Studying the pathogenesis of chronic pancreatitis, it should be noted that this is a pancreatic disease, which is characterized by the presence of focal necrosis with impaired function of the affected organ. The progression of the disease leads to the appearance of atrophy of the glandular tissue, as well as fibrosis.
Complex treatment is very important, which will help stop the progression of the disease and prevent the development of dangerous complications.
Features of the disease
Digestive system - a set of organs, each of which is associated with the rest and is involved in the processing of incoming food. In case of malfunctioning of at least one of the components, dangerous problems may arise that require immediate intervention by specialists. In addition, the appearance of violations can lead to problems with the pancreas.
The most dangerous pathology is considered to be chronic pancreatitis, which develops for a long time and can not only affect the functioning of adjacent organs, but also lead to dangerous complications. Etiology, pathogenesis, clinical features, diagnosis, treatment of chronic pancreatitis are quite non-specific. Quite often, the symptoms of this disease can be confused with gastritis, dyskinesia of the pancreatic ducts, as well as gastritis. The duration of the course from the appearance of pancreatitis to the first symptomatology can be up to 15 years.
The chronic form of the disease is characterized by a delay in the excretion of gastric juice from the pancreas, which contributes to the release of substances such as lipase and trypsin. With the course of the pathology, they provoke severe irritation of this organ, and then more serious consequences. As a result of this, proliferation of connective tissue occurs. Pathology can occur for several years and lead to persistent pancreatic insufficiency. Sometimes, calcifications or stones form right in the pancreatic duct cavity, which significantly complicates the course of the disease.
Etiology and pathogenesis
Pancreatitis often occurs in a chronic form. The disease is characterized by the presence of inflammation in the affected organ and at the same time periods of remission are replaced by exacerbation. The etiology and pathogenesis of chronic pancreatitis are well studied by medicine. Mostly people after 30 years suffer from it.
The appearance of inflammation in this organ can be affected by various factors or existing pathologies. The most common cause is alcohol abuse for a long time. Alcohol provokes the processes of inflammation of the pancreas, and also under its action there is necrosis of certain parts of this organ and the growth of adipose tissue.
In some cases, the etiology and pathogenesis of chronic pancreatitis is difficult to determine, since in some patients the causes of the disease are hidden. If a specialist during the examination excludes possible provoking factors, then they talk about the idiopathic form of the disease. Most often, it develops in adolescents in the presence of renal failure, diabetes. In this case, pancreatitis proceeds with severe soreness. Also, the disease can be in old age, but there is no pain.
The pathogenesis of chronic pancreatitis is characterized by the fact that pancreatic enzymes begin to be activated inopportune. In normal condition, this process should occur in the duodenum.
Causes of occurrence
The pancreas produces hormones that play a very important role in metabolic processes. In addition to glucagon and insulin, it also produces enzymes designed to break down fats, proteins and carbohydrates. In chronic pancreatitis, the excretory ducts become clogged, as a result of which the digestive juices cannot pass freely into the intestines. Violation of the natural and full outflow leads to inflammation of the affected organ or even partial death of the tissue.
If complex treatment is not carried out, then dangerous diseases can develop that sometimes end in the death of the patient. Be sure to know the etiology, pathogenesis, clinic of chronic pancreatitis. Diagnosis and treatment largely depends on these indicators. Among the main causes of the disease, it is necessary to highlight such as:
- diseases of the liver and biliary tract;
- cholecystitis;
- chronic alcoholism;
- gastritis;
- hepatitis;
- irregular nutrition;
- taking certain drugs;
- lack of protein foods;
- smoking;
- genetic predisposition;
- prolonged stress.
With the hereditary form of the disease in humans, there is a lack of certain substances that are important for the normal functioning of the pancreas. Secondary or reactive pancreatitis occurs against a background of cirrhosis, chronic hepatitis, mumps, and ulcers.
Main symptoms
The pathogenesis of chronic pancreatitis is associated with the occurrence of inflammation in the gland and structural changes within the tissues. Doctors believe that the biggest difference from the acute form is the progression of the pathology inside the organ even when the provoking factor has already been eliminated. As a result of this, a person may feel the insufficiency of the gland.
At the initial stage of chronic pancreatitis, inflammation in the organ lasts several years. During this period, the symptoms of the disease can periodically appear and disappear. The next stage begins when unpleasant symptoms appear constantly. Over the years, the patient may complain of the appearance of characteristic signs, which manifest themselves in the form of short-term painful sensations that bother about 15 minutes after eating.
Discomfort lasts from 1 hour to 3-5 days. The pains are concentrated mainly in the upper abdomen. Sometimes pain is felt in the region of the heart or in the lumbar region. In some cases, it is herpes zoster. You can reduce its intensity with the help of bending forward or squats.
An attack of pain can be accompanied by nausea, diarrhea, flatulence, and sudden weight loss. Such symptoms do not bother a person all the time, since with complex treatment it is possible to reduce all these manifestations and return to a normal lifestyle again until the next attack.
Gradually, the skin of a sick person becomes unexpressed yellow. Yellowing of the sclera is also noted. The yellowness of the skin can periodically pass. If the pancreas is completely atrophied, then a person develops diabetes.
Diagnostics
To prescribe the required therapy, diagnostics are of great importance, in which the pathogenesis of chronic pancreatitis must be taken into account. It is very important to study the functioning of the pancreas, to establish how its exocrine properties are violated. For this, a coprogram is assigned, which is an analysis of particles of undigested food that comes out with feces. In addition, with chronic pancreatitis, blood and urine tests may be required to help assess the severity of the course of the disease.
In addition, the specialist directs the patient for an ultrasound examination, tomography, as well as other instrumental studies. However, initially the doctor conducts an examination of the patient, finds out which particular manifestations concern him.
After the diagnosis of chronic pancreatitis is made, an appropriate treatment technique is selected.
Treatment features
In each case, the doctor selects the treatment individually, depending on the results of the examination. The most important is the observance of dietary nutrition. The main requirements are to exclude fried, fatty, spicy dishes, as well as alcohol from the diet. You need to eat in small portions 5-7 times a day.
In addition, medications are prescribed, which in their composition contain digestive enzymes. In the most severe cases, surgery is required.
Drug therapy
Drug therapy of chronic pancreatitis is aimed primarily at eliminating painful symptoms and dyspepsia. To stop the pain, you can use analgesics ("Baralgin", "Analgin") or antispasmodics ("Drotaverin", "No-Shpa").
Antihistamines are used to suppress the excessive functioning of the pancreas. To reduce the secretion of the stomach and gland, proton pump inhibitors are required. Antacid medications help neutralize hydrochloric acid, providing pancreatic functional peace.
Prokinetics are prescribed for disruption of the digestive tract. Enzymes are required to compensate for the insufficient function of the affected organ. They are used throughout life. In the treatment of chronic pancreatitis and cholecystitis, all medications should be prescribed only by the attending doctor, who also selects the dosage and determines the method of their use. Self-medication without consulting a doctor is strictly prohibited, as this can aggravate the course of the disease and lead to the development of complications.
Operation
To cure the disease, surgery may sometimes be required. An indication for this is obstruction of pancreatic and biliary tracts, purulent complications, the complex course of the disease, stenosis, and tissue changes in the affected organ. All these conditions are not amenable to conservative therapy. The types of operations that can be assigned are:
- excision of stones in the ways of the gland;
- sphincterotomy;
- Pancrectomy
- opening and sanitation of purulent foci.
If there are complications in the bile duct or bladder, it may be necessary to remove it. Also sometimes excision of a part of the stomach is prescribed. To reduce the stress of the main pancreatic pathways, the creation of circumferential bile outflows is required.
Dieting
Sometimes a good result cannot be achieved even with medical treatment of chronic pancreatitis. Diet will help to achieve the desired result, which is why a balanced diet is important. During remission, you can eat raw vegetables and fruits, mild soft cheeses, pasta, baked fish. You can also cook various soups, but it is desirable that they are vegetarian.
In the period of exacerbation of chronic pancreatitis, treatment and diet should be correctly selected. For 2 days, it is recommended to observe hunger and bed rest. After normalization of health, it is allowed to eat mashed vegetables and soups, low-fat varieties of boiled fish, porridge, poultry. Veal and rabbit dishes are best baked without spices or steamed.
In the usual diet, it is recommended to include fermented milk products, as well as sour cream and cottage cheese, but only they should be of minimal fat content. It is forbidden to consume fried, salty, fatty, spicy foods. Drink carbonated drinks. Do not drink alcohol even with a low alcohol content. It is important to quit smoking. It is useful to drink jelly from non-sour berries, as well as herbal teas.
Menus for chronic pancreatitis should be selected especially carefully. All food should be divided into 6-8 receptions and eat in small portions. Patients should not consume mushroom dishes. To give a soft consistency, it is best to wipe or whisk the food with a blender. Sparing nutrition mainly leads to a positive result.
Possible complications
Complications of chronic pancreatitis include malabsorption syndrome. Among the violations, it is necessary to highlight such as:
- pseudocyst;
- diabetes;
- thrombosis of the splenic or portal vein;
- bile duct obstruction;
- pyloric stenosis;
- neoplasms.
Pancreatic adenocarcinoma develops mainly in people who suffer from this disease for more than 20 years.
Forecast
The mortality rate in chronic pancreatitis reaches almost 50% with the course of the disease for 20-25 years. Approximately 15-20% of patients die from complications associated with exacerbation of the disease. In other cases, death is due to malnutrition, smoking, injuries, infections.
Prophylaxis
To prevent the development of chronic pancreatitis, it is necessary to carry out comprehensive prevention. Excessive exercise can provoke an attack of the disease. For people suffering from pancreatitis, breathing exercises and massage are the best stresses.
It is important to give up bad habits, in particular such as smoking and alcohol abuse. This helps to reduce the load on the affected organ, which will achieve sustainable remission. Timely treatment of pathology of the gallbladder and bile ducts will prevent the transition of the disease into a chronic form. If stones have already formed inside the gallbladder, then they urgently need to be removed.
Preventive measures include proper balanced nutrition. The portions should be small, but you need to eat often. The principle of separate nutrition will greatly facilitate the functioning of the pancreas. Do not mix proteins and carbohydrates, as this will significantly increase the load on the affected organ.
It is not recommended to drink coffee. It is necessary to limit its consumption or completely abandon this drink.