Symptoms and treatment of acute pancreatitis. Pancreatitis - what is it, causes, first signs, symptoms and treatment of pancreatitis in adults

Sudden inflammation of the pancreas, which is one of the most severe surgical diseases, leading to the necrosis of the pancreatic tissue.

In acute pancreatitis, the gland tissue is damaged by its own gland enzymes, which are activated under the influence of one or another factor, then penetrating into the glandular tissue and destroying it. Active enzymes circulating in the blood lead to dysfunction of all organs and systems of the body.

The main symptoms of acute pancreatitis are: acute pain in the upper abdomen, nausea and vomiting. Diagnosis of acute pancreatitis is based on determining the level of pancreatic enzymes (amylase and lipase) in the blood.

The treatment of acute pancreatitis is conservative and consists in following a diet, cleansing the blood of pancreatic enzymes, and also in symptomatic treatment. In the case of a progressive deterioration of the condition, an operation may be performed to remove dead tissue from the pancreas.

Causes of acute pancreatitis

The greatest importance in the occurrence and development of this disease belongs to the abuse of alcohol, the abuse of juice and choleretic foods (for example, fatty meat fried foods).

Also important are injuries of the pancreas, diseases of the digestive system (liver, biliary tract, duodenum), various vascular diseases.

Besides:

Attack of acute pancreatitis

An attack of acute pancreatitis usually develops suddenly, after eating or drinking.

The main symptoms of an attack of acute pancreatitis include:

First aid for an attack of acute pancreatitis

Important: with an attack of pancreatitis, you should immediately call a doctor, because. any delay can lead to serious complications and even death of the patient.

Before his arrival, you can not eat anything, and to reduce the secretion of the gland, you can put an ice pack on your stomach.

You should not take analgesics that are available without prescriptions. They will not bring relief, but may complicate the clinical picture of pancreatitis. You can take the following drugs:

"No-shpa";
"Baralgin";
"Papaverine" in combination with "Platifillin".

It should be noted that the first strong dose should not exceed two tablets, and the next dose should be taken only after two hours.

Important: with unbearable pain, the patient is injected with potent drugs that will protect against pancreatic necrosis.

Symptoms of acute pancreatitis

The disease begins with severe girdle pain in the upper abdomen. Sometimes a strong attack of pain is preceded by the initial symptoms of acute pancreatitis - a state of discomfort, short-term fuzzy pain in the abdomen, loose stools.

The position on the back exacerbates the pain. With the onset of necrosis of the pancreatic tissue, pain may decrease due to the fact that necrosis has also affected the nerve endings. Mandatory symptoms of acute pancreatitis are also nausea, vomiting and bloating.

Vomiting is excruciating, persistent, sometimes indomitable and never brings relief. Increasing bloating due to the accumulation of gases disrupts the motor activity of the intestine.

When enzymes enter the blood, its circulation in small blood vessels is disturbed, stagnation leads to the appearance of small pinpoint hemorrhages on the skin in the navel and buttocks.

The skin of such patients becomes pale, with a bluish tint. General intoxication of the body with enzymes and products of the breakdown of the pancreas affects the activity of all organs.

acute pain

Acute pain, encircling nature, localized in the right and left hypochondrium, epigastric (pit of the stomach). The pain radiates (radiates) to the left side of the body: to the area of the shoulder, shoulder blade, lower ribs from the back. Intense pain, constant, even against the background of drug treatment, can continue for another day. The cause of pain is necrosis (death) of tissue and nerve endings of the pancreas.

Lack of appetite

Lack of appetite, aversion to food develops, is the result of a lack of excretion of pancreatic enzymes into the intestines.

Nausea with vomiting

Nausea with vomiting, provoked as a result of eating, is the result of a lack of enzymes in the intestines necessary for normal digestion. Indomitable, profuse vomiting of stomach contents or bile, which does not bring relief.

Symptoms of intoxication

Symptoms of intoxication develop with the development of purulent foci in the pancreas:

body temperature rises above 38C with chills;
pulse quickens above 90 beats / min;
the skin becomes cold and damp;
quickening of breathing.

Shock

Signs of shock appear as a result of severe pain and loss of fluid by the body, due to indomitable vomiting: a decrease in pressure below 90 mm / Hg.

Bloating

Bloating of the upper abdomen and a feeling of fullness, as a result of indigestion associated with a lack of enzymes and a violation of transit through the intestines.

Diarrhea

Frequent loose stools, due to indigestion, as a result of a lack of pancreatic enzymes in the intestines.

The skin is pale with a dark tint

Acute pancreatitis is characterized by specific symptoms of cyanosis, which develop as a result of a sharp violation of microcirculation, due to a decrease in the volume of circulating blood, as a result of profuse vomiting. Cyanotic spots are formed on different parts of the body (in the face and neck, lateral parts of the abdomen, navel).

Stomach tension

The abdominal wall of the abdomen is tense to the left below the costal arch.

Descriptions of symptoms of acute pancreatitis

Complications of acute pancreatitis

Acute pancreatitis can be complicated by the formation of abscesses (abscesses limited to the capsule), as well as the transition of inflammatory phenomena to other organs of the gastrointestinal tract, for example, to the biliary tract and gallbladder.

If the wall of the blood vessel is broken, acute gastrointestinal bleeding can begin.

In the process of destruction of pancreatic tissue, various substances enter the bloodstream, which can cause complications in the form of a sharp decrease in blood pressure (collapse), impaired renal function, and various complications from other internal organs.

In addition, blood poisoning (sepsis) can begin.

Diagnosis of acute pancreatitis

Acute pancreatitis has very characteristic signs. The diagnosis is confirmed by laboratory tests. So, in the very first hours after the onset of the disease, a high content of the pancreatic enzyme amylase appears in the urine.

When the pancreatic tissue is destroyed, the amount of amylase, on the contrary, decreases, or may be completely absent. The amount of amylase and another enzyme, lipase, in the blood also increases.

In the blood of a patient with acute pancreatitis, signs of an inflammatory process are found: a large number of leukocytes and an accelerated ESR (erythrocyte sedimentation rate).

To clarify the diagnosis, the following studies are sometimes carried out:

Treatment of acute pancreatitis

Patients with acute pancreatitis primarily require hospitalization, pain medication, and intravenous fluid infusions to restore fluid and salt balance.

About one in five acute pancreatitis is severe and requires close monitoring in an intensive care unit or intensive care unit (ICU) because pancreatitis can damage the heart, lungs, or kidneys.

Some cases of pancreatitis can lead to necrosis of pancreatic tissue (pancreatic necrosis). In these cases, or if there is a secondary infection, surgery may be required to remove the damaged tissue.

Which doctors to contact for acute pancreatitis

Surgical treatment of acute pancreatitis

An acute attack of pancreatitis caused by a blockage of the bile duct by a stone may require removal of the gallbladder or a much less traumatic restoration of the patency of the bile ducts using an endoscope.

Once the gallstones are removed and the inflammation subsides, the pancreas usually returns to normal fairly quickly. Surgery on the pancreas and gallbladder can be performed both with a wide section and with a laparoscopic, or "minimally invasive" method.

During laparoscopic surgery, a small (usually 5-10 mm) incision is made on the abdominal wall, through which the laparoscope and the surgical instrument itself are inserted into the abdominal cavity. The surgeon during the operation is guided by the image of the internal organs transmitted from the laparoscope camera to the monitor.

The advantages of laparoscopic surgery include a reduced risk of infection, faster recovery, minimal cosmetic damage, less risk of postoperative adhesions, and a much less painful postoperative period.

Diet for acute pancreatitis

An important therapeutic factor in all forms of acute pancreatitis is the diet:

Questions and answers on the topic "Acute pancreatitis"

I have a brother, 61 years old in a hospital with acute pancreatitis, he worked as a bricklayer. After treatment, is it possible for him to work at this hard job? Wouldn't that aggravate again?

As a rule, after the normalization of the general condition of the patient, employment should be carried out in those conditions where the following will be excluded: physical stress; traumatization of the abdomen; various concussions of the body; contact with toxic substances. But, it depends on many factors and is determined by the attending physician.

I'm 47 years old. A month ago there was an attack of biliary acute pancreatitis. She was in intensive care, amylase was 4000 and was hospitalized. At this time, I drink Creon, Legalon and Motilium, I follow a diet. A cholecystectomy was scheduled. I constantly feel discomfort, heartburn. With FGDS, the diagnosis is superficial gastroduodenitis. Tell me please, if I do the operation, will the pancreatitis go away or will it become chronic? Can I take any other drugs besides these? How often can an attack recur?

Everything is individual! With cholelithiasis, pancreatitis, as a rule, is already chronic. In this case, a severe exacerbation (relapse). After cholecystectomy, pancreatitis will not go anywhere, but the risk of exacerbations of the disease and the development of severe relapses is reduced. Questions of therapy should be discussed only with the attending physician!

I am 26. The fact is that I was taken to surgery with acute pancreatitis - this is the first time in my life, and they immediately wrote that it was chronic. My stomach hurt with a burning pain and that's it, the pain did not radiate to the shoulder blades and back. In the urine, indicators of pancreatitis were not found, but during the FGS procedure, I was told that I had a shell in my duodenum like "semolina" and this is a sign of pancreatitis. At the ultrasound, they told me that everything is fine with my pancreas and liver, but there are echo signs of changes (although, as the doctor said, everyone has them). I have a question - do I have a chance to completely cure pancreatitis and do I have it at all, because only they saw it at the FGS, but according to the analyzes - no. Maybe the doctor who treated me just played it safe? Or is it a common poisoning that caused my pancreas to react?

I can't answer any of your questions with 100% certainty either yes or no. Pancreatitis is proven or refuted primarily by blood and stool tests. According to the data presented by you, I would still say that there is chronic pancreatitis without exacerbation without further specification of the form.

IM 33 years old. Four months ago I had acute pancreatitis, I was treated inpatiently: laparoscopy, droppers, injections. To this day, there is nothing to worry about. I follow a diet, I do without enzyme preparations, as there are no problems with digestion. I have a question - how long do you need to follow a diet (or is it for life?) and will it ever be possible to eat fresh vegetables, cabbage, soups on low-fat meat broth. Is it possible, taking into account good health, to allow yourself occasionally for the holidays a little wine or beer (after removing gases from it)?

The rehabilitation period after acute pancreatitis is at least a year. All nutritional issues are resolved strictly individually. Alcohol is excluded in any form completely and forever. The risk of developing recurrent acute pancreatitis with alcohol consumption is significantly increased. You may not survive repeated acute pancreatitis!

Daughter is 3 years old. Since birth, she suffers from constipation (often given antibiotics). Approximately 3 months ago, an ulcer appeared in the mouth, similar to a cut - the dentist said that this was from inflammation of the pancreas. Indeed, during that period of time, the daughter often complained of pain in the abdomen (upper part). Then, they turned to the local therapist. They passed tests: blood, urine, a smear on the eggs of the worm, they did an ultrasound - they said that everything was normal. A few days ago, my daughter vomited, complained of pain in the upper abdomen, vomited 8 times, the last 2 times with bile. An ambulance was called, after examination the doctor diagnosed acute pancreatitis. The district doctor prescribed Linex and Creon. There was no diarrhea. Again we suffer from constipation. There is no gastroenterologist in our city. Can you please tell me if pancreatitis can be cured, how? What to do with constipation, especially now, when the diet is limited to a strict diet?

Indeed, the pancreas may respond to antibiotics. Discuss with the pediatrician observing you the intake of omeprazole, esomeprazole (Nexium) or rabeprazole (Zulbex) at a dose of 10 mg 1 time per day for 2 weeks + children's motilium, continue Linex up to 1 month + enzymes (Creon up to 1 month) If constipation persists, children's forlax or duphalac.

Recently I was treated by a gastroenterologist with a diagnosis of acute pancreatitis, the treatment helped. A week later, pain appeared again in the stomach and left hypochondrium. I broke my diet, ate smoked fish and apples. What can I drink, what medicines to remove the exacerbation completely?

Take what you were prescribed earlier, and do not break the diet, otherwise you will constantly relieve the exacerbation. Acute pancreatitis is the first step to chronic.

That disease can be dealt with.

During the period of exacerbation, the main recommendations are, hunger, rest. Bed rest and an ice pack will help you reduce inflammation and , and hunger will reduce excretion . Until the inflammation subsides, the usual is replaced by intravenous fluids.

In chronic cases, the point of treatment is to stop further destruction of the gland. It's important to remember that the most important thing you can do for your pancreas before it's too late is diet. Prohibited (even beer), cigarettes, caffeine (including black), spices, animal fats in large quantities, red vegetables and fruits, legumes and cabbage, mushrooms, fatty heavy foods.

Avoid contact with any toxic substances (do not inhale paint fumes, do not use nail polish and do not use chlorine-containing household chemicals when cleaning, do not breathe washing powder suspension). Take as directed by your doctor.

If you are periodically worried about exacerbations of pancreatitis, then get yourself a homeopathic remedy called Apis in the sixth dilution. In an acute condition, take 3 grains of this remedy, but be sure to every two hours. When the condition improves, take Apis less often - every 4 hours. This will help to quickly remove inflammation and mucous membranes.

Almost always with pancreatitis, doctors recommend the use of artificial enzymes to help digest food. Since this can lead to a completely passive state of the gland, after the exacerbation stops, gradually reduce their number. Cleanse your body better, breathe fresh air, avoid harsh chemical odors, help yourself with other well-known, but gentle means.

Within a month, 2 times a day, drink 0.2 g of mummy, diluted in a small amount of water. The course is carried out 2 times a year. Mumiyo heals the body, gives additional strength to fight chronic pancreatitis, relieves inflammation in the pancreas and kills microbes in everything. During the treatment of mummy, one should not take alcoholic beverages, eat meat and smoke, but with pancreatitis all this is already prohibited.

Massage the middle part of the sole on your feet daily - there are reflex zones. By doing this, you stimulate the gland to produce its own enzymes and speed up the removal from the diseased organ. do it with a chronic form of pancreatitis - in an acute state, you should not stimulate the flow to the inflamed organ.

It has been noticed that people who are constantly angry and experience a sense of hopelessness of the situation are more likely to suffer from pancreatitis. Remember that there are no hopeless situations in life. Learn to accept everything that life gives you with understanding and humility. To make healing go faster, say these words to yourself every day as a healing mood; “I enjoy life and everything that surrounds me. The world is full of joy and pleasant moments. I love myself. I love life and accept it for what it is. Start the morning with these words, and end the day with the same words. Fall asleep with a feeling of joy because tomorrow will be another joyful, interesting day full of discoveries and pleasant surprises.

Phytotherapy for pancreatitis

Take 500 g of parsley root, wash thoroughly, pour over with boiling water and cut into pieces. Put the chopped root in a clay pot or pan and pour milk so that it completely covers the parsley. Place the bowl of milk and parsley in a low oven so that the milk is heated but not boiled over. As soon as the milk turns into baked milk (it thickens a little), strain and drink the infusion every hour for 1 or 2 tablespoons. You need to drink the entire amount received in one day. This remedy restores the normal functioning of the pancreas well after the first attack of acute pancreatitis. You can repeat the treatment again after 2 weeks. In the presence of an acute inflammatory process in the kidneys, parsley is allowed to be consumed only in collections - the independent use of this greenery is contraindicated.

In chronic pancreatitis, drink an infusion of St. John's wort or plantain for a month. Pour 1 tablespoon of any of the herbs with 1 cup of boiling water, let it brew and strain. Drink 100-150 ml 3 times a day 30 minutes before meals. With gastritis with increased secretory function, it is better to refuse plantain.

In the treatment of pancreatitis, use a tincture of Rhodiola rosea (golden root). Drink it 20-30 drops 3 times a day on an empty stomach - 30 minutes before meals, dissolving the tincture in a small amount of water. Before using this remedy, consult your doctor, as Rhodiola has a strong tonic effect on the body. With a tendency to, nervous overexcitation, hypertension and elevated temperature, Rhodiola should not be drunk.

Mix in equal parts peppermint leaves, elecampane root, dill fruits, cudweed herb, St. John's wort and coriander seed. Pour 1 tablespoon of the mixture with a glass of boiling water and let it brew for about 1 hour, take 1/2 cup 4 times a day. This tool helps get rid of stagnation, improves, relieves inflammation, and also has a slight calming effect. With elecampane, you can not use it, and for kidney diseases, it is introduced into the collection in small quantities.

In the chronic form of pancreatitis, chop and mix thoroughly in equal parts the herb cudweed, horsetail, wormwood, sage, St. John's wort, succession, chamomile flowers, calendula flowers, elecampane roots and burdock roots. Pour 1 tablespoon of the mixture with 1 cup of boiling water, let it brew and strain. Drink 100-150 ml of infusion 3 times a day 30 minutes before meals for 2-3 months. This collection has pronounced properties. If you suffer from an inflammatory disease of the kidneys, then carefully include horsetail grass in the fees, as it has a pronounced irritant effect on the kidneys. If the inflammatory process is in an acute stage, then also refuse from sage officinalis.

Hunger is the main cure for pancreatitis

Diet for pancreatitis is the main cure. In the first days of the disease, you can’t eat at all. Hunger is the only and most effective medicine. For acute pain, apply ice in a heating pad to the stomach and, if possible, observe bed rest.

After the aggravation has passed, proceed to a diet of low-fat light foods, vegetables and fruits (not red ones!). Buy green apples (do not eat more than one apple a day and only use it stewed in the beginning), stew zucchini, boil potatoes when you start to feel good, use greens that add just a little bit at the end of cooking. Do not eat anything fried, because such food carries two dangers for your pancreas at once. The first is excess fat in fried foods, and the second is carcinogenic substances formed due to overheating of the oil. These carcinogens are literally poison, and with pancreatitis they greatly aggravate the course of the disease.

First, use all vegetables and fruits in a pureed form, remove the peel from the fruit, since coarse fiber is prohibited. Boil and stew vegetables. Do not buy bread with bran, do not use barley in soups, as it contains too much fiber. Spices, animal fats, any alcoholic beverages are excluded. Do not buy carbonated drinks, as they greatly irritate the mucous membranes. Then add cottage cheese and porridge on the water. Buy only chopped buckwheat, that is, chopped, also use it in oatmeal for baby food. Drink a drink made from chicory, in which you add milk in half with water.

When the state of health is completely normal, add boiled fish, meat to the diet to increase the protein content.

Every day, morning and evening, 2 hours before meals, drink 100-200 ml of freshly squeezed red potato juice, and 5 minutes after that - 1 glass of homemade kefir. To prepare the juice, wash the potatoes thoroughly with a brush and prepare the juice from the vegetable along with the peel. Squeeze the juice immediately before drinking so that it does not have time to darken. Drink the juice for 15 days, then take a break for 12 days. Repeat the course in the same way 3-4 times. Do not use potato juice with low acidity, as potatoes give a pronounced alkaline reaction in the stomach. For squeezing juice, choose mature tubers; in no case should you use green potatoes due to their high content of toxic components.

With pancreatitis, prepare an infusion of buckwheat flour in kefir for breakfast. Before going to bed, pour 1 tablespoon of buckwheat flour with one glass of kefir and leave to infuse overnight. In the morning, eat the mixture instead of breakfast. Also, in chronic pancreatitis, it is recommended to drink from chicory during the day. Dilute 1 teaspoon of chicory powder in half a glass of boiling water, add another half a glass of milk and drink instead. You should not drink a chicory drink too hot, the drink can be quite warm, but it should not burn. Common chicory is contraindicated in exacerbations of gastric ulcer and.

Oats have a healing effect on the pancreas. Sort the oats, removing any spoiled grains, soak them in cold water (just add a little water) and put in a warm place. On the second day, the grains should germinate. When you notice that the sprouts have hatched, then rinse the grains and dry them well, then grind them to a state of flour. Dilute the resulting powder in a small amount of water, and then pour boiling water and boil over low heat, but not more than 2 minutes. Then remove the jelly from the heat and let it brew for 20 minutes, strain and drink immediately. Never prepare yourself oatmeal jelly in advance, it will thicken and may lose its medicinal properties.

Pancreatitis is an inflammatory process in the pancreas that has a degenerative character, i.e. changing the structure of the gland and violating its functions. Due to poor digestion, indigestion of nutrients, diseases such as osteochondrosis and atherosclerosis of the vessels can develop. According to statistics, the number of people suffering from pancreatitis tends to increase. This, first of all, leads to an inactive and unhealthy lifestyle of most people, the abuse of fatty foods and fast food. External factors that negatively affect the pancreas: alcohol intake, smoking, overeating, overweight, infections, drug abuse, complications from concomitant diseases.

Pancreatitis acute and chronic

In the acute nature of the disease, severe pain occurs unexpectedly in the left side and captures the back from the left. Antispasmodics do not help reduce pain, it weakens when you lean forward or if you take a sitting position. Perhaps the presence of sensations - difficulty breathing, pressure on the ribs (with an increase in the pancreas). Increased vomiting with a bitter or sour taste. In chronic pancreatitis, less severe pain occurs after eating large amounts of fatty or fried foods and alcohol. Pain can also be caused by blockage of excretory ducts by gallstones. Chronic pancreatitis can contribute to the development of a cancerous tumor in the pancreas. The human body is able to independently fight metabolic disorders and for a long time a person may not feel pain and other symptoms of the disease so acutely. Over time, the body will gradually lose its margin of safety and resistance will weaken. If you miss the first calls of the body for help, then there is a possibility of developing necrosis, serious changes, and even an irreversible process of degeneration of the jelly tissue of the pancreas into an organic one, leading to death.

Symptoms of pancreatitis

If you have the following factors of malaise, then perhaps this is inflammation of the pancreas. - Nausea when eating. - Frequent lack of appetite, even after exercise. - Diarrhea or soft stools with the presence of undigested particles of food eaten, or liquid oily discharge without yellowish stools (lipase deficiency), - Bloating, rumbling, due to the ingress of undigested food from the small intestine into the large intestine, resulting in increased gas production. - Pain in the left hypochondrium in the upper abdomen. - Thirst after meals or in the morning. - Sudden uncontrolled weight loss without lifestyle changes. - Frequent high body temperature. - Attacks of insomnia. - Frequent desire "for a little" after eating. Varying degrees of these symptoms may indicate the degree of development of the disease. If you constantly observe several of the above symptoms, contact your doctor for testing.

The main causes of pancreatitis

Improper nutrition is not as noticeable a factor in everyday life as compared to the others listed above. But with prolonged abuse of junk food, it causes irreparable harm to the body, especially in combination with alcohol and nicotine. If a person eats little, or is content with occasional snacks, this will also attract health troubles. At the first suspicion of a malfunction of the pancreas, it is better to exclude fatty and fried foods, pastries, sweets and even sweet fruits from the diet as soon as possible, as they increase blood sugar levels, which leads to an additional load on the pancreas. A huge impact on the work of the gastrointestinal attack and the pancreas has a constant nervous tension and stress. If the body is constantly subject to unrest and nervousness, then sooner or later it will cause a number of diseases. Remember the phrase: "All diseases are from nerves"? Anxiety releases the strongest stress hormone, adrenaline. As a result, glucose enters the blood in large quantities, and high sugar content is one of the causes of pancreatic disease. The pancreas is not adapted to the rapid breakdown of a large amount of glucose in the blood, and using all its potential, it quickly wears out, which leads to a deterioration in the functioning of the organ and the development of diabetes. In addition to the pancreas, stress also has a very negative effect on the functioning of the thyroid gland. Also, heredity can contribute to the development of pancreatitis. If your close relatives suffered from diseases of the pancreas, then you are at risk, and it is especially important for you to monitor your health in order not to give the disease a single chance.

Diagnosis of pancreatitis

To determine the degree of damage to the pancreas, you need to undergo a laboratory test - donate blood to determine the level of leukocytes, glucose, urine - for amylase and feces - for the content of chymotrypsin, trypsin. Additionally, liver enzymes are studied: alkaline phosphatase, bilirubin - their elevated level will show the presence of gallstones. Using X-ray, determine the size of the pancreas. Computed tomography or MRI is ordered to determine the presence of fluid in the abdominal cavity. Ultrasound - will clarify the state of the common excretory duct, the presence of gallstones and help characterize the structure of the gland, clarify the location of the problem, increase or thicken the body, tail or head of the pancreas.

Prevention and treatment of pancreatitis

Sports in combination with diet and healthy eating help to restore or maintain a normal digestive and endocrine system. To relieve acute symptoms, doctors recommend fasting for 2 days. Therapeutic starvation helps to reduce the production of pancreatic juice and relieve the load on the pancreas. When fasting, to prevent dehydration, it is recommended to drink at least 2 liters of water per day. It is recommended to drink rosehip broth and mineral water without gas. And with an attack of acute pancreatitis, the patient is given a dropper with painkillers and enzymes that suppress the secretion of the pancreas. For pain relief, antispasmodics are used: No-Shpa, papaverine, baralgin, ibuprofen and analogues. In the presence of high temperature use: aspirin, paracetamol. Sometimes antihistamines are prescribed: diphenhydramine, atropine and platifillin. To relieve irritation in the gastrointestinal tract, use: almagel, phosphalugel, as well as means to reduce the release of hydrochloric acid: omez, ocid, gastrosol, pepsidin and other analogues. When acute attacks of the disease recede, aprotinin or contrical is prescribed to reduce the production of enzymes and to restore pancreatic function. To improve the digestion process, pancreatin, mezim, festal, creon and vitamin A are prescribed to stimulate pancreatic secretion. In case of violation of the exocrine function of the pancreas, insulin preparations are prescribed. In extreme cases (with blockage of blood vessels, with a cyst, in the presence of stones, due to pancreatic necrosis), which threaten the patient's life, surgical intervention is prescribed. It is important to remember that any disease must be treated comprehensively. To do this, there are specialists who will accurately determine the degree of the disease and prescribe the necessary dose of medicines. Self-treatment of a serious illness can lead to an irreversible process: blockage of blood vessels and bile ducts, gland cysts, diabetes mellitus, infection and necrosis (tissue necrosis), blood poisoning.

Diet and proper nutrition for pancreatitis

The best remedy that speeds up the recovery of a diseased pancreas is strict adherence to a diet. If a healthy lifestyle and proper nutrition are not followed, no medicine can completely heal the body. At the same time, it is worth considering that the abuse of drugs will at least undermine the work of other organs of the body, in the worst case, you will poison your body. Separate nutrition and compliance with the norm of high-calorie food per day is an important element for the prevention of exacerbations of pancreatitis, gastritis and other gastrointestinal diseases. Proteins and carbohydrates should not be consumed in the same meal. Don't overeat. The amount of food consumed should correspond to the amount of physical energy expended. Eat more healthy foods: - Poultry, rabbit, fish, preferably steamed. - Dairy products - not sour cottage cheese with a low fat content, kefir, yogurt. - Low-fat cheese, scrambled eggs. - Vegetables in boiled or baked form. - Soups with cereals, vegetables, pasta. - Rice porridge, oatmeal, buckwheat. - Vegetable or olive oil. - Compotes, jelly.

Folk remedies

For the health of the pancreas, oatmeal jelly and fresh potato juice are very useful. To do this, pour the washed oats with water and leave for a day. Then drain the liquid, squeeze and dry the oats. Dried oats must be ground into flour, diluted with water and boiled, insisted for 20 minutes. Then cool the mixture and strain. Take only fresh jelly. Potato juice is made with a juicer. You will need 2-3 tubers per 150-200 grams of juice. Drink fresh before meals. Herbal tea works well. It helps to increase appetite, cleanses the body of toxins, and has a calming effect during an exacerbation of pancreatitis. It consists of herbs that reduce the inflammatory process and painful spasms: St. John's wort, immortelle, birch buds and chamomile. These herbs perfectly complement and enhance the beneficial effects of each other. The recipe for its preparation is simple, and the effect is felt after a week of admission. Pour a tablespoon of a mixture of herbs in equal proportions with 0.5 liters of boiling water and brew like black tea. Let the tea steep for at least 10 minutes and drink. To supplement the treatment and prevention of pancreatitis, you can use folk recipes from a decoction of herbs. But at the same time, herbs should have antispasmodic, choleretic properties. Decoctions of different herbs should be alternated at least after two months of admission. Collections of herbs with choleretic and antispasmodic properties can be bought at pharmacies.
© Zozh - Healer :

Reviews: 6

1. Stas 04.02.17, 15:45

Most pancreatic problems arise from an unhealthy lifestyle. If you are a fan of overeating barbecue and washing it all down with strong alcohol, then no pancreas and liver can stand it. Everything needs a measure.

2. Galina 11.02.17, 18:36

Pull the chicken out of the freezer and hold for 10 minutes in the pancreas area. The pain goes away. Checked many times. That's what the cold is about. I do not undertake to explain the mechanism, but you can not argue with the fact.

3. Eve 02.05.17, 23:15

The best diet for an inflamed pancreas is about the same as for cleansing the liver - moderate fasting, namely broths, simple lean low-calorie dishes. No fatty or spicy food. A minimum of meat, and then boiled chicken breast or steam fish. No beer and other alcoholic beverages, and preferably for the rest of your life, not only until the exacerbation passes, if you want to live to old age.

4. Ramona 04.11.17, 17:29

With pankeatitis, it is especially important to balance the consumption of spicy and fatty foods. It is very difficult for me to do this, since I love Asian cuisine (((I also began to take milk thistle and flax seed.

5. Veronica 04.11.17, 17:44

By and large, the main and most important thing is the control of portions of food. It is difficult for the stomach to produce enzymes with pankeatitis. Now many good drugs, for example, ovesol, have proven themselves in practice.

Pancreatitis is a chronic inflammation of the pancreas. Today, pancreatitis is a fairly common disease that affects a large number of people of different sex and age. Pancreatitis manifests itself depending on how severe the damage to the pancreas is.

There is a pathology in people who abuse alcohol, constantly overeat, prefer too spicy and fatty foods. Subsequently, inflammatory processes appear, painful and uncomfortable sensations arise. Further the acute form, as a rule, turns into chronic pancreatitis, which requires treatment and an appropriate diet. Even after following all medical recommendations, a quick recovery occurs quite rarely, it is important to prevent the pathology from aggravating and not to start the disease.

How does pancreatitis manifest itself?

Common symptoms that develop in chronic pancreatitis, requiring immediate treatment and diet, are manifested as follows:

there is a feeling of nausea;
possible vomiting;
loss of appetite;
there are frequent eructations;
feeling of soreness in the stomach.

However, the pain syndrome may be absent and appear only in case of overeating, when gallbladder spasms and pancreatic edema begin. In some cases, there is no pain and excessive appetite occurs, you constantly want to eat, while the feeling of fullness does not appear.

Symptoms depend on the type of disease that occurs:

latent course (for a long period of time the patient does not feel any changes);
pancreatitis with pain syndrome (soreness is felt constantly in the abdomen, sometimes there are bouts of unbearable pain);
chronic recurrent pancreatitis (pain syndrome occurs only during attacks, without disturbing the patient the rest of the time);
pseudotumor pancreatitis (occurs quite rarely, characterized by excessive growth of fibrous tissue, due to which the size of the pancreas increases significantly).

What therapeutic measures are used to combat pathology?

In order to determine the most appropriate treatment and diet for chronic pancreatitis, the specialist needs to assess how severe the patient's condition is.

If the symptoms have just begun to appear without any complications, the specialist will prescribe therapy, which will consist of the use of medications and a dietary table.

During the period of exacerbation of pancreatitis, as well as in case of poor health and a serious condition of the patient, immediate hospitalization and therapeutic measures are carried out strictly under medical supervision. Initial assistance will be aimed at stopping the pain syndrome. If the disease progresses rapidly or is too neglected, surgery is performed, during which the dead areas of the gland are removed.

Local planar resection of the head of the pancreas

Medicines for the treatment of pancreatitis

Proper diet and drug treatment of chronic pancreatitis will help relieve discomfort in the stomach. First of all, antispasmodics are prescribed, which will remove soreness and spasms. The most common are Papaverine, No-shpa and Baralgin. Also used drugs that regulate the pancreas, for example, Almagel or Phosphalugel.

If necessary, enzymes are prescribed that contribute to better absorption of food, such agents include Pancreatin, Creon and others. Preparations are taken during meals or after, drinking plenty of water (preferably alkaline mineral).

Drug treatment lasts 1.5-2 months, depending on the severity of the disease. Only the attending physician can determine the dosage or cancel the drug. For a good result after the treatment of chronic pancreatitis, you should follow all the recommendations of a specialist at home and be sure to adhere to the prescribed diet.

How should you eat with this pathology?

In the period after the exacerbation of chronic pancreatitis, the patient is prescribed diet No. 5 in combination with treatment.

Diet food will help normalize the functioning of the affected organ, such food is gentle for the body.

Important! Nutrition implies the use of an increased amount of protein, while reducing carbohydrates and fats.

Vitamins should also be present in the daily diet, dishes are cooked exclusively for steam or in the oven.

Advice! You can not eat cold and too hot food, portions should be small.

What foods make up the menu?

In order to relieve symptoms and treat exacerbation of chronic pancreatitis, a diet is prescribed using the following products:

yesterday's wheat bread;
cookie type "Mary";
liquid boiled porridge - semolina, buckwheat, rice, oatmeal;
cottage cheese casseroles;
Low-fat cottage cheese, kefir (sour cream is added to cooked food);
low-fat hard cheeses.

The diet includes vegetables that are baked or boiled: carrots, potatoes, pumpkin, beets, cauliflower.

From fruits, non-acidic varieties are allowed (they can be baked, stewed, jelly and compotes based on berries and fruits, fresh or dried). Various semi-sweet fruit and berry sauces (flour is not overcooked in a pan).

The diet includes the use of low-fat baked or boiled fish, steamed in crushed form, can be in small pieces. Protein omelettes are allowed (no more than 2 per day).

Vegetable oil is used only in cooked food, no more than 15 ml, butter no more than 30 g.

Stop foods for chronic pancreatitis

It is forbidden to use:

fresh pastries;
soups on meat and mushroom broths, borscht;
meat and fish of fatty varieties;
various semi-finished products;
fatty cottage cheese, sour cream and cream;
fried and hard boiled eggs; legumes;
pearl barley, corn and barley groats, millet.

Attention! You can not eat garlic, radishes, sorrel, onions and mushrooms.

You should forget various sweets (chocolate, jam, sweets, cakes). Bananas, figs and grapes are also banned.

Spices, sauces are also completely excluded from the diet, salt is allowed in a small amount.

You should completely abandon strong tea and coffee, sweet sparkling water. For a person suffering from chronic pancreatitis, it is imperative to follow a diet to prevent an exacerbation of the disease.

Pancreatitis is the name of a whole group of diseases and symptoms in which the inflammatory process of the pancreas occurs. 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.

Thus, the so-called process of self-digestion takes place. Such a pathology is fraught with subsequent damage to other organs, because with the gradual destruction of the pancreas, toxins and enzymes are released. In turn, they can enter the bloodstream and damage other organs. Therefore, acute pancreatitis must be treated immediately after diagnosis. With this condition, treatment is carried out mainly in a hospital.

What it is?

Pancreatitis is a group of diseases and syndromes in which there is inflammation of the pancreas.

With inflammation of the pancreas, the enzymes secreted by the gland are not released into the duodenum, but are activated in the gland itself and begin to destroy it (self-digestion). The enzymes and toxins that are released are often released into the bloodstream and can seriously damage other organs such as the brain, lungs, heart, kidneys, and liver.

Causes

The main causes of acute pancreatitis:

Often develops in people who are aged 30 - 40 years and is most often caused by alcohol abuse for 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;
Use of estrogens, corticosteroids, thiazide diuretics, and azathioprine;
Blockage of the pancreatic duct or common bile duct;
Hypercalcemia - high levels of calcium in the blood;
Hyperlipidemia or hypertriglyceridemia - high levels of fats in the blood;
Metabolic disorders, especially fat, associated with overeating;
Complications of cystic fibrosis, the most common hereditary disorder, when the secrets secreted by various organs have too high viscosity and density.

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.

Symptoms of pancreatitis

Pain in acute pancreatitis (inflammation of the pancreas) is considered one of the strongest. Sharp, sharp pain occurs in the abdomen, in the hypochondrium, in most cases extending to the area of the shoulder blades, back or behind the sternum.

The main symptoms of acute pancreatitis in adults are listed below:

Painful sensations in the right or left hypochondrium, a shingles character is also possible, depending on the degree of the inflammatory process and the area of damage to the pancreas;
Discoloration of the skin: earthy complexion, cyanotic spots around the navel and on the lower back, obstructive jaundice due to sclerosing pancreatitis;
Deterioration of general well-being, a significant increase in body temperature, weakness, malaise, changes in blood pressure upward or downward;
Feeling of dryness in the mouth, prolonged hiccups, belching of a rotten egg, nausea and repeated vomiting, which does not bring relief to the patient;
Disorders of the stool in the form of constipation or diarrhea;
Shortness of breath, increased sweating.

Chronic pancreatitis has a non-aggressive course, accompanied by a decrease in appetite and body weight. The main symptoms in chronic pancreatitis:

Pain syndrome - this species is characterized by combat signs, as a rule, after eating or drinking, unpleasant sensations are constant in the upper abdomen.
Asymptomatic (latent stage) - the disease can last for years slowly destroying the pancreas, the patient almost does not feel any discomfort, or it all comes down to simple discomfort that is given by various simple reasons, such as overeating.
Pseudotumor type - rare, similar to cancer in all symptoms. Signs of pancreatic cancer are jaundice of the body and sclera of the eye. The head of the pancreas is affected. It increases in size due to its replacement by fibrous tissue.
Dyspeptic is expressed by an intestinal disorder (dyspepsia), diarrhea or constipation, bloating, unreasonable weight loss.

Quite often, chronic pancreatitis contributes to the development of diabetes. The manifestation of symptoms is affected by the stage of the disease, as well as whether the patient has received treatment, adherence to food intake, the age of the patient and his general physical condition.

Objective symptoms

Pancreatitis has its own objective symptoms:

Symptom Mussi-Georgievsky - positive phrenicus - a symptom on the left.
Symptom of Gubergrits-Skulsky - palpation is painful along the line connecting the head and tail.
Grott's symptom - to the left of the navel in the projection of the pancreas, hypotrophic changes in the subcutaneous fat are determined.
Symptom of Desjardins - pain is determined on palpation at the pancreatic point of Desjardins (projection of the head of the pancreas), located 4-6 cm from the navel along the line connecting the right axillary cavity with the navel.
Symptom Tuzhilin - when viewed on the skin of a patient with chronic pancreatitis, you can see hemorrhagic rashes in the form of purple droplets up to 1-4 mm in size. These are point angiomas that occur during proteolysis - a destructive effect on the capillaries of pancreatic enzymes that are released into the blood during an exacerbation of the process.
Mayo-Robson's symptom - pain is determined at the Mayo-Robson point, the projection of the tail of the pancreas, on the border of the middle and outer third of the segment of the line drawn through the navel, left costal arch and axillary region on the left. In this case, pain can be determined in the Mayo-Robson zone, the left costovertebral angle.
Chauffard's symptom - pain is detected in the Chauffard zone (projection of the head of the pancreas), located 5-6 cm above the navel on the right side between the bisector of the umbilical angle and the median line of the body.
Kach's symptom is a symptom of pancreatitis, in which palpation is painful in the projection of the transverse processes of the right T1X-TX1 and left TVIII-TIX thoracic vertebrae.
Symptom of Voskresensky - in the projection of the pancreas, the pulsation of the abdominal aorta is not determined.

Diagnostics

To identify the development of chronic pancreatitis, it is necessary to consult a gastroenterologist. Inspection, collection of complaints, analysis of the history of the disease. Based on this, diagnostic procedures are prescribed:

taking tests to determine the level of blood amylase and urine diastase;
biochemistry and complete blood count;
general urine analysis;
Ultrasound of the pancreas is one of the leading research methods that can help determine whether there are pathological changes in the pancreas;
gastroscopy;
radiography of the abdominal organs;
functional tests;
endoscopic retrograde cholangiopancreatography.

When symptoms of acute pancreatitis appear, urgent hospitalization of the patient and examination and treatment in a hospital are necessary. The main task: to stabilize the patient's condition, relieve acute symptoms and exclude the possibility of developing pancreatic necrosis.

Treatment of acute pancreatitis

In acute pancreatitis, treatment should be carried out in a hospital and under the close supervision of specialists, since this condition of the body is considered dangerous. If acute pancreatitis is suspected, a person should be hospitalized as soon as possible.

If an attack of pancreatitis caught you at home, then the following actions are recommended before the ambulance arrives:

The patient should be in bed and at rest. This will reduce blood flow to the diseased organ, which means it will reduce inflammation.
Cold is applied to the epigastric region - this allows you to reduce the intensity of pain, slightly remove swelling and inflammation. It is best if a heating pad filled with cold water is used instead of ice.
No food is allowed. Moreover, you should refrain from eating for 3 days. This must be done to stop the production of enzymes that increase the inflammatory response and pain. You can drink water without gas and additives.
Permitted drugs for self-administration are Drotaverin, Spazmalgon, No-shpa and Maksigan. You can drink them before the ambulance arrives. Meanwhile, it is necessary to call doctors even if the patient is not sure that he has an attack of acute pancreatitis. After all, this pathology is dangerous because it can subside for a while, and then rapidly recur.
With the rapid development of the disease, surgical treatment of pancreatitis is used: removal of part of the pancreas, peritoneal lavage (lavage of the abdominal cavity), etc.

The three main words in the treatment of a patient with acute pancreatitis are Rest, cold and hunger. They are the rules of first aid for an attack.

After hungry days, diet No. 5p according to Pevzner is prescribed for a week. Fractional meals up to 8 times a day, in portions no more than 300g. Food boiled, steamed, semi-liquid, mashed. Food temperature - 20-52˚С. The daily amount of proteins - 80g, fats - 60g, carbohydrates - 280g.

All other products and treatments are excluded.

After achieving positive dynamics and relieving pain, an extended diet is prescribed for three months. Daily amount of nutrients: up to 120g of protein, 70g of fat, up to 400g of carbohydrates.

Recommended: low-fat varieties of meat and fish, poultry, up to two eggs per day, sour cream, cottage cheese, cereals on the water, vegetables, jelly and fruit compotes, tea, rosehip broth, butter in the form of additives to ready meals up to 20 g per day, vegetable oil - up to 15g per day.

All of these products must be steamed, baked or boiled.

Treatment of chronic pancreatitis

Chronic pancreatitis may have bright or mild symptoms. Most often, during an exacerbation of chronic pancreatitis, the patient is shown hospitalization and therapy similar to the acute process.

The patient must follow a diet throughout his life and take drugs from the group of antispasmodics and drugs that normalize the secretory function of the organ. It is especially useful to undergo sanatorium treatment twice a year in the relevant institutions of the Stavropol Territory (Kislovodsk, Zheleznovodsk, Pyatigorsk), where treatment is carried out with the help of natural mineral waters.

Diet

If it is serious enough and is accompanied by severe pain, persistent vomiting, significant changes in laboratory tests, then patients need hunger. Its duration depends on the specific clinical case, but more often ranges from 1 to 3 days. Sometimes in the "hungry" phase, it is allowed to drink rosehip broth, alkaline mineral waters, and weak tea.

Then a special low-calorie diet (up to 2200 kcal) with a normal protein quota is prescribed. It is designed to be as gentle as possible on the pancreas and other digestive organs.

The features of this diet for pancreatitis are:

a ban on fatty foods (lamb, pork, cream, lard, etc.) and alcohol;
fragmentation of eating food (up to 6 times);
salt restriction;
dishes are served exclusively warm;
grinding or wiping used products;
widespread use of mucous cereal soups, vegetable puree soups with added boiled meat, soufflés, protein omelettes, fish and meat quenelles, steam cutlets, meatballs, baked apples, vegetable purees, jelly, mousses, dried white bread, low-fat cottage cheese, jelly;
the exclusion of all products with a high content of extractives or essential oils (fish, meat broths, cocoa, coffee, etc.), fresh berries, vegetables, herbs, fruits, fruits, sour juices, carbonated drinks, marinades.

Subject to clinical and laboratory improvement, nutrition is expanded, increasing its calorie content and the amount of protein needed for a speedy recovery. Although the set of acceptable products is very similar to the already mentioned diet, the list of dishes on the menu is increasing (baking is allowed). If pancreatitis is accompanied by the development of diabetes, then white cereals, potatoes, honey, sweets, pastries are added to the forbidden food list.

Medical treatment

When following a diet, pain is much less likely to make itself felt, but it is worth moving away from it a little, allowing yourself fatty or fried foods, and that's it - you need painkillers.

With intense pain, the doctor may prescribe antispasmodics - No-Shpa, Drotaverine, which reduce inflammation in the pancreas and, accordingly, reduce pain.
To date, the doctor can also prescribe mebeverin (Duspatalin, Spareks) - an antispasmodic, myotropic action, eliminates spasms of the gastrointestinal tract.
It is possible to prescribe antisecretory drugs for a short course (or diacarb on a tablet for three days under the cover of asparkam with edematous form).
Octreotide, a drug that suppresses the gland's production of hormones, is also used because they stimulate it and cause pain. This medicine is prescribed only in hospitals.

With a long course of chronic pancreatitis, the normal cells of the organ are replaced by connective tissue. Thus, the functionality of the organ is impaired, diabetes mellitus and digestive disorders may develop. In order to reduce pain and give rest to the pancreas, pancreatic enzymes should be taken:

Festal - it should be drunk 3 r / day, 1 tablet with meals, it is usually combined with histamine blockers to reduce acidity in the stomach - famotidine, cimetidine.
Pancreatin (Enzistal, Gastenorm, Biozim, Mezim, Mikrazim, Pangrol, Panzinorm, Penzital, Creon, Ermital) are pancreatic enzymes, which should be taken, like Festal, while it is best to drink the drug with alkaline mineral water. They contribute to a better breakdown of proteins, carbohydrates and fats.
Speaking of enzymes, one must remember about their activity, 10,000 units of lipase (mezim-forte tablet) three times a day is a standard requirement for replacement therapy. The original mezim has a not very pleasant smell, if there is no smell, it is a fake (crushed chalk).

In the presence of chronic pancreatitis, symptoms can be observed for a very long time, respectively, the level of insulin decreases, which can eventually lead to the development of diabetes. In the case of the diagnosis of this pathology, the patient should contact an endocrinologist to develop a treatment regimen and coordinate the diet.

Physiotherapy

Physiotherapeutic procedures are used to a limited extent after reducing the activity of inflammation. With intense pain, electrophoresis with novocaine or dalargin, ultrasound, diadynamic currents are prescribed. To combat the remaining inflammation, laser or ultraviolet blood irradiation, an alternating magnetic field are recommended.

Folk remedies

For the treatment of pancreatitis, the following traditional medicine is used:

Collection of herbs. To prepare the collection, string, cudweed, horsetail, chamomile and calendula flowers, St. John's wort, wormwood and sage are taken in equal quantities. Herbs are mixed and crushed. Then an infusion is prepared (a tablespoon of the collection is taken in a glass of boiling water, infused for an hour, filtered). The infusion is consumed three times a day, half a cup, half an hour before meals.
Two leaves of a golden mustache are poured into 0.5 liters of boiling water, put on low heat and boiled for 15 minutes. The mixture is then cooled for 8 hours. Before use, the infusion is heated to a warm state in a water bath and drunk before meals (for half an hour). On the day you need to drink three tablespoons of infusion.
In equal quantities, take the roots of burdock, elecampane and dandelion, grind and mix them. The resulting mixture is placed in boiling water (a dessert spoon of the mixture in a glass of water), boiled for 15 minutes, then insisted for an hour. After that, the infusion is filtered and drunk before meals, a tablespoon, three times a day.
Carrot and potato juice. They take two carrots and two potatoes, squeeze the juice out of them and drink on an empty stomach, in the morning, for a week.
Infusion of motherwort, immortelle and calendula. Take one tablespoon of the above herbs, mix and pour a liter of boiling water. Cover the resulting mixture with a cloth, insist for an hour, then filter. You need to take the resulting decoction 6 times a day, half a cup.
The bark of the barberry is taken, crushed. Then the crushed barberry bark is added to boiling water (a teaspoon of bark in a glass of water), boiled for 15 minutes, after which the resulting broth is cooled and consumed before meals, a tablespoon, three times a day.
Take cumin seeds (2 teaspoons), pour a glass of hot water and leave for 2 hours. Then the mixture is filtered and taken three times a day, before meals, half a cup.

It should be remembered that folk remedies can be used in the treatment of pancreatitis only as an additional therapy and only with the permission of a doctor.

Forecast

Strict adherence to the diet and diet, complete abstinence from alcohol, strict adherence to the recommendations for drug treatment significantly reduce the frequency of exacerbations, translate the process into a rarely recurring variant with slow progression. In some patients, it is possible to achieve a noticeable and stable remission.

Chronic pancreatitis is characterized by a progressive course, however, the cessation of exposure to causative factors and adequate therapy slow down the progression of the disease, significantly improve the quality of life of patients and the prognosis.