Pancreatitis is an acute or chronic inflammation of the pancreatic tissue with subsequent disruption of the body's secretory and endocrine functions. Often, the development of pathology is associated with the systematic use of large amounts of alcohol, smoking, and cholelithiasis.
During an exacerbation of pancreatitis, a person feels a long-lasting severe pain in the upper abdomen, indigestion is disturbed, and yellowness of the skin and mucous membranes may appear.
Treatment consists of following a diet, taking drugs that facilitate the digestion of food, and 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 working-age people aged 30-50. Gallstone disease is more likely to cause pancreatitis in women.
The reasons
The disease can be caused by toxic effects, autoimmune processes, can be hereditary or become a complication of gallstone disease. 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 digestive secretions from the pancreas to the duodenum is disturbed, which causes its stagnation and the organ "digests itself".
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, systematic abuse of alcohol is accompanied by bile thickening, which tends to impaired permeability of the bile ducts. Nicotine addiction also tends to the development of the disease, because it affects the cardiovascular system, narrowing the lumen of the vessels and reducing 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 both in isolation and in combination 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. Here's what happens:
- toxic (alcohol, infectious, medicine);
- bile;
- dysmetabolic;
- autoimmune;
- idiopathic;
- after trauma.
According to 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 disruption of its secretory and endocrine functions. Symptoms of acute pancreatitis are pronounced:
- Severe pain in the epigastric region, left hypochondrium, local or peripheral in nature, often extending under the left shoulder blade. Unpleasant feelings are aggravated in the supine position and after a mistake in the diet.
- Increased salivation, belching, nausea, frequent vomiting that does not bring relief.
- Increase in body temperature. Perhaps the appearance of fire, trembling.
- Discoloration of the skin and mucous membranes. Moistness and paleness of the skin, moderate yellowing of the sclera are often observed. In rare cases, the skin also acquires a yellowish color. Perhaps the appearance of blue spots on the body, bleeding in the navel.
- Dyspeptic manifestations - bloating, heartburn.
- Irritation, tears, pancreatogenic psychosis develops in severe cases.
Chronic pancreatitis is characterized by periods of exacerbation and remission, has a gradual course. In the preclinical stage, there are no signs of the disease, changes in the pancreas become an incidental finding during an ultrasound examination 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 persist during 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 girdle type. The patient loses weight, especially because he refuses to eat due to the 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 disappear, the frequency of pancreatitis attacks decreases. Feces are slimy, fetid with an oily sheen. Exhaustion is observed, pancreatogenic diabetes mellitus develops. In the final 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 progressive long-term course of pathology, a violation of bile flow is possible, followed by obstructive jaundice, abscess, cysts, the development of portal hypertension, pancreatogenic diabetes mellitus, parapancreatitis, "enzymatic" cholecystitis, pneumonia, exudative pleuritis, paranephritis, pancreatic cancer.
The consequences of the acute process may be:
- peritonitis;
- septic phlegmon of retroperitoneal tissue;
- arrhygic 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 can develop, multiple organ failure with a high risk of death.
Diagnostics
Pancreatitis is diagnosed and treated by a general practitioner and a gastroenterologist together with an endocrinologist, surgeon and other specialists. Often, patients with an acute form of the disease are admitted to a surgical hospital, where differential diagnosis of pancreatic lesions with acute appendicitis, cholecystitis and other pathologies is carried out with emergency medical care.
After clarifying the complaints, collecting anamnesis, including the nature of nutrition, bad habits, frequency of relapses, concomitant diseases of the biliary tract, and examination, the doctor directs the patient to tests, as well as instrumental studies.
As part of a patient's laboratory research, the following is performed:
- General clinical analysis of blood. There are signs of inflammation: acceleration of ESR, leukocytosis.
- Biochemistry of blood. 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 indicated for damage to the pancreas. 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:
- 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 to determine the stiffness and rigidity of the tissue, to evaluate the degree of change of the connective tissue and the secretory function of the organ;
- esophagogastroduodenoscopy to assess the condition of the hollow digestive organs.
Treatment
It is necessary to seek medical help at the first signs of pancreatitis, then there will be a higher chance of preventing complications and the disease will turn into a chronic form. It is recommended to fast during the exacerbation of the disease.
All patients suffering from pancreatitis should follow a diet, avoid alcohol and smoking. In the interictal period, it is necessary to eat several times a day in small portions, including in the diet mainly protein and complex carbohydrates, foods rich in dietary fiber and vitamins.
Drug therapy includes 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 complex course of the disease, as well as in 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 low in fat, saturated fat and cholesterol, and include 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 alcoholic beverages for a large amount of fatty, fried and spicy snacks. Fraction in pancreatitis, proper nutrition serves as prevention of exacerbation of its chronic form.