1 Description of the disease according to the

classification Considering pancreatic diseases, in particular chronic pancreatitis, using the ICD-10 international code, you can find two subsections K86.0 and K86.1, the first of which refers to the alcoholic etiology, and the second tells about other causesthe occurrence of this disease. Pancreatitis itself in chronic form manifests itself as a constant inflamed condition of the pancreas. Over time, this disease can lead to ductal strictures and fibrosis, along with the relaxation of endocrine and exocrine functions. And the damage to the gland is of a permanent structural nature. When chronic pancreatitis is not associated with the systematic use of alcohol in large portions, physicians talk about idiopathic disease.

Among the main symptoms of this disease are the following:

• recurrent attacks of pain in the left side;
• malabsorption;
• intolerance to glucose( the initial stage of diabetes mellitus).

Most of the cases of appearance of the considered disease in the adult population of the United States are associated with alcohol dependence, and only 16-24% of patients suffer from pancreatitis for other reasons. Chronic pancreatitis is rarely the result of specific heredity, hyperparathyroidism, pancreatic duct obstruction syndrome. Children and young people in India and some other tropical countries fall ill with idiopathic pancreatitis in chronic form due to the local climate.

A dangerous continuation of the disease in the absence of proper treatment for 10-15 years is the development of diabetes mellitus. But 70-80% of patients manage to avoid the appearance of intolerance to glucose.

This disease sometimes excludes attacks of pain in the left side, but is characterized by progressive malabsorption. If unpleasant strong sensations are present, then their sudden disappearance usually occurs in 7-10 years as a result of the destruction of the acitular cells, which contribute to the normal production of digestive enzymes. The chair in these patients becomes fat.

2 Research methods

In the early stages of the disease it is very difficult to diagnose, as the concentration of lipase and amylase can be normal, because the functionality of the pancreas is significantly reduced. However, patients who abuse alcohol for a long time and suffer frequent attacks of acute pancreatitis with increased pain, when examining the abdominal cavity with an X-ray, immediately after such procedure, an accurate diagnosis is made. All is explained by the presence of calcification in the body with significant disorders of the gland.

When patients with pancreatitis in chronic form do not have a typical history of the disease associated with the presence of alcohol, it is advisable to conduct CT of the abdominal cavity. This diagnostic technique helps to detect calcification, dilated ducts, or pseudocyst. Although the early stages of the disease may not be accompanied by the above-described symptoms. Then specialists resort to ERCP and analyzes of the secretory functioning of the pancreas. These studies have a high sensitivity, and after them sometimes there are even attacks of acute pancreatitis. To protect the patient from negative consequences, doctors offer MRCPG.

In the case when medical experts assume a later stage of the disease, the results of stool tests for fat show steatorrhoea, and the exocrine pancreatic function becomes altered. Not every specialized medical center carries out a secretin test, since the main procedure is to take some pancreatic secretion with a duodenal probe. Urinalysis is done by first taking benthiromide and pancreolauril to determine the breakdown products with these substances. Used orally, these pancreatic enzymes facilitate the passage of necessary chemical reactions. The most reliable are endoscopic ultrasonography and ERCP, especially in the early stages of the disease.

Thus, it is necessary to conduct an examination of the pancreas with ultrasound, make an X-ray of the affected organ and diagnose it in different ways.

And in case of suspicion of chronic pancreatitis the doctor generally gives directions to:

• urine analysis;
• determination of blood glucose;
• general blood test;
• study of pancreatic amylase in blood and urine;
• common bilirubin in the blood;
• determination of pancreatic elastase-1 in feces;
• study of amylase in blood and urine;
• stool analysis.

Treatment of chronic pancreatitis is usually handled by a gastroenterologist.

3 Treatment measures for chronic form

Treatment of this disease depends on the manifestation of the patient's symptoms and necessarily accompanied by a certain diet, the adoption of enzymes and analgesics. Operative intervention is also carried out if there is no other way out.

Acute periods of chronic pancreatitis require fasting and intravenous fluid transfusions.

Naturally, alcohol consumption is out of the question, and when you resume food you can eat extremely low-fat food. This diet can reduce the secretion of pancreatic enzymes. To reduce the stimulation of pancreatin secretion, special inhibitors and blockers are used.

But with painful syndrome it is more difficult to fight, as increasing the dose of medications used leads to addiction. Chronic pancreatic pain is stopped using pancreatic enzymes, producing cholecystokinin. However, this technique helps with idiopathic pancreatitis, which is not so successful with this disease of alcoholic etiology.

The enzymes considered can additionally help in case of steatorrhea. The dose of the drug, containing 30,000 units of lipase, is quite effective for treatment. The tablets themselves should be protected with a coating that prevents rapid penetration of the acid, and the administration of such drugs is prescribed together with eating. In addition, treatment should be supplemented with proton pump inhibitors to prevent acid destruction of enzymes.

The positive effect of the treatment is indicated by a decrease in steatorrhea, weight gain and overall improvement in the patient's well-being. If, as a result of compliance with all prescribed prescriptions, there still remains a severe form of steatorrhoea, then they speak of triglycerides of the middle chain, which are not affected by pancreatic enzymes. Then, in addition, you need to take vitamins of certain groups to relieve inflammation and dissolve these drugs in fats.

Surgery for chronic pancreatitis is used in severe severe pain.

Pancreatic pseudocyst can be drained to the stomach or bowel of the jejunum, because it is often capable of causing pain. This surgical treatment includes a cystejonostomy according to Ru. And the expansion of the pancreatic duct more than 5 mm in many cases requires the operation of Puestow, which is called a lateral pancreaticunostomy. Partial resection is used when the duct does not increase in size. In case of defeat of a head of a pancreas doctors recommend to spend operation Whippl. Distal pancreatectomy is prescribed for problems with the caudal part of the organ under consideration.

4 Additional measures

It should be emphasized that surgical operations are performed only in cases of complete refusal from drinking, as well as with the possibility of controlling manifestations of secondary diabetes, which develops under the influence of the pancreas.

If diabetes occurs in chronic pancreatitis, then insulin should be taken with caution, because then there is a high probability of hypoglycemia.

When there is an increase in the number of symptoms characterizing chronic pancreatitis, doctors refer patients to a cytological analysis. Especially such studies are shown in the development of stricture of the pancreatic duct. Naturally, in most cases susceptibility to pancreatic cancer is suspected.