Pancreatitis is an acute or chronic inflammation of the pancreatic tissue, followed by a violation of the excretory and endocrine functions of the organ. Most often, the development of pathology is associated with the systematic use of large amounts of alcohol, smoking, gallstones.
During an exacerbation of pancreatitis, a person experiences persistent severe pain in the upper abdomen, gastrointestinal disturbances, and possibly yellowing of the skin and mucous membranes.
Treatment includes following a diet, taking medications to aid in the digestion of food, and pain relievers. In some cases, surgery may be required.
Statistically, in general, the incidence does not depend on sex. However, alcoholic pancreatitis is more common in men, and is associated with more alcoholism in this population. The disease mainly affects people of working age between 30 and 50 years old. In women, the development of pancreatitis is often caused by gallstone disease.
The reasons
The disease can be caused by the effect of toxins, by the autoimmune process, have a genetic predisposition or become a complication of gallstone disease. Alcohol abuse, smoking, and biliary obstruction due to gallstones are the most common causes of pancreatitis. In the second case, the outflow of digestive bile from the pancreas into the duodenum is disturbed, leading to stagnation and "self-digestion" of this organ.
The decay products of ethyl alcohol have a direct toxic effect on the cells of the pancreas, as do some drugs (estrogens, sulfonamides, tetracyclines, erythromycin, thiazides, mercaptopurine). In addition, the systematic abuse of alcohol is accompanied by thickening of bile, which leads to a decrease in the ability of the biliary tract to function. Nicotine addiction also leads to the development of the disease, as it affects the cardiovascular system, causing narrowing of the blood vessels and reduced blood flow to the organs.
Pancreatic damage is also associated with heredity, in particular, it can be genetically determined or caused by congenital developmental anomalies. Autoimmune pancreatitis occurs both individually and in association with Sjögren's syndrome, inflammatory bowel disease, and many other autoimmune disorders.
Classify
Depending on the nature of the course of the disease, acute or chronic pancreatitis is distinguished. Due to the occurrence, it happens:
- toxic (alcohol, infectious, drugs);
- gallbladder;
- metabolic disorder;
- autoimmune;
- idiopathic;
- post-traumatic.
Consistent with the clinical manifestations, pancreatitis occurred in mild, moderate or severe forms.
Symptom
The clinical manifestations of the disease are associated not only with damage to the organ, but also with a violation of its secretory and endocrine functions. In acute pancreatitis, the symptoms are pronounced:
- Severe pain in the epigastrium, left hypogastrium, localized or enveloping, often extending below the left shoulder blade. Discomfort is aggravated in the supine position and after an error in the diet.
- Increased salivation, belching, nausea, vomiting frequently without relief.
- Increase body temperature. Perhaps the appearance of fever, chills.
- Change in color of skin and mucous membranes. Moisture and pallor of the skin, moderately yellow sclera are often observed. In rare cases, the skin is also slightly yellow. Perhaps the appearance of bluish spots on the body, hemorrhages in the navel.
- Manifestations of indigestion - bloating, heartburn.
- Irritability, lacrimation, in severe cases develops pancreatogenic psychosis.
Chronic pancreatitis is characterized by periods of exacerbation and remission, having a phased course. In the asymptomatic, preclinical phase of the disease, pancreatic changes become an incidental finding on ultrasound of the abdominal organs. During the initial presentation, repeated exacerbations of acute pancreatitis with manifestations characteristic of the acute form of the disease are observed. Gradually, their frequency becomes lower, but the symptoms persist in the severe period: abdominal pain, intermittent vomiting, nausea, diarrhea, flatulence.
In the period of persistent symptoms, pain in the upper half of the abdomen, often of a urticarial nature. The patient lost weight, especially due to anorexia due to increased fear of pain. Increased manifestations of impaired secretion and endocrine function such as indigestion, hyperglycemia.
In the future, pancreatic atrophy occurs. The pain may become less intense or absent, and the frequency of attacks of pancreatitis decreases. The stool becomes pasty, has a fishy smell, and is greasy. Exhaustion is observed, pancreatogenic diabetes mellitus develops. In the late stages, systemic complications occur, possibly malignant degeneration of the tissues of the affected organ.
Complications
Depending on the form, severity and stage of the disease, the risk of developing certain complications of pancreatitis increases. With a progressive long-term course of the pathology, it is possible to violate the outflow of bile, followed by obstructive jaundice, the formation of abscesses, cysts, the development of portal hypertension, diabetes mellitus. pancreatogenic diabetes, pancreatitis, "enzymatic" cholecystitis, pneumonia, exudative pleurisy, nephritis, pancreatic cancer.
The consequences of an acute process can be:
- peritonitis;
- infected veins of retroperitoneal tissue;
- erosive bleeding in the organs of the gastrointestinal tract, bleeding in the abdominal cavity;
- mechanical jaundice;
- ascites;
- formation of internal and external gastrointestinal fistulas, abscesses and infiltrates.
Severe cases can cause shock, multi-organ failure with a high risk of death.
Diagnose
The identification and treatment of pancreatitis is done by a general practitioner and a gastroenterologist along with an endocrinologist, surgeon, and other specialists. Usually, patients in the acute form of the disease who receive urgent medical care will go to a surgical hospital, where the differential diagnosis of pancreatic injury from acute appendicitis, cholecystitis, and other diseases is carried out. other reason.
After clarifying the complaints, collecting the medical history, including the nature of nutrition, bad habits, frequency of recurrence, concomitant diseases of the biliary system and examination, the physician instructs the patient to do the following: testing, as well as instrumental research.
As part of a laboratory study of a patient, the following are done:
- General clinical analysis of blood. There are signs of inflammation: ESR acceleration, leukocytosis.
- Biochemistry of blood. For pancreatic damage in pancreatitis, increased activity of enzymes (amylase, lipase), hyperglycemia, hypoalbuminemia and hypocalcemia, bilirubinemia, as well as increased activity of liver enzymes (ALT, AST), transaminase), CRP is feasible.
- Biochemical study of urine. It is done to determine the activity of amylase in the urine.
- Copy program. characteristic increase in fat secretion.
- Determination of pancreatic elastase in stool.
Specific diagnoses of pancreatitis include:
- Ultrasound of the abdominal organs is a method to visualize the main gland and surrounding organs;
- SCT and MRI of internal organs to get more detailed information about their anatomical changes;
- endoscopic retrograde cholangiopancreatography to visualize the lumen of the duct, to collect pancreatic secretions, to remove stones;
- elastography of the pancreas - allows you to determine the stiffness and stiffness of the tissue, evaluate the degree of its connective tissue replacement and the excretory function of the organ;
- esophagoscopy to evaluate the condition of the empty digestive organs.
The treatment
Seek medical help at the first signs of pancreatitis, then your chances of avoiding complications and turning the disease into a chronic form are higher. During an exacerbation of the disease, fasting is recommended.
All patients with pancreatitis must follow a strict diet, abstaining from alcohol and smoking. During the growth spurt, you should eat small portions several times a day, including in your diet mainly foods rich in protein and complex carbohydrates, fiber, and vitamins.
Drug therapy includes taking drugs from the following groups:
- analgesics for pain relief in pancreatitis;
- pancreatic enzymes;
- inhibitors of hydrochloric acid secretion in the stomach;
- tranquilizers and antidepressants;
- antibiotics;
- insulin;
- vitamin.
With the complicated course of the disease, as well as some cases of acute abdominal pain, laparoscopic or surgical intervention is indicated.
Prevent
The main prevention of pancreatitis is to avoid alcohol, eat a varied diet low in fat, saturated fat and cholesterol, include whole grains, vegetables and fruits in the diet, and not smoke.
Acute pancreatitis can develop not only in people who regularly abuse alcohol, but also as a result of drinking large amounts of alcoholic beverages for fatty, fried and spicy snacks in large quantities. Proper, fractional nutrition in pancreatitis serves as a means of preventing exacerbations of its chronic form.