Chronic pancreatitis – symptoms, causes,treatment, diet and exacerbation in adults

Chronic pancreatitis is considered progressive damage.
pancreatic inflammatory nature that provokes
malfunctions of exocrine and intrasecretory functions. This, in his
turn, leads to a decrease in the production of participating in digestion
enzymes, important hormones (for example, insulin) and a number of biologically
active substances. Therefore, all patients need to identify in time.
symptoms and comply with the prescribed doctor timely and adequate
treatment.

Next, consider what causes the development of the disease, that
is the first sign and symptom in adults, as well as what
effective treatments exist.

What is chronic pancreatitis?

хронический панкреатит поджелудочной железы

Хронический панкреатит – это воспалительное заболевание
pancreas long relapsing course,
characterized by a gradual pathological change in her
cell structure and the development of functional deficiency.

As a result of the progression of this disease, in the gland
the secretion of enzymes – trypsin and lipase decreases. Because of this
organ circulation and connective tissue deteriorate significantly
grows and specific scars are formed, areas with
sclerosis.

Most often the disease arises due to alcohol abuse.
for a long time. In men, chronic pancreatitis
pancreas may develop if they drink for more than 15 years,
women with alcohol abuse for over 10 years.

The reasons

The main mechanism for the development of chronic pancreatitis,
is an increase in pressure in the pancreatic duct and stagnation
it has pancreatic juice. Long stagnation in the duct leads to
disruption of its structure, resulting in pancreatic enzymes
the glands easily penetrate their own tissue, destroying its cells
(autolysis) and the development of a chronic inflammatory process

It may take 10-15 years, when signs of chronic pancreatitis
will become so obvious that there will be no doubt about the diagnosis
no. The disease can occur due to:

  • Холецистита, гастрита или дуоденита хронической
    forms.
  • Gastric or duodenal ulcers.
  • Infectious lesions – mumps, typhoid or typhus,
    viral hepatitis.
  • Excessive consumption of alcoholic beverages.
  • Unregulated diet.
  • Atherosclerotic disease.
  • Проникновения глистов в организм.
  • Intoxication with harmful substances – arsenic, phosphorus, mercury,
    lead

Stages of development of the chronic form

Stage of pancreatitis
Easy Adults at this time begin to torment the first symptoms of the disease.
The duration of the stage may be several years. AT
in some cases, the disease progresses very quickly. Qty
exacerbations 1-2 times a year.
Average Stage of development of constant clinical symptoms. In patients
There are signs of endocrine and exocrine insufficiency. People
very few eat, complain of pain in the abdomen. There are 3-4
exacerbations per year. They are longer than for easy flow.
pancreatitis. In patients людей уменьшается масса тела. Moderately
reduced exocrine function of the pancreas,
pancreatic hyperfermentemia is observed.
Heavy Regular and prolonged seizures (more than 5 times over
years) with intense hostile feelings and pronounced
symptoms. ATес существенно снижается до истощения, признаком
which is diarrhea. Sometimes adverse can be added
the consequences are diabetes mellitus, duodenal stenosis.

Symptoms of chronic pancreatitis

Often, the initial pathological changes in the tissues of the gland
with the development of chronic pancreatitis proceed without symptoms. Or
the symptoms are mild and non-specific. When the first occurs
pronounced exacerbation, pathological disorders are already quite
are significant.

Chronic pancreatitis is a condition that is accompanied by:

  • Painful discomfort, and the degree of intensity can be
    different. Place of localization – the epigastric region and the left
    hypochondrium The pain is present either constantly or appears
    paroxysmal After the patient has eaten anything, the symptom
    will increase.
  • Dyspeptic disorders – nausea, retching,
    sensations of heaviness in the abdomen, unpleasant taste in the mouth
    cavities, flatulence. The patient may have an aversion to
    greasy food, and also sometimes appetite vanishes.
  • Over the years, the patient may claim
    unpleasant symptoms in the form of short-term pain,
    disturbing him after 15 minutes after eating. Continues
    discomfort from one hour to 3-5 days. The place of their concentration is top
    stomach, sometimes there is pain near the heart or left of the chest
    or lumbar. AT определенных ситуациях она опоясывающая.
    You can lower its strength by bending forward or
    squat.
  • The patient’s skin becomes non-expressed yellow. Like
    applies to sclera. Yellowing of the skin from time to time
    passes
  • Due to lack of enzymes the pancreas disrupts the process
    splitting complex molecules of food we consume into smaller ones,
    which are able to digest in the intestines.  AT связи с этим
    in case of pancreatitis, even enhanced nutrition can
    accompanied by weight loss, lack of vitamins in
    dry skin, brittle nails, iron deficiency
    организме (анемия) и другими symptoms.

With pancreatitis, chronic forms of pain occur in
the result:

  • problems with the outflow of pancreatic juice;
  • increase the amount of gland secretion;
  • pancreatic ischemia;
  • inflammation of the surrounding tissue;
  • changes in nerve endings;
  • squeezing bodies nearby.

With the development of the disease, the frequency of exacerbations is usually
increases. Chronic inflammation of the pancreas may
damage both the gland itself and the adjacent tissues.
However, it may take years before clinical
manifestations of the disease (symptoms).

Aggravation

Chronic pancreatitis can worsen over the two most
common reasons:

  • taking large doses of alcohol;
  • dysfunction of the biliary tract.

There are also a lot of reasons that matter less
but significantly increase the frequency of exacerbations
chronic pancreatitis:

  • regular intake of low doses of alcohol;
  • propensity to overeat;
  • smoking;
  • overweight;
  • eating sick amounts of fat;
  • taking medication;
  • infectious diseases;
  • frequent stress.

AT большинстве случаев признаки обострения хронического
pancreatitis manifested in the form of constant, acute and severe pain,
felt under the ribs, reflected in the back.

  • Often pain is atypical, it is masked as other diseases, it happens
    most pronounced in the upper back, eroded by
    to the stomach.
  • Sometimes the pain gives in the chest, in the side, felt in the depths
    организма, что характерно для обострения pancreatitis.

Характерные признаки обострения chronic pancreatitis:

  1. Severe pain that may be dull or abdominal
    cavities without clear localization, reinforcing after eating and
    smack in the back.
  2. Frequent diarrhea with an admixture of fat particles in the stool.
  3. Sense of bitterness in the mouth.
  4. Vomiting interspersed with bile, difficult to eliminate
    drugs.
  5. Severe nausea.
  6. Loss of appetite.
  7. White bloom on the tongue.

ATсе вышеуказанные признаки могут проявляться как целым букетом,
and one by one. If a person suffers from severely pronounced
pain, there may be dyspeptic syndrome in which
the health of the patient is rapidly deteriorating.

Complications

If time does not conduct a competent and complete treatment
chronic pancreatitis, then against its background will begin to actively
progress to the following complications:

  • панкреатический асцит;
  • сахарный диабет панкреатогенного типа;
  • abscess;
  • формирование флегмоны в забрюшинном
    space;
  • inflammatory process in the excretory ducts;
  • duodenal obstruction in a chronic form;
  • AT12-дефицитная анемия;
  • portal hypertension;
  • gastrointestinal bleeding may occur due to rupture
    pseudocysts;
  • the formation of malignant tumors.

Diagnostics

Chronic pancreatitis can be treated as a general practitioner.
so is a gastroenterologist. With the development of endocrine insufficiency
Consultation of an endocrinologist is shown, when others are squeezed
organs – the surgeon.

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The diagnosis can only be made after the implementation of such
research methods:

  • changes in the content of elastase in urine – the main way
    clinical examination of the patient;
  • detection of steatorrhea – the presence of undigested fat in
    kale;
  • research stimulation test
    glands;
  • Ultrasound;
  • CT scan according to indications;
  • blood glucose testing and testing
    on susceptibility to glucose.

How to treat chronic pancreatitis?

By writing to the patient the plan for the upcoming treatment, the doctor sets
well defined goals. It is necessary:

  • eliminate pain;
  • provide pancreas rest;
  • reduce its secretory activity;
  • compensate for the deficiency of pancreatic enzymes;
  • correct the disturbed carbohydrate metabolism (if
    necessary).

Для достижения этих целей в безоперационном лечении больных
all variants of chronic pancreatitis should be applied
different techniques.

The combined effects of various therapeutic factors (diet,
medicines, physiotherapy, etc.) more
efficiently.

Medications

In chronic pancreatitis, the following can prescribe
medications:

  1. Enzyme-containing agents. Aim to reduce the load
    on the pancreas and accelerating the process of tissue regeneration.
    Digestive enzymes facilitate digestion and absorption
    food, facilitate the work of the gastrointestinal tract. With constant
    their admission disappears nausea, appetite. TO
    ферментосодержащим препаратам относятся: TOреон, Панкреатин и т.
    d.
  2. Antacids that reduce acidity. According to principle
    actions they are divided into: suction (Rennie) and
    nonabsorbable (Almagel, Maalox). ATсасывающие обеспечивают
    fast but short relief. Non-Absorbable Action
    longer, the effect occurs some time after
    reception.
  3. Analgesics are aimed at getting rid of the pains that arise when
    pancreatitis during exacerbation. Antispasmodics (no-shpa, papaverine)
    assigned to relieve spasms of the main pancreatic duct
    glands.
  4. Antisecretory drugs (famotidine, omeprazole) are prescribed
    to neutralize the acid.
  5. Противовоспалительные препараты (Диклофенак) снижают боль,
    за счет уменьшения воспаления в области поджелудочной glands.
  6. Уменьшение активной секреции железы, препараты (Октреотид,
    Sandostatin), used in the exacerbation of chronic pancreatitis,
    with severe pain syndrome, not relieving antispasmodics.
  7. Прокинетики (Мотилиум, Церукал) применяются для подавления
    nausea about vomiting, during the exacerbation.

Treatment of exacerbation of chronic pancreatitis

Features of the treatment of a strong attack consists of
strict observance of bed rest, diet and reception
appropriate drugs only in the hospital because
there is a real threat not only to health, but also to human life.
Before the arrival of the ambulance, the patient should be given first
help:

  • Absolute hunger.
  • On the area of ​​the pancreas attach a cold.
  • Full rest and bed rest.

Many patients would like to clarify how long it can last.
exacerbation of chronic pancreatitis? Doctors emphasize in
most episodes of relapse of the disease does not exceed 7 days.

Auxiliary drugs for the relief of pain:

  • enzymes (Creon or Pangrol);
  • antispasmodics (drotaverine or papaverine);
  • proton pump inhibitors (lansoprazole, rabeprazole).

In order to unload the pancreas is used:

  • diet with a strict restriction of fat or full starvation
    several days;
  • complete elimination of alcohol and smoking;
  • Octreotide – a drug that is an analogue of the pancreatic hormone
    somatostatin glands.

Operation

Surgery for chronic pancreatitis:

  • sphincterotomy in case of occlusion of the sphincter of Oddi;
  • excision of stones in the ducts of the pancreas at
    incremental obturation;
  • opening and sanitation of purulent foci (abscesses, phlegmon,
    cysts);
  • pancrectomy (full or partial);
  • vasectomy, splanchectomy (nerve excision surgery,
    regulating gland secretion), partial
  • excision of the stomach (resection);
  • removal of the gallbladder with complications from the large
    the bile duct and gallbladder;
  • techniques to create circumferential bile outflows to relieve stress from
    main pancreatic ducts (virsungoduodenostomy and
    others).

Diet and nutrition

In adults, the disease becomes chronic, and this
meaning that nutrition should be given due attention because
It can prevent aggravations. Each exacerbation entails
a replacement of the normally functioning tissue of the fibrous gland.
Therefore, over the years, the patient develops a gland insufficiency.
exocrine and intrasecretory.

Basic principles of nutrition in chronic pancreatitis:

  1. Diet number 5p in chronic pancreatitis provides an introduction
    в рацион большего количества белковой пищи за счет
    exclusion of fat and carbohydrates. It is also necessary to abandon
    coarse vegetable fiber and fatty meats.
  2. Fried food is not allowed. Пищу рекомендуется готовить
    in a double boiler, simmer and bake in its own juice.
  3. All products that cause dyspepsia and enhance production
    enzymes are also excluded from the menu.
  4. Food when a patient is dieting for chronic pancreatitis should be
    сбалансирована по своему составу, блюда подаются в теплом и
    semi-liquid form.
  5. Nutrition fractional, consists of 5-6 meals, with
    этом порции небольшого объема.
  6. Полный запрет на употребление алкогольных
    напитков исключает основной фактор опасности для поджелудочной
    glands.
  7. New products in the diet should be introduced carefully, small
    in portions.
  8. at the slightest indisposition, it should be abandoned until a more complete
    stabilization of the pancreas;
  9. a recommendation for thorough chewing of food is appropriate for
    healthy body, but with pancreatic disease it
    the rule must be observed especially carefully, even if filed
    soup puree.

Diet during exacerbation of chronic pancreatitis, despite
restrictions, differs in a big variety. Allowed to include
in the diet:

  • lean meat and poultry;
  • lean fish in boiled form;
  • vegetarian vegetable soured;
  • vegetarian soups with rice, with pasta, with buckwheat, manna,
    oatmeal;
  • boiled grated vegetables (potatoes, carrots, zucchini, color
    cabbage, pumpkin);
  • omelettes from 2 eggs;
  • skimmed milk products, non-sour and low-fat cottage cheese,
    sour cream and cream in moderate quantities, fermented milk
    products;
  • ripe fruits with low acidity, grated berries,
    baked apples;
  • compotes and weak tea with lemon;
  • moderate amount of butter and vegetable oil;
  • cereal cooked in water and milk in a ratio of 1: 1;
  • boiled pasta;
  • sugar free cookies and homemade bread crumbs.

Patients are contraindicated dishes with sokogonnym action:

  • meat,
  • bone,
  • mushroom and fish broth,
  • fried foods.

Fundamentally important is the abandonment of alcoholic beverages,
because they are strong pancreatic stimulants
secretion.

During remission, the list of products is expanded and shown.
the inclusion of vegetables and fruits already and raw. Vegetables are used in
the composition of salads, side dishes, vinaigrettes and as separate dishes.
In addition to cereals, pilaf can be made with dried fruits and boiled meat,
pasta krupeniki. Soups are cooked not pureed and carefully
beetroots, borscht and cabbage soup are introduced. To improve the taste used
homemade sauces and spices.

In chronic pancreatitis, treatment is often prescribed.
taking mineral water. To achieve the effect of drinking water is not for
thirst quenching, and according to the recommendations of the reception, certain
types and by the specified system.

Assign a course of water intake brands Essentuki number 4, Borjomi and
Smirnovskaya with a special effect on the pancreas
gland:

  • prevent stagnant processes in the bile ducts, in the
    pancreas;
  • reduce the risk of inflammatory processes;
  • normalize the work of the stomach and intestines.

Prevention

In order not to learn how to treat chronic pancreatitis,
it is necessary to engage in timely prevention of the disease, which
includes:

  • to give up smoking;
  • elimination of the use of alcoholic beverages;
  • dieting;
  • regular check-ups at narrow
    specialists.

Chronic pancreatitis should be treated under the supervision of a physician.
gastroenterologist. When the first signs described in
article, be sure to pass the diagnosis for setting accurate
diagnosis.

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