Pancreatitis: to recovery step by step

Pancreatitis: to recovery step by step. Detailed leadership

What is pancreatitis? Anatomy and physiology of the pancreas.

Pancreatitis is an inflammation of the pancreas, an important organ located in the abdominal cavity, behind the stomach and between the spleen and the duodenum. To understand the essence of pancreatitis, it is necessary to understand the anatomy and physiology of the pancreas.

The pancreas has an elongated shape and consists of three main parts: head, body and tail. The pancreatic head is located in the bend of the duodenum, the body extends horizontally, and the tail reaches the spleen.

The function of the pancreas is twisted: exocrine and endocrine.

• Exocrine function: This function is responsible for the development and release of digestive enzymes that are necessary for the splitting of proteins, fats and carbohydrates in the duodenum. These enzymes, including amylase, lipase, tripripsin, are synthesized in acynar cells that form most of the gland. Enzymes are distinguished in an inactive form (zytogen) and are activated only in the intestines to prevent self -digestion of the gland. The ducts of acynar cells merge into larger ducts, forming the main pancreatic duct (vissunes of the duct), which leads the enzymes into the duodenum through the vests through the vests.

• Endocrine function: This function is responsible for the production of hormones that regulate blood sugar. Hormones, such as insulin and glucagon, are produced in the islets of Langerganes – accumulations of endocrine cells scattered across the entire pancreatic tissue. Insulin reduces blood sugar, contributing to its absorption by cells, and glucagon increases blood sugar, stimulating glycogen decay in the liver. Other hormones produced by the islands of Langerganes include somatostatin and pancreatic polypeptide.

With pancreatitis, premature activation of digestive enzymes inside the pancreas occurs, which leads to self -digestion of the gland tissue. This process causes inflammation, swelling, hemorrhage and necrosis (wiping) of tissues.

Types of pancreatitis: acute and chronic.

Pancreatitis is classified into two main forms: acute and chronic.

• Acute pancreatitis: This is a sudden inflammation of the pancreas, which usually develops rapidly and can vary from a slight shape to a heavy, threatening life. In acute pancreatitis, damage to the tissue of the pancreas occurs, but with proper treatment and observation of recommendations, it can be restored.

  • Light acute pancreatitis: It is characterized by a minimum organ dysfunction and the absence of local or systemic complications.
  • Moderately severe acute pancreatitis: Associated with temporary organ dysfunction, local complications (for example, accumulation of fluid around the pancreas) or both.
  • Severe acute pancreatitis: It is characterized by persistent organ dysfunction (for example, respiratory, cardiovascular or renal failure), which can lead to death.

• Chronic pancreatitis: This is progressive inflammation of the pancreas, which leads to irreversible damage to the tissue of the gland and impaired its function. Chronic pancreatitis is characterized by repeated episodes of abdominal pain, which can be constant or interspersed. As the disease progresses, the insufficiency of the exocrine and endocrine function of the pancreas may develop, which leads to digestive disorders and diabetes.

  • Early chronic pancreatitis: It is characterized by minor changes in the pancreatic tissue and can be difficult to diagnose.
  • Late chronic pancreatitis: It is characterized by pronounced changes in the pancreatic tissue, including fibrosis (the formation of cicatricial tissue), calcification (deposition of calcium salts) and cysts.

Causes of pancreatitis: risk factors and development mechanisms.

There are many factors that can contribute to the development of pancreatitis. The most common causes of both acute and chronic pancreatitis are:

• Gallstone disease: The gallstones that block the common bile duct can cause the back of the bile in the pancreas, which leads to the activation of enzymes and inflammation. This is the most common cause of acute pancreatitis.

• Alcohol abuse: Chronic alcohol consumption is the main cause of chronic pancreatitis. Alcohol can cause damage to pancreatic cells, leading to inflammation and fibrosis.

• Hyperyglyceridemia: A high level of triglycerides (type of fat) in the blood can contribute to the development of acute pancreatitis.

• Hypercalcemia: A high level of calcium in the blood can cause the activation of pancreatic enzymes and inflammation.

• Medicines: Some drugs, such as thiazide diuretics, sulfasalazine, azathioprine and valproic acid, can cause pancreatitis in rare cases.

• Trauma life: A dumb or penetrating abdominal injury can damage the pancreas and cause pancreatitis.

• Infections: Some infections, such as pig, cytomegalovirus and coksaki virus, can cause pancreatitis.

• Autoimmune diseases: Some autoimmune diseases, such as systemic lupus erythematosus and Shegren’s disease, can affect the pancreas and cause pancreatitis.

• Genetic factors: Some genetic mutations can increase the risk of pancreatitis, especially chronic. These include mutations in PRSS1, Spink1 and CFTR genes.

• Cystic fibrosis: This is a genetic disease that affects the lungs and other organs, including the pancreas. In patients with cystic fibrosis, pancreatitis often develops.

• Idiopathic pancreatitis: In some cases, the cause of pancreatitis cannot be established. In these cases, pancreatitis is called idiopathic.

Pancreatitis development mechanisms include:

• Premature activation of enzymes: Normally, the digestive enzymes of the pancreas are activated only in the duodenum. However, with pancreatitis, these enzymes can be activated inside the pancreas, causing self -digestion of the gland tissue.

• Oxidative stress: Inflammation in pancreatitis leads to the formation of free radicals that damage the cells of the pancreas.

• Inflammatory cascade: Activation of enzymes and oxidative stress trigger a complex inflammatory cascade, in which various inflammation mediators, such as cytokines and chemokins, participate.

• Violation of microcirculation: Inflammation and edema for pancreatitis can disrupt the blood supply to the pancreas, which leads to ischemia (lack of oxygen) and tissue damage.

• Fibroz: In chronic pancreatitis, repeated episodes of inflammation lead to the formation of scar tissue (fibrosis), which gradually replaces the normal tissue of the pancreas.

Symptoms of pancreatitis: clinical manifestations of acute and chronic pancreatitis.

Symptoms of pancreatitis can vary depending on the form (acute or chronic) and the severity of the disease.

Symptoms of acute pancreatitis:

• Abdominal pain: This is the main symptom of acute pancreatitis. The pain usually occurs suddenly and intense, localized in the upper abdomen, often radiates into the back. The pain can intensify in a lying position and decrease in a sitting position with an inclination forward.

• Nausea and vomiting: Nausea and vomiting often accompany abdominal pain. Vomiting can be indomitable and not bring relief.

• Bloating: The stomach can be swollen and tense.

• Fever: Body temperature can increase to 38-39 ° C.

• Tachycardia: Charp heartbeat.

• Hypotonia: Decrease in blood pressure. In severe cases, shock may develop.

• Jaundice: Yellowing of the skin and sclera of the eyes (rarely, with obstruction of the bile ducts).

• Respiratory failure: In severe cases, pulmonary edema and respiratory failure may develop.

• Symptom of Kullin: Blue the skin around the navel (rarely, indicates hemorrhage in the abdominal cavity).

• Gray Turner’s symptom: The blue of the skin in the side areas of the abdomen (rarely, indicates hemorrhage in the retroperitoneal space).

Symptoms of chronic pancreatitis:

• Abdominal pain: Abdominal pain is the main symptom of chronic pancreatitis, although it can be less intense than with acute pancreatitis. The pain can be constant or interspersed, localized in the upper abdomen and radiate to the back. The pain can be intensified after eating, especially after eating fatty foods.

• Indigestion: Chronic pancreatitis can lead to insufficiency of the exocrine function of the pancreas, which means that the pancreas does not produce enough digestive enzymes. This can cause:

  • Steator: The allocation of oily, oily stool.
  • Diarrhea: Frequent, liquid chair.
  • Weight loss: Despite normal appetite, patients can lose weight due to violation of the absorption of nutrients.
  • Bloating of the abdomen and gases: Disgraceal disorders can lead to bloating and gases formation.

• Diabetes sugar: Chronic pancreatitis can damage the islands of Langerganes, which leads to insufficiency of the endocrine function of the pancreas and the development of diabetes. Symptoms of diabetes include:

  • Increased thirst.
  • Frequent urination.
  • Increased fatigue.
  • Loss of weight.
  • Slow healing of wounds.

• Jaundice: It can occur when narrowing the general bile duct due to fibrosis or cysts.

• Pseudo -vsists: The formation of cavities filled with liquid in the pancreas or around it. Pseudocysts can cause pain, pressure on neighboring organs and, in rare cases, infection or bleeding.

• Constipation: In some cases, constipation may occur.

• Nausea and vomiting: They can occur, but less often than with acute pancreatitis.

Diagnosis of pancreatitis: laboratory and instrumental methods.

Diagnosis of pancreatitis includes a history of anamnesis, physical examination, as well as laboratory and instrumental research.

Laboratory research:

• Amylase blood serum: The level of amylase in the blood serum is usually significantly increased in acute pancreatitis. However, the level of amylase can be normal in chronic pancreatitis, especially in the later stages of the disease.

• Blood serum lipase: Lipase is a more specific indicator of damage to the pancreas than amylase. The level of lipase is also increased in acute pancreatitis and can be normal for chronic pancreatitis.

• General blood test: It can reveal signs of inflammation, such as an increased amount of leukocytes.

• Biochemical blood test: It can identify deviations in the level of electrolytes, glucose, bilirubin and other indicators that may indicate complications of pancreatitis.

• Functional pancreatic tests: Used to evaluate the exocrine function of the pancreas in chronic pancreatitis. These include:

  • Fecal elastasis-1: Measurement of the level of elastasis-1 in feces. A decrease in the level of elastasis-1 indicates the insufficiency of the exocrine function of the pancreas.
  • Test with secretin: Stimulation of the pancreas with secrets and measuring the volume and content of bicarbonates in pancreatic juice.
  • Paraiaminobenzoic acid (PABA) Test: Assessment of the ability of the pancreas to split benzoil-tyrosine.

• Analysis Mochi Diastazu: The level of diastase in the urine also increases with acute pancreatitis.

Instrumental research methods:

• Ultrasound examination (ultrasound) of the abdominal cavity: It can identify the gallstones, an increase in the pancreas, the accumulation of fluid around the pancreas and other changes characteristic of pancreatitis. Ultrasound is less informative for the visualization of the pancreas due to the presence of gases in the intestines.

• Computer tomography (CT) of the abdominal cavity: CT is a more informative method than ultrasound for visualization of the pancreas and surrounding tissues. CT can identify inflammation, edema, necrosis, pseudocysts, abscesses and other complications of pancreatitis. CT can also help exclude other diseases that can cause such symptoms.

• Magnetic resonance imaging (MRI) of the abdominal cavity: MRI is another informative method for visualizing the pancreas and surrounding tissues. MRI is especially useful for identifying pseudocysts, tumors and other changes in the pancreas.

• Endoscopic retrograde cholangiopancreatography (ERCP): ERCPG is an invasive method in which an endoscope is introduced into the bile ducts and pancreatic ducts through the mouth and duodenum. ERCPH allows you to visualize the ducts, detect stones, strictures (narrowing) and other anomalies. ERCPS can also be used for medical manipulations, such as stones removal or installation of stents (tubes) to expand the narrowed ducts. Due to the risk of developing pancreatitis, ERCP is used mainly for therapeutic purposes.

• Endoscopic ultrasound (eusy): Eusta is a method in which the ultrasonic sensor is attached to the endoscope and entered into the stomach or duodenum. Euzi allows you to get more detailed images of the pancreas than ordinary ultrasound. Eusta can also be used to take a biopsy (tissue sample) from the pancreas for further examination.

Treatment of acute pancreatitis: basic principles and methods.

Treatment of acute pancreatitis depends on the severity of the disease. The purpose of treatment is to relieve pain, maintaining the body’s functions, preventing complications and eliminating the cause of pancreatitis.

• Conservative treatment:

  • Famine: At the beginning of treatment, the patient is recommended to reduce the load on the pancreas and give it the opportunity to recover. Power is carried out intravenously (parenteral nutrition).
  • Anesthesia: To relieve pain, analgesics are used, such as paracetamol, and non -steroidal anti -inflammatory drugs (NSAIDs), such as Ibuprofen or Diclofenac. In severe cases, opioid analgesics such as morphine or tramadol may be required.
  • Infusion Therapy: Intravenous administration of solutions of electrolytes and glucose to maintain water and electrolyte balance and replenish fluid loss.
  • Proton pump inhibitors (IPP): IPP reduce the production of gastric juice, which can reduce the stimulation of the pancreas.
  • Antibiotics: Antibiotics are prescribed only in the presence of infectious complications, such as an abscess or infected necrosis.
  • Organ support: In severe cases, support for organs such as respiratory support (lung ventilation) with respiratory failure, hemodialysis with renal failure and inotropic drugs to maintain blood pressure in shock may be required.

• Endoscopic treatment:

  • POWER: ERCP can be used to remove bile stones from the common bile duct, if the cause of pancreatitis is gallstone disease.
  • Drainage pseudo -Kistyst: Endoscopic drainage of the pseudo -Kistokist can be performed using an euzi or ERCP.

• Surgical treatment:

  • Removing the gallbladder (cholecystectomy): Cholecystectomy is recommended for patients with acute pancreatitis caused by gallstone disease after stabilizing the condition.
  • Necrotomy: Surgical removal of the necrotic pancreatic tissue may be necessary with severe necrotic pancreatitis.
  • Abscess drainage: Surgical drainage of abscesses may be necessary with the development of abscesses in the pancreas or around it.

Treatment of chronic pancreatitis: monitoring of symptoms and prevention of complications.

Treatment of chronic pancreatitis is aimed at relieving pain, improving digestion, controlling blood sugar and preventing complications.

• Conservative treatment:

  • Anesthesia: To relieve pain, analgesics are used. The initial stage is the use of NSAIDs and paracetamol. With the ineffectiveness of these drugs, stronger analgesics, such as tramadol or opioids, can be prescribed. In some cases, antidepressants or anticonvulsants can also be used, which can also have an anesthetic effect.
  • Feet -replacement therapy (ZFT): ZFT consists in taking drugs containing digestive enzymes (lipase, amylase, protease) to compensate for the insufficiency of the exocrine function of the pancreas. ZFT helps to improve digestion, reduce steator and weight loss. ZFT preparations are taken with each meal.
  • Insulinotherapy: Patients with diabetes who have developed against the background of chronic pancreatitis require insulin therapy to monitor blood sugar.
  • Diet: Compliance with a diet is an important aspect of the treatment of chronic pancreatitis. It is recommended to limit the use of fatty foods, alcohol and smoking. The power should be fractional, 5-6 times a day, in small portions.
  • Vitamins and minerals: Patients with chronic pancreatitis often lack vitamins and minerals due to impaired suction of nutrients. It is recommended to take polyvitamin complexes containing vitamins A, D, E, K and B12, as well as minerals, such as calcium, magnesium and zinc.

• Endoscopic treatment:

  • Drainage pseudo -Kistyst: Endoscopic drainage of the pseudo -Kistokist can be performed using an euzi or ERCP.
  • Expansion of strictures: The endoscopic expansion of pancreatic strictures and the installation of stents can be performed to improve the outflow of pancreatic juice and reduce pain.
  • Neurolysis: Endoscopic administration of anesthetics or other drugs into the area of ​​the celiac plexus (accumulation of nerves in the abdominal cavity) can help reduce pain in chronic pancreatitis.

• Surgical treatment:

  • Freya operation: This is a surgical procedure in which the pancreatic head is removed and the pancreatic duct expands. Frey’s operation can help reduce pain and improve the outflow of pancreatic juice.
  • Operation Begera: This is a surgical procedure in which the pancreatic head and duodenum are removed. The runner’s operation can be performed with severe chronic pancreatitis with the formation of cysts and strictures in the pancreatic head.
  • Pancreatectomy: This is surgical removal of part or the entire pancreas. Pancreatectomy can be performed with severe chronic pancreatitis that is not amenable to other methods of treatment. After pancreatectomy, patients need lifelong replacement enzyme therapy and insulin therapy.

Diet for pancreatitis: recommendations for nutrition for acute and chronic pancreatitis.

Compliance with a diet is an important aspect of the treatment of both acute and chronic pancreatitis. The diet helps to reduce the load on the pancreas, improve digestion and prevent complications.

Diet for acute pancreatitis:

• Famine: In the early days of acute pancreatitis, complete hunger is recommended to give the pancreas the ability to relax and recover. Power is carried out intravenously (parenteral nutrition).
• Gradual diet expansion: After the acute symptoms subside, the diet gradually expands. Begin with the use of small portions of easily digestible food, such as:
  • Liquids: Neal water, unsweetened tea, diluted juices.
  • Porridge: Rice, oatmeal, buckwheat porridge on the water.
  • Soups: Vegetable soups-puree.
  • Mashed potatoes: Vegetable mashed potatoes (for example, potato, carrot).
  • Low -fat protein products: Boiled or steamed chicken fillet, fish.
• Restrictions: During the recovery period, it is necessary to avoid:
  • Fat food: Frying dishes, fatty meat, lard, butter, sour cream.
  • Spicy food: Pepper, garlic, horseradish, mustard.
  • Sour products: Citrus fruits, sour fruits, marinades.
  • Alcohol: Alcohol is completely excluded.
  • Soda drinks.
  • Coffee.
  • Chocolate.

Diet in chronic pancreatitis:

• Frequent fractional nutrition: It is recommended to eat 5-6 times a day in small portions. This helps to reduce the load on the pancreas and improve digestion.
• Fat restriction: It is important to limit the use of fats up to 30-50 grams per day. Avoid fried dishes, fatty meat, lard, butter, sour cream and other fatty products. Preference should be given to low -fat sources of protein, such as chicken fillet, fish, tofu, and vegetable oils (olive, sunflower, linen) in small quantities.
• Sufficient amount of protein: Protein is necessary to restore tissues and maintain health. It is recommended to consume 1-1.5 grams of protein per kilogram of body weight per day.
• Complex carbohydrates: The basis of the diet should be complex carbohydrates, such as cereals (buckwheat, oatmeal, rice), vegetables and fruits. Avoid simple carbohydrates such as sugar, sweets and baking.
• Vegetables and fruits: Vegetables and fruits are an important source of vitamins, minerals and fiber. It is recommended to consume at least 5 servings of vegetables and fruits per day. Preference should be given to boiled or baked vegetables. Avoid acidic fruits and vegetables.
• Water: It is important to drink enough water (1.5-2 liters per day) to maintain hydration and improve digestion.
• Alcohol: Alcohol is completely excluded.
• Smoking: Refusal of smoking.
• Recommended products:
  • Porridge: Rice, oatmeal, buckwheat.
  • Soups: Vegetable soups-puree, cereal soups in low-fat broth.
  • Low -fat meat and fish: Boiled or prepared for a couple of chicken fillet, beef, cod, pollock.
  • Vegetables: Potatoes, carrots, beets, zucchini, pumpkin (boiled, baked, steamed).
  • Fruits: Apples, pears, bananas (non -acidic).
  • Sour -milk products: Low -fat cottage cheese, kefir, yogurt.
  • Bread: Dried white bread, bellied cookies.
• Products that should be avoided:
  • Fatty meat and fish: Pork, lamb, duck, goose, mackerel, herring.
  • Frying dishes.
  • Acute and spicy food.
  • Smoked meats and canned food.
  • Marinades and pickles.
  • Assed pastries and sweets.
  • Carbonated drinks and alcohol.
  • Coffee and strong tea.

Complications of pancreatitis: consequences of inflammation of the pancreas.

Pancreatitis can lead to various complications, which can be either local (in the pancreas) and systemic (damaging other organs and systems).

Complications of acute pancreatitis:

• Pseudo -vsists: Pseudocysts are filled with fluid of the cavity, which are formed around the pancreas after acute pancreatitis. Pseudocysts can cause pain, pressure on neighboring organs and, in rare cases, infection or bleeding.
• Abscept: The abscess is a cluster of pus in the pancreas or around it. Abscesses usually occur as a result of infection of the necrotic pancreatic tissue.
• Necrotic pancreatitis: Necrotic pancreatitis is a severe form of acute pancreatitis, in which the dummy (necrosis) of the pancreatic tissue occurs. Necrotic pancreatitis can lead to serious complications, such as sepsis (blood poisoning) and death.
• Sepsis: Sepsis is a severe systemic inflammatory reaction to infection. Sepsis can occur with pancreatitis as a result of infection of the necrotic tissue of the pancreas or abscess.
• Acute respiratory failure (ARDS): The ARDS is a serious lung disease in which the lungs cannot effectively exchange oxygen and carbon dioxide. The ARDS can occur with pancreatitis as a result of the release of inflammatory mediators into the blood.
• Renal failure: Renal failure is a condition in which the kidneys cannot effectively fulfill their function to filter blood and elimination of waste from the body. Renal failure can occur with pancreatitis as a result of a decrease in blood pressure and impaired blood supply to the kidneys.
• Diabetes sugar: Acute pancreatitis can damage the islands of Langerganes, which leads to the development of diabetes.
• Flood education: Fistulas are abnormal compounds between the pancreas and other organs such as intestines or skin. Fistulas can occur as a result of pancreatic tissue necrosis or surgical intervention.
• Slezer -free thrombosis: Inflammation with pancreatitis can lead to the formation of a blood clot in the spleen vein.

Complications of chronic pancreatitis:

• Diabetes sugar: Chronic pancreatitis can damage the islands of Langerganes, which leads to the development of diabetes.
• The insufficiency of the exocrine function of the pancreas: Chronic pancreatitis can lead to insufficiency of the exocrine function of the pancreas, which means that the pancreas does not produce enough digestive enzymes. This can cause steator, diarrhea and weight loss.
• Pseudo -vsists: Pseudocysts can also form with chronic pancreatitis.
• Obstruction of the bile ducts: Pancreatic tissue fibrosis can lead to narrowing of the common bile duct, which causes jaundice.
• Pancreatic cancer: Chronic pancreatitis is a risk factor for the development of pancreatic cancer.
• Depression: Chronic pain and diet can lead to depression.
• Drug addiction: Long -term use of opioid analgesics to relieve pain can lead to drug addiction.
• Osteoporosis: Violation of the absorption of vitamin D and calcium can lead to osteoporosis.
• Ploster intestine strictures: Inflammation and fibrosis can lead to narrowing of the duodenum.

Prevention of pancreatitis: measures to prevent inflammation of the pancreas.

Prevention of pancreatitis includes taking measures to reduce the risk of developing pancreatic inflammation.

• Refusal of alcohol: Alcohol is one of the main causes of pancreatitis, especially chronic. A complete rejection of alcohol is an important preventive measure.
• Healthy nutrition: Compliance with a healthy diet, with fat restrictions and sufficient amounts of protein, vegetables and fruits, helps reduce the risk of pancreatitis.
• Maintaining normal weight: Obesity is a risk factor for the development of pancreatitis. Maintaining normal weight helps to reduce this risk.
• Treatment of gallstone disease: Gallstone disease is one of the main causes of acute pancreatitis. Timely treatment of gallstone disease, such as the removal of the gallbladder (cholecystectomy), helps to prevent the development of pancreatitis.
• Triglycerides level control: A high level of blood triglycerides can increase the risk of pancreatitis. Maintaining a normal level of triglycerides using a diet, physical exercises and, if necessary, drugs, helps to reduce this risk.
• Refusal of smoking: Smoking is also a risk factor for the development of pancreatitis.
• Cautious use of drugs: Some drugs can cause pancreatitis. Before taking a new drug, you need to consult a doctor