Pancreatitis is an acute or chronic inflammation of the pancreatic tissue with subsequent violation of the secretory and endocrine functions of the organ. In most cases, the development of pathology is associated with the systemic use of heavy drinking, smoking, and cholelithiasis.
During exacerbations of pancreatitis, a person experiences prolonged severe pain in the upper abdomen, his digestion is disturbed, and yellowing of the skin and mucous membranes may occur.
Treatment includes dieting, taking medicines that promote digestion, and pain relievers. In some cases, surgery may be required.
According to statistics, in general, the prevalence of the disease has nothing to do with gender. However, acute alcoholic pancreatitis was more common in men and was associated with greater alcohol addiction in this population. The disease mainly affects people of working age between the ages of 30 and 50. In women, the development of pancreatitis is more common with gallstone disease.
reason
The disease may be caused by toxic effects, autoimmune processes, having a genetic predisposition or becoming a complication of gallstone disease. Alcoholism, smoking, and gallstones blocking the bile ducts are the most common causes of pancreatitis. In the latter case, the flow of digestive secretions of the pancreas into the duodenum is disturbed, causing it to stagnate and the organ to "self-digest".
The decay products of ethanol have direct toxic effects on pancreatic cells and many drugs (estrogens, sulfonamides, tetracyclines, erythromycin, thiazides, mercaptopurines). In addition, the systemic abuse of alcohol is accompanied by thickening of bile, which predisposes to impaired bile duct patency. Nicotine addiction is also prone to the development of the disease because it affects the cardiovascular system, resulting in narrowing of the lumen of the blood vessels and reduced blood flow to the organs.
Damage to the pancreas is also genetically related, and in particular can be genetically determined or caused by congenital developmental abnormalities. Autoimmune pancreatitis can occur alone or in combination with Sjögren's syndrome, inflammatory bowel disease, and many other autoimmune diseases.
Classification
Depending on the nature of the disease process, acute or chronic pancreatitis is distinguished. It happens because of:
- Toxic (alcoholic, infectious, medicinal);
- biliary tract;
- metabolic abnormalities;
- self-immune;
- idiopathic;
- post trauma.
Depending on the clinical presentation, pancreatitis can be mild, moderate, or severe.
symptom
The clinical manifestations of the disease are not only related to damage to the organ itself, but also to the disruption of its secretory and endocrine functions. In acute pancreatitis, symptoms are evident:
- Severe upper abdominal pain, left flank, localized or circumscribed, often extending below the left scapula. The unpleasant feeling is exacerbated after lying on the back and eating wrong.
- Increased salivation, belching, nausea, and frequent vomiting do not relieve symptoms.
- Elevated body temperature. Maybe a fever or chills.
- Changes in skin and mucous membrane color. Moist and pale skin and moderate yellowing of the sclera were frequently observed. In rare cases, the skin can also appear yellowish. Maybe blue spots on the body, bleeding from the belly button.
- Manifestations of indigestion - bloating, heartburn.
- Irritability, tearing, and in severe cases pancreatogenic psychosis.
Chronic pancreatitis is characterized by episodes and remissions, with a phased course. In the preclinical stage, with no symptoms of the disease, changes in the pancreas become unexpected findings during ultrasound scans of abdominal organs. During the initial presentation, recurrent episodes of worsening pancreatitis with characteristics of the acute form of the disease are observed. Gradually, they become less frequent, but symptoms persist between episodes: abdominal pain, occasional vomiting, nausea, diarrhea, gas.
During the persistent symptom stage, there is pain in the upper half of the abdomen, usually in the form of a band. The patient loses weight, especially refuses to eat for fear of increased pain. Increased performance of secretion and endocrine insufficiency, such as indigestion, hyperglycemia.
Pancreatic atrophy will occur in the future. Pain may become less intense or go away, and pancreatitis attacks may be less frequent. Stools become mushy, foul-smelling, and have a greasy sheen. Exhaustion was observed, and pancreas-derived diabetes developed. In the final stage, systemic complications occur, possibly malignant degeneration of the affected organ tissue.
complication
Depending on the form, severity, and stage of the disease, there is an increased risk of developing certain complications of pancreatitis. With long-term progression of the pathology, bile outflow may be violated, followed by obstructive jaundice, abscess formation, cysts, portal hypertension, pancreatic diabetes, parapancreatitis, "enzymatic" cholecystitis, pneumonia, exudative pleurisy, paranephritis, pancreatic cancer.
The consequences of an acute process can be:
- peritonitis;
- Septic sputum of retroperitoneal tissue;
- Acute hemorrhage of the organs of the digestive tract, abdominal hemorrhage;
- mechanical jaundice;
- ascites;
- Formation of internal and external gastrointestinal fistulas, abscesses and infiltration.
In severe cases, shock, multiple organ failure and a high risk of death may occur.
diagnosis
The identification and treatment of pancreatitis is carried out by general practitioners and gastroenterologists in conjunction with endocrinologists, surgeons and other specialists. Often, patients with acute illness through urgent medical care end up in a surgical hospital, where pancreatic lesions are differentially diagnosed from acute appendicitis, cholecystitis, and other pathologies.
After clarifying the chief complaint and collecting medical records, including nutritional properties, bad habits, frequency of recurrence, concomitant diseases of the biliary system, and examination, the doctor instructed the patient to conduct examinations and instrumental examinations.
As part of laboratory studies on patients, the following will be performed:
- General clinical analysis of blood. There are signs of inflammation: accelerated ESR, leukocytosis.
- Biochemistry of blood. For damage to the pancreas from pancreatitis, increased activity of enzymes (amylase, lipase), hyperglycemia, hypoalbuminemia and hypocalcemia, bilirubinemia, and liver enzymes (ALT, AST, transaminases), CRP activity increased is possible.
- Biochemical studies of urine. Measurement of amylase activity in urine was performed.
- coroutines. Characteristic steatorrhea.
- Determination of pancreatic elastase in stool.
Instrumental diagnosis of pancreatitis includes:
- Ultrasound of abdominal organs is a method of visualizing the glands themselves and surrounding organs;
- SCT and MRI of internal organs to obtain more detailed information about their anatomical changes;
- Endoscopic retrograde cholangiopancreatography to visualize the lumen, remove pancreatic secretions, and remove stones;
- Endoscopic elastography of the pancreas - allows you to determine the stiffness and stiffness of the tissue, assess the degree of its connective tissue replacement and the secretory function of the organ;
- Esophagogastroduodenoscopy to assess the condition of hollow digestive organs.
treat
Medical help should be sought at the first signs of pancreatitis, then the chances of avoiding complications and the disease transitioning to a chronic form are higher. During exacerbations of the disease, fasting is recommended.
All patients with pancreatitis must diet, stop drinking and smoking. Between episodes, you should eat fewer meals a day, including foods that are primarily high in protein and complex carbohydrates, dietary fiber, and vitamins in your diet.
Medication includes taking medicines from the following groups:
- Analgesics for pancreatitis pain relief;
- Pancreatin;
- Inhibitors of hydrochloric acid secretion in the stomach;
- Sedatives and antidepressants;
- antibiotic;
- insulin;
- vitamins.
For complex disease processes, and in some cases of acute abdominal pain, endoscopic or surgical intervention is required.
prevention
Primary prevention of pancreatitis is avoiding alcohol, eating a varied diet low in fat, saturated fat, and cholesterol, including a diet of grains, vegetables, and fruits, and not smoking.
Acute pancreatitis can occur not only in people who drink heavily, but can also lead to fatty, fried, and spicy snacks from a single intake of large amounts of alcoholic beverages. Fractions in pancreatitis, proper nutrition prevents the exacerbation of its chronic form.