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Insufficiency of vneshnesekretorny function of a pancreas


In process of progressing of inflammatory process in a pancreas patients to chronic pancreatitis have a gradual substitution of ferruterous (secretory) fabric of body connecting, or cicatricial. As the result, in a pancreas decreases the number of secretory (acinar) cells which in physiological conditions in response to receipt of food in a gleam of a duodenum allocate a secret rich with digestive enzymes and alkali (pancreatic juice) in intestines.

It contains all range of the enzymes capable to digest proteins, fats, carbohydrates, but only a lipase, the enzyme providing in the presence of bile a lipolysis to fatty acids and soaps in a digestive tract has no significant "doublers". And therefore in the conditions of decrease in number of secretory cells of more probable to become the situation when the amount of the juice emitted in a gleam of a duodenum is insufficient for process of digestion and the subsequent absorption, first of all fats and fat-soluble vitamins but only then proteins, carbohydrates.

Specialists call this state vneshnesekretorny insufficiency of a pancreas. Further progressing of inflammatory and cicatricial changes of a pancreas can cause accession of disturbances of endocrine function of body with development of a diabetes mellitus.

Symptoms of Insufficiency of vneshnesekretorny function of a pancreas:

The most typical manifestation of vneshnesekretorny insufficiency of a pancreas is bad portability of greasy food, especially fried and smoked. As a result, emergence after its consumption of feeling of weight in a stomach and a plentiful kashitseobrazny "fat" chair, a so-called pancreatic steatorrhea (allocation with a fat stake). Frequency of excrements usually does not exceed 3-6 times a day. The calla is rather simple and easily definable criterion of the increased "fat content" its ability to leave marks on a toilet bowl which badly wash off.

Emergence of abdominal distention and kolikoobrazny pain in it is possible. Restriction of reception of greasy food, reception of digestive enzymes (see below) promotes decrease in expressiveness of the specified signs and even to their disappearance.

Ostealgias, the increased their fragility and tendency to convulsive reductions of muscles (a hypovitaminosis of D), disturbances in system of a blood coagulation in the form of bleeding (a hypovitaminosis To), disorders of twilight sight, or "night blindness", increase in a xeroderma (a hypovitaminosis And), tendency to infections, decrease in a libido, potentiality (a hypovitaminosis E) can be manifestations of deficit of fat-soluble vitamins B an organism.

Pallor of integuments, asthma, cardiopalmus, bystry fatigue, decrease in working capacity and other symptoms of B12-scarce anemia can be observed owing to disturbance of digestion of the corresponding vitamin arriving with food because of a lack of pancreatic proteases (enzymes, proteolytic). Decrease in body weight, as a result of insufficient intake of nutrients, indicates the expressed vneshnesekretorny insufficiency of a pancreas.

Reasons of Insufficiency of vneshnesekretorny function of a pancreas:

The syndrome of primary vneshnesekretorny insufficiency of the pancreas (P) is caused by a degrowth of the functioning exocrine parenchyma of PZh as a result of an atrophy and fibrosis, or disturbance of outflow of a pancreatic secret in a duodenum (DPK) owing to the block of output channels of PZh a concrement, a tumor, a dense and viscous secret. It is characteristic of a mucoviscidosis and late stages of HP (absolute primary pancreatic insufficiency) or, as a rule, pathologies of a big duodenal nipple (relative primary vneshnesekretorny insufficiency). Secondary mechanisms of development of exocrine pancreatic insufficiency include cases when enough pancreatic enzymes which do not take adequate part in digestion due to insufficient activation, an inactivation, disturbances of a segregation comes to DPK. After a gastrectomy several mechanisms, both primary, and secondary are the cornerstone of development of vneshnesekretorny insufficiency of PZh in patients.

Экзокринная часть поджелудочной железы (гистологическое строение)

Exocrine part of a pancreas (histologic structure)

Treatment of Insufficiency of vneshnesekretorny function of a pancreas:

The integral component of treatment of manifestations of vneshnesekretorny insufficiency of a pancreas are correction of the mode and food allowance. Among the main components of dietary and regime recommendations:
frequent (intervals no more than 4 hours) fractional (small) portions food
to avoid excess meal, especially in evening and night time
restriction of consumption of fats, first of all the animals who underwent heat treatment (frying, smoking)
full refusal of alcohol

As for specific foodstuff, their structure is rather individual and is selected jointly the patient and the doctor, quite often empirically. Considering an important role of food in correction of manifestations of vneshnesekretorny insufficiency of a pancreas, the patient has to coordinate all questions concerning expansion of a diet and/or change of the mode with the attending physician previously.

In the conditions of restriction of receipt in an organism and, quite often, proteinaceous food in providing the patient with energy carbohydrates come fat to the forefront. Of course, preference has to be given to not refined carbohydrates (sweet), and vegetables, fruit and cereals as to the main natural sources not only a cellulose, but also the major vitamins, microelements. However not all patients with vneshnesekretorny insufficiency of a pancreas equally well transfer vegetable food. At a part of patients against the background of reception of such useful and necessary products as haricot, peas, different types of cabbage, eggplants, products from flour of cereals of a rough grinding, etc. raise gas generation in a digestive tract that negatively affects their health.

Alternative to them regular consumption in food of the products containing the fermented wheat Rekitsen-RD bran enriched with a vitamin and mineral complex high-quality can become possible. Their use in a food allowance of patients with vneshnesekretorny insufficiency of a pancreas not only will provide receipt in an organism of enough energy, but also will allow to solve the available problem of overcoming a vitamin deficiency and micronutrients. Besides, such products are capable "to unload" a pancreas what positively to affect its functional activity.

Key medicines in treatment of vneshnesekretorny insufficiency of a pancreas are digestive enzymes (Pancreatinum, mezim-forte, panzinorm-forte, креон, etc.). Among themselves they differ only with quantity of the lipase which is contained in them and additional ingredients (stomach enzymes).

These drugs have to be accepted during food. The quantity of tablets or capsules on reception can widely vary from 1 to 3-4, depending on volume and structure of food. Most fermental drugs are shown at meal, rich with fats, to a lesser extent proteins.

The emphasis on consumption of carbohydrate food reduces the need for digestive enzymes as the importance of a pancreas in their digestion considerably smaller, than proteins and the more so fats. For increase in the digesting ability of digestive enzymes they are accepted with blockers of the protonew pump (omeprazoly, pantoprazoly, lanzoprazoly, rabeprazoly, esomeprazole) which create alkali reaction in upper parts of a digestive tract, favoring thereby to effect of enzymes.

Simple criterion of elimination of manifestations of vneshnesekretorny insufficiency of a pancreas digestive enzymes is disappearance of a diarrhea and normalization of body weight, and also disappearance of a pancreatic steatorrhea according to the clinical analysis a calla and decrease (normalization – less than 7 g) contents of fat in Calais per day.

Drugs, drugs, tablets for treatment of Insufficiency of vneshnesekretorny function of a pancreas:

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