Pancreatitis : Causes, Symptoms , treatment of pancreatitis
Gastroenterology / / August 12, 2017
Pancreas located behind the stomach, adjacent to the duodenum.The pancreas has two main functions:
1. secrete powerful digestive enzymes into the small intestine to help digest carbohydrates, proteins and fats.
2. fermenting the hormones insulin and glucagon into the blood.These hormones are involved in the metabolism of blood glucose is controlled, storage and utilization of energy received by the body from food.
damaged pancreas occurs when digestive enzymes are activated in the pancreas itself, before they enter the duodenum.When these enzymes are active within pancreatic, they begin to destroy pancreatic tissue, there is a kind of self-digestion.This causes swelling, bleeding and damage to the pancreas and its blood vessels.
Pancreatitis can be caused by gallstones (by blocking the release of the pancreas), chronic alcohol consumption, trauma, some medications, infections, tumors, and genetic abnormalities.
There are two major forms of pancreatitis: acute and chron
pancreatitis in children is rare, and is usually caused by an inherited disease or injury of the pancreas, pancreatitis rare cases of children the reason is unknown.
Acute pancreatitis - sudden inflammation that occurs in a short period of time and is accompanied by swelling and inflammation of the pancreas, fever, nausea, vomiting.In most cases, acute pancreatitis caused by gallstones or prolonged alcohol use.About 10% - 15% of cases of acute pancreatitis cause is unknown.
Acute pancreatitis can be classified as light, medium or heavy.This classification is based on the results of physiological, laboratory and radiological studies. Mild disease is not associated with complications or organ dysfunction, and recovery takes place without complications. Severe pancreatitis is characterized by a dysfunction of the pancreas, local and systemic complications, and difficult recovery.
addition, pancreatitis can be divided into acute interstitial and acute hemorrhagic. When the interstitial type, pancreas remains unchanged, but it washes the present swelling. inflammatory cells and interstitial edema can be seen in the parenchyma. haemorrhagic disease is characterized by extensive necrosis, hemorrhage in the tissue, and fat necrosis. In this condition often marked pancreatic necrosis, along with vascular inflammation and thrombosis.
Causes and risk factors of acute pancreatitis
Acute pancreatitis affects men more often than women.
main causes of acute pancreatitis:
- alcoholism and alcohol abuse (70%).
- Genetic predisposition.
- Autoimmune problems (when the immune system attacks its own cells)
- Gallstone disease.
- Blockage of the pancreatic duct or common bile duct such as gallstones.
- parasites such as roundworm, can also cause blockage of the pancreas.
- Damage ducts and pancreas during surgery.
- High blood levels of fats - triglycerides (hypertriglyceridemia).
- Violation of the pancreas circulation.
- Injury of the pancreas in an accident.
- Complications of cystic fibrosis.
- Hemolytic uremic syndrome.
- Kawasaki Disease.
- Reye's Syndrome.
- Use of certain medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine).
- Viral infections, including mumps, mycoplasma pneumonia, and campylobacter, hepatitis C
- duodenal diseases, small and large bowel, accompanied by constipation, such as peptic ulcer disease, enteritis, colitis, enterocolitis, diverticulitis.
Symptoms of acute pancreatitis
- The main symptom of pancreatitis is abdominal pain in the upper left corner or in the middle of the abdomen.Pain can be enhanced in several minutes after eating or drinking, especially if the products have a high fat content.Usually constant pain lasts a few days, intensifying in the supine position, and can also be given in the back or below the left shoulder blade.
- People with acute pancreatitis often look sick, they have been fever, nausea, vomiting, and sweating.
Other symptoms that may occur with this disease include:
- clay-colored stools frothy consistency;
- Loss of appetite;
- Yellowing of the skin and whites of the eyes (jaundice);
- Skin rash (Tuzhilin symptom);
- Blood pressure rises, and then it can be the contrary, too low;
- heart palpitations, shortness of breath;
- a bluish spots in the belly button area and on the back, patches of greenish-blue color in the groin area.
Diagnosis of acute pancreatitis
diagnosis of acute pancreatitis is often difficult due to the deep location of the pancreas.
- abdominal ultrasound.If pancreatitis is caused by gallstones cause inflammation, the ultrasound confirmed their presence with their locations.
- Computed tomography.CT can show gallstones, the presence of stones in the ducts of the pancreas to determine the size and locate foci, as well as the degree of injury to the pancreas.
- Endoscopic ultrasonography.This study is performed with an endoscope - a thin, flexible, lighted tube introduced through the throat and into the stomach into the small intestine.And with the help of ultrasound creates visual images of the pancreas and bile ducts.
- Magnetic resonance cholangiopancreatography.Non-invasive study that produces images of the cross sections of the body.The patient intravenously administered contrast material that helps to visualize the pancreas, gall bladder, pancreas and bile ducts.
- Densitometry, the study provides insights into the body density.
Laboratory tests can determine:
- Complete blood count.It allows you to determine the increase in amylase and increases in serum blood lipase.During acute pancreatitis their level of at least three times the normal amount.Changes may also occur in other chemical indicators such as glucose, calcium, magnesium, sodium, potassium, and bicarbonate.After the condition of the person improves, the levels usually return to normal life.
- Urinalysis shows the increase in urine amylase.
Treatment of acute pancreatitis
Treatment of acute pancreatitis often requires a hospital stay and a special complex therapy, which includes:
- prescription drugs, which include:
- Infusion therapy- intravenous drugs that promote blood purification from pancreatic enzymes and toxins;
- Analgesics (analgesics);
- drugs that destroy pancreatic enzymes (Contrycal, Gordoks;)
- Drugs that decrease pancreatic secretion (Atropine, Platifillin);
- hormones of the digestive tract (Dalargin, Somatostatin);
- complete cessation of food and drink by mouth for 3-6 days in order to restrict the activity of the pancreas;
- Enteral nutrition (intravenous);
- Adherence to a strict diet;
- Direct cleaning blood from poisons: plasmapheresis and hemosorbtion;
- Forced diuresis - artificial stimulation of urination by introducing into the body fluids and diuretics, with a view to early urinary excretion of toxic substances from the body;
- Lavage bowel and abdominal cavity (peritoneal dialysis, and intestinal);
- nasogastric aspirate shows if vomiting or severe pain persist or develop intestinal obstruction;
- Cholecystectomy.If it is confirmed that the pancreatitis is caused by gallstones, the gallbladder must be removed;
- Surgical treatment for acute pancreatitis is rarely necessary in the most severe cases, to remove dead or infected pancreatic tissue.
duration of hospital care depends on the development of complications of pancreatitis and how well patients respond to treatment. This ranges from a few days to a few months of intensive therapy.
Patients may be prescribed in cases where the pain is well controlled with oral pain medications when patients are able to tolerate a diet that meets their needs in calories, and all complications were addressed properly.
Expectations and prognosis of acute pancreatitis
In most cases, acute pancreatitis symptoms improve within a week.However, in some cases acute pancreatitis may develop into a life-threatening disease.
There is a high mortality rate in such complications like:
- Hemorrhagic pancreatitis;
- Liver failure;
- Heart failure;
- Renal failure:
episode of acute pancreatitis may recur.The probability of this depends on the cause of the disease, and how successfully it can be treated.Repetitions of episodes of acute pancreatitis can lead to chronic pancreatitis.
Complications of acute pancreatitis
- Acute renal failure;
- Acute respiratory distress syndrome;
- Accumulation of fluid in the abdomen (ascites);
- Cysts or abscesses in the pancreas;
- Heart failure;
- Low blood pressure.
Chronic pancreatitis occurs more often after an episode of acute pancreatitis, and is a result of ongoing inflammation of the pancreas, which over time leads to irreversible damage to the pancreas.
Causes and risk factors of chronic pancreatitis
Due to chronic inflammation occurs scarring of the pancreas, the body becomes unable to produce the right amount of digestive enzymes.As a result, the body may be unable to digest fat, and other important components of the food.Damage to the pancreas to produce insulin, can lead to diabetes.
Chronic pancreatitis often develops in people who are aged 30 - 40 years and is most often caused by alcohol abuse for years, and men predominate over women.Repeat episodes of acute pancreatitis can lead to chronic pancreatitis.In some cases, genetics can be a factor of development.In the 10-15 cases of chronic pancreatitis, the cause is not known.
Other factors are also associated with chronic pancreatitis:
- Autoimmune problems;
- Blockage of the pancreatic duct or common bile duct;
- Complications of cystic fibrosis, the most common hereditary disorder where the secrets of that allocated to different bodies have very high viscosity and density;
- hypercalcemia - high levels of calcium in the blood;
- Hyperlipidemia or hypertriglyceridemia - high fat levels in the blood;
- Using estrogens, corticosteroids, thiazide diuretics, and azathioprine;
- Metabolic disorders, especially fats associated with overeating.
Symptoms of chronic pancreatitis
Symptoms of chronic pancreatitis may become more frequent, as the deterioration of the patient's condition.These symptoms may mimic pancreatic cancer.The attack of chronic pancreatitis is not much different from an attack of acute pancreatitis.
Damage to the pancreas from excessive use of alcohol does not cause symptoms for many years, but severe pancreatitis symptoms may develop suddenly, including severe pain and disturbance of the pancreas, such as impaired digestion and blood sugar levels.
The main symptoms of chronic pancreatitis include:
- Pain in the upper abdomen radiating to the back, which last from several hours to several days and worse after eating or drinking.Usually, the pain occurs or worsens after consuming alcohol;
- Digestive problems.You receive an aversion to fatty and spicy foods and excessive salivation;
- Chronic weight loss, even if the usual power mode.People with chronic pancreatitis often lose weight, even when their appetite and eating habits are normal.Weight loss occurs because the body does not produce enough pancreatic enzymes to digest food, so nutrients are not absorbed properly.Poor digestion leads to malnutrition through the provision of fat in the stool:
- Diarrhea, nausea and vomiting;
- Flatulence and constant rumbling in the stomach;
- Fat or oil, light or clay-colored stools, with particles of undigested food, which has a foul smell;
- Mechanical jaundice;
- Accession of diabetes;
- Neuropsychiatric disorders: irritability, agitation, poor sleep.
diagnosis of chronic pancreatitis
tests for the diagnosis of chronic pancreatitis include:
- Coprogram, physical, chemical and microscopic examination of faeces for the detection of neutral fat and fatty acids;
- Serum amylase;
- Serum IgG4 (for diagnosing autoimmune pancreatitis);
- Serum lipase;
- Serum trypsinogen;
- CT of the abdomen;
- abdominal ultrasound;
- Endoscopic retrograde cholangiopancreatography;
- Endoscopic ultrasonography;
- Magnetic resonance cholangiopancreatography;
- laparotomy may be done to confirm the diagnosis, if other diagnostic methods have not yielded results.
Treatment of chronic pancreatitis
Treatment of chronic pancreatitis is similar to the treatment of acute pancreatitis and is usually conservative.It aims at reducing gastric acid secretion.For this purpose, use the following drugs:
- antispasmodic drugs to relieve spasms of muscles:
- Drotaverinum (bespo, No-spa, Spazmoverin, Spazmol)
- Papaverine hydrochloride (papaverine)
- Fundsattenuating the secretion of gastric juice:
- Omeprazole (Gastrozol, Demeprazol, Zerotsid, Zolser, Lockit, Losek, Omez, Omezol, Omepar, Onenprol, Omizak, Horta-nol, Otsid, Nexium, Promezol, Proseptin)
- Ranitidine (Atsideks, Atsilok-E Gistak, Duoran, Zantac, Zoran, Ranigast, Ranisan, Ranital, Ranitin, Rantag, Rantak, Renks, Ulkodin, Ulkosan, Ulkuran, Yazitin)
- famotidine (Antodin, Atsipep, Blokatsid, Gasterogen, ha-strosidin, Kvamatel, Nevofarm, Pepsidin, Famogard, Famodar, Famopsin, Famotsid)
- cimetidine (Altramet, Belomet, Gistodil, Neytronorm, Primamet, Simesan, Tagamet, Ulkuzal)
- Enzyme preparations, which correct secretory dysfunction of the stomach, normalizes the process of digestion, as well as regulate the function of the pancreas:
- Gimekromon (Odeston, Holonerton)
- Pancreatin (Digestal, Creon, Mezim, Pankral, pantsitrat, Penzistal, Tagestal, Ferestal, Festal, Forte Enzim,