach, sweet pepper, mushrooms. Raw, ungrated vegetables	Tomatoes without peel, fresh cucumbers without peel - pureed, green salad
Cereals	Porridge from various cereals (semolina, buckwheat, oatmeal, pearl barley, rice), with water or half and half with milk. Cereal souffles, puddings with cottage cheese. Pasta, homemade noodles, vermicelli	Cereals: millet, legumes, crumbly porridge	–
Fruits and berries	Fruits only of sweet varieties, non-sour apples, baked or mashed without peel	Raw unprocessed fruits and berries, grapes, dates, figs, bananas,	Apricots, peaches - without peel, fruit and berry juices without sugar, diluted with water
Sweet dishes	Kissels, jellies, mousses with xylitol or sorbitol, without sugar	Confectionery, chocolate, ice cream, jam	Sugar up to 30 g per day or honey 20 g per day
Beverages	Weak tea with semi-sweet lemon or xylitol. Decoction of rose hips, black currants, compote	Coffee, cocoa; carbonated and cold drinks, grape juice	–
Sauces	Milk, fruit and berry, in a weak vegetable broth. Flour is not sautéed	Sauces based on broths, mushroom broth, tomato. All spices, snacks	–
Fats	Butter up to 30 g per day, refined vegetable oils(10–15 g per day) - in dishes	Meat and cooking fats	Butter and vegetable oil in dishes, 5 g per serving

The main causes of acute pancreatitis are:

Diseases of the digestive system (gastroduodenitis,).
Alcoholism.
Poor nutrition (abuse of spicy, fatty, salty foods).
Genetic predisposition.
Mechanical damage to the pancreas (including after surgery).
Cystic fibrosis.
Congenital anomalies of the pancreas.
Cholelithiasis.
Long-term use of certain medicinal substances(“Azathioprine”, thiazide diuretics, corticosteroids, estrogens and a number of others).
Bacterial (mycoplasmosis) or viral (Coxsackie virus, mumps) infections.

Symptoms of acute pancreatitis

The first symptom is the appearance. They are usually very strong and encircling. The pain is localized in the upper abdomen and can radiate to the lower ribs and shoulder blades. Acute pancreatitis without pain is extremely rare, so the presence of abdominal pain is one of the most important diagnostic signs of pancreatitis.

Acute pain usually lasts from 1 to 3 days, then begins to subside, becomes dull and completely disappears after a week.

An important sign of acute pancreatitis is vomiting. It is usually frequent and does not bring relief. Vomiting can appear not only at the beginning of the disease, but also later. The appearance of late vomiting often indicates the development of complications.

With pancreatitis, tachycardia is also observed, caused by the development of intoxication of the body. The patient's body temperature usually remains within normal limits. Its increase is possible if the course of pancreatitis is complicated by inflammation of the bile ducts and gallbladder.

When examining the patient, the doctor notes bloating in the abdomen, and in the pit of the stomach when pressed. Starting from the fifth day of the disease, an infiltrate (cellular elements mixed with lymph and blood) may begin to accumulate in the epigastric region. Typically, accumulation occurs with severe pancreatitis. Another complication that can develop during the same period is the accumulation of fluid around the pancreas (omentobursitis), which can lead to suppuration and the need for surgical intervention.

The most important diagnostic sign acute pancreatitis is increased content amylase in urine.

Pancreatitis in children is severe, often accompanied by pancreatic necrosis and can even cause the death of the child. Symptoms depend on the form of the disease. Acute pancreatitis in children is accompanied by the following symptoms:

Severe girdling pain in the upper abdomen.
Restlessness and constant crying in infants.
A sharp increase in body temperature.
Loose and frequent stools.
Lack of appetite.
Vomiting during an attack.
In a sitting position, bending forward, the pain subsides.

If the above symptoms appear, you should immediately call ambulance and hospitalize the child.

Treatment of acute pancreatitis

First of all, to reduce pathological process it is necessary to eliminate the causes causing inflammation pancreas. To do this, the patient must stop drinking any alcohol, switch to dietary food low fat, stop taking medications that can damage the gland. In addition, in parallel with the treatment of pancreatitis, they begin to treat gastrointestinal diseases, if any.

The main goals of therapy for pancreatitis are:

Relieving pain.
Restoration of pancreatic functions.
Prevention of complications or their treatment.

To relieve attacks of pain, antispasmodics (Spazmalgon, No-shpa, Mebeverine), narcotic and non-narcotic analgesics are used. The dosage of the drugs is determined by the doctor.

To ensure the rest of the pancreas and restore its functions, pancreatic enzymes (Panzinorm, Creon, Micrazim) and PPIs (Esomeprazole, Pantoprazole, Omeprazole, Pleom) are used. The frequency of administration, dosage and choice of the drug is determined by the doctor.

If conservative treatment of pancreatitis does not produce results, resort to surgical correction of the disease.

Diet for acute pancreatitis

Nutrition for acute pancreatitis should provide the pancreas with maximum rest and help reduce pancreatic secretion.

In the first three days, complete fasting is indicated. If necessary, to maintain the body in tone, intravenous administration of a glucose solution is possible. You can drink water and mineral water without gas (in small sips and not large quantities).

After a few days, the diet begins to be gradually expanded. Food should only be boiled or steamed. Food should not be hot or cold. You need to eat 6 times a day, portions should be small. It is advisable that the food be grated on a fine grater.

By the end of the first week, you can begin to include weak tea, rosehip decoction, mashed potatoes, steamed low-fat fish, chicken, veal, white bread crackers, porridge (except millet), kefir, jelly, slimy soups.

After a few more days, you can add carrot puree and egg white omelet to the menu. Milk in pure form use is not recommended. Apples can be baked or eaten pureed.

It is prohibited to consume salted, smoked, pickled and canned foods, alcohol, cream, pastry, sour cream, lard, and fried foods.

To prevent pancreatitis from becoming chronic, you must follow a diet for a year. It is also very important to avoid overeating, as this creates additional stress on the pancreas and provokes a recurrence of the attack.

Pancreatitis- inflammation of the pancreas. Highlight acute and chronic forms pancreatitis. In the acute form, the disease develops quickly and proceeds violently. The chronic form is characterized by a sluggish and slow course of the disease. The pancreas plays an exclusive role in our body important role. excretory part of the gland secretes essential enzymes necessary for normal digestion. Endocretory part produces insulin, which reduces the concentration of glucose in the blood.

Causes of pancreatitis

Inflammation of the pancreas can occur due to various reasons. Pancreatitis is often caused by alcohol abuse. It can also occur with cholelithiasis, if the bile duct is blocked by a stone. In such cases, the enzymes produced by the gland are activated inside the organ and begin to digest it. As a result, it begins inflammatory process - acute pancreatitis. It is accompanied by severe girdle pain in the upper third of the abdomen. This is the state poses a danger to patient's life, therefore, acute pancreatitis requires hospitalization surgery department.

Approximately 30 % sick It is not possible to establish the cause of acute pancreatitis.

Inflammation with chronic pancreatitis develops slowly. Healthy tissue pancreas is gradually replaced by scar tissue. As a result, the process of enzyme production is disrupted, and this entails a disruption in insulin production. Typical manifestations of chronic pancreatitis are pain in the pit of the stomach, as well as in the left and right hypochondrium, nausea, flatulence, diarrhea, and belching. Over time, diabetes may also develop.

Chronic pancreatitis is treated under the guidance of a gastroenterologist. If a patient develops diabetes mellitus, an endocrinologist should be involved in treatment.

Symptoms of pancreatitis

The main symptom of acute pancreatitis is appearance severe pain in the epigastric region, left and right hypochondrium. Usually this pain is of a girdling nature, so that the patient feels as if the torso has been tied with a belt. These sensations are usually accompanied by vomiting, stool problems, weakness, and dizziness. The disease is very severe and may be fatal.

If the form of pancreatitis is chronic, the patient is also bothered by pain localized in the “episgastric” region. They can often spread to the subcostal area and radiate to the back. There is also a girdling pain, which intensifies if the patient lies on his back, but weakens if he leans forward or sits down. Typically, pain occurs or intensifies about an hour after eating. Especially if a patient with chronic pancreatitis has consumed food in large quantities or eaten something fatty, fried, or spicy. Pain in chronic pancreatitis can radiate to the heart area, symptomatically coinciding with signs of angina pectoris.

Diarrhea also often accompanies chronic pancreatitis. The stool in patients becomes mushy and may contain undigested food. The amount of feces increases significantly. It has a gray tint bold look, bad smell, is difficult to flush from the walls of the toilet. Belching, flatulence, nausea, and occasional vomiting may occur. The patient loses his appetite and quickly loses weight.

Diagnosis of pancreatitis

Identify chronic pancreatitis, especially in early stage, it can be difficult: you need to use both laboratory and instrumental methods treatment.
General clinical analysis blood helps to detect signs of inflammation - an increase in ESR, an increase in the number of leukocytes, etc.
A biochemical blood test is needed to detect increased levels of the enzymes lipase, amylase, trypsin and confirm the presence of the disease (usually in acute pancreatitis).
Blood sugar test shows increased level glucose.
Amylase is detected in the urine of patients, which also indicates pancreatitis, most often acute.
An abdominal ultrasound reveals changes in the pancreas and gallbladder.
Gastroscopy (EGD) helps to assess the extent to which the stomach and duodenum are involved in the inflammatory process.
X-ray of the abdominal organs is especially important when the cause of pancreatitis is cholelithiasis. X-ray examination area of the pancreas reveals intraductal stones and the deposition of calcium salts in the area of inflammation due to changes in the acidity of the pancreatic environment.
ERCP (endoscopic retrograde cholangiopancreatography) is also an x-ray method in which the pancreatic ducts and bile ducts introduced contrast agent to determine their patency.
Computed tomography or magnetic resonance imaging allows you to see the organ in different planes in thin “slices”.
Stool analysis (coprogram) reveals undigested fats muscle fibers meat food, indicating the disease.
Functional tests (Lund test, secretin-cholecystokinin test, PABA test and others).

Treatment of acute pancreatitis

More often for acute pancreatitis treatment is conservative, that is, with the help medicinal methods- medications.

Basic principles of treatment of acute pancreatitis:
pain relief,
cleansing the blood of released pancreatic enzymes,
dieting,
symptomatic treatment.

Following a strict diet for acute pancreatitis is aimed at providing rest to the inflamed pancreas. In the first days after the onset of the disease, it is necessary to fast. A sick person can only drink water. The body is nourished using nutrient solutions, which are administered intravenously (parenteral nutrition). Intravenous administration nutrients lasts from three to six days, the duration of fasting depends on the severity of the disease. Approximately 3-6 a day sick can take a little liquid food.

Acute pancreatitis requires pain relief, which is produced using both narcotic (for example, morphine) and non-narcotic drugs.

Infusion therapy is an intravenous infusion large quantity special solutions that dilute the blood and thereby reduce the concentration of enzymes produced by the pancreas in it.

Patients are prescribed drugs that destroy pancreatic enzymes that enter the blood, for example, Trasylol, Contrical and etc.

Towards measures symptomatic treatment include taking antiemetic drugs for repeated vomiting, increasing the level of calcium in the blood when it decreases, treating heart failure, etc.

Antibiotics may be prescribed for prophylaxis, to prevent infection of organs damaged by the disease.

In the event that after seven days from the beginning conservative treatment There is no improvement in the patient's condition; as a rule, laparotomy - surgical intervention to penetrate the abdominal cavity and remove dead (necrotic) pancreatic tissue.

Treatment of chronic pancreatitis

Basic principles of treatment of chronic pancreatitis:
pain relief,
dieting,
correction of pancreatic dysfunction.

During exacerbations of chronic pancreatitis, the patient must be under the supervision of a doctor, for which, as a rule, he is admitted to a hospital.

Diet for chronic pancreatitis

For chronic pancreatitis, it is recommended from the diet exclude following products: fresh White bread, fried, salted, peppered and fatty dishes, smoked meats, mushroom soups, chocolate, coffee, carbonated drinks, alcohol.

You can eat: boiled vegetables, porridge, vegetable soups, boiled pasta, lean meats and fish, fruits, tea. For chronic pancreatitis, you need to eat fractionally, that is, take food in small quantities 5-6 once a day. And during the period of exacerbation - in small doses every 3 hours.

Fighting pain in chronic pancreatitis

Relief of pain is often achieved by following a diet alone: limiting the consumption of fats, excluding hard-to-digest foods from the diet.

If the pain is severe, non-narcotic painkillers may be prescribed: aspirin, diclofenac etc. They reduce inflammation and help reduce pain.

With strong pain may be assigned Octreotide - special drug, used in the treatment of chronic pancreatitis. It works by suppressing the production of hormones that stimulate the pancreas. Usually, Octreotide prescribed to patients in hospital.

Correction of impaired pancreatic functions

The long course of the chronic form of pancreatitis leads to the fact that normal tissue replaced by scar tissue over time this can lead to loss normal function pancreas.

To correct the digestive disturbances that accompany the course of chronic pancreatitis, pancreatic enzymes are prescribed. These include festal, mezim, pancreatin and other drugs. They not only facilitate digestion and normalize the digestion process, but also reduce pain, as they reduce the load on the pancreas.

Long-term chronic pancreatitis reduces the level of insulin produced by the pancreas. Insulin is a hormone that takes part in glucose metabolism, and its deficiency leads to the development of diabetes mellitus. If a patient with chronic pancreatitis is diagnosed with diabetes mellitus, it is necessary to consult an endocrinologist who will determine a treatment regimen.

Surgical treatment of chronic pancreatitis

For people suffering from chronic pancreatitis, surgery is usually not used. But with severe pain that does not go away medicines(especially in pseudotumor chronic pancreatitis) surgical intervention is recommended - sphincterotomy, that is, an operation in which the outlet of the pancreatic duct is dissected and expanded.

Acute pancreatitis is a disease characterized by acute inflammation pancreas, as a result of which its self-digestion occurs. IN advanced cases this can lead to partial or complete death of pancreatic cells, which can lead to the development of insulin-dependent diabetes mellitus.

Classification

There are 2 types of acute pancreatitis based on their form:

Interstitial edema. The pancreas and surrounding tissue become swollen, and micronecrosis develops.
Pancreatic necrosis. Experts distinguish hemorrhagic, fatty and mixed forms of pancreatic necrosis. In this case, cell death can be local (within one segment of the organ), occupy part of the organ, or spread to almost the entire pancreas.

The stages of development of the disease differ:

Enzymatic phase. Observed during the first 5 days after the onset of acute pancreatitis. During this period, pancreatic cell death occurs. Decay products from dead cells are absorbed into the blood, causing general intoxication of the body.
Reactive phase. Lasts for the second week. The body tries to cleanse itself of dead cells, reactive inflammation develops, in which the cells participate immune system.
Sequestration phase. Starts from the third week. By this time, areas of dead cells (sequestra) begin to separate from healthy tissue. Toxins are released from dead pancreatic cells and cells of the immune system, which negatively affect the functioning of the body. internal organs. It is during this phase that pancreatic cysts and fistulas can form. And if an infection occurs, the disease is complicated by the formation of abscesses in the retroperitoneal space or abdominal cavity. Various gastrointestinal bleeding.
Outcomes phase. It can last up to six months from the onset of the disease.

The main consequences of acute pancreatitis are insulin-dependent diabetes mellitus, chronic pancreatitis with exocrine insufficiency and so on.

Causes

Acute pancreatitis is a multifactorial disease, the development of which is caused by about 140 currently known causes. Some of these factors are related to lifestyle, while others are innate. The most common causes of the disease in adults are:

alcohol abuse;
various infectious diseases- hepatitis, tuberculosis, mycoplasmosis, etc.;
fatty food;
cholelithiasis;
autoimmune diseases - systemic lupus erythematosus, necrotizing angiitis;
taking certain medications - Azathioprine, thiazide diuretics, Metranidazole, Tetracycline or sulfonamide drugs;
duodenal ulcer if it penetrates into the pancreas.

In children, the leading causes of acute pancreatitis are as follows:

congenital metabolic disorders;
cystic fibrosis;
abdominal injuries;
allergy.

Pathogenesis

Common in the development of various clinical forms acute pancreatitis is that as a result of the action of certain factors directly in the tissues of the pancreas itself, trypsin and other pancreatic enzymes that are involved in the digestion process are activated.
In particular, lipase is activated, causing destruction of the membranes of pancreatic cells.

This, in turn, leads to inflammation, organ destruction (edematous, destructive pancreatitis), numerous hemorrhages (hemorrhagic pancreatic necrosis), etc., and those absorbed into circulatory system tissue breakdown products provoke the appearance of various systemic complications. Triggers In this case, the following factors may arise:

Rich fatty foods stimulate abundant secretion of pancreatic juice, leading to a sharp increase in intraductal pressure and activation of enzymes.
Microorganisms - they enter the pancreatic tissue through the lymphatic, blood vessels or bile ducts, causing destruction of the organ or increasing the secretion of pancreatic juice with waste products.
Stress is a disorder nervous regulation leads to increased tone vagus nerve, which stimulates the production of pancreatic juice and also increases its sensitivity to food and hormonal irritants.
Narrowing or blockage gallstone sphincter of Oddi, through which pancreatic juice and bile enter directly into the duodenum, as a result of which intraductal pressure increases, lipase and trypsin are activated, causing self-digestion of the pancreas (biliary pancreatitis).
Excessive intake of alcohol stimulates the production of digestive enzymes, while the pancreatic juice itself is depleted in bicarbonates and overly saturated with proteins, which makes it thick and viscous. Acute pancreatitis develops when there is a sharp increase in pressure inside the excretory ducts. In the case of chronic alcohol abuse, the formation of calcifications inside the ducts additionally occurs, as well as a gradual narrowing of the sphincter of Oddi. These changes, combined with an increase in intraductal pressure, can become a trigger for subsequent alcohol consumption.

Symptoms of acute pancreatitis: typical clinical presentation

The leading signs of pancreatitis depend on the stage of the disease and the presence of complications. In general, an attack is characterized by:

intense pain in the upper abdomen, often radiating to the back or chest;
increased temperature;
bloating, flatulence, intestinal paresis, stool retention;
decreased blood pressure, increased heart rate;
shortness of breath, bluish skin.

Similar symptoms can be observed with other diseases of the digestive system, so when they appear, it is better not to guess what it is and what to do, but to immediately contact a surgeon.

Diagnostics

If acute pancreatitis is suspected, doctors usually prescribe the following tests:

determination of the level of serum amylase in the blood (increases within 3–4 hours from the onset of the disease);
the level of diastase in the urine (its growth occurs);
duodenal contents (decrease enzyme activity duodenal secretions).

Ultrasound of the pancreas and MRI are also prescribed. Differential diagnosis carried out in the case of an atypical course of the disease.

Treatment of acute pancreatitis with medications

Performed in a hospital (surgery). Upon admission to the department, medications are prescribed for aggressive intravenous hydration. In case of biliary pancreatitis, endoscopic or classical surgically the lumen of the sphincter of Oddi expands and stones are removed from the duct. In addition, fasting is required, as well as medications that reduce inflammation and secretory activity. In order to prevent the occurrence of infectious complications, antibiotic therapy is carried out in the following days. After discharge from the hospital, it is necessary to long time continue treatment at home.

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Nutrition

As the patient’s condition improves, the diet for acute pancreatitis gradually expands, and tables No. 1 and 2 are replaced by table No. 5 after a month or two. As a rule, the nutritionist should not only give general recommendations, but to develop balanced menu for a week, a month. In general, you can eat low-fat foods, boiled, baked or steamed, containing a minimum amount of spices and herbs. Alcohol, hot and fiery seasonings, marinades, fried foods and anything fatty are strictly prohibited. Usually meals are split, in small portions (up to 5 times a day). Salt is introduced into the diet gradually, increasing to 8–10 grams per day.

Complications and consequences of acute pancreatitis

As a rule, it develops in the first days of the attack and is associated with fluid loss due to repeated vomiting or fluid accumulation in the abdominal cavity, as well as loss of albumin.

It occurs as a result of impaired intestinal motility, resulting in the development of electrolyte imbalance.

Characterized by sharp increase temperatures, phenomena general weakness and ailments. As a rule, the main causative agents of infection are microorganisms of the intestinal flora.

Acute pancreatitis can cause increased capillary permeability in the lungs, which is accompanied by the development of severe oxygen deficiency.

It is a cavity filled with fluid and cellular detritus. Formed during the first month from the onset of the disease. If the ducts of the gland are destroyed, pain appears in the back or abdomen.

In acute pancreatitis, gastrointestinal bleeding may develop, especially during the formation of fistulas and pseudocysts.

It occurs as a result of DIC syndrome, which is accompanied by intravascular coagulation.

If a significant number of pancreatic cells responsible for the production of insulin are lost, insulin-dependent diabetes mellitus may develop, which requires lifelong replacement therapy.