Pancreatitis is acute or chronic inflammation of the tissues of the pancreas with subsequent violation of the secretory and endocrine functions of the organ. Most often, the development of pathology is associated with the systematic consumption of large amounts of alcohol, smoking, cholelithiasis.
During an exacerbation of pancreatitis, a person feels persistent severe pain in the upper abdomen, his digestion is disturbed, and there may be yellowing of the skin and mucous membranes.
Treatment includes following a diet, taking medications that make food easier to digest, painkillers. In some cases, surgery may be required.
In general, according to statistics, 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. 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 blockage of the bile ducts from gallbladder stones are the most common causes of pancreatitis. In the latter case, the outflow of the digestive secrets of the pancreas into the duodenum is disturbed, which leads to its stagnation and "self-digestion" of the organ.
The decomposition products of ethyl alcohol have a direct toxic effect on the cells of the pancreas, as well as a number of drugs (estrogens, sulfonamides, tetracycline, erythromycin, thiazides, mercaptopurine). In addition, systematic alcohol abuse is associated with thickening of the 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, which leads to narrowing of the vascular lumen and a decrease in blood flow to the organs.
Damage to the pancreas is also hereditary, in particular it can be genetic or caused by congenital developmental disorders. 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, a distinction is made between acute and chronic pancreatitis. Due to the event it happens:
- toxic (alcoholic, contagious, medicinal);
- Bile;
- dysmetabolic;
- autoimmune;
- idiopathic;
- post traumatic.
According to the clinical manifestations, pancreatitis occurs in mild, moderate or severe form.
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. With acute pancreatitis, the symptoms are pronounced:
- Intense epigastric pain, left hypochondrium, local or circumferential in nature, often extending under the left shoulder blade. Unpleasant sensations are aggravated in the supine position and after an error in nutrition.
- 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. Dampness and pallor of the skin, moderate yellowing of the sclera are often observed. In rare cases, the skin also takes on a yellowish tinge. 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 and has a gradual course. At the preclinical stage there are no symptoms of the disease, changes in the pancreas become an incidental finding during an ultrasound scan of the abdominal organs. During the period of the first 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, pain in the upper half of the abdomen appears, often with a belt character. The patient loses weight, particularly through refusal to eat for 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 absent, the frequency of attacks of pancreatitis is reduced. The stool becomes soggy, fetid, with a greasy sheen. Exhaustion is observed, pancreatogenic diabetes mellitus develops. At the last stage, systemic complications appear, possibly malignant degeneration of the tissues 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 the pathology, disturbances in the outflow of bile are 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.
The consequences of an acute process can be:
- peritonitis;
- septic phlegmon of retroperitoneal tissue;
- arrosive 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.
diagnosis
Diagnosis and treatment of pancreatitis is carried out 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, through emergency 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, taking an anamnesis, including the type of diet, bad habits, frequency of recurrence, concomitant diseases of the biliary system and examination, the doctor directs the patient to tests, as well as instrumental studies.
As part of a laboratory examination of a patient, the following are carried out:
- General clinical analysis of blood. There are signs of inflammation: acceleration of the ESR, 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 examination 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 visualizing the gland itself and the surrounding organs;
- SCT and MRI of internal organs to get more detailed information about anatomical changes in them;
- endoscopic retrograde cholangiopancreatography to visualize the lumen of the ducts, take pancreatic secretions, remove stones;
- endoscopic elastography of the pancreas - allows you to determine the stiffness and rigidity of the tissues, assess the degree of its connective tissue replacement and the secretory function of the organ;
- Esophagogastroduodenoscopy to assess the condition of the hollow digestive organs.
treatment
At the first signs of pancreatitis, medical help should be sought, then the chance of avoiding complications and the transition of the disease into a chronic form is higher. If the condition worsens, fasting is recommended.
All patients suffering from pancreatitis must follow a diet, give up alcohol and smoking. In the interictal period, you should eat several times a day in small portions, with the diet containing mainly protein-rich and complex carbohydrates, fiber and vitamins.
Drug therapy involves taking drugs from the following groups:
- analgesics for pain relief in pancreatitis;
- pancreatic enzymes;
- Inhibitors of the secretion of hydrochloric acid in the stomach;
- tranquilizers and antidepressants;
- antibiotics;
- Insulin;
- vitamins.
In the case of a complicated course of the disease and in some cases of acute abdominal pain, an endoscopic or surgical intervention is indicated.
prevention
The main prevention of pancreatitis is avoiding alcohol, eating a varied diet low in fat, saturated fat, and cholesterol, including 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 greasy, fried and spicy snacks in large quantities. Fractional, proper nutrition in pancreatitis serves to prevent exacerbations of its chronic form.