Pancreatitis: how to save the pancreas?

Symptoms and complications of pancreatitis

Symptoms of acute and chronic pancreatitis differ exactly, as well as the features of its flow and possible complications. Symptomatics of chronic pancreatitis is often erased. Signs of the disease flowing acutely are always pronounced, but it is important not only to urgently consult a doctor, but also to exclude the development of other no less dangerous diseases, for example, acute cholecystitis or appendicitis.

Symptoms of acute pancreatitis

Symptoms of acute pancreatitis

Activating in the pancreas itself, enzymes in digestive juice are striking her fabrics. Thus, the action of lipase intended for fats splitting leads to cellular cellular dystrophy. TRIPSIN, digesting protein, causes different chemical reactions, leading to the edema of the pancreas tissues and necrosis (eliminate) of its cells. At first, necrosis is aseptic, later infections can be joined by the formation of purulent foci. The general symptoms of acute pancreatitis include:

  • Pain, often encircling, in the right or left hypochondrium. Painful feelings are intense and cannot be eliminated with drugs even with timely early treatment in the first day. In some patients on the background of an attack of acute pancreatitis, pain shock can develop.
  • The complete absence of appetite, nausea and indomitable vomiting, not bringing facilitating the patient. Massows, as a rule, consist of the contents of the stomach and bile.
  • Increase body temperature (more than 38 ° C), pulse increase (more than 90 ° C / min.) And respiration, decrease in blood pressure (less than 90 mm / RT.).
  • The tension of the abdominal wall of the abdomen in the region under the rib arc on the left.
  • Break, brightly felt in the upper stomach departments. The appearance of such a symptom is due to a violation in the work of the digestive system.

In addition, for acute pancreatitis, the skin color or the development of mechanical jaundice is characterized in the event that the cause of the disease is the gall-eyed disease.

Symptoms of chronic pancreatitis

The pain in the exacerbations of pancreatitis of chronic form is localized, as a rule, in the region of the right or left hypochondrium, and gives it in the back, gaining concerning character. Wrong the exacerbation of pancreatitis can be taken alcohol, fatty or acute food. The pain arising from exacerbations is developing against the background of the emergence of an inflammatory process affecting the nerve end of the body, as well as increasing the pancreas in size. In addition to pronounced painful sensations, patients with exacerbations of chronic pancreatitis are observed:

  • Owliness of the belly, the appearance of belching, diarrhea, nausea and vomiting. Causes such symptoms the lack of enzymes involved in digestion.
  • Reducing body weight and deterioration of the general condition of the body. Due to the violation of the exchange of proteins, carbohydrates and fats in patients with chronic pancreatitis, there is a pronounced dryness of the skin, avitaminosis, nail fragility, the development of anemia, etc.
  • High gas formation, stool disorders. This is due to poor digestion of food and excessively active formation of bacteria in it, disturbing the normal intestinal microflora.

If the exacerbation of pancreatitis is pronounced, the symptoms of the disease in chronic and in an acute form of similar to each other. Against the background of a sudden exacerbation of the inflammatory process, necrosis of the pancreas tissue may develop, causing a sharp acute pain and requiring urgent hospitalization.

Cholecystitis and pancreatitis

Cholecystitis, pancreatitis - inflammatory diseases of the organs of the digestive tract. When cholecistics, the inflammatory process is subjected to a gallbladder, and with pancreatitis - pancreatic tissues. Both processes can occur as separately and be interconnected. There is even a term for both diseases arising in the complex - cholecystopancatite.

Cholecystitis, pancreatitis cause patients painful sensations in the upper stomach departments. But their main differences is that when the gall bubble inflammation, pain is localized in the right hypochondrium, and with inflammation of the pancreas, it is looking.

In Pancreatitis, the patient feels the heaviness in the stomach, exacerbated after meals, there is a bloating and a violation of the chair. According to external signs, it is extremely difficult to distinguish cholecystitis from pancreatitis. The diagnosis is possible only after the differential diagnosis.

Complications of pancreatitis

As with almost any disease, timely appeal to the doctor and the beginning of the prescribed treatment of any form of pancreatitis will reduce the possibility of the development of complications to virtually zero and will slow down destructive processes in one of the main organs of the digestive system. Complications of the disease occurring in acute form can develop in the shortest possible time and even cost a patient of life. Chronic pancreatitis is more "cunning", and its complications develop as the pancreas tissue damage and loss of their functions.

Complications of chronic pancreatitis

Complications of chronic pancreatitis

The main complications of the chronic inflammatory process in the tissues of the pancreas are:

  • development of diabetes mellitus arising against the background of insulin hormone development;
  • The overall exhaustion of the body, in which nutrients entering the body together with food, due to the lack of pancreatic enzymes, cannot be fully absorbed;
  • development of diseases of various organs of the gastrointestinal tract, for example, cholecystitis or duodenal ulcer disease;
  • the formation of the acquired cyst in the tissues of the glandular organ;
  • Mechanical jaundice appearing against the background of squeezing bile ducts.

In exacerbations of pancreatitis, infectious processes may develop, both in the tissues of the pancreas itself and beyond. In the absence of full treatment and adherence, abscesses and bleeding can develop with pancreatitis.

Complications of the disease occurring in acute form

In the acute form of inflammation of the pancreas, complications may have an early or later manifestation. In early complications, developing directly at the beginning of the attack, development is possible:

  • hypovolemic shock leading to the lack of oxygen in the tissues of all organs of the digestive system;
  • liver and renal failure, provoked by the toxic effects of digestive enzymes;
  • peritonitis, which can be either aseptic or purulent, developing against the background of joining the inflammatory process of infection;
  • cardiovascular or respiratory failure, etc.

The development of late complications in acute pancreatitis occurs mainly against the background of infections. Such complications include sepsis, abdominal abscesses, the formation of fistulas, purulent inflammation of nearby fabrics, the formation of pseudocyst pancreatic glands, bleeding, etc.

Pancreatitis is an acute or chronic inflammation of the enzymatic pancreas and peripancreative tissues, manifested by the raws in the lower back and the increased activity of the pancreas enzymes. About two thirds of cases of acute pancreatitis (OP) are caused by a long excessive use of alcohol or bile stones.

The etiology of OP, recurrent and chronic pancreatitis (CP) is very diverse. Various combinations of genetic, epigenetic, metabolic and environmental factors can run the inflammatory process and lead to its effects in several systems regulating and supporting the function of the pancreas.

In the treatment of the patient and making preventive measures, it is important to determine the etiological factors to prevent the recurrence of the disease. The article discusses more rare causes of acute and chronic pancreatitis.

Epidemiology

According to the latest research, every 34 people out of 100 thousand are ill, and due to the increase in the prevalence of basic etiological risk factors - obesity, alcoholism, smoking, stone formation disease is diagnosed with younger people. Also, such statistics are related to the improvement of the diagnosis, and the identification of less common causes of pancreatitis.

Independent Risk factor op - smoking . This habit exacerbates the pancreatic damage caused by alcohol.

If you or your loved ones suffer from inflammation of the pancreas, seek help in Medunication Medical Center. We are engaged in the diagnosis and treatment of any diseases in Krasnoyarsk. Powerful equipment for conducting CT, MRI and X-ray, experienced doctors who, if necessary, hold the primary inspection at home, are waiting for you to "Medunion". To find out the details or make an appointment, call 201-03-03.
Pancreatitis Risk Factor - Smoking

Most patients have a mild pancreatitis, a heavy form of pancreatitis occurs in 20-30% of cases. Mortality from severe pancreatitis is about 15%.

Etiology

The etiological factors of pancreatitis are very diverse - metabolic, mechanical, infectious, vascular. Often the disease occurs as a result of the interaction of several factors. The etiology of the OP is determined only in 75% of patients.

Chronic pancreatitis is classified according to etiology and risk factors according to TiGAR-O classification (Table 1).

Table 1. The etiological classification of chronic pancreatitis (Tihar-O)

Toxic-metabolic

Alcohol;

Tobacco, smoking;

Hypercalcemia (hyperparathyroidism);

Hyperlipidemia;

Chronic renal failure;

Drugs and toxins.

Idiopathic

Early start;

Later start;

Tropical calcification pancreatitis, fibrocalcular pancreatic diabetes.

Genetic

Autosomal dominant

  • Hereditary pancreatitis (PRSS1 mutation);
  • Autosomal recessive (CFTR mutations, spink1).

Aukoimmune

Autoimmune pancreatitis 1 type (positive IgG4);

Autoimmune type Pancreatitis (negative IgG4).

Recurrent (reversible) and acute

Ponkermatic (acute);

Reversible acute:

  • biliary pancreatitis;
  • Yatrogenic (postprocessed);
  • traumatic;

Ischemic (postoperative, hypotensive);

Infectious (viral);

Chronic alcoholism;

Radiative;

Diabetes.

Observing

Breast-quality pancreatic duct stricture:

Malignant stricture;

Periampular carcinoma;

Pancreatic adenocarcinoma.

Table 2. Rare causes of pancreatitis

Nosology

Specifications

Diagnostics

Metabolic pancreatitis

Hypertriglyceridemia and hypercalcemia

OP or HP

Medicinal Pancreatitis

Azatioprin, 6-mercaptopurine, sulfonamides, estrogens, tetracycline, valproic acid, antiretroviral

OP or HP

Autimmune pancreatitis

Focal or diffuse increasing pancreas, hypotensive indentation of the pancreas, the expansion of the paraticle part due to lymphoplasmocytes p. Penetration water

Hp

Hereditary pancreatitis

It usually occurs in young age, gene mutations are found.

Acute recurrent pancreatitis

Pancreatitis after the procedure

Endoscopic retrograde cholangiopancopyography has recently been carried out.

Most often

Pancreatitis with precipitation of bile (draft )

Bile sediments and small stones (microlithiasis)

Most often

Parcreatitis Paraduodeninio Groove ( furridge )

Fibrous formations between the pancreas head and the thickened wall of the duodenum, leading to the stenosis of the duodenum, cystic changes in the pancreatododenal furrow or the wall of the duodenum, the stenosis of the pancreas and bile ducts

Exclusively hp

Diverticulous duodenum

Peripular diverticul Windmate deformation sock The walls of the digestive duodenum

OP> hp

Traumatic pancreatitis

Direct pancreatic injury, intrapaccreative hematoma, pancreas breaking with liquid around

OP or HP

Infectious pancreatitis

Various infectious factors: viruses, bacteria, fungi.

Most often in op

Ischemic pancreatitis

Pancreatitis due to circulatory disorders, arterial hypotension, cardiogenic shock

OP or HP

Hypertrigliserineic pancreatitis

Hypertriglyceridemic pancreatitis is 1-14% of the cases of OP and 56% of cases of pancreatitis in pregnant women. Hypertriglyceridemia is considered increased triglycerides (TG) on an empty stomach (> 1.7 mmol / l). The level of TG in serum above 11.3 mmol / l can lead to the development of OP in 5% of cases. In cases where the TG concentration exceeds 22.6 mmol / l, the frequency of OP is 10-20%. The risk of OP increases at a concentration of TG 5.6 mmol / l: the higher it is higher, the higher the risk of OD and heavier pancreatitis.

With pancreatitis caused by hyperitriglyceridemia, associated both primary (genetic - dyslipidemies I, IV, V types) and secondary (purchased) violations of lipoprotein exchange. The main causes of the acquired hyperitriglyceridemia are obesity, diabetes, hypothyroidism, pregnancy and drugs - treatment with estrogen or tamoxifen, beta-adrenoblockers, antiretroviral drugs, thiazide diuretics.

During pregnancy, the TG level is usually rising to 3.3 mmol / l in the third trimester and does not cause pancreatitis. Inheritance is most common during pregnancy due to hereditary family dlypidemia.

The inflammation of the pancreas is caused by tg themselves, but toxic free fatty acids formed by the hydrolysis of the pancreas with pancreatic lindas. The clinic of the disease is usually no different from ordinary pancreatitis. In some cases, severe hyperitriglyceridemia, xanthoman, xanteliosis, hepatosteatosis, etc. can be observed.

It is important to diagnose hyperitriglyceridemic pancreatitis in a timely manner and adjust the levels of triglycerides. Standard treatment of pancreatitis is also appointed - infusion therapy, analgesics.

The main methods of reducing the hyperitriglyceridemia are apferesis, especially plasmapheresis, and insulin therapy. True, these randomized research on the effectiveness of these methods is absent. Treatment is selected depending on the severity of pancreatitis and disturbing symptoms, including hypocalcemia, lactoacidosis, syndrome of exacerbation of the systemic inflammatory response and progressive dysfunction of organs.

Intravenous insulin should be used if the patient does not tolerate or cannot pass apferesis. Insulin reduces the level of TG, but the purpose of this treatment is with severe hyperitrigliserineic pancreatitis - to prevent the release of fatty acids from adipocytes caused by stress. The usual dose of insulin infusion is 0.1-0.3 units / kg / h. At the same time required Easy measurements of blood glucose levels . Glucose solution is prescribed for hypoglycemia prophylaxis.

Easy measurements of blood glucose levels
Easy measurements of blood glucose levels

For therapeutic apferesses, the level of triglycerides should be monitored after each procedure. Plasmapheresis continues until the concentration of TG does not fall to 5.6 mmol / l. For one insulin, the TG level is controlled every 12 hours. Insulin infusion is terminated when the concentration of TG reaches 5.6 mmol / l (usually in a few days).

Further long-term correction of the hyperitriglyceridemia using TG <2.2 mmol / l is important to prevent the recurrence of pancreatitis. For this, there are medical and non-medical measures. The latter includes a diet, weight loss in obesity, an increase in physical activity, limiting the addition of sugar, good glycemic control in diabetes. Also avoid drugs that increase the level of TG. Medicines include anti-lipid preparations, usually fibrates (fenofibrate).

Calcinous (hypercalcemic) pancreatitis

Calcinous pancreatitis occurs very rarely. The most frequent causes of hypercalcemia (about 90%) are hyperparathyroidism and malignant neoplasms. According to studies, hyperparathyroidism causes about 0.4% of the cases of OP.

Calcium is believed that calcium accumulated in the pancreatic duct activates trypsinogen in the pancreas parenchyma. The low frequency of pancreatitis among patients with chronic hypercalcemia assumes that also affect OP other factors (sudden increase in serum calcium).

In patients with hyperparathyroidism and associated hypercalcemia, pancreatitis develops 10-20 times more often than in the population as a whole. The most frequent causes of hyperparathyroidism are:

  • Adenoma of the parachitoid gland (80%);
  • hyperplasia of all 4 parathyroid glands (15-20%);
  • Thyroid cancer (2%).
Adenoma of the parachitoid gland
Adenoma of the parachitoid gland

The most important principles of treatment are the correction of hypercalcemia and the elimination of the root cause. In patients with asymptomatic hypercalcemia of easy degree (Calcium concentration 3.5 mmol / l), the initial treatment is from 200 to 300 ml / h of isotonic sodium chloride solution at the rate of diurus from 100 to 150 ml in 1 hour.

For immediate short-term treatment of patients who develop symptoms (lethargia, stupor) are prescribed calcitonin, and for long-term treatment, bisphosphonate intravenously is added. If the bisphosphonates are contraindicated, you can use zoldronic acid or denosuumab.

Toxic (medicinal) pancreatitis

Pancreatitis caused by drugs is occurring in less than 5% of cases. The forecast for this pancreatitis is generally good, and low mortality. The pathogenetic mechanism of drug pancreatitis includes:

  • immunological reactions (6-mercaptopurin, aminoalcylates, sulfonamides);
  • direct toxic effects (diuretics, sulfonamides);
  • accumulation of toxic metabolites (valproic acid, didanosine, pentamidine, tetracycline), ischemia (diuretics, estrogens);
  • Increased viscosity of pancreatic juice (diuretics and steroids).

Demonstrate interaction between pancreatitis and medicine is usually difficult. Pancreatitis can develop within a few weeks after the start of treatment. Possible rash and eosinophilia. Meanwhile, in patients taking valproic acid, pentamidine or didanosine pancreatitis develops only after many months due to the chronic accumulation of the metabolite of the drug.

When recuiting treatment, patients must be under careful observation. If the symptoms are repeated, the drug should be discontinued.

Autimmune pancreatitis

An autoimmune pancreatitis (AIP) is a rare disease that causes fibrous inflammation of the pancreas. The prevalence of the disease is not established in detail. It is estimated that AIP accounts for 5-6% of cases of chronic pancreatitis.

An autoimmune pancreatitis is an increasingly recognizable disease. As a rule, AIP begins with weight loss, jaundice and diffuse pancreatic increase in visualization studies imitating oncological diseases.

According to the criteria of international consensus, autoimmune pancreatitis is divided into:

  • AIP type 1, or lymphoplasmatic sclerosing pancreatitis;
  • AIP type 2, or idiopathic protocutrical pancreatitis.

An autoimmune pancreatitis type 1 is most often manifested by a mechanical jaundice, in 50% of cases. Mechanical jaundice It develops due to the compression of distal bile ducts (increasing the head of the pancreas) or stricture of proximal bile ducts.

Mechanical jaundice
Mechanical jaundice

Despite the intensive inflammation, patients do not experience a typical abdominal pain or it is weak. Autoimmune pancreatitis Type 1 refers to the spectrum of immunoglobulin diseases (Ig) G4, which can affect almost all organs of the body (the strictures of the biliary tract, the interstitial jade, exocrinopathy glands associated with IgG4, Xialadenit, retroperitol).

AIP should be suspected of patients with signs of both pancreatic and hepatobiliary disorders. The elevated level of IgG4 in serum is detected in most patients with type AIP 1.

Typical radiographic signs after computed tomography (CT) are:

  • Diffuse pancreatic parenchyma (pancreas of sausage form);
  • rim of frame-type or focal lesions;
  • Diffuse atrophy of the pancreas.

Endoscopic retrograde cholangiopanmatography (ERCP) reveals a diffuse or multifocal narrowing of pancreatic duct without dilatation. To confirm the diagnosis, it is important to estimate all the tests, but is considered to be a standard of diagnosis. Histological examination.

Table 3. Table of comparison of autoimmune pancreatitis type 1 and 2

Type 1 AIP.

Type 2 AIP

Age in which the disease develops

About 60 years old

About 40 years old

Male

75%

fifty%

Damage to other organs / communication with the disease associated with IgG4

fifty%

No

Inflammation

Small

High (10-20%)

Enhance serum igg4

Controls about 66%

Set at about 25%

Histological data:

Lymphoplasmocyte infiltration

Characterized

Characterized

Stormiform fibrosis

Characterized

Characterized

Obriculting Flebit

Characterized

Rarely noticeable

Defeat of granulocyte epithelium

There is no

Characterized

Peridectal inflammation

Characterized

Characterized

LGG4 cells

≥10 cells / DPL (in the area of ​​significant increase)

Response to steroid treatment

100%

100%

Risk of recurrence

Up to 60%

Autoimmune pancreatitis is treated with corticosteroids at a dose of 40 mg / day. 4-6 weeks, followed by a decline of 5 mg per week. Inadequate response or recurrence is more common in patients with accompanying sclerosing cholangitis associated with IgG4. In this case, 2 mg / kg of azatiotric is recommended.

Hereditary pancreatitis

Genetic pancreatitis can manifest itself as a sharp, recurrent, family or invoked pancreatitis of unknown origin, which later becomes chronic. The frequency of genetically induced pancreatitis is unknown. Some cases remain unidentified. Idiopathic pancreatitis meets most often, especially in young people.

Autosomal dominant hereditary pancreatitis is caused by mutations in the PRSS1 gene. Mutations in the CFTR gene are associated with recessive hereditary pancreatitis. SPINK1 penetration mutations can act as a factor changing the disease, along with other genetic factors and environmental factors.

Patients with PRSS1 or SPINK1 GENDATIONS (hereditary pancreatitis) increase the risk of exocrine pancreatic dysfunction, pancreas diabetes and cancer. According to research, the risk of pancreatic cancer ranges from 7 to 20%. Smoking increases the risk of pancreatic cancer by 2 times.

The American College of Gastroenterologists agree that patients with hereditary pancreatitis should be examined annually on the subject of pancreatic cancer with magnetic resonance tomography (MRI) or endosonoscopy from 50 years.

The principles of treatment of hereditary pancreatitis are the same as during pancreatitis of other etiologies. It is crucial to the disclaimer of bad habits (alcohol, smoking), since they significantly increase the risk of exacerbations, complications and progression to the terminal stage of pancreatitis. Pancreatomy with autotransplantation of pancreatic islands can be performed with younger patients with recurrent heavy OP or CP.

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December 10 2020.

Pancreatitis is an acute or chronic inflammation of the pancreas, in which the process of splitting the substances derived from food is disturbed. The risk group includes people with age of 35-50 years. The ailment delivers a lot of discomfort, reduces the quality of life and is dangerous by the development of heavier diseases. Therefore, we often ask whether it is possible to cure pancreatitis. All doctors gastroenterologists converge in the opinion that this diagnosis is not a sentence. With qualified treatment, you can get rid of pathology without consequences and side effects, and timely appeal will significantly reduce the duration of the course.

Pancreatitis Risk Factor - Smoking

When the attack of pancreatitis appears, you need to seek help

A qualified doctor-gastroenterologist. It will conduct a comprehensive diagnosis, will determine the nature of the disease and will prescribe an effective plan of therapy, taking into account the characteristics of the body. Self-medication with pain in the abdomen or other disorders of the digestive system is categorically contraindicated, since pancreatitis has similar symptoms with other diseases of the gastrointestinal tract.

  • In most cases, a specialist appoints pharmacological therapy aimed at losing pain and restoring pancreatic functions. Types of conservative methods: Elimination of pain syndrome.
  • Analgesics are used to relieve pancreatic pain, antioxidants are prescribed to prevent pain in pancreas. In the development of the disease due to infection, antibacterial therapy will be required; Enzyme therapy.
  • This method is indispensable with the insufficiency of the excessive function of the PZ. It is used to unload and restore the digestive function of the organ to ensure good digestibility of food. Among those who cured pancreatitis, reviews are positive about pills with the content of pancreatic enzymes. In challenging cases, drugs can be used to suppress the gastric secretion; Treatment of pancreatic diabetes.

In case of endocrine insufficiency, the gastroenterologist prescribes a diet with fractional nutrition as with type I diabetes mellitus and controls the level of glucose. If this method does not give a result, insulin is prescribed to the patient.

Operational intervention will be required with the exacerbation of pancreatitis 3 months after the start of conservative treatment or suspicion of pancreatic cancer.

  • In accordance with medical protocols, the surgical treatment of pancreatitis can be of two types: 1. Direct.
  • Operations are carried out to remove stones, drainage cyst or resection of PJ. 2. Indirect.

This treatment includes operations on the gastrointestinal tract and biliary ways.

Surgical treatment is particularly shown in the complex form of the disease, the formation of cysts and sharp pains that have not disappeared after drug treatment.

  • With any form and method of treatment, the gastroenterologist is an individual diet. According to the proper power mode, the following foods should be eliminated from the diet:
  • Smoked and fried meat;
  • Spicy food;
  • Salted products;
  • Cocoa, coffee and strong tea;
  • Sweet carbonated water;
  • Bakery products;

Mushrooms.

During diet, patients showing 5-time fractional nutrition and use of useful mineral waters.

Patients recommended use of food with a high content of proteins and carbohydrates, if the symptoms are not sharpened after them.

When exacerbating the disease will have to be treated for 3-5 days to reduce the secretion of the PJ.

If you are treated with pancreatitis and your pancreas hurts, immediately contact the gastroenterologist. It will appoint additional research and adjusts the therapy plan, taking into account the current state of the body.

We will help with the choice of drugs in pancreatitis

  • Content:
    • Which pills can be used in pancreatitis
    • Blockers receptors and proton pumps
    • Enzyme preparations
    • Analgesics and antispasmodics
  • Additional means

How to choose the drug with pancreatitis

Pancreatitis is inflammation of the pancreas that can flow in acute or chronic form. The disease is accompanied by a violation of the outflow of the secret from the authority, as a result of which the enzymes begin to destroy the cells of the gland, and the digestion of food in the intestine almost stops. To stop this process, experts practice the treatment of pancreatitis by medicines with various properties: to eliminate symptoms, neutralization of enzymes in the gland or replenishing their lack of intestines. Special attention is paid to lifestyle and diet.

Fig. one

Content:

From how correct the choice of drugs, not only the result of therapy, but also the life of a person depends on. Incorrectly chosen preparations for pancreatitis are able to reduce the efforts of doctors to save the life of the patient. As a result of improper treatment, necrosis of the pancreas, diabetes can develop. There are often cases when an abscess is formed in the authority, the breakthrough of which leads to peritonitis, the formation of fistulas between the pancreas and located near the authorities. All these diseases are dangerous to the high risk of fatal outcome or a significant deterioration in the quality of the patient's life.

  • In case of disease, pill pancreatitis is selected taking into account the available symptoms, and the main purpose of their reception is to unload the pancreas and reducing its activity. Suspend the synthesis of digestive enzymes of organs helps the drugs of the following groups:
  • Blockers of proton pumps and inhibitors of H2-histamine receptors;
  • enzyme preparations with pancreatin;
  • Motropic spasmolyts;

Analgesics.

Fig. 2.

Which pills can be used in pancreatitis

This set of funds is sufficient to eliminate the inflammatory process and restoring the functions of the pancreas. Preparations of other groups (enterosorbents, funds that save from heartburn, antibiotics, etc.) are prescribed if necessary or complications.

This group of medicines does not affect the gland directly on the gland, but partially or completely stops the extraction of hydrochloric acid in the stomach. As a result of the reduction in its synthesis, the pancreas receives a signal that the body does not need digestive secretion. The slowdown in the body leads to a more rapid restoration of its functionality, and the risk of complications is reduced.

Fig. 3.

When choosing funds to reduce the secretion of hydrochloric acid, it is possible to make a choice in favor of drugs that block H2-histamine receptors or inhibitory proton pumps.

N2-histamine receptor blockers (Roxatidine, Ranitidine, Famotidine and Lafutidine) suspend only one mechanism for the production of hydrochloric acid in the stomach (on garbage and acetylcholine receptors such drugs do not affect), there are short time, have side effects and cause addictive.

Fig. four

Blockers receptors and proton pumps

Proton pump inhibitors ("omeprazole", "Pantoprazole", "Rabeprazole" and others) are more efficient and safe, do not cause side effects and addiction, there are long and suspend the formation and separation of hydrochloric acid, acting on the shelter cells of the stomach walls. Reviews of the effectiveness of these drugs in most cases are positive.

Enzymes - indispensable drugs for pancreatitis that allow you to restore the process of digestion and unload the pancreas. Drugs for pancreatitis of this group are represented by pills with pancreatin, including plant origin ("Pancreatin", "Mesim Forte", "Pepfaz", "Wobenzyme") and acid-resistant capsules with microgranules of the programmed release ("Creon", "Ermal", "Micrazim ").

Fig. five

When choosing enzyme preparations, the role plays not only the dosage of actors. Specialists pay attention to the course of the disease, the causes of its occurrence, the presence of concomitant diseases or intolerance to individual components.

Important! Tablets with a bile, turmeric extract and simeticone with pancreatitis are contraindicated, since they not only reimburse the lack of enzymes, but also enhance their synthesis in the pancreas, provoking inflammation.

The most efficient and safe drugs suitable for the treatment of pancreatitis, gastroenterologists call:

  • Fig. 6.
  • Capsules "Creon";
  • Capsules "Ermal";

Mikrazim capsules.

Enzyme preparations

The listed drugs are used in chronic pancreatitis, as well as in power errors to prevent exacerbations. Reviews of them in most cases are positive, but the likelihood of side effects during their reception is not excluded.

In acute inflammation of the pancreas or the exacerbation of the chronic process, it is important to eliminate pain syndrome. For this use analgesics and antispasmodics. The first is well coped with discomfort, which occurred during primary inflammation. Antispasmodics are also recommended to use with pain syndrome caused by the pressure of cyst, pseudokist and stones on the gland ductures.

Fig. 7.

  • Recommended to use analgesics in pancreatitis:
  • Paracetamol is an efficient and safe drug that does not irritate the gastric mucosa and helps reduce inflammation.
  • Analgin is a potent drug that is used independently or in a complex with spasmolitics.

Baralgin is similar in composition and action with analgic agent.

Preparations with anesthetic effect are not devoid of flaws. They can irritate the mucous membranes, cause allergies and affect the work of the cardiovascular system, liver and kidney. Therefore, they are prescribed, taking into account the individual characteristics of the patient. Nevertheless, the reviews about these painkillers are more often positive than negative.

  • If sharp pains appeared due to an increase in pressure in pancreatic ducts, analgesics will be ineffective. To eliminate symptoms, it is better to use antispasmodics:
  • Papaverin is a means based on the connection of the same name, which effectively relaxes the smooth muscles, from which the PJ dlys consist.
  • DROTAVERIN - Miotropic spasmolitic, which contributes to the restoration of pancreatic ducts under their spasme. It has a weakly pronounced anti-inflammatory effect.

Mebavverin (Duspatalin) is a drug with a pronounced and long effect, but acts mainly on the smooth muscles of the stomach, intestines and bile ducts. Its use is especially useful in secondary pancreatitis, arising against the background of the pathologies of the gallbladder.

Fig. 8

Each of the listed drugs is positively assessed by patients. In rare cases, the reviews contain negative, and often it is caused by non-quality of drugs, but their high cost.

Analgesics and antispasmodics

Experts note that antispasmodics require strict dosage, as they affect smooth muscles throughout the body, including myocardium, vascular walls, bladder. They are not prescribed patients with reduced arterial pressure, some types of arrhythmias, a bowel atony.

In addition to enzyme preparations and painkillers for pancreatitis, prebiotics based on soluble food fibers are recommended. They are needed to restore intestinal microflora and protect the pancreas from excessive load.

If the fibers and glucose, which stimulate the PZ stimulate the digestive secret and insulin are absorbed into the fiber digestive tract. Thanks to this, iron functions due to its capabilities, which allows it to recover faster. In addition, the soluble fiber is a good nutrient medium for useful microflora, as a result of which the absorption of the main nutrients in the thick intestine is improved.

Additional means

The source of soluble fibers can be all kinds of cabbage, citrus, apples, beans and pumpkin, zucchini and carrots, oat groats, prunes and whole grain bread. Unfortunately, most of the products listed during exacerbation are prohibited for receiving, as they cause bloating and violation of the chair. Replace them with rye bran or husky plantain. A more convenient and safe option is the "Smart Fireber" additive. The fiber in it has a powder structure, which is dissolved without a trace in any food and beverages, without changing the taste, color and consistency of the dish. On a day, it is enough to use one spoonful tool to cover the daily need for food fibers and get rid of the unpleasant feelings in the abdomen.

Make the right choice in the treatment of pancreatitis pills and soberly appreciate which one is better, can only the attending physician. Even the most expensive and modern medicine may not be suitable for a number of reasons: due to concomitant diseases, intolerance, the characteristics of the body.

A tool that helped a neighbor, a relative or friend can lead to serious complications. The lack of effect is less, which can happen when taking an incorrectly selected drug. The symptoms of pancreatitis may well join the problems with the heart, the brain, the blood system. Therefore, the choice of funds can only be entrusted with a gastroenterologist.

To reduce all sorts of risks, you need to tell the doctor about all diseases, intolerance to drugs and allergies (if any), recently transferred or existing diseases. It is also worth telling about which drugs are constantly being accepted, even if it is vitamins or biologically active food additives. This information will help you choose effective and secure funds in the desired dosage.

Overview

Chronic pancreatitis is a pancreatic disease associated with constant damage to its tissues under inflammation.

Whether pancreatitis is curing and what to do with exacerbationChronic pancreatitis can meet in people of different ages, but men are most often sick of 45-54 years. The prevalence of chronic pancreatitis among the Russian adult population is 3-5 cases per 10,000 people.

The most characteristic symptom of chronic pancreatitis are repeated pain in the abdomen, which may be intensive. Other signs of chronic pancreatitis depend on the degree of damage to the pancreas and in time increase. One of these symptoms is the formation of a chair with a greasy, greasy shine and a flicker smell.

If the inflammation of the gland is short-term, they talk about acute pancreatitis. Repeated cases of acute pancreatitis associated with the use of alcohol can sooner or later lead to the development of chronic pancreatitis.

Alcohol abuse is the cause of 7 out of 10 cases of chronic pancreatitis. This is due to the fact that alcoholism for many years has a multiple damaging effect on the pancreas.

  • Less common reasons:
  • smoking that increases the risk associated with pancreatitis alcohol;
  • problems with the immune system, when it attacks its own pancreatic cells;

Genetic mutation due to which the pancreas functions are violated, which can be inherited.

Approximately 2 cases out of 10 causes of chronic pancreatitis cannot be determined.

Pancreas

  • The pancreas is a small organ, in the form of a taller, located behind the stomach below the chest. It performs 2 important features:
  • The formation of digestive enzymes that are used in the intestine to digest food;

The production of hormones, the main of which is insulin, regulating the level of sugar (glucose) in the blood.

Treatment is mainly aimed at changing lifestyle (see below) and pain relief. If strong long-term pains are bothering, which are not removed by the reception of drugs, surgery may be required. It is noted that people who do not smoke and avoid alcohol, as a rule, feel less pain and live longer those who failed to get rid of these harmful habits after diagnosis.

Symptoms of chronic pancreatitis

In half patients with chronic pancreatitis, the pancreas is damaged so much that insulin cannot produce insulin, which leads to the development of diabetes. Patients with chronic pancreatitis refer to a group of increased risk of developing pancreatic cancer. Always contact the doctor if you are experiencing a strong abdominal pain - this is an important sign that something is wrong.

Repeated attacks of stomach pain are the most characteristic symptom of chronic pancreatitis. The pain usually arises in the center of the abdomen or in its left half and can spread (give) in the back. Most of the patients describe their pain as stupid and at the same time very strong. Pain lasts a few hours, and sometimes days. Pain occurs after meals, more often - for no reason.

The described attacks may be accompanied by nausea and vomiting. As the chronic pancreatitis, the attacks become heavier and frequent. In some cases, the pain remains between the attacks, only changing the character on light or moderate. It happens more often in people with pancreatitis, which cannot refuse alcohol despite their diagnosis. On the contrary, people who refuse alcohol and smoking can observe the decrease in the severity and frequency of episodes of pain. Progressive chronic pancreatitis

  • Over time, with chronic pancreatitis, the pancreas loses the ability to produce digestive juices, which are necessary for sprouting of food in the intestine. As a rule, it occurs years of years from the first manifestations of the disease. In the absence of digestive juice, fats and certain proteins are poorly digested, which leads to the appearance of a fetus chair with a fatty glitter, which is poorly washed off when the water is drained in the toilet. Other symptoms are observed:
  • weight loss;
  • loss of appetite;
  • jaundice (yellowing of the skin and scool);

Thirst, frequent urination, weakness, - symptoms of joining diabetes.

Always contact the doctor if you are experiencing a strong pain - this is an important sign that something is wrong. Doctor's help will need if you have jaundice. In addition to pancreatitis, jaundice has many other reasons, however, in any case, this is a sign of improper operation of the digestive system. You should also refer to the doctor in the event of constant (indomitable) vomiting.

Causes of chronic pancreatitis

A lot of causes of chronic pancreatitis have been studied, however, no more than 2 cases find them out of 10. The most frequent factors leading to the development of chronic pancreatitis are discussed below.

At least in 7 out of 10 cases, the development of pancreatitis is associated with the intake of alcohol, especially with long-term abuse of alcoholic beverages. Acceptance of alcohol causes episodes of acute pancreatitis. Acute pancreatitis usually goes quickly, but repeating time after time, under the action of permanent admission of alcohol, causes irreparable damage to the pancreas. Frequent inflammatory processes in the gland, in the end, cause the development of chronic pancreatitis.

Regular use of alcohol carries an increased risk of developing chronic pancreatitis, however, fortunately, the disease develops only in a few.

In rare cases, the occurrence of chronic pancreatitis is associated with a disease of the immune system, in which the immunity attacks its own pancreatic tissues. This disease is known as autoimmune pancreatitis, its reasons until late are not studied.

An autoimmune pancreatitis is often combined with other diseases when immune cells damage healthy fabrics. For example, Crohn's disease or ulcerative colitis that are associated with inflammation in the digestive system.

Sometimes chronic pancreatitis is inherited. It is believed that the cause of the hereditary forms of the disease are mutations (changes) in a number of genes, including PRSS1 and SPINK-1 genes. These mutations violate the normal operation of the pancreas. There is evidence that in some people, under the action of genetic mutations, pancreatic cells are becoming more vulnerable to alcohol.

  • Other, more rare causes of chronic pancreatitis are installed:
  • pancreatic injury;
  • blockage or narrowing of output pancreatic ducts;
  • smoking;

Radiation therapy of the abdomen.

Diagnosis of chronic pancreatitis

The final diagnosis of chronic pancreatitis can only be installed after the instrumental studies. But first, the doctor asks about complaints and conducts a simple inspection. If, according to the results of the inspection, it suspects chronic pancreatitis, an additional study is assigned to confirm the diagnosis.

  • Research that you can assign:
  • Ultrasonic research (ultrasound), during which, using sound waves, a picture of the inner structure of the pancreas is created;
  • Computed tomography (CT) - with this study, with a series of X-ray shots, a more accurate, three-dimensional image of the organ is created; Endoscopic ultrasonography (see below);

Magnetic resonance cholangiopancratography or MRHPG (see below).

During endoscopic ultrasonography in the stomach through the mouth, a flexible telescopic tube (endoscope) is carried out, at the end of which the ultrasonic sensor is located. Being in the immediate vicinity of the pancreas, the sensor allows you to create a high-precision image of the organ and its structure. During the procedure, as a rule, give a sedative (sedative) drug to help relax.

To get a clearer image of the pancreas and nearby organs, such as the liver and a gallbladder, an introduction of a contrast agent must be administered to the MRHP. To create detailed images of the internal organs, the magnetic resonance tomograph uses the magnetic field energy and radio waves. MRHPG makes it possible to estimate whether the causes of chronic pancreatitis stones in the gallbladder were caused.

Sometimes the symptoms of chronic pancreatitis and pancreatic cancer are very similar. Therefore, with the appearance of jaundice (yellow color of the skin and eye proteins) and weight loss to eliminate malignant neoplasm in the gland, biopsy is prescribed. Biopsy is the take of small samples of the pancreas cells and send them to the laboratory, where the material obtained is studied under a microscope in search of cancer cells.

To take biopsy, use a long thin needle, which is injected into the place of the intended tumor through the abdominal wall. To control the accuracy of the needle introduction use ultrasound examination or computed tomography. Alternatively, biopsy is possible during the endospopic ultosonography procedure (see above).

Treatment of chronic pancreatitis

Healing chronic pancreatitis is not possible, but with the help of treatment it is possible to control the course of the disease and reduce the severity of symptoms. If you were diagnosed with chronic pancreatitis, some lifestyle changes are recommended.

The most important thing you can do is to exclude alcoholic drinks from your life, even if alcohol is not the cause of your pancreatitis. This will prevent further damage to the pancreas and reduce the severity of pain. The continued intake of alcohol increases the likelihood of painful pain and the risk of death from complications of chronic pancreatitis.

  • People with alcohol addiction requires additional help and support to throw drinking. If this applies to you, talk to your doctor to help you find a way to combat alcoholism. For the treatment of alcoholism use:
  • Individual consultation of the psychologist;
  • Participation in mutual assistance groups, such as society "Anonymous Alcoholics";

The use of drugs that reduce the thrust to alcohol.

Read more about the common myths about alcohol and their exposure.

If you are subject to this bad habit, try to quit smoking. Smoking worsens the course of chronic pancreatitis, accelerating the violation of the pancreas function. The doctor may recommend antitabachic treatment, for example, replacement therapy with funds containing nicotine (NZT) or drugs that reduce craving for cigarettes. People who use drug therapy are easier to quit smoking than those who count only on their own power.

Since chronic pancreatitis leads to a disruption of food digestion, you may need to change the nature of nutrition, for example, limit the amount of fats in the diet. Your doctor will give you relevant recommendations for changing the diet, and if necessary, will send to a nutritionist.

Blockers receptors and proton pumps Medicinal treatment of chronic pancreatitis

containing artificial analogs of pancreas enzymes are used to improve digestion. Side effects may include diarrhea, constipation, nausea, vomiting and stomach pain. When developing side effects, tell us about this to your attending doctor, as you may need a dose correction of an enzyme preparation. Treatment with steroid (corticosteroid) hormones

which reduce inflammation, damaging the structure of the pancreas, is appointed in cases where the cause of chronic pancreatitis has become problems with the immune system. However, the reception of corticosteroids for a long time can lead to the development of complications, such as: osteoporosis (bone fragility) and weight gain. Package.

An important component of treatment with chronic pancreatitis is anesthesia. First, weak painkillers are prescribed. If they do not help, stronger preparations have to use.

In most cases, a paracetamol or a drug from a group of non-steroidal anti-inflammatory agents (NSAIDs), for example, ibuprofen is prescribed the first anesthetic drug. Long-term reception of the NSAID increases the risk of ulcers in the stomach, in connection with which you can additionally assign a proton pump inhibitors that protect from it.

If the NSAIDs or paracetamol does not sufficiently reduce the pain, it will be assigned opioid (narcotic) painkillers, for example, codewayin or tramadol. The side effects of this group of drugs include constipation, nausea, vomiting and drowsiness.

Publishers are particularly transported against the background of long-term treatment with opioid painkillers. In such cases, you can help the reception of laxatives. Read more about the treatment of constipation. If you feel drowsiness after taking opioid analgesics, avoid control of the machine or complex mechanisms.

If you are experiencing an attack of strongest pain, you may need even stronger drug, for example, morphine. Its side effects are similar to those of the above-mentioned opioid painkillers. Long-term techniques are not recommended for strong drug painkillers, as it can cause physical dependence on drugs. Therefore, if you are constantly experiencing severe pain, you will be offered surgical treatment.

In some cases, amitriptyline is prescribed as additional treatment. This drug was originally created for the treatment of depression, but some people helps to alleviate pain.

If the treatment is not effective, severe pain can be removed using the nervous blockade. This procedure helps facilitate a few weeks or months. The nervous blockade is an injection (injection), stopping the pains of pain that the pancreas sends.

Worsening state

In case of a sudden strengthening of inflammation in the pancreas, hospitalization is needed to the hospital for a short time. Hospital treatment will include the introduction of liquids into a vein, nutritional support using the probe (tube) and an additional suspension of oxygen to the nose on a special tube.

Surgical treatment of chronic pancreatitis

A surgical operation can be used to treat strong pain in chronic pancreatitis. The choice of surgical technique in each case depends the cause of the disease. Some of them are described below. Endoscopic intervention.

If pancreatitis is associated with the blockage of the withdrawal ducts of the pancreas with gap bubble stones, it is possible to carry out endoscopic treatment with lithotripsis. Lithotripsy is to destroy the stones using shock waves into smaller parts, which are then extracted using an endoscope (long thin tube, equipped with a light source, video camera and mini-tools at one end). This type of treatment to some extent makes it easier for pain, but the effect of the operation may be non-permanent. Pancreatic resection.

In cases where individual parts of the pancreas are inflamed and cause severe pain, they can be surgically removed. This type of operation is called pancreatic resection. Recreation is used when endoscopic treatment is inefficient. The resection technique depends on which parts of the pancreas are subject to removal. For example, some operations include simultaneous removal of part of the pancreas and gallbladder.

As a rule, all types of resection have approximately the same efficacy in terms of reducing pain and preserve the pancreatic function. However, the higher the complexity of the operation, the most likely the risk of complications, such as inner bleeding or infection, and a longer period of recovery after intervention. Discuss all the advantages and disadvantages of methods with your doctors before making a decision on the operation. Total pankettectomy (complete removal of the pancreas).

In the most severe cases of chronic pancreatitis, when most of the pancreas is damaged, it may be necessary to remove the entire organ. This operation is called total pancreatomy (complete removal of the pancreas). This is a very effective way to get rid of pain syndrome. However, after removal of the pancreas, your body will no longer be able to produce a vital hormone insulin. To cope with this situation, a new technique called Autogenous cell transplantation of the island of Langerhans is developed.

Complications of chronic pancreatitis

It lies in the fact that even before removing the pancreas, the cells of the Islands of Langerhans are extracted, which are responsible for the production of insulin. The cells are then mixed with a special solution and entered into your liver. In case of success, islet cells are coming out in the tissues of the liver and begin to produce insulin there. For a short time, transplantation is effective, but you may need to treat insulin preparations in the future.

Damage to the pancreas in chronic pancreatitis often leads to the development of complications in the future.

Approximately 50% of cases, chronic pancreatitis leads to the development of diabetes. This complication develops years after the diagnosis of pancreatitis (usually passes about 20 years before diabetes mellitus).

Diabetes occurs when the pancreas cells are no longer capable of synthesize insulin - a hormone, which is necessary for glucose cleavage in order to obtain energy. Main symptoms of diabetes:

If diabetes develops against chronic pancreatitis, you will need regular injections (injections) insulin to compensate for its absence in the body.

Any chronic disease, especially associated with constant pain, can have a negative effect on emotional and mental health. In the course of the study of patients with chronic pancreatitis, they found out that one of 7 people developed psychological and emotional problems: stress, anxiety or depression.

  • Another frequent complication of chronic pancreatitis are pseudokists are cavities (bubbles) filled with liquid on the surface of the pancreas. Pseudokists are formed in each fourth patient chronic pancreatitis. In most cases, pseudokists do not cause any symptoms and are a random find when CT-study (computed tomography). However, some people have pseudocysts:
  • bloating;
  • indigestion;

Stomach abdominal pain.

If the pseudokists of small sizes and do not cause any symptoms, then there is no need for treatment. They usually disappear independently. Pseudokists are subject to treatment more than 6 cm in diameter causing anxiety. In such cases, the risk of breaking cysts, internal bleeding or attachment infection.

The treatment of pseudokists is to remove fluid from it using the needle entered through the skin. An alternative is endoscopic drainage when through the mouth to the digestive system is carried out a thin flexible tube - an endoscope. The removal of the fluid is performed using special microinstructions.

Sometimes pseudokists are treated, removing part of the pancreas using a low-alignment operation - laparoscopic distal resection of the pancreas.

Chronic pancreatitis is associated with an increased risk of pancreatic cancer. However, in general, this risk is not great. It is believed that the pancreas cancer will only have 1-2 people from 100 patients with chronic pancreatitis. The most common initial manifestations of pancreatic cancer are almost the same as in pancreatitis. They include jaundice, pain in the stomach and weight loss.

What doctor to apply for chronic pancreatitis?

With the help of the service, you can find a good gastroenterologist who is engaged in the treatment of chronic pancreatitis. If there is no possibility to contact a specialist, find a wide profile doctor, such as the therapist or family doctor.

The aggravation of chronic pancreatitis is usually treated on the basis of gastroenterological departments of hospitals and specialized gastroenterological clinics. After reading the reviews, you can choose them yourself by clicking on the links.

Anatomy of the pancreas, chronic pancreatitis

If the operation takes place, find a good clinic of abdominal surgery or general surgery.

Pancreatitis is the inflammation of the tissues of the pancreas (PZh) with a violation of the outflow of its secrets. The disease is caused by poor passability of withdrawing ducts against the background of increased activity of enzyme systems. At the same time, the highlighted juices do not have time to go out into the lumen of the duodenum, but they accumulate and begin to digest their own gland tissues.

Over the past 10 years, the "popularity" of the disease increased 3 times and became a characteristic phenomenon not only for adults, but also for the younger generation. The most frequent causes are a disruption of the diet and the absence of a proper culture of alcoholic beverage consumption.

Causes of the disease

  • The main reasons for the development of pancreatitis:
  • Long and non-valid alcohol consumption. Ethyl alcohol increases the saturation of pancreatic juices and provokes a sphincter spasm that regulates their receipt to the duodenum. Statistics: 40% of patients with pancreatitis are sick alcoholism; 70% - periodically abuse alcohol.
  • Gallgamed disease - the biliary concretion is able to cause the blockage of the incoming ducts and cause inflammation of the iron tissue. Statistics: 30% of patients have a history of the stones in the gallbladder.
  • The violation of lipid metabolism associated with overeating and obesity leads to increased development of enzymes, which provokes the risk of inflammation. Statistics: 20% of cases are accompanied by overweight and lipid metabolic diseases.
  • Viral infections, including hepatitis, tuberculosis, chickenpox, vapotitis, corte, abdominal typhoids, etc.
  • Disturbance of calcium metabolism - hypercalcemia. Leads to sclerotization (hardening) of tissues of the gland with a violation of secretory function and spasp of ducts.
  • Autoimmune diseases - some types of allergies can provoke autoimmune antibodies to their own PJ cells.
  • Parasitic invasions - the accumulation of large parasites, for example, Askarid, can overlap the governing devices of the organ.
  • Damage to the ducts during injuries and during operations.
  • Poisoning or intoxication of the body - leads to overloading enzyme systems with excessive production of digestive juices.
  • Endocrine diseases - directly or indirectly affect the work of all glands of internal and external secretion. Particularly adversely affect the PJ disorders of the thyroid gland and diabetes.
  • The pathology of the structures of the digestive system - enterocolitis, colitis, duodenitis, diverticulitis, ulcerative disease, Reee syndrome (liver fatty).
  • Prolonged reception of some drugs - steroid preparations, certain types of diuretic products, antibiotics, sulfanimamides.
  • Vascular pathologies (arterial hypertension, atherosclerosis) with circulatory impairment in the pancreas area, as well as complications during pregnancy in women.
  • Hemolytic diseases - including hemolytic-uremic syndrome.
Pancreatitis

Hereditary pathologies (most often fibrousosis). The associated thickening of internal secrets, including pancreatic juices, leads to a violation of their outflow.

Causes of pancreatitis causes can manifest themselves independently or in the complex. This determines not only the etiology of the disease, but also the degree of its manifestation, the severity of the flow and therapeutic forecast.

Repeated attacks of acute pancreatitis provoke the transition of the disease into a chronic form. Because of the frequent inflammation, the organ is covered with a scar cloth (fibrous rebirth) and loses the ability to produce the desired amount of enzymes. If areas produce insulin (Langerhans islands) are damaged by damage, an insulin-dependent form of diabetes is developed.

How Pancreatitis is manifested: symptoms and signs

  • The main list of symptoms at acute form:
  • pronounced pain in the hypochondrium - taking into account the causes of the disease and accompanying pathologies may be concerning, right- or left-hand;
  • reactions from the digestive tract - Icota, belching with an unpleasant odor, nausea and multiple seizures of vomiting, constipation or diarrhea;
  • The general deterioration of the state is dehydration of the body, the feeling of dryness in the mouth, weakness, increase or decrease in blood pressure, shortness of breath, reinforced sweating, high temperature;

External manifestations - dim, earthy skin, blue, or brownish spots in the lower back area and the obsequency zone, can mechanical jaundice.

Attention! Acute form requires urgent hospitalization with subsequent hospital treatment.

  • In chronic form, the sign of pancreatitis is less pronounced:
  • pain is manifested only after receiving fried and fatty food or alcohol; The rest of the time in the field of hypochondriums may be observed light discomfort;
  • The reactions from the digestive system are manifested only during dyspeptic form in the form of meteorism, diarrhea or constipation;

External skin manifestations in the form of light yellowness; With a long lack of treatment, weighing loss, anemia, 2-type diabetes mellitus are observed.

In the latent stage, the disease proceeds asymptomatic; When fibrous form, the scar tissue can grow with the formation of pseudo-pumping structures. Important! Pancreatic pancreatitis

Rarely manifests as an independent disease. Usually, the pathological process combines several digestive organs, involving hepatobiliary system in it (liver, gallbladder and ducts), duodenum, stomach. This fact requires the diagnosis of the entire human digestive system.

How to examine

Diagnosis and treatment of pancreatitis are within the competence of the gastroenterologist. To make a diagnosis, the doctor collects history, conducts inspection and assigns diagnostic procedures.

Medical examination

  • The procedure includes an assessment of the condition of the skin, eye scool, language, the operation of the salivary glands. The patient is then placed on the couch and carry palpation and the awake to identify objective symptoms of pancreatitis:
  • The symptom of Mussi-Georgievsky, or Frainian-symptom - painful sensations when pressing the tips of the fingers in the region over the left clavicle - where the diaphragmal nerve is passed between the legs of the municipal muscles;
  • Sensitivity in the Zone of Shoffhara - in the area of ​​projection of the pancreas head, 5-6 cm above and the right of the navel;
  • The symptom of the governor-Sculiansky - pain is manifested in the zone of the body of the pancreas body, a little left of the Soffara zone;
  • The pain in the Meio-Robson zone is the left edge-vertebral angle - the area of ​​the attitude of the pancreas tail;
  • Symptom of dezharden - sensitivity at a point located on 5-6 cm above the navel of the line connecting the navel and the axillary depression; Like the Soffara zone, the point is the projection of the pancreas head;
  • The hypotrophic sign of Grotta is a lack of subcutaneous fatty fiber in the area of ​​the projection of the gland;
  • The hemorrhagic symptom of Thalilina, or the symptom of "red droplets", is manifested in the form of fine burgundy rashes or brown pigmentation over the area of ​​the gland;
  • The symptom of kaches is pain in palpation at the output of nerve processes at the level of breast vertebrae: 8-9th - left, 9-11 - right.

The symptom of Voskresensky - with an increase in the pancreas with an edema of the tag, the pulse of the abdominal aorta is not forgiven.

Together with the poll, the palpation allows you to determine the presence of dyspeptic phenomena from the digestive tract: meteorism, belching, nausea, diarrhea, constipation.

Attention! A sign of chronic pancreatitis can be a pronounced weight loss. It develops due to a violation of the food digestion process against the background of a decrease in the secretory function of the gland and the shortage of enzymes. Accompanied by increased dry skin, anemia, dizziness.

Diagnostic procedures

  • Laboratory diagnostic methods:
  • Common blood test identifies signs of inflammation - a high level of leukocytes, reduced ESP;
  • Biochemical blood test determines the level of pancreatic enzymes - amylases, alkaline phosphatase, as well as bilirubin pigment;
  • urine analysis shows the residual content of amylase enzymes and diastases;
  • DOG DIAGNOSTICS Estimates the activity of the digestive process by introducing substrates for pancreatic enzymes, followed by tracking their assimilation;
Causes of pancreatitis

An analysis of the feces on the parasites is carried out as needed.

  • Tool Methodology:
  • Ultrasound - determines the form and size of the organ, the presence of seals and fibrous sections;
  • Gastroscopy - assesses the degree of inflammation of the walls of the stomach and duodenum;
  • X-ray and its type - endoscopic retrograde cholangiopancatography - help to detect the clusters of clusters of clusters or stones causing blockage;
  • Protecting methods for determining the outer-generating function of the gland - the secretine-panoposimine test, the Lund test;
  • CT or MRI allows you to estimate the degree of tissue necrosis in heavy patients;

Laparoscopy is used in difficult cases for visual assessment and tissue biopsy.

How to treat pancreatic pancreatitis

  • Three rules for the treatment of this pathology - peace, cold and hunger:
  • Peace slows down blood circulation and reduces blood flow to the patient;
  • Cold compresses on the region of hypochondrium lower the temperature of inflammation and the severity of pain syndrome;

Fasting for 1-6 days suspends the production of enzymes causing inflammation.

Additionally, conservative treatment with the use of medicines, physiotherapy and phytotherapy is prescribed.

  • Medical treatment:
  • spasmolitics and NSAIDs to eliminate gastrointestinal spasms and inflamed pancreas;
  • antibiotics - with an active infectious process;
  • antisecretory preparations - to suppress external (enzyme) and internal (hormone) secretion;
  • Pancreatic enzymes - to maintain healthy digestion during the treatment period, as well as with a significant degeneration of the tissues of the gland;

Insulin preparations - when damaged hormone production zones.

  • Physiotherapy is connected to treatment after removing the acute phase of inflammation. The most effective techniques:
  • Electrophoresis with painkillers and anti-inflammatory drugs increases the intensity of their action, better relieves pain and inflammation;
  • Ultrasounds are used as an anesthetic with a sickening pain syndrome;
  • Dyadynamic currents - exposure to low-frequency pulses improve blood supply, enhances fabric exchange, anesthetics;
  • Laser and UV irradiation of blood remove inflammation, improve microcirculation of liquid media and tissue regeneration;

A variable magnetic field successfully helps to eliminate swelling and inflammation.

Fitotherapy is used as accompanying treatment - to enhance the effect of drugs and eliminate possible "sides". To this end, plants with anti-inflammatory, detoxification, antispasmodic, soothing effects are used. These include chamomile, calendula, St. John's wort, wormwood, dandelion, burdock, golden mustache, mother-in-law, immortelle, barbaris, cumin and a number of other herbs that are used as a one, and as part of comprehensive fees.

In severe cases, when conservative treatment methods do not help, resort to surgical removal of the organ or its part, followed by the appointment of substitution enzyme therapy on an ongoing basis. Indications: Full disintegration of the organ, the presence of cyst, necrosis, tumors, abscesses, fistula, resistant blockage of duct stones.

After removing acute inflammation, special diet food is prescribed. In chronic pancreatitis or in the case of surgical treatment of the gland, it must be lifelong.

Diet number 5 under pancreatitis With iron pancreatitis, it is not able to cope with a large set of diverse food, so the best way out is fractional separation.

Fully exclude products that stimulate increased secretion: fat, salty, fried, smoked, spices, chocolate, coffee, sturdy tea, meat, fish, mushroom broths, coarse fiber in the form of fresh fruits and vegetables, as well as any alcoholic beverages.

  • Strict diet number 5P (according to Pevznera) is relevant in the first days after exacerbations. Features:
  • fractional food with minor portions 8 times a day; The size of the one-time portion is not more than 300 g.;
  • Food structure - thermally processed, crushed in Cashitz products: mashed potatoes, kisins, puddings, mucous porridges on water, softened in chimneys;
  • Food composition - boiled in water or a pair of vegetables (carrots, potatoes, zucchini, pumpkin), low-fat meat and fish, low-fat dairy products, chicken squirrels, vegetable broths, pasta, cereals, semi-sweet berries and fruits; emphasis should be made on protein food with a reduced content of fats and carbohydrates;
  • Salt consumption is not more than 10 g per day; Instead of sugar, it is desirable to use a sugar substitute;

The food must be warm - a temperature of 20-52 degrees; Hot and cold is impossible!

  • When remission reaching, the diet requires a little softened:
  • The number of food meals are reduced to 5 times a day with increasing portions;
  • It is allowed to use non-grinding products, stewed and baked dishes, milk kas;

You can increase the amount of carbohydrates.

Attention! Of great importance is the disclaimer of smoking, especially if the disease is triggered by the poor state of the vessels.

Diagnosis of pancreatitis

A single case of acute pancreatitis with timely and high-quality treatment may pass without consequences for the body. When moving the disease in chronic form, the full recovery of the PZ is impossible. However, when compliance with strict diet and recommendations on drug treatment, you can achieve a resistant remission with a significant improvement in the quality of life.

We will help with the choice of drugs in pancreatitis

Improper nutrition, alcohol abuse and a sedentary lifestyle can provoke the attack of pancreatitis from any person. To avoid the development of mortal pathology, it is important to know the reasons that are causing it, and be able to recognize the symptoms on time.

What is pancreatitis and what it is dangerous

Pancreatitis is called a group of diseases with certain symptoms for which inflammation of the pancreas is characteristic. In this state, the enzymes produced by this body do not go to the duodenum. As a result, their active action begins in the gland itself, provoking its self-extinguishing. This process negatively affects the work of other organs, since the toxins allocated during slow destruction fall into the bloodstream.

For this reason, acute pancreatitis is treated immediately and in the hospital. Among men, the disease occurs more often than among women. The highest risk of developing the disease in older people and in persons with overweight.

The danger of pathology is that when tightening with treatment, pancreatitis quickly goes into a difficult form. From blockage of ducts and increase the pressure in them, the fracturing of the body of the body of the body begins. Next, a fatty fiber surrounding the iron, and organs located in the abdominal cavity are involved in the process. In the absence of adequate therapy, a patient begins a pancreatogenic aseptic peritonitis, the outcome of which can be lethal.

Basic forms of the disease

By the nature of the course, pancreatitis may be:

Acute pancreatitis can be accompanied by a sudden pancreatic edema (interstitial pancreatitis), hemorrhage in tissue (hemorrhagic pancreatitis) or seal with decay foci (acute pancreaticosis).

Cholecystopancatite develops in the presence of a patient acute cholecystitis.

When revealed in the gland foci of purulent content, purulent pancreatitis is diagnosed. The listed forms of the disease over time can transform from one to another.

For acute pancreatitis, inflammatory changes in tissues with necrosis foci are characterized, fibrosis and atrophy begins. With a more severe course, the abscess and the risk of death of the patient even with adequate treatment appears.

In chronic pancreatitis, the disease progresses slowly, the function of the gland is violated gradually. The inflammatory process may affect both the organ as a whole and its part. At the same time, the food digestion function weakens, and remission and exacerbation of the disease replace each other.

  • Chronic pancreatitis may leak:

  • asymptomatic with preservation of normal well-being;

  • with pain in the top of the abdomen;

With pain only during recurrence.

If acute pancreatitis is accompanied by the exacerbation of the pathologies of the stomach, gallbladder or liver, then the diagnosis of jet pancreatitis is made.

Causes and symptoms of pancreatitis

  1. The main causes of pancreatitis:

  2. Eating very sharp, fried and fatty dishes.

  3. Overeating.

  4. Presence in the Fastfud menu, monotonous products.

  5. Alcohol poisoning is chronic or acute.

  6. Strong nervous excitement.

  7. Cholelithiasis.

  8. Injuries and surgical operations.

  9. Viral diseases.

Endoscopic interventions.

The risk group for the development of the disease is the persons abused by alcoholic beverages, pregnant women and young mothers in the period after delivery.

Chronic form is often developing after a sharpness of the disease or as a consequence of cholecystitis, liver pathologies, intestines or ulcerative disease.

The symptoms of pancreatitis are manifested in different ways depending on the form of the disease. The main sign of acute form is a strong pain in the field of right / left hypochondrium or under the spoon, may be constant, stupid or cutting. With the defeat of the entire body, the pains are clothing. The progression of pathology leads to the strengthening of pain, can become unbearable and cause shock.

Additional features include: Icoto, nausea, vomiting bile, belching, dryness in the oral cavity, a stolen chair with an unpleasant smell.

In the absence of medical care, the patient's condition is worse rapidly. Against the background of the pulse, blood pressure is reduced, the body temperature rises, shortness of breath and sticky sweat appears, the skin is pale and becomes gray. A characteristic feature when inspection is a swollen stomach and lack of intestinal cuts and stomach.

  • For chronic form of pancreatitis, characteristic:

  • The pain in the left hypochondrium with the impact in the chest or in the blade, under the spoon - during the period of exacerbation.

  • Singing pain - both stupid and sharp.

  • Strong vomiting after consuming oily food.

  • Cappy body weight loss.

  • Dry mouth and nausea.

Ponom.

During the period of remission, the patient may nauseate, disturb the stupid pain and constipation.

Treatment of inflammation of the pancreas

Attachment of acute pancreatitis is an indication for hospitalization to the department of surgery for a thorough examination, prescribing drugs and find under medical supervision. The earlier treatment started, the smaller the risk of complications.

  1. Therapy of the acute state includes:

  2. Full rejection of food in the first 3-5 days.

  3. From the second day it is recommended to drink mineral alkaline water in a volume of at least two liters per day.

  4. Gradual input into the diet of liquid porridge.

  5. Food with small but nutritional portions (cottage cheese, low-fat boiled fish, steam cutlets, yogurt, 1 banana, cheese).

Under the ban: Fresh vegetables, milk, sausage, eggs, fat broths, coffee, fried, sharp dishes.

Important! A diet must be adhered to at least 3 months, and with a severe form of the disease - 1 year.

Depending on the state of the patient in the hospital, detoxification, cleaning of the kidneys, intestines and peritoneum is carried out. In infectious complication, an operation is carried out.

Atropine or platifilin are prescribed from drugs to reduce the production of hormones with pancreas, fluorouracil or ribonuclease to brake the function of the organ, the antifimensions of the city forces or conficure, as well as antibiotics.

After the patient is discharged, put pressure on a gastroenterologist appointing treatment in order to prevent recurrence.

With exacerbation of chronic pancreatitis, fasting is also shown with the introduction of nutrients intravenously. To reduce the secretion of pancreatic enzymes, you can put a bubble with ice on the abdomen area. Otreotide or somatostatin are prescribed from drugs to reduce the production of enzymes, painkillers and antispasmodic preparations, omeprazole or ranitidine to reduce the secretion of the stomach. After exiting a hungry diet, enzymes are taken - pancreatin, mezim-forte. To relieve nausea - Cerukal or Motilium. When complicated, antibiotics are prescribed infection.

  • During the remission, you need:

  • To completely eliminate alcohol.

  • Feed 5-6 times a day in small portions.

  • Exclude coffee, tea, gas, fried and acute food, welded broths, marinades.

Use low-fat meat and fish, low-fat cottage cheese and unshakful cheese.

If chronic pancreatitis is accompanied by non-compatible pain, bleeding or suspected cancer, then the operational treatment is shown.

Pancreatitis is inflammation of the pancreas (the body responsible for the production of digestive juice).

The pancreas in the human body performs a very important function: produces enzymes, which, falling into a small intestine, are activated and involved in digesting proteins, fats and carbohydrates. The organ produces hormone insulin, which regulates blood glucose levels.

Pancreatitis forms

Acute - characterized by an acute sling of pain in the top of the abdomen. Often pain appears after consuming oily food or alcohol. An unpleasant feeling can be both barely noticeable and unbearable with irradiation in a blade or sternum. There is nausea, vomiting, stool violation. Because of the difficult outflow of bile, the skin takes a yellowish color.

Chronic - the main localization of pain is located on the top of the abdominal wall with irradiation in the back, chest (left part), the lower part of the abdomen. An unpleasant sensation occurs after taking oily heavy foods, alcoholic beverages, constant stress.

The development of chronic pancreatitis is characterized by nausea, loss of appetite, bloating, stool violation, sometimes vomiting.

The chronic form of pathology differs from acute periods of remission and exacerbation. Over the course of the disease, the exacerbation periods become increasingly, the development of intestinal disorders, violations of normal digestion, a decrease in body weight is possible.

Chronic pancreatitis often gives complications (gastric bleeding, cancer, cysts and abscesses, liver damage, diabetes, enterocolitis). That is why the disease should be treated seriously and with the slightest suspicion of the development of inflammation, consult a doctor.

Causes of pancreatitis development

  • The disease is developing due to the damage to the pancreas tissues. This happens for the following reasons:

  • Alcohol and Tobacco Abuse

  • Belly injuries, surgical interventions

  • Uncontrollable and long-term reception of medicines: antibiotics, hormonal drugs, corticosteroids, some diuretics

  • Incicacy of food products, chemicals

  • Genetic predisposition

Incorrect diet with a predominance of acute and greasy meals and with large interruptions between meals

Pancreatitis: Causes, Symptoms and TreatmentSymptoms of pancreatitis

  • The manifestations of pathology differ depending on the form - acute or chronic pancreatitis. In acute pancreatitis, there are:

  • The pain is intense, constant, the nature of pain is described by patients as cutting, stupid.

  • High body temperature, high or low pressure - the patient's well-being is worse rapidly due to the rapid development of the inflammatory process.

  • Pale or yellowish faces.

  • Nausea and vomiting - dryness appears in the mouth and white rings, the attacks of vomiting do not bring relief. The most correct step at this point is to starve, any reception can only worsen the situation.

  • Diarrhea or constipation - a chair in acute pancreatitis most often foamy, frequent with a mowing smell, with particles not digestible food. There are both the opposite, bloating, hardening the abdominal muscles, which may be the very first signal of a starting acute attack of pancreatitis.

  • The bloating of the stomach and the intestines during the attack are not reduced.

Dyspnea - appears due to the loss of electrolytes during vomiting.

  • Chronic pancreatitis is characterized by the following features:

  • Abdominal pain - can be encircling or have a clear localization with irradiation in the back. Appears after eating.

  • Intoxication of the body - a general weakness appear, a decrease in appetite, tachycardia, an increase in body temperature, decrease in blood pressure.

Endocrine disorders - ketoacidosis, diabetes, tendency to hypoglycemia. Bright red spots in the area of ​​the abdomen, back, chest, which are not disappeared upon pressing, may also appear.

With a long-term course of the disease, the patient gradually arises anemia, loss of body weight, dry skin, hair and nail fragility, avitaminosis symptoms, increased fatigue.

First aid in the attack of pancreatitis

To reduce pain, you can use a heap filled with cold water. It must be applied to the abdomen area, namely, to the epigastric area (area under a mildo-shaped process, corresponding to the projection of the stomach on the front abdominal wall). This reduces the intensity of pain, remove swelling and inflammation.

The patient must be observed the hospital mode. This will reduce blood flow to the organ, which means reduce inflammation.

It is forbidden to eat. The digestion process may cause stronger pain, nausea and vomiting appear. A diet will reduce the production of enzymes that enhance the inflammatory response and pain. Adheres to starvation you need 3 days. You can drink clean water without gases.

It is necessary to call a doctor for inspection, even if the patient is definitely not sure that it is an attack of acute pancreatitis. As we already know, this pathology can sink, and then rapidly recur. At this time, you can drink an anesthetic drug to reduce unpleasant sensations.

Diagnosis of the disease to the Private Medical Clinic "Medunion"

Diagnose this disease is not difficult, since the first signs speak for themselves. However, to assign adequate treatment, it is necessary to determine the form of the disease. For this, the doctor conducts laparoscopy - a method that allows you to examine the abdominal cavity from the inside with the help of a special tool.

  • In suspected acute pancreatitis, laboratory tests are carried out:

  • General blood analysis

  • Blood chemistry

  • Analysis of urine

  • Analysis of Cala

  • Ultrasound, MRI or radiography of abdominal organs

Computer tomography on testimony

In chronic form, the same studies are carried out, but it is better to take tests during the exacerbation of the disease.

Treatment of acute pancreatitis

When discovering acute patient pancreatitis, it is necessary to immediately hospitalize. Treatment should be held in the hospital, as this condition is very dangerous.

Antispasmodics are taken to remove pain, in difficult cases, the contents of the stomach content for removing the load on the gland are pumped.

With the exacerbation of pancreatitis, patients need hospitalization with daily over the first week by the control of blood parameters, water balance, leukocyte numbers, serum enzymes. In the first 1-3 days, hunger is recommended, alkaline solutions receiving every 2 hours.

During the exacerbation of chronic pancreatitis, the patient shows therapy similar to the acute process. The patient should abide by the diet throughout the life and take drugs from the group of spasmolitics and drugs that normalize the secretory function of the organ.

The most important thing in the chronic form of the disease to maintain a diet, which implies an exception from the diet of greasy and fried foods. With the slightest violation of the regime in the patient, unpleasant sensations and nausea can begin. With intense pain, the doctor prescribes antispasmodics. Antisecretory therapy can be used short course.

Stomach pain and high temperatureDiet with pancreatitis

With any form of the disease, the patient is assigned a strict diet "Table No. 5P", according to which it is forbidden to eat acute and fried food. All dishes are prepared for a pair, boiled or baked. Alcohol and smoking are also prohibited.

It is also necessary to limit the consumption of salt, to eat in small portions 6 times a day. Dishes should always be fed in warm form. It is necessary to eliminate all products with a high content of extractive substances or essential oils (fish, meat broths, cocoa, coffee, etc.), fresh berries, vegetables, greens, fruits, fruits, acidic juices, carbonated drinks, marinades.

Where to pass the treatment of pancreatitis in Krasnoyarsk?

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