home Calculators Pancreatitis. Symptoms and treatment of pancreatitis. Chronic pancreatitis latent course

Pancreatitis. Symptoms and treatment of pancreatitis. Chronic pancreatitis latent course

Chronic pancreatitis is a progressive pathology of the pancreas, expressed in its destructive damage. The course of the disease leads to persistent impairment of the intra- and exocrine capacity of the gland. Chronic pancreatitis is detected in 5–10% of people suffering from diseases digestive tract. In recent years, gastroenterologists have noted an alarming trend towards “rejuvenation” of chronic pancreatitis - the peak incidence occurs at the age of 30–35 years, although previously people over 40–55 years old were at risk.

Men develop chronic pancreatitis more often than women. Leads among male representatives alcoholic form chronic inflammation of the gland. The danger of the disease lies in the increased risk of developing malignant neoplasms in the pancreas.

Etiology and classification features

The pancreas is a large organ in the gastrointestinal tract, producing up to 700 ml of pancreatic secretion per day. The adequacy of secretory capacity directly depends on lifestyle and diet. In case of frequent errors in nutrition (large amounts of fatty foods, alcohol consumption) and other negative factors, the activity of the gland in the production of digestive enzymes slows down. A long-term decrease in secretory function provokes stagnation of pancreatic juice with its premature activation directly in the pancreatic tissues. As a result, a malfunction occurs in the digestion process and develops. In the absence of treatment and the duration of the pathological process for more than 6 months, the acute form turns into chronic inflammation.

A characteristic feature of chronic inflammation is associated with irreversible degenerative processes in the parenchymatous layer of the gland. The parinchema shrinks, in some places degenerating into areas of fibrous cells. The chronicity of pancreatitis is most reliably indicated by the development of stricture of the pancreatic ducts and the appearance of stones in the ducts or body of the pancreas.

In gastroenterological practice, the following classification of the disease deserves attention:

according to the mechanism of development - primary (from alcohol intoxication, other toxic pancreatitis), secondary (biliary);
according to the characteristics of clinical manifestations - painful pancreatitis of a constant and recurrent nature; pseudotumorous (combining signs of inflammatory and oncological processes simultaneously); latent (without obvious manifestations, with vague symptoms); combined (moderate manifestation of several symptoms of pathology);
according to the characteristics of morphological transformations in pancreatic tissues - chronic pancreatitis with a calcifying, obstructive, infiltrative-fibrous and fibrous-sclerotic course;
according to the type of functional disorders in the activity of the pancreas - chronic pancreatitis of the hypoenzyme and hyperenzyme type; obstructive, ductular types.

Pancreatitis develops gradually, going through several stages:

initial - lasts from 1 to 5 years from the onset of inflammatory changes in the pancreas;
stage of development of the main clinical picture - lasts from 5 to 10 years, during this period the pancreas undergoes dystrophic and degenerative changes;
subsidence of expressed inflammatory process- develops 7–15 years from the onset of the disease; subsidence occurs in 2 variants: in the form of the patient’s adaptation to the disease, or the appearance serious complications in the form of cysts and neoplasms.

Causes

The causes of chronic inflammation of the pancreas are extensive and are caused by both exogenous factors and internal pathologies and dysfunctions in the functioning of organs. Common causes of chronic pancreatitis by external nature of origin:

Endogenous causes of the development of chronic pancreatitis are:

pathologies of the gallbladder and ducts - when obstruction of the biliary tract occurs, a reverse reflux of secretion occurs, a pathological chemical reaction develops in the pancreatic tissues, during which enzymatic substances negatively affect the gland, digesting it; the blood supply process slows down, the organ swells with the formation of internal local hemorrhages;
pathologies of the stomach and duodenum associated with the reflux of the contents of the small intestine into the pancreatic ducts can provoke severe inflammation; the leading role is given to gastritis and peptic ulcer stomach - they cause insufficiency of the sphincter of Oddi, which is responsible for the connection between the gland and the initial part of the duodenum;
slowdown general process blood circulation caused by surges blood pressure, atherosclerosis, diabetes mellitus, negatively affects the blood supply to the gland, which disrupts tissue nutrition and causes inflammation; During pregnancy, for this reason, a relapse of chronic pancreatitis often occurs in women; all pregnant women are at risk for developing the disease;
a tendency to allergic reactions sometimes causes some forms of chronic inflammation - in the body, with allergies, the active production of antibodies with an auto-aggressive orientation begins, the target organ may be the pancreas;
infectious diseases (viral, bacterial, including intestinal infections) - chickenpox, mumps, dysentery, hepatitis - can give a start chronic inflammation pancreas;
a genetically determined predisposition that produces the onset of the disease from an early age.

Statistics on the prevalence of the causes of the disease state that over 40% of people diagnosed with chronic pancreatitis have alcohol dependence. 30% of patients have a complicated medical history in the form of cholecystitis and stones in gallbladder. Overweight people make up no more than 20% of all patients. The most rare causes chronic inflammation of the pancreas - the presence of genetic problems, poisoning and injury - 5% of cases for each factor.

Symptoms

In the initial stages of the disease, pathological processes proceed sluggishly, often without manifestations. The first clinically significant relapse of chronic pancreatitis occurs when degeneration and regressive processes in the pancreas are significant. Symptoms of chronic pancreatitis include not only severe inflammation, but also manifestations of intoxication due to the entry of enzymes into the general bloodstream.

Typical signs of chronic pancreatitis:

intense pain (pain attacks) are cutting or stupid character, last regularly or in the form of attacks; sometimes pain can drive the patient into state of shock; pain in chronic pancreatitis is localized depending on the affected part of the gland - if painful sensations are spread throughout the peritoneum and lower back, the entire organ is completely affected; if the tail or head is affected, irradiation is noted in the cardiac region, epigastrium or right side;
a rise in temperature and surges in blood pressure are directly related to intoxication processes; a rise in temperature to 38–39 °C indicates intense damage with possible bacterial complications or the formation of abscesses; pressure changes occur in a short time interval and worsen the general condition;
change appearance the patient - the face takes on a suffering look, the eyes are sunken, the facial features become pointed; skin color changes to pale gray with an earthy tint; small red spots (“red drops”) may appear in the chest and abdomen area;
development of obstructive jaundice (due to blockage of the bile duct) with yellowing of the skin and eye sclera;
painful vomiting, and after an episode of vomiting there is no relief; vomit consists of undigested food mixed with bile;
attacks of nausea and hiccups in combination with belching of air; in addition, dry mouth may appear;
stool disorder can manifest itself in the form of constipation or diarrhea: repeated loose stools in the form of a foamy, foul-smelling mass with an abundance of mucus are typical for a relapse of the disease; constipation with flatulence and bloating are characteristic of initial stages chronicity of the disease;
lack of appetite and weight loss due to inability to fully digest nutrients.

Chronic pancreatitis in adults can occur with a clear dominance of one or more symptoms. For some, the course of the disease is completely asymptomatic - the person does not suspect the presence of inflammation for several years. In other categories of people, the chronic form of pancreatitis is manifested only by dyspepsia with frequent diarrhea and emaciation. Pain-type inflammation is associated with frequent attacks sharp pain after errors in diet and drinking alcohol. Rarely, the symptoms have a picture of pseudotumor inflammation with signs of cancer and simultaneous yellowing of the skin and eye sclera.

Survey

Diagnosis of chronic pancreatitis includes an extensive list of laboratory and instrumental studies. The tactics of a full examination are determined by a gastroenterologist. To make a final diagnosis, it is enough to confirm the main signs: a characteristic history (attacks of pain, alcohol intake), enzymatic deficiency, pathological changes in the pancreas.

Among laboratory tests Of primary importance for identifying chronic inflammation of the pancreas are:

scatological examination of feces, which allows us to identify the degree of enzymatic deficiency; in the presence of chronic inflammation in stool increased content of neutral fat, fiber, starch grains, muscle fibers;
blood biochemistry, showing an increase in the activity of amylase, lipase, trypsin;
general blood test to determine the intensity nonspecific inflammation according to ESR indications, leukocytosis.

Instrumental diagnostics are necessary to identify the size of the affected organ, study the structure of the parinchema, and assess the condition of other organs of the digestive tract. As part of the examination, sonography of the abdominal organs, CT and MRI are performed. The maximum information content is provided by the method of endoscopic ultrasonography, which allows you to study in detail the structure of pancreatic tissue from the inside. If it is necessary to determine the ability of an organ to synthesize a particular enzyme, functional tests with specific stimulants are organized.

Differential diagnosis

Typical signs of chronic pancreatitis are similar to the clinic " acute abdomen" During the initial examination, it is important to distinguish pathology from acute surgical conditions associated with damage to other peritoneal organs.

or intestines. When perforated, the pain is sharp, sudden (“dagger-like” pain), and the anterior part of the abdomen takes on a “board-like” shape. Vomiting occurs rarely. And with a relapse of chronic inflammation of the pancreas, the pain is constant and moderate, tension in the abdominal muscles is not typical. The final diagnosis is helped by radiography and echography.
Exacerbation of cholecystitis. It is difficult to differentiate between pathologies - often chronic pancreatitis accompanies inflammation of the gallbladder. But the specificity of pain with cholecystitis is its irradiation into right shoulder. Based on the results of ultrasound, you can additionally determine the inflamed area.
The need for intestines is acute. The leading demarcating symptom is pain. With obstruction, it is intense, in the form of contractions.
Myocardial infarction. Differentiation is not difficult - electrocardiography data will indicate necrosis of a section of the heart muscle.

Therapy

Treatment of chronic pancreatitis is organized depending on the severity of the inflammation. Mild forms are subject to treatment on an outpatient basis under the constant supervision of a gastroenterologist and therapist. Treatment in the stadium is divided into conservative and surgical. Leading goals of therapy:

elimination of negative factors (alcohol, somatic diseases);
pain relief;
elimination of enzymatic deficiency;
restoration of gland tissue and parinchema;
treatment of other gastrointestinal dysfunctions.

the main objective drug therapy is aimed at reducing or completely eliminating the progression of chronic pancreatitis, including combating complications. Based on the type of inflammation, general condition patient, drug therapy may include:

enzymes based on pancreatin (Pangrol, Micrasim, Festal, Creon) - taking pancreatin is necessary to normalize the secretory functions of the pancreas; A course of medications helps reduce pain, improve the absorption of nutrients, improve bowel movements, and relieve dyspeptic syndrome;
Painkillers and antispasmodics, due to their ability to reduce muscle tone and tension, are indispensable at any stage of the disease; drugs based on drotaverine and papaverine have a quick and long-lasting effect; if antispasmodics are ineffective, analgesics and NSAIDs are prescribed - Nimesulide, Nise, Voltaren, Meloxicam;
narcotic analgesics - for relapse of chronic pancreatitis and attacks of intolerable pain (Tramadol, Sedalgin-neo);
means to combat intoxication - Ringer, Hemodez-N, saline solution for intravenous infusion;
proton pump inhibitors and H2 antagonists (Omez, Pantoprazole) - with reduced acidity in the digestive tract;
vitamin therapy (isoprenoids A, E, D) and medium chain triglycerides - in order to correct nutritional deficiencies.

For the treatment of complicated forms of chronic pancreatic inflammation ( purulent abscesses, cysts, phlegmon) surgical intervention is indicated. The undeniable indications for surgery include complications that are life-threatening to the patient - blockage of the ducts and necrosis of the gland, sclerotic processes, stenosis of the sphincter of Oddi, critical condition of the patient when conservative treatment is ineffective.

Kinds surgical operations for chronic pancreatitis:

sphincterotomy is indicated for obstruction or compression of the sphincter of Oddi;
excision of stones in the ducts of the organ;
opening of pathological foci (cystic cavities, abscesses with purulent exudate) with subsequent drainage and sanitation;
pancrectomy - removal of the affected areas or the entire pancreas;
excision of the gallbladder in the presence of complications from the central bile duct;
virsungoduodenostomy is a technique for recreating additional channels for the outflow of bile in order to relieve stress on the pancreatic ducts.

Tactics during an attack

Exacerbation of chronic pancreatitis, or attack, is a life-threatening condition that requires immediate hospitalization, otherwise there is a high risk of death from painful shock and intoxication. During an exacerbation, the pain does not stop, which is due to the abundance of nerve fibers in the pancreas and their hypersensitivity. Unbearable pain can result in loss of consciousness.

During an attack, it is important to follow the correct sequence of actions:

the patient is provided with complete rest and strict bed rest- in a lying position, the blood flow to the inflamed organ decreases, the pain gradually decreases;
Eating any food is strictly prohibited, the “starvation” diet continues for at least 72 hours to create complete rest for the gland; fasting stops the synthesis of enzymes, which prevents increased inflammatory reactions;
cold compress (rubber heating pad with cold water, and not pure ice) on the epigastric zone helps relieve pain, relieve shock, reduce swelling and inflammation.

At home, before the ambulance arrives, the patient can take antispasmodics - No-shpu, Duspatalin. Enzyme preparations are strictly prohibited - their use aggravates the condition, provoking degenerative changes in the organ.
It is impossible to treat chronic pancreatitis at home, even if after the manipulations the pain has gone away and your health has improved. When an attack occurs, a comprehensive examination is necessary, otherwise the prognosis for survival can be extremely unfavorable. Persons with confirmed chronic pancreatitis should remember that in case of a sudden relapse, the main rule of first aid is cold, hunger, rest.

Diet as part of therapy

Effective treatment of chronic pancreatitis is impossible without organizing dietary nutrition. Regular adherence to a diet allows you to stop degenerative processes and reduce the likelihood of relapses. The diet changes based on the stages of the disease. In the first 48–72 hours from the moment of exacerbation, food is prohibited, the patient is prescribed parenteral nutrition in the form of droppers with glucose solution. To suppress thirst, it is allowed to drink 1% soda solution.
The diet is enriched vitamin drinks on the 4th day, sweets are allowed for consumption fruit juices, decoction of rose hips, cranberry juice. After 5 days, the patient can eat food with vegetable and milk protein. On days 6–7, carbohydrate foods and fats are introduced (in a limited amount). The entire daily diet is divided into 7–8 small portions. Food is served warm (60–65 °C) and thoroughly pureed.

The diet of patients with chronic pancreatic inflammation may include:

low-fat soups on secondary broth with vegetables, cereals and pasta, sweet milk soups are allowed;
second courses in the form of steamed meat and fish cutlets, zraz, meatballs, chicken egg omelettes;
cereal food in the form of porridge, stale white bread, crackers;
dairy products - butter (no more than 20 g per day), pasteurized milk with liquid 1.5–2.5%, fermented baked milk, low-fat cottage cheese;
vegetables and fruits, fresh and past heat treatment form - carrots, apples, pumpkin, beets;
drinks - weak tea with milk, jelly, compote;
specialized mixtures with a high content of protein and vitamins.

It is important to avoid overeating - it is optimal to consume up to 2.5 kg of food, including liquid, per day. By following dietary recommendations, you can significantly increase positive effect from complex therapy.

ethnoscience

Treatment of chronic pancreatitis traditional methods allowed after consultation with your doctor. Recipes should be selected taking into account individual characteristics patient, well-being and tendency to allergic manifestations. Traditional medicine actively uses decoctions and infusions from medicinal herbs, juices. If you take iron regularly, it will stop faster and your prognosis for recovery will improve.

Herbal collection to normalize the outflow of bile includes immortelle leaves, tansy inflorescences, dandelion root, chamomile flowers and knotweed. All components are taken in equal proportions (10 g each). The mixture is poured with boiling water, left for 2 hours, filtered and drunk 100 ml 30 minutes after each meal.
Juice from plantain leaves helps reduce inflammation, relieve swelling of the organ, and accelerates the regeneration of parinchema. For treatment, you need to drink 10 ml of freshly squeezed juice before meals for a month. After 2 month break The juice therapy course is repeated.
The herbal mixture for pain relief consists of zopnik, agrimony, dandelion root, motherwort herb, dried grass, chamomile flowers and yarrow. The proportions are equal. For 20 g of mixture, 0.5 liters of boiling water is required. The brewed infusion is left for 8 hours and filtered. Drink 100–150 ml at night. A long course is possible - up to 2 months.

Prognosis and prevention

The prognosis for chronic inflammation of the pancreas depends on how a person treats health - whether he follows a diet, eats right, avoids bad habits And stressful situations. If medical recommendations are followed, nutrition is organized as part of the diet, alcohol and nicotine are excluded - the pathology is mild, remissions are long, and the prognosis for survival is favorable. In opposite situations, the course of the disease progresses, degeneration of the gland increases, and serious consequences develop. Life expectancy is decreasing.

Prevention of chronic pancreatitis comes down to following basic rules:

refusal (or minimization) of alcohol and smoking;
proper nutrition with restrictions on animal fats and carbohydrate foods;
adherence to diet and daily routine;
adequate drinking regime;
sufficient intake of vitamins into the body, taking into account age characteristics, gender and nature of work activity.

Medical examinations play an important role in the prevention of chronic pancreatitis. An annual examination allows you to timely identify signs of trouble in the gastrointestinal tract, including the pancreas. Persons with confirmed chronic pancreatitis are required to strictly adhere to the instructions of the gastroenterologist and undergo a comprehensive examination at least 2 times a year. Prognosis for recovery with lifelong remission increases with the organization of sanatorium-resort treatment.

Pancreatitis is a disease characterized by inflammation of the pancreas. Normally, the pancreas performs two important functions. Firstly, the pancreas produces enzymes that, when released into the small intestine, are activated and participate in the digestion of proteins, fats and carbohydrates. Secondly, this organ produces the hormone insulin, which regulates blood glucose levels.

If, due to various reasons, pancreatic enzymes begin to be activated while still inside the organ, the gland itself is digested and an inflammatory process develops.

There are two forms of pancreatitis: acute and chronic pancreatitis.

Acute pancreatitis

Most often found in overweight women aged from 30 to 60 years. The onset of the disease is characterized by acute girdle pain in the upper abdomen, most often after drinking alcohol or fatty foods. The pain can be mild, tolerable or very severe, radiating to the scapula or sternum. The pain can be so severe that in some cases the patient may go into shock or collapse. Nausea, vomiting, and stool disturbances are observed. Due to the obstructed outflow of bile, the skin and sclera take on a yellowish color. Sometimes cyanosis is possible skin abdomen and anterior abdominal wall. Symptoms of intoxication are observed, the tongue in acute pancreatitis is dry and coated.

At the beginning of the disease, bloating is observed, while the abdominal wall remains soft. With development and progression acute pancreatitis muscle tension and symptoms of peritoneal irritation are observed.

Acute pancreatitis can end in recovery or become chronic. Especially severe cases acute pancreatitis can be fatal.

Chronic pancreatitis

There are several forms of the disease: recurrent pancreatitis, latent, pseudohumorous and sclerosing pancreatitis. Pain in chronic pancreatitis varying intensity, paroxysmal or constant. The main localization of pain is in the upper part of the abdominal wall with irradiation to the back, chest (left side), bottom part belly. Fatty, heavy foods, intake of alcoholic drinks, stress and other factors. The development of chronic pancreatitis is characterized by nausea, loss of appetite, bloating, bowel dysfunction, and sometimes vomiting. Jaundice is possible due to obstruction of bile flow.

Chronic pancreatitis is characterized by periods of remission and exacerbation. As the disease progresses, periods of exacerbation become more frequent, and it is possible to develop intestinal disorders, disturbances of normal digestion, weight loss. Possible development diabetes mellitus.

Chronic pancreatitis often causes complications, including gastric bleeding, cancer, cysts and abscesses, liver damage, diabetes mellitus, and enterocolitis.

Causes of pancreatitis

Symptoms of pancreatitis

The main symptom of pancreatitis is pain in the upper abdomen. The pain is girdling and can be paroxysmal or constant. The use of analgesics and antispasmodics does not always alleviate the condition. Vomiting, diarrhea or constipation, nausea, dizziness and weakness are also observed. Abdominal bloating and belching may bother you. The patient loses weight and loses appetite.

The symptoms of pancreatitis are pronounced. The disease is severe and forces patients to seek medical help.

Treatment of pancreatitis

Treatment of acute pancreatitis requires the patient to be in the hospital. For pain, cold applied to the pancreas area is indicated. therapeutic fasting, alkaline drink, it is possible to suction the stomach contents through a tube. The diet for pancreatitis is protein-carbohydrate, involves limiting table salt and excluding milk. As the symptoms of pancreatitis subside, the diet expands.

Drug treatment of pancreatitis involves the prescription of analgesics and antispasmodics (analgin, baralgin), drugs that inhibit the secretory function of the pancreas and stomach (cimetidine, atropine), as well as drugs that inactivate proteolytic enzymes (pantripin, contrical).

If conservative treatment of pancreatitis does not produce tangible results, surgical intervention is indicated.

Diet for pancreatitis

The diet for pancreatitis is used in cases of chronic disease and during the recovery period.

The diet involves reducing energy value, strict restriction fats and carbohydrates. You should not take foods that promote gas formation in the intestines or contain coarse fiber, stimulate the production of gastric juice.

A diet for pancreatitis involves steaming, boiling and baking. Avoid eating too hot or cold foods.

For pancreatitis, it is allowed to drink tea with lemon, fruit and berry juices diluted with water, without sugar, dried wheat bread, and unsweetened cookies. You can eat fermented milk products and low-fat cottage cheese.

The soup must be cooked without adding meat with various vegetables: carrots, potatoes, zucchini, cereals and pasta. You can add a little to the soup butter or low-fat sour cream.

Meat - lean, preferably beef, veal, chicken, turkey, rabbit. Cook boiled or steamed, you can make chopped cutlets. eat fish low-fat varieties in boiled form.

A diet for pancreatitis involves eating semi-viscous porridges from various cereals (buckwheat, oatmeal, semolina, rice), as well as pasta in boiled form.

Use up to 30 grams of butter per day, vegetable oil - no more than 10-15 grams, adding to various dishes.

Patients can eat various vegetables: carrots, potatoes, pumpkin, beets, green peas, zucchini.

Ripe and non-sour fruits are allowed.

Fresh fruit compotes should not contain a lot of sugar.

It is prohibited to consume various carbonated drinks, coffee, grape juice, cocoa.

Diet for pancreatitis involves avoiding fresh bread and baked goods, soups for meat broth, cold soups (such as okroshka), borscht, milk soups.

It is prohibited to consume hard-boiled eggs and dishes prepared from whole eggs.

Fatty meats, smoked meats and sausages, and offal are prohibited.

You should not eat legumes or crumbly cereals. It is worth limiting the consumption of millet, corn, pearl barley and barley.

You should not eat radish, cabbage, radishes, garlic, sorrel, onions, Bell pepper, grapes, dates, figs and bananas.

Patients need to give up confectionery, chocolate, ice cream, various spices, alcoholic beverages, lard and cooking fats.

Video from YouTube on the topic of the article:

As you know, pancreatitis comes in two types: acute and chronic. Chronic pancreatitis develops in case of untimely therapy acute stage. In most cases, chronic inflammation of the pancreas in residents Russian Federation and the population of countries Western Europe promotes overuse alcohol. Of course, each person has a personal threshold for alcohol tolerance, but many people often exceed it.

Chronic pancreatitis

They only progress over time. Chronic pancreatitis is characterized by alternating periods of exacerbation and remission. These intervals depend on self-activation by the enzyme with further destruction of pancreatic cells.

For treatment, in addition to medications, doctors prescribe a special diet and also recommend using methods traditional medicine. In 15% of people suffering from pancreatitis, the disease is asymptomatic.

The disease can be detected only at the second stage, when endocrine or exocrine insufficiency appears, accompanied by pain. Most often, cases of manifestation occur in men and women aged 35 to 45 years.

General symptoms the following:

Severe, constant pain. It is localized in the pit of the stomach, under the ribs, and can radiate to the back. Shingles pain begins when the entire pancreas becomes inflamed.
Weight loss. At first, the patient is afraid to eat, as pain appears after eating; later, the weight decreases as a result of the development of diabetes mellitus.
Constipation, diarrhea, bloating. Stool with chronic pancreatitis has a nasty smell, food particles are visible in it. Severe tension in the abdominal muscles and constipation indicate the onset of an attack; the patient should know what to do when an attack begins.

The main reasons for the development of the chronic form include:

illiterate and untimely treatment of the acute form of the disease;
kidney and biliary tract diseases;
stomach ulcer;
alcoholism;
heredity;
some infectious diseases.

Types of chronic pancreatitis

Chronic pancreatitis can be: Calcifying. It occurs in most cases and is characterized by the appearance of stones in the tissues and ducts of the gland.

Obstructive chronic. It is quite rare. This type is caused by blockage of the main duct as a result of the appearance of scar and tumor.

Fibrous-indurative chronic. Accompanied by the formation of stones in the pancreas and the replacement of healthy cells with connective tissue, which contributes to a decrease in the function of the gland.

Cystic pancreatitis. This type of disease is caused by the appearance of a large number of small tumors.

Stages of development of chronic pancreatitis

Depending on the characteristics of the flow, four stages are distinguished:

Asymptomatic (latent) form. At this stage there are no signs of chronic pancreatitis, there is no pain, the patient feels normal.
Painful form of chronic pancreatitis. The patient begins to experience constant pain in the upper abdomen, which intensifies significantly during an attack.
Recurrent stage (chronic). During the period of remission, no deterioration in well-being is observed, but during the period of exacerbation, sharp pain appears.
Pseudotumor. A rare form of the disease that affects the head of the pancreas. In addition, the growth connective tissue leads to an increase in the size of the gland.
The latent stage is very for a long time may not manifest itself in any way, which significantly complicates the diagnosis of the disease. It is a consequence of diseases of the stomach and intestines, and develops due to prolonged consumption of alcohol.

If the patient does not adhere to the basic rules of dietary nutrition, the following signs begin to appear:

vomiting that does not bring relief;
heaviness in the pit of the stomach;
stool with a pasty consistency that is difficult to wash off;
formation of gases;
weight loss with normal appetite;
the appearance of bluish skin in the navel and lower back;
increased blood sugar and other metabolic disorders.

When chronic pancreatitis is at an acute stage (20% of all cases), pain in the hypochondrium and pit of the stomach is sharp and can last for a long time. At this stage the following signs are observed:

decreased appetite and, consequently, rapid weight loss;
irregular bowel movements;
bloating and gas;
development of diabetes mellitus.

Chronic manifests itself in waves: severe exacerbations are replaced by remissions, that is, weakening and complete disappearance of symptoms. During the attack they begin sharp pains in the stomach, or rather its upper part, increased body temperature, vomiting, nausea and bloating.

A blood test determines sugar levels, and a stool test determines the presence of fat. There is severe emaciation. The duration of remission may vary; during this period, symptoms disappear.

Treatment of chronic pancreatitis

When inflammation worsens, the patient is indicated for urgent hospitalization. The first days after an attack, the patient can only drink non-carbonated alkaline water. Then the attending physician must prescribe a strict diet, which the person suffering from pancreatitis must follow constantly.

Most tasty dishes should be excluded from the diet, and the recommended food should be chopped and consumed only boiled, or baked. Meals should be taken every 3 hours, but portions should be small. Recommended separate meals. The diet completely excludes even the slightest consumption of alcohol.

To decrease unpleasant feeling, the patient may be prescribed injections of papaverine, contrical, gordox, trasylol, atropine, noshpa. They also put in IVs with anti-enzyme drugs and administer novocaine intravenously.

You can suppress gastric secretion with cimetidine, almagel, and ranitidine. These drugs, as well as some antibiotics, are prescribed by a specialist. If the patient is prone to flatulence, that is, bloating, constipation, he is prescribed: pancreatin, mezim, digestal, panzinorm.

Causes

What can cause chronic pancreatitis? Main reasons:

advanced state of acute pancreatitis;
drinking alcohol;
illnesses digestive system and biliary tract;
organ operations abdominal cavity;
a large number of fatty meat in the diet;
genetic predisposition;
ulcer;
chronic gastritis;
lack of fats and proteins in the diet (common among the population of tropical countries);
insufficient amount of antioxidants in the diet;
negative effects of chemicals;
taking certain medications;
allergy;
blood flow disturbance;
structural features of the organ;
hormonal disbalance.

The sequential processes that determine the occurrence and course of pancreatitis are characterized by degeneration, sclerosis, and weakening of the functional part of the organ (exocrine parenchyma). In addition, the ducts change, and calcification occurs in the pancreas.

From the non-calcifying form, the calcifying form gradually develops. Studies have shown that the reason for its maturation, first of all, is the insufficient content of antioxidants in the food people eat.

After all, antioxidant substances such as copper, selenium, and zinc prevent negative impact on cells of food toxic substances (cyagens). In patients suffering from the disease, calcified concretions (stones) form in the ducts of the organ.

Pancreatitis can also be caused by a genetic predisposition.

Scientists from different countries have conducted research and described the hereditary tendency to chronic disease pancreas in different families. They found that the hereditary form develops in children who reach the age of 10 years. Both girls and boys can suffer equally. The disease can be inherited by a child if at least one of the parents suffers from this disease. Sick children are prone to developing pancreatic tumors.

Danger and complications after treatment

It is dangerous because if it is not treated in a timely manner, serious local and systemic complications. Impaired absorption and breakdown of nutrients leads to general complications.

Local complications are not that common. These include:

Jaundice.

It develops as a result of depression of the bile duct. Compression of this duct may occur where it passes through the gland, but it may be affected by a mistaken cyst.

Chronic pancreatitis can be protracted, when the disease drags on for years with a tendency to progress.

By clinical course The following classification of chronic pancreatitis has been adopted.

1. Chronic recurrent pancreatitis, which flows with clinical picture relapses of acute pancreatitis. During the period of exacerbation, attacks of pain occur in the left hypochondrium or girdling pain radiating to the back. Pain most often appears due to errors in diet and consumption of alcoholic beverages. Painful sensations accompanied by bloating, nausea and vomiting. The number of leukocytes in the blood increases, changes leukocyte formula, amylase activity in the blood and urine may increase.

According to statistics, in 60% of cases we are talking about this type of chronic pancreatitis. During the period of remission, its symptoms subside, and then during a relapse they increase again.

2. So-called painful form of chronic pancreatitis. It is characterized by constant pain in certain areas. As a rule, pain occurs in the upper half of the abdomen, often to the left of the navel, spreading to the left half of the lower back, chest and heart area. The pain is also girdling in nature.

If there is an error in nutrition, the pain intensifies. At this time, there is a decrease in appetite, heaviness and bloating in the upper abdomen. Patients begin to lose weight, and diabetes mellitus often develops against this background. The painful form occurs in approximately every fifth patient.

3. Pseudotumor chronic pancreatitis. If the disease is not complicated, pain is always typical. It is localized deep in the epigastric region on the left and radiates to the back, in top part lower back. During an attack, it can be severe and can last for a long time, regardless of food intake. Exacerbation of the disease is accompanied by nausea, vomiting, loss of appetite, bloating and weight loss.

Characteristic clinical sign with this form of pancreatitis there is jaundice, which is caused by the localization of pathological changes in the head of the pancreas. Against the background of jaundice, inflammation of the bile ducts, that is, cholangitis, often develops.

A late symptom indicating extensive damage to the pancreas is a large amount of neutral fat and muscle fibers in the feces, indicating a violation of pancreatic digestion.

4. Latent form of chronic pancreatitis (painless) is the most insidious form of the disease. There may be no manifestations for a long time, even when pathological processes in the pancreas are in full swing. Distinct symptoms occur when there is a significant impairment of external or internal secretion.

Defeat external secretion leads to indigestion. In this case, the breakdown of animal fats is disrupted, which are excreted in the feces in the form of neutral fat. The breakdown of carbohydrates and proteins is disrupted. The latter contributes to the development of fermentation and putrefactive processes in the intestines, which is expressed in flatulence and diarrhea. As a result, the body suffers from a lack of vitamins and new, accompanying anomalies appear. The skin loses elasticity and becomes very dry; the mucous membranes of the mouth, small and large intestines become inflamed.

If the intrasecretory function of the pancreas is impaired, insulin secretion worsens. Accordingly, blood sugar levels increase and carbohydrate metabolism. As a result, secondary diabetes mellitus begins to develop.

Chronic pancreatitis this is an inflammatory-dystrophic disease glandular tissue pancreas with impaired patency of its ducts, causing, with further progression, sclerosis of the gland tissue and disruption of intra- and exocrine function.

Causes of chronic pancreatitis

Most common cause occurrence of chronic pancreatitis are diseases of the biliary tract and liver. The second most important reason is chronic alcohol intoxication. Stomach diseases play a role duodenum, food allergy, viral infections(epidemic paratitis, hepatitis B virus), disturbances of blood flow in the vessels of the abdominal cavity, pancreatic injuries, intake cytostatic drugs and etc.

Factors contributing to the development of chronic pancreatitis

These factors include poor nutrition (protein deficiency in food products), hereditary predisposition, decreased function thyroid gland, lipid metabolism disorder. Etiological and accompanying factors contribute to the activation of its own proteolytic and lipolytic enzymes, which leads to self-digestion of the pancreatic parenchyma, blockage of its ducts and disruption of pancreatic secretion.

Forms and symptoms of chronic pancreatitis

The following are distinguished: clinical manifestations chronic pancreatitis.

Recurrent form characterized by intense pain in the upper half of the abdomen (in case of inflammation of the head of the pancreas - in the epigastrium on the left; in case of damage to the tail part - in the left hypochondrium, and in case of damage to the body of the pancreas - girdle pain). The pain is usually prolonged, pressing, intense, especially when consuming alcohol, fatty and fried foods, and is accompanied by vomiting. Patients complain of poor appetite, bloating, diarrhea, and increased body temperature.

Pseudotumor form Chronic pancreatitis occurs when the pathological process is localized in the head of the gland, causing its swelling and compression of the common bile duct. In this case, the outflow of bile is disrupted and jaundice appears, itchy skin, nausea and vomiting, dark urine; the pain syndrome is localized in the epigastric region on the right, the stool becomes discolored. During palpation, painful areas and a dense, painful head of the pancreas can be felt.

Painful form(with constant pain) chronic pancreatitis is characterized by the presence constant pain in the upper half of the abdomen, radiating to the back, decreased appetite, nausea, unstable stools, weight loss, bloating and flatulence.

Latent form chronic pancreatitis is accompanied by mild pain syndrome, periodic loss of appetite, mild nausea, unstable stools, disorders of exocrine function.

Sclerosing form chronic pancreatitis entails severe disturbances of exocrine function, as well as endocrine function with the development of diabetes mellitus. With this form, the pain is localized in the upper abdomen and intensifies after eating. The sick suffer poor appetite, nausea, weight loss, diarrhea.

At mild flow In chronic pancreatitis, exacerbations are observed 1-2 times a year, quickly subside, and the pain syndrome is insignificant.

Moderate severity exacerbation is accompanied by significant pain, moderate exocrine insufficiency, increased level pancreatic enzymes.

Severe degree of flow chronic pancreatitis manifests itself a sharp violation digestion, exhaustion, persistent, prolonged pain syndrome, significant disorders of secretory function, frequent and prolonged exacerbations.

When examining blood and urine, an increase in amylase activity is detected, the ESR increases, leukocytosis is observed with a shift to the left, and an increase in sugar in the blood and urine is possible. A scatological examination reveals undigested fiber, creatorrhea, steatorrhea, and amilorrhea. Echo scanning of the pancreas shows changes in its size, the presence of stones in the pancreatic duct, and heterogeneity of the organ parenchyma.