Pancreatitis: symptoms and treatment
Pancreatitis is a group of diseases in combination with the accompanying syndromes, the course of which is accompanied by a common factor for them, which is inflammation of the pancreas. Pancreatitis, the symptoms of which are manifested in the fact that there is no release of the enzymes released into the duodenum by the gland, proceeds with the activation of these enzymes directly in the gland, which results in its gradual destruction, in other words, self-digestion.
It should be noted immediately that the described specificity of processes, which is relevant for pancreatitis, is very serious, because both toxins and enzymes, which are actively released in this case, often go directly to the bloodstream, and this, in turn, can Provoke serious damage to a number of organs, such as the liver, heart, brain, kidneys, lungs. With the development of hemorrhages on the background of the pancreas, the possibility of a lethal outcome is not ruled out.
By itself, the pancreas, if you go into its anatomical features, is a fairly long organ (actually the gland), covered by the 12-duodenum. This gland takes a direct part in the processes associated with digestion, promotes the regulation of metabolic processes, etc. The course of pancreatitis, in addition to its existing classification, is possible in two main forms, namely in the form of acute or chronic. Due to the enzymes retained in the gland and due to which the development of the pathological condition occurs in this case, in general, assistance is provided in digesting the fats of the fats, proteins and carbohydrates, but the hormones of this gland (such as insulin, etc.) are responsible for the regulation In the blood glucose level.
In considering the factors that contribute to the development of pancreatitis, it can be said that the development of pancreatitis can lead to disorders related to the outflow of bile, as well as nutrition (for example, consumption of fatty and abundant meat food, stress, hereditary predisposition, alcohol And so on).
Various diseases, such as influenza, appendicitis, herpes, gastritis, allergies (food), etc. can provoke pancreatitis. Considering the peculiarity that the gland is deep enough, the diagnosis of the disease directly related to it is to a certain extent complicated. Provoke the development of the inflammatory process in the pancreas can, for example, trauma (getting into the stomach ball, etc.).
In a special group of risk for predisposition to pancreatitis are, first of all, men who do not deny themselves alcohol and overeating, in addition to them at risk are women during pregnancy and in the early postpartum period. In general, pancreatitis occurs in children, young adults and adults, regardless of age and other specific features.
Let us single out those factors that contribute to the development of the inflammatory process, topical for pancreatitis:
- excessive alcohol consumption, alcohol poisoning (including chronic alcoholism)
- Connective tissue diseases
- diseases of the gallbladder and pathways
- abdominal trauma
- diseases of the duodenum
- vascular diseases;
- infectious diseases
- diet violation;
- bile duct disorder
- use of certain medications (glucocorticosteroid hormones, antibiotics, estrogens, anticoagulants, etc.)
- hereditary predisposition
- liver cirrhosis
- endoscopic manipulation, surgery
- parasitic diseases
As we have already noted, pancreatitis can be acute or chronic, while the development of its chronic form is possible against the background of the previous acute form of this disease. In addition, the chronic form of pancreatitis can develop due to atherosclerosis, liver disease, ulcerative colitis, thyroid diseases, etc.
Pancreatitis is treated in different sources in its own different classifications. The first of these classifications appeared in early 1946, in particular, it was aimed at identifying the clinical features that accompany the course of chronic form of pancreatitis against the background of alcohol use by patients. Later, in 1963, a new version of the classification was developed, containing a description of etiological factors and morphological characteristics in combination with the substantiation of the relevance of the relationship existing between them. Already after this began to appear these initially variants of classifications with additions and corrections.
The most «fresh» version of the classification was the classification created in 2007, in it, depending on the nature of the course of pancreatitis, the following forms are distinguished:
- acute pancreatitis
- acute recurrent pancreatitis
- chronic pancreatitis
- Pancreatitis is chronic in an acute form of flow.
As we have already noted, chronic pancreatitis can develop from a previous acute pancreatitis, and it is in this variant, as a rule, that this disease manifests itself, that is, a transition from one form to another. The gradation (sequence, increase) between the acute recurrent form of the disease and exacerbation of the chronic form is very conditional. The appearance of a pancreatic syndrome in the patient (including pain syndrome, lipase and amylase) within a period of less than six months from the moment of the onset of pancreatitis appears to be defined as a relapse of its acute form, if it is a term of more than six months, then the exacerbation of the chronic form of the disease .
In accordance with the characteristics of the lesion of the gland, in which the volume of this lesion indicates the size of the site of its necrosis, the following forms of pancreatitis are distinguished:
- Edema (in this case, the necrosis of single pancreas is considered, in which characteristic islets of necrosis are not formed)
- Pancreatonecrosis (or destructive form of the disease), which, in turn, can match the nature of the lesion in the following forms:
- pancreatonecrosis small-focal
- pancreatonecrosis of medium-height foci
- large-pore pancreate necrosis
- pancreatonecrosis is totally-subtotal.
This definition, «pancreatonecrosis», is more pathological than clinical, for this reason, therefore, determine it as a diagnosis incorrectly. Total-subtotal pancreatonecrosis defines such destructive processes in the gland, in which all its parts, that is, the tail, body and head, are affected. Exceptionally, the total form of pancreatonecrosis does not occur in practice.
There are certain phases of pancreatitis that are considered in the acute form:
- enzymatic phase (within three to five days)
- the reactive phase (within 6 to 14 days);
- Sequestration phase (from 15 days)
- phase of the outcome (from six months or more since the onset of pancreatitis)
The actual moment in the course of this disease is lethality, which also determines for it the corresponding positions in the classification, there are only two of them:
- early lethality — occurs as a result of the development of multiple organ failure
- Late mortality — occurs as a result of development of purulent-septic forms of complications manifested in destructive pancreatitis (purulent-necrotic parapancreatitis).
What is noteworthy, the statistics indicate that about 50% of patients with pancreatitis in destructive form or with pancreatic necrosis abuse alcohol, which, as we have already pointed out, serves as a serious background for the development of the disease. In addition, it is known, again, on the basis of statistical data, that in 20% of patients pancreatitis developed as a complication of cholelithiasis.
Acute pancreatitis: symptoms
Acute pancreatitis by itself implies, respectively, an acute form of aseptic inflammation, to which the pancreas is exposed. The basis of the disease is necrobiosis of pancreatocytes in combination with enzymatic autoaggression, which subsequently develops necrosis of the gland and its dystrophy, in addition to which a secondary purulent infection also joins the process.
The disease in this form, despite the fact that modern variants of methods based on the implementation of measures of conservative treatment and treatment of operative ones are used in its treatment, is characterized, however, by a rather high degree of lethality. So, in general, it is about 7-15%, and in the case of the development of destructive forms of pancreatitis can reach 40-70%.
Pausing specifically on the symptomatology of this form, we note that the acute clinic has no acute pancreatitis, and therefore its diagnosis implies a need for a number of studies.
In patients, complaints of acute pain in the abdomen are noted, which is accompanied by nausea and vomiting without relief (vomiting — in the form of duodenal contents, which in turn implies the presence of vomiting masses of digestive juices, mucus, bile, Digested food, saliva, etc.). Also noted bloating, dry mouth, belching. Against the backdrop of intoxication with concomitant vomiting, water-electrolyte balance is disturbed in patients, and dehydration occurs. From the left side of the abdomen, bluish spots often appear, in some cases they have a yellowish tint (this symptom is defined as a symptom of Gray Turner). Also, there may be spots in the area near the navel.
Progressive course of the acute form of pancreatitis can be accompanied by a rapid deterioration in the general condition of the patient, which is accompanied by increased heart rate, increased temperature, lower blood pressure, pale skin (it can be replaced by an earthy gray tinge), the face can acquire a characteristic sharpening of the features.
Inspection determines bloating, the appearance of signs indicating paresis of the stomach and intestines (which is manifested in the absence of cuts). Complications of acute pancreatitis can be manifested in complications from both organs located in the peritoneum and from organs concentrated in other areas, that is, beyond its borders. The main group of complications includes suppuration of the omentum bag, complications of intraperitoneal, gastrointestinal ulcers, peritonitis, pulmonary pneumonia and pulmonary abscesses, exudative pleurisy (in which the fluid accumulates in the pleural cavity). Often, acute pancreatitis is accompanied by hepatitis and disorders in carbohydrate metabolism, which manifests itself as a violation of blood sugar levels, as well as in its appearance in the urine.
The basis of pancreatitis symptomatology in any case is the pain that arises from the actual processes for it in part of the secretion of the secretion of the gland. This is expressed in the form of a strained state of the capsule of the gland, as well as in the form of increased pressure in the solar plexus. An exceptional condition for the onset of pain syndrome is the fact that the pancreas contains a lot of nerve endings involved in the whole process. The duration of the manifestation of pain can be as several hours, and to reach two days (the lengthening of this period is not excluded). As for the intensity of actual pain sensations, it is determined by the severity of the actual inflammation in the gland. With her swelling, the pain can appear in an intense sharp form. In some cases, the course of the disease symptomatic of pancreatitis can manifest itself in the form of pain, giving to the region of the heart and chest. Diagnosis of pancreatitis in this case should take into account a similar option.
Pancreatitis can also be accompanied by the following symptoms:
- weight loss
- the appearance of a white patch on the tongue
- symptomatology of hypovitaminosis (appearance of «zaed» in the corners of the mouth, brittle hair, peeling and dry skin, etc.)
- nausea and vomiting
- the appearance of «ruby droplets», localized in the abdomen and chest.
The above symptoms do not necessarily combine with each other, moreover, they do not always indicate pancreatitis, but their appearance in any case should not be ignored.
We have already noted that the chronic form of pancreatitis can develop against the background of the acute form, but the option is also possible in which acute pancreatitis develops against a background of its chronic form, and in any case, acute pancreatitis has nothing to do with the concept of chronic exacerbation Pancreatitis.
After transferring acute pancreatitis to patients, pseudocysts appear in their pancreas, which, in turn, due to their own increase in size and accumulation in the cavities of the pathological fluid, as well as through the compression thus produced of organs in close proximity to May cause painful sensations. In addition, the process of progression in the stomach and duodenum of the food may be disrupted, and the possibility of suppuration of pseudocysts is not excluded.
In some cases, puffiness or sclerosis that appear in the area of anatomical concentration in the pancreas of its head causes a clinical picture similar to the compression of the bile ducts, as well as the pancreatic duct. This type of pattern is typical for the development of a head tumor, on the basis of which this form of pancreatitis is defined as a pseudotumorous form. Because of the urgency of the disorder in such a flow of bile outflow, mechanical jaundice often develops.
Predominantly, the death of patients with acute pancreatitis during the first days of its occurrence is due to endogenous intoxication, which in turn is accompanied by the development of hypovolemic shock, acute renal failure and cerebral edema.
Chronic pancreatitis: symptoms
Pancreatitis in chronic form is a common disease, its main manifestations are reduced to the appearance of periodic or permanent pain sensations, as well as to the appearance of signs of endocrine and exocrine insufficiency. In terms of actual processes occur pathological changes irreversible parenchyma of the pancreas, which is its atrophy, proliferative fibrosis, with the disappearance in some places acini. In addition, the stricture of the duct (i.e., its organic constriction) occurs, concrements (dense formations, stones) or in the gland tissues are formed in it.
is manifested pancreatitis with a minimum of clinical symptoms, and in some cases the masking of this form of pancreatitis by other diseases arising in the abdominal cavity (e.g., a hernia in hiatal organs, biliary dyskinesia, chronic cholecystitis, peptic ulcer 12- Guts or bile ducts, etc.). Given the similar nature of the course of this disease, establishing the true frequency of its occurrence is impossible in principle.
Chronic pancreatitis has its own classification, it distinguishes the following forms:
- toxic-metabolic pancreatitis
- pancreatitis idiopathic;
- hereditary pancreatitis
- autoimmune pancreatitis
- Obstructive pancreatitis
- recurrent pancreatitis
- primary and secondary pancreatitis
Primary pancreatitis, in accordance with the classification used by MI Kuzin, can be alcoholic, which arose as a result of disorders in nutrition, against a background of metabolic rate disorders. In addition, in this form, chronic pancreatitis manifests as a drug pancreatitis (respectively, on the basis of taking certain drugs that provoke it), as well as pancreatitis of an unknown origin.
In accordance with the same classification, pancreatitis is secondary and post-traumatic. Posttraumatic pancreatitis arises against blunt trauma pancreas open her injuries, as well as against the background of the preceding intraoperative damage, a study of pancreatic duct and biliary duct during filling of a contrast agent for the follow-up by applying X-ray unit (ERPHG method). As for secondary pancreatitis, cholangiogenic pancreatitis is distinguished here, incl. lymphogenous holetsistopankreatit (occurring at the background papillostenoza, choledocholithiasis), pancreatitis, developing on the background of digestive diseases, endocrinopathies, occlusion of the abdominal aorta branches, as well as other factors etiologic scale.
As for the part we are interested in, which is the symptomatology of chronic pancreatitis, then, as a rule, exocrine insufficiency is the main clinical sign of the disease. Such a failure is demonstrated by the impossibility of producing the required quantity of enzymes by the gland. Often against the background of acute disease, pseudocysts are formed, which, due to their increase in size and the accumulation of pathological fluid, lead to compression of the organs surrounding them. This, in turn, leads to the appearance of pain, as well as to disruption of movement in the duodenum and in the stomach of food. It is also possible that pseudo-cysts can be suppurated against this background.
In some cases, as a result of sclerotic processes occurring in the head of the pancreas is shown clinic, similar to the clinic at the compression of O path duct with bile pancreatic duct. This variant of the current is relevant for development of the tumor gland in the head, therefore this form of pancreatitis is defined as a pseudotumorous form. Due to the actual disturbance of the outflow of bile in a similar course of pancreatitis, mechanical jaundice can develop. With mechanical jaundice, the skin becomes yellow, sclera and mucous membranes are similarly affected. Due to the development of this form of jaundice, the condition of patients is significantly impaired, which is why the course of the underlying disease, which is, in fact, chronic pancreatitis, also becomes heavier, respectively. Symptoms of this form of pancreatitis can also determine the transition to acute form, but it is not considered as an exacerbation of pancreatitis due to inconsistency with this condition.
Chronic pancreatitis is a slowly progressive inflammation, inflammation, as we have already pointed out, is subject to the stages of regression, that is, it periodically, it escalates, it calms down. Eventually there is atrophy of the body, fibrosis or its calcination, the course of the disease eventually leads to the replacement of tissues in the gland (normal tissue in it is replaced by a scar tissue).
Attack of pancreatitis: symptoms
An attack of pancreatitis is accompanied by a symptomatology in the form of painful sensations arising from the upper half of the abdomen and giving to the back. These painful sensations appear after eating, can last for many hours, but in some cases the duration of their manifestation reaches the term of several days. Often the condition of an attack of pancreatitis is accompanied by nausea and vomiting, the development of jaundice. Prolonged course of the attack leads to the appearance of an abundant stool with a characteristic fatty shine, as well as to the loss of weight to the patients.
If there is an attack of pancreatitis, urgent hospitalization is needed, because otherwise the patient may develop a number of complications directly related to this organ, one of which is the necrosis of his part.
Alcoholic pancreatitis: symptoms
Alcoholic pancreatitis is a chronic form of the disease, it appears in patients who abuse alcohol. Symptom is manifested in particular after eating acidic and acute foods, as well as after eating fresh fruits and vegetables. Sometimes the signs of the disease can manifest similarly to the signs of biliary colic in fairly pronounced manifestations in the form of pain in the right hypochondrium (with its spread to the back), and also with the appearance of vomiting, in which an admixture of bile is found.
Early stages of the disease are accompanied by the appearance of constipation, which is combined with the hypomotor form of dyskinesia. Gradually, the stool becomes unstable, there is an alternation of diarrhea with constipation. Diarrhea (diarrhea) is the main «companion» of patients with alcoholic pancreatitis.
Reactive pancreatitis: symptoms
Reactive pancreatitis, like pancreatitis in general, develops against the background of a malfunctioning pancreas, which in turn is due to its inflammation. At the initial stage, the reactive form of pancreatitis is accompanied by constant heartburn, frequent occurrence of bloating, belching. Patients have an aversion to fatty foods, there is a sharp intolerance to the odors peculiar to them.
Already when these symptoms appear, you should seek medical help. In itself, the disease in this form is not dangerous, but if you exclude the referral to the doctor as a necessity, it will begin to progress, moving to an even more serious form. The same form of pancreatitis is considered as the first reaction from the body to the malnutrition. In most cases, pancreatitis develops in adult men, which is associated with frequent disregard for consumed food, as well as with occasional consumption of alcoholic beverages.
Given the increase in the pressure exerted in this case on the gallbladder and 12-colon, blockage of the outflow of pancreatic juice occurs, this, in turn, causes the progression of the disease. As in other forms, often reactive pancreatitis is the cause of other diseases already present in a sick person (cirrhosis, cholelithiasis, gastritis, hepatitis, etc.). It can also arise as a result of impact, due to tissue rupture, which also leads to the impossibility of passage of enzymes, produced by the stomach, to the 12 duodenal gut. This causes self-digestion of the stomach and, as a consequence, destruction of the gland tissues.
Signs of reactive pancreatitis consist in the appearance of strong cutting pains that appear under the ribs, as well as in the appearance of regular hiccups and unceasing vomiting. Pain sensations can also be replaced in the area of their localization, which is determined on the basis of a specific area of inflammation. So, the inflammation of the bottom of the body is indicated by pain in the right hypochondrium area, the inflammation of the body’s body is indicated by pain in the area under the scapula, and the inflammation of its neck is pain in the region of the right hypochondrium.
In addition to these symptoms, the patient may have problems with appetite (loss of appetite until the appearance of aversion to food), in a more neglected version of the disease there is increased salivation, occasional nausea, bloating. Reactive pancreatitis in children is often accompanied by diarrhea (it has a permanent character of manifestation), fever and, again, loss of appetite.
Diagnosis of pancreatitis involves the following methods:
- blood and feces analysis
- Coprogram (allows to determine the features of digestive functions of the gastrointestinal tract, and also to reveal the actual insufficiency of digestion of carbohydrates, proteins and fats)
- Ultrasound (the areas of the gallbladder, liver, bile ducts, and, in fact, the pancreas) are being studied;
- CT (computed tomography, in which the whole body is concentrated in the abdominal cavity)
Treatment of pancreatitis
Treatment of pancreatitis depends on the severity of the flow characteristic of the pancreatitis. In the absence of complications (with lung lesions, kidneys) pancreatitis in acute form passes. The basis of his treatment is to provide the patient with dormant conditions, in particular, rest for the affected organ is meant, which is ensured by fasting during several days. Also in the definition of treatment measures are repelled from the goal of maintaining the vital functions inherent in the body, while preventing the development of complications. If it is necessary to introduce a specific type of medication, hospitalization may be required.
The formation of false cysts can be the reason for the operation to remove them.
A stone blockage of the bile duct or duct of the gland can lead to an acute attack lasting several days. With advanced or complicated form of pancreatitis, treatment may require the provision of intravenous nutrition lasting for 3-6 weeks (determined by the specific period of the patient’s condition when taking into account the restoration of the normal state of the body). Mild cases of the disease do not require such manipulations, it is sufficient to restrict oneself to the appropriate diet. Diet for pancreatitis is used № 5, it exists in two versions, designed for use within the stage of exacerbation or remission.
In chronic pancreatitis, the treatment is focused on pain relief, then on the planning of an appropriate diet with the restriction of consumption of foods saturated with fats and carbohydrates. In addition, pancreatic enzymes used as a substitution therapy measure can be prescribed, as well as for lowering the level of enzyme production and for rest in the functioning of the pancreas organ.
In any of the forms of pancreatitis, drinking is excluded.
If there is a symptom that indicates the possible presence of pancreatitis, you need to contact the gastroenterologist.