Pancreatitis is an acute or chronic inflammation of the pancreatic tissue with subsequent disruption of the organ's secretory and endocrine function. Most often, the development of the pathology is associated with the systematic use of large amounts of alcohol, smoking, cholelithiasis.
During an exacerbation of pancreatitis, a person experiences long-lasting severe pain in the upper abdomen, his digestion is disturbed, yellowness of the skin and mucous membranes may appear.
Treatment includes following a diet, taking drugs that facilitate the digestion of food, pain relievers. 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. The disease mainly affects persons 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 obstruction of the bile ducts by gallstones 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 stagnation and "self-digestion" of the organ.
The breakdown products of ethyl alcohol have a direct toxic effect on pancreatic cells, as do a number of drugs (estrogens, sulfonamides, tetracycline, erythromycin, thiazides, mercaptopurine). In addition, systemic alcohol abuse is accompanied by thickening of the bile, which predisposes to impaired patency of the bile ducts. Nicotine addiction also predisposes to the development of the disease, as it affects the cardiovascular system, causing a narrowing of the vessel lumen 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 diseases.
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);
- bilious;
- dysmetabolic;
- autoimmune;
- idiopathic;
- post-traumatic.
Depending on the clinical manifestations, pancreatitis occurs in a mild, moderate or severe form.
Symptoms
The 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 expressed:
- Intense pain in the epigastric region, the left hypochondrium, local or surrounding, often extending under the left shoulder blade. Unpleasant sensations worsen in a lying 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 fever, chills.
- Change in the 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 acquires a yellowish tint. Perhaps the appearance of bluish spots on the body, hemorrhages in the navel.
- Dyspeptic manifestations - bloating, heartburn.
- Irritability, lacrimation, in severe cases pancreatogenic psychosis develops.
Chronic pancreatitis is characterized by periods of exacerbation and remission, it has a staged course. In the preclinical stage, there are no symptoms of the disease, changes in the pancreas become an incidental finding during an ultrasound scan of abdominal organs. In the period of the 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 continue in the inter-attack period: abdominal pain, episodic vomiting, nausea, diarrhea, flatulence.
In the stage of persistent symptoms, pain occurs in the upper half of the abdomen, often of a girdle nature. The patient loses weight, in particular due to refusal of food due to fear of increased pain. Increased manifestations of secretory and endocrine insufficiency, such as indigestion, hyperglycemia.
In the future, atrophy of the pancreas appears. The pain may become less intense or absent, the frequency of pancreatitis attacks decreases. The feces become mushy, foul-smelling, with an oily sheen. Exhaustion is observed, pancreatogenic diabetes mellitus develops. In the last stage, systemic complications occur, malignant degeneration of the tissue of the affected organ is possible.
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, disorders of the outflow of bile are possible, followed by obstructive jaundice, abscess formation, cysts, development of portal hypertension, pancreatogenic diabetes mellitus, parapancreatitis, "enzymatic" cholecystitis, pneumonia, exudative pleurisy, paranephritis, cancer ofthe pancreas.
The consequences of an acute process can be:
- peritonitis;
- septic phlegmon of the retroperitoneal tissue;
- erosive 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, multiple organ failure with a high risk of death may develop.
Diagnosis
Pancreatitis is identified and treated by a general practitioner and gastroenterologist together with an endocrinologist, surgeon and other specialists. Often, patients with an acute form of the disease through emergency medical care end up in a surgical hospital, where a differential diagnosis of pancreatic lesions with acute appendicitis, cholecystitis and other pathologies is carried out.
After clarifying complaints, collecting anamnesis, including the nature of nutrition, bad habits, the frequency of relapses, concomitant diseases of the biliary system and the examination, the doctor refers the patient to tests, as well as instrumental studies.
As part of a laboratory examination of 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, transaminase), CRP are possible.
- Biochemical examination of urine. It is carried out to determine the activity of amylase in urine.
- Co-program. characteristic steatorrhea.
- Determination of pancreatic elastase in feces.
Instrumental diagnosis of pancreatitis includes:
- Ultrasound of abdominal organs is a method of 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, take pancreatic secretions, remove stones;
- endoscopic elastography of the pancreas - allows you to determine the stiffness and hardness of the tissue, assess the degree of its 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 the chance to avoid complications and the transition of the disease into a chronic form will be higher. During an exacerbation of the disease, fasting is recommended.
All patients suffering from pancreatitis should follow a diet, give up alcohol and smoking. In the inter-attack period, you should eat in small portions several times a day, including in the diet mainly foods with a high content of proteins and complex carbohydrates, dietary fiber and vitamins.
Drug therapy includes 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 complex 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 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 a single intake of alcoholic beverages for fatty, fried and spicy snacks in large quantities. Partial proper nutrition in pancreatitis serves as prevention of exacerbations of its chronic form.