External pancreatic insufficiency
PancreasIron is an important exocrine organ, which provides an adequate flow of the digestive process. Disorders in the body and insufficiency of the pancreas has become an urgent problem in modern medicine.
number of patients with organ pathology every year only increases it is often associated with increased growth of diseases due to exocrine pancreatic insufficiency.
Symptoms of
Typical manifestations of insufficient organ performance are associated with impaired digestion of food. The person badly tolerates the consumption of fatty, fried and spicy food.
After its adoption, there are complaints of severity in the epigastric region. The chair becomes unformed, plentiful, the color is faded, discolored and poorly washed off the toilet. This is due to the presence of fat in the stool( steatorrhea).The frequency of bowel movements increases and can go up to 6 times a day.
In addition, the food is unable to fully digest, the stool becomes mushy. The intestine is swollen from excess gases, painful colic is present.
The patient's body weight decreases, the appetite disappears, weakness and activity decrease. Because of the low intake of fat-soluble vitamins, joints and bone pains develop and osteoporosis develops, convulsive muscle contractions are often attached.
Lack of vitamin K leads to a reduction of blood clotting, vitamin A - increases the dryness of the skin, and insufficient amounts of vitamin E increases the risk of infection, reduces libido and potency.
The patient looks pale, tired. There is shortness of breath, palpitations, rapid fatigue.
reasons
basis for the development of this condition are the following mechanisms:
- Infringement in pancreas development and immaturity of the body.
- The destruction of acinar cells, which leads to a decrease in the production of enzymes.
- Difficulty reaching the duodenum of pancreatic juice.
- Insufficient activity of enzymes due to low levels of enterokinase and bile.
- Lack of protein nutrition leads to a violation of the synthesis of enzymes.
- Discovery of the small intestine and duodenum.
absolute insufficiency
Distinguish primary or absolute insufficiency of the pancreas. It develops because of the reduction in the mass of pancreatic tissue and is rare in practice.
Accompany the absolute insufficiency of congenital diseases:
- glandular hypoplasia,
- hereditary pancreatitis,
- cystic fibrosis,
- abnormalities of the pancreatic ducts,
- deficiency of lipase.
It can also be a disease acquired - acute and chronic pancreatitis. The relative insufficiency
secondary or relative exocrine pancreatic insufficiency caused by rapid transit of intestinal content. In this condition, the pancreas is not damaged, its functions are preserved, but for certain reasons, the enzymes do not fulfill their task.
The relative insufficiency caused gland :
- At damage the small intestinal mucosa, disrupted production of cholecystokinin and secretin.
- Decreased intraduodenal pH less than 5.5, which inactivates the enzymes.
- Disorder of intestinal motility, which leads to a violation when mixing enzymes with a food lump.
- Excessive growth of bacteria in the small intestine leads to the destruction of enzymes.
- Lack of bile and enterokinase.
Pancreatic insufficiency in children
The child's organism, as well as in adults, is susceptible to the development of pancreatic diseases. The appearance and course of the ailment is slightly different from the clinical picture.
Cystic fibrosis( cystic fibrosis)
In children, the occurrence of pancreatitis is associated with anatomical or structural anomalies of a congenital or genetic nature. The most common is cystic fibrosis - a monogenic autosomal recessive disease.
Reason - a mutation in the gene responsible for the composition and function of the protein. It is located in the epithelial cells that line the outflow ducts of the pancreas, small intestine, bronchi, lungs, genitourinary system. The task is to regulate the electrolyte exchange between the apical cells in which this gene is located and the intercellular fluid.
Cystic fibrosis affects all organs and systems of the body, which gives an unfavorable prognosis and a rather complicated course of the disease. The severity of the disease increases the damage to the respiratory system and digestive system. Characterized by severe exocrine pancreatic insufficiency. The clinical manifestations of : steatorrhea, frequent bronchitis, pneumonia, atrophic gastritis, enterocolitis. Criteria for diagnosis, in addition to clinical indicators, chlorine in the sweat fluid and gene analysis. Treatment involves large doses of pancreatic drugs, anabolic steroid drugs, diet and vitamins.
Schwamman Syndrome
Another, equally complex syndrome of Shwachman-Diamond, is congenital. It is expressed by lipase insufficiency, that is, there is an enzyme that helps to digest, dissolve and divide fats into fractions.
In the process of embryonic development of the organism there is a violation when laying the pancreas, which leads to its hypoplasia( underdevelopment).Hematologic shift is expressed by neurophenia, anemia and thrombocytopenia. In children with Shvakhman's syndrome, there is a lack of growth, defeat of the head of the femur and knee joints, hypoplasia of the phalanx of the fingers, and the thorax is narrow.
Clinical manifestations: steatorrhea, diabetes mellitus, recurrent respiratory tract infections, otitis media, sinusitis, skin infections.
Treatment is carried out by replacement therapy, pancreatic drugs, sometimes with antibiotics.
Acute pancreatitis develops very rarely in children, however, as well as chronic pancreatitis.
Chronic duodenitis is characterized by damage to the mucous membrane of the small intestine, its atrophy, this leads to a violation of the production of cholecystokinin and secretin, enzymes that regulate the production of pancreatic juice.
There is a deficiency and in connection with the inflammatory and ulcerative lesions of the stomach and duodenum, with increased acidification in the intestines, enzymes lose activity, the process of digestion and assimilation of food suffers.
Insufficiency also causes liver disease and bile duct system.
Causes of development of pancreatitis in children :
- Anomalies in the development of the pancreas and its ducts.
- Gallstone disease( increasing number of diseases).
- Duodenal obstruction. Injuries to the abdominal cavity, infection.
- Diseases of the intestine.
Therapy for exocrine insufficiency
There is no doubt that, along with compliance with the diet for successful treatment, modern enzyme preparations, antisecretory and analgesics should be used.
In the treatment of exocrine pancreatic insufficiency, drugs that contain pancreatin and pancreaticase are used. Essential components of medicinal products:
- Lipase - destroys fats.
- Protease is a protein.
- Amylase - cleaves carbohydrates.
Cleavage proceeds to elementary particles, which then allows them to be transported through the intestinal mucosa into the circulatory system. The nutrition of the body improves, the material for building cells is supplied.
Effective drugs that contain pancreatic enzymes are activated in the duodenum. The drug lowers the pressure inside the pancreatic ducts, thereby stopping the pain.
Drugs contain pancreatin, an enzyme of animal origin. Treatment is effective and with a monocomponent, and with the addition of bile acids, amino acids, adsorbents, etc. Dosage forms are either tablets or capsules.
All medical preparations are made in a shell, which protects enzymes from the destructive effect of hydrochloric acid in the stomach.
Positive effect in the treatment of exocrine pancreatic insufficiency is multivitamin complexes with microelements, probiotic and cholagogue.
Treatment with enzyme preparations is contraindicated in mechanical jaundice, patients with acute hepatitis and intestinal obstruction.
Diet
Treatment of gland failure can not be performed without adherence to diet. Food requirements: as gentle as possible mechanically and chemically. Subject to restriction: fats, spices, fried foods. Excluded carbonated drinks. Reduce the intake of carbohydrates, whole milk. The patient should take meals in small portions.
The treatment becomes more productive when carrying out unloading days. Fasting with therapeutic purposes should be carried out from 1 to 3 days. It is necessary to take a large amount of liquid: pure water, weakly boiled tea, broths of dogrose, compote, chamomile, mineral water.
When acute, alcohol is strictly forbidden, it concerns not only strong, but also low-alcohol beverages.
Compliance with the regime of the day, eating by the hour, treatment with medications give a positive effect, improve the patient's well-being. Improves the quality of life in general strengthening activities: walking, moderate exercise, therapeutic and relaxing baths.
