Pancreatitis is an inflammation in the pancreas in which there is a development of a deficiency in the production of pancreatic enzymes of varying severity.
- diseases of the gallbladder and biliary tract
- drugs (aspirin, hypothiazide, etc.)
- toxic substances
- metabolic acidosis
- protein deficiency
- hormonal disorders
The main mechanism of development of pancreatitis is self-digestion as a result of the activation of its own enzymes with the development of edema, death and replacement of normal pancreatic tissue.
The picture of the disease consists of three main features:
- abdominal pain,
- disruption of the digestive process,
- diabetes mellitus.
Pain in pancreatitis due to inflammation in the pancreas, are permanent, localized in the center of the epigastric region, given to the back, do not depend on food intake, they usually subside spontaneously or significantly decrease 5-7 days after the onset of exacerbation, are eliminated by painkillers, antispasmodics.
Pain in the presence of blockage of the pancreas ducts, as well as the development of pseudocyst and cysts, usually encircling, paroxysmal, occur during or immediately after a meal, often accompanied by nausea and vomiting, not bringing relief. These pains are reduced by taking antispasmodics and drugs that reduce pancreatic secretion.
With the development of pancreatitis appear diarrhea, flatulence, nausea, lack of appetite, weight loss. Fecal masses acquire gray greasy color and fetid odor.
1. Evaluation of pancreatic function: scopological test with elastase-1:
- more than 200 mcg / g of feces is the norm
- 100-200 mcg / g of feces – mild – moderate degree of pancreatic insufficiency,
- less than 100 µg / g of feces – severe pancreatic insufficiency.
Disorders of carbohydrate metabolism in chronic pancreatitis are detected in about 1/3 of patients as a result of damage to the cells of the pancreas, resulting in a deficit of hormones.
3. X-ray examination
Conservative therapy of pancreatitis includes a set of measures. The basis of therapy is based on the following principles:
- correction of pancreatic insufficiency;
- elimination of pain;
- prevention of complications.
In the treatment of pancreatitis, it is necessary to exclude the use of alcohol, taking medications that can have a damaging effect on the pancreas (antibiotics, antidepressants, sulfonamides, diuretics – hypothiazide and furosemide, indirect anticoagulants, indomethacin, brufen, paracetamol, gluco-coctoco, and anticoagulants, indomethacin It is extremely important to treat diseases of the gastrointestinal tract and timely prevention of infectious diseases that cause damage to the pancreas ( viral hepatitis B and C, mumps ).
Eating disorders such as overeating, alcohol abuse, nutritional protein deficiency, food allergies may be the immediate cause of pancreatitis.
Without the use of diet therapy, it is difficult to expect a sufficient therapeutic effect. Properly organized food can prevent the development of complications, exacerbations of the disease and its progression.
Treatment of acute pancreatitis
During exacerbation of pancreatitis, patients need to be hospitalized with daily monitoring of blood parameters, water balance, white blood cell count, serum enzyme levels, acid-base balance during the first week.
Suppression of pancreatic secretion is the most important event in the treatment of exacerbation of pancreatitis. For this purpose, the following methods are used:
- cold on the epigastric region;
- in the first 1–3 days of exacerbation of pancreatitis, hunger and alkaline solutions every 2 hours are recommended (for example, alkaline mineral waters);
- use of peripheral M-anticholinergics (gastrotsepin)
- the appointment of somatostatin analogue – sandostatin in order to reduce pancreatic secretion, eliminate abdominal pain, reduce the need for painkillers. Sandostatin is administered at a dose of 100 mcg subcutaneously 1–3 times per day (maximum up to 600 mcg / day) for a period from several days to several weeks;
- reducing the acidity of gastric contents to ensure functional rest of the pancreas. For this purpose, antacid preparations are used, H2-histamine receptor blockers (cimetidine), as well as blockers of “proton pump” of obkladochnyh cells (omeprazole);
- inhibition of pancreatic function: dalargin 1 ml intramuscularly 2 times a day for 22-24 days; Peritol seems to be promising (4 mg 3 times a day orally for 8–10 days)
- enzyme inhibitors are used after determining the individual tolerance of the drug to patients. The following drugs are used: trasilol, contrycal, gordox. They are administered intravenously simultaneously in a 5% glucose solution or drip in an isotonic solution of sodium chloride. Allergic reactions to the introduction of these drugs are observed with a frequency of 10–12%;
- antimicrobial therapy. It is used for exacerbation of pancreatitis, which occurs with fever, intoxication, and also for the prevention of complications. Typically, broad-spectrum antibiotics are used — penicillins or cephalosporins (ampicillin, oxacillin, ampioks, kefzol, claforan, and others) for 5–7 days in usual daily dosages.
Insufficiency of pancreatic function is manifested by impaired intestinal absorption syndrome. According to modern concepts, this syndrome does not manifest itself in chronic pancreatitis until the secretion of enzymes decreases to 10% of its original potential. Treatment of pancreatic insufficiency is reduced to the appointment of a diet and enzyme replacement therapy. In this case, the dose of the enzyme preparation is selected for each patient individually.
The main criterion for the effectiveness of treatment is the dynamics of the amount of fat in the feces and body weight of the patient. Usually, treatment starts with 3 tablets before, after and during main meals. In severe forms, the amount of the drug can reach 20 or more tablets daily. Enzyme preparations for chronic pancreatitis are prescribed for a very long time, often for life. It is possible to achieve a reduction in their dose while maintaining a strict diet with restriction of fat and protein. However, with the expansion of the diet dose of enzyme preparations should increase.
Physical therapy has an analgesic effect and a certain anti-inflammatory effect. As a rule, physiotherapy is used in the phase of exacerbation. Most commonly used:
- electrophoresis 5–10% solution of novocaine or dalargin
- diadynamic currents
- sine wave modulated currents
In the remission phase, balneotherapy is widely used in the form of carbon dioxide-hydrogen sulphide, carbon dioxide-radon, carbon dioxide, “pearl” or sulphide baths. They are taken at a temperature of 36–37 ° С, duration – 10–15 minutes, treatment course – 8–10 procedures.
- fractional meals: frequent (5–6 times a day) meals in small portions. A mandatory addition to this principle is slow food and thorough chewing of food;
- inclusion in the diet of an increased amount of proteins (110–120 g / day), of which 60% should be animal proteins. The use of foods rich in lipotropic factors, and proteins, easily attacked by enzyme systems (cottage cheese, lean meats, fish, egg white, etc.);
- limiting fat intake (up to 80 g / day). The amount of fat should be evenly distributed throughout the day. Fats in their pure form are excluded from the diet;
- restriction in the diet of carbohydrates (300-350 g / day), mainly due to simple sugars;
- restriction in the diet of salt (up to 8 g / day).
Strict adherence to diet and diet, complete abstinence from alcohol, strict adherence to the recommendations for drug treatment significantly reduce the frequency of exacerbations, translate the process into a rarely recurring option with slow progression. In some patients it is possible to achieve noticeable and lasting remission.
Chronic pancreatitis is characterized by a progressive course, but the cessation of exposure to causative factors and adequate therapy slow down the progression of the disease, significantly improve the patient’s quality of life and prognosis.