Pancreatitis is an acute or chronic inflammation of the pancreatic tissue with subsequent violation of the organ's secretory and endocrine functions. Most often, the development of the pathology is associated with the systematic use of large amounts of alcohol, smoking, cholelithiasis.
During an exacerbation of pancreatitis, a person experiences intense and prolonged pain in the upper part of the abdomen, his digestion is disturbed, and yellowing of the skin and mucous membranes may appear.
Treatment includes following a diet, taking medication that facilitates the digestion of food, pain relievers. In some cases, surgery may be necessary.
According to statistics, in general, the prevalence of the disease does not depend on sex. However, acute alcoholic pancreatitis is more common in men, which is associated with greater alcohol dependence in this population. The disease mainly affects people of working age from 30 to 50 years old. In women, the development of pancreatitis is most often caused by gallstones.
The reasons
The disease can be caused by toxic effects, autoimmune processes, have a hereditary predisposition or become a complication of gallstones. Alcohol abuse, smoking, and obstruction of the bile ducts by gallstones are the most common causes of pancreatitis. In the latter case, the flow of the digestive secret from the pancreas to the duodenum is disturbed, which leads to stagnation and "self-digestion" of the organ.
The breakdown products of ethyl alcohol have a direct toxic effect on the cells of the pancreas, as do various drugs (estrogens, sulfonamides, tetracycline, erythromycin, thiazides, mercaptopurine). In addition, systematic alcohol abuse is accompanied by a thickening of the bile, which predisposes to impaired permeability of the bile ducts. Nicotine dependence also predisposes to the development of the disease, as it affects the cardiovascular system, causing narrowing of the vessel lumen and decreased blood flow to the organs.
Damage to the pancreas is also related to heredity, in particular, it can be genetically determined or caused by congenital developmental anomalies. Autoimmune pancreatitis occurs alone and in combination with Sjögren's syndrome, inflammatory bowel disease, and many other autoimmune disorders.
Classification
Depending on the nature of the course of the disease, acute or chronic pancreatitis is distinguished. Due to the occurrence, it happens:
- toxic (alcoholic, infectious, medicinal);
- biliary;
- dysmetabolic;
- autoimmune;
- idiopathic;
- post traumatic.
According to the clinical manifestations, pancreatitis occurs in mild, moderate or severe forms.
Symptoms
Clinical manifestations of the disease are associated not only with damage to the organ itself, but also with a violation of its secretory and endocrine functions. In acute pancreatitis, symptoms are pronounced:
- Severe pain in the epigastric region, left hypochondrium, of a local or surrounding nature, often extending under the left shoulder blade. Unpleasant sensations are aggravated in the supine position and after a dietary error.
- Increased salivation, belching, nausea, frequent vomiting that does not bring relief.
- Increase in body temperature. Perhaps the onset of fever, chills.
- Change in skin color and mucous membranes. Moisture and pallor of the skin, moderate yellowing of the sclera are often observed. In rare cases, the skin also acquires a yellowish hue. Perhaps the appearance of bluish spots on the body, bleeding from the navel.
- Dyspeptic manifestations - bloating, heartburn.
- Irritability, crying, in severe cases pancreatogenic psychosis develops.
Chronic pancreatitis is characterized by periods of exacerbation and remission, has a staged course. In the preclinical phase, there are no symptoms of the disease, changes in the pancreas become an incidental finding during an ultrasound of Organs abdominal organs. During the period of initial manifestations, repeated episodes of exacerbation of pancreatitis with characteristic manifestations of the acute form of the disease are observed. Gradually, its frequency decreases, but symptoms persist in the interictal period: abdominal pain, episodic vomiting, nausea, diarrhea, flatulence.
In the stage of persistent symptoms, there is pain in the upper half of the abdomen, often of a waist character. The patient loses weight, mainly due to food refusal due to fear of increased pain. Increased manifestations of secretory and endocrine insufficiency, such as indigestion, hyperglycemia.
In the future, atrophy of the pancreas occurs. Pain may become less intense or absent, the frequency of pancreatitis attacks is reduced. The stool becomes soft, foul-smelling, with a greasy sheen. Exhaustion is observed, pancreatogenic diabetes develops. In the last stage, systemic complications occur, possibly malignant degeneration of the tissue 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 long-term progressive course of pathology, violations of bile outflow are possible, followed by obstructive jaundice, abscess formation, cysts, development of portal hypertension, pancreatogenic diabetes mellitus, parapancreatitis, "enzymatic" cholecystitis, pneumonia, exudative pleurisy, paranephritis, pancreatic cancer.
The consequences of an acute process can be:
- peritonitis;
- septic phlegmon of retroperitoneal tissue;
- arrosive bleeding in the organs of the digestive tract, bleeding in the abdominal cavity;
- mechanical jaundice;
- ascites;
- formation of internal and external digestive fistulas, abscesses and infiltrates.
In severe cases, shock, multiple organ failure with a high risk of death can occur.
Diagnosis
The identification and treatment of pancreatitis is performed by a general practitioner and a gastroenterologist along with an endocrinologist, a surgeon, and other specialists. Often, patients with an acute form of the disease by emergency medical care end up in a surgical hospital, where a differential diagnosis of pancreatic lesions with acute appendicitis, cholecystitis and other pathologies is carried out.
After clarifying the complaints, collecting an anamnesis, including the nature of diet, bad habits, frequency of relapses, concomitant diseases of the biliary system and examination, the doctor refers the patient for examinations, as well as instrumental studies.
As part of a laboratory study of a patient, the following are performed:
- General clinical analysis of blood. There are signs of inflammation: ESR acceleration, leukocytosis.
- Blood biochemistry. For damage to the pancreas in pancreatitis, an increase in enzyme activity (amylase, lipase), hyperglycemia, hypoalbuminemia and hypocalcemia, bilirubinemia, as well as an increase in liver enzyme activity (ALT, AST, transaminase), CRP are possible.
- Biochemical study of urine. It is performed to determine the activity of amylase in the urine.
- co-program. characteristic steatorrhea.
- Determination of pancreatic elastase in feces.
Instrumental diagnosis of pancreatitis includes:
- Ultrasound of abdominal organs is a method of visualizing the gland itself and adjacent organs;
- SCT and MRI of internal organs to obtain more detailed information about anatomical changes in them;
- endoscopic retrograde cholangiopancreatography to visualize the lumen of the ducts, remove pancreatic secretions, remove stones;
- endoscopic elastography of the pancreas - allows you to determine the stiffness and stiffness of the tissue, assess the degree of replacement of the connective tissue and the secretory function of the organ;
- esophagogastroduodenoscopy to assess the condition of hollow digestive organs.
Treatment
Medical help should be sought at the first signs of pancreatitis, so the chance of avoiding complications and the transition of the disease to a chronic form will be greater. During an exacerbation of the disease, fasting is recommended.
All patients suffering from pancreatitis must follow a diet, give up alcohol and smoking. In the interictal period, you should eat in small portions several times a day, including in the diet mainly foods rich in protein and complex carbohydrates, dietary fiber and vitamins.
Drug therapy involves taking drugs from the following groups:
- analgesics for pain relief in pancreatitis;
- pancreatic enzymes;
- inhibitors of hydrochloric acid secretion in the stomach;
- sedatives and antidepressants;
- antibiotics;
- insulin;
- vitamins.
With a complicated course of the disease, as well as in some cases of acute abdominal pain, endoscopic or surgical intervention is indicated.
Prevention
The primary prevention of pancreatitis is to avoid alcohol, eat a varied diet that is low in fat, saturated fat and cholesterol, including grains, vegetables and fruits in the diet, and not to smoke.
Acute pancreatitis can develop not only in people who regularly abuse alcohol, but also as a result of a single intake of alcohol-containing beverages for fatty, fried and spicy snacks in large quantities. Fractional and adequate nutrition in pancreatitis serves to prevent exacerbations of its chronic form.