Studying the pathogenesis of chronic pancreatitis, it should be noted that this is a disease of the pancreas, which is characterized by the presence of focal necrosis with a deterioration in the function of the affected organ. The progression of the disease leads to atrophy of the glandular tissue, as well as fibrosis.
Complex treatment is very important, which will help stop the progression of the disease and prevent the development of dangerous complications.
Features of the disease
The digestive system is a collection of organs, each of which is connected to the others and is involved in the processing of incoming food. If at least one of the components malfunctions, dangerous problems may arise that require the immediate intervention of specialists. In addition, the appearance of violations can lead to problems with the pancreas.
The most dangerous pathology is chronic pancreatitis, which develops for a long time and cannot only affect the functioning of nearby organs, but also lead to dangerous complications. The etiology, pathogenesis, clinic, diagnosis, treatment of chronic pancreatitis are rather non-specific. Quite often, the signs of this disease can be confused with gastritis, pancreatic duct dyskinesia, and gastritis. The duration of the course from the onset of pancreatitis to the first symptoms can be up to 15 years.
The chronic form of the disease is characterized by a delay in the excretion of gastric juice from the pancreas, which contributes to the release of substances such as lipase and trypsin. When the pathology occurs, they provoke severe irritation of this organ, and then more serious consequences. As a result, the connective tissue grows. Pathology can proceed for several years and lead to sustainable pancreatic insufficiency. Sometimes, right in the cavity of the pancreatic ducts, the formation of calcifications or stones occurs, which significantly complicates the course of the disease.
Etiology and pathogenesis
Pancreatitis quite often occurs in a chronic form. The disease is characterized by the presence of inflammation in the affected organ, and at the same time periods of remission are replaced by exacerbation. The etiology and pathogenesis of chronic pancreatitis are well studied by medicine. Mostly people over 30 suffer from it.
The appearance of inflammation in this organ can be affected by various factors or existing pathologies. The most common cause is alcohol abuse for a long time. Alcohol provokes processesinflammation of the pancreas, as well as under its action, necrosis of certain parts of this organ and proliferation of adipose tissue occurs.
In some cases, the etiology and pathogenesis of chronic pancreatitis is difficult to determine, since in some patients the causes that provoke the disease are hidden. If a specialist during the examination excludes possible provoking factors, then they speak of an idiopathic form of the disease. Most often it develops in adolescents in the presence of renal failure, diabetes. In this case, pancreatitis proceeds with severe pain. Also, the disease can be in old age, but there is no pain.
The pathogenesis of chronic pancreatitis is characterized by the fact that pancreatic enzymes begin to activate untimely. Normally, this process should take place in the duodenum.
Causes of occurrence
The pancreas produces hormones that play a very important role in metabolic processes. In addition to glucagon and insulin, it also produces enzymes designed to break down fats, proteins, and carbohydrates. In chronic pancreatitis, the excretory ducts are clogged, as a result of which the digestive juices cannot pass freely into the intestines. Violation of the natural and complete outflow leads to inflammation of the affected organ or even partial tissue death.
If complex treatment is not carried out, then dangerous diseases can develop, which sometimes end in the death of the patient. Necessarilyyou need to know the etiology, pathogenesis, clinic of chronic pancreatitis. Diagnosis and treatment largely depends on these indicators. Among the main causes of the disease, it is necessary to highlight such as:
- diseases of the liver and biliary tract;
- cholecystitis;
- chronic alcoholism;
- gastritis;
- hepatitis;
- irregular meals;
- taking certain drugs;
- lack of protein food;
- tobacco smoking;
- genetic predisposition;
- prolonged stress.
With a hereditary form of the disease, a person has a lack of certain substances that are important for the normal functioning of the pancreas. Secondary or reactive pancreatitis occurs against the background of cirrhosis of the liver, chronic hepatitis, mumps, ulcers.
Main symptoms
The pathogenesis of chronic pancreatitis is associated with the course of inflammation in the gland and structural changes within the tissues. Doctors believe that the biggest difference from the acute form is the progression of the pathology inside the organ, even when the provoking factor has already been eliminated. As a result, a person may feel the lack of work of the gland.
At the initial stage of chronic pancreatitis, inflammation in the organ lasts for several years. During this period, the symptoms of the disease may periodically appear and disappear. The next stage begins when unpleasant symptoms appear constantly. Over the years, the patient may complain of the appearance of characteristic signs,which manifest themselves in the form of short-term painful sensations, disturbing about 15 minutes after eating.
Discomfort lasts from 1 hour to 3-5 days. Pain is concentrated mainly in the upper abdomen. Sometimes pain is felt in the region of the heart or in the lumbar region. In some cases, it is encircling in nature. You can reduce its intensity by bending forward or squatting.
A pain attack can be accompanied by nausea, diarrhea, flatulence and sudden weight loss. Such symptoms do not bother a person all the time, since with complex treatment it is possible to reduce all these manifestations and return to a normal lifestyle again until the next attack.
Gradually, the skin of a sick person becomes an unexpressed yellow color. There is also yellowing of the sclera. The yellowness of the skin can periodically pass. If the pancreas is completely atrophied, then the person develops diabetes.
Diagnostics
For the appointment of the required therapy, diagnosis is of great importance, in which it is necessary to take into account the pathogenesis of chronic pancreatitis. It is very important to investigate the functioning of the pancreas, to establish how disturbed its exocrine properties are. For this, a coprogram is prescribed, which is an analysis of the particles of undigested food that comes out with the feces. Additionally, blood and urine tests may be required for chronic pancreatitis, which will help assess the severity of the course of the disease.
In addition, the specialist directs the patient for an ultrasound examination, tomography, and other instrumental studies. However, initially the doctor examines the patient, finds out exactly what manifestations bother him.
After the diagnosis of chronic pancreatitis is made, the appropriate treatment method is selected.
Features of treatment
In each case, the doctor selects the treatment individually, depending on the results of the examination. The most important thing is to follow the diet. The main requirements are to exclude fried, fatty, spicy foods, as well as alcoholic beverages from the diet. You need to eat in small portions 5-7 times a day.
In addition, medications are prescribed, which contain digestive enzymes in their composition. In the most severe cases, surgery is required.
Drug therapy
Drug therapy of chronic pancreatitis is aimed primarily at eliminating painful symptoms and dyspepsia. To stop the pain, you can use analgesics ("Baralgin", "Analgin") or antispasmodics ("Drotaverin", "No-Shpa").
Antihistamines are used to suppress excessive functioning of the pancreas. To reduce the secretion of the stomach and glands, proton pump inhibitors are required. Antacids contribute to the neutralization of hydrochloric acid, providing functional rest of the pancreas.
Prokinetics are prescribed in violation of the digestive tract. Enzymes are required to compensate for the insufficient function of the affected organ. They are used throughout life. In the treatment of chronic pancreatitis and cholecystitis, all medications should be prescribed only by the attending physician, who also selects the dosage and determines the method of their use. Self-medication without consulting a doctor is strictly prohibited, as this can aggravate the course of the disease and lead to the development of complications.
Operating
Sometimes surgery may be required to cure a disease. The indication for this is obstruction of the pancreatic and biliary tract, purulent complications, complex course of the disease, stenosis, changes in the tissues of the affected organ. All these conditions are not amenable to conservative therapy. Operations such as: can be assigned
- excision of stones in the ways of the gland;
- sphincterotomy;
- pancreectomy;
- opening and sanitation of purulent foci.
If there are complications in the bile duct or bladder, it may need to be removed. Also sometimes prescribed excision of part of the stomach. To reduce the tension of the main pancreatic tract, the creation of circumferential bile ducts is required.
Dieting
Sometimes a good result cannot be achieved even with medical treatment of chronic pancreatitis. Diet will help achieve the desired result, which is why a balanced diet is important. During remissionyou can eat raw vegetables and fruits, mild soft cheeses, pasta, baked fish. You can also prepare various soups, however, it is desirable that they be vegetarian.
During the exacerbation of chronic pancreatitis, treatment and diet should be well-chosen. For 2 days, it is recommended to observe hunger and bed rest. After normalization of he alth, it is allowed to eat vegetable purees and soups, low-fat varieties of boiled fish, porridge, poultry. Veal and rabbit dishes are best baked without spices or steamed.
It is recommended to include fermented milk products, as well as sour cream and cottage cheese in the usual diet, but only they should be of minimal fat content. It is forbidden to consume fried, s alty, fatty, spicy foods. Drink carbonated drinks. Do not drink alcoholic beverages, even with a low alcohol content. It is important to quit smoking. It is useful to drink kissels from non-acidic berries, as well as herbal teas.
The menu for chronic pancreatitis should be selected especially carefully. All food should be divided into 6-8 meals and eat in small portions. Patients should not consume mushroom dishes. To give a soft texture, food is best rubbed or whipped with a blender. A sparing diet will generally lead to positive results.
Possible Complications
Complications of chronic pancreatitis include malabsorption syndrome. Among the violations, it is necessary to highlight such as:
- pseudocyst;
- diabetes;
- thrombosis of the splenic or portal vein;
- obstruction of bile ducts;
- pyloric stenosis;
- new growths.
Adenocarcinoma of the pancreas develops mainly in people who have suffered from this disease for more than 20 years.
Forecast
The mortality rate in chronic pancreatitis reaches almost 50% with the course of the disease for 20-25 years. Approximately 15-20% of patients die from complications associated with an exacerbation of the disease. In other cases, death is due to malnutrition, smoking, injuries, infections.
Prophylaxis
To prevent the development of chronic pancreatitis, it is imperative to carry out comprehensive prevention. Excessive physical activity can provoke an attack of the disease. For people suffering from pancreatitis, breathing exercises and massage will be the best loads.
It is important to give up bad habits, in particular, such as smoking and alcohol abuse. This helps to reduce the load on the affected organ, which will achieve a stable remission. Timely treatment of the pathology of the gallbladder and bile ducts will prevent the transition of the disease into a chronic form. If stones have already formed inside the gallbladder, then you need to urgently remove them.
Prophylactic measures should include a proper balanced diet. Portions should be small, but you need to eat often. The principle of separate nutrition will greatly facilitate the functioning of the pancreas. Do not mix proteins and carbohydratesas this will significantly increase the load on the affected organ.
It is not recommended to drink coffee. It is necessary to limit its consumption or completely abandon this drink.
