Chronic pancreatitis is a progressive inflammatory and destructive disease of the pancreas. It leads to dysfunction of the organ. With exacerbation of chronic pancreatitis, pain occurs in the left hypochondrium, dyspeptic disorders appear in the form of nausea, vomiting. In order for the doctor to be able to accurately diagnose, an ultrasound is performed, ERCP and other diagnostic examinations are performed. As soon as an exacerbation of chronic pancreatitis is confirmed, therapy is prescribed, including various types of medications and a diet. If they are ineffective, they carry out surgical treatment of the disease.
Chronic pancreatitis
Chronic pancreatitis is a disease of the pancreas that develops over a long period of time and is characterized by gradual pathological changes at the cellular level. As a result of the disease, functional insufficiency develops. Among all types of pathologies of the digestive tract, pancreatitis is diagnosed in eight out of a hundred people. Moreover, earlier it suffered mainly from people over the age of fifty, and now - fromthirty years.
Men suffer from pancreatitis more often than women. Over the past few years, against the background of alcohol consumption, the risk of developing the disease has increased to eighty percent. Also, various neoplasms of the pancreas that occur due to chronic pathology have become more often diagnosed.
Causes of illness
Exacerbation of chronic pancreatitis occurs for various reasons, but most often due to alcohol abuse, cholelithiasis.
Alcohol is a toxic factor for the parenchyma. With cholelithiasis, inflammation is the result of infection passing from the bile ducts through the lymphatic system or due to the reflux of bile into the pancreas.
Exacerbation of chronic pancreatitis may occur for other reasons. These include:
- cystic fibrosis;
- increased content of calcium ions in the blood;
- use of certain drugs;
- other types of pancreatitis that were not cured or treated incorrectly.
Types of chronic inflammation
Classification of the chronic type of pancreatitis is as follows:
- By origin. Pancreatitis can be primary or secondary.
- According to clinical manifestations. Pathology can be pain, pseudotumor, latent, combined.
- According to the morphological picture. Pancreatitis can be obstructive, calcifying, fibrosclerotic, infiltrative fibrous.
- By the nature of violations, they distinguishhyposecretory, obstructive, hypersecretory, ductular, hypo- and hyperinsulin pancreatitis.
Symptoms of exacerbation of chronic pancreatitis indicate the severity of the disease and structural disorders. According to this indicator, the disease is divided into mild, severe and moderate.
Clinical manifestations
Usually, the onset of the pathology occurs without any clinical manifestations or the symptoms are mild. The first acute symptoms of exacerbation of chronic pancreatitis are already observed with significant violations.
The main complaint of patients is pain in the upper abdomen in the left hypochondrium. There is an encircling character. The pain may be constant or paroxysmal. Sometimes it gives to the region of the heart. Chronic pancreatitis in the acute stage is accompanied by dyspeptic disorders in the form of nausea, vomiting. During an exacerbation, vomiting can be frequent, debilitating, it does not bring relief. The nature of the stool also changes: it becomes unstable, constipation alternates with diarrhea. Appetite is disturbed, digestion is upset, due to which body weight decreases.
With the development of the disease, the frequency of exacerbations increases. Chronic disease of the gland leads not only to damage to the pancreas, but also to adjacent organs. However, before a person turns to a doctor to treat an exacerbation of chronic pancreatitis, the disease will proceed in a latent form, without reminding of itself. This process can continue for many years.
External inspection
During the examination, the doctor assesses the condition of the skin and sclera. This is an important clinical criterion for suggesting pancreatitis. During the period of exacerbation, patients experience yellowness of the skin and sclera. Sometimes the shade becomes brownish. Pale skin, dry skin are all symptoms of an exacerbation. Also, red spots may appear on the chest and abdomen, which remain after pressing on them.
Palpation
To prescribe the correct treatment for an exacerbation of chronic hepatitis, the doctor must palpate the abdomen. During this procedure, there is a moderate swelling in the epigastric region, atrophy of the subcutaneous adipose tissue.
On palpation, there may be pain in the upper abdomen, around the navel, and also in the left hypochondrium, in the costovertebral angle. In some cases, pancreatitis is accompanied by splenomegaly and hepatomegaly.
Diagnosis
To clarify the diagnosis, the gastroenterologist prescribes various diagnostic methods, including a complete blood count, blood for sugar, fecal analysis.
In the general blood test, nonspecific inflammation is determined. For differential diagnosis, samples are taken for the activity of gland enzymes in the blood. Radioimmunoassay shows increased activity of elastase, trypsin. The coprogram determines a large amount of fat, which helps to suggest an enzyme deficiency in the organ.
If the diagnosis is confirmed, then the dietexacerbation of chronic pancreatitis is necessary, without it, treatment will be ineffective.
For a more accurate diagnosis, be sure to prescribe an ultrasound of the organ. It shows changes in the parenchyma and structure. According to indications, CT, MRI, endoscopy are performed. The latter method allows you to see the organ from the inside, evaluate the tissues of the gland.
In case of pancreatitis, a retrograde cholangiopancreatography can be performed, during which a radiopaque substance is injected into the duodenal papilla and the result is examined.
To assess the ability of the gland to produce enzymes, functional tests with secretion stimulation are prescribed.
Complications of pancreatitis
They choose a diet and treatment of exacerbation of chronic pancreatitis according to symptoms, do not neglect the doctor's recommendations in order to avoid complications. In the early stages, obstructive jaundice is observed, which appears due to a violation of the outflow of bile. Internal bleeding and hypertension may also occur.
Complications of a systemic nature in the form of multiorgan pathologies, functional insufficiency of organs and systems, DIC syndrome are less common. As the disease progresses, pancreatitis can be complicated by bleeding of the esophagus, diabetes, and neoplasms.
Treatment methods
The main thing in the treatment of chronic pancreatitis is a diet that is selected individually in each case of the disease. Drug therapy plays an important role.
The treatment regimen for the disease is as followsway:
- Diet therapy. In the treatment of symptoms of exacerbation of chronic pancreatitis, diet plays an important role. During a period of severe exacerbation, it is recommended to refrain from enteral nutrition, and when it subsides, table No. 5B is prescribed. Alcohol, spicy, fatty, fried foods, as well as pickles and sour foods fall under a strict ban. If there is diabetes mellitus, then sugar-containing products must be monitored.
- Chronic pancreatitis is treated in the same way as acute pancreatitis. Be sure to prescribe painkillers, anti-inflammatory, as well as medications that restore digestive function.
If pancreatitis is caused by alcohol, then you should stop drinking it completely. It is this factor that is key to the success of pancreatitis therapy.
In cases of purulent complications, as well as obstruction of the bile and / or pancreatic ducts, sphincter stenosis, the presence of a cyst, in case of severe disease, surgical treatment is prescribed.
Diet
Diet during exacerbation of chronic pancreatitis is very important. In the first three days, it is important to withstand the hungry period. After that, you need to stick to the diet for several weeks.
- Fractional nutrition. Meals should be sparing. To do this, you need to divide the daily ration into six or eight doses. Food is accepted only boiled or steamed in a pureed state. In this form, iron will not experience strongload.
- Choice of food. The ideal option is to choose a predominantly protein food. In this case, it is recommended to eat mashed beef, low-fat varieties of fish. It is important to take a lot of vitamins. A decoction of currant or wild rose gives a good effect.
Strong broths, s alty foods, fresh pastries, sweets, smoked meats, canned food should be excluded from the diet. Do not use sour cream.
Each additional food is introduced into the diet with care so as not to provoke soreness.
Symptoms and treatment of chronic pancreatitis are two inseparable concepts. Therapy is carried out not only to improve the function of the organ, but also in accordance with the clinical picture. For example, to relieve pain, painkillers are selected, and antispasmodics are used to relieve spasms.
The symptoms and diagnostic data speak about the best treatment for exacerbation of chronic pancreatitis. In some cases, patients are shown surgery.
Patients with chronic pancreatitis in remission are advised to follow a fat-restricted diet. It is best to add protein-rich foods to the menu. From the diet it is also worth forever eliminating carbonated, acidic drinks, spicy, coffee, alcohol. But mineral waters such as Essentuki, Smirnovskaya and others should be included in the daily diet.
