What is chronic pancreatitis symptoms. Symptoms and treatment of chronic pancreatitis

According to the international classification of ICD-10, chronic pancreatitis is assigned the value K86. At the same time, K86.0 corresponds to the alcoholic form of the disease, and K86.1 is the designation for other types of chronic pancreatitis.

According to the clinical picture, chronic pancreatitis is of the following forms:

1. relapsing form. It develops in more than 50% of clinical cases. It is characterized by undulating bouts of intense pain. Often this form of the disease is accompanied by vomiting and is localized in the epigastric region.
2. pain form. In this case, the disease is accompanied by a constant pain syndrome. Additionally, the patient has weight loss and impaired stool (diarrhea, constipation).
3. sclerosing form. With this type of chronic pancreatitis, indigestion and absorption of food develop rapidly. The patient experiences nausea, vomiting, and diarrhea. The sensation of pain mainly occurs in the upper abdomen, while its intensity increases after eating.
4. Icteric (pseudotumor) form. Basically, this type of pathology occurs in men. According to statistics, the frequency of diagnosed cases reaches 10% of all forms of chronic pancreatitis. It is characterized by symptoms such as pain in the epigastric region, weight loss, yellowness of the skin and mucous membranes, itching, discolored feces.
5. Asymptomatic (latent) form. It is one of the most dangerous and insidious forms of the disease. For a long period of time, the patient does not feel any discomfort. But at the same time, pathological processes in the pancreas are in full swing. Vivid clinical manifestations occur suddenly, when the violation of secretion is already significant.

There are 2 clinical stages of chronic pancreatitis, which differ in the severity of symptoms and the duration of the disease:

1. First (initial) stage. On the this stage of pancreatic function the glands are not yet broken, but the symptoms of the disease in the vast majority of cases are already present.
2. Stage of exocrine insufficiency. Typically, such digestive disorders develop 10 years after the onset of the disease.

Reasons for the development of chronic pancreatitis

In a healthy adult, the pancreas produces inactive enzymes that enter the bile and pancreatic ducts, as well as duodenal gut. In cases of failure, prematurely activated enzymes do not participate in the digestive process and begin to adversely affect the pancreas directly.

With a long course of the disease, the negative impact only intensifies. Chronic pancreatitis in adults is a natural result of an untreated acute form of pathology. The following negative factors can provoke the development of the inflammatory process:

• alcohol abuse;
• smoking;
• binge eating;
• fungal infections;
• inflammatory process in duodenal intestine;
• frequent consumption of fatty, salty, spicy and smoked foods;
• metabolic disorder;
• tumors in the pancreas;
• pathology of the biliary tract;
• diseases of the endocrine system;
• stress;
• long-term use of anti-inflammatory and diuretic drugs;
• injuries of the pancreas (including during surgical intervention);
• regular stress.

In rare cases, allergic reactions, hereditary predisposition, and exposure to pesticides can contribute to the development of chronic pancreatitis.

Clinical manifestations

The clinical picture of chronic pancreatitis is often confused with manifestations of stomach ulcers, biliary dyskinesia and chronic cholecystitis. Therefore, self-diagnosis and self-treatment can lead to disastrous consequences. Since the drugs taken will only suppress the symptoms, and not treat the disease.

The main symptom of pancreatitis at the initial stage (except for the latent form) is pain. Depending on the form of the disease, the pain can be girdle, localized in the left hypochondrium and upper abdomen. To relieve pain with the first analgesics that came to hand, and it makes no sense, it is better to immediately consult a doctor who can pick up the necessary drugs. In addition, chronic pancreatitis in adults may be accompanied by the following symptoms:

• nausea, vomiting;
• flatulence;
• heartburn;
• diarrhea or constipation;
• weight loss;
• lack of appetite;
• dehydration;
• increased salivation;
• dryness of the skin.

With the icteric form of chronic pancreatitis, there is a change in the color of the mucous membranes, skin and a slight increase in the size of the spleen and liver.

Diagnostic methods

In order to differentiate chronic pancreatitis from other pathologies of the digestive system, it is necessary to refer to gastroenterologist. The diagnosis can be made by a doctor based on the following studies:

• a blood test for the presence of bilirubin and an increase in ESR;
• examination of feces to detect undigested fat;
• Ultrasound diagnostics to determine the size and structure of the pancreas;
• coprogram allows you to identify pieces of undigested food.

Additionally, the patient may be assigned a CT scan (computed tomography) of the abdominal cavity and an x-ray of the biliary tract.

Therapy Methods

Treatment of chronic pancreatitis process long enough. Moreover, the more time has passed since the onset of the disease, the less likely it is to get rid of it forever. In drug therapy, the following groups of drugs are used:

1. Medicines to reduce the activity of produced enzymes. For example, Omeprazole, Kontrykal.
2. Digestive enzymes (Festal, Pancreatin, Mezim, Creon).
3. Antispasmodics (No-shpa, Drotaverine, Papaverine).
4. Antibacterial drugs ( Ampicillin, Amoxicillin). In certain cases, they are prescribed to prevent the development of infectious processes.

In the vast majority of cases, chronic pancreatitis in adult patients is accompanied by increased acidity. In an acidic environment, some drugs lose their effectiveness. In order to normalize the acidity, the patient is prescribed the intake of mineral water without gas. For example, Essentuki No. 4 and 17, Borjomi or Polyana Kvasova.

If chronic pancreatitis accompanies beriberi, the patient is additionally prescribed vitamins of group B, C and retinol. In severe cases of the disease, doctors perform surgery. The indications for surgery may be the following conditions:

• bleeding in the ducts of the pancreas;
• malignant neoplasms;
• stenosis duodenal intestines;
• clinical manifestations that are not amenable to drug therapy;
• pancreatic ascites.

The duration, volume and method of the operation depend on the nature of the disease and the degree of damage to the pancreas. Compliance with all the recommendations of the attending physician and timely treatment will avoid the development of serious complications.

Traditional medicine and prevention

First of all, the prevention of chronic pancreatitis is to give up bad habits and follow a certain diet. After completing the course of therapy, nutritional adjustment should become a way of life.

This is based on fractional nutrition with the exception of fatty, spicy and fried foods. Most dishes are steamed, boiled or stewed. The diet of a patient with chronic pancreatitis should include lean meat, fish, non-acidic fruits, dried bread and cereals.

In combination with traditional treatment, you can use folk methods. For example:

1. Decoction of flax seeds. To prepare it, you need to take 3 tbsp. l seeds, pour a glass of boiling water and leave to infuse for 10-12 hours. Then the broth is filtered and taken 1/3 cup 3 times a day.
2. Mother's milk. It is accepted for one article. l 3 times a day.
3. A decoction of dandelion roots. It is necessary to take 50 g of raw materials, grind, pour 60 ml of boiling water and insist for two hours. Further, the broth is filtered and taken in half a glass 3 times a day.

Remember get rid of chronic pancreatitis with traditional medicine impossible. You can get an effect from it only with an integrated approach and under the full supervision of the attending physician.

Chronic pancreatitis is a group of pancreatic disease variants, which are characterized by the presence of focal necrosis in the pancreas against the background of segmental fibrosis with a deterioration in the functions of the gland of varying severity. The progression of chronic pancreatitis leads to the appearance and development of atrophy (depletion) of the glandular tissue, fibrosis and replacement of the cellular elements of the pancreatic parenchyma with connective tissue.

The main causes of chronic pancreatitis:

1) alcohol consumption - alcoholic pancreatitis (more often in men over 35 years old) at a dose of more than 20-80 mg of ethanol / day. for 8–12 years. Protein diet and smoking further exacerbate the course of pancreatitis;
2) diseases of the biliary tract and duodenum - biliary pancreatitis (more often in women);
cholelithiasis is the cause of chronic pancreatitis in 35-56% of cases;
pathology of the sphincter of Oddi (stenosis, strictures, inflammation, tumor);
duodenitis and peptic ulcer. Thus, duodenal ulcer in 10.5-16.5% of cases is the direct cause of chronic pancreatitis.

Chronic pancreatitis, which develops with cholelithiasis, choledocholithiasis, occurs more often in women aged 50–60 years. As a rule, such patients have signs of the metabolic syndrome: obesity, hyperlipidemia, a tendency to arterial hypertension, coronary artery disease, impaired carbohydrate tolerance, hyperuricemia and / or hyperuricosuria.

These 2 points are the most likely and most likely to become the causes of chronic pancreatitis. The least common causes:

Pain can occur both during exacerbation and in the phase of remission of chronic pancreatitis. It does not have a clear localization, arising in the upper or middle abdomen on the left or in the middle, radiates to the back, sometimes takes on a shingles character. More than half of the patients have very intense pain.

Localization of pain in chronic pancreatitis

The causes of pain in chronic pancreatitis are as follows:

1) acute inflammation of the pancreas (damage to the parenchyma and capsule);
2) pseudocysts with perifocal inflammation;
3) obstruction and dilatation of the pancreatic and bile ducts;
4) fibrosis in the area of ​​sensory nerves, leading to their compression;
5) pressure on the surrounding nerve plexuses of the enlarged pancreas;
- stenosis and dyskinesia of the sphincter of Oddi.
- Pain associated with pseudocysts and duct obstruction is greatly aggravated during or immediately after eating. Pain, as a rule, girdle, paroxysmal. Significantly reduce pain antisecretory drugs and pancreatin preparations (Panzinorm), which reduce pancreatic secretion by a feedback mechanism.
- Inflammatory pains do not depend on food intake, are localized, as a rule, in the epigastrium, radiating to the back. Such pains are stopped by analgesics (NSAIDs, in severe cases - narcotic analgesics)
- Exocrine pancreatic insufficiency leads to excessive bacterial growth in the small intestine, which is also the cause of pain in a significant proportion of patients with chronic pancreatitis. These pains are caused by increased pressure in the duodenum.

In the later stages of chronic pancreatitis, with the development of fibrosis, pain decreases and after a few years may disappear. Then manifestations of exocrine insufficiency come to the fore.

Symptoms of exocrine insufficiency

Exocrine pancreatic insufficiency is manifested by a violation of the processes of intestinal digestion and absorption. Symptoms:

Diarrhea (3 to 6 stools per day)
steatorrhea (occurs with a decrease in pancreatic secretion by 10%, feces are mushy, fetid, with a greasy sheen).
weight loss,
nausea,
occasional vomiting,
loss of appetite.

The syndrome of excessive bacterial growth in the small intestine develops quite quickly, its symptoms:

Flatulence,
rumbling in the stomach,
belching.

Later, symptoms characteristic of hypovitaminosis join - anemia, weakness, changes in the skin, hair, metabolism.

The following mechanisms underlie exocrine pancreatic insufficiency:

Destruction of acinar cells, resulting in reduced synthesis of pancreatic enzymes;
- obstruction of the pancreatic duct, which disrupts the flow of pancreatic juice into the duodenum;
- a decrease in the secretion of bicarbonates by the epithelium of the ducts of the gland leads to acidification of the contents of the duodenum to pH 4 and below, resulting in denaturation of pancreatic enzymes and precipitation of bile acids.

Symptoms of biliary hypertension

The syndrome of biliary hypertension is expressed in obstructive jaundice and cholangitis and is relatively common. Up to 30% of patients in the acute stage of chronic pancreatitis have transient or persistent hyperbilirubinemia. The causes of the syndrome are an increase in the head of the pancreas with compression of the terminal part of the common bile duct, choledocholithiasis and pathology of the major duodenal papilla (stones, stenosis).

Symptoms of endocrine disorders in chronic pancreatitis

Appears in about a third of patients. The development of these disorders is based on the defeat of all cells of the islet apparatus of the pancreas, resulting in a deficiency of not only insulin, but also glucagon. This explains the features of the course of pancreatogenic diabetes mellitus: a tendency to hypoglycemia, the need for low doses of insulin, the rare development of ketoacidosis, vascular and other complications.

Symptoms of chronic pancreatitis due to fermentemia

Intoxication syndrome is manifested by general weakness, decreased appetite, hypotension, tachycardia, fever, leukocytosis, and increased ESR.
Symptom Tuzhilin (symptom of "red droplets"): the appearance of bright red spots on the skin of the chest, back, abdomen. These spots are vascular aneurysms and do not disappear with pressure.

Diagnosis of chronic pancreatitis

Diagnosis of chronic pancreatitis is quite complicated and is based on 3 main features: a characteristic history (pain attacks, alcohol abuse), the presence of exocrine and / or endocrine insufficiency, and the detection of structural changes in the pancreas. Often, the diagnosis of chronic pancreatitis is formed after a long observation of a patient who has clinical signs suggesting the presence of chronic pancreatitis.

Laboratory diagnostics

Blood for biochemistry. The level of amylase, serum lipase often remains normal or reduced during the attack of pancreatitis, which is explained by a decrease in the number of acinar cells producing these enzymes. When alcoholic pancreatitis is combined with alcoholic liver disease, abnormal liver function tests may be detected. In 5-10% of cases of chronic pancreatitis, there are signs of compression of the intrapancreatic part of the bile duct, due to edema or fibrosis of the pancreatic head, which is accompanied by jaundice, increased levels of direct bilirubin and serum alkaline phosphatase.

Impaired glucose tolerance develops in 2/3 of patients, diabetes mellitus - in 30% of patients with chronic pancreatitis.

Exocrine insufficiency becomes apparent and easily detected with the development of malabsorption syndrome, in which fat in the feces can be determined qualitatively (Sudan stain) or quantitatively. Secretory insufficiency at an earlier stage is detected using pancreatic functional tests.

In clinical practice for the diagnosis of chronic pancreatitis, an enzyme-linked immunosorbent assay for the determination of elastase-1 in the blood serum and feces of patients is being introduced, which makes it possible to assess the exocrine function of the pancreas.

Instrumental diagnosis of chronic pancreatitis

Instrumental data to confirm the assumption of the presence of chronic pancreatitis can be considered quite informative. Are used:

Ultrasound examination of the abdominal organs;
- endoscopic ultrasound, spiral computed and magnetic resonance imaging of the pancreas.

ERCP can detect duct stenosis, localization of obstruction, structural changes in small ducts, intraductal calcifications and protein plugs, but there is a high risk of developing acute pancreatitis

Differential diagnosis of pancreatitis

Symptoms of pancreatitis refers to the signs of an "acute abdomen". This means that it is necessary to distinguish pancreatitis from acute surgical pathology of the abdominal cavity, namely: from a perforated ulcer; acute cholecystitis; intestinal obstruction; thrombosis of the veins of the intestine; myocardial infarction.

Perforated ulcer. Perforation (perforation) of a stomach or intestinal ulcer differs from acute pancreatitis with “dagger pain”. This pain is associated with the penetration of gastric or intestinal contents into the peritoneum, which causes a reflex tension of the anterior abdominal wall, or the so-called board-shaped abdomen. This is not typical for pancreatitis. Vomiting during perforation of the ulcer is extremely rare. The patient lies motionless. A patient with pancreatitis is restless, tossing about in bed. Plain radiograph indicates gas in the abdominal cavity with a perforated ulcer. The final diagnosis is made on the basis of ultrasound or laparoscopy.

Acute cholecystitis. It can be quite difficult to distinguish between these two pathologies. But in favor of cholecystitis, the predominant localization of pain on the right with irradiation to the right shoulder will speak. When performing ultrasound, you can determine the localization of inflammation, but it is worth remembering that pancreatitis can accompany cholecystitis.

Acute intestinal obstruction. Pain with intestinal obstruction is cramping, and with pancreatitis, the pain is constant, aching. On x-ray with pancreatitis, the large intestine will be swollen, but without Kloiber cups.

Mesothrombosis. Mesothrombosis most often affects older people with cardiovascular disease. Symptoms at the same time grow quickly, but they are in no way connected with food intake. Laparoscopy or angiography will help resolve doubts.

Myocardial infarction. Upon arrival at the hospital, electrocardiography is performed as standard; it is not difficult to distinguish pancreatitis from myocardial infarction.

Treatment of chronic pancreatitis

Treatment of uncomplicated chronic pancreatitis can be carried out on an outpatient basis under the guidance of a gastroenterologist or general practitioner.

The goal of the treatment of chronic pancreatitis can be considered the solution of several problems:

Exclusion of provoking factors (alcohol, drugs, obstruction);
- pain relief;
- correction of exo- and endocrine insufficiency;
- treatment of comorbid disorders.

The main goals of conservative treatment are to stop or slow the progression of chronic pancreatitis and combat its complications. Depending on the severity of the abdominal pain syndrome, a phased treatment of chronic pancreatitis is used, which may include the following components:

Diet, fractional nutrition, fats less than 60 g / day.
- Pancreatic enzymes (pancreatin, creon, mezim, panzinorm, festal, penzital, enzistal) + H2-blockers (famotidine, ranitidine, cimetidine, nizatidine).
- Non-narcotic analgesics (acetylsalicylic acid, diclofenac, ibuprofen, piroxicam).
- Octreotide (sandostatin).
- Endoscopic drainage (Olimpus, LOMO, Pentax, Fujinon).
- Narcotic analgesics (butorphanol, antaxon, fortal, tramadol, sedalgin-neo).
- Blockade of the solar plexus.
- Surgical intervention.

With mild pain, success can be achieved through a strict diet, fractional (every 3 hours) food intake and fat restriction to 60 g per day, which helps to reduce pancreatic secretion with a low-calorie diet.

Drugs for the treatment of chronic pancreatitis

Given the fact that the main cause of pain is intraductal hypertension, it is advisable to use drugs that block stimulated pancreatic secretion. Normally, the release of cholecystokinin, the main stimulator of exogenous pancreatic function, is regulated by the cholecystokinin-releasing peptide in the proximal small intestine, which is trypsin-sensitive and active in the intestinal lumen. The appointment of pancreatic enzymes (mezim forte, pancreatin, panzinorm, pancitrate likrease) provides a significant relief of pain in some patients due to the inclusion of a feedback mechanism: an increase in the level of proteases in the lumen of the duodenum reduces the release and synthesis of gastrointestinal hormones (cholecystokinin), which leads to a decrease in stimulation of the exocrine function of the pancreas, reduction of intraductal and tissue pressure and pain relief.

One should be aware of the possibility of inactivation of exogenous digestive enzymes by gastric acid and pancreatic proteases. To prevent this effect, a combination of enzymes (pancreatin, creon, mezim, panzinorm, festal, penzital, enzistal) with H2-histamine blockers (famotidine, ranitidine, cimetidine, nizatidine) is widely used. Doses of enzyme preparations for pain relief should be adequate; in a placebo-controlled double-blind study, pancreolipases at a dose of 6 tablets 4 times a day for 1 month significantly reduced pain in 75% of patients with moderate to severe pancreatitis. Pancreatic enzymes in encapsulated form containing acid-resistant mini-microspheres (creon) are currently the drugs of first choice in the treatment of abdominal pain in exocrine pancreatic insufficiency. Microgranular dosage forms (Creon 10,000 or 25,000) are characterized by a rapid (after 45 minutes) release of more than 90% of enzymes at a pH of the duodenal and small intestine contents of 5.5 and above.

At very low pH values ​​in the gastrointestinal tract, adjuvant therapy with H2 antagonists or proton pump inhibitors (lansoprazole, omeprazole, pantoprazole, rabeprozole) is used. In addition, enzyme replacement therapy has been shown to improve the transit of food through the gastrointestinal tract by affecting the motor function of the gastrointestinal tract and thereby helping to reduce malabsorption.

Pancreatic enzymes are prescribed in all cases of chronic pancreatitis to correct the exocrine function of the pancreas. Taking these drugs reduces intestinal distension and diarrhea due to malabsorption of fats, and therefore pain is reduced. Enzyme preparations reduce the intensity of pain in moderate chronic pancreatitis, especially in women with obstructive pancreatitis; on the background of doubling of the pancreatic duct. In men with alcoholic calcific pancreatitis, these drugs are significantly less effective.

For the relief of steatorrhea in chronic pancreatitis, coated preparations with a high content of lipase are shown; for pain relief - preparations with a high content of proteases without a shell.

In the absence of the effect of enzyme replacement therapy in combination with H2-histamine blockers, it is necessary to prescribe analgesics, for this purpose paracetamol (daleron, prodol, efferalgan), non-steroidal anti-inflammatory drugs: diclofenac (apo-diclo, voltaren, diclofenac, ortofen), ibuprofen (apo ibuprofen, ibuprofen, ibufen, solpaflex), piroxicam (piroxicam, piroxifer, felden, erazone), celecoxib (celebrex), lornoxicam (xefocam), meloxicam (meloxicam, movalis), nimesulide (mesulide, nise, nikulide), naproxen (apo naproxen, nalgesin, naproxen).

To relieve pain in chronic pancreatitis, octreotide (sandostatin) is prescribed. Being a potent inhibitor of neuroendocrine hormones of the gastrointestinal tract, sandostatin inhibits exogenously stimulated and endogenously stimulated exocrine pancreatic secretion by direct action on exocrine tissue and reduces the release of secretin and cholecystokinin. The drug is also effective in the treatment of pseudocysts, pancreatic ascites and pleurisy. Used 50-100 mcg subcutaneously 2 times a day for 1 week to treat the pain form of chronic pancreatitis.

If the pain syndrome persists, it is necessary to perform ERCP for morphological clarification of the nature of the damage to the ducts, to exclude dysfunction of the sphincter of Oddi. In this case, the possibility of using invasive methods of treatment is discussed: endoscopic drainage and bypass, blockade of the solar plexus with steroids, pancreaticojejunostomy and pancreatic resection.

The greatest difficulties are associated with the treatment of dysfunction of the sphincter of Oddi, one of the causes of chronic pancreatitis, difficult to diagnose. With dysfunction of the sphincter of Oddi, there is an increased sensitivity of the wall of the pancreatic and bile ducts to changes in volume and pressure.

It is necessary to exclude drugs that have a choleretic effect (bile acids, including in the composition of enzyme preparations - festal, enzistal, etc.; decoctions of choleretic herbs, synthetic choleretic agents).

To relieve spasm of the smooth muscles of the sphincters of Oddi and the cystic duct, nitrates are used: nitroglycerin - for quick relief of pain, nitrosorbitol - for course treatment (under the control of drug tolerance).

Myotropic antispasmodics (bendazole, benziklan, drotaverine, mebeverine, papaverine) reduce the tone and motor activity of smooth muscles. The main representatives of this group are papaverine, drotaverine (no-shpa, no-shpa forte, vero-drotaverine, spazmol, spakovin), benziklan (galidor). The most effective myotropic antispasmodic is duspatalin (mebeverin) - a muscle-tropic, antispastic drug that has a direct effect on smooth muscles. Selectively acting on the sphincter of Oddi, it is 20-40 times more effective than papaverine in terms of the ability to relax the sphincter of Oddi. It is important that duspatalin does not affect the cholinergic system and therefore does not cause such side effects as dry mouth, blurred vision, tachycardia, urinary retention, constipation and weakness. It is actively metabolized when passing through the liver, all metabolites are rapidly excreted in the urine. Complete excretion of the drug occurs within 24 hours after taking a single dose, as a result, it does not accumulate in the body, even elderly patients do not require dose adjustment. Duspatalin is prescribed 1 capsule (200 mg) 2 times a day, it is better to take it 20 minutes before meals.

Another myotropic antispasmodic with selective properties is hymecromon (odeston) - a phenolic derivative of coumarin that does not have anticoagulant properties and has a pronounced antispasmodic and choleretic effect. Hymecromone is a synthetic analogue of umbelliferone found in anise and fennel fruits, which were used as antispasmodics. The drug provides one or another effect, depending on the characteristics of its action at various levels of the biliary tract. Odeston causes dilatation of the gallbladder, reduces intraductal pressure and, thus, is an antagonist of cholecystokinin. At the level of the sphincter of Oddi, it acts synergistically with cholecystokinin, reduces basal pressure and increases the duration of the sphincter of Oddi opening, thereby increasing the passage of bile through the biliary tract. Being a highly selective antispasmodic, odeston also has choleretic properties. Its choleretic effect is due to the acceleration and increase in the flow of bile into the small intestine. An increase in the flow of bile into the lumen of the duodenum helps to improve digestion, activate intestinal motility and normalize stools.
Odeston is prescribed 400 mg (2 tablets) 3 times a day 30 minutes before meals, which ensures a relatively constant concentration of the drug in serum, exceeding 1.0 μg / ml. The duration of treatment is individual - from 1 to 3 weeks. Odeston has low toxicity, its tolerance is usually good.

In the absence of the effect of conservative therapy for dysfunction of the sphincter of Oddi and the presence of data on its stenosis, the restoration of the patency of the sphincter of Oddi is carried out surgically (sphincterotomy).

Replacement therapy for chronic pancreatitis

Replacement therapy of exocrine pancreatic insufficiency in the outcome of chronic pancreatitis is carried out in the presence of steatorrhea of ​​more than 15 g of fat per day, progressive weight loss and dyspeptic disorders. A single dose of enzymes should contain at least 20,000-40,000 units of lipase, so it is prescribed 2-4 capsules with main meals and 1-2 capsules with additional meals of a small amount of food. With clinically pronounced pancreatic insufficiency, it is often not possible to completely eliminate steatorrhea. An increase in body weight, normalization of stool, a decrease in flatulence indicate the adequacy of the selected dose of digestive enzymes.

The ineffectiveness of replacement therapy requires the exclusion of other causes of malabsorption syndrome - Crohn's disease, celiac disease, thyrotoxicosis. In order to correct nutritional deficiencies, medium chain triglycerides (trisorbon) and fat-soluble vitamins A, D, E, K are prescribed.

Complications of chronic pancreatitis

Complications of chronic pancreatitis include malabsorption syndrome, diabetes mellitus, pseudocysts, thrombosis of the portal or splenic vein, pyloric stenosis, obstruction of the common bile duct, and tumor. Pancreatic adenocarcinoma develops in 4% of cases in individuals with more than 20 years of history of chronic pancreatitis.

Forecast

The mortality rate in chronic pancreatitis reaches 50% at 20-25 years of disease. 15-20% of patients die from complications associated with exacerbations of pancreatitis, other deaths are caused by trauma, malnutrition, infection, smoking, which are often observed in patients with chronic pancreatitis.

Video about the symptoms, diagnosis and treatment of chronic pancreatitis

Chronic inflammation of the pancreas. It usually occurs in middle and old age, more often in women. There are primary chronic pancreatitis and secondary, or concomitant, developing against the background of other diseases of the digestive tract (chronic gastritis, cholecystitis, enteritis, etc.).

Among all diseases of the gastrointestinal tract, the frequency of chronic pancreatitis ranges from 5.1 to 9%, and in the past few decades, the incidence of pancreatitis in our country has doubled. Chronic pancreatitis is a severe disease, largely due to its recurrent nature. Patients are often concerned about periods of exacerbation, accompanied by severe pain, nausea, and vomiting.

Chronic pancreatitis is very insidious - this process "disfigures" the glandular tissue, leads to its wrinkling, the formation of various cysts, the rebirth of the acini themselves, which secrete valuable pancreatic juice. They are scarred, replaced by connective tissue, there are various narrowings of the excretory ducts in the gland, calculi (stones) are formed.

This disease can occur with minimal clinical signs, and with regular severe attacks, as well as masquerading as various diseases of the digestive system that occur with pain or impaired digestion of food. Signs and treatment of chronic pancreatitis in the acute stage do not differ from the acute form.

Pancreas

Pancreas It is a large digestive gland, second in size only to the liver. During the day, it produces 500-700 ml of pancreatic juice, which contains enzymes involved in the digestion of proteins, fats and carbohydrates, and enters the duodenum through the ducts.

Secondly, individual accumulations of pancreatic cells produce hormones that regulate carbohydrate and fat metabolism in the body and penetrate directly into the blood, so this part of the pancreas belongs to the endocrine system.

Causes of chronic pancreatitis

Prolonged acute pancreatitis can turn into chronic, but more often it forms gradually against the background of:

Pathogenesis: delayed release and intraorganic activation of pancreatic enzymes - trypsin and lipase, which autolyse the parenchyma of the gland, reactive growth and cicatricial wrinkling of the connective tissue, which then leads to sclerosis of the organ, chronic circulatory disorders in the pancreas.

In the progression of the inflammatory process, the processes of autoaggression are of great importance. In chronic pancreatitis of infectious origin, the pathogen can penetrate into the pancreas from the lumen of the duodenum (for example, with dysbacteriosis) or from the biliary tract through the pancreatic ducts in an ascending way, which is facilitated by dyskinesia of the digestive tract, accompanied by duodeno- and choledocho-pancreatic reflux.

Predispose to the occurrence of chronic pancreatitis spasms, inflammatory stenosis or tumor of the Vater nipple, which prevent the release of pancreatic juice into the duodenum, as well as insufficiency of the sphincter of Oddi, which facilitates the free entry of duodenal contents into the pancreatic duct, especially enterokinase contained in intestinal juice, activating trypsin.

The inflammatory process may be diffuse or limited to the area of ​​the head or tail of the pancreas. There are chronic edematous (interstitial), parenchymal, sclerosing and calculous pancreatitis.

Symptoms of chronic pancreatitis

Symptoms of chronic pancreatitis are:

severe pain

Severe and continuous pain is the most pronounced symptom of pancreatitis. Patients describe the nature of the pain as dull and cutting. If the pain is not relieved in time, then pain shock will soon set in. Localization of pain sensations occurs under the pit of the stomach, on the right or left hypochondrium, depending on the site of the lesion, with extensive inflammation of the organ, the pain becomes girdle.

Vomit

The initial, acute stage of the development of the disease is accompanied by bouts of vomiting with the presence of bile. During this period, you should completely refuse to eat. Problems with bowel movements - constipation or diarrhea. Acute pancreatitis is characterized by frothy, strong-smelling stools and the presence of undigested food. Less commonly, the opposite condition occurs - constipation with swelling and hardening of the abdominal muscles, indicating the approach of an acute attack of pancreatitis.

Muscle malfunctions

In the midst of an attack, the abdominal muscles do not contract, which leads to bloating. Severe swelling is determined by the doctor during examination - during palpation, the abdominal muscles do not tighten.

Temperature and pressure are unstable

The rapid development of inflammation leads to a rapid deterioration in well-being, the body temperature can rise significantly, blood pressure may decrease or increase.

Skin color changes

During pancreatitis, the patient's facial features are sharpened, the skin turns pale, acquiring an earthy gray color.

Blood pressure disorder

Pressure surges lead to disturbances in the functioning of the cardiovascular system, causing constant shortness of breath, the release of sticky sweat, and the appearance of a large amount of yellow plaque on the tongue.

Hemorrhage

The skin in the foci of pain acquires a bluish tint, expressed in the form of spots around the navel and on the lower back, they give the skin a marbled tint, and in the groin the skin may become blue-green. This can be explained by the penetration of blood from the inflamed gland under the skin into the abdomen.

Mechanical jaundice

The skin and sclera may become icteric. Pancreatitis in the sclerosing form causes obstructive jaundice, which occurs after the affected tissues of the hardened gland compress the common part of the bile duct. Icteric color of the sclera, which is one of the symptoms of pancreatitis.

In addition, you may experience:

• Loss of appetite.
• Rumbling in the stomach.
• Nausea.
• Dry mouth.

The pain is localized in the epigastric region on the right with the predominant localization of the process in the region of the head of the pancreas, with involvement in the inflammatory process of her body - in the epigastric region on the left, with the defeat of her tail - in the left hypochondrium; often the pain radiates to the back and has a girdle character, it can radiate to the region of the heart, simulating angina pectoris.

The pain may be constant or paroxysmal and appear some time after eating fatty or spicy foods. There is pain in the epigastric region and left hypochondrium. Often there is pain in the point in the left costovertebral angle (symptom of Mayo-Robson).

Sometimes a zone of skin hyperesthesia is determined, corresponding to the zone of innervation of the eighth thoracic segment on the left (Kach's symptom) and some atrophy of the subcutaneous fatty tissue in the projection of the pancreas on the anterior wall of the abdomen. Dyspeptic symptoms in chronic pancreatitis are almost constant.

The course of chronic pancreatitis

The course of the disease is protracted. According to the characteristics of the course, chronic recurrent pancreatitis is distinguished, pain, pseudotumor, latent form (rare).

Descriptions of symptoms of chronic pancreatitis

Diagnosis of chronic pancreatitis

In the blood - moderate hypochromic anemia, during an exacerbation - an increase in ESR, neutrophilic leukocytosis, hypoproteinemia and dysproteinemia due to an increased content of globulins. With the development of diabetes, hyperglycemia and glucosuria are detected, in more severe cases, electrolyte disturbances, in particular hyponatremia.

In the duodenal contents, the concentration of enzymes and the total volume of juice in the initial period of the disease may be increased, however, with a pronounced atrophic-sclerotic process in the gland, these indicators decrease, pancreatic hyposecretion occurs.

Duodenoroentgenography reveals deformations of the internal contour of the duodenal loop and depressions due to an increase in the head of the pancreas.

Sonography and radioisotope scanning show the size and intensity of the shadow of the pancreas; in diagnostically difficult cases, computed tomography is performed.

Chronic pancreatitis is differentiated primarily from a tumor of the pancreas, while pancreatoangioroentgenography, retrograde pancreatocholangiography (vireungography), echography and radioisotope scanning of the pancreas are of great importance.

It may be necessary to differentiate chronic pancreatitis with cholelithiasis, gastric and duodenal ulcers (the possibility of a combination of these diseases should also be taken into account), chronic enteritis, and less often other forms of pathology of the digestive system.

Complications of chronic pancreatitis

• abscess;
• cyst or calcifications of the pancreas;
• severe diabetes mellitus;
• thrombosis of the splenic vein;
• cicatricial-inflammatory stenosis of the pancreatic duct and duodenal papilla, etc.

In the sclerosing form of chronic pancreatitis, subhepatic (mechanical) jaundice can be observed due to compression of the segment of the common bile duct passing through it with compacted gland tissue.

Important: against the background of long-term pancreatitis, secondary development of pancreatic cancer is possible.

Treatment of chronic pancreatitis

Treatment of patients with uncomplicated chronic pancreatitis is aimed at eliminating the pain syndrome.

Which doctors to contact for chronic pancreatitis:

One of the main problems in the treatment of patients with chronic pancreatitis is the timely diagnosis of complications and referral of the patient to a specialized surgical gastroenterological center for consultation and possible surgical treatment. The sooner the patient receives qualified assistance, the more likely it is to maintain pancreatic function and a high quality of life.

In turn, a competent diagnosis of chronic pancreatitis is not possible without a qualified assessment of changes in the pancreatic parenchyma, its ductal system by doctors, and this is possible only in specialized clinics with extensive experience in the treatment of pancreatitis.

Therefore, we recommend that patients with pancreatitis who are repeatedly admitted to the hospital with exacerbation of chronic pancreatitis, or with persistent pain syndrome, ask the attending physician to refer him for treatment to such a clinic in order to avoid diagnostic errors.

Conservative treatment

The possibilities of conservative treatment in the chronic phase of pancreatitis are limited; medications that specifically affect the development of chronic pancreatitis are practically absent.

Therefore, the main efforts should be aimed at alleviating pain, rational diet therapy, correcting external and intrasecretory insufficiency of the pancreas, as well as eliminating the causes of pancreatitis by stopping the inflammatory process in the biliary tract, and combating the patient's alcohol dependence.

The need for diet therapy is due to a decrease in body weight in patients with chronic pancreatitis, the presence of beriberi; it is also an important means of preventing exacerbations of pancreatitis.

The presence of signs of exocrine pancreatic insufficiency (weight loss, steatorrhea, increased gas formation) requires replacement therapy with modern drugs with a high content of lipase, which facilitate the correction of steatorrhea and impaired absorption of fat-soluble vitamins.

The use of microgranular preparations in capsules protected by a special coating (Creon) prevents lipase deactivation in the acidic environment of the stomach.

The intake of enzyme and antisecretory drugs also has an analgesic effect, since by increasing the content of proteases in the lumen of the initial intestine, it can reduce the secretion of pancreatic enzymes and reduce pressure in the ductal system and pancreatic tissues.

Instructions for use of drugs for chronic pancreatitis

Surgery

Complications of pancreatitis are an indication for its surgical treatment. To eliminate complications, direct operations on the pancreas are performed. Their arsenal is diverse, taking into account various variants of the gland damage, but they are all divided into two large groups - operations aimed at draining the main pancreatic duct and the second group of operations aimed at resection of the fibrous tissues of the pancreas itself.

Treatment of pancreatitis at home with folk remedies

Treatment of pancreatitis at home can be carried out independently after consultation with your doctor.

To cure pancreatitis with herbs, you need to carefully select recipes. Consider the advice of doctors regarding the treatment of the disease with folk remedies, which they recommend to patients with chronic inflammation of the pancreas.

Without natural recipes, lifelong treatment of pancreatitis with pills could not be ruled out. Fortunately, there are effective herbs that help normalize organ function and prevent disease complications. In the chronic form of the disease, drugs are indispensable.

True, it should be understood that the recipes described below are suitable for the treatment of inflammation of the pancreas in adults. When treating a disease in children, it is better to strictly adhere to medications. What can replace pancreatitis drugs in adults:

• Decoctions of herbs that improve the excretion of bile;
• Anti-inflammatory infusions;
• Normalization of the diet.

Any treatment tactics should be agreed with the doctor, as there are several forms of the disease (acute, chronic, reactive) and many causes.

To improve the excretion of bile

Mix a tablespoon of immortelle, dandelion roots, tansy, chamomile, and knotweed. Brew the mixture in a liter of boiling water and infuse for 1-2 hours. Take a decoction in a glass, every 30 minutes after eating. Before each meal, consume mineral hydrochloride-sodium water with the decoction.

To relieve inflammation

Squeeze the juice from the plantain herb and consume it 1 teaspoon before meals for a month. Freshly squeezed psyllium juice contains vitamin R, which is a natural hepatoprotector. After a month of use, take a break for 2-3 months, and then repeat the course.

For pain relief

Mix the herb of zopnik, agrimony, dandelion, plantain, motherwort, chamomile, cudweed, yarrow. Chop them up. Take 2 tablespoons of the mixture and add to a thermos with boiling water (0.5 liters). The product must be infused for 8 hours. It should be drunk at night to eliminate pain and increased bile secretion. Don't forget that the best cure for pancreatic pain is alkaline mineral water.

Is it possible to completely recover from chronic pancreatitis?

Having got rid of pain, it will no longer be possible to lead the same lifestyle as before the illness, without thinking about what is eaten. We'll have to forget about fast food, delicacies, alcoholic beverages.

Important: any inflammatory process does not pass without a trace, functional cells are not restored. Therefore, a complete cure and forever is hardly possible.

But it is possible to prevent exacerbations and live in peace, it is only necessary to make certain efforts. To do this, you need to streamline the diet and follow the rules, because any disease is treated. They say that with an exacerbation of the disease, it is necessary to adhere to three components:

• cold;
• hunger;
• peace.

During recovery, dietary table number 5 must be followed. This diet involves limiting fats and carbohydrates, prohibits those foods that can cause bloating, with coarse fiber. Food is cooked in steam, in water and in crushed form.

Very hot or too cold dishes are harmful. Despite the subsequent improvement in health, these tips should not be neglected. You should eat often and in small portions. For prevention, it is advisable to drink herbal decoctions.

Diet for chronic pancreatitis

Diet therapy for chronic pancreatitis is not only a therapeutic method, but also an important condition for preventing exacerbations, and hence the progression of the disease.

In the first 2-3 days exacerbation of chronic pancreatitis, food intake is excluded. Nutrition of the body is provided by intravenous administration of glucose, isotonic sodium chloride solution. Thirst is quenched with a 1% solution of baking soda.

From the fourth day gradually increase the energy value of food. Unsalted food should contain easily soluble simple carbohydrates, ascorbic acid, B vitamins, and plenty of fluids.

It is necessary to take food in small portions, 7-8 times a day. You can use fruit juices, sugar, honey, jam; blackcurrant decoction, rosehip decoction, cranberry juice - only up to 2-2.5 liters per day of liquid.

On the fifth day food with a small content of vegetable and milk proteins is allowed.

From 6-7 days treatment in the diet increase the amount of proteins and carbohydrates, introduce fats into it. Food must be washed. Products that have a pronounced stimulating effect on gastric secretion and pancreatic function are excluded from the patient's diet:

• decoctions of meat;
• fishes;
• vegetables;
• mushrooms;
• alcoholic and carbonated drinks;
• black bread;
• coffee;
• strong tea;
• raw vegetables and their juices;
• smoked meats;
• canned food;
• spices.

Pancreatic secretion stimulants such as:

• chocolate;
• cocoa;
• sweet dough;
• sour cream;
• sausages;
• acidic fruit juices;
• acids (citric, acetic, etc.).

In order to reduce the reflex excitability of the gallbladder, pancreas and limit the motor function of the digestive system during an exacerbation of the disease, foods rich in plant fiber, connective tissue (cartilage and tendons), cold dishes and drinks are excluded from the diet.

It has now been shown that sufficient proteins in the diet of a patient with chronic pancreatitis improves the course of the disease. Therefore, about 140 g of proteins are included in the diet of such a patient, of which 60-70% are of animal origin.

Quantity carbohydrates limited to 350-400 g per day, and sometimes up to 150-200 g due to the exclusion of simple carbohydrates. Content fat reduced to 80 g per day.

During the period of exacerbation of chronic pancreatitis and during remission, mechanically and chemically sparing food, steamed, chopped, mashed, is recommended.

In chronic pancreatitis are allowed:

wheat bread from flour of the 1st and 2nd grades (dried or yesterday, in the form of crackers), unsweetened dry cookies;

pureed and semi-viscous cereals made from oatmeal, buckwheat, semolina, rice, boiled in water and half with milk, cereal soufflés, puddings with cottage cheese, casseroles, boiled pasta;

dairy products (mainly reduced fat content: fresh non-acidic cottage cheese of 9% fat content and low-fat, calcined in its natural form, infusion, steam and baked puddings (milk - if tolerated), sour-milk drinks, sour cream and cream (in dishes), low-fat cheese and Not spicy;

meat and poultry of low-fat varieties (beef, veal, rabbit, chicken, turkey), boiled (or steamed), mashed and chopped (cutlets, dumplings, mashed potatoes, soufflé, beef stroganoff, etc.), low-fat chickens, rabbit, veal - piece, boiled;

pureed vegetarian soups with potatoes, carrots, zucchini, pumpkin, semolina, oatmeal, buckwheat, rice, pasta;

boiled and baked vegetables in pureed form (potatoes, carrots, cauliflower, speckle, zucchini, pumpkin, green peas);

ripe soft non-acidic fruits and berries, mashed raw, baked apples, mashed fresh (and dry) fruit compotes, jelly, mousses on xylitol (sorbitol) or semi-sweet on sugar;

milk sauces, fruit and berry semi-sweet sauces on a weak vegetable broth (the flour is not sautéed);

lean fish (boiled), in pieces and chopped, aspic after boiling;

protein omelettes from 2 eggs, yolks - limited (up to 1/2 per day) in meals;

weak tea with lemon, semi-sweet or with xylitol, milk, rosehip broth, fruit and berry juices without sugar, diluted with water, if tolerated;

butter (30 g), refined vegetable oils (10-15 ml) - in dishes.

In chronic pancreatitis, the following are excluded:

rye and fresh bread, puff and pastry products;

soups on meat, fish broth, decoction of mushrooms and vegetables, with millet, milk soups, borscht, cabbage soup, cold soups - okroshka, beetroot;

fatty meats, duck, goose, smoked meats, sausages, canned food, liver, brains, kidneys;

fatty species, fried and stewed, smoked, salted fish, canned food, caviar;

dairy products of high fat content and with the inclusion of sugar;

whole egg dishes, especially hard-boiled and fried;

legumes, crumbly cereals (limited - pearl barley, barley, corn grits, millet);

white cabbage, eggplant, radish, turnip, radish, onion, garlic, sorrel, spinach, sweet pepper, mushrooms;

raw unmashed fruits and berries, grapes, dates, figs, banana and confectionery, chocolate, jam, ice cream;

sauces on meat, fish, mushroom broths, tomato, all spices;

coffee, cocoa, carbonated and cold drinks, grape juice.

Questions and answers on the topic "Pancreatitis"

Question:Hello. I have an exacerbation of chronic pancreatitis with cholecystitis and gastroduodenitis. They don’t go to the hospital, how to endure three days of hunger without drug support and how to start eating right, each site has different recommendations on what to choose.

Answer: In case of exacerbation of pancreatitis, you are required to be hospitalized. Self-medication is dangerous. Hotline of the Ministry of Health of Russia: 8 800 200 03 89.

Question:I have abdominal pain after eating and immediately loose stools. Two days already.

Answer: Hello. The reasons can be different, internal consultation of the doctor is necessary to you.

Question:Hello. With inflammation of chronic pancreatitis, I try to starve for the first two or three days. I would like to know if the prescribed drugs smecta, pancreatin, hilak forte 3 times should be taken from the first day? When am I hungry? They are taken, as I understand it, before meals? Am I not eating at this time? Please tell me. Thanks.

Answer: Hello. When exiting fasting mode.

Question:Hello, I am 35 years old, I have pancreatitis. A year ago, I was admitted to the hospital with acute appendicitis, when the pancreatitis was cut open, it turned out to be in a very bad stage. Acute pancreatitis is written in the extract. During the year I did ultrasound, there were no exacerbations. Is it possible to cure pancreatitis and how long should the diet be followed, how strict should the diet be when there is no exacerbation. Thanks.

Answer: As a rule, acute pancreatitis becomes chronic and requires lifelong diet and medication. The severity of the diet, diet and dosage of enzyme replacement therapy (creon, festal, pancreatin) is prescribed by the attending gastroenterologist, depending on the pancreatic enzyme deficiency.

Question:Hello! I have such a problem about 2 weeks ago, my tongue turned yellow, just the other day I took the tests and went to the therapist. Ultrasound showed that the pancreas is slightly enlarged and cholesterol is also elevated! Still there is a slight nausea, flatulence. The doctor said it was pancreatitis! Is this so, is it worth worrying about or should I turn to another specialist to make a more accurate diagnosis?

Answer: Such symptoms, indeed, may be manifestations of pancreatitis. If you do not trust the qualifications of the specialist who examined you, you can always turn to another gastroenterologist, perhaps to clarify the diagnosis, you will need to take a stool test for a coprogram and a stool test for dysbacteriosis.

Question:Hello. I'm 19 years old. 2 months ago I started having rashes on my skin with very severe itching. The dermatologist did tests, no skin infections were found. I went to an allergist and they didn't find anything. I took tests, the therapist, based on their (analysis) results, sent me for an ultrasound scan. An anomaly in the shape of the gallbladder was revealed, the diagnosis was biliary tract dysfunction, pancreatitis. I drink holosas a week a month. The doctor said that the rashes on the skin are associated with pancreatitis. A week ago, a very strong itching began in intimate places. Before that, she did tests at the gynecologist - they did not find anything. Tried spraying with Epigen spray - didn't help. Acne appeared on the inside of the buttocks, which also itch very much. Can these rashes and itching be associated with pancreatitis and how to get rid of them?

Answer: Rashes can indeed be associated with pancreatitis and bile stasis. If the number of rashes has increased dramatically and the itching has intensified, this may indicate an exacerbation of the underlying disease. You need to retake a general and biochemical blood test, a general urine test, and personally consult with a gastroenterologist. Perhaps, according to the results of the examination, it will be necessary to undergo a course of enzyme therapy, or a course of treatment to restore the normal functional activity of the liver and gallbladder. In addition to drug treatment, you, at the time of exacerbation, must follow a strict diet.

Question:Is it possible to play sports (dumbbells, horizontal bar, parallel bars, barbell) with chronic pancreatitis?

Answer: During exacerbations, physical activity is contraindicated. Outside of exacerbations, only the attending gastroenterologist will be able to recommend you an acceptable level of physical activity, since only he has the most complete information about your state of health. General recommendations are to reduce the intensity of training as much as possible, since they can exacerbate pancreatitis, you may have to give up sports altogether - it depends on the degree of damage to the pancreas and on the frequency of exacerbations.

Question:I am 24 years old, I have pancreatitis. I like to drink chicory very much, I replaced it with coffee. Recently I heard that with pancreatitis, drinking chicory is not recommended. Please answer, is it possible to drink chicory with pancreatitis? Thank you in advance.

Answer: The main contraindications to the use of chicory are the presence of hemorrhoids and severe varicose veins. This nutritional supplement, of plant origin, has a normalizing effect on the pancreas, therefore, without exacerbations of pancreatitis, it can be eaten.

Question:I am 30 years old suffering from chronic pancreatitis. For two weeks, the stomach hurts in the epigastric region, the stomach swelled like a ball. Constant feeling of fullness in the stomach. Even in your favorite position on your stomach, it hurts to sleep. I tried to drink Creon with no results, I also tried Omez without results. What to do?

Answer: Most likely, these symptoms are manifestations of exacerbation of chronic pancreatitis. Be sure to undergo a second examination with a gastroenterologist. It will be necessary to pass a general blood and urine test, a biochemical blood test, and an ultrasound of the abdominal organs. Remember that during the period of exacerbation, it is extremely important to follow a diet - exclude fatty and fried foods, smoked meats, spices, coffee, alcohol, meals should be regular and fractional (i.e., in small portions).

Question:Hello. I have frequent back pain on the right side that radiates to the abdomen. What could it be? Pinching or pancreatitis? Thanks.

Answer: Unfortunately, girdle pain originating from the back is observed both in pancreatitis and in radicular syndrome. Therefore, to diagnose this condition, you need a personal consultation of specialists - a gastroenterologist and a neuropathologist. You will need a clinical examination, an ultrasound examination, a laboratory blood test for pancreatic enzymes.

Question:Dear doctor! I turn to you with the following question: I am 26 years old. 7 years ago, my gallbladder was removed by laparoscopic method. stones were found in it. My grandmother suffered from this disease and the doctor told me that it was inherited from me. a month ago I was taken away with severe epigastric pain in an ambulance. I was treated in the hospital, it turned out to be an attack of acute pancreatitis. I've been following diet #1 for a month now. Please tell me is it really a cross, now you can never eat fried, smoked. And what about alcohol? Is it really impossible to have a glass of champagne for the new year? And what kind of drink can you have?

Answer: In your case, it is recommended to completely exclude fried and smoked foods from the diet, in the event that a long-term remission is achieved, it is possible to consume prohibited foods in limited quantities, the same applies to alcohol. However, uncontrolled intake of prohibited foods can again provoke an exacerbation of the process.

Question:Is it possible to give birth with chronic pancreatitis, and if there are problems with the intestines.

Answer: Chronic pancreatitis is not a contraindication for pregnancy.

Question:Good afternoon! The doctor diagnosed chronic pancreatin in the acute stage, chronic non-cholecystitis, chronic gastroduodenitis. Treatment: Creon 10000, phosphalugel, meteospazmil, bifiform-complex, collection of herbs (chamomile, calendula, dill and linseed, horse sorrel). I took all this for 2 weeks plus a diet (No. 5). There was no pain before, only a feeling of fullness on the left side under the rib. Ultrasound: pancreas (head-31mm, body-20mm, tail-29mm, echo-increased). After a two-week course, I ate apples, cherries, cucumbers, tomatoes again burst a little on the left side. And I have a lot of gas. What is the cause of these gases? How can this be treated? Continue treatment and for how long or do I need to add some more drugs? How long to stick to the diet? Can you eat fruits and vegetables? Thanks!

Answer: In this situation, it is necessary to undergo a second examination by the attending gastroenterologist, perhaps the course of treatment will need to be repeated. With pancreatitis and cholecystitis, the use of tomatoes in any form, eggplant, legumes is contraindicated.

Question:I am 26. For a week now, I have been disturbed by unpleasant sensations in the abdomen on the left, right next to the ribs. I feel this area all the time. Now the feeling is less, but there is. Before that, there was bloating for about three days, and then some kind of attack with pain. After that, the pulling sensations practically do not leave. What could it be? Thanks for the answer!

Question:Hello. For the third week I have had discomfort in the navel, to the left and to the right of it, as well as in the right and left hypochondrium. Gives to the lower back, the same feeling of a coma in the throat and belching. There is no temperature, the stool is normal, no nausea or vomiting, no other symptoms other than those described above. Prompt, what is it can be and what to do?!

Answer: Pancreatitis may be a possible cause. To diagnose this condition and prescribe adequate treatment, it is necessary to seek personal advice from a gastroenterologist or general practitioner. Clinical and laboratory examinations will be required.

Pancreatitis is an inflammatory and degenerative process in the pancreas. The number of people suffering from pancreatitis is growing every year. The symptoms and treatment of this disease directly depend on the severity of the inflammatory process, the severity of the pancreatic lesion.

The main victims of pancreatitis are most often people prone to overeating, lovers of fatty foods, alcohol. Under the influence of certain provoking factors in the pancreas, the production of proteolytic enzymes is activated, which causes inflammatory processes.

Causes of pancreatitis

Symptoms of acute pancreatitis

The pancreas is not a very large organ, however, it performs the most important functions in the human body, the most important of which are the secretion of food enzymes for normal digestion and the production of insulin, the deficiency of which leads to such a serious disease as diabetes mellitus. What happens when the gland becomes inflamed? In the period of acute pancreatitis, symptoms develop as with severe poisoning. Enzymes produced by the pancreas linger in it or its ducts, and begin to destroy the gland itself, and when they enter the bloodstream, they cause symptoms of general intoxication:

Fast food is one of the main enemies of the pancreas.

• Pain. This is the most pronounced symptom, pain in pancreatitis is usually very intense, constant, the nature of pain is described by patients as cutting, dull. With untimely provision of medical care and pain relief, the patient may experience pain shock. The pain is localized under the pit of the stomach, hypochondrium, either on the right or on the left, depending on the site of the lesion of the gland, in the case when the entire organ becomes inflamed, the pain is of a girdle character.
• High temperature, low or vice versa high pressure. With the rapid development of the inflammatory process, the patient's health deteriorates rapidly, the temperature may rise to high numbers, and blood pressure may decrease or rise.
• Complexion. With pancreatitis, the patient's facial features are sharpened, at first the skin becomes pale, gradually the complexion acquires a gray-earthy tint.
• Hiccups, nausea. Pancreatitis is also characterized by symptoms such as hiccups, belching and nausea.
• Vomit. Attacks of vomiting with bile do not bring relief to the patient. Therefore, at the beginning of the acute period, there is no question of any food intake; fasting in the case of acute pancreatitis is the main condition for successful further treatment.
• Diarrhea or constipation. The stool in acute pancreatitis is most often frothy, often with a fetid odor, with particles of undigested food. Vomiting can also be eaten food (when it vomits gastric contents at the beginning of an attack), then bile appears from the duodenum 12. However, there are also constipation, bloating, hardening of the abdominal muscles, which may be the very first signal of an acute attack of pancreatitis.
• Dyspnea. Shortness of breath is also caused by the loss of electrolytes during vomiting. The patient is worried about constant shortness of breath, sticky sweat, appears.
• Bloating. The stomach and intestines do not contract during an attack, therefore, upon examination, the doctor determines severe bloating, palpation does not determine the tension of the abdominal muscles.
• Blueness of the skin. Around the navel or on the lower back, bluish spots may appear, giving the skin a marbled tint, in the groin area, the skin color may acquire a blue-green tint. This is due to the fact that from the inflamed gland, blood can penetrate under the skin of the abdomen.
• Jaundice of sclera, skin. With a sclerosing form of pancreatitis, it can occur, which appears as a result of squeezing a part of the common bile duct with compacted gland tissue.
• With such symptoms of pancreatitis in a person, the condition worsens every minute, it is impossible to delay in such cases and you should call an ambulance as soon as possible.

Treatment of acute pancreatitis

In acute pancreatitis, treatment is possible only in a hospital, under the supervision of qualified specialists, this is considered a very dangerous condition. If acute pancreatitis is suspected, an ambulance should be called urgently and the person should be urgently hospitalized.

Sometimes delayed medical care can cost a person a life. The first aid that can be provided to a person from whom it is obvious is to apply cold to the stomach, take an antispasmodic - Na-shpa, as well as refusing to eat any food and bed rest until the ambulance arrives.

The main 3 pillars on which the treatment of acute pancreatitis is based: HUNGER, COLD AND REST

Emergency assistance provided in the Ambulance:

• puncture a vein, a dropper with saline
• antiemetic - metoclopramide (cerucal) 10 mg
• pain reliever - ketorolac
• antisecretory - octreotide (sandostatin) 250 mg or quamatel () 40 mg

In a hospital setting, they usually do:

• In the hospital, intravenous administration of sodium chloride (saline), reopoliglyukin + contrical
• Diuretics are used, they prevent pancreatic edema, and also help to remove enzymes from the blood, toxins from the body. From diuretics, either Furosemide (Lasix) during infusion therapy (in gum after a dropper) or Diacarb in tablets under the cover of potassium preparations.
• Omeprazole 80 mg per day, there are forms for intravenous administration during a dropper - Kvamatel.
• Antispasmodics -
• With persistent vomiting - metoclopramide intramuscularly
• Painkillers for pain
• In severe or purulent pancreatitis - antibiotics (3-4 generation cephalosporins or fluoroquinolones).
• In the acute period, enzyme inhibitors (contrical and gordox) are indicated.
• Vitamin therapy is also included in the complex maintenance of a weakened body, especially vitamin C and B vitamins are indicated.
• For 4-5 days, the patient is prescribed hunger and drinking warm water without gases. In severe pancreatitis, when starving for several weeks, parenteral nutrition is indicated (protein hydrolysates and fat emulsions are administered intravenously if cholesterol in the blood is normal).
• Only after this time has passed, the patient is allowed to eat, at first you can only drink yogurt, gradually adding cottage cheese to the menu, and after 3-4 days the patient can gradually take dietary food according to a special diet 5P.

Surgical treatment is indicated for suspected destructive pancreatitis and signs of inflammation of the peritoneum, as well as for the ineffectiveness of conservative therapy.

In this case, laparoscopy is indicated for suspected fluid in the abdominal cavity or signs of peritonitis. It is also performed for the differential diagnosis of acute pancreatitis with other diseases.

Laparotomy (wide surgical access with a dissection from the sternum to the groin) is performed with previously performed surgical interventions on the abdomen, ventral hernias, unstable blood circulation (shock).

Symptoms and signs of chronic pancreatitis

Chronic pancreatitis is considered to be predominantly an inflammatory disease of the pancreas, in which structural changes in the tissue of the organ occur. Most researchers believe that the hallmark of chronic pancreatitis is that after the elimination of the action of provoking factors, pathological changes in the gland not only persist, but also continue to progress functional, morphological disorders of the gland. At the same time, exogenous and endogenous insufficiency of this organ is formed.

In the occurrence of chronic pancreatitis, two periods are determined, the initial one - which can last for years and then manifest itself as characteristic symptoms, then subside, and the period - when violations, damage in the pancreas are pronounced and disturb the person constantly.

• During the onset of the disease, which usually lasts for decades, a person experiences only periodic pain that occurs 15 minutes after eating and lasts from several hours to several days. The pain is localized most often in the upper abdomen, sometimes in the region of the heart, on the left side of the chest, on the left in the lumbar region, and can also be of a girdle character. Its intensity decreases when a person leans forward while sitting.
• Basically, the appearance of characteristic pains is provoked by excessive consumption of fatty, fried foods, alcohol or an abundance of carbonated drinks, as well as chocolate, coffee. The worst thing is for a person if a large number of different dishes are taken at the same time. It is difficult for the pancreas to cope with different types of proteins, fats and carbohydrates. Therefore, people who adhere to the principles of separate nutrition are less susceptible to pancreatic diseases.
• With pain, there can also be, such as vomiting, nausea, chronic diarrhea, bloating, weight loss. However, this does not always happen, and pain and dyspepsia disappear with adequate symptomatic treatment, the function of the gland for the production of enzymes is not greatly disturbed, and the patient continues a quiet life, until the next overeating or failure.
• In the case of prolonged existence of chronic pancreatitis, the structure of the gland tissue begins to collapse, the production of enzymes and hormones is reduced, and secretory insufficiency gradually forms. In this case, the pain syndrome may be absent altogether, or be mild, and dyspepsia, rather, on the contrary, becomes the predominant symptom of chronic pancreatitis with secretory insufficiency.
• Also, chronic pancreatitis is characterized by a slight yellowness of the skin, sclera, it does not happen to everyone and can also disappear periodically.
• In the later stages of pancreatitis, when the gland begins to atrophy, diabetes mellitus may develop.

Based on the various symptomatic complexes experienced by patients with chronic pancreatitis, several types of the disease are distinguished:

• Dyspeptic appearance- with this form of pancreatitis, the patient suffers from chronic diarrhea, bloating, weight loss.
• Asymptomatic appearance- this form is the strangest, since pancreatitis has not shown any signs or symptoms for years, and the person is unaware of the ongoing violations.
• Pseudotumoral appearance- this form of pancreatitis resembles the course and symptoms. The main symptom of this disease is the emerging yellowness of the skin, sclera, etc.
• Pain type - from the name it is clear that it is characterized by a painful syndrome, which happens very often after eating and especially alcohol.

What to do if you suspect chronic pancreatitis?

Of course, if you suspect chronic pancreatitis, you should seek a comprehensive diagnosis from a gastroenterologist. The doctor, based on the patient's complaints, the history of the disease and the following diagnostic measures, will establish an accurate diagnosis:

• Laboratory diagnosis of chronic pancreatitis - a change in the level of elastase in the feces.
• Fecal analysis can determine whether there is steatorrhea, that is, the content of undigested fat in the feces, which will indicate malfunctioning of the gland.
• Test with special preparations for pancreatic stimulation.
• Ultrasound can also help in establishing the correct diagnosis.
• Computed tomography also helps in case of doubt or for greater certainty of the diagnosis.
• You should take a blood test for glucose to detect diabetes, and you can also take a test for.

The diagnosis only on the basis of ultrasound data is not reliable, since there are no specific signs, and there may be only minor diffuse changes in the structure or swelling during an exacerbation. Most often, there are no ultrasound manifestations at all.

Treatment of chronic pancreatitis

Symptoms of chronic pancreatitis can be mild or pronounced. As a rule, with an exacerbation of chronic pancreatitis, hospitalization and similar therapy are also indicated, as in an acute process.

The patient must follow a diet for life, take drugs for secretory pancreatic insufficiency, antispasmodics. It is very useful to visit sanatoriums 2 times a year, especially in the Stavropol Territory, such as Pyatigorsk, Zheleznovodsk, Kislovodsk, with complex treatment and the intake of natural mineral water from sources (Slavyanovskaya and Smirnovskaya water are especially effective). Basic principles of treatment:

Diet for chronic

This is the most difficult treatment principle to implement, since the diet for pancreatitis excludes all the delicious foods that everyone loves - barbecue, chocolate, sweets, mushrooms, spicy, fried foods, fast food. All products up to fruits and vegetables should be chopped, only boiled, baked.

How to relieve pain in chronic pancreatitis

Alcohol is the worst enemy of the pancreas

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 - 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 (omeprazole) and diuretic agents for a short course (diacarb per 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.

Pancreatic enzymes for the correction of pancreatic dysfunction

With a long course of chronic pancreatitis, the normal tissues of this organ are replaced, its normal function is lost, therefore diabetes mellitus appears and digestion is disturbed. To give rest for the pancreas and reduce pain in patients, it is necessary to take additional pancreatic enzymes:

• 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 (Ermital, Creon, Penzital, Panzinorm, Pangrol, Micrasim, Mezim, Biozim, Gastenorm, Enzistal) are pancreatic enzymes, also taken 3 r / day, 2 tablets each. during a meal, it is advisable to drink alkaline mineral water. They help break down fats, carbohydrates, proteins.
• 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 chronic pancreatitis, when the symptoms are observed for a very long time, the level of insulin decreases, which sooner or later leads to the development of diabetes. In the case of its diagnosis, the patient should consult an endocrinologist to clarify the treatment regimen and diet.

Pancreatitis is an inflammatory disease of the pancreas. Depending on the clinical picture, acute and chronic pancreatitis are distinguished. These two forms of pancreatitis differ both in the mechanism of occurrence, the etiology of pancreatitis, and in the choice of primary therapy and recovery prognosis.

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What is pancreatitis?

Pancreatitis is an inflammatory process that affects the tissues of the pancreas, an organ of intra- and exocrine function. The pancreas itself is located behind the stomach, in the retroperitoneal region, adjacent to the duodenum. The name "pancreas" was given because of its location closer to the back, thus, when examined lying down, it is "under the stomach".

The main purpose of this organ is the production of pancreatic juice with enzymes and bicarbonates that take part in the process of digestion of the body. When waiting for food and when it enters the stomach, enzymes and juices begin to be transported from the pancreas through the connective duct to the small intestine, providing the process of enzymatic processing of nutrients, participating in metabolism, facilitating the absorption of nutrients through the walls of the small intestine.

Pancreatic fluid neutralizes the acidic environment of gastric juice directly in the intestine, where digestive enzymes are activated and begin to perform their functions of splitting and processing substances.
The main digestive enzymes produced by the pancreas are:

• amylase, which promotes the processing of starch into sugars;
• lipase, an enzyme that breaks down fats;
• trypsin, chymotrypsin - enzymes involved in the breakdown of proteins;
• insulin, polypeptide, glucagon and others.

The causes of pancreatitis are in violation of the outflow of pancreatic (digestive) juice from the pancreas to the duodenum. Lingering inside the gland with partial or complete blockage of the ducts, as well as when intestinal contents are thrown into the ducts, the enzymes are activated ahead of time and begin to process, digest the surrounding tissues.

The retention of juice and enzymes that occurs during inflammation of the pancreas has a destructive effect on the tissues of the pancreas in the first place, however, with prolonged exposure, the negative effect of accumulating pancreatic enzymes and pancreatic juice also extends to nearby tissues, organs, and blood vessels. Destroying cells increase the activity of digestive enzymes, involving an increasingly large area in the traumatic process. In severe cases, accompanied by necrosis of the pancreas, pancreatitis can be fatal.

The maximum amount of digestive juice and enzymes is required to process carbohydrate foods. Excessive consumption of fatty foods, especially rich in spices, as well as alcohol abuse contribute to the retention of enzymes in the pancreas. The reasons for the delay of digestive enzymes and juices can be other factors.

The development of pancreatitis in adults

Statistical data on the prevalence of the disease in adults fluctuate significantly depending on the climate, the dietary habits adopted in different countries, and the traditions of drinking alcoholic beverages. There is also a significant difference in the incidence of female and male, both in terms of the mechanism of the disease, and for the reasons that cause it.
The main risk group for the development of pancreatitis consists of the adult population, due to the frequency of alcohol consumption, an unbalanced diet and the addition of concomitant diseases.

Causes of the development of the disease in men

The "trigger" in male patients with primary pancreatitis with a high frequency is the intake of alcohol (the so-called alcoholic pancreatitis) and the predominance of fatty foods, semi-finished products. Also, a distinctive feature of pancreatitis in men is the chronic form, ignoring the characteristic symptoms and exacerbations, "neglected" pancreatitis due to a late visit to a gastroenterologist.

Etiology of pancreatitis in women

The most common causes of pancreatitis in women are:

• cholelithiasis, causing the development of pancreatitis and cholecystitis;
• hormonal fluctuations and disorders that cause inflammation of the pancreas: pregnancy, menopause, taking hormone-containing contraceptives;
• starvation, adherence to diets that are unbalanced in the composition of food that are harmful to health.

Causes of the reactive form of the disease in adults

Secondary or reactive pancreatitis develops against the background of existing diseases and the consequences of injuries of the abdominal organs, surgery, etc. The most common factors contributing to the development of reactive pancreatitis are diseases of the digestive system, such as:

• non-infectious hepatitis;
• cholelithiasis;
• gastritis;
• cirrhosis of the liver;
• biliary dyskinesia;
• intestinal infections.

Causes of pancreatitis in children

The definition of the cause of the development of pancreatitis in a child is carried out by a specialist - a pediatric gastroenterologist. Due to childhood, the etiology of inflammatory processes in the pancreas differs from the adult mechanisms of the onset of the disease.
Most often, pancreatitis in children is the result of trauma, surgery, resulting in damage to the pancreatic ducts and / or its tissues. Hereditary predisposition to excessive production of digestive juice, cystic fibrosis (intestinal, pulmonary, mixed form), as well as food allergies, chronic inflammatory processes in the body, the effects of parotitis and other diseases and disorders of digestion and other functions cause the development of pancreatitis in children and adolescents.

Classification and causes of pancreatitis

Symptoms of pancreatitis, the mechanism of the development of the disease, methods of diagnosis and therapy have been the object of study by specialists for several centuries. In the process of improving diagnostic methods, research capabilities and the accumulation of experience, several types of classification of pancreatitis were proposed, based on the characteristics of clinical symptoms, the nature of tissue damage, the causes of occurrence, and so on.
At the moment, there are varieties of pancreatitis according to the etiology of the disease, the form and characteristics of the course of the disease.

Classification of the disease by cause

For the reasons for the development of the disease, primary and secondary, reactive pancreatitis are distinguished.
The primary form of the disease develops against the background of damage to the tissues of the pancreas itself. Among the main causes of destructive processes are the following:

• abuse of alcohol-containing drinks (from 40 to 70% of cases depending on the region), nicotine smoking;
• damage to the pancreas due to abdominal trauma, surgical interventions and certain diagnostic procedures, in particular, such consequences are possible during endoscopy (retrograde pancreatocholangiography and endoscopic papillosphincterotomy);
• long-term, especially uncontrolled use of medications that aggressively affect the pancreas (some groups of antibiotics (tetracyclines), estrogen-containing drugs, glucocorticosteroids, acetylsalicylic acid (Aspirin), sulfanilamine drugs, some diuretics, etc.);
• food poisoning, chemicals;
• eating large amounts of food with synthetic additives, treated with pesticides and other chemicals;
• genetic predisposition to diseases of the digestive system, congenital pathologies of the development of the pancreas;
• an unbalanced diet with an excess of fatty and spicy foods, especially with long breaks between meals.

The primary form of the disease can develop at any age. Timely diagnosis and therapy allows you to stop or slow down the destructive processes in the tissues of the pancreas, restore the lost functions of the organ and avoid serious complications.
They say about secondary, reactive pancreatitis, when in the etiology of the disease it is possible to diagnose the main cause in the form of diseases of other organs of the gastrointestinal tract and the digestive system as a whole (statistically, cholelithiasis is considered the most common cause of reactive pancreatitis), as well as with the provocative action of infectious diseases (more often total - viral hepatitis, as well as dysentery, sepsis, chronic foci of inflammation, for example, with tonsillitis); diabetes; hereditary diseases, in particular, cystic fibrosis or Crohn's disease; diseases of the cardiovascular system; helminthic invasions in the biliary tract and so on. Diagnosing the cause of pancreatitis can be difficult. However, the success of therapy mainly depends on the elimination of the factors that caused the onset of the disease and the prevention of exacerbations.

Classification of pancreatitis according to the form and characteristics of the course of the disease

The inflammatory process leads to partial or complete loss of the main functions of the pancreas. The destruction of the cells of this glandular organ threatens with irreversible processes. In the human body there is no backup organ that can replace the pancreas.
Depending on the symptoms and the form of the course of the disease, acute and chronic pancreatitis are distinguished. The forms of the disease differ in the clinical picture, methods of therapy and health consequences.
Acute pancreatitis is a rapidly developing inflammatory disease, accompanied by the threat of irreversible changes in the tissues and structure of the pancreas, destruction, partial or complete, of other organs, and even death. In the acute form, pancreatic juice, stagnating in the gland, is activated and destroys its cells.
With this course of the disease, significant damage to the cells of the organ, accompanied by edema, is observed. The main risk group is adults in the age period of 30-60 years, although acute pancreatitis can also occur in children as a result of such negative factors as:

• lack of food intake;
• the predominance in the diet of fatty and spicy foods, semi-finished products, fast food;
• blunt abdominal trauma;
• helminthic invasion of the digestive system;
• congenital anomalies in the development of the gallbladder, its ducts, duodenum, pancreatic ducts;
• hereditary tendencies and disorders, infectious diseases, etc.

In the childhood period, the acute form of pancreatitis, as a rule, has less pronounced symptoms. The clinical picture of the disease, diagnostic methods and principles of therapy differ from acute destructive pancreatitis in adult patients.

Features of chronic inflammation of the pancreas

Pancreatitis in a chronic form is said to occur when the disease proceeds with periods of exacerbations and remissions. As the progression progresses, pancreatic insufficiency develops: the glandular tissue of the organ undergoes changes and is replaced by connective tissue, which is not capable of producing digestive enzymes and pancreatic juice. The lack of enzymes causes disturbances in the functioning of the digestive system.
This form of the disease is observed in patients of different ages. Recently, experts have noted a trend towards an increase in the diagnosis of recurrent pancreatitis occurring in a chronic form, which is provoked by the popularization and availability of semi-finished products, fast food, junk food, as well as alcoholization of the population.
There are two stages of chronic disease. The initial stage is expressed by minor symptoms and can last for several years, depending on the lifestyle and general health of the person. The initial stage is followed by a period in which deviations and disturbances in the functioning of the pancreas become more pronounced and disturb almost constantly. Exacerbation of the chronic form mainly provokes the use of spicy, fatty or fried foods, carbonated drinks and alcohol, especially on an empty stomach.

Symptoms of pancreatitis

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The symptoms of acute and chronic forms of pancreatitis differ, as well as the features of their course and possible complications of the disease. The symptoms of chronic pancreatitis are most often mild, but the signs of the disease in an acute form are pronounced. With a clinical picture of an acute form, it is important to urgently consult a specialist not only for treatment, but also for differential diagnosis from acute cholecystitis, appendicitis, which can cause similar symptoms.

Symptoms of the acute stage

In acute pancreatitis, being activated directly in the pancreas, digestive juice enzymes affect its cells. So, the action of the enzyme lipase, which breaks down fats, leads to fatty tissue degeneration. Trypsin, which promotes the digestion of proteins, provokes various chemical reactions, causing swelling of the pancreatic tissues and necrosis (death) of cells.
At the first stage of destruction, necrosis is aseptic, local, but without urgent treatment it covers nearby organs, joining infections cause the formation of new foci of inflammation, purulent complications.
Common symptoms of acute pancreatitis include:

• girdle pain, with localization in the region of the right or left hypochondrium. Pain symptoms are intense and are not eliminated by medications even with the timely start of treatment at the first attack. The pain syndrome is so pronounced that it can provoke the onset of a painful shock, loss of consciousness, and cause death. The duration of the attack can be from one hour to several days;
• complete lack of appetite, nausea, bouts of vomiting that do not improve well-being. In the vomit, the contents of the stomach with bile inclusions are observed;
• hyperthermia of the body (more than 38 ° C), increased heart rate (over 90 beats / min.), respiration, lowering blood pressure (less than 90 mm / hg);
• heartburn, hiccups, belching, dry mouth;
• the appearance of a white or yellowish coating on the tongue;
• tension of the abdominal wall;
• bloating in the upper peritoneum, which is caused by dysfunctions of the digestive systems;
• bouts of diarrhea, constipation, inclusions in the feces in the form of undigested food debris;
• discoloration of the skin: pallor, cyanosis, yellow tint of the skin and sclera as a result of the development of obstructive jaundice in reactive acute pancreatitis of the sclerosing form, provoked by cholelithiasis or causing compression of the bile ducts due to enlargement and swelling of the pancreas;
• change in blood pressure - an increase or decrease in its indicators;
• a general significant deterioration in well-being, rapid weight loss, bouts of sweating.

Signs of exacerbation of the chronic form of the disease

Pain attacks during exacerbations of chronic pancreatitis are localized in the same place as in acute pancreatitis, and, depending on the characteristics of the disease, are felt in the right or left hypochondrium, pain radiates to the back, is of a girdle character, can spread to the area of ​​the scapula, sternum, depending from the site of the inflammatory process and the stage of the disease. Alcohol intake, fatty, spicy food can provoke exacerbations of chronic pancreatitis.

Pain during exacerbations of the disease occurs against the background of the development of an inflammatory process that affects the nerve endings of the pancreas, as well as with swelling and enlargement of the organ, involving the nerve endings in the surrounding tissues. Soreness can occur after a violation of the diet, last from several minutes to several days. A decrease in pain syndrome is noted with downward bending, squatting.

In addition to severe pain, exacerbation of chronic pancreatitis is also accompanied by the following symptoms:

• bloating, belching, diarrhea, nausea, vomiting due to disruption of the digestive system due to enzyme deficiency;
• weight loss, deterioration in general well-being. Dry skin, fragility of the nail plates, anemia, symptoms of vitamin deficiency, increased fatigue, etc. are also observed as a result of metabolic disorders of protein, carbohydrates, fats, as well as chronic intoxication of the body with decay products of undigested food;
• increased gas formation, stool disorders, chronic diarrhea, prolonged constipation due to insufficient digestion of food, activation and reproduction of bacteria that negatively affect the intestinal microflora.

The clinical picture of a pronounced exacerbation of chronic pancreatitis is similar to the acute form. With a sudden exacerbation of the disease, pancreatic tissue necrosis may also develop, causing acute pain attacks and requiring urgent medical intervention and hospitalization of the patient.

Complications of pancreatitis

Almost any form of pancreatitis, therapy for which is started in a timely manner, is capable, if not of a complete cure, then of a significant reduction in probable complications and slowing down the processes of destruction of one of the most important organs of the human digestive system.
Complications of acute pancreatitis or exacerbation of the chronic form can develop into extremely compressed juices and cause significant damage to health, even death.
At the same time, chronic pancreatitis, even in an erased form with an unexpressed clinical picture, is also dangerous. As the cells are damaged, the glandular tissue is replaced by the connective pancreas gradually loses the ability to function.
The main complications of chronic pancreatitis include:

• diabetes mellitus, which develops as a result of pancreatic insufficiency, a decrease in the production of the hormone insulin;
• general exhaustion, chronic intoxication of the body;
• abscess of the pancreas;
• pulmonary complications;
• development of pancreatogenic ascites;
• diseases and dysfunctions of other organs of the gastrointestinal tract (cholecystitis, duodenal ulcer);
• cystic formations in the tissues of the glandular organ;
• obstructive jaundice as a result of compression of the bile ducts;
• fatal outcome.

With exacerbations of inflammation, infectious processes can develop, both in the tissues of the pancreas and in adjacent organs and tissues. The localization of the pancreas near the large aorta contributes to the rapid spread of inflammation, associated infections, and general intoxication with the decay products of necrotic tissues. In the absence of the necessary therapy, strict adherence to the rules of nutrition in pancreatitis, abscesses can form, bleeding can begin.

Early and late consequences of acute pancreatitis

In acute pancreatitis, complications may appear immediately or have long-term consequences. Early complications that develop at the onset of an attack include:

• hypovolemic shock, leading to a lack of oxygen in the tissues of all organs of the gastrointestinal tract;
• liver, kidney failure, provoked by the toxic effects of digestive enzymes;
• peritonitis, aseptic or purulent, developing against the background of infection joining the inflammatory process;
• cardiovascular, respiratory failure and other complications.

The development of late complications in acute pancreatitis occurs mainly against the background of infections. The most common late complications of pancreatitis include sepsis, abdominal abscesses, the formation of fistulas in the organs of the digestive system, purulent inflammation, the formation of pancreatic pseudocysts, internal bleeding, etc. The high statistical frequency of mortality from advanced forms of pancreatitis - according to various sources, from 15 to 90%, especially due to alcohol intoxication, indicates the need for timely therapy and preventive measures to prevent the development of this disease.

Methods for diagnosing pancreatitis

A timely diagnostic study, the establishment of the causes of pancreatitis, and the initiation of treatment help to avoid the development of severe and numerous consequences. Acute forms and exacerbations of a chronic disease require immediate medical attention. However, with the initial signs of the disease: discomfort during or after eating, sensations of bloating, disorders of the digestive system, it is also necessary to consult a gastroenterologist before the onset of more pronounced clinical signs of pancreatitis.
Diagnostic procedures include an external examination of the skin, evaluating dryness, elasticity, discoloration, the patient's tongue (with pancreatitis, a whitish coating and atrophy of the taste buds are noted on the surface). Superficial and deep palpation of the epigastric region and the left hypochondrium allows you to determine the presence of pain when pressed, which is also a clinical sign in pancreatitis.

After examination and history taking, laboratory and instrumental methods for diagnosing pancreatitis can be prescribed. These include general, biochemical blood tests, stool and urine tests.

Early laboratory diagnosis makes it possible to determine an increase in the level of amylase in the blood and urine, which manifests itself in the first hours of an exacerbation of the disease. The amount of lipase increases by 2-3 days from the onset of a pronounced inflammatory process, and its elevated level indicates a prolonged exacerbation. The enzyme trypsin, determined in the patient's blood, indicates the onset of damage to the tissues of the organ.
During an exacerbation, an increased value of bilirubin and sugar is also noted, and the presence of partially split, underdigested fats, proteins, carbohydrates in the feces indicates pancreatic insufficiency.
A complete blood count is not so informative, however, without indicating enzymes and the consequences of their deficiency, it demonstrates the number of leukocytes and the erythrocyte sedimentation rate. Both indicators increase with pancreatitis.

Methods of instrumental diagnostics

Instrumental diagnostics allows you to determine the size of the affected organ, the presence of inclusions in it, cystic formations, tissue structure, glandular, connective or with signs of necrosis, involvement in the inflammatory process of surrounding organs, their general condition.
The methods of instrumental diagnostics for pancreatitis include ultrasound examination (ultrasound) of the abdominal organs, radiographic examination, esophagogastroduodenoscopy (EGDS), endoscopic retrograde cholangiopancreatography (ERCP), computed, magnetic resonance imaging, laparoscopy. The choice of method is based on the severity of symptoms and the overall clinical picture of the disease.
If the presence of pronounced tissue necrosis is established, they can resort to the method of percutaneous puncture to extract biopsy material for the purpose of bacteriological examination, identifying the nature of necrosis, and the sensitivity of the infectious agent to drug groups.

Features of the treatment of acute and chronic pancreatitis

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Methods of therapy for acute and chronic forms of pancreatitis differ depending on the clinical symptoms, severity of pancreatitis, etiology, the presence of concomitant diseases, the general health of the patient and his age period.
Treatment of acute pancreatitis is carried out exclusively in stationary conditions. The first appointment for acute pancreatitis is complete fasting for several days without exception. Staying in a surgical hospital allows not only to control the diet and prescribe appropriate medication, but also, if necessary, to urgently or routinely use surgical methods in case of a severe course of the disease and a threat to the patient's life.
The methods of surgical treatment for pancreatitis include the removal of areas of necrotic tissue, the installation of a drainage system.

Drugs used in the acute stage of the disease

Drug therapy for the acute form of the disease includes courses of targeted drugs. These include the following groups of medicines:

• cytostatics to block inflammatory processes;
• painkillers, antispasmodics, anticholinergics, in acute pain attacks, drugs of the narcotic group can be used;
• antisecretory drugs, blockers of the production of pancreatic enzymes are used to reduce the likelihood of complications, necrotization of organ tissues;
• with the spread of the inflammatory process, the attachment of infection, the development of purulent foci, antibiotics are prescribed;
• the introduction of solutions of drugs aimed at reducing the level of intoxication of the body, provoked by the circulation of digestive enzymes in the blood, parenteral nutrition, the introduction of electrolyte solutions, essential amino acids intravenously.

Drug treatment of the chronic form of the disease

In chronic recurrent pancreatitis during the period of remission, preparations of pancreatic enzymes are prescribed, which do not perform their functions effectively enough. The choice of what doctors prescribe to a patient with pancreatitis and at what dosage is based on the results of laboratory tests of blood, urine and feces. The course of drug therapy with enzyme preparations is supplemented with drugs to normalize digestion processes, enhance intestinal motility, and restore acid-base balance. Vitamin therapy is used: medicines and medicines with vitamins A, C, D, K, E and group B, prescribe the intake of lipoic acid, cocarboxylase, and so on according to indications.

An important component of treatment is a diet with the strict exception of fatty, spicy foods, alcohol is strictly prohibited. With an exacerbation of the chronic form, complete fasting for one to two days is recommended. Eliminating the symptoms of pancreatitis does not mean a complete cure and is not a reason to include prohibited foods in the diet.

First aid for acute pancreatitis

The appearance of the first signs of an acute form of the disease is the reason for the immediate call of a team of ambulance specialists. Before they appear, the following rules must be observed:

• it is absolutely impossible to eat and drink anything, as this provokes the production of pancreatic juice and can significantly aggravate the situation and increase the area of ​​​​damage to the pancreas, involve other organs in the inflammatory process;
• take a horizontal position (with bouts of vomiting - lie on your side), you can press your knees to your stomach if this relieves pain;
• try to relax the muscles of the abdomen, abdominals;
• put a cold object on the stomach: ice in a bag and a towel, a plastic bottle, a heating pad, etc., which will reduce the rate of inflammation.

It is highly not recommended to use drugs to relieve pain, firstly, at the beginning of an attack, they are ineffective, and secondly, such medications can reduce the information content of the clinical picture and make it difficult to diagnose. If necessary, you can use antispasmodic drugs to reduce the strength of spasm: drotaverine (Drotaverine, No-Shpa), Spasmalgon. It is necessary to inform specialists about taking medications.

With an exacerbation of chronic pancreatitis, the general rule of the first day is expressed in three words: cold, hunger and peace. This helps to reduce the development of inflammation, returning to a state of remission. However, in acute pancreatitis, treatment should take place exclusively in stationary conditions under the supervision of specialists.

Nutrition for pancreatitis

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Compliance with the prescribed diet for pancreatitis is the basis of therapy. It is impossible to both cure pancreatitis and slow down its development without following the rules of nutrition.
With the help of diet, it is possible to correct the functioning of the pancreas for the most part, to control how the disease proceeds. The diet is prescribed at the stage of remission, at the end of the period of exacerbation of pancreatitis. The chronic form of pancreatitis requires lifelong compliance with the rules of nutrition.

An attack of pancreatitis, depending on the severity of the course, requires strict fasting from 2 to 5 days. From the second day, you can begin to take warm alkaline water that reduces acidity, a weak decoction of rose hips, clean water. If there are improvements for 3-6 days, you can start using liquid cereal cereals without the addition of milk, sugar, butter and other taste improvers.

On the sixth day from the onset of an attack, the diet can be expanded to include low-fat broths, vegetarian vegetable soups, lean fish, weak tea, and other foods on the recommendation of a doctor. Next, a general diet is prescribed for pancreatitis, depending on the stage of the disease.
So, in chronic pancreatitis in remission, the diet is adjusted based on the analysis of the digestive system functioning under conditions of enzyme deficiency.

Diet during remission

The general rules of nutrition for chronic pancreatitis during remission include the following:

• the total amount of food consumed per day is divided into 5-6 small approximately equivalent parts to facilitate the functioning of the digestive system;
• food temperature should approximately correspond to body temperature and in no case exceed 60 ° C, the use of hot and cold dishes is excluded;
• the maximum restriction of the volume of fatty, spicy, fried foods, sausages, smoked meats, canned food, semi-finished products, seasonings and spices that can provoke an exacerbation of the disease, the exclusion of foods rich in coarse fiber (white cabbage, legumes, etc.), caffeinated and carbonated drinks, alcohol, chocolate, sweets with oily, fatty creams, and so on;
• replacement of rough food with soft ones: boiled or steamed grated vegetables and fruits, mashed soups, etc .;
• adhere to the daily intake of fats (no more than 60 g in total), proteins (60-120 g depending on body weight, age, physical activity, stage and characteristics of pancreatitis), carbohydrates (300-400 g).

The following foods should be included in the diet for chronic pancreatitis:

• slightly dried wheat bread made from flour of the first or second grade (fresh pastries are excluded);
• chopped vegetable puree soups;
• boiled cereals, cereals: rice, buckwheat, small pasta, oats;
• lean meats, fish, chicken, turkey, cooked by boiling or steaming;
• steamed or baked protein omelettes;
• boiled, baked vegetables (potatoes, pumpkin, beets, carrots, zucchini, squash);
• fresh natural dairy products with a low percentage of fat without dyes and preservatives, with low acidity (cottage cheese, yogurt, kefir), low-fat and non-spicy cheese, milk with a reduced percentage of fat (limited, only when added to dishes or tea);
• butter and sunflower oil in limited quantities;
• fruits and berries with a low level of acidity, sugar content, preferably non-acidic apples;
• honey, jam, jam, fruit and berry jellies, mousses and so on.

Prohibited foods and the principle of food processing

It is not recommended for patients at any stage of pancreatitis such types of products as pork, lamb, goose meat, ducks, mushrooms, garlic, sorrel, pickles and marinades in any form, radish, legumes, fresh cabbage, grapes and grape juice, margarine, coffee , cocoa, cinnamon, bananas, ice cream and sherbets. For any form of pancreatitis, the consumption of alcoholic beverages must be forgotten.

The correct methods of preparation and choice of products contribute to the remission of all forms of pancreatitis and reduce the likelihood of exacerbations and relapses in chronic pancreatitis or a single episode of the disease in history. A wide selection of culinary recipes allows you to diversify the diet, not experience the consequences of the restrictive principles of dietary nutrition, and avoid breakdowns.
With exacerbations of chronic forms of pancreatitis, complete fasting is prescribed on the first day, supplementing it with the decrease in the severity of symptoms with the use of heated alkaline water every two hours in small doses.
After the end of the stage of exacerbation of pancreatitis, they return to a sparing diet, starting with pureed liquid cereals, vegetable purees, low-fat varieties of fish.
With pancreatitis, it is not recommended to mix different types of protein during one meal, for example, eat fish and cheese, beef and chicken, etc.

The preferred method of cooking when heat treatment is required is to grind the product, followed by boiling, baking or steaming. On demand, grinding, pureeing is done twice, before cooking and after.

Prevention of pancreatitis

Pancreatitis is a disease that is easier to prevent than to cure. Prevention of inflammatory diseases of the pancreas includes proper diet and diet, limiting or eliminating factors that contribute to disorders in the digestive system, other systems and organs, prevention of infectious diseases, a healthy lifestyle, as well as a timely visit to the doctor in case of any discomfort or pain.

The prevention of exacerbations in chronic pancreatitis in remission includes not only taking prescribed medications and dieting, but also spa treatment, as well as examination by a gastroenterologist at least twice a year.