Pancreatitis is an acute or chronic inflammation of the pancreatic tissue, which is associated with a subsequent violation of the secretory and endocrine functions of the organ. Most often, the development of pathology is associated with large amounts of alcohol, smoking, and systematic use of the gallbladder.
During the exacerbation of pancreatitis, a person feels long-lasting intense pain in the upper part of the abdomen, digestion is disturbed, and yellowing of the skin and mucous membranes may occur.
The treatment includes following a diet, taking medicines to aid in the digestion of food, and pain relievers. In some cases, surgery may be necessary.
According to statistics, in general, the occurrence of the disease does not depend on gender. However, acute alcoholic pancreatitis is more common in men, which is associated with greater alcohol dependence in this population. The disease mainly affects people of working age between 30 and 50 years. In women, the development of pancreatitis is more often caused by gallstone disease.
The reasons
The cause of the disease can be a toxic effect, autoimmune processes, hereditary predisposition, or it can become a complication of gallstone disease. Alcohol abuse, smoking, and obstruction of the bile ducts by gallstones are the most common causes of pancreatitis. In the latter case, the outflow of the digestive secretion of the pancreas into the duodenum is disturbed, which leads to its stagnation and "self-digestion" of the organ.
The decomposition products of ethyl alcohol have a direct toxic effect on the cells of the pancreas, as well as on many drugs (estrogens, sulfonamides, tetracycline, erythromycin, thiazides, mercaptopurine). In addition, the systematic abuse of alcohol is associated with the thickening of bile, which predisposes to damage to the patency of the bile ducts. Nicotine addiction also predisposes to the development of the disease, as it affects the cardiovascular system, which causes a narrowing of the lumen of blood vessels and a decrease in blood flow to the organs.
Damage to the pancreas is also related to heredity, and can be caused by genetic or congenital malformations. Autoimmune pancreatitis occurs in isolation and in combination with Sjögren's syndrome, inflammatory bowel disease, and many other autoimmune diseases.
Classification
Depending on the nature of the course of the disease, acute or chronic pancreatitis is distinguished. Due to the occurrence, it occurs:
- toxic (alcoholic, infectious, medicinal);
- bile;
- dysmetabolic;
- autoimmune;
- idiopathic;
- post-traumatic.
According to the clinical manifestations, pancreatitis occurs in a mild, moderate or severe form.
Symptoms
The clinical manifestations of the disease are associated not only with damage to the organ itself, but also with violations of its secretory and endocrine functions. In acute pancreatitis, the symptoms are pronounced:
- Intense pain in the epigastric region, in the left hypochondrium, local or circling, often extending below the left shoulder blade. Unpleasant sensations are aggravated in a lying position and after a mistake in the diet.
- Increased salivation, belching, nausea, frequent vomiting that does not bring relief.
- An increase in body temperature. Perhaps the appearance of fever, chills.
- Changes in the color of the skin and mucous membranes. Moisture and paleness of the skin, moderate yellowing of the sclera are often observed. In rare cases, the skin also acquires a yellowish tint. Perhaps the appearance of bluish spots on the body, bleeding in the navel.
- Dyspeptic manifestations - flatulence, heartburn.
- Irritability, tearfulness, pancreatogenic psychosis develops in severe cases.
Chronic pancreatitis is characterized by periods of exacerbation and remission, and has an intermittent course. In the preclinical stage, the disease has no symptoms, pancreatic changes become an accidental finding during the ultrasound examination of the abdominal organs. During the period of the initial manifestations, episodes of repeated exacerbation of pancreatitis with manifestations characteristic of the acute form of the disease can be observed. Their frequency gradually decreases, but the symptoms persist even in the interictal period: abdominal pain, episodic vomiting, nausea, diarrhea, flatulence.
In the stage of persistent symptoms, pain occurs in the upper half of the abdomen, often in the form of a girdle. The patient loses weight, especially due to refusal to eat because he is afraid of increased pain. Increased manifestations of secretory and endocrine insufficiency, such as indigestion, hyperglycemia.
In the future, atrophy of the pancreas occurs. Pain may decrease or disappear, and the frequency of pancreatitis decreases. The feces will be pasty, smelly, and have a greasy sheen. Exhaustion is observed, pancreatogenic diabetes mellitus develops. In the last stage, systemic complications occur, possibly malignant degeneration of the tissue of the affected organ.
Complications
Depending on the form, severity and stage of the disease, the risk of developing certain complications of pancreatitis increases. In the case of a progressive, long-term course of the pathology, a violation of the outflow of bile is possible, followed by obstructive jaundice, the formation of abscesses, cysts, the development of portal hypertension, pancreatogenic diabetes mellitus, parapancreatitis, "enzymatic" cholecystitis, pneumonia, exudative pleurisy, paranephritis, pancreatic cancer.
The consequences of the acute process can be as follows:
- peritonitis;
- septic phlegmon of retroperitoneal tissue;
- erosive bleeding in the organs of the digestive system, bleeding in the abdominal cavity;
- mechanical jaundice;
- ascites;
- formation of internal and external digestive fistulas, abscesses and infiltrates.
In severe cases, shock can develop, with multiple organ failure and a high risk of death.
Diagnostics
Pancreatitis is identified and treated by a general practitioner and a gastroenterologist together with an endocrinologist, surgeon and other specialists. During emergency medical care, patients with an acute form of the disease are often transferred to a surgical hospital, where differential diagnosis of pancreatic lesions with acute appendicitis, cholecystitis and other pathologies is carried out.
After clarifying the complaints, collecting the anamnesis, including the nature of the diet, bad habits, the frequency of relapses, simultaneous diseases of the biliary system and examination, the doctor directs the patient to tests and instrumental tests.
As part of the patient's laboratory examination, the following are performed:
- General clinical analysis of blood. There are signs of inflammation: acceleration of ESR, leukocytosis.
- Biochemistry of blood. In case of damage to the pancreas, in the case of pancreatitis, an increase in the activity of enzymes (amylase, lipase), hyperglycemia, hypoalbuminemia and hypocalcemia, bilirubinemia, as well as an increase in the activity of liver enzymes (ALT, AST, transaminase), and CRP are possible.
- Biochemical examination of urine. This is done to determine amylase activity in the urine.
- Co-program. characteristic steatorrhea.
- Determination of pancreatic elastase in feces.
Instrumental diagnosis of pancreatitis includes:
- Abdominal ultrasound is a method for visualizing the gland and surrounding organs;
- SCT and MRI examination of internal organs to obtain more detailed information about anatomical changes;
- endoscopic retrograde cholangiopancreatography to visualize the lumen of the ducts, collect pancreatic secretions, and remove stones;
- endoscopic elastography of the pancreas - makes it possible to determine the stiffness and rigidity of the tissue, the degree of replacement of connective tissue and the secretory function of the organ;
- esophagogastroduodenoscopy to assess the condition of the hollow digestive organs.
Treatment
Medical help should be sought at the first signs of pancreatitis, then there is a greater chance of avoiding complications and the transition of the disease into a chronic form. When the disease worsens, fasting is recommended.
All patients with pancreatitis must follow a diet, stop drinking alcohol and smoking. During the interictal period, you should eat in small portions several times a day, including in the diet mainly foods high in protein and complex carbohydrates, dietary fibers and vitamins.
Drug treatment means taking drugs from the following groups:
- pain relievers for pancreatitis;
- pancreatic enzymes;
- inhibitors of the secretion of hydrochloric acid in the stomach;
- tranquilizers and antidepressants;
- antibiotics;
- insulin;
- vitamins.
In the case of a complicated course of the disease, as well as in some cases of acute abdominal pain, endoscopic or surgical intervention is necessary.
Prevention
The primary prevention of pancreatitis is avoiding alcohol, eating a varied diet low in fat, saturated fat, and cholesterol, including whole grains, vegetables, and fruits, and not smoking.
Acute pancreatitis can develop not only in people who regularly abuse alcohol, but also in the case of one-time consumption of alcoholic beverages, fatty, fried and spicy foods. Partial, adequate nutrition of pancreatitis serves to prevent exacerbation of its chronic form.