Pseudotumor pancreatitis is one of the forms of long-existing pancreatitis with a chronic course. This disease affects more often men than women. The name of the pathology comes from the ancient Greek words "pancreas" - pancreas, "itis" - inflammation and "tumor" - a tumor. That is, you can literally translate it like this - inflammation of the pancreas that mimics the tumor process.
Pseudotumor pancreatitis: causes, symptoms
Provoking factors in the development of this disease are pathologies of the hepatobiliary system (for example, cholelithiasis) and prolonged intake of alcohol. Much less often - medication and other somatic diseases. Most often, pseudotumor pancreatitis is a consequence of a chronic inflammatory process in pancreas tissues and much less often (about 10% of cases) it is detected after acute inflammation.
The development of symptoms against the background of cholelithiasis is more often recorded in women. However, not only it can become a provoking factor, malformations of the biliary system, diseases of the bile duct or Vater papilla are of great importance here. In these cases, inflammation develops as a result of constant reflux of bile into the pancreatic duct.
One of the ways for the development of pseudotumor pancreatitis can be lymphogenous tissue damage pancreas (usually the area of the head of the gland), when the inflammatory process spreads from the gallbladder through the lymphatic network of nodes and blood vessels.
In more rare cases, the pseudotumor form of chronic pancreatitis can occur against the background of prolonged use of estrogens, acetaminophen and other drugs, or may be hereditary. Moreover, with a hereditary etiology, the disease is actively progressing, the likelihood of malignancy (malignancy) is increasing, and gland failure is rapidly increasing.
Clinical manifestations
Symptoms of this form of pancreatitis are associated with compression of the biliary tract, endocrine insufficiency and a lack of pancreatic enzymes that are involved in digestion. In addition, among the clinical manifestations, there are symptoms of tumors and severe pain. The initial stage of the pseudotumorous form can be asymptomatic.
But most often, the following symptoms of the disease are present in patients:
- obstructive jaundice;
- girdle pain that occurs after eating spicy or fatty foods, any alcohol or overeating;
- undigested food in feces ;
- nausea followed by vomiting, which brings relief;
- fat stool (steatorrhea);
- diarrhea alternating with constipation;
- decreased glucose tolerance;
- causeless weight loss;
- on palpation - a compacted pancreas head;
- enlargement of the gland.
The mechanisms of the appearance of the main symptoms
With the described disease, an increase in the pancreas occurs, which is associated with the appearance of cysts (chronic pseudotumor pancreatitis, pancreatic cyst), the development of lipomatosis and autoimmune lesions.
The inflammatory process, as a rule, affects the pancreas head - the exit site of the main pancreatic duct. As a result, the latter narrows and the pancreatic juice stagnates in the organ. As a result, the duct overflows, and the pressure in it rises. Enzymes contained in the juice begin to digest pancreatic tissue, which causes the occurrence of severe pain syndrome, which is often accompanied by a pseudotumor form of pancreatitis.
Obstructive jaundice
In the mechanism of development of this symptom, the enlarged head of the gland, which compresses the common bile duct (bile duct), plays a dominant role. As a result, bile formed in the liver cannot enter the duodenum, which is why the pressure in the duct rises and the bile gradually enters the bloodstream.
The main complaints with obstructive jaundice are: discolored feces, severe itching, dark urine, and yellowing of the sclera and skin.
How to find out pseudotumor pancreatitis or cancer in a patient
The described diagnosis implies that all complaints and clinical manifestations of the disease were taken into account and other diseases were excluded, not only the pancreas (for example, cancer), but also neighboring organs with similar symptoms. For this, the following are mandatory:
- Consultation of the gastroenterologist.
- Collection of medical history and complaints (previous pancreatitis, cholelithiasis, medication, complaints of pain in the right hypochondrium and epigastric region and others).
- Examination of the patient with palpation (possibly compaction and soreness in the pancreas).
- Blood tests. This form of pancreatitis is characterized by a slight increase in the levels of trypsin, amylase and lipase, impaired glucose tolerance.
- Determination of tumor markers and pancreatic polypeptide levels (to exclude cancer). With an increase in the amount of cancer embryonic antigen, CA 125, CA 19-9, pancreatic polypeptide, the diagnosis of the tumor is confirmed, and with a decrease in the above substances, it is concluded that there is an inflammatory process, which confirms the diagnosis of pseudotumor pancreatitis.
- Ultrasound pancreas (presence of hypertrophy, changes in the structure of ducts and gland tissue, absence / presence of calcifications).
- CT or MRI (to exclude malignant neoplasms).
- ERCP. Method for visualizing changes in the pancreatic duct.
- Selective celiacography (determination of the state of the vessels of the pancreas).
Therapy
Pseudotumor pancreatitis, the treatment of which during periods of exacerbation is carried out in gastoenterology, is characterized by a wavy course (that is, an alternation of remissions and exacerbations).
Therapy of this pathology involves the appointment of a sparing diet (table No. 5). Frequent meals are allowed (five to six times a day), but in small portions. Methods of cooking: cooking and baking, rarely - stewing. Fatty, fried foods, scrambled eggs, strong tea, coffee are forbidden, the amount of meat (especially pork) and milk is strictly limited.
The main focus of therapy is etiotropic treatment, that is, the elimination of provoking factors (alcohol, drugs) and the reasons that caused this condition. For example, with cholelithiasis - cholecystectomy, and so on.
Drug treatment should be aimed at correcting intra- and exocrine gland insufficiency. To do this, prescribe enzyme preparations: Pancreatin in combination with Solizim or Lipase. Antacids and calcium preparations are used to reduce steatorrhea.
In order to reduce dyskinesias, anticholinergics are prescribed. For relief of severe pain, antispasmodics or Atropine are used. As an effective antispasmodic for the sphincter of Oddi, they use Mebeverin or Gimekromon. In the period of exacerbation, antibacterial drugs are included in the treatment. If drug therapy does not reduce swelling of the gland and hypersecretion, then local hyperthermia (local) or regional radiation exposure is prescribed.
In addition to the above treatment methods, quite often with pseudotumor pancreatitis, endoscopic operations (for example, papillosphincterotomy) are performed aimed at decompression of the ductal system. Such interventions are especially effective for strictures of the prepalillary region, papillostenosis, an increase in the head of the pancreas, accompanied by obstructive jaundice and compression of the common bile duct.
Prevention
Preventive measures for the diagnosis of pseudotumor pancreatitis are reduced, first of all, to refusal to drink alcohol. Adequate and timely treatment of diseases that can provoke this pathology is also very important. Help to avoid pathology and accurate, specialist-controlled intake of potentially dangerous drugs.
Forecast
The predictions for the occurrence of the described form of pancreatitis are relatively favorable. This disease occurs with rare exacerbations and slowly progresses, and endocrine insufficiency rarely entails the development of kidney damage and angiopathy. The progress of the disease can be stopped by prescribing timely treatment and following the recommendations of the attending physician during periods of remission. Be healthy!