Alcoholic pancreatitis – the most severe form of an inflammation of a pancreas. Alcoholic pancreatitis can arise both against the background of chronic alcoholism, and at single reception of alcohol or its substitutes together with greasy high-calorific food. At the same time there are severe surrounding pains in the top part of a stomach, nausea and vomiting, temperature increase, diarrhea. It is possible to make the correct diagnosis on the basis of a research of level of pancreatic enzymes, on ultrasonography, KT or MPT, ERHPG. Treatment of alcoholic pancreatitis – very complex challenge which key factor is the full refusal of alcohol.
Alcoholic pancreatitis – the pancreas inflammation which developed in response to chronic alcohol intake and its substitutes or at single reception of alcoholic drinks along with greasy food, smoking. At the same time has no crucial importance neither a look, nor quality of alcohol – pancreatitis can develop as at the daily use of beer, good cognac, and when using substitutes. The last researches in the field of gastroenterology show that alcoholism does not play a crucial role in development of pancreatitis; genetic predisposition to this disease is supposed. Also induction of damage of a pancreas is not excluded by a combination of several factors: reception of alcohol, smoking, the use of a large number of the greasy food which is grown poor by protein. About 50% of patients with chronic alcoholic pancreatitis perish within 20 years from the beginning of a disease, however as a cause of death often serve the diseases associated with alcoholism, but not pancreatitis.
Reasons of alcoholic pancreatitis
Toxic defeat of cells of a pancreas is the products of disintegration of ethyl alcohol or substances which are formed at the use of substitutes the reason of development of alcoholic pancreatitis. The pathogenesis of a disease is rather difficult. At damage of cages enzymes are activated and begin to digest gland, causing a necrosis of an increasing number of fabrics. Gland hypostasis develops, it increases and squeezes surrounding bodies, its cover stretches, causing severe pain. At the same time the specific pseudo-cysts filled with nekrotizirovanny fabrics and liquid contents are formed.
In fabrics of gland process of fibrosis is started, the formed connecting fabric deforms to Strom and channels, causing stagnation of a secret of a pancreas and its bigger damage. Function of release of enzymes in this connection the dispepsichesky phenomena appear suffers. Finally normal fabric of gland is replaced with fat and connecting fabric therefore begins to suffer and endocrine function – develops diabetes.
It is known that binge causes education of free radicals who have the heavy damaging effect on cages. At the same time, smoking causes an angiospasm and ischemia of a pancreas at the expense of what damage of fabrics amplifies. Reception of greasy food intensifies production of enzymes, aggravating their damaging action on gland.
Classification of alcoholic pancreatitis
On time of development distinguish sharp and chronic pancreatitis. Sharp alcoholic pancreatitis usually develops at one-stage reception of high doses of alcohol, especially if it was followed by smoking, reception of food fat and poor in protein. This form strikes generally young men, proceeds very hard.
Chronic pancreatitis can develop and as continuation sharp and as an independent disease. Researches show that developing of this disease is possible even at daily reception of only 20 g of alcohol, and the first symptoms can appear in 2 years. But in most cases development of chronic pancreatitis is favored by long reception of high doses of alcohol.
Symptoms of alcoholic pancreatitis
The clinical picture of a disease usually demonstrates from emergence of the severe surrounding pains though a quantity of cases proceeds also without pain syndrome. Pains are localized in the top half of a stomach, irradiating in podreberye, a back. Can be both constant aching, and sudden sharp. Pain amplifies in situation on a back, decreases in the compelled sitting position and having bent forward. Also pain becomes more severe after food in this connection at patients fear of meal often develops. At chronic pancreatitis pain can be a constant moderate, after binge or reception of greasy, spicy food considerably to amplify.
Also often nausea, vomiting, diarrhea disturb. A chair at the same time plentiful, grayish color, fetid, with a greasy luster and pieces of undigested food. Also the raised meteorizm, an eructation, abdominal murmur disturb. Because of violation of splitting and absorption of nutrients (a consequence of insufficient production of enzymes of a pancreas), and also because of fear to eat food bystry loss of weight is noted.
At the complicated course of pancreatitis cysts and abscesses of a pancreas, fistulas with the next bodies or an abdominal cavity, mechanical jaundice, diabetes can be formed. Long uncured chronic pancreatitis can lead to development of an adenocarcinoma of a pancreas.
Diagnosis of alcoholic pancreatitis
Diagnosis of this disease at early stages before tissue of a pancreas is critically damaged, almost impossible. At the beginning of a disease there are neither typical signs on ultrasonography, nor characteristic changes in analyses (for example, enzyme amylase keeps sufficient activity until its production does not decrease less than 10% of norm). Symptoms also appear when there is considerable hypostasis and a necrosis of fabric of gland.
When collecting the anamnesis surely register the alcohol intake fact. Establishment of the diagnosis of alcoholic pancreatitis presents difficulties also because many hide alcoholism and even single alcohol intake.
Symptoms, characteristic of pancreatitis, dictate need of carrying out a number of researches. At the same time in clinical blood test reveal inflammation markers (high level of leukocytes, changes of a leykoformula, increase in SOE). In biochemical blood test change of activity of enzymes of a pancreas is noted, diagnostic value has increase in level gamma - which indicates not only existence of pancreatitis, but also chronic alcoholism.
In urine the level of glucose, albumine and transferrin increases. Find a large amount of neutral fat, food fibers and fatty acids in a koprogramma.
For assessment of vneshnesekretorny work of a pancreas the special test with sekretiny and holetsistokininy is carried out (they stimulate production of enzymes of gland). After their introduction the fence of six tests of intestinal juice from a duodenum is made, its quantity is estimated. In the first three tests determine the level of bicarbonates, in the last – enzymes. Test results allow to estimate digestive function of a pancreas.
On ultrasonography of abdominal organs estimate the pancreas sizes, existence in it of cysts and kaltsinat, expanded channels. Also the attention is paid to a condition of a liver and bile-excreting channels as at pancreatitis their work can be broken too. On MPT and KT of abdominal organs receive data on the sizes and an arrangement of gland, cysts and sites of calcination, exclude tumoral process. Carrying out ERHPG (an endoscopic retrograde holangiopankreatografiya) allows to estimate a condition of channels of gland. For this purpose by means of the endoscope enter contrast solution into them, then estimate result in x-ray pictures.
Treatment of alcoholic pancreatitis
Treatment of this disease is performed under complex observation of the gastroenterologist, surgeon, endoscopist, endocrinologist, radiologist, psychotherapist, narcologist, and if necessary and other experts. The main thing and by all means a treatment condition – refusal of alcohol, but even in this case it is impossible to guarantee a complete recovery. Begin treatment with the general actions. At the heavy course of pancreatitis medical hunger within several days can be appointed. In all other cases the fifth pancreatic table is appointed, alcohol and smoking is forbidden.
Conservative treatment includes reception of fermental medicines with the replaceable purpose, antiemetic and anesthetics. Sugar level is controlled, if necessary it korrigirutsya. Fat-soluble vitamins, necessary minerals are surely appointed.
Surgical treatment consists in opening of cysts and abscesses, a resection of a part of gland, a rassoyedineniya of solderings, closing of the svishchevy courses. Surgical treatment is required at the complicated course of pancreatitis. In need of operation forecasts of a disease worsen. It is necessary to remember that expeditious treatment of pancreatitis considerably increases probability of development of diabetes.
Forecast and prevention of alcoholic pancreatitis
The forecast at the chronic course of pancreatitis adverse. At a sharp current the outcome depends on disease severity, rather often the disease comes to an end pankreonekrozy which can lead to death of the patient.
Prevention of alcoholic pancreatitis consists in full refusal of alcohol and cigarettes, good nutrition with sufficient protein content, annual inspection at the gastroenterologist.