Pancreatitis is acute or chronic inflammation of the pancreatic tissue with subsequent violation of the secretory and endocrine functions of the organ. 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 prolonged intense pain in the upper abdomen, his digestion is disturbed, and yellowness of the skin and mucous membranes may appear.
Treatment includes following a diet, taking medications that facilitate the digestion of food, pain relievers. In some cases, surgery may be required.
According to statistics, in general, the prevalence of the disease does not depend on sex. 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 most 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 obstruction of the bile ducts from gallbladder stones 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.
The decomposition products of ethyl alcohol have a direct toxic effect on the cells of the pancreas and on numerous drugs (estrogens, sulfonamides, tetracycline, erythromycin, thiazides, mercaptopurine). In addition, systematic alcohol abuse is accompanied by thickening of the bile, which predisposes to a reduced patency of the bile ducts. Addiction to nicotine also predisposes to the development of the disease, as it affects the cardiovascular system, causing a narrowing of the lumen of the 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 abnormalities. Autoimmune pancreatitis occurs both in isolation 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 occurrence, it happens:
- toxic (alcoholic, infectious, medicinal);
- biliary;
- dysmetabolic;
- autoimmune;
- idiopathic;
- post traumatic.
Depending on the clinical manifestations, pancreatitis manifests itself 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, local or surrounding nature, often extending under the left shoulder blade. Unpleasant sensations aggravate in the supine position and after a mistake in the diet.
- Increased salivation, belching, nausea, frequent vomiting which does not bring relief.
- Increased body temperature. Perhaps the appearance of fever, chills.
- Change in color of the skin and mucous membranes. Moisture and pallor of the skin, moderate yellowing of the sclera are often observed. In rare cases, the skin also acquires a yellowish tinge. Perhaps the appearance of bluish spots on the body, hemorrhages in the navel.
- Dyspeptic manifestations: bloating, heartburn.
- Irritability, crying, in severe cases pancreatogenic psychosis develops.
Chronic pancreatitis is characterized by periods of exacerbation and remission, has a gradual course. In the preclinical stage, there are no symptoms of the disease, changes in the pancreas become an accidental finding during an ultrasound 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 in the interictal period: abdominal pain, episodic vomiting, nausea, diarrhea, flatulence.
In the phase of persistent symptoms, there is pain in the upper half of the abdomen, often of the girdle type. The patient loses weight, in particular due to the refusal of 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 is reduced. The stool becomes soft, fetid, with a greasy sheen. Exhaustion is observed, pancreatogenic diabetes mellitus develops. In the last stage, systemic complications occur, possible malignant degeneration of the affected organ tissue.
Complications
Depending on the form, severity and stage of the disease, the risk of developing some complications of pancreatitis increases. With a long-term progressive course of the pathology, violations of the outflow of bile are possible, followed by obstructive jaundice, the formation of an abscess, cyst, 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 the retroperitoneal tissue;
- reddening bleeding in the organs of the digestive tract, hemorrhage in the abdominal cavity;
- mechanical jaundice;
- ascites;
- formation of internal and external digestive fistulas, abscesses and infiltrates.
In severe cases, shock can develop, multi-organ failure with a high risk of death.
Diagnostics
Identification and treatment of pancreatitis is performed by a general practitioner and gastroenterologist along with an endocrinologist, surgeon, and other specialists. Often patients with an acute form of the disease for emergency medical care end up in a surgical hospital, where a differential diagnosis of pancreatic lesions with acute appendicitis, cholecystitis and other pathologies is made.
Having clarified the complaints, collected an anamnesis, including the nature of nutrition, bad habits, frequency of relapses, concomitant diseases of the biliary system and examination, the doctor directs the patient for tests and instrumental studies .
As part of a laboratory study on a patient, 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, 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, transaminases), CRP are possible.
- Biochemical study of urine. It is carried out to determine the activity of amylase in the urine.
- Coprogram. characteristic steatorrhea.
- Determination of pancreatic elastase in stool.
Instrumental diagnosis of pancreatitis includes:
- Ultrasound of the abdominal organs is a method of visualizing the gland itself and surrounding organs;
- SCT and magnetic resonance imaging of internal organs to obtain more detailed information on the anatomical changes contained in them;
- endoscopic retrograde cholangiopancreatography to visualize the lumen of the ducts, collect pancreatic secretions, remove stones;
- endoscopic elastography of the pancreas - allows you to determine the stiffness and rigidity of the tissue, assess the degree of its replacement of the connective tissue and the secretory function of the organ;
- esophagogastroduodenoscopy to assess the condition of the hollow digestive organs.
Treatment
Medical assistance should be sought at the first signs of pancreatitis, so the possibility of avoiding complications and the transition of the disease to a chronic form will be greater. During an 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 the diet mainly foods rich in proteins and complex carbohydrates, dietary fiber and vitamins.
Drug therapy involves taking drugs from the following groups:
- analgesics to relieve pain in pancreatitis;
- pancreatic enzymes;
- inhibitors of the secretion of hydrochloric acid 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 primary 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 alcohol-containing drinks for fatty, fried and spicy snacks in large quantities. Proper fractional nutrition in pancreatitis serves as a prevention of exacerbations of its chronic form.