Chronic pancreatitis is a group of ailments associated with the disruption of the normal functioning of the pancreas.
Diseases of this group are characterized by the presence of inflammation and necrosis in the organ tissues, which are accompanied by segmental fibrosis, leading to malfunction of the gland in varying degrees of severity.
The progression and exacerbation of chronic pancreatitis leads to the emergence and development of atrophy of the tissues of the gland. In addition, fibrosis progresses, and the glandular cells of the organ parenchyma are replaced by connective tissue cells.
The main causes of the appearance of the disease
The disease is characterized by delayed excretion of pancreatic enzymes and their intraorgan activation.
First of all, there is activation in this situation of trypsin and lipase. These enzymes cause autolysis of the parenchyma of the gland, proliferation of connective tissue and the formation of cicatricial wrinkling. All of them provoke hardening of the gland, which leads to the appearance of irregularities in the implementation of normal blood circulation in the pancreas.
Autoagression plays a huge role in the development of inflammation.
The main root cause is the abuse of alcoholic beverages.
In addition, the protein diet for a long time and tobacco use for smoking can aggravate the state of the organ.
Additionally, the causes of the inflammatory process in the pancreas, which can cause pathology, can be:
- diseases associated with the work of the biliary tract and duodenum;
- pathology in the functioning or anatomy of the sphincter of Oddi;
- duodenal ulcer.
In the presence of cholelithiasis and choledocholithiasis, it is much more common in women aged 50-60 years.
Very often, the onset of symptoms of the disease is accompanied by progression of the metabolic syndrome, the main symptoms of which are:
- Tendency to arterial hypertension.
- Impaired carbohydrate tolerance.
These reasons are most likely when the disease occurs.
Rarely, but can also cause the appearance of the disease:
- cystic fibrosis;
- disease associated with the presence of hereditary predisposition;
- idiopathic species;
- autoimmune factor of inflammation;
- the presence of the patient systemic diseases and vasculitis;
- defeat of the body by some viruses and pathogenic bacteria;
- development in the body of diabetes;
- ischemic variety;
- abnormalities in the anatomy of the pancreas;
- getting sick injuries in the area of the organ and the occurrence of acute poisoning.
The inflammatory process may be diffuse or limited only to the lesion of an organ in the region of the head or tail.
Doctors distinguish several types of the disease - edematous, parenchymal, sclerotic and calculous and fibrocystic.
Common Classification Methods
Chr. pancreatitis is a slowly progressive disease that has an inflammatory nature.
Patrun is accompanied by the formation of necrosis.
There are several classifications of the group of diseases related to chronic pancreatitis.
In accordance with the ICB, the following types of pathology are distinguished:
- Toxic metabolic.
- Primary form.
- Secondary form.
In accordance with the classification developed by MI. Kuzin pathology is divided into the following types - primary, post-traumatic and secondary.
The primary type of pathology in turn is divided into the following types:
- on the basis of a violation of a healthy diet;
- against the background of disruptions in metabolism;
- unclear etiology.
Post-traumatic type of the disease is divided into types:
- Post-traumatic, against the background of patients receiving open pancreatic injury.
- Post-traumatic, against the background of getting a blunt injury to patients.
- On the background of obtaining intraoperative damage.
The secondary type of inflammatory process in pancreatic tissues can be divided into:
- lymphogenous cholecystopancreatitis, developing on the background of holndocholithiasis;
- in the presence of diseases of the gastrointestinal tract, including primary and secondary duodenostasis, duodenal diverticulum, with the progression of peptic ulcer, in the presence of colitis;
- disease arising from occlusion of the branches of the abdominal aorta;
- endocrinopathy disease;
- pathology that is formed in the event of exposure to other etiological factors.
The last is the classification developed by German doctors. It divides patients into groups according to the etiology, stage and severity of the disease.
Symptoms characteristic of the disease
Symptoms of chronic pancreatitis may vary slightly in each case and depend on the degree of damage to the organ and its area undergoing an inflammatory process.
Most often, the disease is accompanied by periods of remission and exacerbations.
In the period of exacerbations, the patient appears incessant pain. This symptom is the most pronounced.
The pain can be either dull or cutting. In some cases, if you do not take appropriate measures in a timely manner, pain can provoke pain shock in a person.
Localization of pain can be both in the right and left hypochondrium. It depends on the location of the lesion of the organ. In the case of the defeat of the entire body by the inflammatory process, the occurrence of surrounding pain occurs.
The most characteristic clinical symptoms of the disease are as follows:
- the appearance of abdominal syndrome;
- development of syndrome of exocrine insufficiency;
- endocrine function disorder syndrome;
- dyspeptic syndrome.
In addition, progression of biliary hypertension is often observed.
In some cases, the disease may develop in a painless form. Most often, this form is preceded by pain, and may have a different duration. The progression of painless pancreatitis is usually masked under the discomfort that develops in the epigastric region.
In such cases, the patient often the disease is accompanied by the appearance of digestive disorders, a tendency to diarrhea and steatorrhea.
Exocrine insufficiency, biliary hypertension and endocrine disruptions
The main manifestation is a violation of digestion.
In addition, exocrine deficiency is characterized by pathologies in the processes of absorption of digested food.
For this pathology characteristic appearance of a number of signs and symptoms.
The main symptoms of exocrine insufficiency are the following:
- weight loss;
- the appearance of nausea;
- regular vomiting;
- loss of appetite.
If a gland insufficiency occurs, progression of excess bacterial growth is observed, which provokes:
- Rumbling in the intestines.
- Unpleasant belching.
Further progression of the pathology leads to the appearance of the following characteristic of hypovitaminosis:
- changes in the color of the skin;
- metabolic disorders.
The basis for the progression of exocrine insufficiency is the destruction of acinar gland cells. As a result, the flow of pancreatic enzymes into the intestinal lumen is disrupted.
Biliary hypertension is characterized by obstructive jaundice and cholangitis. Most patients have transient or persistent hyperbilirubinemia. The cause of this pathology is an increase in the glandular head, which causes squeezing of the choledochus and the progression of the choledocholithase and the pathology of the large duodenal papilla.
Endocrine disruptions result from damage to the glandular tissue of the islet apparatus, which leads to insulin and glucagon deficiency, which causes pancreatic diabetes.
The diagnosis of the disease causes some difficulties.
The whole process is based on three main features - a characteristic history. The presence of external and intrasecretory insufficiency and the identification of characteristic structural changes in the tissues of the organ.
Very often, diagnosis is associated with long-term observation of the patient, who has a predisposition to pathology.
When conducting diagnostics methods are used:
- Laboratory examination.
- Instrumental examination.
- Differential diagnosis.
Laboratory examination involves taking blood for a biochemical examination, conducting a glucose tolerance test, determining the presence of fat in fecal masses by qualitative and quantitative methods, conducting pancreatic functional tests.
As an instrumental methods of examination used ultrasound and ERCP. The latter method allows to identify the echo signs of an increase in the gland and the development of the inflammatory process in it.
Symptoms of the manifestation of pathology resemble signs of acute abdomen. Therefore, this disease should be distinguished from perforated ulcer, acute cholecystitis, intestinal obstruction or intestinal vein thrombosis. For this purpose, applied differential diagnosis. All examinations are carried out in a hospital.
After a comprehensive examination, the doctor makes a description of the pathogenesis and gives a conclusion about the presence of a chronic form of pancreatitis in the patient, then appropriate treatment is prescribed, and recommendations are given on changing the diet.
Disease treatment methods
Treatment of the disease without complications can be carried out by outpatient treatment under the supervision of a gastroenterologist.
The main objectives of the medical outpatient treatment are a complete cessation or a significant slowdown in the progression of the disease and the fight against complications, it is impossible to fully cure the disease and restore the functionality of the organ in full.
In the process of conducting medical treatment of an acute attack of the disease several problems are solved.
The main objectives of therapy are:
- exclusion of provoking factors;
- relief of pain;
- correction of gland insufficiency;
- treatment of associated complications.
The main task of the patient is to follow the dietary diet - it is forbidden to eat vegetables that increase the acidity of the contents of the gastrointestinal tract, for example, tomatoes; In some cases, therapeutic fasting is used for pancreatitis.
In the treatment of used medications belonging to different groups of therapeutic drugs.
To reduce the load on the gastrointestinal tract in the first 2-3 days it is recommended to carry out medical fasting, which consists in refusing food intake. During this period, you can drink in a small amount of mineral water without gas.
To reduce the load on the gland should take drugs that contain digestive enzymes.
In addition, you should drink pills that reduce the acidity of the contents and inhibit the production of gastric acid. Such a drug may be Pancreatin.
Antibiotics are used to inhibit the inflammatory process. Traditional medicine recommends in the period of exacerbation to use mucous porridge in food, which contribute to the improvement of the digestive tract organs. For the preparation of such porridge you can use oats.
In case of identifying the objective prerequisites for surgery, an operation is performed in a clinic.
The prognosis for recovery is not very favorable, for example, the mortality rate in the presence of the disease with a period of 20-25 years is about 50%. About 20% of patients die from complications as the disease progresses.
What is chronic pancreatitis will tell the experts in the video in this article.