Pancreatitis: Signs, Symptoms and Treatment

Pancreatitis is an inflammation of the pancreas that causes irreversible changes in the organ. The process can be acute or chronic.

In this book, we will talk about chronic inflammation of the pancreas.

The disease usually occurs between the ages of 30-50. In Russia, the incidence of pancreatitis is 50 people per 100 thousand. population per year. Recently, the number of cases has doubled.

In the first 10 years after diagnosis, 20% of patients die. 20 years after diagnosis of pancreatic inflammation, the mortality rate is 50%. One fifth of patients die due to complications of the disease.

Varieties of chronic pancreatitis

Chronic pancreatitis is classified depending on the causes, clinical manifestations, and the presence of complications.

Depending on the cause of the inflammation of the pancreas:

• biliary-dependent - chronic pancreatitis has developed against the background of damage to the liver and biliary tract;
• alcoholic - due to alcohol abuse;
• dysmetabolic - as a result of metabolic disorders;
• infectious - when the pathogen enters the pancreas from the intestines. Often found in viral hepatitis and childhood infections;
• medicinal - occurs with prolonged use of drugs (some antibiotics, diuretics, glucocorticoids, oral contraceptives);
• autoimmune - characterized by the appearance of antibodies to the cells of the pancreas. That is, the organism itself affects the organ;
• idiopathic - when the cause is unknown.

Depending on the predominant symptomatology:

• painful;
• dyspeptic;
• combined;
• hidden (latent).

Depending on the course of the disease:

• rarely recurrent;
• often recurrent;
• with the constant presence of symptoms.

Depending on the presence of complications:

• violation of the outflow of bile;
• increased pressure in the portal vein of the liver;
• diabetes;
• hypoglycemic conditions;
• abscess (purulent fusion of organ tissues);
• pancreatic cyst;
• inflammation of the gallbladder;
• pneumonia;
• inflammation of the pleura;
• inflammation of the tissue located near the kidneys, etc.

Also, chronic pancreatitis is divided into stage IV:

• Stage I - there are no signs of pancreatitis. The disease is discovered by chance, during examination;
• Stage II (initial manifestations) - characterized by frequent exacerbation of the inflammatory process. Over time, the severity of exacerbations decreases, but the manifestations of pancreatitis remain even during remission, which worsens the patient's quality of life. This stage lasts about 4-7 years;
• Stage III - pain after eating is common. For fear of pain, patients reduce the amount of food they eat. There are signs of pancreatic insufficiency;
• Stage IV - the pancreas atrophies. Patients complain of fatty feces, weight loss. There are signs of diabetes mellitus. Patients notice a decrease in pain in the abdomen, attacks are reduced. Development of pancreatic cancer is possible.

Causes

Inflammation of the pancreas can develop due to several factors. Let's consider each in more detail.

So, pancreatitis develops due to:

• alcohol or smoking abuse, chronic kidney failure, long-term medication. The pancreas in 10-15 years, if you take 60-80 ml of ethanol daily. Smoking exacerbates the toxic effects of alcohol and increases the likelihood of chronic pancreatitis. According to some reports, tobacco smoke is more important for the development of pancreatitis than alcohol. The likelihood of developing pancreatitis varies depending on the number of cigarettes smoked per day and the smoking history. In people who quit smoking, the likelihood of developing the disease is significantly reduced;
• hereditary predisposition. People with hereditary pancreatitis experience earlier onset of symptoms (around age 20). Pathology develops and progresses rapidly, which increases the risk of developing cancer of the gland;
• blockage of the pancreatic ducts. This condition can occur against the background of trauma and scarring, the presence of stones, cysts and tumors;
• suffered acute pancreatitis or recurrent acute inflammation of the pancreas;
• obesity;
• chronic cardiovascular diseases can also cause pancreatitis due to insufficient oxygen supply to the organ;
• autoimmune damage to the pancreas by the body's immune cells.

Symptoms

What are the manifestations of chronic pancreatitis? Most often, patients with inflammation of the pancreas complain of abdominal pain. Sometimes complications of the disease may be the first signs.

Abdominal pain is localized in the epigastric region (in the navel and 2-3 cm above it). Soreness "gives" to the back and becomes worse after eating.

The pain syndrome subsides after adopting a sitting position or when the trunk is tilted forward. In 10% of cases, the pathology can proceed without abdominal pain.

Pancreatitis is characterized by recurrence of pain, with short attacks lasting up to 10 days. In some cases, the pain is permanent.

Painful episodes are long, the painless period lasts about 2 months (typical for alcoholic chronic pancreatitis).

With the progression of the disease, the pain gradually subsides, it becomes less common.

If the function of the pancreas is affected by more than 90%, then there are signs of exocrine insufficiency. The absorption of fats is impaired, which is manifested by fatty feces, which are poorly washed off the toilet.

Characterized by weight loss, bloating, nausea, vomiting that does not bring relief. Often worried about diarrhea, alternating with constipation.

Such symptoms appear in alcoholic patients about 10 years after the first manifestations of pancreatitis. In addition, the absorption of vitamin B is impaired.₁₂.

The appearance of yellowness of the sclera and skin, dryness of the skin is characteristic. On the body, red eruptions are found, which do not disappear when pressed.

In most cases, impaired glucose tolerance occurs, which is manifested by signs of diabetes mellitus. These patients often develop hypoglycemic conditions.

Patients complain of dry mouth, frequent and profuse urination, blurred vision, slow healing of skin lesions, weakness and fatigue, "creeping creeps" in the limbs.

Which doctor to contact

If symptoms of pancreatitis occur, you should immediately contact a physician or gastroenterologist.

After the examination, you may need the help of an endocrinologist, surgeon, immunologist or narcologist (to stop alcohol).

Survey

The diagnosis of chronic pancreatitis is made on the basis of laboratory and instrumental research methods.

Laboratory research methods:

• a general blood test - the number of leukocytes and the level of ESR increases;
• the level of amylase in the urine and biochemical blood test - in chronic pancreatitis, an increase in the level of amylase is rarely observed. If the patient has a prolonged increase in the level of amylase, then this may indicate a cyst or pancreatic ascites (effusion into the abdominal cavity). Also, the level of amylase in urine and blood may be increased due to kidney failure, tumors, burns, pregnancy, diabetes, diseases of the salivary glands, head trauma, morphine intake, cholecystitis, ulcers;
• determination of the level of glucose and glycated hemoglobin in the blood - the study allows you to assess the level of insufficiency of the function of the pancreas. Diabetes is diagnosed when the level of glycated hemoglobin is more than 6.5%;
• breath test to determine the level of exhaled carbon dioxide. The patient takes a special mixture, which is processed by pancreatic enzymes in the intestine with the release of carbon dioxide, the level of which is measured during breathing;
• determination of fat content in feces - conduct a study of the patient's feces under a microscope. You need to take such an analysis three times, while following a five-day diet with a high fat content in the diet. A high level of fat in the stool indicates a dysfunction of the pancreas;
• determination of elastase-1 activity in feces. Elastase-1 is a pancreatic enzyme that hardly changes when passing through the organs of the gastrointestinal tract. If the level of the enzyme in the stool is low, then this indicates a lack of pancreatic function.

Instrumental research methods:

• plain x-ray of the abdominal organs - the method is rarely used at the moment. Allows you to identify calcification in the projection area of ​​the pancreas or stones in its ducts;
• ultrasound echography (transabdominal ultrasound) - using this method you can detect free fluid in the abdominal cavity, assess the size and surface of the liver, bile duct, kidneys. Diseases of these organs can cause pain in the abdomen, and suggest chronic pancreatitis.
  With inflammation of the pancreas, it is possible to detect pseudocysts, calcifications, stones in the organ duct, expansion of the pancreatic duct or bile duct, portal, splenic veins.
  Ultrasound examination cannot accurately answer the question of the presence of chronic pancreatitis;
• computed tomography of the abdominal organs is the method of choice for the diagnosis of "Chronic pancreatitis". When an organ is inflamed, CT will show atrophic changes in the gland, stones in its ducts, expansion of the main duct, cysts, blood clots in the splenic vein. Also, for chronic pancreatitis, the heterogeneous structure of the pancreas, its fuzzy contours and an increase in size will speak;
• endoscopic ultrasound (EUS) - allows you to detect even small stones in the ducts glands, changes in the tissues of the organ, its structure, the presence of foci of compaction, cysts, cords, expansion ducts. The study can be carried out with stimulation of the pancreas, with its contrasting (staining);
• magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRPCG) - studies allow you to detect changes in tissues, organ ducts, detect cysts, assess the function of the pancreas glands. These studies are of particular value when carried out with contrast;
• endoscopic cholangiopancreatography - using this method, you can accurately diagnose chronic pancreatitis. However, the study carries the risk of complications;
• assessment of pancreatic juice – carried out with a probe. The study allows you to measure the volume of pancreatic secretion, the content of enzymes, bicarbonates in it.

Treatment

Diet and drug treatment helps to eliminate the symptoms of chronic pancreatitis. In some cases, surgery may be necessary.

When treating a disease, you must complete 5 tasks:

• give up alcohol and smoking;
• determine the cause of pain in the abdomen;
• take drugs that compensate for the lack of pancreatic enzymes;
• take medications to eliminate the symptoms of diabetes mellitus (if any);
• constantly undergo examination for the timely diagnosis of pancreatic cancer.

Let's talk about everything in more detail.

Non-drug treatment

During the treatment of chronic pancreatitis, first of all, you need to completely give up alcohol and smoking.

It is proved that in this case the pain syndrome is significantly reduced, and the deterioration of organ function does not progress. In addition, in this case, the effectiveness of taking drugs is much higher.

It's also important to stick to your diet. You need to eat at least 5 times a day, in small portions. You need to increase the amount of protein and carbohydrates consumed.

If the patient is not worried about fatty stools, then the amount of fat consumed can not be reduced.

In the case of pronounced fatty feces, it is necessary to limit the fat in the diet. In this case, the amount of fat consumed should be 40-60 g per day.

A patient with chronic pancreatitis should consume 2-2.5 thousand. calories and 1.5 g / kg protein.

It is necessary to exclude from the menu:

• fatty foods;
• spicy;
• smoked meats;
• chocolate;
• fish, mushroom and meat broths;
• coffee;
• alcohol;
• carbonated drinks;
• legumes;
• eggs;
• pastry with cream;
• frozen desserts.

The diet must include:

• steam omelet;
• porridge with milk;
• soup made from rice, buckwheat, barley;
• fruit soup;
• lean meat broth;
• milk;
• yogurt;
• kefir;
• oil;
• pureed vegetables and fruits;
• tea with milk;
• fruit and vegetable juices.

Drug treatment

Drug treatment of chronic pancreatitis is carried out with analgesics, antidepressants, enzyme preparations, non-steroidal anti-inflammatory drugs, insulin.

Pain relief

Analgesics, antidepressants, or NSAIDs will help eliminate pain syndrome. At the beginning of treatment, the patient is prescribed Paracetamol three times a day. If it is ineffective, the patient is injected with the narcotic analgesic Tramadol.

The duration of treatment with paracetamol is no more than 3 months. If the patient notes the appearance of abdominal discomfort after eating, then Paracetamol should be taken half an hour before or immediately after meals.

In some cases, the patient may be prescribed antidepressants. They not only reduce the manifestation of depression, but also reduce the severity of pain. They also enhance the effect of Paracetamol.

The minimicrospheres of pancreatin will also help to reduce the severity of the pain syndrome. They are prescribed for up to 50 weeks.

Elimination of enzyme deficiency

The defeat of more than 90% of the organ leads to a decrease in the secretion of pancreatic enzymes. This leads to pain, heaviness in the abdomen, nausea and vomiting, fatty feces.

In this case, it is necessary to take enzyme preparations. They contribute to the normal digestion and assimilation of food, the absorption of fats, and an improvement in the patient's quality of life.

Enzyme replacement therapy is indicated for oily, fetid feces, persistent diarrhea, discharge a large amount of feces, weight loss, the presence of stones in the pancreatic ducts, previous operations on the pancreas iron.

A patient with chronic pancreatitis should take at least 25-45 thousand. units lipases for the main meal and 10-25 thous. units per intermediate.

The effectiveness of enzymatic treatment is assessed by the relief of diarrhea, the absence of fatty, fetid feces, and a decrease in its amount.

If symptoms are present even after the appointment of the necessary doses of enzymes, then you need to additionally take proton pump inhibitors (Omeprazole, Lansoprazole, Esomeprazole, etc.).

All enzyme preparations are divided into two-shell and single-shell. Two-membered shells are considered more effective, since one of their shells dissolves in the stomach, which does not allow gastric juice to dissolve enzymes, and the other membrane allows the enzymes to reach the intestines, where they begin act.

These drugs include Creon, Lycrease, Pancitrat.

Single-shell drugs (Mezim, Pancreatin, Penzital) are prescribed for severe pain syndrome.

Such drugs as Panzinorm, Festal, Digestal are contraindicated, as they contain bile components. They cause the gland to secrete more secretions, which makes the pain worse.

Diabetes mellitus treatment

In pancreatogenic diabetes mellitus, you must follow a diet similar to type 1 diabetes. Most patients are prescribed insulin for the treatment of endocrine pancreatic insufficiency, the doses of which are selected individually.

Endoscopic intervention

If the pain is not relieved by drugs within 3 months, endoscopic intervention is possible.

In some cases, it is supplemented by crushing stones in the ducts of the gland or by installing special dilators (stents). Patients have a reduced need for hospitalization and analgesic use for a period of 5 to 9 months.

Endoscopic intervention is a temporary measure for the development of jaundice, inflammation of the bile ducts, or bile stasis.

Surgery

Planned surgery is indicated in the case of:

• lack of effectiveness of drug treatment for 3 months;
• the appearance of complications of chronic pancreatitis;
• severe pain syndrome and disability of the patient;
• suspected pancreatic cancer.

The extent to which the operation will be performed is decided individually in each case.

Traditional methods of treatment

Alternative methods of treatment can be used in conjunction with drug therapy. Before using folk recipes, you should consult your doctor.

Recipes:

• Dissolve 10 g of chicory in a glass of boiling water. Drink several times a day. Also, chicory can be added to tea or cocoa;
• Squeeze juice from 2 small potatoes and 1 carrot. You need to get at least 200 ml of liquid. Take half an hour before meals for a week. Then take a break for 7 days and repeat the course;
• Pour 45 g of burdock roots with a liter of boiling water and leave for 3 hours. Then put on fire for 10 minutes. Take half a glass three times a day before meals. Course - 5 days;
• Pour 200 g of buckwheat with half a liter of kefir and leave overnight. In the morning, instead of breakfast, drink half. Drink the rest 2 hours before bedtime instead of dinner;
• chop half a glass of rosehip berries, place in a thermos, pour a liter of boiling water and leave for 2 hours. Strain and divide the resulting liquid into 5 parts. Drink during the day;
• mix equal amounts of chamomile, mint, calendula and plantain and 2 tablespoons of corn silk. Add a liter of boiling water to the mixture. Insist until cool. Then put on fire for 25 minutes, and then infuse again for 3 hours. Take 50 ml three times a day.

Complications

What can chronic pancreatitis lead to? The disease threatens the development of the following complications:

• pseudocyst;
• jaundice due to compression of the common bile duct by the edematous pancreas;
• splenic or portal vein thrombosis;
• inflammation of the esophageal mucosa with erosions;
• ulcers in the duodenum or stomach;
• obstruction in the duodenal region;
• insufficient blood circulation in the abdominal organs;
• purulent fusion (abscess) of the pancreas;
• sepsis;
• purulent inflammation of the bile ducts;
• pancreas cancer;
• deficiency of vitamins A, D, E, K, B₁₂.

Prophylaxis

How to prevent the development of chronic pancreatitis? It is necessary to give up excessive alcohol consumption, smoking.

It is important not to overeat, lose weight, and move as much as possible. It is necessary to limit the use of fatty, fried, spicy foods, take multivitamins.

To prevent exacerbation of pancreatitis, you should:

• eat at least 5 times a day, in small portions;
• eat a variety of foods;
• include more grains, vegetables and fruits in the diet;
• increase physical activity.

Conclusion

Pancreatitis is an inflammation of the pancreas that causes irreversible changes in the organ. In recent years, the incidence of pancreatitis has increased significantly.

Alcohol, smoking, heredity, prolonged use of medications, metabolic disorders can lead to inflammation of the pancreas. The disease has 4 stages of its course.

The main symptoms are pain that "radiates" to the back, increases after eating, and decreases in a sitting position or forward bending of the trunk.

With the development of a failure of the organ's function, the patient is worried about fatty, fetid stools, which are excreted in large quantities.

If more than 90% of the organ is damaged, symptoms of diabetes mellitus develop. Also, pancreatitis is characterized by bloating, nausea, and vomiting. The disease is diagnosed on the basis of laboratory and instrumental research methods.

Laboratory tests include general, biochemical blood tests, a study of the level of amylase in the blood and urine, determination of glucose levels and glycated hemoglobin, breath test to detect the amount of exhaled carbon dioxide, measurement of fat and elastase-1 in kale.

Instrumental methods include ultrasound, CT scan, MRI, plain X-ray of the abdominal organs, MRPHG, endo-ultrasound, determination of fat in feces, assessment of pancreatic juice.

Treatment for the disease includes cessation of alcohol, smoking, diet, and drug therapy. To eliminate the symptoms of pathology, analgesics, antidepressants, NSAIDs, enzyme preparations, insulin are used.

In the absence of the effect of drug treatment, surgery is performed. Chronic pancreatitis can lead to serious complications.

To prevent the disease, it is necessary to limit alcohol intake, quit smoking, eat small portions at least 5 times a day, include cereals, vegetables and fruits in the diet, reduce weight and increase physical activity.