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Pancreatitis

Методы диагностики хронического воспаления поджелудочной железы

  1. Description of the pathology
  2. Classification and types
  3. Causes
  4. Symptoms
  5. Complications
  6. Diagnostics
  7. Treatment
  8. Prevention

The pancreas is located behind the stomach, its bile duct opens into the duodenum. Pancreatitis is a disease caused by the inflammatory process in the tissues of this organ.

Description of the pathology

The pancreas performs two main functions:

  • producing digestive enzymes that pass through the bile ducts into the duodenum, where they activate and participate in breaking down proteins and fats;
  • secretion of two hormones - insulin and glucagon, which are secreted into the blood and regulate glucose level.

If the patency of the bile ducts is broken for any reason, the pressure of pancreatic juice increases in them. The gland cells are damaged. In acute pancreatitis, the mechanism of "self-digestion" of tissues is triggered. The result of chronically ongoing inflammation is a permanent deficit of digestive enzymes, replacing glandular cells by a connective tissue, followed by a weakening exocrine function, as well as bad producing hormones.

Classification and types

Many classifications of pancreatitis have been created on different grounds.

In accordance with international classification of diseases, there is:

  • acute pancreatitis (code ICD-10 K85);
  • chronic pancreatitis of alcoholic origin (code ICD-10 K86.0);
  • other chronic pancreatitis (code ICD-10 K86.1).

Variants of acute pancreatitis are:

  • swollen with a rapidly worsening gland function;
  • necrotic (pancreatic necrosis), which is a heavier form, accompanied by disintegrating organ tissues under the influence of its own enzymes.

Types of chronic inflammatory process of the pancreas:

Type Cause Features
Calcifying Drinking alcohol Chronic damage to the smallest pancreatic bile ducts causes forming gradually calcifying slugs
Obstructive Cholelithiasis, tumor, cicatricial deformation It occurs during compressing large bile ducts; the cells are damaged again due to increasing in-duct pressure
Parenchymal-fibrous Autoimmune process, recurrent inflammation It is rare and accompanied by a common damaged glandular cells

Chronic pancreatitis can be asymptomatic, but more often there is alternating remissions and exacerbations. During the remission, the patient does not complain. The exacerbation of the chronic inflammatory process is accompanied by appearing symptoms.

Causes

The disease occurs due to the following factors:

  • In 60% of cases, the cause of pancreatitis is alcohol consumption; but the disease develops only in 5-7% alcoholics featuring genetic predisposition;
  • cholelithiasis, chronic cholecystitis and other conditions accompanied by bile stagnation;
  • cicatricial deformity of the duodenum, Fater's nipple tumor, that is, mechanical obstacles to releasing pancreatic juice into the intestine;
  • cystic fibrosis, which is a genetic disease with impaired secretory activity of the glands, accompanied by damaged respiratory system;
  • bad lipid metabolism manifested by repeated episodes of acute inflammation;
  • autoimmune diseases (primary pancreatic damage, Sjogren's syndrome, primary biliary cirrhosis, sclerosing cholangitis);
  • some drugs - azathioprine, furosemide, tetracyclines, estrogen solutions, prednisolone, metronidazole and others.

Childish pancreatitis is often associated with both congenital and acquired (opisthorchiasis) pathological structure of the bile duct and pancreas. The cause of the childich disease is often a blunt abdominal trauma. A certain role is played by infections - herpes,mononucleosis, parotitis, salmonellosis.

Symptoms

The leading symptom of pancreatitis is varying painful upper abdomen. The pain occurs suddenly or develops gradually. Often, this sign appears after having meal or drinking alcohol.

Симптомы панкреатита

Signs of acute gland inflammation:

  • sudden pain happens in the upper abdomen with irradiation in the lower back, interscapular area;
  • severe nausea and persistent vomiting happen;
  • increased pain happens after having meal;
  • the abdominal wall gets sensitive when touched;
  • fever, chills, poor health, weakness occurs.

Symptoms of chronic form of pancreatitis:

  • failure in the upper abdomen gets worse after 2 to 6 hours after having meal; 2 to 3 days after drinking alcohol, an attack of pancreatitis can develop;
  • gradual weight loss, first caused by decreasing having meal due to fear of pain, and then with a deterioration in the absorption of nutrients;
  • oily stool with an unpleasant smell associated with the release of undigested proteins and fats.

When 80% of the glandular cells are destroyed, secondary diabetes mellitus develops.

Complications

Pancreatitis can be accompanied by the complications:

  • bile stagnation with painful right hypochondrium, nausea, bitterness in the mouth and forming gallstones;
  • infectious diseases - purulent inflammation of the bile ducts, peritonitis, sepsis;
  • formation of large cavities in pancreatic tissue;
  • bleeding caused by damaged esophagus, stomach ulcer or duodenal ulcer;
  • thrombosis of the veins of the liver and spleen;
  • pleurisy, which means fluid accumulated in the cavity around the lungs, ascites, i.e. effusion in the abdominal cavity;
  • compression or narrowing of the lumen of the duodenum, deterioration of its patency;
  • hypoglycemic stroke, i.e. a condition caused by a lack of glucagon, manifested by severe weakness, muscle tremor, sweating, palpitations, impaired consciousness;
  • pancreas cancer.

Diagnostics

To confirm the diagnosis of pancreatitis, in addition to analyzing the patient`s complaints, medical history and examination, doctors use methods of laboratory and instrumental diagnostics.

Tests

If severe inflammatory process happens in the gland, nonspecific changes are revealed during blood analysis: an increase in the number of white cells and ESR. Such disorders are stated in acute and a third of cases of exacerbation of the disease. The remaining patients have no changes in the blood test.

The main biochemical sign of the disease is appearing numerous enzymes in the blood and urine, which are necessary for the starch cleavage. It is an enzyme of amylase; During urine researching it is called diastase. In addition, the concentration of other pancreatic enzymes also increases: lipase, phospholipase A2, trypsin, elastases.

Diagnostics

Additional biochemical signs of pancreatitis:

  • increasing bilirubin and transaminase levels;
  • increasing fibrinogen levels - a sign of increased blood clotting;
  • increasing glucose and urea concentration.

Revealing enzymes in the blood is observed in the acute course of the disease and exacerbation of the chronic form of the pathology. In many patients, analyzes remain normal. Therefore, the key role in the diagnosing disease, especially its chronic forms, belongs to instrumental research.

Additional value for detecting exocrine insufficiency, that is, lack of digestive enzymes, has a coprogram, i.e. stool research. There are muscle fibers, neutral fats and starch grains in the feces.

Instrumental methods

Computer or magnetic resonance imaging is beneficial to diagnose acute pancreatitis. They make it possible to detect destructed glandular cells and edema of tissues. The diagnosis is confirmed by laparoscopy.

Methods of diagnosing chronic inflammation of the pancreas:

  • radiography reveals small clusters of calcium in the pancreatic ducts;
  • ultrasound reveals increasing tissue density, uneven outlines, size changes, and deformed ducts in 70% of patients;
  • computed tomography is useful in researching pseudotumoral and cystic forms of the disease and for diagnosing malignant tumor;
  • MRI helps in diagnosing gland fibrosis, that is, diffuse proliferation of its connective tissue;
  • magnetic resonance cholangiopancreatography, i.e. a non-invasive method without radiation, which allows to create a detailed image of the common bile and pancreatic ducts, is useful for detecting concrements, malformations;
  • ERCP (endoscopic retrograde cholangiopancreatography), i.e. a research involving filling the gland ducts with contrast through the endoscope inserted into the duodenum and a thin catheter; It is prescribed only in severe cases of the disease and cancer suspected;
  • endoscopic ultrasonography, i.e. a modern ultrasound combined with endoscopy, it is informative for diagnosing sand and tumors;
  • EFGDS is endoscopic research of the esophagus, stomach and duodenum to identify concomitant diseases - reflux-esophagitis, peptic ulcer, duodenitis;
  • angiography is introduction of contrast for researching organ's vasculature, it is usually performed with simultaneous increasing spleen to exclude portal hypertension.

Treatment

Inflammation of the pancreas can happen for different causes, feature different symptoms and treatment. That is why a gastroenterologist`s consultation is required to learn how to treat pancreatitis on a case-by-case basis.

Diet

All patients suffering from pancreatitis are prescribed therapeutic nutrition.

During an exacerbation, the patient should refuse to having meal for 1 to 2 days, then start gradual drinking unsweetened tea, having croutons, water-based liquid porridges, soup-mash, and omelet.

During a remission, the patient should limit having fat and carbohydrate. The patient should have warm baked or steamed dishes 6 times a day.

Healthy meal:

  • lean, poultry, fish;
  • oatmeal;
  • scrambled eggs;
  • soy products;
  • potatoes.

The following meal should be excluded:

  • causing bloating (brown bread, legumes, grapes);
  • containing coarse fiber (raw vegetables and fruits, whole grain cereal);
  • stimulating producing digestive enzymes (rich soups, fried things, spices, spices, smoked or salted meal).

Treatment of acute pancreatitis

In acute pancreatitis, hospitalization is required. Treatment is often conducted in the intensive care unit. Intensive infusion therapy (intravenous injection of solutions aimed at removing intoxication) and anesthesia are carried out. The stroke duration amounts several days.

With necrotic form, a surgical operation is performed, aimed at removing dead tissue. If the attack is caused by cholelithiasis, surgeons remove the gallbladder. As a result, inflammation of the pancreas subsides.

Treatment of chronic pancreatitis

Micrazim

During the therapy, drugs replacing enzymatic function of the gland are used. Micrasim is a modern medicinal product containing pancreatin. This substance replaces the missing enzymes - lipase, amylase, protease. The protection of the drug microparticles against acting acidic stomach environment allows the drug to penetrate fast into the duodenum. Enzymatic therapy is carried out for a long time, taht allows the body to assimilate nutrients properly. At the same time, the patient should follow the diet and stop drinking alcohol. With developing pancreatitis exacerbation, medicines oppressing pancreas function are prescribed.

If the disease is associated with bad patency of the excretory ducts of the gland, a surgical intervention can be required to eliminate it.

Tokens of chronic pancreatitis requiring surgery:

  • constant pain without relief;
  • pseudocyst or blockage of the common bile duct, which can not be treated with endoscopic treatment;
  • suspicion of the gland cancer;
  • constant vomiting and weight loss.

Prevention

The main way to prevent pancreatitis in adults is to limit drinking alcoholic beverages. The proper diet without having irritating meal, fast food, and avoiding injuries are recommended to prevent the illness in children.

Secondary prevention, that is, prevention of recurrences, exacerbations and complications, includes:

  • refusal to drink alcohol;
  • treating cholecystitis, cholelithiasis;
  • constant intake of enzyme preparations and following diet.

If these conditions are met, pancreatitis does not lead to serious consequences, the health prognosis is favorable.

 

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