Biliarny pancreatitis – a chronic inflammatory disease of a pancreas which results from damage of a liver and ZhVP (bile-excreting channels). It is shown by bilious colic, the dispepsichesky phenomena, jaundice, diabetes and weight reduction. The diagnosis is made after performing ultrasonography of gepatobiliarny system, KT or MPT of abdominal organs, a number of functional tests. Conservative therapy consists in introduction of the anti-inflammatory and anesthetizing medicines, replacement therapy by enzymes, corrections of level of sugar of blood. An indispensable condition for treatment is observance of a strict diet and refusal of alcohol. Surgical intervention is carried out in the presence of concrements in a gall bladder. Lack of the timely help at this disease can lead to the most serious complications therefore patients with biliarny pancreatitis surely have to be constantly under observation of the gastroenterologist.
Biliarny pancreatitis – the persistiruyushchy disease of a pancreas which is closely connected with inflammatory and other diseases of gepatobiliarny system. Around the world incidence of pancreatitis for the last decades grew more than twice; at the same time this indicator among adults increased in Russia three times, and among children – in four. One of the most frequent conditions of developing of chronic pancreatitis is ZhKB (cholelithiasis) – pancreatitis at it comes to light in 25-90% of cases. Exacerbations of a disease are usually connected with migration of a stone on biliary tract. In this situation expeditious treatment is recommended to the patient. If the patient refuses operation, he should be warned that at repeated colic the volume of intervention can be much wider. Timely treatment of diseases of bile-excreting channels leads to decrease in frequency of pancreatitis of biliarny genesis.
Reasons of biliarny pancreatitis
Even more than thirty years ago the leading gastroenterologists specified that diseases of biliary tract are the reason of development of pancreatitis more than at 60% of patients. Mechanisms of development of inflammatory process a little. The first is implemented by means of spread of an infection with ZhVP on a pancreas on lymphatic ways. The second arises in the presence of the stones in the general bilious channel leading to development of hypertensia in channels with the subsequent hypostasis of a pancreas.
The third mechanism consists in a bile pelting to pancreatic canals at pathology of a faterov of a nipple (the place of opening of the general channel of a liver and in a duodenum). Damage of channels and tissue of a pancreas results, inflammatory process develops. The last will be aggravated at inflammatory diseases of a liver as at them the bile thrown in contains a huge number of free radicals and perekisny connections which considerably damage .
Researches in the field of gastroenterology opened one more mechanism of inflammatory process at biliarny pancreatitis – formation of a biliarny sladzh. At cholecystitis and the subsequent dysfunction of a gall bladder the physical and chemical condition of bile is broken, some of its components drop out in a deposit with formation of microstones - it is and is biliarny . At advance on ZhVP this deposit injures mucous, causing narrowing of channels and a faterov of a nipple. The stenosis of the last leads to violation of release of bile in 12 perstny gut and to its throwing to pancreatic canals, and also to stagnation of a secret in channels .
In a consequence of stagnation, activation of the pancreatic enzymes which are contained in a secret happens not in an intestines cavity, and in channels. The protective barrier is damaged, and the infection easily gets into gland fabric. Large stones of a gall bladder can cause obstruction of the general bilious channel or Oddi's sphincter that too will lead to a bile reflux to canals of a pancreas.
Thus, biliarny pancreatitis can develop at the following diseases: ZhKB, anomalies of a structure of bilious and pancreatic channels, dyskinesia of a gall bladder, DZhVP, chronic cholecystitis, cirrhosis, pathology of a faterov of a nipple (inflammation, spasm, striktura, obstruction by a stone). Reception of products or medicines, the possessing bile-expelling action, sharp weight loss can provoke an exacerbation of chronic pancreatitis.
Symptoms of biliarny pancreatitis
The clinic of this disease is similar to other diseases of a GIT: stomach ulcer and duodenum, intestines tumors, antralny gastritis, viral hepatitis, tumors , chronic beskamenny cholecystitis and others. Therefore in the presence of following symptoms it is necessary to exclude first of all these diseases, besides they can support chronic inflammatory process in a pancreas.
In 90% of cases the pain syndrome is dominating at pancreatitis. Belly-aches can be localized in an epigastriya, irradiate in both podreberye, the right shoulder, a back. Usually pains develop in 2-3 hours after food or at night, sometimes right after the use of the carbonated drinks provoking a spasm of a sphincter of Oddi. Most often pain arises after violation of a diet – the use of greasy, fried, spicy and extractive food. Pains can be followed by temperature increase, nausea, emergence of bitterness in a mouth. At full obstruction of a faterov of a nipple a stone mechanical jaundice develops – skin, mucous is painted.
At development of inflammatory process in tissues of a pancreas also ekzokrinny function is broken it endo-. Endocrine frustration are characterized by violations of exchange of carbohydrates (a hyperglycemia or a hypoglycemia during an attack), and ekzokrinny – fermental insufficiency of a pancreas with the subsequent failures in digestion. At the patient the liquid chair several times in days, at the same time by kcal of grayish coloring, fat, fetid is noted. The raised meteorizm, muttering in a stomach disturbs. The Dispepsichesky phenomena also include an eructation, heartburn, a loss of appetite. Against the background of a diarrhea, the increased loss of fats, violation of digestion there is a decrease in body weight. The phenomena of a vitamin deficiency and minerals accrue.
Biliarny pancreatitis in the absence of due treatment can have a number of complications. Refer malfunction of other bodies and systems to early (shock, an acute liver failure, OPN, respiratory insufficiency, encephalopathy, gastrointestinal bleedings, impassability of intestines, abscess , , a diabetic coma, jaundice of mechanical genesis) and late complications (pseudo-cysts, ascites, fistulas, narrowing of intestines).
Diagnosis of biliarny pancreatitis
In clinical and biochemical blood tests at chronic pancreatitis of biliarny genesis inflammatory changes, increase in level of bilirubin, cholesterol and alkaline phosphatase, decrease and violation of a ratio of the main proteins are noted. Amylase level in blood and urine increases by 3-6 times. Changes in a koprogramma usually occur after loss of function of more than 90% of ekzokrinny cages: these are undigested muscle fibers, starch, neutral fat. A number of tests with introduction to a stomach of substances which under the influence of pancreatic enzymes have to be split with release of specific markers is carried out. On existence of these markers in blood judge vneshnesekretorny function of a pancreas.
Performing ultrasonography of gepatobiliarny system and ultrasonography of a pancreas allows to estimate existence of concrements in ZhVP and pancreatic channels, the general condition of a pancreas. Most effectively in respect of identification of stones endoscopic or intra pro-current ultrasonography. More informative method (to 90%) is KT of biliary tract, especially, if it is carried out with introduction of contrast substance. ERHPG and MRPHG are also widely used in diagnosis of diseases of bile-excreting and pancreatic channels.
Treatment of biliarny pancreatitis
Not only the gastroenterologist, but also the endoscopist, the surgeon takes part in treatment of biliarny pancreatitis. The main condition of the termination of progressing of a disease and the prevention of aggravations is treatment of the main disease. If necessary removal of stones or improvement of a condition of a faterov of a nipple is carried out (it is desirable by an endoscopic method).
At an exacerbation of a disease treatment has to include removal of a pain syndrome (analgetics and spazmolitik), correction of external and internal sekretorny functions of a pancreas, desintoxication, prevention of infectious complications (antibiotics). Usually in the first three days of an aggravation medical starvation is recommended, it is necessary to drink not aerated alkaline mineral waters. After renewal of food it is necessary to limit amount of fats in a diet, to strictly consider reception of carbohydrates. Food has to be eaten in the frequent portions, with observance of a mechanical and thermal shchazheniye.
For reduction of destructive effect of the activated pancreatic enzymes it is appointed , inhibitors of a proton pomp, inhibitors of proteases. For restoration of enzymatic dysfunction of a pancreas microspherical enzymes, and for normalization of level of sugar in blood – antihyperglycemic means are appointed. Surgical treatment is carried out only in the presence of concrements and pathology of a sphincter of Oddi.
Forecast and prevention of biliarny pancreatitis
The forecast at timely treatment of kalkulezny cholecystitis and a holangit favorable. The refusal of timely operation can lead to deterioration in process, at the subsequent aggravation expanded surgery can be required. At non-compliance with dietary recommendations, refusal of treatment, alcohol intake the forecast adverse.
Prevention of this form of chronic pancreatitis is timely diagnostics and treatment of diseases of gepatobiliarny system, if necessary – surgical removal of concrements. In the presence of symptoms of biliarny pancreatitis for prevention of aggravations it is necessary to keep to a diet, to avoid the use of bile-expelling products and medicines. It is regularly necessary to undergo inspection at the gastroenterologist (annually).