Pancreatitis: complete guidance for treatment and restoration

Pancreatitis: complete guidance for treatment and restoration

Section 1: Understanding Pancreatitis: Fundamentals, types and causes

1.1 Anatomy and pancreatic physiology: the basis of the health of digestion

The pancreas is a vital organ located behind the stomach at the top of the abdominal cavity. It plays a double role, performing exocrine and endocrine functions.

• Exocrine function: The production of digestive enzymes (amylase, lipase, proteases). These enzymes are transported through the duct of the pancreas into the duodenum, where they break down carbohydrates, fats and proteins, ensuring their absorption. Amilase breaks starch on simple sugars. Lipase breaks fats into fatty acids and glycerin. Proteases (tripsin, chimotrypsin, carboxypeptidase) split the proteins into amino acids. These enzymes are distinguished in an inactive form (zytogen) and are activated only in the duodenum to prevent self -transmission of the pancreas.
• Endocrine function: Production of hormones (insulin, glucagon, somatostatin, pancreatic polypeptide). Insulin reduces blood sugar, contributing to its flowing into the cells. Glucagon increases blood sugar, stimulating the release of glucose from the liver. Somatostatin regulates the secretion of insulin and glucagon, and also slows down digestion. Pancreatic polypeptide regulates the secretion of pancreatic enzymes and intestinal motility.

Violation of any of these functions can lead to serious health consequences, including pancreatitis and diabetes.

1.2 Definition and classification of pancreatitis: acute against chronic

Pancreatitis is inflammation of the pancreas. It is classified into two main forms: acute and chronic.

• Acute pancreatitis: Sudden inflammation of the pancreas, which usually occurs for several days or weeks. Symptoms can vary from lungs to severe, and in some cases can be life -threatening. We usually turn acute pancreatitis, that is, the pancreas can recover after inflammation. Typical signs are severe pain in the upper abdomen, which can radiate to the back, nausea, vomiting, fever and rapid heartbeat. Laboratory tests show an increased level of amylase and blood lipase.
• Chronic pancreatitis: The progressive, irreversible inflammation of the pancreas, which leads to damage to the tissue and the deterioration of its functions. Chronic pancreatitis develops gradually, usually for several years. Symptoms may include chronic abdominal pain, diarrhea, weight loss, steator (fat stool) and the development of diabetes. Damage to the pancreas can lead to insufficiency of exocrine function (lack of digestive enzymes) and endocrine function (lack of insulin). Chronic pancreatitis often leads to the formation of cicatricial tissue and cysts in the pancreas.

It is important to note that acute pancreatitis can develop into chronic, especially if the main causes are not treated or if the episodes of acute pancreatitis are repeated.

1.3 The main causes of acute pancreatitis: gallstones and alcohol are the main culprits

Acute pancreatitis can be caused by many factors, but the most common causes are:

• Gallstones: Approximately 40-70% of cases of acute pancreatitis are associated with gallstones. Gallstones can block the overall bile duct, which also serves as the pancreatic enzymes. Blocking causes a delay in the pancreatic enzymes, which leads to its self -digestion and inflammation.
• Alcohol abuse: Chronic alcohol consumption is the second most common cause of acute pancreatitis. Alcohol can damage pancreatic cells and cause inflammation. The exact mechanism of alcohol action on the pancreas has not been fully studied, but it is believed that it includes an increase in the secretion of enzymes, the formation of toxic metabolites and impaired blood supply to the pancreas.
• Other reasons: Other, less common causes of acute pancreatitis include:
  • Hyperyglyceridemia: High level of triglycerides in the blood.
  • Medicines: Some drugs, such as diuretics, antibiotics and anti -inflammatory drugs.
  • Injuries: Abdominal injuries or operations on the abdominal cavity.
  • Infections: Viral infections, such as epidemic mumps (pig).
  • Autoimmune diseases: Diseases in which the immune system attacks the body’s own tissues.
  • Genetic factors: Mutations in genes associated with the function of the pancreas.
  • Endoscopic retrograde cholangiopancreatography (ERCP): The procedure used for the diagnosis and treatment of diseases of the bile ducts and the duct of the pancreas. In rare cases, pancreatitis can cause.
  • Idiopathic pancreatitis: Pancreatitis, the cause of which cannot be established.

Determining the cause of acute pancreatitis is an important step in the treatment and prevention of relapses.

1.4 Risk factors for the development of chronic pancreatitis: alcohol, smoking and genetics

Chronic pancreatitis develops gradually and irreversibly. The most common risk factors include:

• Chronic abuse of alcohol: The most common cause of chronic pancreatitis. Long -term alcohol consumption causes damage to the pancreatic tissue, which leads to inflammation, fibrosis and loss of function. The risk of developing chronic pancreatitis increases with an increase in the amount and duration of alcohol.
• Smoking: Smoking increases the risk of chronic pancreatitis, especially in combination with alcohol use. Smoking can damage pancreatic cells and enhance inflammation.
• Genetic factors: Some genetic mutations can increase the risk of chronic pancreatitis. These include mutations in genes related to the production and regulation of trippsin, an enzyme that breaks down proteins in the pancreatic gland. The most common genetic mutations are associated with PRSS1, Spink1, CFTR and CTRC genes.
• MukoviScidoz: A genetic disease that affects the lungs and other organs, including the pancreas. Cycassocidosis can lead to blockage of pancreatic ducts with thick mucus, which causes inflammation and damage.
• Autoimmune pancreatitis: The type of chronic pancreatitis, in which the immune system attacks the pancreas. Autoimmune pancreatitis can be associated with other autoimmune diseases such as Crohn’s disease and ulcerative colitis.
• Obstructive pancreatitis: Pancreatitis caused by blockage of the pancreatic duct, for example, a tumor or stricture.
• Recurrent acute pancreatitis: Repeating episodes of acute pancreatitis can lead to the development of chronic pancreatitis.
• Idiopathic chronic pancreatitis: Pancreatitis, the cause of which cannot be established.

Understanding the risk factors for the development of chronic pancreatitis can help in taking measures to prevent and early diagnosis.

Section 2: Diagnostics of Pancreatitis: Examination, Analyzes and Visualization

2.1 Clinical signs and symptoms of acute pancreatitis: pain, nausea and fever

Clinical signs and symptoms of acute pancreatitis can vary depending on the severity of the disease. The most common symptoms include:

• Abdominal pain: Strong, constant pain in the upper abdomen, which can radiate to the back. The pain often intensifies after eating and can decrease when tilted forward.
• Nausea and vomiting: Nausea and vomiting often accompany abdominal pain.
• Fever: Improving body temperature.
• Far heartbeat: Ocute pulse.
• Soreness on the palpation of the abdomen: The stomach can be painful when touching.
• Bloating: The feeling of bursting and bloating in the stomach.
• Jaundice: Yellowing of the skin and sclera of the eyes (rarely).
• Dehydration: Dry mouth, dizziness.
• Reduced blood pressure: In severe cases.

In severe cases of acute pancreatitis, complications, such as respiratory failure, renal failure and shock, can develop.

2.2 Clinical signs and symptoms of chronic pancreatitis: chronic pain, weight loss and steator

Clinical signs and symptoms of chronic pancreatitis can be more diverse and develop gradually. The most common symptoms include:

• Chronic abdominal pain: Constant or periodic pain in the upper abdomen. The pain can be stupid, aching or sharp. It can intensify after eating and can be difficult to control with the help of painkillers.
• Weight loss: Unintentional weight loss due to poor absorption of nutrients.
• Steatorrhea: A fat, fetid chair that is difficult to wash off. Stiatoraea occurs due to insufficient splitting and assimilation of fats in the intestines.
• Diarrhea: Frequent liquid chair.
• Diabetes sugar: The development of diabetes due to damage to insulin-producing pancreatic cells.
• Nausea and vomiting: They may arise episodically.
• Bloating: The feeling of bursting and bloating in the stomach.
• Weakness and fatigue: A general feeling of fatigue and weakness.

Symptoms of chronic pancreatitis can significantly worsen the quality of the patient’s life.

2.3 laboratory tests: amylase and lipase – key indicators

Laboratory tests play an important role in the diagnosis and monitoring of pancreatitis. The most important indicators:

• Amylase blood serum: The level of amylase in the blood usually increases with acute pancreatitis. Amilase is an enzyme that breaks down starch. An increased level of amylase indicates damage to the pancreatic cells and the release of amylase into the blood. However, the level of amylase can be normal in chronic pancreatitis, especially with significant damage to the pancreas. It is important to note that an increased level of amylase can be caused by other conditions, such as the diseases of the salivary glands, renal failure and obstruction of the intestine.
• Blood serum lipase: Lipase is an enzyme that breaks down fats. The level of lipase in the blood usually increases with acute pancreatitis and is a more specific indicator than amylase. An increased level of lipase also indicates damage to the pancreatic cells and the release of lipase into the blood. Like amylase, the level of lipase can be normal in chronic pancreatitis.
• Other blood tests: Other blood tests that can be useful in the diagnosis of pancreatitis include:
  • General blood test: It can identify signs of inflammation, such as an increased level of leukocytes.
  • Liver tests: They can help identify the presence of diseases of the bile ducts that can cause pancreatitis.
  • Triglycerides level: A high level of triglycerides can cause pancreatitis.
  • Calcium level: Low calcium levels can be a sign of severe pancreatitis.
  • Blood glucose: To identify diabetes.

2.4 Instrumental diagnostic methods: ultrasound, CT and MRI

Instrumental diagnostic methods play an important role in confirming the diagnosis of pancreatitis, determining its cause and assessing the severity of the disease.

• Ultrasound examination (ultrasound): Ultrasound can be used to visualize the pancreas and gall bladder. It can help identify bile stones that can cause acute pancreatitis. Ultrasound can also identify signs of pancreatic inflammation, such as its increase and swelling. However, ultrasound may be limited in the visualization of the pancreas due to gas in the intestines.
• Computed tomography (CT): CT is a more accurate method for visualization of the pancreas than an ultrasound. CT can identify signs of pancreatic inflammation, such as edema, necrosis and the formation of pseudocyst. CT can also help identify other causes of pancreatitis, such as tumors and abnormalities of pancreatic ducts. CT is often used to assess the severity of acute pancreatitis and detect complications.
• Magnetic resonance tomography (MRI): MRI is an even more accurate method for visualizing the pancreas than CT. MRI can provide more detailed visualization of the soft tissues and pancreatic ducts. MRI is often used to diagnose chronic pancreatitis, detect tumors and assess the degree of damage to the pancreas. Magnetic resonance cholangiopancreatography (MRHPG) is a special type of MRI, which is used to visualize the bile ducts and pancreatic ducts.
• Endoscopic retrograde cholangiopancreatography (ERCP): ERCPG is an invasive procedure that is used to visualize the bile ducts and pancreatic ducts. During the ERCP, a flexible endoscope is introduced through the mouth into the duodenum. Then the catheter is inserted into the bile ducts and ducts of the pancreas, and a contrast medium is administered. ERCPH can be used to diagnose and treatment diseases of the bile ducts and pancreatic ducts, such as gallstones, strictures and tumors. However, ERCP can cause complications, such as pancreatitis, therefore it is used only in certain cases.
• Endoscopic ultrasound examination (Eusta): Eusi combines endoscopy and ultrasound. An endoscope with an ultrasound sensor at the end is inserted through the mouth into the stomach and duodenum. Euzi allows you to get high -quality images of the pancreas and surrounding organs. It can be used to diagnose tumors, cysts and other pancreatic anomalies.

The choice of diagnostic method depends on the clinical picture of the patient, the suspected cause of pancreatitis and the presence of complications.

Section 3: Treatment of acute pancreatitis: supportive therapy and elimination of the cause

3.1 supporting therapy: fasting, anesthesia and infusion therapy

Treatment of acute pancreatitis is aimed at alleviating the symptoms, maintaining vital functions and eliminating the cause of inflammation. Supporting therapy is the cornerstone of treatment of acute pancreatitis.

• Starvation: In the early days of acute pancreatitis, the patient is recommended to starve to give a pancreas to rest. Fasting reduces the stimulation of the secretion of pancreatic enzymes, which helps to reduce inflammation. The nutrition resumes gradually, starting with a low -fat liquid food, as the patient’s condition improves.
• Anesthesia: Pain is the main symptom of acute pancreatitis, so pain relief is an important part of treatment. Analgesics are usually used, such as opioids (for example, morphine, oxycodon) and non -steroidal anti -inflammatory drugs (NSAIDs). In severe cases, epidural anesthesia may be required to relieve pain.
• Infusion Therapy: Acute pancreatitis can lead to dehydration due to vomiting, diarrhea and fluid loss as a result of inflammation. Infusion therapy using intravenous solutions helps restore the volume of fluid and electrolyte balance.
• Oxygen therapy: In severe cases of acute pancreatitis, respiratory failure may develop. In such cases, oxygen therapy or even artificial ventilation of the lungs may be required.
• Monitoring of vital functions: It is necessary to carefully monitor the vital functions of the patient, such as blood pressure, pulse, respiratory rate and diuresis.
• Installation of the nasogastric probe: In cases of severe vomiting or swelling of the abdomen, a nasogastric probe can be installed to remove the contents of the stomach and reduce pressure on the pancreas.

3.2 Treatment of the main causes of acute pancreatitis: removal of bile stones and correction of hyperthyglyceridemia

After stabilizing the patient’s condition, it is necessary to eliminate the main cause of acute pancreatitis.

• Gallstones: If acute pancreatitis is caused by bile stones, their removal is necessary. There are two main methods of removing the gallstones:
  • Endoscopic retrograde cholangiopancreatography (ERCP): ERCP can be used to remove bile stones from the common bile duct. During ERCP, a catheter is introduced into the general bile duct, and the stones are removed using special tools.
  • Cholecystectomy: Removing the gall bladder surgically. Cholecystectomy is usually recommended after the relief of acute pancreatitis to prevent re -formation of bile stones and relapse of pancreatitis. Cholecystectomy can be performed by laparoscopic or open.
• Hyperyglyceridemia: If acute pancreatitis is caused by hyperyglyceridemia, it is necessary to reduce the level of triglycerides in the blood. This can be achieved using a low -fat diet, drugs (for example, fibrates, niacin) and plasmapheresis (in severe cases).
• Medicines: If acute pancreatitis is caused by the medicine, it is necessary to stop taking this medicine.
• Autoimmune pancreatitis: Treatment of autoimmune pancreatitis usually includes the use of corticosteroids.
• Other reasons: Treatment of other causes of acute pancreatitis should be aimed at eliminating the main problem.

3.3 Complications of acute pancreatitis and their treatment: pseudocysts, necrosis and infections

Acute pancreatitis can lead to various complications that may require additional treatment.

• Pseudo -vsists: Pseudocysts are clusters of fluids that form around the pancreas after acute pancreatitis. Pseudocysts can be asymptomatic or cause pain, nausea, vomiting and compression of the surrounding organs. Small pseudocysts are usually absorbed independently. Large pseudocysts that cause symptoms or complications may require drainage. Pseudokist drainage can be performed endoscopic, percutaneous or surgically.
• Pancreatic necrosis: Pancreatic necrosis is the death of pancreatic tissue. Necrosis can be infected or unfortunate. Infected pancreatic necrosis is a serious complication, which can lead to sepsis and death. The treatment of pancreatic necrosis usually includes antibiotic therapy and surgical removal of necrotic tissue.
• Infections: Acute pancreatitis can increase the risk of infections, such as pneumonia, urinary tract infections and sepsis. Treatment of infections includes antibiotic therapy.
• Respiratory failure: In severe cases of acute pancreatitis, respiratory failure may develop. Treatment of respiratory failure may include oxygen therapy, artificial ventilation of the lungs and other supporting measures.
• Renal failure: In severe cases of acute pancreatitis, renal failure may develop. Treatment of renal failure may include hemodialysis or other methods of replacement renal therapy.
• Shock: In severe cases of acute pancreatitis, shock may develop. Treatment of shock includes infusion therapy, vasopressors and other supporting measures.

The severity of complications and their treatment depend on the degree of damage to the pancreas and the general condition of the patient.

Section 4: Treatment of chronic pancreatitis: pain control, enzyme therapy and diet

4.1 Pain control in chronic pancreatitis: medication and non -drug methods

Chronic pain is one of the most exhausting symptoms of chronic pancreatitis. Pain control is an important part of the treatment of chronic pancreatitis. There are both drugs and non -drug methods of pain control.

• Medication methods:
  • Analgesics: Analgesics, such as NSAIDs, tramadol and opioids, can be used to relieve pain. However, long -term use of opioids can lead to dependence and other side effects, so they should be used with caution.
  • Tricyclic antidepressants: Tricyclic antidepressants, such as amitriptylin, can be used to relieve neuropathic pain.
  • Anticonvulsants: Anticonvulsants, such as gabapentin and pregabalin, can be used to relieve neuropathic pain.
  • Proton pump inhibitors (IPP): IPP can be used to reduce the acidity of the stomach, which can reduce abdominal pain.
  • Pancreatic enzymes: The intake of pancreatic enzymes can reduce the stimulation of the pancreas and relieve pain.
• Non -drug methods:
  • Nerves blockade: Nerve blockade can be used to block the transmission of pain signals from the pancreas to the brain.
  • Acupuncture: Acupuncture can help relieve pain.
  • Physiotherapy: Physiotherapy can help improve mobility and reduce pain.
  • Psychological support: Psychological support can help patients cope with chronic pain and improve the quality of life.
  • Life change change: A change in lifestyle, such as rejection of alcohol and smoking, compliance with a low fat content and regular physical exercises, can help reduce pain.
  • Surgical treatment: In some cases, surgical treatment may be required to relieve pain. This may include the removal of part of the pancreas (pancreatic resection) or drainage of the pancreatic duct.

The choice of pain control depends on the severity of the pain, individual characteristics of the patient and the presence of concomitant diseases.

4.2 Office of enzyme therapy: replenishment of a lack of digestive enzymes

In chronic pancreatitis, the pancreas may not produce a sufficient amount of digestive enzymes, which leads to impaired digestion and absorption of nutrients. Furranted therapy (ZFT) consists in taking drugs containing digestive enzymes (lipase, amylase, proteases) to make up for their deficiency.

• Pancreatic enzymes: Pancreatic enzymes are available in various dosages and release forms (capsules, tablets). They are accepted while eating to help break down food and improve its absorption.
• Dosage: The dosage of drugs of pancreatic enzymes depends on the degree of insufficiency of the exocrine function of the pancreas and the amount of fat consumed. Usually the dosage is selected individually under the supervision of a doctor.
• Take of drugs: Pancreatic enzymes should be taken during food so that enzymes can mix with food and begin to split it. Capsules should be swallowed entirely, without chewing or crushing to protect the enzymes from destruction in the stomach.
• Efficiency: ZFT can significantly improve digestion, reduce steator (fat stool), increase weight and improve the general condition of the patient.
• Side effects: Side effects of ZFT are rare and usually insignificant. They can include nausea, vomiting, diarrhea and abdominal pain.

ZFT is an important part of the treatment of chronic pancreatitis and can significantly improve the quality of life of patients.

4.3 Diet in chronic pancreatitis: low fat content, frequent fractional nutrition

Diet plays an important role in the treatment of chronic pancreatitis. The diet should be aimed at reducing the load on the pancreas, improving digestion and absorption of nutrients, as well as maintaining normal weight.

• Low fat content: A low fat diet is an important part of the diet in chronic pancreatitis. Fat stimulate the secretion of pancreatic enzymes, so the restriction of fat consumption can reduce the load on the pancreas and reduce the pain. It is recommended to consume no more than 20-30 grams of fat per day.
• Frequent fractional nutrition: Frequent fractional nutrition (5-6 small meals per day) can help reduce the load on the pancreas and improve digestion.
• A sufficient amount of proteins and carbohydrates: It is necessary to use a sufficient amount of proteins and carbohydrates to maintain normal weight and energy needs.
• Easily digestible products: Preference should be given to easily digestible products, such as boiled meat, fish, vegetables and fruits.
• Exception of alcohol: The complete exclusion of alcohol is mandatory in chronic pancreatitis. Alcohol can damage pancreatic cells and aggravate inflammation.
• Caffeine restriction: The limitation of caffeine consumption can also be useful, since caffeine can stimulate the secretion of pancreatic enzymes.
• Sufficient fluid consumption: It is important to use a sufficient amount of liquid (at least 2 liters per day) to avoid dehydration.
• Vitamins and minerals: Patients with chronic pancreatitis often need to take vitamins and minerals, especially fat -soluble vitamins (a, d, e, k), since their absorption can be disturbed.
• Nutrition recommendations: It is recommended to consult a nutritionist for the development of an individual food plan, taking into account the patient’s needs and the degree of insufficiency of the exocrine function of the pancreas.

Compliance with a diet is an important part of the treatment of chronic pancreatitis and can significantly improve the quality of life of patients.

4.4 Treatment of complications of chronic pancreatitis: diabetes and steatore.

Chronic pancreatitis can lead to various complications, such as diabetes and steator. Treatment of these complications is an important part of the treatment of chronic pancreatitis.

• Diabetes sugar: Diabetes mellitus develops with chronic pancreatitis due to damage to insulin-producing pancreatic cells. Treatment of diabetes includes diet, physical exercises and drugs (insulin or oral sugar -free drugs). It is important to carefully control the blood sugar in order to prevent complications of diabetes.
• Steatorrhea: Stiatoraea is the release of a large amount of fat with feces. It occurs due to insufficient splitting and absorption of fats in the intestines due to lack of lipase. Treatment of steatores includes ZFT, a low fat diet and taking vitamins and minerals.
• Pseudo -vsists: Pseudocysts, as in acute pancreatitis, can also form with chronic. Treatment is similar, depending on the size and symptoms.
• Pain: Chronic pain requires an integrated approach described earlier.
• Clogging of a common bile duct or duodenum: These complications require surgical intervention.

Careful treatment of complications of chronic pancreatitis can significantly improve the quality of life of patients.

Section 5: Surgical treatment of pancreatitis: indications, types of operations and rehabilitation

5.1 Indications for the surgical treatment of pancreatitis: the inefficiency of conservative therapy and complications

Surgical treatment of pancreatitis is usually considered in cases where conservative therapy is ineffective or with the development of complications. Indications for surgical treatment include:

• Inefficiency of conservative therapy: If conservative therapy (drugs, diet, ZFT) does not allow control of pain, steator or other symptoms of chronic pancreatitis.
• Complications of acute pancreatitis:
  • Infected pancreatic necrosis: Surgical removal of necrotic tissue is necessary for infected necrosis.
  • Pseudo -vicacles that cause symptoms or complications: Surgical drainage or removal of a pseudocyst may be necessary.
  • Bleeding: Surgical treatment may be necessary to stop bleeding from the vessels of the pancreas or surrounding tissues.
• Complications of chronic pancreatitis:
  • Clogging of a common bile duct or duodenum: Surgical treatment may be necessary to eliminate blockage.
  • Suspicion of pancreatic cancer: Surgical removal of the pancreas may be necessary for the diagnosis and treatment of pancreatic cancer.
• Chronic pain that is not amenable to control: In rare cases when the pain is not amenable to control