Chronic pancreatitis

Document Sample
Chronic pancreatitis Powered By Docstoc
					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.

Description: Document about the treatment of diseases