Chronic pancreatitis (Reasons Development Clinic, Treatment) Chronic pancreatitis - chronic inflammatory and dystrophic disease of the pancreas, causing the progression of the disease process violation cross its ducts, and a substantial disruption of the pancreas. Chronic pancreatitis (CP) - quite frequent disease: in different countries the incidence of chronic pancreatitis is 5-7 new cases per 100 000 population. Thus for the last 40 years there has been an increase of about two-morbidity pancreatitis. This is due not only to improved methods of diagnosis of chronic pancreatitis, but also with an increase in alcohol consumption in some countries, the increasing impact of environmental factors that weaken a variety of security mechanisms. Acute and chronic pancreatitis (CP and CP) is often seen as two separate diseases . The thing is. that 60% of patients with acute phase of pancreatitis remains unrecognized or recognized as food poisoning, gallstones, etc. Therefore, it is clear that the outcome of chronic pancreatitis is ostorgo. Causes of chronic pancreatitis main causes of chronic pancreatitis - alcoholic and biliary (bile) - are more common in developed countries with high consumption of alcohol, protein and fat. Alcohol abuse (alcoholic pancreatitis). Leading reason - from 40 to 95% of all forms of pancreatitis, mostly men. recognize its nature difficult.Upon questioning, the patient often states that he drinks "like everyone else, no more." However, patients with alcoholic pancreatitis consumed significantly more alcohol than the recommended modern medical postulates. The pancreas is more sensitive to alcohol than the liver (liver- toxic doses of more doses to the pancreas by 1/3). Type of alcoholic beverage (There is a myth that the expensive alcohol is harmless) and the method of their use does not have a decisive influence on the development of HP. clinically significant symptoms occur in women 10-12 years and men over 17-18 years from the beginning of the systematic abuse of alcohol. The main factors influencing the development of chronic alcoholic pancreatitis: The first is the toxic effect of alcohol. Even after a single dose of a lot of alcohol and hypoxic developing degenerative changes in pancreatic tissue. With prolonged use of alcohol produced necrosis of the pancreas, formed stones prtokah cancer. Besides alcohol causes spasm of the sphincter of Oddi (place where the main pancreatic duct into the duodenum), thus prepyatsvuya normal outflow of pancreatic juice. But that's not all. Alcohol abuse leads to thickening of the pancreatic juice, which also contributes to the delay in his pancreatic cancer. With continued secretion of the pancreas leads to a progressive increase in pressure in the ducts of the pancreas and edema. Diseases of the liver and biliary tract in chronic pancreatitis (biliary pancreatitis) biliary disease (biliary) systems cause chronic pancreatitis in 25-40% of cases, mostly in women. Biliary chronic pancreatitis associated with gallstone disease (GSD). Frequent recurrence of biliary pancreatitis usually occur during the migration of small and very small stones. Particularly severe and prolonged exacerbation of chronic pancreatitis are observed after treatment kamenogonnoy purpose (choleretic drugs). Painful seizures do not develop in all patients, even with ultra-fine stones, and the "gourmet" that tasty foods provoke spasm of the gall bladder, the sphincter of Oddi and pancreatic edema cancer. As provocateurs most often serve meat pies, fish, mushrooms, fresh bread rolls, cakes, chocolate, hash, hodgepodge, champagne, cold fizzy drinks. throw of bile into the pancreatic duct. Abnormal liver function in hepatitis, cirrhosis leads to the production of diseased bile, containing a large amount of free radicals, which are in contact with the bile into the pancreatic ducts lead to stone formation and development of inflammation. Diseases duodenal ulcer (DU) and papillary in chronic pancreatitis (OBD) Pathology PDK development of chronic pancreatitis is often associated reflux content KDP in the pancreatic duct. Reflux occurs when: The presence of failure (hypotension) - papillita, diverticulitis, the passage of the stone, dysmotility,development of duodenal stasis (chronic duodenal obstruction) Combinations of these two states. Development of chronic pancreatitis can be a complication of peptic ulcer - ulcer penetration into the pancreas (secondary pancreatitis). nutritional factors in chronic pancreatitis Eating fatty, fried, spicy foods, low protein content in the diet (eg, fibrosis and atrophy of the pancreas and its severe secretory failure occurs in cirrhosis, malabsorption). genetically based (hereditary), pancreatitis emit so-called hereditary pancreatitis - an autosomal dominant pattern of inheritance with incomplete penetrance. The same is essentially hereditary pancreatitis in cystic fibrosis. Medicinal pancreatitis is rare. Among the factors pankreatopovrezhdayuschih anti-inflammatory (brufen) Furosemide, thiazide diuretics, tetracycline, Indirect anticoagulants,cimetidine, metronidazole, cholinesterase inhibitors. clinical picture of primary chronic pancreatitis. outcomes of chronic pancreatitis. clinical picture of chronic pancreatitis is characterized by three major syndromes: Pain in chronic pancreatitis,exocrine insufficiency syndrome pancreas (disturbance of digestion, diarrhea), endocrine deficiency syndrome (violation of insulin, diabetes). Pain in chronic pancreatitis pain, the leading feature of chronic pancreatitis. She felt mostly in my left side, may have the character of "encircling" pain, t . is to capture the entire left side, calling on his back. Unlike pain in acute pancreatitis is that the intensity of the pain is such that the patient writhes and can not even straighten up. Increasingly, such attacks occur after alcohol abuse, especially of poor quality, or its substitutes that contain large amounts of toxic substances. However, these attacks can be triggered and excessive intake of excess fatty or spicy foods. exacerbation of chronic pancreatitis is characterized, first, less severe pain, and secondly, as a rule, these painful episodes are repeated periodically after errors in diet or alcohol abuse. Most of pain occur after a heavy meal, especially fat, fried, often appear on an empty stomach pain or 3-4 hours after a meal, which requires exclude duodenal ulcer. When fasting pain settle down, so many people have enough to eat and lose weight. There is a daily rhythm of pain: pain before lunch a little worried after lunch amplified (or appear) and grow in the evening. Pain may be pressing, burning, boring, considerably expressed pain supine position and decreased in the sitting position with the trunk bent forward. pain in chronic pancreatitis has a diverse origins: it may be due to violation of the outflow of pancreatic juice, increased secretion of the pancreas organ ischemia, inflammation of the surrounding tissue, changes in the nerve endings, the compression of the surrounding organs (bile duct, stomach, duodenum). Therefore, the first step in the treatment of such a patient is to conduct a thorough examination (endoscopy, x-ray of the stomach and duodenum, computed tomography, endoscopic ultrasound), which can detect some complications of pancreatitis, such as pseudocysts, bile duct stricture or disease, often combined with chronic pancreatitis.Following a preliminary examination in the absence of complications, patients are administered high doses of pancreatic enzymes (Creon, mezim forte, pancreatin, etc.). Most often, the pain can cut short under mild CP, in the absence of steatorrhea, with primary parenchymal organ ("small duct disease"), as well as in women. diarrheal syndrome in pancreatitis - Hypersalivation (excessive salivation), burp air or ingested food nausea, vomiting, aversion to fatty foods, bloating. Weight loss- induced food restrictions due to pain in the abdomen + vyrobotka lack of pancreatic enzymes. pancreatic diarrhea and malabsorption syndromes in the cavity of the intestine - are typical for heavy and long- existing forms of chronic pancreatitis with severe violation of exocrine function (when the functional ability of the pancreas of 10% of the original). Diarrhea caused by impaired release of pancreatic enzymes and intestinal digestion. Abnormal composition of chyme irritates the intestine and causes diarrhea. Characteristic of a great amount of fetid fecal kashetseobraznogo with greasy luster (steatorrhea) and bits of undigested food. Severe forms of chronic pancreatitis develop symptoms of malabsorption of nutrients, which leads to weight loss, dry skin, polyhypovitaminosis, dehydration, electrolyte imbalance, anemia, Kale found starch, undigested muscle fibers. nedostatochnot endocrine- manifested impaired glucose tolerance, in severe cases insulinpotrebny developing diabetes. Stages of chronic pancreatitis in the course of chronic pancreatitis can be distinguished stages of the disease: The initial phase of the disease for a mean of 5.1 years (up to 10 years). The most common manifestation - the pain of varying intensity and localization in the upper right part of the abdomen in the defeat of the pancreatic head, in the epigastric region of the body with lesions in the left upper quadrant with the defeat of the tail of the pancreas, pain associated with herpes zoster paresis of the nature of the transverse colon and occur infrequently. Dyspeptic syndrome and if there is, it is clearly associated in nature and are reduced by the treatment of the first. detailed picture of the disease is detected more often later and lasts mostly 5-10 years. The main symptoms: pain, signs of exocrine insufficiency, elements endocrine insufficiency (increase or decrease in blood sugar). Signs of exocrine insufficiency come out on top. Complicated flow HP version (in any period). Subsided active pathological process or complications occur more frequently after 7-15 years of onset. In two thirds of patients have subsided pathological process by adapting the patient to CPs (alcohol withdrawal, brushing biliary system, diet), 1/3 of developing complications. Changes the intensity of pain, or irradiation, the dynamics under the influence of treatment. Complications of chronic pancreatitis , pancreatic ductal hypertension (increased pressure in the lumen of the main pancreatic duct) cysts and pseudocysts of the pancreas cholestasis (bile stasis) infectious complications (inflammatory infiltrates, purulent cholangitis, peritonitis, septic conditions), obstruction of the duodenum, thrombosis of the portal and splenic veins obstructive portal hypertension, bleeding (erosive esophagitis, Mallory-Weiss syndrome, gastroduodenal ulcers)pleuritis swampy, pancreatic ascites, hypoglycemic crises, abdominal angina. stones removed from the duct PancreaticTreatment Treatment of patients with uncomplicated chronic pancreatitis engaged therapist? gastroenterologist, it is aimed at the elimination of pain, compensation exocrine insufficiency, compensation endocrine insufficiency. A major problem in the treatment of patients with chronic pancreatitis is a timely diagnosis of complications and referral to a specialist surgical gastroenterology center for consultation and possible surgery. The sooner a patient receives professional help, the more likely to preserve the function of the pancreas and a high quality of life. in turn competent diagnosis of chronic pancreatitis is not possible without an efficient assessment of changes of pancreatic parenchyma, its duct system of doctors, and this is possible only in specialized clinics with extensive experience in the treatment of pancreatitis. Therefore, we recommend that patients with pankretitom repeatedly admitted to hospital with acute exacerbation of chronic pancreatitis, or with a constant pain, ask your doctor to send him for treatment in a clinic, to avoid diagnostic errors. Possibilities of conservative treatment in the chronic phase of pancreatitis are limited, of drugs, specifically influence the development of chronic pancreatitis, are virtually absent. Therefore, the main effort should be made to mitigate the pain, rational diet therapy, correction of external and endocrine pancreatic insufficiency, and to eliminate the causes of pancreatitis by coupling of inflammation in the bile ducts, anti-alcohol dependent patients. need diet caused by a decline in patients with chronic pancreatitis body weight, a vitamin deficiency, it is also an important tool for the prevention of exacerbations of pancreatitis. Signs of exocrine pancreatic insufficiency (weight loss, steatorrhea, bloating) requires replacement therapy with modern drugs with increased lipase to facilitate correction of steatorrhea and malabsorption of fat-soluble vitamins. Microgranular use drugs in capsules, surface coated (Creon), prevents deactivation of lipase in the acidic environment of the stomach. Admission enzymatic and antisecretory drugs also has analgesic effect as increasing the content of proteases in the lumen of the initial part of the intestine, reduces the secretion of pancreatic enzymes and reduce the pressure in the duct system and pancreatic tissues.Indications for surgical treatment of chronic pancreatitis complications of pancreatitis are indications for its surgical treatment.To eliminate complications with direct operations in the pancreas. Arsenal of diverse, account for any variations defeat cancer, but they are divided into two groups - operations aimed at draining the main pancreatic duct and the second group of transactions aimed at resection of fibrous tissue of the pancreas itself.