Pancreatitis causes. Early and late consequences of acute pancreatitis

Pancreatitis is a progressive disease of the pancreas, which leads to a serious violation of its activity.

The pancreas is an organ of the digestive system that ensures the efficiency of the process of digesting food and takes part in the regulation of carbohydrate metabolism in the body. It carries out the process of producing pancreatic juice and the synthesis of hormones, especially insulin, which is responsible for maintaining the balance of glucose in the blood. Pancreatic juice consists of a unique set of enzymes (amylase, lipase and protease) that help break down carbohydrates, fats and proteins.

Pancreatitis is a disease of the pancreas, which is the result of inflammation of this organ under the influence of pancreatic enzymes, activated prematurely in the tissues of the pancreas and in the pancreatic ducts.

Causes of pancreatitis

The most common causes of pancreatitis are:

• hereditary predisposition;
• cystic fibrosis;
• Taking medications such as cytostatics, sulfonamides, tetracyclines;
• severe food allergy;
• Smoking;
• Injuries of the pancreas (including operations);
• Diseases of the endocrine system (hyperparathyroidism);
• Viral infections (hepatitis B, mumps);
• Diseases of the stomach and duodenum (tumor, gastritis, peptic ulcer);
• Disorders of the hepatobiliary system (hepatitis, cholecystitis, cholelithiasis);
• Obesity;
• Regular consumption of fatty, smoked, fried and spicy foods in large quantities;
• Alcohol abuse.

The risk group includes people who are prone to overeating and alcohol abuse, as well as women during pregnancy and lactation.

Types and symptoms of pancreatitis

There are two forms of pancreatitis: acute and chronic.

Acute pancreatitis most often develops in overweight women aged 30 to 60 years. The first symptom of pancreatitis is a sharp pain that occurs high in the pit of the stomach, in the left or right hypochondrium. If the entire gland is affected, the patient may complain of girdle pain. Acute pancreatitis is usually accompanied by belching, hiccups, nausea, dry mouth, and frequent bilious vomiting.

With the progression of the disease, a sharp deterioration in the patient's condition can be observed. In this case, the symptoms of pancreatitis are fever, shortness of breath, increased heart rate, lowering blood pressure, dry tongue with abundant coating, sticky sweat, pale skin, sharpening of facial features.

Patients complain of bloating and the absence of contractions of the intestines and stomach. Acute pancreatitis can provoke complications from the organs of the abdominal cavity and organs located outside it. These include phlegmon and suppuration of the stuffing bag, peritonitis, ulcers and erosion of the gastrointestinal tract, pneumonia, pulmonary edema, exudative pleurisy, lung abscesses. Quite often, acute pancreatitis is accompanied by failures in carbohydrate metabolism (increased sugar levels in the urine and blood) and hepatitis.

During chronic pancreatitis, two main periods are distinguished: the initial and the period of pronounced inflammation of the pancreas. The initial period can last up to 10 years. Pain is the main symptom of this phase of pancreatitis. The patient may complain of pain in the upper and middle parts of the abdomen, the left half of the chest (as in coronary heart disease), in the left lumbar. Pain in most cases occurs 20-30 minutes after eating, is girdle in nature and decreases in a sitting position or when the torso is tilted forward. Often chronic pancreatitis is accompanied by dyspeptic symptoms: prolonged nausea, vomiting, diarrhea and bloating.

If chronic pancreatitis is not treated for a long time, a structural restructuring of the pancreatic tissues occurs, as a result, its ability to produce hormones and enzymes is dulled and secretory insufficiency develops. Over time, the severity of pain decreases until they disappear completely. But with each subsequent exacerbation, new complications arise that may be irreversible.

Chronic pancreatitis can cause complications such as diabetes mellitus, stomach bleeding, abscesses, cancer, cysts, liver damage, and enterocolitis.

Diagnostics

In order to diagnose pancreatitis, the doctor may prescribe the following studies:

• Transabdominal ultrasound (to determine the size of the enlarged pancreas);
• Computed and magnetic resonance imaging (to detect calcification, pseudocysts, expansion of ducts, lesions of neighboring organs and malignant neoplasms);
• Endoscopic retrograde cholangiopancreatography;
• Determination of fecal pancreatic elastase;
• General blood analysis;
• Blood test for sugar level (to exclude diabetes mellitus);
• Urinalysis (to exclude inflammation of the kidneys);
• Electrocardiography and echocardiography (to rule out heart disease).

Treatment of pancreatitis

Treatment of pancreatitis should be aimed at eliminating not only the symptoms, but also the causes of its development.

At the time of therapy, it is necessary to completely abandon alcoholic beverages, follow a diet low in animal fats, and exclude medications that can have a negative effect on the pancreas. If pancreatitis occurs against the background of food allergies or gastrointestinal diseases, measures must be taken to eliminate them.

The main goal of treating pancreatitis is to reduce pain, normalize the pancreas, and prevent complications.

To relieve pain, the doctor may prescribe non-narcotic or narcotic analgesics (depending on the intensity of the pain syndrome). Dosages of drugs are selected individually for each patient. Myotropic antispasmodics are also used.

With a moderate exacerbation of chronic pancreatitis, the patient is recommended pancreatic enzymes containing the required amount of lipase, in combination with proton pump inhibitors to protect the enzymes from destruction by gastric juice.

In case of ineffectiveness of conservative treatment of pancreatitis, a surgical operation is performed, which can significantly prolong the patient's life.

The basis of the diet for pancreatitis is eating food that does not harm the stomach and pancreas.

With an exacerbation of the disease during the first 2 days, the patient is recommended fasting. You can only consume liquid, the volume of which should be at least 1 liter per day. It is allowed to drink alkaline water without gas, weak tea or rosehip broth. As the patient's condition improves, they are transferred to a limited, and then to a full, but dietary food.

Expansion of the diet for pancreatitis should be carried out gradually.

Today, people are increasingly turning to doctors with diseases of the digestive system, including inflammation of the pancreas.

To prescribe the right treatment for the doctor, it is important to know the causes of pancreatitis, because they are all divided into congenital and acquired.

Moreover, the percentage of the latter increases over the years, and pathology can occur not only in adults, but also in children.

Knowing the possible causes of the disease, patients will be able to prevent the development of the disease, as well as eliminate possible complications.

Main reasons

Pancreatitis is an inflammation of the pancreas, which is accompanied by irreversible processes in the structure of the organ and its degenerative processes.

The number of people diagnosed with pancreatitis is increasing every year, more and more often the problem appears at a young age.

The risk group includes people who do not eat well, eat a lot of fatty foods, often overeat or drink alcohol without restrictions.

Some reasons can cause activation of the secretion of enzymes that begin to cause an inflammatory process in the organ.

Among all the possible reasons, it is worth highlighting the main ones:

Not always doctors can determine the exact cause of pancreatitis, such a problem occurs in 25-35% of all patients.

Development of pancreatitis

The disease itself has different forms of flow. Pancreatitis can be in the acute and chronic phases, each of them is characterized by certain symptoms and causes, from which the disease occurs.

Despite this, the development process is almost always the same. During inflammation of the pancreas, damage to the tubules and ducts begins, due to protein plugs or calculi.

In addition, inflammation occurs due to the early activation of enzymes that the body secretes for proper digestion and digestion of foods. Because of this factor, cell damage and self-destruction of the organ begin.

If provoking factors appear, for example, there are stones that clog the bile duct, then the pressure in it rises.

Because of this, the normal outflow of biological material is disrupted, and the enzymes begin to activate ahead of time.

Instead of participating in the process of digesting food, they digest the tissues of the pancreas, causing severe inflammation.

In the chronic form of pancreatitis, a change in healthy cells and tissues begins, they are replaced by connective tissues.

Pancreatitis causes different causes, but the complications, regardless of the form, can be the same, and some of them are deadly for any person.

Possible complications include:

1. Shock state.
2. Acute liver or kidney failure.
3. Internal bleeding occurring in the intestines and other parts of the gastrointestinal tract.
4. thrombus formation.
5. Inflammation with purulent contents.
6. Inflammation of the abdominal cavity.
7. Pleurisy or pneumonia.
8. The development of jaundice of a mechanical type.
9. Abscesses.
10. Cysts and fistulas.
11. Blood poisoning.
12. Peritonitis.

Treatment of the disease is to eliminate the main symptoms and causes that caused the inflammatory process.

For this, it is necessary to use hunger at the beginning of treatment, and then a strict diet. In acute course, it is necessary to use analgesics and other means that eliminate pain, intense inflammation.

Treatment of acute pancreatitis is carried out in a hospital, patients are given droppers with medicines and nutrient solutions, drugs are used that block the negative effect of enzymes.

Tissues that are completely destroyed are removed surgically.

Causes of acute pancreatitis

Acute pancreatitis is a disease whose symptoms appear very quickly after the appearance of a provoking factor.

The main action in the acute form is autolysis, in simple terms, this is the digestion of gland tissues with their own enzymes.

The process is carried out due to the early activation of enzymes after their release from the ducts.

The most common causes of the acute phase of the disease are alcohol abuse and the presence of gallstone disease.

The development of acute pancreatitis may be for other reasons, which are divided into different groups.

In the first case, the disease appears with increased secretion and stimulation of pancreatic enzymes. The contributing factors will be:

1. Improper nutrition, in which there are harmful foods or a meal regimen is disturbed.
2. The use of certain medications without a doctor's prescription or in the wrong regimen.
3. The use of alcoholic beverages.
4. Binge eating.

The second group of reasons includes an increase in pressure in the middle of the duct itself. This problem appears due to stones that come out of the gallbladder and can clog the channels.

Stones cause high blood pressure and disruption of the pancreas. In addition, the problem may be hidden in the replacement of healthy scar tissues, as well as in the development of malignant tumors.

The next group of causes causes the release of bile directly into the channels of the pancreas, due to which motility changes, blockage and other disorders appear that cause inflammation.

The following factors can cause this condition:

1. Frequent drinking of alcoholic beverages.
2. Eating fatty foods with alcohol.
3. The presence of gallstone disease and the period of its exacerbation.
4. The appearance of stones in the bile ducts.
5. Cancer of Vater's nipple.
6. Injury to the pancreas that appears after surgical treatment.
7. The use of contrast agents during radiography.
8. The use of powerful drugs, which include Metronidazole or Tetracycline.
9. Diseases of the endocrine system, causing an increase in the norm of calcium in the blood. Over time, the excess is deposited in the channels and leads to their blockage.
10. Viral diseases, for example, infection with hepatitis or herpes. Such diseases can adversely affect the condition and functioning of the pancreas.

In addition to the factors described, it is necessary to know the causes of the development of chronic pancreatitis, because they may differ, and the correct and effective treatment depends on them.

Causes of chronic pancreatitis

There are a lot of reasons for the appearance of the chronic phase of the disease. This condition may develop due to the acute phase of pancreatitis, or it may have other manifestations and factors that cause mild discomfort, but are not a reason for urgent medical attention.

In this case, inflammation and tissue changes occur in the organ for a long time, after which the pancreas gradually fails.

Among the main possible reasons are:

1. Serious violation of nutrition and its basic rules.
2. The systematic use of alcohol, smoking.
3. Gallstone disease.
4. Diseases of the duodenum and other organs of the gastrointestinal tract.
5. Stagnation in the veins of the gland.
6. genetic predisposition.
7. Autoimmune failures in the gland.
8. Long-term use of drugs that have a toxic effect on the body.

From time to time, chronic pancreatitis can cause exacerbations. In this case, the overall picture of symptoms, as well as provoking factors, becomes similar to the acute course of the disease.

The only difference is that an exacerbation occurs with an already developed inflammation of the pancreas.

Causes of pancreatitis in children

The development of pancreatitis in children is a rare occurrence, since many causes for inflammation of the gland are simply absent.

Among the possible factors of the disease are:

1. Anomalies from birth on the part of the digestive tract.
2. Allergy to food.
3. lactase deficiency.
4. Cystic fibrosis is a hereditary disease that causes a gene mutation and is accompanied by malfunctions of the pancreas.
5. Infection of the body with worms, more often roundworms
6. Violation of the biliary tract.
7. Wrong nutrition.
8. Abdominal injuries.

In an infant, pancreatitis may occur due to developmental disorders in the womb.

Infants get sick as a result of allergies to foods that are transmitted through milk. In this case, the reason is the wrong diet of the woman herself.

If there is cystic fibrosis, then its symptoms will appear in the child during the first year of life.

In this case, the work of not only the pancreas, but also other glands of external secretion is disrupted.

Without treatment, the changes intensify and develop, after which healthy tissues are replaced by scar ones.

For children aged 1-3 years, frequent injuries of the abdomen are characteristic, due to the onset of walking and frequent falls.

Parents at this time should monitor the babies to prevent damage to the abdomen, which can cause inflammation of the pancreas.

If children need to be treated with medicines, then you need to choose them correctly, as well as follow clear instructions for use. This avoids complications and the onset of the inflammatory process.

Pancreatitis, like other diseases, is easier to prevent than to engage in further treatment.

It is important to follow the lifestyle from an early age, eat right to be healthy. It is especially important to adhere to the rules for people who are at risk.

Measures during an attack

As soon as an attack of pancreatitis begins, you need to know the basic measures that are important to follow and take.

Among the main ones:

1. It is forbidden to eat, even the lightest foods. The meal should be abandoned for 2-3 days to stop the release of enzymes that increase pain and inflammation. The use of alkaline water without gases is allowed.
2. Put cold on the abdomen to reduce pain, in addition, the cold will relieve swelling from the tissues. It is best to use heating pads in which ice water is collected.
3. It is necessary to observe rest and bed rest, try not to carry out any load, which will reduce blood flow to the affected organ, and also help to remove inflammation.
4. Among the main drugs that can be used independently for pain relief, Drotaverine, No-shpu are distinguished. Such drugs can be used in the acute form of the disease, before the arrival of doctors.

Very often, relapses of the disease occur with the death of tissues or an organ as a whole.

The use of enzymatic agents is prohibited during the acute period, otherwise the condition will worsen.

If the causes of the attack are known, then you should immediately call an ambulance, and upon the arrival of the doctor, report the provoking factor.

Prevention

During an attack of pancreatitis, it will be necessary to provide the patient with urgent assistance, most often people are hospitalized, since the treatment is carried out in a hospital setting.

The need for urgent surgical treatment is not ruled out. Often after acute pancreatitis there is a chronic phase, after which the pancreas constantly destroys itself.

Patients with pancreatitis, as well as people at risk, should use preventive measures to avoid the development of a new attack and the disease itself.

The main measures include:

1. Complete rejection of bad habits in order to reduce the load on the inflamed gland and not aggravate the condition of the organ. This measure makes it possible to significantly increase the time of remission and the overall prognosis of the disease.
2. Increased loads, intense and long running, saunas and baths are excluded. Such activities can provoke a relapse. The best option for pancreatitis is massage, light gymnastic exercises, and breathing exercises.
3. The work and condition of the pancreas directly depends on how the gallbladder and its channels function. When calculi appear, you need to immediately remove them from the body, you need to deal with such treatment as quickly as possible.
4. It is important to monitor nutrition and listen to the body, observe the reaction to different foods. It is forbidden to starve or overeat with pancreatitis, this regimen disrupts metabolic processes, the state of the gallbladder and pancreas.
5. Eat, you need to be dosed, in small portions, but often. Try not to use different foods at one meal, especially carbohydrates and proteins. In chronic pancreatitis, it is useful to spend fasting days using only cereals, soups or other allowed dishes.
6. Avoid coffee, which negatively affects the work and condition of the pancreas. If it is not possible to completely forget about the drink, then with a long remission, you can drink a cup a day, but only after eating. Avoid instant drinks altogether.
7. You should try not to eat raw foods with coarse fiber. Such food is heat-treated. The basic rules of nutrition are spelled out in the dietary table No. 5 according to Pevzner.

Using the basic rules of prevention, undergoing frequent examinations with a doctor, you can avoid exacerbations and deterioration in pancreatitis.

Timely diagnosis of the disease allows you to get rid of it forever, if it is defined at the beginning of development and in a mild form.

Useful video

Pancreas located behind the stomach, next to the duodenum. The pancreas has two main functions:

1. Releases powerful digestive enzymes in the small intestine to help digest carbohydrates, proteins and fats.

2. Ferments the hormones insulin and glucagon in the blood. These hormones are involved in the metabolism of blood glucose, regulate the storage and use of energy received by the body from food.

Pancreatic damage occurs when digestive enzymes are activated in the pancreas itself before they enter the duodenum. When these enzymes become active inside the pancreas, they begin to break down the tissues of the pancreas, a kind of self-digestion occurs. This causes swelling, bleeding, and damage to the pancreas and its blood vessels.

Pancreatitis can be caused by a gallstone (by blocking the output of the pancreas), chronic alcohol use, trauma, certain medications, infections, tumors, and genetic abnormalities.
There are two main forms of pancreatitis: acute and chronic.

Pancreatitis is rare in children and is usually caused by a hereditary disease or injury to the pancreas; in rare cases of childhood pancreatitis, the cause is unknown.

Acute pancreatitis

Acute pancreatitis- sudden inflammation that occurs over a short period of time and is accompanied by swelling and inflammation of the pancreas, fever, nausea, vomiting. In most cases, acute pancreatitis is caused by a gallstone or long-term alcohol use. In about 10% to 15% of cases of acute pancreatitis, the cause is unknown.

Acute pancreatitis can be classified as mild, moderate or severe. This classification is based on the results of physiological, laboratory, and radiological studies.The mild degree of the disease is not associated with complications or organ dysfunctions, and the recovery is uneventful.Severe pancreatitis is characterized by pancreatic dysfunction, local and systemic complications, and difficult recovery.

In addition, pancreatitis can be divided into acute interstitial and acute hemorrhagic.In the interstitial type, the pancreas remains unchanged, but its swelling may be present.Inflammatory cells and interstitial edema are seen in the parenchyma.Hemorrhagic disease is characterized by severe necrosis, hemorrhages in the tissue, and necrosis of fat cells.In this condition, pancreatic necrosis is often noted along with vascular inflammation and thrombosis.

Causes and risk factors for acute pancreatitis

Acute pancreatitis affects men more often than women.

The main causes of acute pancreatitis:

Symptoms of acute pancreatitis

The main symptom of pancreatitis is pain in the abdomen, in the upper left corner or in the middle of the abdomen. The pain may get worse within a few minutes after eating or drinking, especially if the foods are high in fat. Usually, constant pain lasts for several days, aggravated in the supine position, and can also radiate to the back or under the left shoulder blade.
- People with acute pancreatitis often look sick with fever, nausea, vomiting, and sweating.

Other symptoms that may occur with this disease include:

- Clay-colored stools of foamy consistency;
- flatulence;
- Hiccup;
- Indigestion;
- Loss of appetite;
- Yellowing of the skin and whites of the eyes (obstructive jaundice);
- Rash on the skin (Tuzhilin's symptom);
- Bloating;
- Blood pressure rises, and then it can become, on the contrary, too low;
- Palpitations, shortness of breath;
- Bluish spots in the navel and on the lower back, greenish-blue spots in the groin.

Diagnosis of acute pancreatitis

Diagnosis of acute pancreatitis is often difficult due to the deep location of the pancreas.

- Abdominal ultrasound. If pancreatitis is caused by a gallstone causing inflammation, then an ultrasound confirms their presence with an indication of their location.
- CT scan. CT can show gallstones, the presence of stones in the ducts, determine the size of the pancreas and detect foci of the disease, as well as the degree of damage to the pancreas.
- Endoscopic ultrasound. This examination is performed using an endoscope, a thin, flexible, lighted tube inserted through the throat into the stomach and into the small intestine. And with the help of ultrasound, visual images of the pancreas and bile ducts are created.
- Magnetic resonance cholangiopancreatography. A non-invasive study that produces cross-sectional images of body parts. The patient is given an intravenous injection of a contrast agent that helps visualize the pancreas, gallbladder, pancreas, and bile ducts.
- Densitometry, a study that allows you to judge the density of an organ.
Laboratory studies allow you to determine:
- General blood analysis. It allows you to determine the increase in the level of amylase and the increase in the serum level of blood lipase. During acute pancreatitis, their levels are at least three times the normal amount. Changes can also occur in other chemical parameters such as glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After a person's condition improves, levels usually return to normal.
- Urinalysis shows an increase in urine amylase levels.

Treatment of acute pancreatitis

Treatment of acute pancreatitis often requires a stay in the hospital and special complex therapy, which includes:

Prescribing medications that include:

• Infusion therapy - intravenous infusion of drugs that help cleanse the blood of pancreatic enzymes and toxins;
• Painkillers (analgesics);
• Drugs that destroy pancreatic enzymes (Kontrykal, Gordox;)
• Drugs that reduce pancreatic secretion (Atropine, Platifillin);
• Hormones of the digestive tract (Dalargin, Somatostatin);
• antiemetic drugs;
• Antispasmodics;
• antibiotics;

Complete cessation of eating and drinking through the mouth for 3-6 days to limit the activity of the pancreas;
- Enteral nutrition (intravenously);
- Compliance with a strict diet;
- Direct purification of blood from poisons: plasmapheresis and hemosorption;
- Forced diuresis - artificial stimulation of urination by introducing fluids and diuretics into the body, in order to speed up the excretion of toxic substances from the body with urine;
- Bowel and abdominal lavage (intestinal and abdominal dialysis);
- Nasogastric aspiration is indicated if vomiting or severe pain persists or ileus develops;
- Cholecystectomy. If pancreatitis is confirmed to be caused by a gallstone, the gallbladder must be removed;
- Surgery for acute pancreatitis is rarely required, in the most severe cases, to remove dead or infected pancreatic tissue.

The duration of inpatient care depends on the development of complications of pancreatitis and how well patients respond to treatment. This figure ranges from several days to several months of intensive care.

Patients can be discharged when pain is well controlled with oral pain medication, when patients are able to tolerate a diet that meets their caloric requirements, and all complications have been adequately managed.

Expectations and prognosis of acute pancreatitis

In most cases, the symptoms of acute pancreatitis improve within a week. However, in some cases, acute pancreatitis can develop into a life-threatening illness.

There is a high mortality rate with such complications as:

Hemorrhagic pancreatitis;
- Liver failure;

- Kidney failure:
- Pancreatic necrosis.

An episode of acute pancreatitis may recur. The likelihood of this depends on the cause of the disease, and how successfully it can be treated. Repetitive episodes of acute pancreatitis can lead to the development of chronic pancreatitis.

Complications of acute pancreatitis

Acute renal failure;
- Acute respiratory distress syndrome;
- Accumulation of fluid in the abdominal cavity (ascites);
- Cysts or abscesses in the pancreas;
- Heart failure;
- Low blood pressure.

Chronic pancreatitis

Chronic pancreatitis occurs most often after an episode of acute pancreatitis and is the result of ongoing inflammation of the pancreas that, over time, causes permanent damage to the pancreas.

Causes and risk factors for chronic pancreatitis

Due to chronic inflammation, scarring occurs on the pancreas, the organ becomes unable to produce the right amount of digestive enzymes. As a result, the body may not be able to digest fat and other important food components. Damage to the part of the pancreas that produces insulin can lead to diabetes.

Chronic pancreatitis often develops in people who are in their 30s and 40s and is most often caused by alcohol abuse over many years, with males predominating over females. Recurrence of episodes of acute pancreatitis can lead to chronic pancreatitis. In some cases, genetics may be a factor in its development. In 10-15 cases of chronic pancreatitis, the cause is not known.

Other factors that are also associated with chronic pancreatitis include:

autoimmune problems;
- Blockage of the pancreatic duct or common bile duct;
- Complications of cystic fibrosis, the most common hereditary disorder, when the secrets secreted by various organs have too high viscosity and density;
- Hypercalcemia - high levels of calcium in the blood;
- Hyperlipidemia or hypertriglyceridemia - high levels of fats in the blood;
- Use of estrogens, corticosteroids, thiazide diuretics, and azathioprine;
- Metabolic disorders, especially fat, associated with overeating.

Symptoms of chronic pancreatitis

Symptoms of chronic pancreatitis may become more frequent as the patient's condition worsens. These symptoms can mimic pancreatic cancer. An attack of chronic pancreatitis is not much different from an attack of acute pancreatitis.

Damage to the pancreas from excessive drinking does not cause symptoms for many years, however, severe pancreatitis symptoms can develop suddenly, including severe pain and pancreatic dysfunction such as indigestion and blood sugar.

The main symptoms of chronic pancreatitis include:

- Pain in the upper abdomen radiating to the back, which lasts from several hours to several days and is worse after eating or drinking. As a rule, pain occurs or worsens after drinking alcohol;
- Problems with digestion. There is an aversion to fatty and spicy foods and increased salivation;
- Chronic weight loss, even with the usual diet. People with chronic pancreatitis often lose weight even when their appetite and eating habits are normal. Weight loss occurs because the body does not produce enough pancreatic enzymes to digest food, so nutrients are not absorbed normally. Poor digestion leads to malnutrition due to the excretion of fat in the stool:
- Belching;
- Diarrhea, nausea and vomiting;
- Flatulence and constant rumbling in the stomach;
- Fatty or oily, light or clay-colored stools, with particles of undigested food, which have a disgusting smell;
- Mechanical jaundice;
- Addition of diabetes mellitus;
- Neuropsychiatric disorders: irritability, agitation, poor sleep.

Diagnosis of chronic pancreatitis

Tests to diagnose chronic pancreatitis include:

Coprogram, physical, chemical and microscopic examination of feces, to detect neutral fat and fatty acids;
- Serum amylase;
- Serum IgG4 (for the diagnosis of autoimmune pancreatitis);
- Serum lipase blood;
- Serum trypsinogen;
- CT scan of the abdomen;
- Ultrasound of the abdominal cavity;
- Endoscopic retrograde cholangiopancreatography;
- Endoscopic ultrasound examination;
- Magnetic resonance cholangiopancreatography;
- An exploratory laparotomy may be done to confirm the diagnosis if other diagnostic methods have failed.

Treatment of chronic pancreatitis

Treatment of chronic pancreatitis is similar to that of acute pancreatitis and is usually conservative. It is aimed at weakening the secretion of gastric juice. For this purpose, the following drugs are used:

Antispasmodic drugs for relieving muscle spasms:

• Drotaverin (Bespa, No-shpa, Spazmoverin, Spazmol)
• Papaverine Hydrochloride (Papaverine)

- Means that weaken the secretion of gastric juice:

• omeprazole
• Ranitidine (Acidex, Acilok-E, Gistak, Duoran, Zantak, Zoran, Ranigast, Ranisan, Ranital, Ranitin, Rantag, Rantak, Renks, Ulkodin, Ulkosan, Ulkuran, Yazitin)
• Famotidine (Antodin, Acipep, Blockacid, Gasterogen, Gastrosidin, Kvamatel, Nevofarm, Pepsidin, Famogard, Famodar, Famopsin, Famocid)
• Cimetidine (Altramet, Belomet, Histodil, Neutronorm, Primamet, Simesan, Tagamet, Ulkuzal)

Enzyme preparations that correct the secretory dysfunction of the stomach, normalize the digestion process, and also regulate the functions of the pancreas:

• Allochol
• Hymecromon (Odeston, Holonerton)
• Pancreatin (Digestal, Creon, Mezim, Pankral, Pancitrate, Penzistal, Tagetal, Ferestal, Festal, Forte Enzim, Enzistal)
• Phenipentol (Febihol)

- Substances that inhibit the production of pancreatic enzymes

• Aprotinin (Antagozan, Gordox, Iniprol, Kontrykal, Trasilol)

In case of severe pain and sudden weight loss, hospitalization and intensive care may be indicated. Surgery may be recommended in severe cases where part or all of the pancreas may be removed.
An important place in the treatment of chronic pancreatitis is the treatment of concomitant diabetes, if any, which is carried out according to standard methods.

Alas, complete recovery from chronic pancreatitis does not occur. An important task is to prevent further destruction of the gland, so diet is very important for people with chronic pancreatitis. Dietary nutrition helps maintain a healthy weight, and taking vitamins and minerals will provide the body with the necessary micronutrients.

drinking plenty of fluids;
- A diet low in fat, no more than 30 grams per day;
- Frequent fractional meals in small portions;
- Eating foods high in protein and carbohydrates;
- Getting enough vitamins and calcium;
- Restriction of caffeine;
- Complete cessation of smoking and alcohol;
- In case of obesity, smooth weight loss.

Expectations and prognosis of chronic pancreatitis

This is a serious disease that can lead to disability and death. With timely and appropriate treatment, irregular adherence to dietary recommendations can usually alleviate the pain symptoms of chronic pancreatitis.

With a complete refusal of alcohol, a 10-year survival rate of more than 80% of patients was noted, less than 40% of patients survive if they continue to drink. With a 20-25-year period of the disease, mortality is 50%.

For cystic, hyperplastic and fibrosclerotic variants of chronic pancreatitis, the prognosis is usually worse.

Complications of chronic pancreatitis:

Ascites;
- Blockage, obstruction of the small intestine or bile ducts;
- Thrombus in the vein of the spleen;
- Pseudocysts of the pancreas;
- Dysfunction of the pancreas;
- Diabetes;
- Malabsorption - a violation of the absorption of nutrients in the small intestine, most often fat-soluble vitamins A, D, E, or K.

Prevention of pancreatitis

You can reduce your risk of new or recurring episodes of pancreatitis by taking steps to prevent conditions that can lead to illness:

Avoid taking aspirin when treating fever, especially in children, to reduce the risk of Reye's syndrome.
- Do not abuse alcohol.
- Follow a healthy diet.
- Timely vaccination against mumps and other childhood diseases.

Pancreatitis is an inflammatory disease of the pancreas. The main reason is a violation of the outflow of digestive juice and other enzymes produced by the pancreas into the small intestine (duodenum). The incidence of pancreatitis and other pancreatic diseases is increasing worldwide. First of all, this is due to irrational nutrition, alcohol abuse, environmental degradation.

In the article, we will consider in detail: what it is, what are the main causes, the first signs and symptoms, as well as what treatment is prescribed for pancreatitis in adults, and what you need to know if an attack occurs.

What is pancreatitis?

Pancreatitis is an inflammatory and degenerative process in the pancreas. If such a process manifests itself, then the enzymes produced by the pancreas do not enter the duodenum. Consequently, they begin to actively act already in the pancreas, gradually destroying it.

This process is called autolysis, which, translated from Latin, is called "self-digestion". Now you know, in the most general terms, about acute pancreatitis, what it is. This is just a chemical attack, and the transformation of the gland "on its own" into a semi-digested mass.

The pancreas is one of the most complex organs of the human body, which is almost impossible to restore. The efficiency of this gland regulates metabolism, normal digestion.

Its main functions are:

• The release of enzymes for the breakdown of nutrients obtained from food in the small intestine.
• Fermentation of insulin and glucagon in the blood - hormones that regulate the storage and consumption of energy obtained from food.

The reasons

Pancreatitis in adults is a fairly common problem that anyone can face. Violations associated with the outflow of bile, as well as dietary habits (for example, consumption of fatty and rich meat foods, stress, hereditary predisposition, alcohol, etc.) can lead to development.

Consequently, those people who constantly abuse alcohol have a higher risk of developing pancreatitis. According to statistics, it often develops in pregnant women and in young mothers in the postpartum period. The key to preventing the development of pancreatitis is the correct approach to the formation of the diet.

Doctors distinguish the following types of diseases:

Acute pancreatitis

Acute pancreatitis by itself means, respectively, an acute form of manifestation of aseptic inflammation to which the pancreas is exposed. Most often develops in the following cases:

• when taking alcohol - up to 70% of all cases of the disease (mainly in young and mature men),
• in the presence of cholelithiasis - up to 25% or 30% (more often in women),
• operations on the stomach or other abdominal organs - about 4% or a little more.

There are certain phases of pancreatitis, which are considered as part of its acute form:

• enzymatic phase (within three to five days);
• reactive phase (ranging from 6 to 14 days);
• sequestration phase (from 15 days);
• phase of the outcome (from six months or more from the moment of the onset of the appearance).

Chronic form of pancreatitis

What it is? - This is a form of the disease in which inflammation progresses slowly, while the functions of the pancreas are gradually impaired. As a result, fibrosis of the pancreatic tissue or its calcification may occur. It is most often found in older women.

According to the predominant cause of the development of inflammation, chronic pancreatitis is distinguished:

• toxic-metabolic (including alcohol),
• idiopathic,
• hereditary,
• autoimmune,
• recurrent,
• obstructive.

It is possible to distinguish the primary chronic form of pancreatitis, the secondary one, which develops due to diseases of the digestive system - cholecystitis, chronic, enteritis.

The first signs of an attack

If the patient has signs of acute pancreatitis, his condition will deteriorate rapidly. That is why it is so important to seek medical help immediately.

• In the acute form of the disease, pains are localized under the pit of the stomach in the upper part, left and right hypochondrium, if the entire gland is affected, then the pains are girdle.
• Also, the patient has vomiting with an admixture of bile, which does not bring him relief, dry mouth, hiccups, nausea and belching.

The same signs that manifest themselves in both acute and chronic (during exacerbations) forms of pancreatitis are acute, severe pain in the abdomen. Localization depends on which part of the pancreas is covered by the inflammatory process.

Symptoms of pancreatitis in adults

Pancreatitis, the symptoms of which are manifested due to the fact that there is no release of enzymes secreted by the gland into the duodenum, proceeds with the activation of these enzymes directly in the gland, due to which its gradual destruction occurs, in other words, self-digestion.

The acute form of pancreatitis is accompanied by the following symptoms:

• Severe pain in the left hypochondrium, radiating to the back or girdle.
• Nausea, vomiting, flatulence. Malfunction of the digestive tract.
• Increase in body temperature.
• Dry mouth, thick white coating on tongue.
• Headache, sweating. The skin becomes pale.
• Increased blood pressure, palpitations, shock.

In the presence of such symptoms, the patient's condition worsens every minute, so you can not hesitate. At the first suspicion, you should immediately call an ambulance.

In chronic pancreatitis:

• Permanent or temporary abdominal pain. Appears after drinking alcohol and fatty foods.
• Pain in the upper abdomen radiates to the back.
• Rumbling in the abdomen, nausea, vomiting.
• Loss of appetite, upset stool, chronic diarrhea.
• Dehydration. As a result, the body weight of the patient is reduced.
• The skin and mucous membrane of the oral cavity acquire a yellow tint.
• At the last stage of the disease, diabetes mellitus occurs.

With relatively mild pain, the period of exacerbation can last quite a long time (up to several months). This period is characterized by a decrease in appetite, general weakness, and a decrease in mood.

Complications

Complications of pancreatitis can be:

• gland abscess;
• Pancreatic necrosis (necrosis of pancreatic tissue);
• Formation of a false cyst;
• Pancreatogenic ascites;
• Pulmonary complications;
• Diabetes;
• Fatal outcome.

With complications, there is a change in the habitual nature of the disease: the nature, localization and intensity of pain changes, it can become permanent.

Diagnostics

The sooner the patient receives qualified assistance, the less time the treatment will take and it will be more effective. But it is precisely the early diagnosis of this disease that is the main problem.

The most reliable method for detecting pancreatitis and its forms is achieved through a complete examination of the patient. In the diagnosis of the disease, the following stages are distinguished:

• assessment of clinical symptoms;
• study of biochemical parameters;
• carrying out enzymatic tests;
• instrumental studies in the diagnosis of the disease.

Blood tests:

• General (KLA) will reveal, show the erythrocyte sedimentation rate (ESR) and the volume of pancreatic enzymes, and help identify inflammation. The number of leukocytes more than 8.8 thousand / ml or ESR from 15 mm / h are bad signs.
• A biochemical analysis will reveal the level of glucose (it is dangerous to increase the concentration of "sugar" to 6.5 mmol / l and 106 mg / dl - hyperglycemia), cholesterol (should not be less than 3 mmol / l) and pancreatic enzymes: amylase (with pancreatitis increases by tens of times, up to 1000 U / l and above), α2-globulins (should not be less than 7%), trypsin (should not be above 4 μmol / ml.min), lipase (should not exceed 190 U / l), etc.

Instrumental diagnostics:

1. Ultrasound of the abdominal organs can detect an increase in the pancreas and the presence of stones in the ducts.
2. X-ray diagnostics establish paresis of the intestine (impaired contractility), visible subsidence of lung areas (atelectasis) and the presence of effusion in the pleural cavity.
3. The gastroduodenoscopic method reveals an edematous stomach and duodenum 12.
4. The study of blood vessels - angiography, allows you to see deformed and displaced arterial vessels, the accumulation of a contrast agent in them due to congestion.

If only ultrasound diagnostic data is used to make a diagnosis, then it may be unreliable. Often pancreatitis does not give any specific signs and the specialist conducting the examination can detect only minor diffuse changes or swelling of the organ. Although even these indicators are visible on ultrasound only with an exacerbation of the disease.

Treatment of pancreatitis

In acute pancreatitis, treatment is possible only in a hospital, under the supervision of qualified specialists, this is considered a very dangerous condition. Therefore, when the first signs appear, call an ambulance.

First aid

If you suspect an attack of pancreatitis as a first aid - rest, sitting position with your knees pressed to your chest, strict fasting with a quarter glass of water every 30 minutes - an hour, put an ice pack on the pancreas from the back. Shallow breathing will help relieve the attack.

Painkillers and anti-inflammatory drugs should not be taken, this will greatly complicate the diagnosis.

If the pain is intense, the doctor may prescribe antispasmodics (No-shpa, Drotaverine). With their help, inflammation in the pancreas decreases and, as a result, pain subsides.

In the hospital for the treatment of acute pancreatitis, conservative methods of therapy are used. In particular, various solutions are introduced into the bloodstream - saline solutions, protein preparations, glucose, with the help of which intoxication and pain are overcome. The acid-base balance is also normalized.

Medicines for pancreatitis

• With frequent vomiting, drugs are used to restore the water-salt balance, for example, "Sodium chloride solution".
• To restore the work of the gastrointestinal tract, enzyme preparations are taken that replace the pancreatic enzymes that are absent during the illness: "Creon", "Pancreatin", "".
• Vitamin therapy. In the treatment of chronic pancreatitis, an additional intake of vitamins is prescribed - A, E, C, D, K and vitamins of group B. In addition, a reception is prescribed - lipoic acid, cocarboxylase.
• parenteral nutrition. In severe digestive disorders and poor absorption of food by the intestines, parenteral nutrition is prescribed.

As parenteral nutrition, by drip intravenously, the following are usually administered:

• Mixtures of essential amino acids (250-400 ml each): "Alveein", "Alvezin", "Aminosol";
• Electrolyte solutions: 10% potassium chloride solution (10-15 ml) and 10% calcium gluconate solution (10 ml).

Treatment of chronic pancreatitis involves: diet, pain medications, vitamins, enzyme replacement therapy, treatment of diabetes mellitus and other endocrine disorders, timely treatment of cholelithiasis.

Surgery

Surgical treatment is indicated in case of diffuse inflammation of the peritoneum, purulent complications, increasing obstructive jaundice and destruction of the gallbladder and ducts.

Operations can be assigned as follows:

• Emergency. They are carried out at the very beginning of the development of the disease. It can be the first hours and days. Patients with enzyme-induced and acute pancreatitis, which began due to blockage of the duodenum, are operated on urgently.
• Planned. The surgeon begins to operate on the patient only when the acute inflammation in the pancreas has ceased. Before the operation, the patient is carefully examined so that the recurrence of the attack does not begin.

Diet

The basis of successful therapeutic correction of this disease is following a diet. The daily diet is adjusted in such a way: the level of fats and carbohydrate products in the diet is reduced and the level of protein intake is increased. Vitamin preparations are prescribed. The number of meals should be 5-6 in one day.

In acute pancreatitis, in the first 2-3 days it is necessary to completely refuse to eat, only plentiful drinking is allowed - mineral water, rosehip broth or, in extreme cases, ordinary water.

When the exacerbation of pancreatitis has passed, you need to adhere to such nutritional rules as:

1. The diet should contain lipids, proteins and carbohydrates.
2. Eat water-soluble and fat-soluble vitamin complexes.
3. Refuse foods that contain chemicals, because they can greatly irritate the intestinal mucosa.
4. Cannot be consumed spices, smoked meats, spicy.
5. It is best to cook food by steaming, pre-chopping it, you may need to grind it.
6. Food should be consumed warm, but not hot.

After the symptoms of acute pancreatitis are completely gone, you need to eat soup, lean meat, fish, low-fat cottage cheese, various types of cereals, vegetables, you can drink fruit juice, with sweets, give preference to honey, jam and pudding.

Folk remedies

Below, we have collected effective folk remedies for pancreatitis, but be sure to consult your doctor before using them.

1. Golden mustache . 1 large leaf (length 25 cm) or two small ones are crushed and pour 700 ml of water. On medium heat, the broth languish for 15-20 minutes, then it is infused for several hours in the body (you can leave it overnight). You need to use the infusion in a warm form of 25 ml (before meals).
2. Potato-carrot juice. Pass 2 potatoes and 1 carrot through a juicer. Use 2 times a day 30 minutes before meals, the course of treatment for adults will be 7 days, the method helps to normalize digestion, eliminate pain symptoms.
3. Herbs for the pancreas are used in collections and one of them should consist of yarrow herb, calendula flowers and chamomile. All components are taken in a tablespoon and brewed in a ladle with boiling water. After half an hour, you can drink the first portion (100 ml), and 40 minutes after that, eat. It is necessary to drink the medicine at least 4 times a day, only before meals.
4. For a recipe for pancreatitis, you will need immortelle flowers, motherwort, St. John's wort, pour 200 ml of boiling water over everything, leave for 30 minutes, drink up to three times a day before meals.
5. Instead of regular tea, use tea with mint and honey. Mint has a choleretic effect and promotes the release of enzymes from the pancreas.
6. Propolis. Small pieces are thoroughly chewed between meals, the method is a vivid example of effective modern homeopathy and eliminates pain attacks, normalizing digestion.
7. Rowan . An excellent choleretic agent that is used both in the treatment and prevention of pancreatitis. Rowan fruits can be consumed fresh or dried for future use.
8. For 10 days, you need to take 1 teaspoon of rosehip oil. Take two months off and take the course again. Recommended for chronic pathology.
9. Pour a glass of oats with a liter of water, insist for 12 hours. Bring the broth to a boil and boil under the lid for half an hour. Wrap the container with the broth, leave for 12 hours, then strain and add water to a volume of one liter. Adults take a decoction three times a day for 100 - 150 ml half an hour before meals. The course of treatment is a month.
10. Rose hip . In the chronic course of pancreatitis, rose hips can be drunk on an ongoing basis - up to 400 ml per day. Rose hips are poured with hot water (the number of berries is equal to the amount of liquid). In a thermos, the infusion is left for a couple of hours, after which the drink can be consumed.

Prevention

Prevention methods:

• In the first place is the correction of risk factors: alcoholism, various metabolic disorders.
• It is necessary to constantly adhere to a diet. Try to always be indifferent to what you eat, as this will not play into your hands in the future. As often as possible, eat vegetables and fruits that will enrich your body with vitamins. Such prevention will protect you not only from pancreatitis, but also from other diseases.
• It also requires constant adjustment of treatment. For this, it is recommended to visit a gastroenterologist 2 times a year in the absence of relapses. In case of relapse, you should immediately consult a doctor.

Now, you know what kind of disease it is and how it proceeds in adults. Remember that timely treatment can avoid the chronic form of pancreatitis and reduce the risk of complications. Be healthy and take care of your health!

Every year, the number of patients suffering to one degree or another is growing. Pancreatitis is a rather serious pathology in which self-digestion of the digestive gland occurs. Its symptoms directly depend on the severity of the lesion and the severity of the inflammation. The causes of pancreatitis are very diverse, and therefore, in order to be truly effective, it is necessary to find out what provoked its development.

What is pancreatitis and what happens in the pancreas during its development?

Pancreatitis is a collective term that includes a group of diseases and syndromes resulting from inflammation of the pancreas. At the same time, the enzymes that this organ produces do not enter the duodenum, but are activated in the pancreas, which leads to its self-digestion.

Normally, the pancreas produces proenzymes (inactive enzyme precursors). Then they enter the duodenum 12, where they pass into the active form.

However, under the influence of a number of factors, due to an increase in pressure in the duct of the digestive gland, there is a violation of the outflow of its secret. As a result, the enzymes begin to activate prematurely, and begin to digest the organ that produces them. This condition leads to the development of acute inflammation.

Approximately the same mechanism of development of acute pancreatitis is observed in diseases of the duodenum 12. In the event that inflammation develops in the area of ​​Vater's nipple, which combines the hepatic and pancreatic ducts, or scars form, this, due to the narrowing of its lumen, provokes stagnation of bile and pancreatic juice, which over time can lead to the development of an inflammatory process .