Vipoma – the tumor coming from insular cells of a pancreas. It is usually localized in a tail or in a pancreas body, settles down in the field of a sympathetic trunk less often. More than in half of cases has malignant character. It is shown by massive diarrhea, the poured belly-aches, heavy violations of water-salt exchange, hypotonia, spasms and a renal failure caused by loss of salts and liquids. The diagnosis of a vipoma is established on the basis of symptoms, results of the analyses yielded by ultrasonography, KT, MPT and other researches. Treatment – medicamentous therapy, surgical intervention.
Vipoma (Verner-Morrison's syndrome or pancreatic cholera) – the new growth producing a large amount of the vazoaktivny interstitsialny peptide (VIP). Enters into group of tumoral diseases of the APUD system – the neuroendocrine cages located in various bodies and united by certain general properties. 50-75% the VIP at the time of detection have signs of a malignant new growth, in many cases in the course of diagnostics metastasises in other bodies come to light (usually – in a liver). Vipoma is very rare disease. Forecast in most cases adverse. Treatment is performed by experts in the field of oncology and gastroenterology.
The main clinical manifestation of a vipoma is massive long diarrhea. The daily volume of a chair against the background of starvation makes about 1 liter, against the background of meal can increase to 3-4 and more liters. 50% of patients from vipomy suffer from diarrhea constantly, at the others the wavy current is observed. Because of considerable losses of liquid and minerals there are dehydration, acidosis, a gipokaliyemiya and strong weakness. The spasms caused by magnesium losses are possible.
Patients of vipomy lose flesh. Tendency to lowering of arterial pressure is noted. The renal failure develops. There are violations of mentality. Patients from vipomy can show complaints to belly-aches of uncertain localization. The gall bladder can increase, the probability of formation of stones of a gall bladder increases. Level of secretion of gastric juice decreases. In 20-30% of cases there are inflows. The hyperglycemia caused by the strengthened production of a glucagon and intensive destruction of a glycogen is found in every third patient vipomy. When carrying out additional researches opukholevidny education in a pancreas or a sympathetic trunk comes to light. Diameter of a vipoma can reach 7 and more centimeters.
Diagnostics of a vipoma
The diagnosis is established on the basis of clinical manifestations, results of analyses and these additional researches. In the course of diagnostics exclude other possible reasons of long diarrhea (infectious diseases, , fleecy adenoma, reception of laxative medicines etc.). The patient with suspicion on vipy appoint the general blood tests and urine, blood test for determination of the VIP level, a koprotsitogramma and biochemical blood test for determination of level of salts, protein and aminotransferases. Measure the daily volume of a chair at meal and after three-day starvation.
The plan of tool inspection at a vipoma includes FGDS, ultrasonography of a pancreas, pancreas KT or MPT. Diagnostic criteria of a vipoma are diarrhea lasting more than 3 weeks at the daily volume of a chair more than 700 ml; the daily volume of a chair is more than 500 ml against the background of three-day starvation; the VIP high level in blood; existence of opukholevidny education in a pancreas (in 90% of cases) or in the field of a sympathetic trunk (in 10% of cases) by results of ultrasonography, KT or MPT.
The differential diagnosis of a vipoma is carried out with Zollingera-Ellison's syndrome (gastrinomy). Unlike this syndrome, at a vipoma there are no recurrent stomach ulcers and a duodenum, more expressed watery diarrhea is observed, is absent . According to laboratory researches at a vipoma are found hypo - or an akhlorgidriya of gastric juice, sharp increase in the VIP level, decrease in level of sodium and potassium in blood. At a gastrinoma the giperkhlorgidriya of gastric juice and the VIP normal level come to light. Level of sodium and potassium is usually normal, but can decrease at plentiful vomiting.
Treatment of a vipoma
Priority at treatment of a vipoma is correction of gross violations of water-salt exchange. Perform intravenous infusions of bicarbonate. In process of a regidratation the volume of a chair increases therefore constant adequate completion of the lost liquid can represent certain difficulties. For reduction of daily volume of a chair enter Prednisonum or in combination with 5-ftoruratsily. For secretion suppression the VIP appoint . Medicine also promotes reduction of diarrhea and sometimes reduces the vipoma sizes. Oktreotid also suppresses pancreatic secretion therefore if necessary apply Pancreatinum.
The most effective method of treatment of a vipoma is radical surgical intervention. After removal of a tumor the absolute recovery is observed at 50% of patients. In the presence of metastasises carry out palliative operations on removal of the revealed centers for reduction of expressiveness of symptoms and simplification of a condition of the patient suffering from vipomy. At the same time appoint in combination with ftoruratsily or doxorubicine. Palliative surgical interventions in combination with chemotherapy do not allow to achieve an absolute recovery, but provide partial remission and improve quality of life of patients.