Pancreatitis - an inflammation of the pancreas in which there is a development deficit production of pancreatic enzymes of varying severity.
Causes
- alcohol
- gallbladder and bile ducts
- drugs (aspirin, hydrochlorothiazide et al.)
- toxic substances
- metabolic acidosis
- protein deficiency
- hormonal disorders
- infection
- injury
The main mechanism of pancreatitis is self-digestion as a result of the activation of its own enzymes to the development of edema, necrosis and replacement of normal pancreatic tissue.
manifestations of pancreatitis
Painting disease consists of three main features:
- abdominal pain,
- violation of the digestion process,
- diabetes.
Pain during pancreatitis caused by an inflammatory process in the pancreas, are permanent, localized at the center of the pit area to give back, do not depend on the meal, they usually subside spontaneously or substantially reduced within 5-7 days after onset of acute eliminated painkillers antispasmodics.
Pain in the presence of pancreatic ductal obstruction, as well as the development pseudocysts and cysts tend girdle, paroxysmal arise during or immediately after meals, are often accompanied by nausea and vomiting, without generating relief. These reduced pain reception and antispasmodic drugs that reduce pancreatic secretion.
With the development of pancreatitis occur diarrhea, flatulence, Nausea, lack of appetite, drop in body weight. Fecal become greasy gray color and fetid odor.
Diagnostics
1. Assessment of pancreatic function: scatological test with elastase-1:
- more than 200 ug / g of feces - norm
- 100-200 mcg / g of feces - slight - moderate degree pancreatic insufficiency,
- at least 100 micrograms / g of feces - severe degree of pancreatic insufficiency.
Disorders of carbohydrate metabolism in chronic pancreatitis detected in about 1/3 of patients due to destruction of pancreatic cells, resulting in an hormone deficiency.
2. ultrasound
3. X-ray inspection
pancreatitis treatment
pancreatitis conservative therapy involves a series of measures. The basis of the therapy on the following principles:
- dieting;
- correction pancreatic insufficiency;
- elimination of pain;
- prevention of complications.
In the treatment of pancreatitis is necessary to eliminate the use of alcohol, medication that can have damaging effects on the pancreas (Antibiotics, antidepressants, sulfonamides, diuretics - furosemide and hydrochlorothiazide, indirect anticoagulants, indomethacin Brufen, acetaminophen, glucocorticoids, estrogens and many others). It is extremely important to treat diseases of the gastrointestinal tract and timely prevention of infectious diseases that cause pancreatic lesion (viral hepatitis B and C., mumps).
Eating disorders such as overeating, alcohol abuse, nutritional protein deficiency, alimentary allergy can be the direct cause of pancreatitis.
Without the use of diet therapy is difficult to expect a sufficient therapeutic effect. Properly organized power may prevent the development of complications, exacerbations of the disease and its progression.
Treatment of acute forms of pancreatitis
During exacerbation of pancreatitis patients require hospitalization daily in control during the first week blood parameters, the water balance, the number of leukocytes, enzyme levels in the serum acid-base balance.
Suppression of pancreatic secretion is an important activity in the treatment of acute pancreatitis. For this purpose, the following methods are used:
- cold for the epigastric region;
- in the first 1-3 days is recommended acute pancreatitis hunger reception alkaline solutions every 2 of hours (eg alkaline mineral water);
- M-use peripheral anticholinergics (gastrotsepin)
- appointment of somatostatin analogue - Sandostatin to reduce pancreatic secretion, eliminate pain in the abdomen, lowering analgesic requirements. Sandostatin administered in a dose of 100 mcg subcutaneously 1-3 times per day (up to 600 mg / day) for a period of several days to several weeks;
- lowering gastric acidity for pancreatic functional rest. For this purpose, use antacids, H2 blockers, histamine receptor (cimetidine), and blockers "proton pump" parietal cells (omeprazole);
- inhibition of pancreatic function: dalargin 1 ml intramuscularly 2 times a day for 22-24 days; promising application Peritol (4 mg three times a day orally for 8-10 days)
- enzyme inhibitors are used after the determination of individual patient tolerability of the drug. Apply the following drugs: trasilol, contrycal, gordoks. They are simultaneously administered intravenously in a 5% glucose solution or infusion in isotonic sodium chloride solution. Allergic reaction to the introduction of these drugs are observed at a frequency of 10-12%;
- antimicrobial therapy. Used in the exacerbation of pancreatitis occurring with fever, intoxication, as well as for the prevention of complications. broad-spectrum antibiotics commonly used - penicillins or cephalosporins (ampicillin, oxacillin, ampioks, kefzol, klaforan and others) for 5-7 days in normal daily dosages.
Pancreatic insufficiency manifested syndrome of impaired intestinal absorption. According to modern views the syndrome does not manifest itself in chronic pancreatitis as long as the enzyme secretion is reduced to 10% of its original potential. Treatment of pancreatic insufficiency is reduced to the appointment of diet and enzyme replacement therapy. In this case, the dose of the enzyme preparation is selected for each patient individually.
The main criterion for the effectiveness of the treatment is the dynamics of fat in feces and body weight of the patient. Usually the treatment begins with 3 tablets before, during and after the main meals. In severe forms amount of the drug may reach 20 or more tablets daily. Enzyme preparations in chronic pancreatitis are appointed for a very long time, often for life. Possible to reduce their dose, subject to a strict diet with restriction of fat and protein. However, when expanding diet dose of enzyme preparations must increase.
Physiotherapy exerts an analgesic effect and certain inflammatory effect. As a rule, physical therapy is used in the phase of exacerbation remission. The most frequently used:
- electrophoresis 5-10% solution or novocaine dalargin
- diadynamic currents
- sinusoidal modulated currents
In the remission phase balneotherapy widely used as carbon-hydrogen sulfide, carbon-radon, carbonic, "pearl" or sulfide baths. They are taken at a temperature of 36-37 ° C, duration - 10-15 minutes, course of treatment - 8-10 procedures.
Spa treatment is carried out in the compensation stage is acute in the resorts of Essentuki, Truskavets, Zheleznovodsk, as well as in health resorts of Belarus (Naroch, Rechitsa).
Diet for pancreatitis
Read more about the rules of the diet, and can be read on the prohibited and permitted foods here
General principles:
- split meals: frequent (5-6 times a day) meals in small portions by volume. Mandatory addition to this principle is slow food and chewing food thoroughly;
- inclusion in the diet of increased amounts of protein (110-120 g / day), which should be 60% proteins of animal origin. Consumption of foods rich in lipotropic factors and proteins legkoatakuemyh enzyme systems (cottage cheese, low-fat meats, fish, egg albumen and al.);
- restriction of use of fat (up to 80 g / day). The amount of fat should be distributed evenly throughout the day. Fats pure excluded from the diet;
- Carbohydrate restriction diet (300-350 g / day), primarily due to simple sugars;
- restriction salt diet (8 g / d).
Forecast
Strict adherence to diet and diet, abstinence from alcohol, strict adherence to the recommendations of the drug treatment significantly reduces the frequency of exacerbations, transfer process variant rare relapsing slow progression. Some patients may achieve visible and sustained remission.
Chronic pancreatitis is characterized by progressive course, but the impact of the termination of the causal factors and adequate therapy to slow the progression of the disease, significantly improve the quality of life of patients and forecast.
