Chronic pancreatitis – the progressing inflammatory and destructive damage of a pancreas leading to its violation externally - and vnutrisekretorny function. At an exacerbation of chronic pancreatitis there is pain in the top departments of a stomach and the left podreberye, the dispepsichesky phenomena (nausea, vomiting, heartburn, an abdominal distension), yellowness of integuments and a skler. For confirmation of chronic pancreatitis the research of enzymes of digestive gland, ultrasonography, RHPG, a pancreas biopsy is conducted. The basic principles of therapy include observance of a diet, reception of medicines (spazmolitik, giposekretorny, fermental, etc. medicines), at inefficiency – expeditious treatment.
Chronic pancreatitis is the inflammatory disease of a pancreas of a long recidivous current which is characterized by gradual pathological change of its cellular structure and development of functional insufficiency. In gastroenterology 5-10% of all diseases of the digestive system fall to the share of chronic pancreatitis. In the developed countries recently chronic pancreatitis "looks younger" if earlier it was characteristic of persons of 45-55 years, then now the peak of incidence at women is the share of 35-year age.
Men have chronic pancreatitis to several bowl, than women, lately the pancreatitis share against the background of abuse of alcohol increased from 40 up to 75 percent among factors of development of this disease. Growth of emergence of malignant new growths in a pancreas against the background of chronic pancreatitis is also noted. Even more often note direct link of chronic pancreatitis with increase in incidence of diabetes.
Reasons of development of chronic pancreatitis
Alcohol is a factor, directly toxic for gland parenchyma. At a zhelchekamenny disease the inflammation becomes result of transition of an infection from bilious channels in gland on vessels of lymphatic system, development of hypertensia of biliary tract, or direct throwing of bile in a pancreas.
Other factors promoting development of chronic pancreatitis:
- permanent increase in maintenance of ions of calcium in blood;
- use of medicines (corticosteroids, estrogen, tiazidny diuretics, );
- long a pancreas secret (impassability of a sphincter of Oddi owing to cicatricial changes of a duodenal nipple);
- autoimmune pancreatitis;
- genetically caused pancreatitis;
- idiopathic pancreatitis (not clear etiology).
Chronic pancreatitis is classified
- by origin: primary (alcoholic, toxic, etc.) and secondary (biliarny, etc.);
- on clinical manifestations: painful (recidivous and constant), psevdotumorozny (holestaticheskiya, with portal hypertensia, with partial duodenal impassability), latent (the clinic which is not expressed) and combined (several clinical symptoms are expressed);
- on a morphological picture (kaltsifitsiruyushchy, obstructive, inflammatory (infiltrative and fibrous), indurative (fibrous and sclerous);
- on a functional picture (hyper fermental, hypofermental), on the nature of functional violations can allocate gipersekretorny, giposekretorny, obturatsionny, duktulyarny (sekretorny insufficiency also divide on expressiveness degree on easy, average and heavy), a giperinsulinizm, a gipoinsulinizm (pancreatic diabetes);
Chronic pancreatitis is distinguished on weight of a current and structural violations (heavy, moderate severity and easy). During a disease allocate stages of an aggravation, remission and unstable remission.
Symptoms of chronic pancreatitis
Often initial pathological changes in gland fabrics at development chronic pancreatitis proceed without symptoms. Or the symptomatology is ill-defined and is not specific. When there is a first expressed aggravation, pathological violations are already quite considerable.
The main complaint at an exacerbation of chronic pancreatitis most often is pain in more true part of a stomach, in the left podreberye which can gain the surrounding character. Pain or the expressed constant, or has pristupoobrazny character. Pain can irradiate to the area of a projection of heart. The pain syndrome can be followed by dyspepsia (nausea, vomiting, heartburn, an abdominal distension, a meteorizm). Vomiting at an exacerbation of chronic pancreatitis can be frequent, exhausting, not giving relief. The chair can have unstable character, ponosa to alternate with locks. The loss of appetite and disorder of digestion promote decrease in body weight.
With development of a disease the frequency of aggravations, as a rule, increases. The chronic inflammation of a pancreas can lead to damage, both gland, and adjacent fabrics. However there can pass years before clinical displays of a disease (symptoms) appear.
At external survey at patients with chronic pancreatitis often note yellowness a skler and integuments. Jaundice shade brownish (obturatsionny jaundice). Pobledneniye of integuments in combination with dryness of skin. On a breast and a stomach red specks ("red drops") which are not vanishing later pressings can be noted.
The stomach at a palpation is blown moderately up in an epigastriya, in the field of a projection of a pancreas the atrophy of hypodermic fatty cellulose can be noted. At a stomach palpation – morbidity in the top half, around a navel, in the left podreberye, in a costal and vertebral corner. Sometimes chronic pancreatitis is followed moderated gepato-and a splenomegaliya.
Diagnosis of chronic pancreatitis
For specification of the diagnosis the gastroenterologist appoints laboratory blood tests, a calla, methods of functional diagnostics.
The general blood test in the period of an aggravation, as a rule, shows a picture of a nonspecific inflammation. For differential diagnostics take samples on activity of enzymes of a pancreas in blood (amylase, a lipase). The radio immune analysis reveals increase in activity of an elastaza and trypsin. Koprogramma reveals excess of fats that allows to assume fermental insufficiency of a pancreas.
It is possible to investigate the size and structure of a parenchyma of a pancreas (and surrounding fabrics) by means of ultrasonography of abdominal organs, pancreas KT or MPT. A combination of an ultrasonic method to endoscopy – the endoscopic ultrasonografiya (EUS) allows to investigate in details fabric of gland and a wall of a GIT from within. Also the radiological research gives additional information on passability of biliary tract. At pancreatitis use an endoscopic retrograde pankreatokholangiografiya – enter X-ray contrast substance endoscopic into a duodenal nipple.
If necessary to specify ability of gland to production of these or those enzymes appoint functional tests with specific stimulators of secretion of these or those enzymes.
Complications of chronic pancreatitis
Early complications are: obturatsionny jaundice owing to bile outflow violation, portal hypertensia, internal bleedings owing to an ulceration or a perforation of hollow bodies of a GIT, an infection and infectious complications (abscess, parapancreatitis, phlegmon of zabryushinnny cellulose, an inflammation of bilious ways).
Complications of system character: multiorgan pathologies, functional insufficiency of bodies and systems (kidney, pulmonary, hepatic), encephalopathies, DVS-syndrome. With development of a disease there can be gullet bleedings, decrease in body weight, diabetes, malignant pancreas new growths.
Treatment of chronic pancreatitis
Treatment is performed conservatively or a surgical way depending on weight of a course of a disease, and also from presence or development of complications.
Conservative therapy includes the following components.
- Dietotherapy. Sick chronic pancreatitis in the period of a heavy aggravation it is recommended to refrain from an enteroalimentation, at a stukhaniye appoint a diet No. 5B. At chronic pancreatitis alcohol intake is strictly forbidden, from a diet remove spicy, greasy, sour food, a pickles. At the pancreatitis complicated by diabetes – control of sacchariferous products.
- Exacerbation of chronic pancreatitis treat as well as sharp pancreatitis (symptomatic therapy, anesthesia, desintoxication, removal of an inflammation, restoration of digestive function).
- For pancreatitis of alcoholic genesis the refusal of the use of alcohol-containing products is the key factor of treatment in mild cases leading to simplification of symptomatology.
Purulent complications (abscess and phlegmon), obturation of bilious and pancreatic channels, stenosis of a sphincter of Oddi, the expressed heavy changes in gland fabrics (sclerosis, calcifications), cysts and pseudo-cysts of a pancreas, the heavy current resistant to conservative therapy can become indications to surgical treatment of chronic pancreatitis.
Surgeries at chronic pancreatitis:
- sfinkterotomiya at obstruction of a sphincter of Oddi;
- excision of stones in channels of a pancreas at a konkrementny obturation;
- opening and sanitation of the purulent centers (abscesses, phlegmons, cysts);
- pankrektomiya (full or partial);
- vazektomiya, splankhektomiya (operation of excision of the nerves regulating gland secretion), partial excision of a stomach (resection);
- removal of a gall bladder at complications from a big bilious channel and a gall bladder;
- technology of creation of district bilious outflows for removal of loading from the main pancreatic channels (a virsungoduodenostomiya, etc.).
Measures of primary prevention:
- restriction alcohol intake, a balanced diet, the balanced diet without overeating attacks, restriction in greasy food, carbohydrate products;
- refusal of smoking;
- the use of enough water (not less than one and a half liters a day);
- enough vitamins and minerals in a diet;
- the timely address to the doctor concerning violations of work of a GIT, adequate and full treatment of diseases of digestive organs.
For prevention of exacerbations of chronic pancreatitis it is necessary to observe all recommendations of the doctor about a diet and a way of life, it is regular (at least 2 times a year) to undergo inspection. The important role in extension of remission and improvement of quality of life of patients with chronic pancreatitis is played by sanatorium treatment.
When following to recommendations about prevention of aggravations chronic pancreatitis proceeds easily and has the favorable forecast of survival. At violation of a diet, alcohol intake, tobacco smoking and inadequate treatment dystrophic processes in fabric of gland progress and heavy complications develop, many of which demand surgical intervention and can lead to a lethal outcome.