Chronic pancreatitis - symptoms, causes, treatment, diet and exacerbation in adults. Chronic pancreatitis: causes, symptoms, treatment Chronic pancreatitis disease

Pancreatitis is the name of a whole group of diseases and symptoms in which inflammation of the pancreas occurs. If such a process occurs, then the enzymes produced by the pancreas do not enter the duodenum. Consequently, they begin to actively act already in the pancreas, gradually destroying it.

Thus, the so-called self-digestion process occurs. This pathology is fraught with subsequent damage to other organs, because with the gradual destruction of the pancreas, toxins and enzymes are released. In turn, they can end up in the bloodstream and damage other organs. Therefore, acute pancreatitis must be treated immediately after diagnosis. For this condition, treatment is carried out mainly in a hospital.

What it is?

Pancreatitis is a group of diseases and syndromes in which inflammation of the pancreas occurs.

When the pancreas is inflamed, the enzymes secreted by the gland are not released into the duodenum, but are activated in the gland itself and begin to destroy it (self-digestion). The enzymes and toxins that are released are often released into the bloodstream and can seriously damage other organs such as the brain, lungs, heart, kidneys and liver.

Causes

The main causes of acute pancreatitis:

It often develops in people who are between 30 and 40 years of age and is most often caused by alcohol abuse over many years, with men predominating over women. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. In some cases, genetics may be a factor in its development. In 10-15 cases of chronic pancreatitis, the cause is unknown.

Other factors that are also associated with chronic pancreatitis:

• Autoimmune problems;
• Use of estrogens, corticosteroids, thiazide diuretics, and azathioprine;
• Blockage of the pancreatic duct or common bile duct;
• Hypercalcemia - high levels of calcium in the blood;
• Hyperlipidemia or hypertriglyceridemia - high levels of fats in the blood;
• Metabolic disorders, especially fats, associated with overeating;
• Complications of cystic fibrosis, the most common hereditary disorder, when the secretions secreted by various organs are too viscous and thick.

Due to chronic inflammation, scarring occurs on the pancreas, and the organ becomes unable to produce the required amount of digestive enzymes. As a result, the body may be unable to digest fat and other important food components. Damage to the part of the pancreas that produces insulin can lead to diabetes.

Symptoms of pancreatitis

Pain in acute pancreatitis (inflammation of the pancreas) is considered one of the most severe. A sharp, acute pain occurs in the abdomen, in the hypochondrium, in most cases radiating to the area of ​​the shoulder blades, back or behind the sternum.

The main symptoms of acute pancreatitis in adults are listed below:

1. Painful sensations in the right or left hypochondrium, shingles are also possible, depending on the degree of the inflammatory process and the area of ​​damage to the pancreas;
2. Changes in skin color: sallow complexion, bluish spots around the navel and on the lower back, obstructive jaundice due to sclerosing pancreatitis;
3. Deterioration in general well-being, a significant increase in body temperature, weakness, malaise, changes in blood pressure upward or downward;
4. A feeling of dry mouth, prolonged hiccups, belching of rotten eggs, nausea and repeated vomiting, which does not bring relief to the patient;
5. Stool disorders such as constipation or diarrhea;
6. Shortness of breath, increased sweating.

Chronic pancreatitis has a non-aggressive course, accompanied by a decrease in appetite and body weight. The main symptoms of chronic pancreatitis:

1. Pain syndrome - this type is characterized by fighting symptoms, usually after eating or drinking alcohol; the unpleasant sensations are constant in the upper half of the abdomen.
2. Asymptomatic (latent stage) - the disease can last for years, slowly destroying the pancreas, the patient feels almost no discomfort or it all comes down to simple discomfort, which is given by various simple reasons, such as overeating.
3. Pseudotumor type - rare, with all symptoms similar to cancer. Signs of pancreatic cancer are yellowness of the body and sclera of the eye. The head of the pancreas is affected. It increases in size due to its replacement with fibrous tissue.
4. Dyspeptic is expressed by intestinal disorder (dyspepsia), diarrhea or constipation, bloating, causeless weight loss.

Quite often, chronic pancreatitis contributes to the development of diabetes. The manifestation of symptoms is influenced by the stage of the disease, as well as whether the patient has undergone treatment, compliance with food intake instructions, the patient’s age and his general physical condition.

Objective symptoms

Pancreatitis has its own objective symptoms:

• Mussi-Georgievsky's symptom - positive phrenicus - symptom on the left.
• Gubergrits-Skulsky symptom - palpation is painful along the line connecting the head and tail.
• Grotta's symptom - to the left of the navel in the projection of the pancreas, hypotrophic changes in the subcutaneous fat are determined.
• Desjardins' symptom - pain on palpation is determined at the pancreatic point of Desjardins (projection of the head of the pancreas), located 4-6 cm from the navel along the line connecting the right axilla to the navel.
• Tuzhilin's symptom - when examined on the skin of a patient with chronic pancreatitis, hemorrhagic rashes in the form of purple droplets up to 1-4 mm in size can be seen. These are pinpoint angiomas that occur as a result of proteolysis - a destructive effect on the capillaries of pancreatic enzymes released into the blood during an exacerbation of the process.
• Mayo-Robson symptom - pain is determined at the Mayo-Robson point, the projection of the tail of the pancreas, at the border of the middle and outer third of a line segment drawn through the navel, the left costal arch and the axillary region on the left. In this case, pain can be detected in the Mayo-Robson area, the left costovertebral angle.
• Shoffard's symptom - pain is detected in the Shoffard's area (projection of the head of the pancreas), located 5-6 cm above the navel on the right side between the bisector of the umbilical angle and the midline of the body.
• Kach's symptom is a symptom of pancreatitis, in which palpation is painful in the projection of the transverse processes of the right T1X-TX1 and left TVIII-TIX thoracic vertebrae.
• Voskresensky's symptom - in the projection of the pancreas the pulsation of the abdominal aorta is not detected.

Diagnostics

To identify the development of chronic pancreatitis, you must consult a gastroenterologist. An examination is carried out, complaints are collected, and the medical history is analyzed. Based on this, diagnostic procedures are prescribed:

• taking tests to determine the level of blood amylase and urine diastase;
• biochemistry and general blood test;
• general urine analysis;
• Ultrasound of the pancreas is one of the leading research methods that can help determine whether there are pathological changes in the pancreas;
• gastroscopy;
• radiography of the abdominal organs;
• functional tests;
• endoscopic retrograde cholangiopancreatography.

When symptoms of acute pancreatitis appear, urgent hospitalization of the patient and examination and treatment in a hospital are necessary. The main task: to stabilize the patient’s condition, relieve acute symptoms and exclude the possibility of developing pancreatic necrosis.

Treatment of acute pancreatitis

In case of acute pancreatitis, treatment should be carried out in a hospital setting and under the close supervision of specialists, since this condition of the body is considered dangerous. If acute pancreatitis is suspected, a person should be hospitalized as soon as possible.

If an attack of pancreatitis catches you at home, the following actions are recommended before the ambulance arrives:

1. The patient should be in bed and completely at rest. This will reduce blood flow to the diseased organ, and therefore reduce inflammation.
2. Cold is applied to the epigastric area - this reduces the intensity of pain and slightly reduces swelling and inflammation. It is best if you use a heating pad filled with cold water instead of ice.
3. It is forbidden to eat any food. Moreover, you should abstain from food for 3 days. This must be done to stop the production of enzymes that increase the inflammatory response and pain. You can drink water without gas and additives.
4. Approved drugs for self-administration are Drotaverine, Spazmalgon, No-shpa and Maxigan. You can drink them before the ambulance arrives. Meanwhile, it is necessary to call doctors even if the patient is not sure that he is having an attack of acute pancreatitis. After all, this pathology is dangerous because it can subside for some time and then rapidly recur.
5. With the rapid development of the disease, surgical treatment of pancreatitis is used: removal of part of the pancreas, peritoneal lavage (washing of the abdominal cavity), etc.

The three main words in treating a patient with acute pancreatitis are Peace, cold and hunger. These are the rules of first aid during an attack.

After fasting days, diet No. 5p according to Pevzner is prescribed for a week. Fractional meals up to 8 times a day, in portions of no more than 300g. Boiled, steamed, semi-liquid, pureed food. Food temperature – 20-52˚С. The daily amount of proteins is 80g, fats are 60g, carbohydrates are 280g.

All other products and processing options are excluded.

After achieving positive dynamics and relieving pain, an extended version of the diet is prescribed for three months. Daily amount of nutrients: up to 120g protein, 70g fat, up to 400g carbohydrates.

Recommended: lean meats and fish, poultry, up to two eggs per day, sour cream, cottage cheese, water porridge, vegetables, jelly and fruit compotes, tea, rosehip decoction, butter in the form of additives in ready-made dishes up to 20g per day, vegetable oil – up to 15g per day.

All of these products must be steamed, baked or boiled.

Treatment of chronic pancreatitis

Chronic pancreatitis can have severe or mild symptoms. Most often, during an exacerbation of chronic pancreatitis, the patient is indicated for hospitalization and therapy similar to the acute process.

The patient must follow a diet throughout his life and take drugs from the group of antispasmodics and drugs that normalize the secretory function of the organ. It is especially useful to undergo sanatorium treatment twice a year in the appropriate institutions of the Stavropol Territory (Kislovodsk, Zheleznovodsk, Pyatigorsk), where treatment is carried out using natural mineral waters.

Diet

If it is serious enough and accompanied by severe pain, persistent vomiting, and significant changes in laboratory tests, then patients need to starve. Its duration depends on the specific clinical case, but most often ranges from 1 to 3 days. Sometimes during the “hungry” phase it is allowed to drink rosehip decoction, alkaline mineral waters, and weak tea.

Then a special low-calorie diet (up to 2200 kcal) with a normal protein quota is prescribed. It is designed to spare the pancreas and other digestive organs as much as possible.

The features of this diet for pancreatitis are:

• ban on fatty foods (lamb, pork, cream, lard, etc.) and alcohol;
• fractional consumption of food (up to 6 times);
• salt restriction;
• dishes are served exclusively warm;
• chopping or mashing used products;
• widespread use of slimy cereal soups, vegetable puree soups with added boiled meat, soufflés, protein omelettes, fish and meat dumplings, steamed cutlets, meatballs, baked apples, vegetable purees, jellies, mousses, dried white bread, low-fat cottage cheese, jelly;
• exclusion of all products with a high content of extractives or essential oils (fish, meat broths, cocoa, coffee, etc.), fresh berries, vegetables, herbs, fruits, sour juices, carbonated drinks, marinades.

Subject to clinical and laboratory improvement, nutrition is expanded, increasing its calorie content and the amount of proteins needed for a speedy recovery. Although the set of acceptable foods is very similar to the already mentioned diet, the list of dishes on the menu increases (baking is allowed). If pancreatitis is accompanied by the development of diabetes, then white cereals, potatoes, honey, sweets, and baked goods are added to the forbidden food list.

Drug treatment

When following a diet, pain is much less likely to make itself felt, but if you move away from it a little, allow yourself fatty or fried foods, and that’s it - you need painkillers.

1. In case of intense pain, the doctor may prescribe antispasmodics - No-Shpa, Drotaverine, which reduce inflammation in the pancreas and accordingly reduce pain.
2. Today, the doctor can also prescribe mebeverine (Duspatalin, Sparex) - an antispasmodic, myotropic action, eliminates gastrointestinal spasms.
3. You can prescribe antisecretory drugs for a short course (or Diacarb tablets for three days under the cover of asparkam for edematous forms).
4. Octreotide, a drug that suppresses the production of hormones by the gland, is also used because they stimulate it and thereby cause pain. This medicine is prescribed only in hospitals.

With a long course of chronic pancreatitis, normal cells of the organ are replaced by connective tissue. Thus, the functionality of the organ is impaired, diabetes mellitus and digestive disorders may develop. In order to reduce pain and give rest to the pancreas, you should take pancreatic enzymes:

1. Festal - it should be taken 3 times a day, 1 tablet with meals, it is usually combined with histamine blockers to reduce acidity in the stomach - famotidine, cimetidine.
2. “Pancreatin” (“Enzistal”, “Gastenorm”, “Biozim”, “Mezim”, “Mikrazim”, “Pangrol”, “Panzinorm”, “Penzital”, “Creon”, “Ermital”) are pancreatic enzymes, which should be taken like Festal, but it is best to take the drug with alkaline mineral water. They promote better breakdown of proteins, carbohydrates and fats.
3. Speaking about enzymes, we must remember about their activity; 10,000 units for lipase (Mezim-Forte tablet) three times a day is the standard requirement for replacement therapy. The original mezim does not have a very pleasant smell; if there is no smell, it is a fake (crushed chalk).

In the presence of chronic pancreatitis, symptoms can persist for a very long time, and insulin levels decrease accordingly, which can ultimately lead to the development of diabetes mellitus. If this pathology is diagnosed, the patient should contact an endocrinologist to develop a treatment regimen and coordinate a diet.

Physiotherapy

Physiotherapeutic procedures are used to a limited extent after the activity of inflammation has decreased.

For intense pain, electrophoresis with novocaine or dalargin, ultrasound, and diadynamic currents are prescribed. To combat remaining inflammation, laser or ultraviolet irradiation of the blood and an alternating magnetic field are recommended.

Folk remedies

The following traditional medicines are used to treat pancreatitis:

1. Collection of herbs. To prepare the collection, take string, cudweed, horsetail, chamomile and calendula flowers, St. John's wort, wormwood and sage in equal quantities. The herbs are mixed and crushed. Then prepare an infusion (take a tablespoon of the collection per glass of boiling water, infuse for an hour, strain). The infusion is consumed three times a day, half a glass, half an hour before meals.
2. Two leaves of golden mustache are poured into 0.5 liters of boiling water, placed on low heat and boiled for 15 minutes. Then cool the mixture for 8 hours. Before use, the infusion is heated to a warm state in a water bath and drunk before meals (half an hour before). You need to drink three tablespoons of infusion a day.
3. Take burdock, elecampane and dandelion roots in equal quantities, chop and mix them. The resulting mixture is placed in boiling water (a dessert spoon of the mixture per glass of water), boiled for 15 minutes, then infused for an hour. After this, the infusion is filtered and drunk before meals, a tablespoon, three times a day.
4. Carrot and potato juice. Take two carrots and two potatoes, squeeze the juice out of them and drink them on an empty stomach, in the morning, for a week.
5. Infusion of motherwort, immortelle and calendula. Take one tablespoon of the above herbs, mix and pour a liter of boiling water. Cover the resulting mixture with a cloth, leave for an hour, then filter. You need to take the resulting decoction 6 times a day, half a glass.
6. Barberry bark is taken and crushed. Then the crushed barberry bark is added to boiling water (a teaspoon of bark per glass of water), boiled for 15 minutes, after which the resulting decoction is cooled and consumed before meals, a tablespoon, three times a day.
7. Take cumin seeds (2 teaspoons), pour a glass of hot water and leave for 2 hours. Then the mixture is filtered and taken three times a day, before meals, half a glass.

It should be remembered that folk remedies can be used in the treatment of pancreatitis only as additional therapy and only with the permission of a doctor.

Forecast

Strict adherence to nutrition and diet, complete abstinence from drinking alcohol, strict adherence to recommendations for drug treatment significantly reduce the frequency of exacerbations, transforming the process into a rarely relapsing variant with slow progression. In some patients it is possible to achieve noticeable and lasting remission.

Chronic pancreatitis is characterized by a progressive course, however, cessation of exposure to causative factors and adequate therapy slow down the progression of the disease and significantly improve the quality of life of patients and the prognosis.

Chronic pancreatitis is a common disease of the human digestive system in which inflammation of the pancreas occurs. Recently, the average age of the disease has decreased from 50 to 39 years, and the proportion of women has increased by 30%.

Chronic pancreatitis develops over several years and is characterized by alternating periods of exacerbation and subsidence of the disease. Very often, the symptoms of the disease are mild or absent altogether.

According to severity, chronic pancreatitis is divided into three forms:

1. Mild course: exacerbations occur rarely (1-2 times a year), are short-lived, pain is not significant, is easily relieved, weight loss does not occur, the exocrine function of the gland is not impaired.
2. Moderate: exacerbations 3-4 times a year, last a long time with severe pain, in stool analysis - increased fat, muscle fibers, protein, body weight may decrease, exocrine function of the gland may be reduced.
3. Severe course: frequent and prolonged exacerbations (more than 5 times a year) with severe pain. Body weight is sharply reduced to the point of exhaustion, which is caused by pancreatic diarrhea. Complications include diabetes mellitus, duodenal stenosis due to an enlarged head of the pancreas.

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Pain with pancreatitis can radiate to the heart, left half, left shoulder, simulating angina, with inflammation of the head of the pancreas - in the right hypochondrium, with inflammation of the body of the gland - in the epigastric region, with inflammation of the tail - in the left hypochondrium. With an inflammatory process that affects the entire gland, the pain is girdling in nature. The pain intensifies when lying on the back and weakens if the patient sits, leaning forward and pulling his legs to his chest.

Dyspeptic syndrome manifested by nausea, decreased or lack of appetite, vomiting that does not bring relief, belching, less often - heartburn, bloating, excessive gas formation, a feeling of transfusion and rumbling in the abdomen. With severe exacerbations, loose stools and weight loss occur. Sometimes, instead of pain, a person feels a pronounced appetite.

Exocrine pancreatic insufficiency characterized by disruption of digestive processes, excessive growth of bacteria in the small intestine. As a result, patients experience diarrhea, steatorrhea, flatulence, loss of appetite, etc.

Intrasecretory pancreatic insufficiency occurs in about a third of patients, it is associated with dysfunction of the islets of Langerhans, which produce insulin and glucagon, which are involved in the regulation of carbohydrate metabolism.

Methods for diagnosing chronic pancreatitis

1. Clinical picture.
2. Laboratory diagnostics.
3. Instrumental diagnostics:

• radiography;
• ultrasonography;
• CT scan;
• endoscopic ultrasonography;
• Cholangiopancreatography;

Studies required to determine the phase of pancreatitis*

Anamnesis	Previous gallstone disease Alcohol consumption Family history* Use of medications Previous viral diseases
Acute phase	Pancreatic enzymes in plasma Liver function tests Ultrasound of the gallbladder
Recovery phase	Blood plasma lipids Blood plasma calcium Antibody titers to viruses Repeated ultrasound of the biliary tract MRCP (magnetic resonance cholangiopancreatography) CT (spiral or layered according to the protocol for the pancreas)
Additional Research (usually used in cases of recurrent idiopathic acute pancreatitis)	Repeated ultrasound Endoscopic ultrasound Autoimmune markers RCCP with taking a bile sample for the presence of bile crystals and performing a cytological examination of the pancreas Pancreatic function tests to exclude chronic pancreatitis

* Genetic analysis is indicated if there is a family history of one or more of the following: acute pancreatitis, repeated abdominal pain of unknown diagnosis, pancreatic carcinoma or type 1 diabetes mellitus. Modified from recommendations of the World Association.

Treatment of chronic pancreatitis

Non-drug treatment

The main role in the treatment of chronic pancreatitis is adherence to a strict diet. In case of severe exacerbations, food is completely excluded for 3-5 days. Protein solutions, plasma, and electrolytes are administered parenterally.

After 3-5 days, you are allowed to switch to normal nutrition. Meals are divided into 4-6 times, portions are limited. Food should be chopped, with a high content of easily digestible proteins, such as egg whites, lean meats and fish. Limit consumption of acidic foods and fats. The patient is strictly prohibited from consuming alcohol, spicy foods, carbonated drinks, and canned food.

Drug therapy

In case of exacerbation of chronic pancreatitis, it is necessary first of all to relieve pain and dyspeptic syndrome.

• To relieve pain, analgesics (analgin, baralgin, etc.) and antispasmodics (papaverine, no-shpa, drotaverine, etc.) are used.
• Antihistamines (diphenhydramine, suprastin, etc.) are used to suppress the activity of the pancreas.
• Proton pump inhibitors (omeprazole, lansoprazole, rabeprazole, etc.) are prescribed to reduce pancreatic and gastric secretion.
• Antacids neutralize hydrochloric acid, thereby ensuring functional rest of the pancreas.
• Prokinetics (domperidone, cerucal, etc.) are prescribed for insufficiency of the sphincter of Oddi and gastrointestinal motility disorders.
• Enzyme preparations (Mezim-Forte, Creon, Pancreatin, etc.) are necessary to compensate for insufficient pancreatic function; as a rule, they are prescribed for life.

Preventionchronic pancreatitis

Prevention of chronic pancreatitis mainly consists of following a diet of abstinence from alcohol. Also, well-chosen drug therapy by a doctor can significantly reduce the number of exacerbations of chronic pancreatitis.

Approximate one-day diet menu for chronic pancreatitis (5p, mechanical sparing)*

	Name of dishes	Output, g	Proteins, g	Fats, g	Carbohydrates, g
1st breakfast	Steamed protein omelette	75	6,0	2,4	1,6
	Mashed rice milk porridge without sugar	220	6,3	7,3	36,4
	Tea	200	-	-	-
2nd breakfast	Fresh low-fat cottage cheese	100	16,7	9,0	2,0
Dinner	Vegetarian pureed vegetable soup	250	1,2	3,8	7,6
	1/2 serving without sour cream and cabbage	110	18,9	8,8	7,2
	Steamed meat cutlets	150	2,2	3,8	12,1
	Carrot puree	200	0,1	-	23,8
	Compote of fresh pureed apples without sugar	/	/	/	/
Afternoon snack	Steamed protein omelette	75	6,0	2,4	1,6
	Rose hip decoction	200	-	-	-
Dinner	Boiled fish dumplings without oil	100	15,4	2,6	4,8
	Mashed potatoes	175	3,8	5,0	26,5
	Oatmeal milk porridge pureed without sugar	250	8,3	9,9	30,3
	Tea	200	-	-	-
For the night	Kefir	200	5,0	6,3	8,1
All day	White crackers	50	-	2,4	96,6
	Sugar	15	-	-	14,8
	Total	/	106,1	64,7	228,0
Energy value = 2411 kcal

Approximate one-day diet menu for chronic pancreatitis (5p, without mechanical sparing)*

	Name of dishes	Output, g	Proteins, g	Fats, g	Carbohydrates, g
1st breakfast	Steamed protein omelette	75	6,0	2,4	1,6
	Buckwheat milk porridge without sugar	200	9,1	5,0	36,4
	Tea	200	-	-	-
2nd breakfast	Freshly prepared cottage cheese	100	18,0	0,6	1,8
	Kefir	200	5,0	6,3	8,1
	Fresh apple without peel	100	0,3	0,3	8,6
Dinner	Vegetarian pureed vegetable soup, 1/2 serving	250	3,1	4,5	20,1
	Boiled chickens	100	20,5	7,9	0,5
	Boiled rice or grated carrots	150	3,8/2,2	4,1/3,8	38,6/12,1
	Fruit juice jelly without sugar	200	0,2	-	13,6
Afternoon snack	Rose hip decoction	200	-	-	-
	Rusks from the daily bread allowance	25	-	-	-
Dinner	Boiled fish	100	19,2	0,7	-
	Boiled potatoes	150	3,1	5,6	25,2
	Oatmeal porridge without sugar	250	8,3	9,8	30,3
	Tea	200	-	-	-
For the night	Kefir with vegetable oil	200	5,0	20,7	7,3
All day	Wheat bread	200	16,2	2,4	96,6
	Sugar	30	-	-	29,8
	Total	/	117,3	70,3	288,7
Energy value = 2656.7 kcal

* L.V. Vinokurova, E.A. Dubtsova, T.V. Popova. Functional pancreatic insufficiency in chronic pancreatitis: enzyme replacement therapy, nutritional therapy // Attending Physician. 2012. No. 2.

Approximate one-day diet menu for chronic pancreatitis (5p for patients with constipation)*

1st breakfast	Boiled carrot and pumpkin salad, boiled cod, curd mass, tea
2nd breakfast	Boiled beet salad, vegetable juice, protein-bran wheat bread croutons
Dinner	Fresh vegetable salad, vegetarian beet soup, boiled meat goulash, mashed potatoes, prune compote
Afternoon snack	Baked apple, wheat bran decoction, protein-bran wheat bread croutons
Dinner	Boiled tongue, vegetables stewed in milk, meat pate, tea
For the night	One-day sour milk
All day	Wheat protein-bran bread - 300 g, butter - 20 g, sugar - 30 g

Diseases of the digestive system are among the most common. An unbalanced diet and bad habits have a detrimental effect on internal organs. The pancreas is one of the first to suffer.

ABOUT symptoms and treatment of chronic pancreatitis in adults Every person should know in order to identify pathology in time and take the necessary measures.

What is the pathology characterized by?

Pancreatitis is a rather dangerous and serious pathology. Under the influence of unfavorable factors, the process of inflammation begins in the pancreas, as a result of which the process of producing enzymes is disrupted, and their movement into the intestines is hampered. This causes the gland to begin self-digestion. Pancreatitis is dangerous for the entire body.

As it develops, the production of toxins begins that affect other internal organs.

The number of cases of this pathology has increased significantly over the past decades. Pancreatitis is accompanied by characteristic symptoms and requires long-term treatment.

Beware of pancreatitis! Video:

For what reasons does pathology occur?

The most likely factor in the occurrence of pancreatitis is alcohol addiction. Drinking large amounts of strong alcohol leads to the development of a spasm of the sphincter of the gland, as a result of which enzymes accumulate and the gland begins to self-digest.

Reasons also include:

presence of cholelithiasis;

development of pathologies of other internal digestive organs;

smoking;

poor nutrition, predominance of fatty, spicy or sweet foods in the diet;

poisoning of the body;

trauma to the pancreas as a result of mechanical impact;

viral lesions;

surgical interventions;

stressful situations and depression;

pregnancy period.

Forms

The disease can occur in several forms:

• acute;
• chronic;
• reactive.

Acute pancreatitis can also have different forms, which have different symptoms and treatment:

• Interstitial accompanied by acute swelling of the organ;
• Hemorrhagic characterized by internal hemorrhages;
• In acute necrosis foci of decomposition of gland tissue appear;
• Cholecystopancreatitis accompanied by cholecystitis;
• The purulent form implies the appearance of purulent foci.

All forms of acute pancreatitis can transform into one another. In this case, inflammation processes in the pancreas always lead to tissue necrosis. That is why the pathology requires immediate treatment.

Chronic pancreatitis is an inflammatory process in an internal organ that develops slowly, but also leads to disruption of its functioning. As a rule, this form of the disease has periods of exacerbations and remissions.

This type can occur with virtually no symptoms. Pain often occurs only during exacerbation of chronic pancreatitis.

Also distinguished reactive pancreatitis, which is an acute, transient attack of the disease. It develops in the presence of pathologies of other internal organs - the stomach, gall bladder, liver or duodenum.

It is characterized by the rapid development of symptoms in a matter of seconds.

As a rule, such pancreatitis often occurs in young children. The reason for this is the incompletely formed digestive tract and immunity.

Symptoms

The symptoms of the disease depend on its stage and form. At the initial stage they are practically absent. The first signs begin to appear when dangerous changes develop in the pancreas.

The chronic form of pancreatitis is accompanied by nausea, heartburn, and belching. In some cases, loss of appetite and weight loss may occur. With a long course of the disease, yellowness may develop on the skin and eye whites. The skin becomes dry and small red spots appear on it.

If the diet is violated and the consumption of fatty foods or alcohol, periods of exacerbation occur.

The main symptoms of exacerbation of pancreatitis:

• severe pain in the stomach area on the left side;
• the pain may be shingles;
• attacks of nausea and vomiting with bile;
• change in constipation and diarrhea;
• high body temperature;
• bitterness in the mouth;
• bloating, increased gas formation;
• loss of appetite;
• attacks of hiccups, dry mouth;
• drop in blood pressure;
• dyspnea;
• coating on the tongue.

If such symptoms appear, you should immediately consult a doctor.

The sooner a diagnosis is made and treatment is started, the lower the risk of developing serious complications. It is strictly forbidden to self-medicate!

5 exercises for pancreatitis. Video:

Diagnostics

Despite the fact that the symptoms of acute pancreatitis are always pronounced, the doctor must conduct an examination to clarify the form and severity of the disease. Only after an accurate diagnosis is made, therapy is selected.

Among the main methods for diagnosing the disease are:

• urine test;
• study of feces;
• blood tests ( general and biochemical);
• Ultrasound of the abdominal organs;
• X-ray;
• endoscopy;
• laparoscopy;
• CT or MRI.

Treatment

Treatment methods for pancreatitis are selected depending on the form and stage of the disease. But, as a rule, this pathology requires lifestyle changes and constant therapy throughout the rest of life.

Stopping treatment and returning to bad habits lead to exacerbations and worsening of the patient’s condition.

Therapy for acute form

If an acute form of the disease occurs, food and drink should be completely avoided on the first day. On the second day you are allowed to drink pure still water. To calm the gland, you need to place a heating pad with ice on your stomach.

Acute pancreatitis requires immediate medical attention. Therefore, it is necessary to call an ambulance. Before her arrival, you are allowed to take painkillers ( for example, No-shpu).

In a hospital setting, the patient is prescribed the following medications for acute pancreatitis:

• saline solutions or plasma substitutes;
• painkillers ( No-shpa, Papaverine, Ketanov);
• diuretics to relieve swelling of the gland ( Furosemide, Daicarb);
• antiemetics (Cerucal, Metoclopramide);
• drugs to delay enzyme production ( Contriven, Trasylol);
• vitamin complexes.

Fasting can last up to 5 days, in some cases even up to 2 weeks. At this time, droppers with nutrients are placed. The introduction of products begins in small portions. Kefir and cottage cheese are allowed to be introduced first.

If there is no improvement from drug treatment, surgical treatment is prescribed. In this case, the nature of the operation depends on the type of complication:

1. removing stones from ducts;
2. removal of foci of inflammation;
3. cyst removal;
4. removal of nerve endings responsible for the production of enzymes;
5. complete or partial removal of the pancreas;
6. complete or partial removal of the stomach or gallbladder;
7. conducting bypass ducts;
8. release of the sphincter.

Treatment of chronic pancreatitis

Pancreatitis may not cause discomfort to the patient for a long time. If a pathology is detected, a person must first adhere to a certain diet.

It is proper nutrition that becomes the basis of treatment and allows you to avoid exacerbations.

Basics of diet for pathology:

Violation of dietary nutrition leads to complications of the disease and pain. How to treat chronic pancreatitis during exacerbation?

In such cases, medications are used:

1. analgesics for pain relief ( No-shpa, Papaverine);
2. antibiotics to reduce inflammation ( Amoxicillin);
3. enzyme agents to improve digestion ( Mezim, Pancreatin, Festal);
4. drugs to reduce acidity ( Rennie, Maalox).

ethnoscience

In folk medicine there are many recipes that help improve well-being and normalize the functioning of the pancreas:

Traditional medicine is an auxiliary method of treatment. All prescriptions must be agreed with the attending physician.

Danger of disease

Chronic pancreatitis with a long course without the necessary treatment not only leads to metabolic disorders and the digestive process, but can also lead to serious complications.

Inflammatory processes in the tissues of the pancreas threaten the functioning of the entire body.

Prognosis and prevention

Pancreatitis is a disease that cannot be completely cured. The reason for this lies not in the fact that medicine is poorly developed, but in the specifics of the disease itself.

Chronic pancreatitis is a progressive pathology of the pancreas, expressed in its destructive damage. The course of the disease leads to persistent impairment of the intra- and exocrine capacity of the gland. Chronic pancreatitis is detected in 5–10% of people suffering from diseases of the digestive tract. In recent years, gastroenterologists have noted an alarming trend towards “rejuvenation” of chronic pancreatitis - the peak incidence occurs at the age of 30–35 years, although previously people over 40–55 years old were at risk.

Men develop chronic pancreatitis more often than women. In males, the alcoholic form of chronic inflammation of the gland is the leading one. The danger of the disease lies in the increased risk of malignant neoplasms in the pancreas.

Etiology and classification features

The pancreas is a large organ in the gastrointestinal tract, producing up to 700 ml of pancreatic secretion per day. The adequacy of secretory capacity directly depends on lifestyle and diet. In case of frequent errors in nutrition (large amounts of fatty foods, alcohol consumption) and other negative factors, the activity of the gland in the production of digestive enzymes slows down. A long-term decrease in secretory function provokes stagnation of pancreatic juice with its premature activation directly in the pancreatic tissues. As a result, a malfunction occurs in the digestive process and acute pancreatitis develops. In the absence of treatment and the duration of the pathological process for more than 6 months, the acute form turns into chronic inflammation.

A characteristic feature of chronic inflammation is associated with irreversible degenerative processes in the parenchymatous layer of the gland. The parinchema shrinks, in some places degenerating into areas of fibrous cells. The chronicity of pancreatitis is most reliably indicated by the development of stricture of the pancreatic ducts and the appearance of stones in the ducts or body of the pancreas.

In gastroenterological practice, the following classification of the disease deserves attention:

• according to the mechanism of development - primary (from alcohol intoxication, other toxic pancreatitis), secondary (biliary);
• according to the characteristics of clinical manifestations - painful pancreatitis of a constant and recurrent nature; pseudotumorous (combining signs of inflammatory and oncological processes simultaneously); latent (without obvious manifestations, with vague symptoms); combined (moderate manifestation of several symptoms of pathology);
• according to the characteristics of morphological transformations in pancreatic tissues - chronic pancreatitis with a calcifying, obstructive, infiltrative-fibrous and fibrous-sclerotic course;
• according to the type of functional disorders in the activity of the pancreas - chronic pancreatitis of the hypoenzyme and hyperenzyme type; obstructive, ductular types.

Pancreatitis develops gradually, going through several stages:

• initial - lasts from 1 to 5 years from the onset of inflammatory changes in the pancreas;
• stage of development of the main clinical picture - lasts from 5 to 10 years, during this period the pancreas undergoes dystrophic and degenerative changes;
• subsidence of the pronounced inflammatory process - develops 7–15 years from the onset of the disease; subsidence occurs in 2 variants: in the form of the patient’s adaptation to the disease, or the appearance of serious complications in the form of cysts and neoplasms.

Causes

The causes of chronic inflammation of the pancreas are extensive and are caused by both exogenous factors and internal pathologies and dysfunctions in the functioning of organs. Common causes of chronic pancreatitis by external nature of origin:

Endogenous causes of the development of chronic pancreatitis are:

• pathologies of the gallbladder and ducts - when obstruction of the biliary tract occurs, a reverse reflux of secretion occurs, a pathological chemical reaction develops in the pancreatic tissues, during which enzymatic substances negatively affect the gland, digesting it; the blood supply process slows down, the organ swells with the formation of internal local hemorrhages;
• pathologies of the stomach and duodenum associated with the reflux of the contents of the small intestine into the pancreatic ducts can provoke severe inflammation; the leading role is given to gastritis and gastric ulcer - they cause insufficiency of the sphincter of Oddi, which is responsible for the connection between the gland and the initial part of the duodenum;
• a slowdown in the general circulatory process caused by surges in blood pressure, atherosclerosis, and diabetes mellitus negatively affects the blood supply to the gland, which disrupts tissue nutrition and causes inflammation; During pregnancy, for this reason, a relapse of chronic pancreatitis often occurs in women; all pregnant women are at risk for developing the disease;
• a tendency to allergic reactions sometimes causes some forms of chronic inflammation - in the body, with allergies, the active production of antibodies with an auto-aggressive orientation begins, the target organ may be the pancreas;
• infectious diseases (viral, bacterial, including intestinal infections) - chickenpox, mumps, dysentery, hepatitis - can give rise to chronic inflammation of the pancreas;
• a genetically determined predisposition that produces the onset of the disease from an early age.

Statistics on the prevalence of the causes of the disease state that over 40% of people diagnosed with chronic pancreatitis have alcohol dependence. 30% of patients have a complicated medical history in the form of cholecystitis and gallstones. Overweight people make up no more than 20% of all patients. The rarest causes of chronic pancreatic inflammation are the presence of genetic problems, poisoning and trauma - 5% of cases for each factor.

Symptoms

In the initial stages of the disease, pathological processes proceed sluggishly, often without manifestations. The first clinically significant relapse of chronic pancreatitis occurs when degeneration and regressive processes in the pancreas are significant. Symptoms of chronic pancreatitis include not only severe inflammation, but also manifestations of intoxication due to the entry of enzymes into the general bloodstream.

Typical signs of chronic pancreatitis:

• intense pain (pain attacks) are cutting or dull in nature, lasting regularly or in the form of attacks; sometimes the pain can put the patient into shock; pain during chronic pancreatitis is localized depending on the affected part of the gland - if the pain is diffuse throughout the peritoneum and lower back, the entire organ is completely affected; if the tail or head is affected, irradiation is noted in the cardiac region, epigastrium or right side;
• a rise in temperature and surges in blood pressure are directly related to intoxication processes; a rise in temperature to 38–39 °C indicates intense damage with possible bacterial complications or the formation of abscesses; pressure changes occur in a short time interval and worsen the general condition;
• change in the patient’s appearance - the face takes on a suffering look, the eyes become sunken, facial features become sharpened; skin color changes to pale gray with an earthy tint; small red spots (“red drops”) may appear in the chest and abdomen area;
• development of obstructive jaundice (due to blockage of the bile duct) with yellowing of the skin and eye sclera;
• painful vomiting, and after an episode of vomiting there is no relief; vomit consists of undigested food mixed with bile;
• attacks of nausea and hiccups in combination with belching of air; in addition, dry mouth may appear;
• stool disorder can manifest itself in the form of constipation or diarrhea: repeated loose stools in the form of a foamy, foul-smelling mass with an abundance of mucus are typical for a relapse of the disease; constipation with flatulence and bloating are characteristic of the initial stages of chronic disease;
• lack of appetite and weight loss due to the inability to fully absorb nutrients.

Chronic pancreatitis in adults can occur with a clear dominance of one or more symptoms. For some, the course of the disease is completely asymptomatic - the person does not suspect the presence of inflammation for several years. In other categories of people, the chronic form of pancreatitis is manifested only by dyspepsia with frequent diarrhea and emaciation. Pain-type inflammation is associated with frequent attacks of severe pain after errors in diet and alcohol intake. Rarely, the symptoms have a picture of pseudotumor inflammation with signs of cancer and simultaneous yellowing of the skin and eye sclera.

Survey

Diagnosis of chronic pancreatitis includes an extensive list of laboratory and instrumental studies. The tactics of a full examination are determined by a gastroenterologist. To make a final diagnosis, it is enough to confirm the main signs: a characteristic history (attacks of pain, alcohol intake), enzymatic deficiency, pathological changes in the pancreas.

Among laboratory tests, the following are of primary importance for identifying chronic inflammation of the pancreas:

• scatological examination of feces, which allows us to identify the degree of enzymatic deficiency; in the presence of chronic inflammation in the stool, the content of neutral fat, fiber, starch grains, and muscle fibers is increased;
• blood biochemistry, showing an increase in the activity of amylase, lipase, trypsin;
• a general blood test to determine the intensity of nonspecific inflammation according to ESR, leukocytosis.

Instrumental diagnostics are necessary to identify the size of the affected organ, study the structure of the parinchema, and assess the condition of other organs of the digestive tract. As part of the examination, sonography of the abdominal organs, CT and MRI are performed. The maximum information content is provided by the method of endoscopic ultrasonography, which allows you to study in detail the structure of pancreatic tissue from the inside. If it is necessary to determine the ability of an organ to synthesize a particular enzyme, functional tests with specific stimulants are organized.

Differential diagnosis

Typical signs of chronic pancreatitis are similar to the clinical picture of an “acute abdomen.” During the initial examination, it is important to distinguish pathology from acute surgical conditions associated with damage to other peritoneal organs.

• Perforated ulcer of the stomach or intestines. When perforated, the pain is sharp, sudden (“dagger-like” pain), and the anterior part of the abdomen takes on a “board-like” shape. Vomiting occurs rarely. And with a relapse of chronic inflammation of the pancreas, the pain is constant and moderate, tension in the abdominal muscles is not typical. The final diagnosis is helped by radiography and echography.
• Exacerbation of cholecystitis. It is difficult to differentiate between pathologies - often chronic pancreatitis accompanies inflammation of the gallbladder. But the specificity of pain with cholecystitis is its irradiation to the right shoulder. Based on the results of ultrasound, you can additionally determine the inflamed area.
• The need for intestines is acute. The leading demarcating symptom is pain. With obstruction, it is intense, in the form of contractions.
• Myocardial infarction. Differentiation is not difficult - electrocardiography data will indicate necrosis of a section of the heart muscle.

Therapy

Treatment of chronic pancreatitis is organized depending on the severity of the inflammation. Mild forms are subject to treatment on an outpatient basis under the constant supervision of a gastroenterologist and therapist. Treatment in the stadium is divided into conservative and surgical. Leading goals of therapy:

• elimination of negative factors (alcohol, somatic diseases);
• pain relief;
• elimination of enzymatic deficiency;
• restoration of gland tissue and parinchema;
• treatment of other gastrointestinal dysfunctions.

The main goal of drug therapy is aimed at reducing or completely eliminating the progression of chronic pancreatitis, including combating complications. Based on the type of inflammation and the general condition of the patient, drug therapy may include:

• enzymes based on pancreatin (Pangrol, Micrasim, Festal, Creon) - taking pancreatin is necessary to normalize the secretory functions of the pancreas; A course of medications helps reduce pain, improve the absorption of nutrients, improve bowel movements, and relieve dyspeptic syndrome;
• Painkillers and antispasmodics, due to their ability to reduce muscle tone and tension, are indispensable at any stage of the disease; drugs based on drotaverine and papaverine have a quick and long-lasting effect; if antispasmodics are ineffective, analgesics and NSAIDs are prescribed - Nimesulide, Nise, Voltaren, Meloxicam;
• narcotic analgesics - for relapse of chronic pancreatitis and attacks of intolerable pain (Tramadol, Sedalgin-neo);
• means to combat intoxication - Ringer, Hemodez-N, saline solution for intravenous infusion;
• proton pump inhibitors and H2 antagonists (Omez, Pantoprazole) - with reduced acidity in the digestive tract;
• vitamin therapy (isoprenoids A, E, D) and medium chain triglycerides - in order to correct nutritional deficiencies.

For the treatment of complicated forms of chronic inflammation of the pancreas (purulent abscesses, cysts, phlegmon), surgical intervention is indicated. The undeniable indications for surgery include complications that are life-threatening to the patient - blockage of the ducts and necrosis of the gland, sclerotic processes, stenosis of the sphincter of Oddi, critical condition of the patient when conservative treatment is ineffective.

Types of surgical operations for chronic pancreatitis:

• sphincterotomy is indicated for obstruction or compression of the sphincter of Oddi;
• excision of stones in the ducts of the organ;
• opening of pathological foci (cystic cavities, abscesses with purulent exudate) with subsequent drainage and sanitation;
• pancrectomy - removal of the affected areas or the entire pancreas;
• excision of the gallbladder in the presence of complications from the central bile duct;
• virsungoduodenostomy is a technique for recreating additional channels for the outflow of bile in order to relieve stress on the pancreatic ducts.

Tactics during an attack

An exacerbation of chronic pancreatitis, or an attack, is a life-threatening condition that requires immediate hospitalization, otherwise there is a high risk of death from painful shock and intoxication. During an exacerbation, the pain does not stop, which is due to the abundance of nerve fibers in the pancreas and their increased sensitivity. Unbearable pain can result in loss of consciousness.

During an attack, it is important to follow the correct sequence of actions:

• the patient is provided with complete rest and strict bed rest - in the lying position, the blood flow to the inflamed organ decreases, the pain gradually decreases;
• Eating any food is strictly prohibited, the “starvation” diet continues for at least 72 hours to create complete rest for the gland; fasting stops the synthesis of enzymes, which prevents increased inflammatory reactions;
• a cold compress (a rubber heating pad with cold water, not pure ice) on the epigastric zone helps relieve pain, relieve shock, reduce swelling and inflammation.

At home, before the ambulance arrives, the patient can take antispasmodics - No-shpu, Duspatalin. Enzyme preparations are strictly prohibited - their use aggravates the condition, provoking degenerative changes in the organ.
It is impossible to treat chronic pancreatitis at home, even if after the manipulations the pain has gone away and your health has improved. When an attack occurs, a comprehensive examination is necessary, otherwise the prognosis for survival can be extremely unfavorable. Persons with confirmed chronic pancreatitis should remember that in case of a sudden relapse, the main rule of first aid is cold, hunger, rest.

Diet as part of therapy

Effective treatment of chronic pancreatitis is impossible without organizing dietary nutrition. Regular adherence to a diet allows you to stop degenerative processes and reduce the likelihood of relapses. The diet changes based on the stages of the disease. In the first 48–72 hours from the moment of exacerbation, food is prohibited, the patient is prescribed parenteral nutrition in the form of droppers with glucose solution. To suppress thirst, it is allowed to drink 1% soda solution.
The diet is enriched with vitamin drinks on the 4th day; sweet fruit juices, a decoction of rose hips, and cranberry juice are allowed for consumption. After 5 days, the patient can eat food with vegetable and milk protein. On days 6–7, carbohydrate foods and fats are introduced (in a limited amount). The entire daily diet is divided into 7–8 small portions. Food is served warm (60–65 °C) and thoroughly pureed.

The diet of patients with chronic pancreatic inflammation may include:

• low-fat soups on secondary broth with vegetables, cereals and pasta, sweet milk soups are allowed;
• second courses in the form of steamed meat and fish cutlets, zraz, meatballs, chicken egg omelettes;
• cereal food in the form of porridge, stale white bread, crackers;
• dairy products - butter (no more than 20 g per day), pasteurized milk with liquid 1.5–2.5%, fermented baked milk, low-fat cottage cheese;
• fresh and heat-treated vegetables and fruits - carrots, apples, pumpkin, beets;
• drinks - weak tea with milk, jelly, compote;
• specialized mixtures with a high content of protein and vitamins.

It is important to avoid overeating - it is optimal to consume up to 2.5 kg of food, including liquid, per day. By following dietary recommendations, you can significantly increase the positive effect of complex therapy.

ethnoscience

Treatment of chronic pancreatitis with traditional methods is allowed after consultation with your doctor. Recipes should be selected taking into account the individual characteristics of the patient, well-being and tendency to allergic manifestations. Traditional medicine actively uses decoctions and infusions of medicinal herbs and juices in the treatment of chronic pancreatitis. If you take iron regularly, it will stop faster and your prognosis for recovery will improve.

1. Herbal collection to normalize the outflow of bile includes immortelle leaves, tansy inflorescences, dandelion root, chamomile flowers and knotweed. All components are taken in equal proportions (10 g each). The mixture is poured with boiling water, left for 2 hours, filtered and drunk 100 ml 30 minutes after each meal.
2. Juice from plantain leaves helps reduce inflammation, relieve swelling of the organ, and accelerates the regeneration of parinchema. For treatment, you need to drink 10 ml of freshly squeezed juice before meals for a month. After a 2-month break, the course of juice therapy is repeated.
3. The herbal mixture for pain relief consists of zopnik, agrimony, dandelion root, motherwort herb, dried grass, chamomile flowers and yarrow. The proportions are equal. For 20 g of mixture, 0.5 liters of boiling water is required. The brewed infusion is left for 8 hours and filtered. Drink 100–150 ml at night. A long course is possible - up to 2 months.

Prognosis and prevention

The prognosis for chronic inflammation of the pancreas depends on how a person treats health - whether he follows a diet, eats right, avoids bad habits and stressful situations. If medical recommendations are followed, nutrition is organized as part of the diet, alcohol and nicotine are excluded - the pathology is mild, remissions are long, and the prognosis for survival is favorable. In opposite situations, the course of the disease progresses, degeneration of the gland increases, and serious consequences develop. Life expectancy is decreasing.

Prevention of chronic pancreatitis comes down to following basic rules:

• refusal (or minimization) of alcohol and smoking;
• proper nutrition with restrictions on animal fats and carbohydrate foods;
• adherence to diet and daily routine;
• adequate drinking regime;
• sufficient intake of vitamins into the body, taking into account age characteristics, gender and nature of work activity.

Medical examinations play an important role in the prevention of chronic pancreatitis. An annual examination allows you to timely identify signs of trouble in the gastrointestinal tract, including the pancreas. Persons with confirmed chronic pancreatitis are required to strictly adhere to the instructions of the gastroenterologist and undergo a comprehensive examination at least 2 times a year. Prognosis for recovery with lifelong remission increases with the organization of sanatorium-resort treatment.