Among all patients who have an inflammatory disease of the pancreas, almost half have chronic biliary-dependent pancreatitis. The sound of the diagnosis leads to a stupor, especially those who did not even guess about the presence of pathology.
Description of the disease
Chronic biliary pancreatitis, in fact, is not a primary disease, as, for example, alcoholic pancreatitis. This form of the disease of the gland is manifested with the already existing pathologies of other organs, in particular, with the disease of the gallbladder and bile ducts, liver, kidneys.
Diseases against which biliary pancreatitis develops most often:
- The deposition of gallstones and the sludge syndrome is an increase in bile density, in which suspended particles precipitate;
- Congenital abnormalities of the gastrointestinal tract;
- Congenital diseases of the gallbladder and biliary tract;
- Cholecystitis;
- Inflammation of the biliary tract - cholangitis;
- Cirrhosis;
- Choledocha cyst;
- Disease of the pharyngeal papilla - through it the bile passes into the duodenum, the cause may be disturbances in the work of the sphincter of Oddi, infection with parasites, overlapping with neoplasm or stone, inflammation.
The development of pancreatitis against these diseases is more likely than with alcohol dependence. In addition, the longer these pathologies are present, the more likely the occurrence of inflammation in the pancreas.
The most common acute biliary pancreatitis is accompanied by stone formation in the gallbladder, and with the removal of stones inflammation passes.
The development of the disease
The bile formed by the liver accumulates in the pancreas. In a normal state, it is designed to break down the lipids that enter the body with food. The movement of bile begins from the bile ducts, then through the pharynx of the papilla in the duodenum, in which the lipid emulsification begins with bile.
In the pathological state, the bile flow through the papilla is disrupted. For example, the papilla is blocked by a stone or a tumor, its work is prevented by parasites, ascarids. Also, the spasm of the papilla can interfere with movement. In this case, there is a reflux - the ingress of bile into the ducts of the pancreas.
The ingestion of bile there is not a natural process, therefore it leads to an increase in pressure and rupture of the microscopic ducts of the gland. Bile contains special acids, which in this pathology enter the tissues and thickness of the pancreas.
Acidic compounds cause so-called self-digestion of the gland due to impaired functions that performed the gallbladder.
Biliary HP may be complicated by a qualitative change in the secretion, in which the aggressiveness of the medium is increased in secret, which means that the inflammatory process becomes worse when it enters the gland.
In the bile can get bacteria that develop in inflamed organs, and the process of inflammation can spread to the pancreas through the blood supply of the body.
A similar process accompanies parenchymal pancreatitis, which develops against the background of gallbladder diseases, but its etiology may be not only in this, but also in alcohol or malnutrition.
Symptomatic acute form
Like any other pancreatitis, biliary is manifested in a chronic and acute form. Knowledge of the manifestations of acute form helps to stop the attack before the arrival of an ambulance and provide the proper medical care to the patient.
Acute biliary pancreatitis manifests itself in the following:
- Acute abdominal pain with shingles;
- Non-stop vomiting, nausea;
- Jaundice;
- Increase body temperature to 38-39 ° C;
- Indigestion, constipation, followed by diarrhea.
As can be seen, the symptomatology is very similar to all types of pancreatitis, therefore a specific gastroenterology will determine the specific belonging to a certain type of disease according to the results of the diagnosis.
Symptomatic of chronic form
In the remission phase, the disease manifests itself quite typically for the inflammatory process in the pancreas:
- Aversion from food, loss of appetite;
- Nausea;
- Constipation, followed by diarrhea;
- Weight loss for no apparent reason;
- Vomiting;
- Pain in the abdominal cavity, can give in the side, arm, back, shoulder blade.
Chronic pancreatitis also necessarily requires treatment, because without a proper treatment schedule, frequent attacks of acute pancreatitis are possible, which in time only increase and their intensity becomes more pronounced.
Features of biliary pancreatitis
This form of the disease can be recognized by typical and characteristic features only of it. Painful cider with this form of the disease especially often develops after eating foods with choleretic effect.
In this case, the pain attacks last longer than in other forms, resembling biliary colic. Often patients note the localization of pain under the ribs on the right, and also in the waist and right arm, under the right scapula.
The patient may feel a burp with bitterness, the same feeling is almost always present in the oral cavity. The danger of the biliary form is that it causes prolonged and frequent constipation, which can lead to the development of acute obstruction of the intestines, a decrease in their peristalsis.
Diagnostics
To diagnose the acute phase, no special methods are required - the symptomatology of it is such that an experienced doctor immediately distinguishes an attack of pancreatitis from food poisoning or irritated stomach syndrome. In particular, one of the indicators is an increase in temperature in the area of the inflamed gland, which can be easily felt by touching.
There are no pains when palpating the spine, but with the examination of the gland the syndrome can lead to even painful shock. All this allows an ambulance doctor to immediately provide the patient's assistance.
Chronic pancreatitis is diagnosed by examining blood and urine for inflammation, ultrasound of the abdominal cavity and gastroenteroscopy.
Treatment of
Biliary pancreatitis, being a secondary disease, requires, in the first place, treatment of the underlying cause. General principles of treatment remain the same for all forms of inflammation of the pancreas: relief of pain syndrome, removal of inflammation, proper diet.
With biliary form, the pathology of gallbladder motility is taken into account. When spasms are prescribed antispasmodics, for example, drotaverin, debride. Atony, on the contrary, motilium, cerucal, eglonil, being prokinetics. Patients prescribe drugs that stabilize the quality characteristics of bile, for example, hepatofalk.
If the cause is hidden in the stone formation, or overlapping the papilla with a tumor, you need to remove the stones or the tumor. Today, surgery is not so terrible as before, as modern endoscopic methods allow you to operate through small incisions not more than 1 cm.
Small stones can be excreted by drugs based on ursodeoxycholic acid, which dissolves them and removes them from the body. With more serious stones, shock wave therapy can be performed, which destroys stones with ultrasound without incisions and operations. The deposit particles are then dissolved.
And, last but not least, the obligatory condition of treatment is the proper adherence to the diet and the refusal to drink alcohol and smoking. The patients are assigned table number 5 according to Pevzner, their corrections can be made by a gastroenterologist and a nutritionist. Compliance with the diet guarantees a reduction in the number of acute attacks.
