Pancreatitis is an acute or chronic inflammation of the pancreatic tissue with subsequent disruption 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 long-term intense pain in the upper abdomen, digestion is disturbed, yellowing of the skin and mucous membranes may occur.
Treatment includes following a diet, taking drugs 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 gallstones.
Reasons
The disease can be caused by toxic effects, autoimmune processes, have a hereditary predisposition or become a complication of gallstones. Abuse of alcohol, smoking and obstruction of the bile ducts with stones in the gallbladder are the most common causes of pancreatitis. In the latter case, the outflow of the digestive secret of the pancreas into the duodenum is disturbed, which leads to its stagnation and "self-digestion" of the organ.
Ethyl alcohol decomposition products 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 consumption of alcohol is accompanied by thickening of bile, which predisposes to impaired patency of the bile ducts. Nicotine addiction also predisposes to the onset of the disease, as it affects the cardiovascular system, causing the lumen of blood vessels to narrow and blood flow to the organs to decrease.
Damage to the pancreas is also linked to heredity, and in particular it can be genetically determined or caused by congenital developmental anomalies. Autoimmune pancreatitis occurs both in isolation and in combination with Sjogren'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 occurrence happens:
- toxic (alcoholic, infectious, medicinal);
- biliary;
- dysmetabolic;
- autoimmune;
- idiopathic;
- post-traumatic.
According to 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:
- Intense pain in the epigastric region, left hypochondrium, of a local or surrounding nature, often extending under the left shoulder blade. Unpleasant sensations worsen in a lying position and after a mistake in diet.
- Increased salivation, belching, nausea, frequent vomiting that does not bring relief.
- Increase in body temperature. Perhaps the onset of fever, chills.
- Discoloration 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, 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, it has a gradual course. In the preclinical phase, there are no symptoms of the disease, changes in the pancreas become an incidental finding during ultrasound imaging of the abdominal organs. In 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 in the interictal period: abdominal pain, episodic vomiting, nausea, diarrhea, flatulence.
In the phase of persistent symptoms, pain occurs in the upper half of the abdomen, often of a girdle type. The patient loses weight, especially by refusing food for fear of increased pain. Increased manifestations of secretory and endocrine insufficiency, such as indigestion, hyperglycemia.
In the future, pancreatic atrophy occurs. The pain may become less intense or absent, the frequency of pancreatitis attacks decreases. The stool becomes mushy, smelly, with a greasy sheen. Exhaustion is observed, pancreatogenic diabetes mellitus develops. In 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. Along with the progressive long-term course of the pathology, bile outflow disorders are possible, accompanied 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.
The consequences of an acute process can be:
- peritonitis;
- septic phlegmon of retroperitoneal tissue;
- erosive 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, multi-organ failure with a high risk of death can develop.
Diagnostics
Pancreatitis is recognized and treated 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 end up in a surgical hospital, where differential diagnosis of pancreatic lesions with acute appendicitis, cholecystitis and other pathologies is carried out.
After clarifying complaints, collecting anamnesis, including the nature of diet, bad habits, frequency of recurrence, accompanying diseases of the biliary system and examination, the doctor refers the patient to tests, as well as instrumental studies.
As part of the patient's laboratory examination, the following are performed:
- General clinical blood analysis. There are signs of inflammation: acceleration of ESR, leukocytosis.
- 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 used.
- Biochemical study of urine. It is performed to determine amylase activity in urine.
- 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 in order to obtain more detailed information about anatomical changes in them;
- endoscopic retrograde cholangiopancreatography for visualization of the duct lumen, taking of pancreatic secretions, removal of stones;
- endoscopic elastography of the pancreas - allows you to determine the stiffness and rigidity of the tissue, assess the degree of 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 there will be a greater chance to avoid complications and the transition of the disease into a chronic form. During the exacerbation of the disease, fasting is recommended.
All patients suffering from pancreatitis must follow a diet, give up alcohol and smoking. In the interictal period, you should eat in small portions several times a day, including in your diet mainly food rich in proteins and complex carbohydrates, dietary fiber and vitamins.
Drug therapy involves 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 some cases of acute abdominal pain, endoscopic or surgical intervention is indicated.
Prevention
The primary prevention of pancreatitis is avoiding alcohol, eating a varied diet 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 one-time consumption of large quantities of alcohol-containing drinks for fatty, fried and spicy snacks. Fractional, proper nutrition in pancreatitis serves as prevention of exacerbations of its chronic form.