Pancreatitis is an acute or chronic inflammation of the pancreatic tissue with subsequent violation of the secretory and endocrine functions of the organ. Most often, the development of pathology is associated with the systematic use of large amounts of alcohol, smoking, cholelithiasis.
During an exacerbation of pancreatitis, a person experiences prolonged intense pain in the upper abdomen, his digestion is disturbed, and yellowness of the skin and mucous membranes may appear.
Treatment includes following a diet, taking medications that facilitate the digestion of food, painkillers. In some cases, surgery may be required.
According to statistics, in general, the prevalence of the disease does not depend on gender. However, acute alcoholic pancreatitis is more common in men, which is associated with greater alcohol addiction among this population. The disease mainly affects persons of working age from 30 to 50 years. In women, the development of pancreatitis is more often caused by gallstone disease.
The reasons
The disease can be caused by toxic effects, autoimmune processes, have a hereditary predisposition, or become a complication of gallstone disease. Alcohol abuse, smoking, and obstruction of the bile ducts by gallbladder stones are the most common causes of pancreatitis. In the latter case, the outflow of the digestive secret of the pancreas into the duodenum is disturbed, which leads to its stagnation and "self-digestion" of the organ.
The decay products of ethyl alcohol have a direct toxic effect on the cells of the pancreas, as well as a number of drugs (estrogens, sulfonamides, tetracycline, erythromycin, thiazides, mercaptopurine). In addition, the systematic abuse of alcohol is accompanied by a thickening of bile, which predisposes to impaired patency of the bile ducts. Nicotine addiction also predisposes to the development of the disease, as it affects the cardiovascular system, causing narrowing of the lumen of the vessels and a decrease in blood flow to the organs.
Damage to the pancreas is also related to heredity, in particular, it can be genetically determined or caused by congenital developmental anomalies. Autoimmune pancreatitis occurs both in isolation and in combination with Sjögren's syndrome, inflammatory bowel disease, and many other autoimmune disorders.
Classification
Depending on the nature of the course of the disease, acute or chronic pancreatitis is distinguished. Due to the occurrence, it happens:
- toxic (alcoholic, infectious, medicinal);
- biliary;
- dysmetabolic;
- autoimmune;
- idiopathic;
- post-traumatic.
In accordance with the clinical manifestations, pancreatitis occurs in mild, moderate or severe forms.
Symptoms
Clinical manifestations of the disease are associated not only with damage to the organ itself, but also with a violation of its secretory and endocrine functions. In acute pancreatitis, the symptoms are pronounced:
- Intense pain in the epigastric region, left hypochondrium, local or encircling nature, often extending under the left shoulder blade. Unpleasant sensations are aggravated in the supine position and after an error in the diet.
- Increased salivation, belching, nausea, frequent vomiting that does not bring relief.
- Increase in body temperature. Perhaps the appearance of fever, chills.
- Change in color of the skin and mucous membranes. Humidity and pallor 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, hemorrhages in the navel.
- Dyspeptic manifestations - bloating, heartburn.
- Irritability, tearfulness, in severe cases, pancreatogenic psychosis develops.
Chronic pancreatitis is characterized by periods of exacerbation and remission, has a staged course. In the preclinical stage, there are no symptoms of the disease, changes in the pancreas become an accidental finding during an ultrasound scan of the abdominal organs. During the period of initial manifestations, repeated episodes of exacerbation of pancreatitis with manifestations characteristic of the acute form of the disease are observed. Gradually, their frequency becomes lower, but the symptoms persist in the interictal period: abdominal pain, episodic vomiting, nausea, diarrhea, flatulence.
In the stage of persistent symptoms, there is pain in the upper half of the abdomen, often of a girdle character. The patient loses weight, in particular due to refusal of food due to fear of increased pain. Increased manifestations of secretory and endocrine insufficiency, such as indigestion, hyperglycemia.
In the future, atrophy of the pancreas occurs. The pain may become less intense or absent, the frequency of pancreatitis attacks is reduced. The stool becomes mushy, fetid, with 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. With a progressive long-term course of the pathology, violations of the outflow of bile are possible, followed by obstructive jaundice, the formation of an abscess, cysts, the development of portal hypertension, pancreatogenic diabetes mellitus, parapancreatitis, "enzymatic" cholecystitis, pneumonia, exudative pleurisy, paranephritis, pancreatic cancer.
The consequences of an acute process can be:
- peritonitis;
- septic phlegmon of retroperitoneal tissue;
- arrosive bleeding in the organs of the digestive tract, hemorrhage in the abdominal cavity;
- mechanical jaundice;
- ascites;
- formation of internal and external digestive fistulas, abscesses and infiltrates.
In severe cases, shock may develop, multiple organ failure with a high risk of death.
Diagnostics
The identification and treatment of pancreatitis is carried out by a general practitioner and a gastroenterologist together with an endocrinologist, a surgeon and other specialists. Often, patients with an acute form of the disease by emergency medical care end up in a surgical hospital, where a differential diagnosis of pancreatic lesions with acute appendicitis, cholecystitis and other pathologies is carried out.
After clarifying the complaints, collecting an anamnesis, including the nature of nutrition, bad habits, the frequency of relapses, concomitant diseases of the biliary system, and examination, the doctor directs the patient for tests, as well as instrumental studies.
As part of a laboratory study of a patient, the following are carried out:
- General clinical analysis of blood. There are signs of inflammation: acceleration of ESR, leukocytosis.
- Biochemistry of blood. For damage to the pancreas in pancreatitis, an increase in the activity of enzymes (amylase, lipase), hyperglycemia, hypoalbuminemia and hypocalcemia, bilirubinemia, as well as an increase in the activity of liver enzymes (ALT, AST, transaminase), CRP are possible.
- Biochemical study of urine. It is carried out to determine the activity of amylase in the urine.
- Coprogram. characteristic steatorrhea.
- Determination of pancreatic elastase in feces.
Instrumental diagnosis of pancreatitis includes:
- Ultrasound of the abdominal organs is a method for visualizing the gland itself and surrounding organs;
- SCT and MRI of internal organs to obtain more detailed information about anatomical changes in them;
- endoscopic retrograde cholangiopancreatography to visualize the lumen of the ducts, take pancreatic secretions, remove stones;
- endoscopic elastography of the pancreas - allows you to determine the stiffness and rigidity of the tissue, assess the degree of its connective tissue replacement and the secretory function of the organ;
- esophagogastroduodenoscopy to assess the condition of the hollow digestive organs.
Treatment
Medical help should be sought at the first signs of pancreatitis, then the chance to avoid complications and the transition of the disease to a chronic form will be higher. During an exacerbation of the disease, fasting is recommended.
All patients suffering from pancreatitis must follow a diet, give up alcohol and smoking. In the interictal period, you should eat in small portions several times a day, including in the diet mainly foods high in protein and complex carbohydrates, dietary fiber, and vitamins.
Drug therapy involves taking drugs from the following groups:
- analgesics for pain relief in pancreatitis;
- pancreatic enzymes;
- inhibitors of secretion of hydrochloric acid in the stomach;
- sedatives and antidepressants;
- antibiotics;
- insulin;
- vitamins.
With a complicated course of the disease, as well as in some cases of acute abdominal pain, endoscopic or surgical intervention is indicated.
Prevention
The primary prevention of pancreatitis is avoiding alcohol, eating a varied diet that is low in fat, saturated fat, and cholesterol, including grains, vegetables, and fruits in the diet, and not smoking.
Acute pancreatitis can develop not only in people who regularly abuse alcohol, but also as a result of a single intake of alcohol-containing drinks for fatty, fried and spicy snacks in large quantities. Fractional, proper nutrition in pancreatitis serves as a prevention of exacerbations of its chronic form.