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 pathology is associated with the systematic use of large amounts of alcohol, smoking, cholelithiasis.
During an exacerbation of pancreatitis, a person experiences prolonged intense pain in the upper abdomen, his digestion is disturbed, and yellowing of the skin and mucous membranes may occur.
Treatment includes following a diet, taking medications that facilitate the digestion of food, painkillers. In some cases, surgery may be required.
According to statistics, in general, the prevalence of the disease does not depend on gender. 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 more often caused by gallstone disease.
The disease can be caused by toxic effects, autoimmune processes, have a hereditary predisposition or become a complication of gallstone disease. Alcohol abuse, smoking, and blockage of the bile ducts by gallstones are the most common causes of pancreatitis. In the latter case, the exit of the digestive secretion of the pancreas into the duodenum is disturbed, which leads to its stagnation and "self-digestion" of the organ.
The decay products of ethyl alcohol have a direct toxic effect on pancreatic cells, as well as a number of drugs (estrogens, sulfonamides, tetracycline, erythromycin, thiazides, mercaptopurine). In addition, the systematic abuse of alcohol is associated with a thickening of the bile, which predisposes to damage the patency of the bile ducts. Nicotine addiction also predisposes to the development of the disease, as it affects the cardiovascular system, causing the narrowing of the lumen of the vessels and the reduction of blood circulation in the organs.
Damage to the pancreas is also related to heredity, in particular, it can be genetically determined or caused by congenital developmental abnormalities. Autoimmune pancreatitis occurs both in isolation and in combination with Sjögren's syndrome, inflammatory bowel disease, and many other autoimmune disorders.
Depending on the nature of the course of the disease, acute or chronic pancreatitis is distinguished. Due to the phenomenon, it happens:
- toxic (alcoholic, infectious, medicinal);
In accordance with the clinical manifestations, pancreatitis occurs in mild, moderate or severe forms.
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, the symptoms are pronounced:
- Intense 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 lying position and after a mistake in the diet.
- Increased salivation, belching, vomiting, frequent vomiting that does not bring relief.
- Increase in body temperature. Perhaps the appearance of fever, chills.
- Change in the color of the skin and mucous membranes. Moistness and pallor of the skin, moderate yellowing of the sclera are often observed. In rare cases, the skin also takes on a yellow tint. Perhaps the appearance of bluish spots on the body, hemorrhages in the navel.
- Dyspeptic manifestations - bloating, heartburn.
- Irritation, tears, in severe cases pancreatogenic psychosis develops.
Chronic pancreatitis is characterized by periods of exacerbation and remission, has a graduated course. In the preclinical stage, there are no symptoms of the disease, changes in the pancreas become an accidental finding during an ultrasound of the abdominal organs. During the period of initial manifestations, repeated episodes of exacerbation of pancreatitis with manifestations characteristic of the acute form of the disease are observed. Gradually, their frequency decreases, but the symptoms continue 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 with a girdle character. The patient loses weight, especially due to refusal of food due to fear of increased pain. Increased manifestations of secretory and endocrine insufficiency, such as dyspepsia, hyperglycemia.
In the future, pancreatic atrophy occurs. The pain may become less intense or absent, the frequency of pancreatitis attacks decreases. The stool becomes soft, fetal, with a greasy sheen. Exhaustion is noted, pancreatogenic diabetes mellitus develops. In the last stage, systemic complications occur, possibly malignant degeneration of the tissue of the affected organ.
Depending on the form, severity and stage of the disease, the risk of developing some complications of pancreatitis increases. With a long-term progressive course of the pathology, violations of bile flow are possible, followed by obstructive jaundice, the formation of an abscess, cysts, the development of portal hypertension, pancreatogenic diabetes mellitus, parapancreatitis, "enzymatic" cholecystitis. pneumonia, exudative pleurisy, paranephritis, pancreatic cancer.
The consequences of an acute process can be:
- septic phlegm of retroperitoneal tissue;
- bleeding in the organs of the digestive tract, bleeding in the abdominal cavity;
- mechanical jaundice;
- the formation of internal and external digestive fistulas, abscesses and infiltrates.
In severe cases, shock, multiple organ failure with high risk of death may develop.
Identification and treatment of pancreatitis is carried out by a general practitioner and a gastroenterologist together with an endocrinologist, a surgeon and other specialists. Often, patients with an acute form of the disease from 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 complaints, collecting an anamnesis, including the nature of nutrition, bad habits, frequency of relapses, accompanying diseases of the biliary system and examination, the doctor directs the patient for analysis, as well as instrumental studies.
As part of a laboratory study of a patient, the following are performed:
- General clinical blood analysis. There are signs of inflammation: acceleration of ESR, leukocytosis.
- Blood biochemistry. For pancreatic damage in pancreatitis, increased activity of enzymes (amylase, lipase), hyperglycemia, hypoalbuminemia and hypocalcemia, bilirubinemia, as well as increased activity of liver enzymes (ALT, AST, transaminase), CRP are. possible.
- Biochemical study of urine. It is performed to determine amylase activity in urine.
- The co-program. characteristic steatorrhea.
- Determination of pancreatic elastase in feces.
Instrumental diagnosis of pancreatitis includes:
- Abdominal ultrasound is a method for visualizing the gland itself and the surrounding 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, obtain pancreatic secretions, remove stones;
- endoscopic elastography of the pancreas - allows you to determine the stiffness and rigidity of the tissue, evaluate the degree of replacement of its connective tissue and the secretory function of the organ;
- esophagogastroduodenoscopy to assess the condition of the empty digestive organs.
Medical help should be sought at the first signs of pancreatitis, then the chance to avoid 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 should 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 includes taking drugs from the following groups:
- analgesic for pain relief in pancreatitis;
- pancreatic enzymes;
- inhibitors of the secretion of hydrochloric acid in the stomach;
- tranquilizers and antidepressants;
With a complicated course of the disease, as well as in some cases of acute abdominal pain, endoscopic or surgical intervention is indicated.
The primary prevention of pancreatitis is avoiding alcohol, eating a varied diet that is low in fat, saturated fat, and cholesterol, including whole grains, vegetables, and fruits in the diet, and not smoking.
Acute pancreatitis can develop not only in people who regularly abuse alcohol, but also as a result of a single intake of alcohol-containing drinks for fatty, fried and spicy foods in large quantities. Partial, proper nutrition in pancreatitis serves as prevention of exacerbations of its chronic form.