Pancreatitis is an acute or chronic inflammation of pancreatic tissue with subsequent violations of the secretory and endocrine functions of the organ. 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 severe, 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 medicines 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 among this population. This disease mainly affects people of working age from 30 to 50 years. In women, the development of pancreatitis is more often caused by gallstone disease.
The reasons
This disease can be caused by toxic effects, autoimmune processes, have a hereditary tendency, or be a complication of kidney stones. Alcohol abuse, smoking, and blockage of the bile ducts by gallstones are the most common causes of pancreatitis. In the second case, the outflow of the digestive secret of the pancreas into the duodenum is disrupted, which leads to stagnation and "self-digestion" of the organ.
The decay products of ethyl alcohol have a direct toxic effect on pancreatic cells, as well as some drugs (estrogens, sulfonamides, tetracycline, erythromycin, thiazides, mercaptopurine). In addition, systematic alcohol abuse is accompanied by bile thickening, which predisposes to bile duct patency disorders. Nicotine addiction also predisposes to the development of the disease, because it affects the cardiovascular system, causing narrowing of the lumen of blood vessels and a decrease in 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 separately and in combination with Sjögren's syndrome, inflammatory bowel disease, and many other autoimmune disorders.
Classification
Depending on the nature of the course of the disease, acute or chronic pancreatitis is distinguished. Due to the incident, it happened:
- toxic (alcohol, infectious, medicinal);
- bile;
- dysmetabolic;
- autoimmune;
- idiopathic;
- after trauma.
In accordance with the clinical manifestations, pancreatitis occurs in mild, moderate or severe form.
symptoms
The clinical manifestations of this disease are associated not only with damage to the organ itself, but also with violations of its secretory and endocrine functions. In acute pancreatitis, symptoms are expressed:
- Severe pain in the epigastric region, left hypochondrium, localized or circling, often extending under the left shoulder blade. Unpleasant sensations worsen in the supine position and after mistakes in the diet.
- Increased salivation, belching, nausea, frequent vomiting that does not bring relief.
- Increased body temperature. Perhaps the appearance of fever, chills.
- Changes in the color of the skin and mucous membranes. Moistness and pallor of the skin, moderate yellowing of the sclera is often observed. In rare cases, the skin also acquires a yellowish tint. Perhaps the appearance of bluish spots on the body, bleeding in the navel.
- Dyspeptic manifestations - flatulence, heartburn.
- Irritability, tearfulness, in severe cases, pancreatogenic psychosis develops.
Chronic pancreatitis is characterized by periods of exacerbation and remission, having a gradual course. In the preclinical stage, there are no symptoms of the disease, changes in the pancreas become an accidental discovery during an ultrasound scan of the abdominal organs. During the period of initial manifestations, repeated episodes of exacerbation of pancreatitis with characteristic manifestations of the acute form of the disease are observed. Gradually, their frequency becomes lower, but the symptoms persist in the interictal period: abdominal pain, episodic vomiting, nausea, diarrhea, flatulence.
In the persistent stage of symptoms, there is pain in the upper part of the abdomen, often of a girdle nature. The patient loses weight, especially because of food refusal for fear of increased pain. Increased manifestation of secretion and endocrine deficiency, such as indigestion, hyperglycemia.
In the future, pancreatic atrophy occurs. Pain may become less intense or absent, the frequency of pancreatitis attacks decreases. Faeces become mushy, putrid, with an oily sheen. Fatigue is observed, pancreatogenic diabetes mellitus develops. In the final stage, systemic complications occur, possibly malignant degeneration of the affected organ tissue.
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 pathological course, a violation of the outflow of bile is possible, followed by obstructive jaundice, the formation of abscesses, cysts, the development of portal hypertension, pancreatogenic diabetes mellitus, parapancreatitis, "enzymatic" cholecystitis, pneumonia, exudative pleurisy, paranephritis, pancreatic cancer.
Consequences of the acute process can be:
- peritonitis;
- septic phlegmon of retroperitoneal tissue;
- erosive bleeding in organs of the digestive tract, bleeding in the abdominal cavity;
- mechanical jaundice;
- ascites;
- the formation of internal and external digestive fistulas, abscesses and infiltrates.
In severe cases, shock may occur, failure of multiple organs with a high risk of death.
Diagnostics
Identification and treatment of pancreatitis is carried out by general practitioners and gastroenterologists together with endocrinologists, surgeons and other specialists. Often, patients with an acute form of the disease with emergency medical treatment end up in a surgical hospital, where the differential diagnosis of pancreatic lesions with acute appendicitis, cholecystitis and other pathologies is carried out.
After explaining the complaint, collecting the anamnesis, including dietary habits, bad habits, frequency of relapses, concomitant diseases of the biliary system, and examination, the doctor directs the patient for tests, as well as instrumental studies.
As part of the patient's laboratory study, the following is carried out:
- General clinical analysis of blood. There are signs of inflammation: ESR acceleration, leukocytosis.
- Blood biochemistry. For damage to the pancreas in pancreatitis, an increase in the activity of enzymes (amylase, lipase), hyperglycemia, hypoalbuminemia and hypocalcemia, bilirubinemia, as well as an increase in the activity of liver enzymes (ALT, AST, transaminase), CRP are possible.
- Biochemical study of urine. It is carried out to determine amylase activity in urine.
- Coprogram. characteristic steatorrhea.
- Determination of pancreatic elastase in feces.
Instrumental diagnosis of pancreatitis includes:
- Ultrasound of the abdominal organs is a method to visualize 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 duct lumen, take 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 hollow digestive organs.
Treatment
Medical help should be sought at the early signs of pancreatitis, then the chances of avoiding complications and the transition of the disease to a chronic form will be higher. During an exacerbation of the disease, fasting is recommended.
All patients suffering from pancreatitis must follow a diet, stop alcohol and smoking. In the interictal period, you need to eat in small portions several times a day, including in the diet mainly foods high in protein and complex carbohydrates, dietary fiber, and vitamins.
Drug therapy involves taking drugs from the following groups:
- analgesics to relieve pain in pancreatitis;
- pancreatic enzymes;
- inhibitor 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 avoiding alcohol, eating a variety of diets that are 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 snacks in large quantities. Fractional, correct nutrition in pancreatitis serves as a prevention of exacerbation of its chronic form.