Defeat pancreatitis forever: myth or reality

Defeat pancreatitis forever: myth or reality

I. Understanding pancreatitis: Fundamentals and classification

A. Anatomy and pancreatic physiology

1. Location and structure: The pancreas is a vital organ located in the abdominal cavity behind the stomach and next to the duodenum. It has an elongated shape and consists of a head, body and tail. Microscopically, the pancreas consists of two main types of fabric: exocrine and endocrine.

2. Exocrine function: The exocrine part of the pancreas is responsible for the production and secretion of digestive enzymes. These enzymes, including amylase (splitting carbohydrates), lipase (splitting fats) and proteases (split proteins), are transported through the ducts of the pancreas into the duodenum, where they play a key role in the digestion of food. Cells producing these enzymes are called acinar cells, and they are grouped into acinus.

3. Endocrine function: The endocrine part of the pancreas consists of Langerganes islands. These islands contain various types of cells that produce hormones directly released into the bloodstream. The main hormones produced by the pancreas include insulin (produced by beta cells and reduces blood glucose levels), glucagon (produced by alpha cells and increases the level of glucose in the blood), somatostatin (performs the secretion of other hormones) and pancreatic polypeptide (produced by PP cells and affects PP-cells and affects PP digestion).

4. Regulation of pancreatic functions: The activity of the pancreas is regulated by a complex system of nerve and hormonal signals. The secretion of exocrine enzymes is stimulated by hormones, such as secretin and cholecystokinin (CCK), which are released in response to the presence of food in the duodenum. The endocrine function is regulated by the level of glucose in the blood and other factors such as nervous impulses.

B. Definition and classification of pancreatitis

1. Determination of pancreatitis: Pancreatitis is inflammation of the pancreas. Inflammation occurs when digestive enzymes, usually inactive before reaching the duodenum, are prematurely activated inside the pancreas, starting to digest its own tissues. This self -transmission leads to inflammation, swelling and damage to the pancreas.

2. Classification of pancreatitis: acute and chronic

   • Acute pancreatitis: Acute pancreatitis is a sudden inflammation of the pancreas, which usually develops for several days. It can vary from a slight shape, which passes independently, to a severe form, which can lead to serious complications, such as infection, necrosis (death of tissues) and even death. The characteristic signs of acute pancreatitis are sudden severe pain in the upper abdomen, often giving in the back, nausea, vomiting and fever. The diagnosis is usually made on the basis of symptoms, blood tests (determining the level of amylase and lipase) and visualization methods such as computed tomography (CT).

   • Chronic pancreatitis: Chronic pancreatitis is a progressive inflammatory pancreatic disease, which leads to irreversible organ damage. Damage may include fibrosis (scar tissue formation), calcification (calcium deposits) and the loss of exocrine and endocrine function. Symptoms of chronic pancreatitis may include constant abdominal pain, which can be weak or severe, weight loss, diarrhea (due to insufficient digestion of fats) and the development of diabetes (due to damage to the islands of Langerganes). The diagnosis of chronic pancreatitis is based on the medical history, physical examination, blood tests, visualization methods (CT, MRI, endoscopic ultrasonography) and functional pancreatic tests.

3. Other forms of pancreatitis:

   • Autoimmune pancreatitis: The form of chronic pancreatitis caused by an autoimmune process, when the immune system attacks the pancreas.

   • Hereditary pancreatitis: The genetically determined form of pancreatitis associated with mutations in certain genes.

   • Tropical pancreatitis: The form of chronic pancreatitis, found in tropical regions, the cause of which is not completely studied, but is associated with power factors and the environment.

II. Causes and risk factors for the development of pancreatitis

A. The causes of acute pancreatitis

1. Gallstone disease: The most common cause of acute pancreatitis. The gallstones formed in the gall bladder can block the total bile duct along which bile and enzymes of the pancreas fall into the duodenum. This blockade can lead to the opposite stream of bile and enzymes of the pancreas into the pancreas, causing its inflammation.

2. Alcohol abuse: The second most common cause of acute pancreatitis. Alcohol has a toxic effect on the cells of the pancreas and can contribute to premature activation of digestive enzymes.

3. Hyperyglyceridemia: A high level of triglycerides (type of fat) in the blood can lead to acute pancreatitis.

4. Hypercalcemia: A high blood calcium level can also cause acute pancreatitis.

5. Medicines: Some drugs, such as Azatioprine, didanosine, estrogen and corticosteroids, can be associated with an increased risk of acute pancreatitis.

6. Abdominal injuries: Abdominal injuries, especially stupid injuries, can lead to damage to the pancreas and the development of acute pancreatitis.

7. Postoperative pancreatitis: It can develop after surgical interventions on the abdominal cavity, especially on the biliary tract or pancreas.

8. Infections: Some infections, such as a pig, the Koksaki and mycoplasma virus, can cause acute pancreatitis.

9. Endoscopic retrograde cholangiopancreatography (ERCP): This procedure, used for the diagnosis and treatment of diseases of the biliary tract and pancreas, can in rare cases cause acute pancreatitis.

10. Idiopathic pancreatitis: In some cases, the cause of acute pancreatitis remains unknown.

B. The causes of chronic pancreatitis

1. Chronic abuse of alcohol: The most common cause of chronic pancreatitis. Long -term alcohol consumption can lead to irreversible damage to the pancreas.

2. Smoking: Smoking is an independent risk factor for the development of chronic pancreatitis.

3. MukoviScidoz: A genetic disease that causes the formation of thick mucus, which can block the ducts of the pancreas and lead to chronic pancreatitis.

4. Hereditary pancreatitis: Genetic mutations can increase the risk of chronic pancreatitis.

5. Autoimmune pancreatitis: Autoimmune disease that causes inflammation of the pancreas.

6. Pancreatic duct obstruction: The narrowing or blocking of the pancreatic ducts caused, for example, by tumors, cysts or scar tissue, can lead to chronic pancreatitis.

7. Tropical pancreatitis: It is found in tropical regions, the cause is not completely studied.

8. Idiopathic chronic pancreatitis: In some cases, the cause of chronic pancreatitis remains unknown.

C. Risk factors for the development of pancreatitis

1. Age: The risk of the development of pancreatitis increases with age.
2. Floor: In men, pancreatitis develops more often than in women, especially related to alcohol use.
3. Family history: The presence of cases of pancreatitis in a family increases the risk.
4. Obesity: Obesity is associated with an increased risk of acute pancreatitis.
5. Diabetes sugar: Diabetes can increase the risk of pancreatitis.
6. Some drugs: Some drugs can increase the risk of pancreatitis.
7. High level of triglycerides: A high level of blood triglycerides can increase the risk of pancreatitis.
8. Smoking: Smoking increases the risk of pancreatitis.
9. Alcohol abuse: Alcohol abuse significantly increases the risk of pancreatitis.

III. Diagnosis of pancreatitis

A. Clinical picture and symptoms

1. Acute pancreatitis:

   • Abdominal pain: Strong, sudden pain in the upper abdomen, often giving in the back. The pain can intensify after eating.
   • Nausea and vomiting: Frequent symptoms of acute pancreatitis.
   • Fever: Improving body temperature.
   • Far heartbeat: Increasing heart rate.
   • Bloating: A feeling of overflow and discomfort in the stomach.
   • Abdominal sensitivity: Soreness on palpation of the abdomen.
   • Jaundice: Yellowing of the skin and proteins of the eyes (rarely, with obstruction of the bile ducts).
   • Dehydration: The deficiency of fluid in the body due to vomiting and loss of appetite.

2. Chronic pancreatitis:

   • Abdominal pain: Chronic, constant or periodic abdominal pain, which can be weak or severe. The pain can be intensified after eating or drinking alcohol.
   • Weight loss: Unintentional weight loss due to insufficient digestion of food and malabsorption.
   • Diarrhea: Frequent liquid stool, often containing undigested fat (steatore).
   • Steatorrhea: The presence of fat in feces, which gives it an oily appearance and an unpleasant odor.
   • Diabetes sugar: The development of diabetes due to damage to the islets of Langerganes.
   • Nausea and vomiting: They may occur, but less pronounced than in acute pancreatitis.
   • Weakness and fatigue: A feeling of fatigue and lack of energy.

B. Laboratory research

1. Amylase and lipase: A blood test for measuring the level of amylase and lipase – enzymes produced by the pancreas. With pancreatitis, the level of these enzymes is usually significantly increased. Lipase is considered a more specific pancreatitis marker than amylase.

2. General blood test (UAC): For assessing inflammation and infection. May show an increase in the level of leukocytes (leukocytosis).

3. Biochemical blood test: To assess the function of the liver, kidneys and electrolyte balance. It can show an increase in the level of bilirubin, alkaline phosphatase and glucose.

4. Lipid profile: To measure triglycerides and cholesterol.

5. Calcium level: To detect hypercalcemia.

6. Fecal analysis for fecal elastasis: To assess the exocrine function of the pancreas. The low level of fecal elastase indicates the failure of the pancreas.

7. Specialized tests (with suspicion of autoimmune or hereditary pancreatitis):

   • Igg4: For diagnosis of autoimmune pancreatitis.
   • Genetic testing: To identify mutations associated with hereditary pancreatitis.

C. Instrumental research methods

1. Ultrasound examination (ultrasound) of the abdominal cavity: Used to visualize the pancreas and gall bladder. It can help identify bile stones, pancreatic edema and other anomalies. However, ultrasound may be limited in the visualization of the pancreas due to its location behind the stomach and intestines.

2. Computer tomography (CT) of the abdominal cavity: Provides more detailed images of the pancreas and surrounding tissues. It is used to diagnose acute and chronic pancreatitis, evaluate the severity of inflammation, detect complications, such as necrosis and pseudocysts, and the exclusion of other diseases. CT with contrast amplification provides better visualization of blood vessels and tissues.

3. Magnetic resonance imaging (MRI) of the abdominal cavity: An alternative visualization method that does not use ionizing radiation. Provides detailed images of the pancreas and bile ducts. MRHPG (magnetic resonance cholangiopancreatography) is a specialized type of MRI, which is used to visualize the bile and pancreatic ducts.

4. Endoscopic ultrasonography (EUS): Combines endoscopy and ultrasound. An ultrasonic sensor is built into a thin tube with a camera at the end. The tube is inserted through the mouth into the stomach and duodenum, which allows you to obtain high -quality images of the pancreas and surrounding tissues. EUS can be used to diagnose chronic pancreatitis, detect small tumors and cysts, as well as for a biopsy of pancreatic tissue.

5. Endoscopic retrograde cholangiopancreatography (ERCP): Invasive procedure used to visualize the bile and pancreatic ducts. A contrast medium is introduced into a thin tube with a camera at the end, which is then visualized using x -rays. ERCP can be used to diagnose and treatment diseases of the bile ducts and pancreas, such as gallstones, narrowing of the ducts and tumors. However, ERCPG is associated with the risk of pancreatitis, therefore it should be used only if there are strict indications.

IV. Pancreatitis treatment: strategies and approaches

A. Treatment of acute pancreatitis

1. Hospitalization: Patients with acute pancreatitis usually need hospitalization for monitoring and maintenance therapy.

2. Anesthesia: Pain control is an important aspect of the treatment of acute pancreatitis. Analgesics such as opioids are usually used.

3. Intravenous infusion therapy: To restore water and electrolyte balance and prevent dehydration.

4. Starvation: At the beginning of treatment, patients are usually prescribed starvation to reduce the load on the pancreas and give it the opportunity to recover.

5. Nutrition: After stabilizing the condition of patients, they gradually begin to give light food with a low fat content. In severe cases, parenteral nutrition (intravenous nutrition) may be required.

6. Antibiotics: They are prescribed if there is an infection such as infected necrosis.

7. Endoscopic treatment: ERCPG with sphincterotomy can be performed to remove bile stones that block the common bile duct, and relieve pressure on the pancreas.

8. Surgical treatment: It may be required in the presence of complications, such as infected necrosis, pseudocysts or abscesses. Surgical intervention may include removal of necrotic tissue (necrectomy), drainage of pseudocyst or abscesses.

B. Treatment of chronic pancreatitis

1. Anesthesia: Pain control is the main aspect of the treatment of chronic pancreatitis. Various analgesics are used, including non -steroidal anti -inflammatory drugs (NSAIDs), opioids and adjuvant drugs (for example, antidepressants and anticonvulsants). In some cases, a block of nerves or surgical treatment of pain may be required.

2. Enzyme replacement therapy: Patients with chronic pancreatitis are often prescribed enzymes containing lipase, amylase and proteases to help digest food and reduce steator. Enzymes should be taken with each meal.

3. Diet: A low fat diet, rich in protein and carbohydrates, is recommended. Alcohol and smoking should be avoided. It is necessary to consume small, frequent meals.

4. Vitamins and minerals: Patients with chronic pancreatitis are often required to take vitamins and minerals, as they can experience nutrient deficiency due to malabsorption. Especially important are B vitamins, vitamin D, calcium and magnesium.

5. Treatment of diabetes sugar: Patients with diabetes caused by chronic pancreatitis need to treat diabetes with diet, physical exercises and drugs (insulin or oral sugar -lowering drugs).

6. Endoscopic treatment: ERCP can be used to treat narrowing of the pancreatic ducts, removal of stones and drainage pseudocyst.

7. Surgical treatment: It may be required in the presence of complications, such as simple pain, obstruction of the bile ducts or duodenum, pseudo -vanity or suspicion of pancreatic cancer. Surgical options include drainage of the pancreatic duct, pancreatic resection (part of the part or all pancreas) and pancreatododododenectomy (WipPla operation).

8. Treatment of autoimmune pancreatitis: It is usually treated with corticosteroids.

C. Supporting therapy and rehabilitation

1. Psychological support: Chronic pancreatitis can have a significant effect on the quality of life of patients. Psychological support and counseling can help patients cope with pain, anxiety and depression.

2. Physiotherapy: Physiotherapy can help patients improve their physical form and reduce pain.

3. Refusal of alcohol and smoking: A complete rejection of alcohol and smoking is a prerequisite for the successful treatment of pancreatitis.

4. Rehabilitation: Rehabilitation programs can help patients restore their function and improve the quality of life.

V. Complications of pancreatitis

A. Complications of acute pancreatitis

1. Pancreatic necrosis: The death of pancreatic tissue. Infected necrosis is a serious complication, which can lead to sepsis and death.

2. Pancreatic pseudokist: The accumulation of fluid and tissue residues surrounded by a capsule. Pseudocysts can cause pain, obstruction of the bile ducts or duodenum, and also infect.

3. Pancreatic abscess: The cluster of pus in the pancreas or around it.

4. Acute respiratory failure (ARDS): Severe complication characterized by inflammation and edema of the lungs.

5. Renal failure: Disorders of the kidney function.

6. Sepsis: Severe infection spreading throughout the body.

7. Shock: A state characterized by a decrease in blood pressure and impaired blood supply to organs.

8. Diabetes sugar: It can develop due to damage to the islands of Langerganes.

B. Complications of chronic pancreatitis

1. Chronic pain: The main complication of chronic pancreatitis, which can significantly reduce the quality of life.

2. Malibsorption and steatororea: Insufficient digestion of food and absorption of nutrients, which leads to weight loss, diarrhea and nutrient deficiency.

3. Diabetes sugar: It develops due to damage to the islands of Langerganes.

4. Pseudocysts of the pancreas: They can cause pain, obstruction of the bile ducts or duodenum, as well as infect.

5. Obstation of bile ducts or duodenum: Narrowing or blocking of the bile ducts or duodenum caused by inflammation or scar tissue.

6. Pancreatic cancer: Chronic pancreatitis increases the risk of pancreatic cancer.

7. Portal hypertension: Increased pressure in the gate vein, which can lead to ascite (accumulation of fluid in the abdominal cavity) and bleeding from varicose veins of the esophagus.

8. Depression and anxiety: Chronic pain and other complications of chronic pancreatitis can lead to depression and anxiety.

VI. Pancreatitis Prevention

A. Primary prevention

1. Refusal of alcohol abuse: The most important measure of pancreatitis prevention.

2. Refusal of smoking: Smoking increases the risk of pancreatitis.

3. Healthy nutrition: A balanced diet with a low fat content and a high fiber content.

4. Maintaining a healthy weight: Obesity is associated with an increased risk of pancreatitis.

5. Regular physical exercises: Physical activity helps to maintain healthy weight and reduces the risk of pancreatitis.

6. Timely treatment of gallstone disease: Removing the gallbladder (cholecystectomy) can prevent the development of acute pancreatitis caused by bile stones.

7. Avoid taking drugs associated with the risk of pancreatitis: If you need to take such drugs, consult a doctor.

8. Triglycerides level control: A high level of blood triglycerides can increase the risk of pancreatitis.

B. Secondary prevention

1. Compliance with the doctor’s recommendations: Patients with pancreatitis should strictly follow the doctor’s recommendations regarding the diet, treatment and lifestyle.

2. Regular medical examinations: Regular medical examinations can help identify complications of pancreatitis at an early stage.

3. Enzyme replacement therapy: Patients with chronic pancreatitis should take enzyme preparations to improve food digestion and reduce steator.

4. Anesthesia: It is important to effectively control the pain in chronic pancreatitis.

5. Life support support: Patients with pancreatitis may need support for a change in lifestyle, for example, in the abandonment of alcohol and smoking.

VII. Can pancreatitis be cured forever?

A. Acute pancreatitis:

In most cases, acute pancreatitis, especially mild and moderate severity, is successfully treated, and the patient is completely recovering. Recovery includes relief of pancreatic inflammation and resolution of symptoms. After recovery, the pancreas usually returns to a normal function. However, if acute pancreatitis is caused by gallstone disease, it is necessary to remove the gall bladder to prevent repeated episodes. It is important to eliminate risk factors, such as alcohol abuse and a high level of triglycerides to prevent relapse. Although acute pancreatitis can be effectively cured, it can go into a chronic shape if damage to the pancreas is repeated or strong enough.

B. Chronic pancreatitis:

Currently, chronic pancreatitis is considered an incurable disease. Damage to the pancreas in chronic pancreatitis is progressive and irreversible. Treatment is aimed at alleviating symptoms, preventing complications and improving the quality of the patient. Key treatment goals include pain control, malabsorption correction with enzymes replacement therapy, treatment of diabetes and the elimination of risk factors such as alcohol and smoking. Although chronic pancreatitis cannot be cured, it can be effectively controlled using an integrated approach, including drug therapy, diet, a change in lifestyle and, in some cases, endoscopic or surgical treatment. Studies in the field of regenerative medicine, such as cell therapy, can in the future offer new opportunities for restoring the function of the pancreas and, possibly, the treatment of chronic pancreatitis.

C. Factors affecting the forecast:

1. The cause of pancreatitis: Pancreatitis caused by gallstone disease has the best prognosis than pancreatitis caused by alcohol abuse or genetic factors.

2. The severity of the disease: Light pancreatitis has the best prognosis than severe pancreatitis with complications.

3. Compliance with the treatment regimen: Compliance with the doctor’s recommendations regarding the diet, treatment and lifestyle plays an important role in the forecast of pancreatitis.

4. Related diseases: The presence of concomitant diseases, such as diabetes, cardiovascular diseases and kidney diseases, can worsen the prognosis of pancreatitis.

5. Age: Elderly patients with pancreatitis have a higher risk of complications and the worst forecast.

VIII. Alternative and additional treatment methods

A. Dietary strategies

1. Low fat diet: Limiting fat consumption helps to reduce the load on the pancreas and facilitates the digestion of food.

2. Frequent small meals: The use of small, frequent meals instead of large, rare meals can reduce the load on the pancreas.

3. Alcohol consumption restriction: A complete rejection of alcohol is a prerequisite for the successful treatment of pancreatitis.

4. Caffeine consumption restriction: Caffeine can stimulate the secretion of acid in the stomach, which can worsen the symptoms of pancreatitis.

5. Increase in fiber consumption: Fiber helps to improve digestion and prevent constipation.

6. The use of easily digestible products: Easily digestible products, such as boiled vegetables, fruits, rice and chicken, can reduce the load on the pancreas.

B. Plant products and additives

1. Turmeric: Kurkumin, the active ingredient of turmeric, has anti -inflammatory and antioxidant properties. Some studies show that turmeric can help reduce inflammation for pancreatitis.

2. Ginger: Ginger has anti -inflammatory and antiemetic properties. It can help reduce nausea and vomiting associated with pancreatitis.

3. Milk thistle: Proopsha contains silimarin, which has hepatoprotective and antioxidant properties. It can help protect the pancreas from damage.

4. Probiotics: Probiotics are useful bacteria that can help improve digestion and strengthen the immune system. Some studies show that probiotics can help reduce inflammation for pancreatitis.

5. Vitamins and minerals: The deficiency of vitamins and minerals can worsen the symptoms of pancreatitis. It is recommended to take polyvitamin complexes containing B vitamins, vitamin D, calcium and magnesium.

C. Other alternative methods

1. Acupuncture: Acupuncture is a traditional Chinese medical equipment that includes the introduction of thin needles into certain points on the body. Some studies show that acupuncture can help reduce pain in chronic pancreatitis.

2. Meditation and yoga: Meditation and yoga can help reduce stress and anxiety associated with pancreatitis.

3. Massage: Massage can help improve blood circulation and reduce pain.

Important: Before you start using any alternative or additional treatment methods, you need to consult a doctor. Alternative methods should not replace traditional medical treatment.

IX. New directions in the treatment of pancreatitis

A. cell therapy

Cell therapy is a promising direction in the treatment of pancreatitis aimed at restoring damaged pancreatic tissue. Some studies have shown that the introduction of stem cells into the pancreas can contribute to tissue regeneration and improve the function of the organ.

B. General therapy

Gene therapy is another promising direction in the treatment of pancreatitis aimed at correcting genetic defects that cause the disease. Studies in this area are at an early stage, but they give hope for the development of new methods of treatment of hereditary pancreatitis.

C. Target therapy

Targeted therapy is a type of treatment that is aimed at specific molecules or cells involved in the development of pancreatitis. This can help reduce inflammation and damage to the pancreas.

D. Nanotechnology

Nanotechnologies can be used to deliver drugs directly to the pancreas, which increases the effectiveness of treatment and reduces side effects.

E. Development of new enzyme preparations

The development of new enzyme preparations continues that more effectively digest food and reduce steator.

F. Artificial pancreas

Artificial pancreas are developed, which can automatically control the level of blood glucose and release insulin, which can help patients with diabetes caused by pancreatitis.

** x. Life