Pancreatitis is an acute or chronic inflammation of the pancreatic tissue with subsequent violation of the secretory and endocrine functions of the organ. 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 feels severe and prolonged pain in the upper abdomen, his digestion is disturbed, and yellowing of the skin and mucous membranes may appear.
Treatment includes following a diet, taking drugs that facilitate the digestion of food, painkillers. In some cases, surgery may be necessary.
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 reasons
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 obstruction of the bile ducts by gallbladder stones are the most common causes of pancreatitis. In the latter case, the outflow of the digestive secret from 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 the cells of the pancreas, as well as on a number of drugs (estrogens, sulfonamides, tetracycline, erythromycin, thiazides, mercaptopurine). In addition, systematic alcohol abuse is accompanied by thickening of bile, which predisposes to impaired patency of the bile ducts. Nicotine addiction also predisposes to the development of the disease, since it affects the cardiovascular system, causing a narrowing of the lumen of the vessels and a decrease in blood flow to the organs.
Damage to the pancreas is also linked to heredity, in particular, it can be genetically determined or caused by congenital anomalies of development. Autoimmune pancreatitis occurs both in isolation and in association with Sjögren's syndrome, inflammatory bowel disease, and many other autoimmune diseases.
Classification
Depending on the nature of the course of the disease, acute or chronic pancreatitis is distinguished. Due to the event, it occurs:
- poisonous (alcoholic, infectious, medicinal);
- biliary;
- dysmetabolic;
- autoimmune;
- idiopathic;
- Posttraumatic.
Depending on 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, the symptoms are pronounced:
- Severe pain in the epigastric region, left hypochondrium, local or encircling in nature, often extending under the left shoulder blade. Unpleasant sensations are aggravated when lying down and after a diet error.
- Increased salivation, belching, nausea, frequent vomiting that does not bring relief.
- Increase in body temperature. Perhaps the appearance of fever, chills.
- Change in color of the skin and mucous membranes. Wetness and pallor of the skin, moderate yellowing of the sclera are often observed. In rare cases, the skin also acquires a yellowish tint. Perhaps the appearance of bluish spots on the body, hemorrhages in the navel.
- Dyspeptic manifestations - bloating, heartburn.
- Irritability, lacrimation, in severe cases, pancreatogenic psychosis develops.
Chronic pancreatitis is characterized by periods of exacerbation and remission, has a staged course. At the preclinical stage, there are no symptoms of the disease, changes in the pancreas become an accidental finding during an ultrasound examination of the abdominal organs. During the period of the 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 persist in the interictal period: abdominal pain, episodic vomiting, nausea, diarrhea, flatulence.
At the stage of persistent symptoms, there is pain in the upper half of the abdomen, often belt-like. The patient loses weight, including through refusal of food for fear of increased pain. Increased manifestations of secretory and endocrine insufficiency, such as indigestion, hyperglycemia.
In the future, atrophy of the pancreas occurs. The pain may become less intense or absent, the frequency of attacks of pancreatitis is reduced. The stools become mushy, fetid, with a greasy sheen. Exhaustion is observed, pancreatogenic diabetes mellitus develops. At 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 gradual course of the pathology, violations of bile outflow are possible, followed by obstructive jaundice, the formation of an abscess, cysts, the development of portal hypertension, dpancreatigenic diabetes mellitus, parapcreatitis, "enzymatic" cholecystitis, pneumonia, exudative pleurisy, paranephritis, pancreatic cancer.
The consequences of an acute process can be:
- peritonitis;
- septic phlegmon of the retroperitoneal tissue;
- watery bleeding in the organs of the digestive tract, hemorrhage in the abdominal cavity;
- mechanical jaundice;
- ascites;
- formation of internal and external digestive fistulas, abscesses and infiltrates.
In severe cases, shock may develop, multi-organ failure with a high risk of death.
Diagnostic
The identification and treatment of pancreatitis is carried out by a general practitioner and a gastroenterologist in collaboration 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 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 nutrition, bad habits, the frequency of relapses, concomitant diseases of the biliary system and examination, the doctor directs the patient to tests, as well asinstrumental studies.
As part of a laboratory study of a patient, the following are carried out:
- General clinical analysis of blood. There are signs of inflammation: acceleration of ESR, hyperleukocytosis.
- Blood biochemistry. For damage to the pancreas 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 the activity of amylase in urine.
- Coprogram. characteristic steatorrhea.
- Determination of pancreatic elastase in feces.
Instrumental diagnosis of pancreatitis includes:
- Ultrasound of the abdominal organs is a method of viewing the gland itself and the surrounding organs;
- SCT and MRI of internal organs to get more detailed information about their anatomical changes;
- endoscopic retrograde cholangiopancreatography to visualize duct lumen, collect pancreatic secretions, remove stones;
- endoscopic elastography of the pancreas - allows you to determine the stiffness and stiffness of the tissue, to assess the degree of its replacement of connective tissue and the secretory function of the organ;
- esophagogastroduodenoscopy to assess the condition of the hollow digestive organs.
Treatment
Medical help should be sought at the first signs of pancreatitis, then the chances of avoiding complications and the transition of the disease into a chronic form will be higher. During an exacerbation of the disease, fasting is recommended.
All patients with pancreatitis should follow a diet, give up alcohol and tobacco. During the interictal period, you need to 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 consists of taking drugs from the following groups:
- analgesics for the relief of pain 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 main prevention of pancreatitis is to avoid alcohol, eat a varied diet that is low in fat, saturated fat and cholesterol, including cereals, vegetables and fruits in the diet, and notno smoking.
Acute pancreatitis can develop not only in people who regularly abuse alcohol, but also as a result of a single consumption of alcoholic beverages for fatty, fried and spicy snacks in large quantities. Fractional and proper nutrition in pancreatitis serves as a prevention of exacerbations of its chronic form.