Chronic pancreatitis – an inflammatory disease of the pancreas prolonged recurrent course characterized by progressive pathological changes in its cellular structure and the development of functional impairment. In gastroenterology, the share of chronic pancreatitis accounts for 5-10% of all diseases of the digestive system. In developed countries in recent years chronic pancreatitis “younger”, if earlier it was typical for people 45-55 years old, now the peak incidence in women accounted for 35-year-old age.
Men suffering from chronic pancreatitis more often than women in recent years the proportion of pancreatitis on a background of alcohol abuse increased from 40 percent to 75 percent among the factors in the development of this disease. Also noted is the growth of occurrence of malignant tumors in the pancreas with chronic pancreatitis. Increasingly, the direct connection of chronic pancreatitis with an increase in the incidence of diabetes .
The causes of chronic pancreatitis
Just as in the case of acute pancreatitis , the main causes of chronic inflammation of the pancreas is the abuse of alcohol and gallstone disease .
Alcohol is directly toxic to breast parenchyma factor. When gallstones inflammation becomes the result of the transition from an infection of the bile ducts in the gland through the vessels of the lymphatic system, the development of hypertension, biliary tract or direct reflux of bile into the pancreas.
Other factors contributing to the development of chronic pancreatitis:
- persistent increase in the concentration of calcium ions in the blood;
- cystic fibrosis ;
- the use of drugs (corticosteroids, estrogens, thiazide diuretics, azathioprine);
- prolonged stasis of pancreatic secretions (obstruction of the sphincter of Oddi due to scarring of duodenal papilla);
- autoimmune pancreatitis;
- genetically caused pancreatitis;
- idiopathic pancreatitis (unknown etiology).
Classification of chronic pancreatitis
Chronic pancreatitis is classified
- origin: primary ( alcoholic , toxic, etc.) and secondary ( biliary , and others.);
- Clinical manifestations: pain (recurrent and persistent), pseudotumor (cholestatic, with portal hypertension, with partial duodenal obstruction), latency (unexpressed clinic) and match (expressed by several clinical symptoms);
- on the morphological picture (calcification, obstructive, inflammatory (infiltrative fibrotic) induration (fibro-sclerotic);
- on the functional film, the nature of functional disorders may allocate hypersecretion, giposekretorny, obstructive, ductular (secretory deficiency is also divided on the degree of severity in the light, medium and heavy), hyperinsulinism, gipoinsulinizm (pancreatic diabetes);
Chronic pancreatitis is distinguished by the severity and structural damage (heavy, moderate and light). In the course of the disease distinguish acute stage of remission and unstable remission.
Symptoms of chronic pancreatitis
Often the initial pathological changes in the breast tissue during the development of chronic pancreatitis occur without symptoms. Either slabovyrazhena and nonspecific symptoms. When it is the first expression of the aggravation of pathological disorders quite significant.
The main complaint with exacerbation of chronic pancreatitis is often a pain in the upper abdomen, in the left upper quadrant, which can acquire herpes character. The pain is constant or severe or is paroxysmal in nature. The pain may radiate to the projection area of the heart. Pain may be accompanied by dyspepsia (nausea, vomiting, heartburn, bloating, flatulence). Vomiting during exacerbation of chronic pancreatitis can be frequent, exhausting, not bringing relief. The chair can be unstable, diarrhea alternating with constipation . Decreased appetite and indigestion contribute to weight loss.
With the development of the disease relapse rate usually increases. Chronic inflammation of the pancreas could lead to damage of both the prostate and adjacent tissues. However, it could be years before you see clinical manifestations of the disease (symptoms).
At external examination in patients with chronic pancreatitis often mark yellowness of the skin and sclera. Hue brownish jaundice (obstructive jaundice). Blanching of the skin in combination with dry skin . On the chest and abdomen may experience red spots ( “red drop”), does not disappear after pressing.
Abdominal palpation is moderately swollen epigastric, in the pancreas projection can be marked atrophy of subcutaneous fat. On palpation of the abdomen – pain in the upper half, around the navel, in the left upper quadrant, in the costovertebral corner. Sometimes chronic pancreatitis accompanied by mild hepatic- and splenomegaly.
Diagnosis of chronic pancreatitis
To clarify the diagnosis “chronic pancreatitis” gastroenterologist appoints laboratory blood tests, stool, functional diagnostics methods.
Complete blood count during the exacerbation, as a rule, shows a picture of nonspecific inflammation. For differential diagnosis sampled on the enzyme activity of the pancreas (amylase, lipase). Radioimmunoassay reveals increased activity of elastase and trypsin. To program reveals excess fat, suggesting that the enzyme pancreatic insufficiency .
Explore the size and structure of the pancreatic parenchyma (and surrounding tissues), you can use ultrasound of the abdomen , CT, MRI . The combination of ultrasound endoscopy method – endoscopic ultrasonography (EUS) enables detailed study of breast tissue and the inside wall of the gastrointestinal tract. Also provides additional information on the patency of the biliary tract X-ray examination. If pancreatitis using endoscopic retrograde cholangiopancreatography – radiopaque substance injected endoscopically into the duodenal papilla.
For further information on the ability of the gland to the development of certain enzymes prescribed functional tests with specific stimulators of the secretion of certain enzymes.
Complications of chronic pancreatitis
Early complications of chronic pancreatitis are obstructive jaundice due to the violation of the outflow of bile, portal hypertension , internal bleeding as a result of ulceration or perforation of the hollow organs of the digestive tract, infection, and infectious complications (abscess, parapankreatit, abscess zabryushinnnoy fiber, cholangitis).
Complications of a systemic nature: multiorgan pathology, functional insufficiency of organs and systems ( kidney , lung , liver) encephalopathy , DIC . With the development of the disease can occur esophageal bleeding, weight loss, diabetes, malignant neoplasm of the pancreas.
Treatment of chronic pancreatitis
Treatment of chronic pancreatitis is carried out surgically or conservative, depending on the severity of the disease, and the presence or development of complications.
Conservative treatment includes the following components.
- Diet therapy. Patients with chronic pancreatitis during severe exacerbation is recommended to refrain from enteral nutrition at stuhanii prescribed diet number 5B. In chronic pancreatitis, the use of alcohol is strictly prohibited, removed from the diet of spicy, fatty, acidic foods, pickles. In pancreatitis, complications of diabetes, – control of sugar-containing products.
- Exacerbation of chronic pancreatitis treated in the same way as acute pancreatitis (symptomatic therapy, pain relief, detoxification, removal of inflammation, restoration of digestive function).
- For alcoholic pancreatitis genesis rejection of the use of alcohol-containing products is a key factor in treatment, in mild cases, leading to relief of symptoms.
Indications for surgical treatment of chronic pancreatitis may become purulent complications ( abscess and cellulitis ), obstruction of the bile and pancreatic ducts, stenosis of the sphincter of Oddi, expressed serious changes in the breast tissue (sclerosis, calcification), cysts and pseudocysts of the pancreas, severe course, intractable conservative therapy .
Surgery for chronic pancreatitis:
- sphincterotomy with occlusion of the sphincter of Oddi;
- excision of the stones in the ducts of the pancreas at konkrementnoy obturation;
- opening and rehabilitation of purulent foci (abscesses, abscesses, cysts);
- pankrektomiya (full or partial);
- vasectomy, splanhektomiya (operation excision of nerves that regulate the secretion of the prostate), partial resection of the stomach ( resection );
- gallbladder removal complications from the large bile duct and gall bladder;
- the art of creating the district bile outflows to relieve the main pancreatic duct.
Prevention of development and exacerbation of pancreatitis
Measures of primary prevention of chronic pancreatitis:
- limiting alcohol consumption, rational nutrition, a balanced diet without overeating attacks, limit fatty foods, starchy foods;
- to give up smoking;
- use enough water (at least half liters per day);
- a sufficient amount of vitamins and minerals in the diet;
- timely access to a doctor about the disorders of the gastrointestinal tract, adequate and full treatment of digestive diseases .
For the prevention of exacerbations of chronic pancreatitis is necessary to observe all the doctor’s advice on diet and lifestyle, regularly (at least 2 times per year) to be screened. An important role in prolonging remission and improved quality of life for patients with chronic pancreatitis plays a spa treatment.
The prognosis of chronic pancreatitis
If you follow the recommendations for prevention of exacerbations of chronic pancreatitis is mild and has a favorable prognosis for survival. In violation of the diet, alcohol, smoking, and inadequate treatment of advanced degenerative processes in the prostate tissue and develop severe complications, many of which require surgery and can be fatal.