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July 19, 2012
Pancreatitis is a name of the whole group of diseases and symptoms at which there is an inflammatory process of a pancreas. If such process, then the enzymes produced by a pancreas is shown do not get into a duodenum. Therefore, they begin to act actively already in a pancreas, gradually destroying it. Thus, there is a so-called process of self-digestion. Such pathology is fraught with the subsequent defeat of other bodies, at gradual destruction of a pancreas there is a release of toxins and enzymes. In turn, they can appear in a blood-groove and damage other bodies. Therefore acute pancreatitis it is necessary to treat at once after establishment of the diagnosis. At such state treatment is carried out generally in a hospital.
At women pancreatitis is diagnosed more often than for men. Also corpulent and elderly people are more subject to pancreatitis.
How pancreatitis develops?
In pancreat ducts pressure, and enzymes gradually increases, coming to gland fabric, stimulate process of its destruction. If pancreatitis passes into more severe form (in this case it is about a pancreatonecrosis), then necrosis of considerable part of tissue of pancreas is characteristic of pathological process. If at development of such process adequate treatment is not made, then the necrosis can touch later also fatty tissue which surrounds a pancreas, to mention some other bodies which are located in retroperitoneal space. At hit of active enzymes of a pancreas pankreatogenny aseptic peritonitis develops in an abdominal cavity at the patient. At such state lack of treatment leads to a lethal outcome.
Pancreatitis can be subdivided into several types. Depending on what character of a course of an illness is observed, pancreatitis can be acute, acute recurrent, chronic, and also the exacerbation of chronic pancreatitis is possible.
In turn, acute pancreatitis can develop in several forms. At intersticial pancreatitis there is acute hypostasis of a pancreas; at hemorrhagic pancreatitis in fabric of gland there is hemorrhage; at an acute pancreatonecrosis of iron it is condensed, and on it the disintegration centers appear. If at the patient pancreatitis is combined with acute cholecystitis, then in this case it is about an acute holetsistopankreatit. Purulent pancreatitis is diagnosed if in iron there are centers of purulent fusion. All these forms of pancreatitis can gradually pass from one into other.
At acute pancreatitis the patient has gradual inflammatory changes of fabrics of gland, and also the necrosis centers appear. Gradually such state is replaced by fibrosis, an atrophy or calcification of gland. However in certain cases acute pancreatitis is shown by exclusively inflammatory process with hypostases of a certain department of a pancreas. In other cases the necrosis, suppuration and developing of multiple hemorrhages in fabric and abscesses takes place. At such development of acute pancreatitis the condition of the patient is extremely heavy and can end with a lethal outcome even if treatment will be adequate.
Chronic pancreatitis is a form of an illness at which the inflammation progresses slowly, at the same time functions of a pancreas are gradually broken. As a result there can be fibrosis of tissue of pancreas or its calcification. At chronic pancreatitis the periods of remissions and aggravations alternate. As a result the weakened function of digestion of food can turn out to be consequence of chronic inflammatory process of tissues of pancreas. At such patients the diabetes mellitus develops often later. At chronic pancreatitis inflammatory process can develop or in iron in general, or in its separate parts.
At chronic pancreatitis it is also accepted to distinguish several different forms of a disease. If at the patient the asymptomatic form of an illness is observed, then in that case his health remains normal a long span. At a painful form of chronic pancreatitis at the top of a stomach the pain considerably increasing in the period of an aggravation is constantly shown. At chronic recurrent pancreatitis pain is shown only at recurrence of an illness. Most less often the "pseudo-tumoral" form of an illness at which development there is an increase in a head of gland meets, fibrous fabric expands, and the sizes of gland increase.
Also reactive pancreatitis at which acute pancreatitis is combined with an exacerbation of diseases of a duodenum, stomach, gall bladder, liver is allocated.
Normal work of a pancreas of the person is broken sometimes by the use of very spicy, fried, fat food. Also development of pancreatitis is promoted by an overeating, chronic or acute alcoholic poisoning. Also arousing psychological character can stimulate sharp release of pancreatic juice.
Therefore, those people who constantly abuse alcohol have higher risk of development of pancreatitis. Also pancreatitis develops at pregnant women and at young mothers in a puerperal period more often. Pledge of the prevention of development of pancreatitis is the correct approach to forming of a food allowance. Therefore, the illness is often diagnosed for those who regularly eat unhealthy food: fast food, uniform food, food with the high content of dyes and other chemical impurity.
Development in sick chronic pancreatitis very often happens after the postponed acute form of an illness. However rather often chronic pancreatitis develops and as an effect of other diseases: cholecystitis, peptic ulcer, diseases of intestines, liver, etc.
Most often the zhelchekamenny illness becomes the reason of development of pancreatitis. Besides, pancreatitis washes to be shown against severe poisonings, injuries, viral diseases, carrying out surgeries and endoscopic manipulations. Sometimes chronic pancreatitis becomes aggravated owing to receiving too high doses of vitamins A and E.
At an acute and chronic form of a disease symptoms of pancreatitis are shown differently. Besides after the person had acute pancreatitis, at it the pancreas pseudocysts relating to chronic pancreatitis can be formed. On the other hand at a chronic form of an illness also acute pancreatitis can develop.
If at the patient acute pancreatitis develops, then its signs directly depend on what form and a stage of an illness takes place, and also from some specific features of each person. The most expressed and constant symptom of pancreatitis of an acute form is severe pain in a stomach. Pain is constant, stupid or cutting. If the disease progresses, pain amplifies and even sometimes becomes the shock reason. The place of localization of pain – the right or left hypochondrium, in the pit of the stomach. If all pancreas is surprised, then pain has the surrounding character. Besides, symptoms of pancreatitis of an acute form is the hiccups, dryness in a mouth, an eructation, nausea. The person suffers from frequent vomiting in which bile impurity is found. However after vomiting the patient does not lighten. A chair in it it is possible to find parts of not digested food in the person having acute pancreatitis, kashitseobrazny. The chair differs in an unpleasant smell, foamy.
If the disease progresses, then the general condition of an organism of the patient worsens very quickly. Pulse becomes frequent, body temperature increases, indicators of arterial pressure decrease. The person is constantly disturbed by an asthma, in language the plentiful plaque is observed, on a body the clammy sweat constantly appears. Features of the patient look pointed, skin turns pale and gradually becomes earthy-sulfur. During survey the doctor finds strong abdominal distention, intestines and a stomach are not reduced. In the course of a palpation of a painful stomach the long time is not defined a muscle tension. There are symptoms of irritation of a peritoneum later.
At patients with acute pancreatitis a number of serious complications can develop over time both from abdominal organs, and from bodies outside a peritoneum. The most widespread complications are abscesses and phlegmons of an omental bursa, peritonitis, ulcers and erosion of a gastrointestinal tract, hypostasis and abscesses of lungs, exudative pleurisy, pneumonia. Very often acute pancreatitis provokes development of hepatitis, also owing to a disease the content in sugar blood increases, besides, sugar is found also in the patient's urine.
Symptoms of pancreatitis of a chronic form are expressed by pain in the pit of the stomach in the period of an aggravation, pains in left hypochondrium, giving to a shovel or to a thorax. Display of pain of the surrounding character which varies from stupid to very sharp is in certain cases possible. Such feelings remind pain at pancreatitis of an acute form. After the use of fat food of the patient can suffer from severe vomiting. Besides, symptoms of chronic pancreatitis strong weight loss, dryness in a mouth, ponosa, nausea becomes frequent. Even when the exacerbation of an illness is not observed, can feel sick the person, he suffers from locks, dull ache. If during this period ponosa are observed, then it demonstrates that abilities of a pancreas to digest are broken very strongly.
Diagnosis of pancreatitis
It is, as a rule, simple to diagnose this disease as its symptoms are practically always brightly expressed. But nevertheless the doctor for purpose of adequate treatment has to define a disease form surely. Carrying out a laparoscopy – the method allowing to examine by means of the special tool an abdominal cavity from within is for this purpose reasonable.
At suspicion on acute pancreatitis some laboratory analyses are carried out. This general blood analysis, analysis of urine, biochemical researches. Similar analyses are carried out at suspicion on chronic pancreatitis. However it is important to conduct biochemical researches in the period of an exacerbation of a disease. Also special research a calla is conducted.
Treatment of pancreatitis
It is important that treatment of pancreatitis of an acute form was carried out surely in a hospital under control of the specialist. Therefore at suspicion on acute pancreatitis of the patient it is necessary to hospitalize at once. But before the person will be taken to hospital, in house conditions it is necessary to make everything to avoid painful shock. It is important not to eat food, and emergency doctors in certain cases through a probe take food eaten earlier. On upper part of a stomach the cold for delay of products of digestive enzymes is put by a pancreas. To remove a spasm, 1-2 drops of Nitroglycerine are recommended to drip under language or to administer intramusculary the drug removing spasms, for example, Nospanum. Emergency doctors surely enter an anesthetic.
In a hospital for treatment of pancreatitis of an acute form conservative methods of therapy are used. In particular, various solutions – saline solutions, proteinaceous drugs, glucose by means of which intoxication and a pain syndrome is overcome are entered into a blood stream. Also acid-base equilibrium is normalized.
To relieve pain and to remove spasms, drugs spasmolysants are applied. And for maintenance of normal action of the heart use heart drugs. Besides, complex treatment provides reception of vitamins of group B, vitamin C, diuretic drugs which prevent hypostasis of a pancreas and promote removal of decomposition products. Without fail the course of treatment includes the drugs suppressing production of enzymes of pancreatic acid.
The use of still mineral water is recommended, and here patients with acute pancreatitis can only eat food 4-5 days later after the acute beginning of a disease. It is initially recommended to take curdled milk (on 100 g of a product everyone half an hour), and next day to this diet 200 grams of cottage cheese are added. In the next days treatments the patient has to follow strictly a special diet as healthy nutrition at pancreatitis – the major factor promoting treatment.
If conservative treatment is inefficient, then it is necessary to carry out surgical intervention. As a rule, operation is performed 10-14 days later after acute pancreatitis begins. The indication for faster carrying out operation are some complications. Surgical intervention assumes removal of part of a pancreas which underwent a necrosis, and carrying out sanitation of an abdominal cavity.
If the exacerbation of chronic pancreatitis takes place, then treatment is carried out according to the same scheme, as therapy of acute pancreatitis. Patients with chronic pancreatitis have to adhere constantly to a diet, and also regularly accept the drugs compensating secretory insufficiency and alkalizing drugs (for example, Almagelum). At display of pain the means removing a spasm — a papaverine, atropine, Nospanum, drugs with analgesic effect are shown. Patients with chronic pancreatitis should visit periodically special sanatoria and to pass there treatment.
There are a lot of checked folk remedies helping to cope with a disease. Three times a day before food sick chronic pancreatitis recommends to accept on a half-glass of oat kissel. That to prepare it, it is necessary to fill in one glass of previously washed out oats with 1 l of water and to insist 12 hours. After that kissel cooks 30 minutes and 12 more hours are drawn. Before the use it needs to be diluted with water up to the initial volume and to filter.
It is useful to accept in the morning mix of freshly squeezed juice of potatoes and carrots: on an empty stomach it is necessary to drink 200 g of such mix. The course of treatment proceeds week then the week break follows.
Diet at pancreatitis
Special attention sick pancreatitis should be paid on food. In the acute period the diet at pancreatitis is directed to most sparing mode for a pancreas. So, in the first days of an acute form of an illness (as a rule, for two days) full refusal of food is recommended. In day it is possible to use up to six glasses of mineral water, weak tea or broth of a dogrose. After that for a week a diet at pancreatitis very strict, with the minimum calorie content. These days it is possible to use the wiped cottage cheese, fast meat, potatoes, vegetable marrows.
During remission such diet becomes already more caloric: the day diet contains about 2500 kilocalories. At the same time food the fullest, observance of such diet continues many years.
In day of the patient has to use not less than 120 grams of protein. At the same time it is better to refuse digestible carbohydrates which contain in honey, sugar, sweets. It is important to limit amount of fat. It is strictly forbidden to eat that food which irritates a mucous membrane. It is impossible to eat fried: patients with pancreatitis include exclusively baked, boiled, stewed dishes in a diet.
So, the patients keeping to a diet at pancreatitis can include the following dishes and products in a diet: white bread of yesterday's pastries or croutons, lenten soups with sour cream, low-fat meat and fish, an omelet, cottage cheese, kefir, various porridges, creamy and vegetable oil, vegetables with the low content of cellulose, apples not acid, juice from fruit and berries without sugar. At the same time it is impossible to eat some fat meat, strong broths, sausages, canned food, fried dishes, bean, smoked products. Coffee, chocolate, alcohol, carbonated drinks is forbidden. The food always has to be a little warmed up, but is not hotter. An optimum diet – 5-6 times a day.
Prevention of pancreatitis
Not to allow development of this illness, it is extremely important to eat rationally and regularly. It is not necessary to take alcoholic drinks, especially if alcohol at the same time is combined with fat food. More often pancreatitis develops at the people who are chronically taking alcohol, however the illness can be shown also after single plentiful acceptance of alcohol. It is important to leave off smoking, to treat all diseases of a gastrointestinal tract promoting development of pancreatitis in time, to watch a condition of a gall bladder.