Chronic pancreatitis

Description:

Chronic pancreatitis is the chronic inflammatory process in a pancreas lasting more than 6 months of which repeated aggravations, the progressing destruction, diffusion or segmented fibrosis of m dysfunction of a pancreas are characteristic.
In most cases the disease is diagnosed at advanced age, and also at persons is a female.
There is a division of chronic pancreatitis on primary (primary inflammatory process of not changed pancreas) and secondary, developing against the background of cholecystitis, gastritis, enteritis and other diseases.
Marseilles-Roman classification of chronic pancreatitis:
1. Chronic kaltsifitsiruyushchy pancreatitis
2. Chronic obstructive pancreatitis
3. Chronic fibrous indurative pancreatitis
4. Chronic pseudocysts and cysts of a pancreas
Classification of pancreatitis by MKB-10:
1. Alcoholic chronic pancreatitis
2. Other forms: a) infectious) continuous and recuring in) returnable
3. Pancreas cysts
4. Pancreas pseudocysts
5. Other specified pancreas diseases: a) an atrophy) fibrosis in) cirrhosis of) pancreatic infantility д) an aseptic and fatty necrosis е) a pancreatic steatorrhea.

Reasons of Chronic pancreatitis:

The set of the reasons and the contributing factors to developing of chronic pancreatitis from which distinguish is established:
1. Proteinaceous and caloric insufficiency
2. Alcohol and greasy food
3. Obstruction of pancreatic channels at any level
4. Acute pancreatitis in the anamnesis
5. Toxic, including medicinal, impact on a pancreas (organic solvents, cytostatics, furosemide, tetracycline, estrogen, corticosteroids, NPVS)
6. Lipidemia
7. Hypercalcemia
8. Pancreas injuries
9. Smoking
10. Deficit of antioxidants

Also genetic predisposition to a disease which is transferred by an autosomal and dominant mode of inheritance is revealed.

Pathogeny:

At alcoholic and hereditary chronic pancreatitis the precipitation test of calcium and proteins in pancreatic channels is observed. Normal precipitation is prevented by PSP-proteins which cosecrete atsinalny cells. Level of this type of proteins at patients with chronic pancreatitis is considerably reduced that promotes increase in calcium in pancreatic juice, its mikrokristalization. In a gleam of a channel the kaltsinata corking channels are formed, there is an increase in pressure in them. Eventually fibrosis develops.

Symptoms of Chronic pancreatitis:

On the course of a disease allocate 2 main forms of chronic pancreatitis: in the form of a recurrence and in the form of constant abdominal pains.
The clinical picture of chronic pancreatitis consists of a combination of painful, dispeptic syndromes to malabsorption, loss of body weight, various symptoms of functional insufficiency of the insulyarny device.
Pain is localized in the field of the left hypochondrium or has the surrounding character, arises or amplifies after meal (within half an hour). Duration of a painful attack – till 2 o'clock. Pain can have diffuse character or irradiate in a back. In process of progressing of chronic pancreatitis pain loses touch with reception of food and becomes a constant.
Development of a sprue is connected with disturbance of exocrine function of a pancreas. Processes of band hydrolysis are broken that leads to increase of a chair up to 10 times a day. Later manifestations of a sprue are loss of body weight, a steatorrhea, a creatorrhea.
Quite often patients with chronic pancreatitis are disturbed by ostealgias, symptoms of osteoporosis come to light that is a consequence of deficit of B12 vitamin and fat-soluble microelements, first of all vitamin D.
Dyspepsia at chronic pancreatitis is shown by an eructation, a meteorism, nausea, vomiting. At 80% of patients the aggravation begins with repeated vomiting, and then the pain syndrome only joins.
30% of patients with chronic pancreatitis have the accompanying diagnosis a diabetes mellitus or disturbance of tolerance to glucose.

Complications:

Complications of chronic pancreatitis are included by formation of abscesses or pseudocysts of a pancreas, development of mechanical jaundice, chronic duodenal impassability, pancreatic ascites, accession of an infection, gastrointestinal bleeding, shock and a pancreatic cancer.

Diagnosis:

At survey of the patient red spots of the size of prosyany grain come to light, dryness and a peeling of skin, a glossitis, stomatitis is noted.
Inspection of status localis reveals abdominal distention, morbidity in epigastriums or left hypochondrium with possible irradiation.
Morbidity in Dezharden's point which will be defined on lines from a navel to an axillary hollow on 5-7 cm is noted. Dezharden's point is a projection of a head of a pancreas to integuments.
To a midline from Dezharden's point Shofar's zone (a pancreas body projection) is defined. The tail of a pankreas is projected on Meyo-Robson's point.
The form, size, features of an ekhostruktura, contours, condition of pancreatic channels, cysts or tumors, state inside - and extrahepatic channels is defined on ultrasonography. As considerable plus serves the possibility of carrying out ultrasonography diagnosis in dynamics.
The KT-research gives still big accuracy. It is possible to reveal small kaltsinata and pseudocysts.
The endoscopic retrograde holetsistokholangiopankreatoskopiya is carried out by introduction of a cannula to a big duodenal nipple through фиброгастроскоп with retrograde radiological filling and a series of pictures.
Rentgenissledovany a ryushny cavity reveals scattered calcification.
The elastase research in blood allows to define weight of a current. Elastase level tells less than 100 about heavy pathology of an exocrine fnktion of a pancreas.
Carrying out a kaprogramma allows to find a steatorrhea. Existence of more than 10 гр fat in Calais, when finding the patient on the diet containing no more than 100 гр fat in Racine testifies about steatorrheas.
With the diagnostic purpose investigate the level of alpha amylase and its isoenzymes in blood.

Treatment of Chronic pancreatitis:

During remission of chronic pancreatitis the diet and replacement therapy is shown.
The exacerbation of chronic pancreatitis demands purpose of a complex pathogenetic and symptomatic treatment, the including parenteral food, infusional therapy, purpose of spasmolysants, anesthetics and anti-secretory drugs.
In the first 2-3 days the complete starvation is appointed. Then, at slightly the expressed pain syndrome, pass to food according to a table No. 5 with depreciation in fats, the fried dishes, smoked products, alcohol, sparkling water. It is necessary to eat 5-6 times a day.
For the purpose of decrease in gastric secretion it is enough to accept ranitidine or фамодитин in a dose of 40-60 mg/days.
Purpose of somatostatin gives such effects as decrease in level of gastrin, HCl, oppression ekzo-and endocrine function of a pancreas, decrease in volume of a visceral blood-groove, pressure in portal system, at the same time without causing fluctuations of arterial pressure in a system blood-groove.
As infusional therapy use plasma, реополиглюкин, 5% glucose solution.
Correction of vneshnesekretorny function is reached by purpose of a kreon (panzinorm) on 1 drazhzha during food.
Indications to surgical treatment:
1. Formation of pseudocysts
2. Pancreas abscess
3. Recurrent gastrointestinal bleeding.