Causes of pancreatitis and what happens

In case of violations of the outflow of digestive juice from the pancreas, its return to the organ, activation of enzymes in it, and not in the intestine, a disease develops - pancreatitis.

Its reasons are associated with alcohol consumption, unhealthy diet, taking certain medications, and other pathologies.

Pancreas

An unpaired oblong organ with a dense structure, which is located approximately at the level of the first to eleventh vertebrae of the lower back, is called the pancreas.

In an adult, its length reaches 22 cm, weight - 80 g. The organ has a rather complex structure that allows it to perform functions related to digestion and hormonal regulation.

Structure

There are three divisions in the gland. The tail is located near the spleen, the body of the organ is on the left side behind the stomach.

The thickest part is called the head. It is located at the exit to the duodenum.

The internal cavity of the organ is lined with epithelial cells, which are covered from above with connective cells.

Much of the tissue is formed by lobules called acini. Their function is to synthesize pancreatic secretion, transfer it to a separate Wirsung duct - the organ's main canal.

This duct merges with the bile duct and is a natural transition to the duodenum. It is here that the food masses are digested.

A special sphincter regulates the secretion and prevents its return to the organ.

The organ produces up to two liters of secretion per day. It contains enzymes involved in the digestion of carbohydrates, fats, proteins.

The other main component is bicarbonates. They are assigned the main role in creating an alkaline environment, which is aimed at reducing acid from the stomach.

A small part of the pancreas (about 2 percent) is the islets of Langerhans.

They are made up of cells that secrete some hormones into the nearby capillaries. They are mostly found in the tail.

The capillaries fill all the lobules, thereby providing them with nutrition. They are a branch of the pancreatic arteries.

The saturation of the pancreas with vessels leads to the fact that any inflammatory process causes tissue edema and compression, as a result of which its nutrition is disrupted.

The gland is laid in the first trimester, in the fifth week. It is considered fully formed at the age of 6.

Functions

There are two main functions of the digestive gland. On the one hand, it participates in digestion, secreting pancreatic juice and synthesizing special enzymes:

1. Amylase. Converts carbohydrates into a transition state - oligosaccharides. Subsequently, they are converted into glucose under the action of other enzymes and in this state enter the bloodstream.
2. Lipase. The function of this enzyme is to break down fats that enter the pancreas intact. There are two end products entering the blood: fatty acids and glycerin.
3. Protease. The action of this substance is aimed at the formation of amino acids from proteins.
4. Lactase. The main function is to break down lactose into glucose and galactose.

Enzymes begin to be produced when the organ receives a signal that the walls of the digestive tract are stretched, as well as under the influence of taste and smell. Their synthesis stops when the required concentration is reached.

The pancreas also has a hormonal function. Hormones are produced by Langerhans cells and synthesized directly into the blood.

The insulin produced by the body regulates the metabolic processes of cells, the intake of nutrients into them. A decrease in its level leads to diabetes mellitus.

The function of glucagon is to regulate glucose levels. With a deficiency of its intake with food, it activates its receipt from the reserves of fat that is in the body.

Pancreatic polypeptin and somatostatin are aimed at stopping the synthesis of other hormones.

Pancreatitis

Under the influence of various reasons, inflammation of the pancreas occurs. In this case, there is edema, a violation of the patency of the ducts, a reverse request for pancreatic juice, sometimes with bile, activation of enzymes.

As a result, organ tissue splitting, necrosis and intoxication occurs. Several classifications of pancreatitis have been developed.

However, the most common is the allocation of acute and chronic forms of pathology.

Acute pancreatitis

The emergence of this form is associated with a violation of the patency of the ducts, the activation of enzymes produced by the pancreas in situ.

The acute form occurs unexpectedly, the symptoms appear vividly. Most often, the pathology passes quickly.

In the development of the disease, 3 stages are distinguished. At the first, about five days after the onset of the first symptoms, enzyme intoxication and tissue edema occurs.

This is followed by the reactive stage, distinguished by its apparent temporary improvement. The third is the stage of pus and sepsis formation.

The nature of the pathology depends on the degree of its severity. In a mild form, a person experiences tolerable pain in the left abdomen, pressure fluctuations, nausea, and slight tachycardia.

The complexion remains the same. The temperature rises to 37.5 ° C. Flatulence develops, stool is disturbed.

The disease is moderately characterized by severe girdle pain, frequent vomiting, a decrease in blood pressure, accompanied by significant tachycardia (up to 110 beats per minute). The temperature rises to 38 ° C. The skin becomes pale, a little cyanotic.

In severe condition, the pressure drops sharply, the patient experiences terrible abdominal pains, is very pale. The skin becomes yellowish.

The temperature rises, the heart beats violently. Vomiting is repeated many times, does not bring relief, occurs after each sip of water.

First, traces of food masses are present in the vomit, then only bile and mucus are found in it.

The emetic process only intensifies the pathology, increasing the tension in the peritoneum and activating the transfer of substances into the gland.

Lack of timely treatment leads to fistulas, cysts, abscess, peritonitis, septic phlegmon, violation of secretion.

In some cases, severe pain leads to a reflex decrease in lung mobility, pneumonia. Peritonitis, purulent abscesses can be fatal in a short time.

Chronic pancreatitis

In some cases, the acute form becomes chronic. However, this type of disease often occurs on its own.

The disease has a rather complex classification.

1. Pathogenesis. Depending on the nature of the causes, primary and secondary forms are distinguished.
2. Signs. Pain depends on the regularity of manifestations - constant or recurrent. Pseudotumorous is isolated depending on pressure and permeability. Latent is characterized by an unexpressed course. Combined combines several features.
3. Morphological manifestations. Depending on the nature of the process, they speak of calcifying, fibro-sclerotic, inflammatory and obstructive pancreatitis.
4. Functional disorders. Allocate hypoenzyme, hyperenzyme. The amount of secretion allows you to isolate the hyposecretory and hypersecretory forms.
5. Severity. Allocate heavy, medium, light. Severe is characterized by long-term frequent exacerbations (more than five times a year). It is accompanied by severe pain. The patient is losing weight greatly, sometimes exhaustion is observed. Complications appear - compression of the duodenum, diabetes mellitus. Exacerbations with an average form occur up to four times a year. Painful sensations are intense. The functions of the gland are reduced. With a mild form, attacks occur up to twice a year, and quickly end. Painful sensations do not cause severe discomfort.

In chronic pancreatitis, discomfort appears on average one hour after eating. It intensifies if the person is lying. It is transmitted to the shoulder blade, heart.

Its localization depends on which part of the organ is affected. Inflammation in the head leads to painful sensations in the right abdomen, body - under the spoon, tail - to the left relative to the navel.

An exacerbation has symptoms similar to those of acute pancreatitis.

Causes

The mechanism of development of pancreatitis is based on a violation of the secretion of pancreatic secretion into the intestine.

As a result, its concentration in the organ increases, there is a supersaturation with enzymes, which, being synthesized, begin to digest the cells of the gland. Swelling of the tissues of the organ arises and increases.

When the process is started, not accompanied by treatment, they die off and are replaced by connecting ones. The formation of calcifications occurs, consisting of calcium and the same connective tissue.

New formations disrupt the blood supply processes. As a result, the pancreas lacks oxygen and nutrients.

At the site of inflammation, an increase in the concentration of leukocytes is observed. The formation of pus in some situations leads to tissue rupture and peritonitis.

Depending on the pathogenesis and nature of the causes, the primary and secondary types of the disease are distinguished.

In the first case, the disease occurs due to direct damage to the pancreas. The secondary is based on the pathology of other organs.

Primary pancreatitis

This form of the disease is associated with direct damage to the pancreas itself.

There are several theories of its origin. Among the main reasons that lead to the development of this pathology is alcoholism. However, this is not the only cause of primary pancreatitis.

Theory of toxic metabolites

Drinking alcohol triggers the activation of enzymes that are produced in the pancreas.

According to doctors' statistics, it is this reason that causes inflammation most often. Usually the disease occurs after 5-15 years of alcohol consumption. However, sometimes an attack can occur in people after the first intake of alcoholic beverages, especially while consuming salty foods that retain fluid in the body.

Most people who develop pancreatic inflammation drink 80 to 500 mg of alcoholic beverages every day. In many cases, the disease is diagnosed between the ages of 30 and 40.

It is often believed that alcohol affects only the liver and do not understand what causes the damage to the pancreas.

In reality, the disease progresses with the fact that up to 80% of the ethanol contained in alcoholic beverages enters the bloodstream, then is processed by the liver.

Part of it ends up in the pancreas, causing a spasm of its sphincter, as well as swelling of the duodenal papilla.

When the sphincter spasms, its ability to contract is disrupted, reflux appears, i.e. reverse reflux of pancreatic juice into the gland, stagnation is formed. At the same time, secret allocation can be violated.

The disease arises in an acute type, and in half of the cases it does not go into a chronic form, but ends in death.

At the same time, there is no exact statistics that death was caused precisely by acute pancreatitis. Respiratory failure and heart disease join the disease.

The average age of death in the chronic form is 54 years. Approximately 40% of cases of pancreatitis are attributed to alcohol.

Medication

Similar processes are initiated when taking medications. Moreover, it cannot be said that the disease occurs due to their uncontrolled use or exceeding the dosage.

Pathology often appears as a side effect. It cannot be predicted, it entirely depends on the characteristics of the organism and its reactions to the ingress of drugs.

Symptoms often appear after the drug has been discontinued. In other cases, the reaction occurs after the first dose.

The following medications lead to the development of the disease:

1. Antibiotics of different groups. These are Ampicillin, Erythromycin, Tetracycline, Metronidazole, and others.
2. Drugs that reduce blood pressure. Diuretics: Furosemide, Chlothiazide.
3. Medicines for heart disease. Captopril, Losartan, Enalapril have an effect on the pancreas.
4. Remedies for diseases of the gastrointestinal tract. You can select Omeprazole, Ranitidine.
5. Immunosuppressants In particular, these are Cytosine, Dexamethasone, Tacrolimus.
6. Medication for mental health problems. Allocate Sertalin, Valproic acid.
7. For the treatment of HIV. Dangerous for the pancreas Didanosine, Nelfinavir.
8. Preparations of different pharmacological groups. These are Paracetamol, Ergotamine, Codeine, Prednisolone.

Taking medications leads to damage to the pancreas in approximately 3% of cases. It develops more often in children and HIV-infected people.

Allergic

According to this theory, the disease is caused by allergies. Hypersensitivity to food causes the release of histamine.

It has a negative effect on blood flow. As a result, the blood supply to the pancreas is disrupted.

It gets fewer nutrients and releases fewer enzymes. As a result, sensitivity to allergens increases, and antibodies to the cells of this organ are produced in the blood.

In case of violation of immune tolerance, the process is also triggered by the products of protein metabolism and microbial toxins.

Common channel theory

Before entering the duodenum, the pancreatic duct forms a common cavity with the gallbladder duct.

When a stone enters, this cavity is blocked, pressure increases in it, as a result of which the pancreatic fluid is now thrown back into the gland together with bile.

Most researchers support this theory, however, many consider it insufficient.

The ligation of the duct, performed for medical purposes, did not cause inflammatory damage to the pancreas, but only led to the formation of connective tissue.

In this regard, they consider it necessary to involve additional causes in the process, for example, of an infectious-allergic nature.

Neurogenic

In accordance with this theory, damage to the lobules of the pancreas occurs due to increased excitation of the vagus nerve.

It activates the glands of the endocrine system, which leads to hypersynthesis of pancreatic enzymes.

Viral-infectious

Coxsackie viruses, influenza, typhoid fever, cetamegalovirus lead to the disease. In this case, there is a twofold effect.

On the one hand, the disease is caused by a virus that has entered the body. On the other hand, there are foci of infection that have already formed in the pancreas.

Moreover, they appear faster in the case of a chronic form. It is noted that the main role in the development of the disease is played by cell death, rather than a violation of enzyme synthesis and the process of self-digestion.

One of the most dangerous viruses that infects the pancreas is cetamegalovirus. It develops as CMV pancreatitis, with symptoms beginning to resemble cystic fibrosis.

Infection with certain bacteria, such as Salmonella and Brucella, also leads to pancreatitis.

Hereditary

A gene mutation is noted, in accordance with which the amino acid leucine is replaced by valine.

As a result, the process of activation of trypsin from trypsinogen is disrupted. It occurs in the pancreas and begins to digest it.

Hereditary character is noted in less than 5% of cases of pancreatitis.

Congenital

The pancreas forms from the fifth week of pregnancy. If during this period the child's mother abused alcohol, suffered infectious and other diseases, the fetus could develop developmental abnormalities.

The pancreas is malformed.

Eating disorder

It's not just alcohol that causes pancreatic inflammation. Improper nutrition has a negative impact on the health of this organ.

Disease-causing foods include fresh bread. In the stomach, starch decomposes into alcohol and carbon dioxide, causing flatulence and bloating.

Legumes and soy products contain coarse fiber. It activates the work of the pancreas and intestines.

Pickled, fried and smoked dishes also provoke increased organ activity.

Excess weight, which often occurs as a result of malnutrition, is also what causes pancreatitis.

Approximately 20% of cases of the disease are diagnosed in people who are overweight.

Psycho-emotional disorders

Stress, increased anxiety, emotional instability and depression can cause both an acute form of the disease and exacerbation of a chronic one.

However, these factors act indirectly. Thus, stress causes an increased desire for sweets. Coffee or alcohol can help some people cope with overwork and depression.

All these factors, coupled with emotional upheavals, provoke the development of the disease.

Traumatic

Damage to the pancreas occurs during thermal, closed injuries, as a result of operations, some therapeutic measures.

By the nature of the injury, there are:

1. External. Open and closed injuries occur due to blows, the consequences of operations on the stomach and duodenum, radiation exposure. About 30% of injuries occur due to the crushing of the pancreas with an external object, a blow to the spinal column. In this case, hemorrhage, rupture of the tissue membrane, damage to the duct occurs.
2. Internal. They are caused by the appearance of neoplasms in the internal organs, metabolic disorders, toxins, the formation of abscesses, emboli.

Secondary pancreatitis

Sometimes the disease is caused by pathologies that have already affected certain organs of a person.

The main causes of secondary pancreatitis include the following diseases.

Pathology of the gallbladder

First of all, it is cholecystitis and gallstone disease. Cholecystitis is associated with pancreatitis. It is believed that one causes the other.

This is due to the processes occurring in these organs in parallel, as well as their relationship in the digestive process.

The gallbladder accumulates and secretes bile into the duodenum.

The pancreas produces and secretes pancreatic juice into the same part of the intestine. the relationship of the two processes sometimes allows us to talk about cholecystopancreatitis.

Another common cause is gallstone disease. In fact, it is this theory that underlies the flow theory.

Together with bile, sand or stones are released, blocking the entrance to the duodenum and provoking reflux of pancreatic fluid.

Cholelithiasis is diagnosed in about 30% of cases of pancreatitis, mainly in women.

Chronic liver disease

Such diseases include cirrhosis and hepatitis. Bile secreted into the duodenum from the gallbladder is synthesized by the liver.

The relationship is due to the peculiarities of the participation of these organs in the digestive process.

Parasites

Protozoa settle in the biliary tract, and then enter the pancreatic ducts, causing their blockage.

Giardia, toxoplasmosis, dysentery amoeba, microsporidia settle in the gastrointestinal tract.

Roundworms, echinococci, feline fluke, tapeworms, strongioids settle directly in the pancreas.

The influence of ascaris is associated mainly with the accumulation of eggs in the duct. The feline fluke lives in the organ canal.

Echinococci lead to the formation of a cyst in which they lay their eggs. If it is located next to the duct of the gland, then squeezing occurs. Giardia causes inflammation.

In some cases, protozoa also settle in the pancreas. Dysentery amoeba is ingested with food or water.

Affects the liver and pancreas. Microsporidia have an effect with weak immunity.

Hormonal imbalance

Hyperproductivity of the parathyroid glands. Such a relationship was found statistically: in 6.5% of patients with cancer, adenoma, parathyroid hyperplasia in Europe, pancreatic pathologies were found.

Their appearance is associated with increased calcium production in violation of the regulation of phosphorus-calcium metabolism by parathyroid hormone.

Calcium clogs the pancreatic duct. Some researchers also believe that increased calcium increases the secretion of pancreatic juice.

Genetically determined diseases

First of all, this group of causes includes cystic fibrosis. The increased viscosity of pancreatic juice leads to a violation of its secretion, as a result of which the processes that cause inflammation of the pancreas are triggered.

With cystic fibrosis, the disease occurs already in children. Another inherited disease that can eventually lead to pancreatitis is Crohn's disease.

The inflammatory process affects all structures of the gastrointestinal tract, but most often (up to 80%) the small intestine, in particular the duodenum, is targeted. There are ulcers, erosion, stenosis of the intestinal walls, edema.

The defeat of the duodenum, in particular, can lead to its narrowing and disruption of the passage of pancreatic juice and its outflow back.

Diagnostics

Timely diagnostic measures will help clarify the nature of the disease, determine its form, features and causes.

The following methods are used:

1. General blood analysis. The formula, the number of leukocytes is being clarified, the ESR is checked.
2. Biochemical test. The level of enzymes secreted by the pancreas is determined.
3. Analysis of urine.
4. Stool samples. The remains of undigested food, the presence of fats are analyzed.
5. Esophagogastroduodenoscopy.
6. Ultrasound of internal organs. Echographically, signs of organ enlargement, violation of its structure are noted.
7. Radiography.

Treatment

The main direction of therapeutic tactics is the removal of acute symptoms, restoration of the functioning of the pancreas, elimination of pain, blocking the production of enzymes.

If the disease is caused by gallstone disease, the appearance of a neoplasm, surgical treatment is indicated.

In some cases, traditional medicine recipes can help relieve symptoms.

Pancreatitis is a complex disease of the pancreas that is caused by a variety of factors.

It is sometimes impossible to accurately determine them; in such situations, several factors simultaneously influence the development of the disease and the human condition. Lack of treatment leads to serious consequences and even death.

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