How to prevent exacerbation of pancreatitis. What causes exacerbation of chronic pancreatitis? Features of treatment and diagnosis of an attack. Correction of water and electrolyte disorders

Let's figure out how to relieve an exacerbation of pancreatitis, how long does it last and what to do to avoid it? The answers to these questions are important for patients with a chronic form of the disease.

How long does an exacerbation last?

The acute phase can last from several hours to seven days, sometimes longer. How long the exacerbation of pancreatitis lasts depends on the length of the disease and the aggressiveness of the provoking factor. A simple violation of the diet causes a short-term deterioration in well-being, and taking a large amount of alcohol, a long course of antibiotics, cytostatics, or an exacerbation of cholelithiasis lead to long-lasting symptoms.

If the experience of the disease is small, the exacerbation of the process with severe pain can last a week or more. In patients with a long history of the disease, the intensity and duration of the pain component of the exacerbation decrease, the remaining symptoms persist for a long time, but are not so pronounced.

The duration of the exacerbation also depends on the age of the patient, the presence of concomitant diseases. Usually, treatment lasts for a month, and maintenance therapy lasts at least 6 months.

Signs of exacerbation of pancreatitis

In the early stages, signs of exacerbation of pancreatitis resemble the clinic of an acute form of the disease that occurs with severe pain. As a rule, the pain decreases when bending forward, squatting.

In addition to abdominal pain, the patient complains of the following:

• air or eaten food,;
• rumbling in the abdomen, increased;
• unstable stool with a tendency to diarrhea;
• the presence of undigested food particles, impurities of mucus, blood in the feces;
• nausea that does not bring relief;
• fever, muscle pain, chills;
• fatigue, lack of appetite, irritability.

If the process is long, the pain syndrome is no longer leading. In adult patients, complaints of icterus of the skin and sclera come to the fore. Light stools and dark urine may appear.

Symptoms

Symptoms of exacerbation of pancreatitis in patients with a short duration of the disease are very similar to an acute attack. The main symptom in the clinical picture is severe and prolonged pain.

There are several types of pain syndrome, depending on its nature and localization:

• Ulcerative pains. Night and hungry pains in the epigastric region are characteristic, which requires differential diagnosis with.
• Pain resembling left-sided renal colic. Localized in the left side and lumbar region on the left.
• Pain simulating or acute appendicitis. They are localized in the right hypochondrium and in every 2-3 patients are accompanied by the appearance of yellowness of the skin and sclera. If jaundice occurs, an exception is necessary
• Pain accompanied by impaired intestinal motility (belching, nausea and vomiting after eating make them look like manifestations of intestinal dyskinesia).
• Intense pain without a specific localization, as in the picture of an acute abdomen with the development of peritonitis.

On examination: the skin is pale, dry, there is a whitish coating on the tongue, with a long course of the disease, atrophy of the taste buds is possible. On palpation of the abdomen, the doctor can determine the dense, enlarged and painful head of the pancreas. The abdomen is swollen, painful in the epigastric region and left hypochondrium.

With exacerbation of pancreatitis in patients suffering from this disease for many years, abdominal pain is less pronounced, disturbing for a short time. This is due to progressive pancreatic insufficiency due to fibrotic changes in its tissues.

The following manifestations of pathology become dominant:

• Intermittent jaundice of varying severity.
• Steatorrhea (frequent, offensive, greasy stools).
• Malabsorption syndrome with severe weight loss.
• Diabetes mellitus with high levels of glucose in the blood, resistant to correction with sugar-lowering drugs.

Even a chronic process that proceeds in an erased form with a mild exacerbation clinic is dangerous, as it leads to a gradual degeneration of the pancreas.

Exacerbation during pregnancy

Chronic pancreatitis may worsen during pregnancy. During this period, the body experiences overload, as a result of which there is a risk of activation of any inflammatory process.

Deterioration of pancreatic function during pregnancy can also be triggered by unbalanced nutrition, dietary disorders due to a woman's altered taste preferences.

What to do with an exacerbation?

What to do with exacerbation of pancreatitis? First of all, you need to call an ambulance.

If symptoms of pancreatitis appear, first aid for an exacerbation includes the following steps:

• complete exclusion of food and liquid intake;
• observance of rest, you need to lie in bed on your back, with vomiting, you can take a position lying on your side with your knees pressed to your stomach;
• using an ice pack as a cold compress on the abdomen.

After delivery to the hospital, the patient will be examined, based on the results obtained, the doctor will choose the most effective therapeutic tactics. It is forbidden to independently prescribe pills and administer medications during exacerbation of pancreatitis.

If the exacerbation of a chronic process is limited to nausea after eating, the appearance of diarrhea, abdominal discomfort, you still need to contact a specialist for advice to avoid complications. After the examination, the doctor will decide where it is necessary to undergo a course of treatment - in an inpatient or outpatient setting.

Is it possible to remove the exacerbation at home?

Aggravated pancreatitis always carries a potential threat of the development of necrotic changes in the gland tissue. Pancreatic necrosis requires urgent medical care in a surgical hospital, as it can lead to death in the shortest possible time.

Many patients with exacerbation of pancreatitis are interested in how to relieve pain. But it is important to remember that at home, while waiting for doctors, the patient should in no case be taken. They will not have the desired effect, but they can distort the clinical picture. A tablet (No-shpa, Papaverine) will alleviate the patient's condition.

If the degree of exacerbation of the chronic inflammatory process allows you to be treated at home, you must strictly follow all the doctor's recommendations. In this case, the main therapeutic method is diet, drinking regimen and taking prescribed drugs.

Treatment Methods

If pancreatitis is in the acute stage, treatment is aimed at suppressing the production of proteolytic enzymes by the gland, which destroy its own tissue. Complex therapy should be used against the background of a protective regime with the complete exclusion of any loads. The main role is given to drug therapy.

Medicines for exacerbation of pancreatitis in adults are the following:

• solutions for detoxification infusion therapy;
• anesthetics;
• antacids;
• protease inhibitors;
• antispasmodics;
• pancreatic enzymes;
• anticholinergics;
• antibiotics;
• sedatives.

Which drug from different groups is optimal is always decided on an individual basis. In the phase of inflammation subsidence, confirmed by laboratory and instrumental methods, exercise therapy, physiotherapy (electro- and phonophoresis with anesthetics and antispasmodics, mud therapy, magnetotherapy) are added to the treatment.

How and how to treat an exacerbation of pancreatitis, if conservative methods do not help, pain persists, and there is a threat of complications? All these circumstances make urgent surgical intervention necessary.

Folk remedies

How to relieve an exacerbation of pancreatitis at home with the help of folk remedies? With an exacerbation, resorting to the use of folk recipes is not only useless, but also dangerous. Various infusions and decoctions of medicinal plants are widely used in the chronic form of the disease in remission. Their choice should be agreed with the gastroenterologist.

Trying treatment with folk remedies, you can lose valuable time and create a serious threat to life. In a hospital, after the inflammatory phenomena subside, if the attending specialist allows, the patient can take herbal and vitamin teas, decoctions, infusions.

Cholagogue herbs are effective in exacerbation of pancreatitis, but their use is possible only in the absence of gallstones. The collection should contain corn stigmas, tansy, rose hips, St. John's wort, chamomile, immortelle, mint. You should mix dry medicinal raw materials, prepare an infusion and take it warm before meals 3 times a day for a month.

A decoction made from chicory root also has a good effect. It should be taken between meals 3 times a day, 100 ml.

You can mix in equal parts the following dried medicinal herbs: St. John's wort, sage, chamomile, calendula, wormwood. Then prepare a decoction in a water bath and take half a glass before meals for a month.

Diet for exacerbation of pancreatitis

The diet, frequency of food intake and its volume are regulated by the attending specialist.

• 1 day - fasting;
• Day 2 - drinking alkaline mineral water, rosehip broth;
• on the 3-5th day, liquid cereal porridges on the water are allowed.

Then there is a gradual expansion of the diet: the use of vegetable soups, lean meats and fish is allowed. Proper nutrition is the basis for the treatment of inflammation of the pancreas and its prevention.

Food should be boiled or steamed. You need to eat often, take food in a warm form and in small volumes. Fried, spicy foods, carbonated drinks, canned food are strictly prohibited. It is important that the mineral water used for acute pancreatitis is degassed.

Prevention

To avoid the progression of pathology, you need to know why the disease can worsen, and avoid the influence of negative factors.

The following preventive measures must be taken:

• strict adherence to diet number 5a;
• refusal of alcohol;
• compliance with the regime of work and rest with the exception of physical and nervous overload;
• dispensary observation by a gastroenterologist with the passage of prescribed tests and examinations at least twice a year;
• course intake of pancreatic enzymes prescribed by a specialist;
• control of cholesterol and blood sugar levels;
• courses of drugs that normalize the motility of the stomach and intestines, several times a year;
• therapy of concomitant chronic diseases of the gastrointestinal tract;
• exclusion of toxic effects on the body - uncontrolled medication, occupational hazards;
• treatment in sanatoriums of the corresponding profile.

Chronic pancreatitis is an insidious and dangerous disease, exacerbations of which significantly reduce the quality of life and cause serious damage to health. To avoid them, you need to be regularly observed by a gastroenterologist, take supportive therapy, and lead a proper lifestyle. A complete recovery is impossible, but the main task of the patient is to live and be treated in such a way as to make exacerbations rare and not dangerous to health.

Useful video about chronic pancreatitis

Exacerbation of chronic pancreatitis - symptoms and treatment

In most cases, an exacerbation of the disease does not require mandatory surgical intervention, but neglecting conservative treatment, there is a risk of serious complications in the form of problems with the digestion process and absorption of substances in the body.

What it is?

Chronic pancreatitis is an inflammatory process in the tissues of the pancreas that occurs for more than six months. The disease is characterized by an undulating course - periods of remission are replaced by periods when it worsens.

Causes of exacerbation

The main cause of exacerbation of chronic pancreatitis is the abuse of alcoholic beverages.

Other causes of exacerbation of the disease:

1. Mechanical trauma of the abdomen.
2. Complications after surgical operations.
3. Diets that involve a minimum of protein.
4. Autoimmune diseases.
5. Infectious diseases of the body.
6. Excessive consumption of fatty and fried foods.
7. hereditary factors.
8. High stress on the nervous system, frequent stress.
9. Senile age (lack of enzymes in the body).
10. Taking toxic drugs.
11. Smoking, especially when overweight.
12. Chronic diseases of the liver, duodenum and gallbladder.

During an exacerbation, the activity of pancreatic enzymes sharply increases, the pancreatic tissue is irritated under their influence, edema occurs, compression of the large pancreatic duct, the blood supply to the gland worsens - the clinical picture resembles acute pancreatitis and, in fact, differs little from it.

Symptoms of exacerbation of chronic pancreatitis

As a rule, the symptoms of exacerbation of chronic pancreatitis develop quite quickly. Already on the first day, a person's condition deteriorates sharply, as a result of which he has to take medications or seek help from a doctor.

The patient may suspect exacerbations of chronic pancreatitis according to the following clinical signs:

• frequent and loose stools, admixture of fat in the feces;
• abdominal pain with diffuse localization, radiating to the back, aggravated after eating;
• , vomiting of bile, which does not bring relief and is difficult to stop with medication.

All these clinical signs are not characteristic only for chronic pancreatitis. But if a person does not experience an exacerbation of this disease for the first time, he already knows that it was inflammation of the pancreas that caused all the symptoms.

What should be done in case of abdominal pain and dyspepsia? It is advisable to consult a doctor. If the pain is severe, and vomiting cannot be eliminated, it is worth calling an ambulance to immediately take the patient to the intensive care unit for correction of water and electrolyte metabolism. Such conditions are life-threatening, so you should not delay contacting a doctor. Exacerbation of pancreatitis may well lead to partial destruction of the pancreas, which may require surgical treatment.

How long does an attack last?

Chronic pancreatitis in the acute phase may be accompanied by severe pain and a significant deterioration in health. However, not all patients have such sharp pain sensations, but instead they suffer from other symptoms: lack of appetite, high fever, vomiting, diarrhea, etc.

But how long does the acute phase last? Doctors do not give a definite answer, since many factors influence the duration of an attack, for example, the reasons that led to the development of this pathology or the presence of concomitant ailments. On average, with an exacerbation of pancreatitis, an attack lasts 1–2 hours or more than a day.

What to do with an exacerbation?

First of all, you need to call an ambulance. If symptoms of pancreatitis appear, first aid for an exacerbation includes the following steps:

• complete exclusion of food and liquid intake;
• observance of rest, you need to lie in bed on your back, with vomiting, you can take a position lying on your side with your knees pressed to your stomach;
• using an ice pack as a cold compress on the abdomen.

After delivery to the hospital, the patient will be examined, based on the results obtained, the doctor will choose the most effective therapeutic tactics. It is forbidden to independently prescribe pills and administer medications during exacerbation of pancreatitis.

If the exacerbation of a chronic process is limited to nausea after eating, the appearance of diarrhea, abdominal discomfort, you still need to contact a specialist for advice to avoid complications. After the examination, the doctor will decide where it is necessary to undergo a course of treatment - in an inpatient or outpatient setting.

Diagnostics

After determining the symptoms and etiology of the disease, the specialist doctor prescribes tests. Usually this:

• general and biochemical blood tests;
• Analysis of urine;
• biochemistry of feces;
• saliva tests to determine amylase levels.

Additional abdominal examinations, such as computed tomography, MRI, organ x-rays, ultrasound, or endoscopy, may be required for an accurate diagnosis.

How to treat exacerbation of pancreatitis?

Comprehensive treatment of exacerbation consists of a regimen, diet and drug therapy. With severe pain syndrome, bed rest is prescribed, the patients are disabled.

Medical treatment

Treatment of pancreatitis during an exacerbation should begin immediately and always under the supervision of a specialist. Only a gastroenterologist can prescribe the right treatment aimed at quickly relieving the exacerbation of the disease and preventing possible complications.

First of all, drug treatment is used:

1. Vitamin therapy: fat-soluble A, E, K, D and B vitamins.
2. Pancreatic enzymes: Pancreatin, Creon, Panzinorm with lipase at least 10 thousand.
3. Drugs aimed at lowering the secretory function of the gland: Esomeprazole, Octreotide, Pantoprazole, Omeprazole.
4. Drugs that relieve concomitant pain syndrome. These are antispasmodics: Drotaverin, Mebeverin, Spazmalgon, No-shpa. As well as non-steroidal anti-inflammatory drugs: Tramadol, Ketoprofen.

It should be noted that drug treatment of patients is individual. Only a doctor should select drugs, having carefully studied the symptoms of the disease. It is impossible to inject, take pills without consulting a specialist. This can lead to dire consequences.

Nutrition and diet

In the first few days, hunger is necessary, you can only drink water - purified without gas, or boiled. In the future, the diet is gradually expanded, table number 1a is prescribed, as in exacerbation of gastric ulcer. Protein-rich foods are allowed - lean meat - beef, rabbit, turkey, in the form of steam meatballs or soufflé, boiled low-fat fish, steam protein omelet, low-fat cottage cheese, mashed viscous cereals. From drinks you can drink tea, rosehip broth, blackcurrant compote.

All dishes are cooked either steamed or boiled, carefully crushed or rubbed. Portions are small, not exceeding the amount that fits in one handful. The number of meals - from 6 to 8 times a day.

Extractive substances that enhance secretion are excluded from the menu - strong broths, mushrooms, coffee, cocoa, chocolate, marinades, smoked meats. All foods that require effort from the pancreas - fatty, fried, salty, spicy, seasonings and spices, canned food, cream, sour cream, fatty cottage cheese, lard - will have to be set aside. You can’t fast food, soda, multi-colored candy and chocolate bars, chips, crackers, nuts - everything that we used to snack on the go. Unconditional, categorical, not discussed taboo on alcohol. And for beer. And for non-alcoholic, including.

Usually, the diet solves about 70% of the problems that arise during an exacerbation of chronic pancreatitis. It is worth giving the gland rest - and the inflammation will begin to subside. The main thing is to endure the necessary time, and not to “break loose” when everything began to improve and stopped hurting.

Prevention

Of course, the best treatment is prevention. Chronic pancreatitis can worsen and throw out "surprises" that the patient does not even know about. This can be hyperglycemia and hypoglycemia, severe beriberi, processes leading to atrophic gastritis, liver dysfunction and nervous and physical exhaustion.

The basic rule of prevention is very simple. If you want to be healthy, "pass through your head" what gets into your mouth. Before swallowing something, you need to think about whether it will harm digestion?

Alcohol should be strictly avoided. In conditions of insulin deficiency, it can lead to hypoglycemia and the development of a serious condition, and if you are “lucky” and a pleasant intoxication develops, then a person “without brakes” eats junk food. Therefore, a complete rejection of drinking, smoking (swallowing tobacco saliva irritates the digestive tract) and food temptations will allow you to avoid this disease.

Pancreatitis is an inflammation of the pancreas. The main function of this organ is to produce digestive enzymes to break down proteins, fats and carbohydrates. Enzymes enter the duodenum, are activated and perform their function. But under certain circumstances, they start working while still in the pancreas. The gland begins to digest itself, causing inflammation or tissue necrosis.

According to statistics, most of all patients with pancreatitis are people who abuse alcohol. Then patients with a history of cholelithiasis, obesity, organ injury, intoxication of the body.

The main reason for the development of pancreatitis is a violation of the diet, gallbladder disease (cholelithiasis) and drinking alcohol.

Then other causes are possible that are not of particular importance, but can cause an exacerbation of the disease:

In about 30% of patients, it is not possible to establish the exact cause of the development of the disease.

How long does an exacerbation last?

Often exacerbation of pancreatitis continues for a week. Sometimes the disease can turn into a relapsing form and last for years.

The organ itself recovers slowly. Therefore, it is very important to follow a long period of diet, take enzymes and follow all the doctor's recommendations for drug treatment.

Symptoms of the development of exacerbations of pancreatitis

Clinical manifestations of pancreatitis of the pancreas appear very quickly. Already on the first day, the patient feels a deterioration in his condition. The exacerbation of the disease is dangerous for the life of the patient, so you should immediately seek help from a specialist.

The first sign of a pancreatic lesion is a severe dull or sharp pain of a girdle character (pitus, right or left hypochondrium). The pain radiates under the shoulder blade, in the back.

A liquid stool appears with a characteristic greasy sheen, an unpleasant odor, a grayish color, with pieces of undigested food. In the analysis of feces, there are fragments of muscle fibers, fiber, fat drops.

With exacerbation of pancreatitis, other symptoms appear:

• bitterness in the mouth, rumbling in the stomach, white coating on the tongue;
• nausea, vomiting of bile, belching, hiccups;
• possible increase in body temperature;
• loss of appetite;
• weakness, lethargy, decreased blood pressure;
• weight loss.

Symptoms of an exacerbation of the disease are complicated by the fact that it is very difficult to relieve pain and stop vomiting, even with the help of drugs.

If the pancreas is disturbed, pleurisy may occur

In violation of the function of the pancreas, complications may occur:

• diabetes mellitus, abscess, cyst;
• pneumonia, pleurisy;
• general depletion of the body;
• pancreatic stones, spleen infarction, cholecystitis, hepatitis;
• infectious processes, jaundice.

Patients who did not treat pancreatitis, did not adhere to proper nutrition, who have a genetic predisposition, may develop pancreatic cancer in a few years.

Exacerbation during pregnancy

Chronic pancreatitis is not a contraindication to conception and pregnancy. It is necessary to plan pregnancy for the period of remission, to follow a diet all the time of bearing the fetus. But this does not exclude the possibility of exacerbation of the disease. During pregnancy, it is categorically not recommended to engage in treatment on your own. If the expectant mother experiences discomfort in the epigastric region, you should immediately contact a specialist.

The clinical picture of exacerbation of pancreatitis during pregnancy has no features.

Important! Nausea and vomiting are characteristic of both pancreatitis and toxicosis during pregnancy.

Features of the treatment of exacerbations of pancreatitis

The treatment of the disease is complex, aimed at restoring the normal function of the organ.

In acute pancreatitis, the following requirements must be observed:

• Do not take any food during the first three days of acute pain. Drink mineral water without gas or rosehip broth without sugar.
• On the third day, it is allowed to introduce mucous soups, cereals, jelly.
• Eliminate solid foods for 7-14 days.
• Eat small meals and often.
• To relieve pain, apply cold to the epigastric region.
• Ensure complete rest (bed rest), ventilate the room.
• Before the doctor arrives, you can drink antispasmodics Papaverine, No-shpu, Maksigan, Novocaine.

As the condition improves, the diet gradually expands. Protein-rich foods are introduced into the diet - lean meat in the form of steamed soufflé or meatballs, boiled lean fish, cottage cheese, protein steam omelet. All dishes are served mashed or chopped.

Completely excluded from the diet:

• strong broth, mushrooms, chocolate, cocoa, marinades, pickles, smoked meats;
• fatty, fried, spicy, bacon, canned food, sour cream, heavy cream, nuts;
• spirits, carbonated drinks, beer.

Proper dietary nutrition solves the problem by almost 70%. At the same time, it is necessary to reduce the emotional and physical stress.

Drug treatment of acute pathology

Treatment with medications can only be prescribed by a specialist

In the drug course of treatment to suppress pancreatic secretion, proton pump inhibitors (omeprazole, contrical) are used. To relieve swelling of the pancreas, a diuretic is administered. To restore vascular microcirculation, heparin and drugs that prevent the development of blood clots are used. If necessary, prescribe antibiotics and anti-inflammatory drugs.

Enzyme preparations for the treatment of pathology in the acute period and for pain are not prescribed. When the inflammatory process begins to subside, laboratory parameters improve, digestion can be helped and an enzyme can be prescribed.

Surgical methods for the treatment of pancreatic pancreatitis are direct and indirect. The indirect method is surgery on the biliary tract, gastrointestinal tract, neurotomy. Direct method - removal of stones, glands, cyst drainage. Surgical treatment is indicated for the development of complications that are accompanied by jaundice, the formation of cysts, severe pain that is not amenable to drug treatment.

Prevention of exacerbations of pancreatitis

Drinking alcohol can aggravate a person's condition with pancreatitis

To avoid periods of exacerbation of pancreatitis, it is necessary to eliminate the causes that can cause this. First of all, give up smoking and alcohol, eat right, do not overeat, and prevent weight gain. Adhere to a diet and a proper diet. In this case, all the signs and manifestations of the disease will not bother for a long time.

Try not to be nervous, treat other diseases of the gastrointestinal tract in time. Avoid feasts, accompanied by an abundance of alcohol and food. Do not take medicines without a doctor's prescription.

Every four months, undergo preventive examinations with a general practitioner, a gastroenterologist. Preventive measures include spa treatment, which will help to avoid exacerbation and the development of complications.

Pancreatitis is an inflammatory disease of the pancreas. Depending on the clinical picture, acute and chronic pancreatitis are distinguished. These two forms of pancreatitis differ both in the mechanism of occurrence, the etiology of pancreatitis, and in the choice of primary therapy and recovery prognosis.

Photo: Syda Productions / Shutterstock.com

What is pancreatitis?

Pancreatitis is an inflammatory process that affects the tissues of the pancreas, an organ of intra- and exocrine function. The pancreas itself is located behind the stomach, in the retroperitoneal region, adjacent to the duodenum. The name "pancreas" was given because of its location closer to the back, thus, when examined lying down, it is "under the stomach".

The main purpose of this organ is the production of pancreatic juice with enzymes and bicarbonates that take part in the process of digestion of the body. When waiting for food and when it enters the stomach, enzymes and juices begin to be transported from the pancreas through the connective duct to the small intestine, providing the process of enzymatic processing of nutrients, participating in metabolism, facilitating the absorption of nutrients through the walls of the small intestine.

Pancreatic fluid neutralizes the acidic environment of gastric juice directly in the intestine, where digestive enzymes are activated and begin to perform their functions of splitting and processing substances.
The main digestive enzymes produced by the pancreas are:

• amylase, which promotes the processing of starch into sugars;
• lipase, an enzyme that breaks down fats;
• trypsin, chymotrypsin - enzymes involved in the breakdown of proteins;
• insulin, polypeptide, glucagon and others.

The causes of pancreatitis are in violation of the outflow of pancreatic (digestive) juice from the pancreas to the duodenum. Lingering inside the gland with partial or complete blockage of the ducts, as well as when intestinal contents are thrown into the ducts, the enzymes are activated ahead of time and begin to process, digest the surrounding tissues.

The retention of juice and enzymes that occurs during inflammation of the pancreas has a destructive effect on the tissues of the pancreas in the first place, however, with prolonged exposure, the negative effect of accumulating pancreatic enzymes and pancreatic juice also extends to nearby tissues, organs, and blood vessels. Destroying cells increase the activity of digestive enzymes, involving an increasingly large area in the traumatic process. In severe cases, accompanied by necrosis of the pancreas, pancreatitis can be fatal.

The maximum amount of digestive juice and enzymes is required to process carbohydrate foods. Excessive consumption of fatty foods, especially rich in spices, as well as alcohol abuse contribute to the retention of enzymes in the pancreas. The reasons for the delay of digestive enzymes and juices can be other factors.

The development of pancreatitis in adults

Statistical data on the prevalence of the disease in adults fluctuate significantly depending on the climate, the dietary habits adopted in different countries, and the traditions of drinking alcoholic beverages. There is also a significant difference in the incidence of female and male, both in terms of the mechanism of the disease, and for the reasons that cause it.
The main risk group for the development of pancreatitis consists of the adult population, due to the frequency of alcohol consumption, an unbalanced diet and the addition of concomitant diseases.

Causes of the development of the disease in men

The "trigger" in male patients with primary pancreatitis with a high frequency is the intake of alcohol (the so-called alcoholic pancreatitis) and the predominance of fatty foods, semi-finished products. Also, a distinctive feature of pancreatitis in men is the chronic form, ignoring the characteristic symptoms and exacerbations, "neglected" pancreatitis due to a late visit to a gastroenterologist.

Etiology of pancreatitis in women

The most common causes of pancreatitis in women are:

• cholelithiasis, causing the development of pancreatitis and cholecystitis;
• hormonal fluctuations and disorders that cause inflammation of the pancreas: pregnancy, menopause, taking hormone-containing contraceptives;
• starvation, adherence to diets that are unbalanced in the composition of food that are harmful to health.

Causes of the reactive form of the disease in adults

Secondary, or reactive pancreatitis develops against the background of existing diseases and the consequences of injuries of the abdominal organs, surgery, etc. The most common factors contributing to the development of reactive pancreatitis are diseases of the digestive system, such as:

• non-infectious hepatitis;
• cholelithiasis;
• gastritis;
• cirrhosis of the liver;
• biliary dyskinesia;
• intestinal infections.

Causes of pancreatitis in children

The definition of the cause of the development of pancreatitis in a child is carried out by a specialist - a pediatric gastroenterologist. Due to childhood, the etiology of inflammatory processes in the pancreas differs from the adult mechanisms of the onset of the disease.
Most often, pancreatitis in children is the result of trauma, surgery, resulting in damage to the pancreatic ducts and / or its tissues. Hereditary predisposition to excessive production of digestive juice, cystic fibrosis (intestinal, pulmonary, mixed form), as well as food allergies, chronic inflammatory processes in the body, the effects of parotitis and other diseases and disorders of digestion and other functions cause the development of pancreatitis in children and adolescents.

Classification and causes of pancreatitis

Symptoms of pancreatitis, the mechanism of the development of the disease, methods of diagnosis and therapy have been the object of study by specialists for several centuries. In the process of improving diagnostic methods, research capabilities and the accumulation of experience, several types of classification of pancreatitis were proposed, based on the characteristics of clinical symptoms, the nature of tissue damage, the causes of occurrence, and so on.
At the moment, there are varieties of pancreatitis according to the etiology of the disease, the form and characteristics of the course of the disease.

Classification of the disease by cause

For the reasons for the development of the disease, primary and secondary, reactive pancreatitis are distinguished.
The primary form of the disease develops against the background of damage to the tissues of the pancreas itself. Among the main causes of destructive processes are the following:

• abuse of alcohol-containing drinks (from 40 to 70% of cases depending on the region), nicotine smoking;
• damage to the pancreas due to abdominal trauma, surgical interventions and certain diagnostic procedures, in particular, such consequences are possible during endoscopy (retrograde pancreatocholangiography and endoscopic papillosphincterotomy);
• long-term, especially uncontrolled use of medications that aggressively affect the pancreas (some groups of antibiotics (tetracyclines), estrogen-containing drugs, glucocorticosteroids, acetylsalicylic acid (Aspirin), sulfanilamide drugs, some diuretics, etc.);
• food poisoning, chemicals;
• eating large amounts of food with synthetic additives, treated with pesticides and other chemicals;
• genetic predisposition to diseases of the digestive system, congenital pathologies of the development of the pancreas;
• an unbalanced diet with an excess of fatty and spicy foods, especially with long breaks between meals.

The primary form of the disease can develop at any age. Timely diagnosis and therapy allows you to stop or slow down the destructive processes in the tissues of the pancreas, restore the lost functions of the organ and avoid serious complications.
They say about secondary, reactive pancreatitis, when in the etiology of the disease it is possible to diagnose the main cause in the form of diseases of other organs of the gastrointestinal tract and the digestive system as a whole (statistically, cholelithiasis is considered the most common cause of reactive pancreatitis), as well as with the provocative action of infectious diseases (more often total - viral hepatitis, as well as dysentery, sepsis, chronic foci of inflammation, for example, with tonsillitis); diabetes; hereditary diseases, in particular, cystic fibrosis or Crohn's disease; diseases of the cardiovascular system; helminthic invasions in the biliary tract and so on. Diagnosing the cause of pancreatitis can be difficult. However, the success of therapy mainly depends on the elimination of the factors that caused the onset of the disease and the prevention of exacerbations.

Classification of pancreatitis according to the form and characteristics of the course of the disease

The inflammatory process leads to partial or complete loss of the main functions of the pancreas. The destruction of the cells of this glandular organ threatens with irreversible processes. In the human body there is no backup organ that can replace the pancreas.
Depending on the symptoms and the form of the course of the disease, acute and chronic pancreatitis are distinguished. The forms of the disease differ in the clinical picture, methods of therapy and health consequences.
Acute pancreatitis is a rapidly developing inflammatory disease, accompanied by the threat of irreversible changes in the tissues and structure of the pancreas, destruction, partial or complete, of other organs, and even death. In the acute form, pancreatic juice, stagnating in the gland, is activated and destroys its cells.
With this course of the disease, significant damage to the cells of the organ, accompanied by edema, is observed. The main risk group is adults in the age period of 30-60 years, although acute pancreatitis can also occur in children as a result of such negative factors as:

• lack of food intake;
• the predominance in the diet of fatty and spicy foods, semi-finished products, fast food;
• blunt abdominal trauma;
• helminthic invasion of the digestive system;
• congenital anomalies in the development of the gallbladder, its ducts, duodenum, pancreatic ducts;
• hereditary tendencies and disorders, infectious diseases, etc.

In the childhood period, the acute form of pancreatitis, as a rule, has less pronounced symptoms. The clinical picture of the disease, diagnostic methods and principles of therapy differ from acute destructive pancreatitis in adult patients.

Features of chronic inflammation of the pancreas

Pancreatitis in a chronic form is said to occur when the disease proceeds with periods of exacerbations and remissions. As the progression progresses, pancreatic insufficiency develops: the glandular tissue of the organ undergoes changes and is replaced by connective tissue, which is not capable of producing digestive enzymes and pancreatic juice. The lack of enzymes causes disturbances in the functioning of the digestive system.
This form of the disease is observed in patients of different ages. Recently, experts have noted a trend towards an increase in the diagnosis of recurrent pancreatitis occurring in a chronic form, which is provoked by the popularization and availability of semi-finished products, fast food, junk food, as well as alcoholization of the population.
There are two stages of chronic disease. The initial stage is expressed by minor symptoms and can last for several years, depending on the lifestyle and general health of the person. The initial stage is followed by a period in which deviations and disturbances in the functioning of the pancreas become more and more pronounced and disturb almost constantly. Exacerbation of the chronic form mainly provokes the use of spicy, fatty or fried foods, carbonated drinks and alcohol, especially on an empty stomach.

Symptoms of pancreatitis

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The symptoms of acute and chronic forms of pancreatitis differ, as well as the features of their course and possible complications of the disease. The symptoms of chronic pancreatitis are most often mild, but the signs of the disease in an acute form are pronounced. With a clinical picture of an acute form, it is important to urgently consult a specialist not only for treatment, but also for differential diagnosis from acute cholecystitis, appendicitis, which can cause similar symptoms.

Symptoms of the acute stage

In acute pancreatitis, being activated directly in the pancreas, digestive juice enzymes affect its cells. So, the action of the enzyme lipase, which breaks down fats, leads to fatty tissue degeneration. Trypsin, which promotes the digestion of proteins, provokes various chemical reactions, causing swelling of the pancreatic tissues and necrosis (death) of cells.
At the first stage of destruction, necrosis is aseptic, local, but without urgent treatment it covers nearby organs, joining infections cause the formation of new foci of inflammation, purulent complications.
Common symptoms of acute pancreatitis include:

• girdle pain, with localization in the region of the right or left hypochondrium. Pain symptoms are intense and are not eliminated by medications even with the timely start of treatment at the first attack. The pain syndrome is so pronounced that it can provoke the onset of a painful shock, loss of consciousness, and cause death. The duration of the attack can be from one hour to several days;
• complete lack of appetite, nausea, bouts of vomiting that do not improve well-being. In the vomit, the contents of the stomach with bile inclusions are observed;
• hyperthermia of the body (more than 38 ° C), increased heart rate (over 90 beats / min.), respiration, lowering blood pressure (less than 90 mm / hg);
• heartburn, hiccups, belching, dry mouth;
• the appearance of a white or yellowish coating on the tongue;
• tension of the abdominal wall;
• bloating in the upper peritoneum, which is caused by dysfunctions of the digestive systems;
• bouts of diarrhea, constipation, inclusions in the feces in the form of undigested food debris;
• discoloration of the skin: pallor, cyanosis, yellow tint of the skin and sclera as a result of the development of obstructive jaundice in reactive acute pancreatitis of the sclerosing form, provoked by cholelithiasis or causing compression of the bile ducts due to enlargement and swelling of the pancreas;
• change in blood pressure - an increase or decrease in its indicators;
• a general significant deterioration in well-being, rapid weight loss, bouts of sweating.

Signs of exacerbation of the chronic form of the disease

Pain attacks during exacerbations of chronic pancreatitis are localized in the same place as in acute pancreatitis, and, depending on the characteristics of the disease, are felt in the right or left hypochondrium, the pain radiates to the back, is of a girdle character, can spread to the area of ​​the scapula, sternum, depending from the site of the inflammatory process and the stage of the disease. Alcohol intake, fatty, spicy food can provoke exacerbations of chronic pancreatitis.

Pain during exacerbations of the disease occurs against the background of the development of an inflammatory process that affects the nerve endings of the pancreas, as well as with swelling and enlargement of the organ, involving the nerve endings in the surrounding tissues. Soreness can occur after a violation of the diet, last from several minutes to several days. A decrease in pain syndrome is noted with downward bending, squatting.

In addition to severe pain, exacerbation of chronic pancreatitis is also accompanied by the following symptoms:

• bloating, belching, diarrhea, nausea, vomiting due to disruption of the digestive system due to enzyme deficiency;
• weight loss, deterioration in general well-being. Dry skin, fragility of the nail plates, anemia, symptoms of vitamin deficiency, increased fatigue, etc. are also observed as a result of metabolic disorders of protein, carbohydrates, fats, as well as chronic intoxication of the body with decay products of undigested food;
• increased gas formation, stool disorders, chronic diarrhea, prolonged constipation due to insufficient digestion of food, activation and reproduction of bacteria that negatively affect the intestinal microflora.

The clinical picture of a pronounced exacerbation of chronic pancreatitis is similar to the acute form. With a sudden exacerbation of the disease, pancreatic tissue necrosis can also develop, causing acute pain attacks and requiring urgent medical intervention and hospitalization of the patient.

Complications of pancreatitis

Almost any form of pancreatitis, therapy for which is started in a timely manner, is capable, if not of a complete cure, then of a significant reduction in probable complications and slowing down the processes of destruction of one of the most important organs of the human digestive system.
Complications of acute pancreatitis or exacerbation of the chronic form can develop into extremely compressed juices and cause significant damage to health, even death.
At the same time, chronic pancreatitis, even in an erased form with an unexpressed clinical picture, is also dangerous. As the cells are damaged, the glandular tissue is replaced by the connective pancreas gradually loses the ability to function.
The main complications of chronic pancreatitis include:

• diabetes mellitus, which develops as a result of pancreatic insufficiency, a decrease in the production of the hormone insulin;
• general exhaustion, chronic intoxication of the body;
• abscess of the pancreas;
• pulmonary complications;
• development of pancreatogenic ascites;
• diseases and dysfunctions of other organs of the gastrointestinal tract (cholecystitis, duodenal ulcer);
• cystic formations in the tissues of the glandular organ;
• obstructive jaundice as a result of compression of the bile ducts;
• fatal outcome.

With exacerbations of inflammation, infectious processes can develop, both in the tissues of the pancreas and in adjacent organs and tissues. The localization of the pancreas near the large aorta contributes to the rapid spread of inflammation, associated infections, and general intoxication with the decay products of necrotic tissues. In the absence of the necessary therapy, strict adherence to the rules of nutrition in pancreatitis, abscesses can form, bleeding can begin.

Early and late consequences of acute pancreatitis

In acute pancreatitis, complications may appear immediately or have long-term consequences. Early complications that develop at the onset of an attack include:

• hypovolemic shock, leading to a lack of oxygen in the tissues of all organs of the gastrointestinal tract;
• liver, kidney failure, provoked by the toxic effects of digestive enzymes;
• peritonitis, aseptic or purulent, developing against the background of infection joining the inflammatory process;
• cardiovascular, respiratory failure and other complications.

The development of late complications in acute pancreatitis occurs mainly against the background of infections. The most common late complications of pancreatitis include sepsis, abdominal abscesses, the formation of fistulas in the organs of the digestive system, purulent inflammation, the formation of pancreatic pseudocysts, internal bleeding, etc. High statistical mortality rate from advanced forms of pancreatitis - according to various sources, from 15 to 90%, especially due to alcohol intoxication, indicates the need for timely therapy and preventive measures to prevent the development of this disease.

Methods for diagnosing pancreatitis

A timely diagnostic study, the establishment of the causes of pancreatitis, the initiation of treatment help to avoid the development of severe and numerous consequences. Acute forms and exacerbations of a chronic disease require immediate medical attention. However, with the initial signs of the disease: discomfort during or after eating, sensations of bloating, disorders of the digestive system, it is also necessary to consult a gastroenterologist before the onset of more pronounced clinical signs of pancreatitis.
Diagnostic procedures include an external examination of the skin, evaluating dryness, elasticity, discoloration, the patient's tongue (with pancreatitis, a whitish coating and atrophy of the taste buds are noted on the surface). Superficial and deep palpation of the epigastric region and the left hypochondrium allows you to determine the presence of pain when pressed, which is also a clinical sign in pancreatitis.

After examination and history taking, laboratory and instrumental methods for diagnosing pancreatitis can be prescribed. These include general, biochemical blood tests, stool and urine tests.

Early laboratory diagnosis makes it possible to determine an increase in the level of amylase in the blood and urine, which manifests itself in the first hours of an exacerbation of the disease. The amount of lipase increases by 2-3 days from the onset of a pronounced inflammatory process, and its elevated level indicates a prolonged exacerbation. The enzyme trypsin, determined in the patient's blood, indicates the onset of damage to the tissues of the organ.
During an exacerbation, an increased value of bilirubin and sugar is also noted, and the presence of partially split, underdigested fats, proteins, and carbohydrates in the feces indicates pancreatic insufficiency.
A complete blood count is not so informative, however, without indicating enzymes and the consequences of their deficiency, it demonstrates the number of leukocytes and the erythrocyte sedimentation rate. Both indicators increase with pancreatitis.

Methods of instrumental diagnostics

Instrumental diagnostics allows you to determine the size of the affected organ, the presence of inclusions, cystic formations in it, the structure of tissues, glandular, connective or with signs of necrosis, involvement in the inflammatory process of surrounding organs, their general condition.
The methods of instrumental diagnostics for pancreatitis include ultrasound examination (ultrasound) of the abdominal organs, radiographic examination, esophagogastroduodenoscopy (EGDS), endoscopic retrograde cholangiopancreatography (ERCP), computed, magnetic resonance imaging, laparoscopy. The choice of method is based on the severity of symptoms and the overall clinical picture of the disease.
If the presence of pronounced tissue necrosis is established, they can resort to the method of percutaneous puncture to extract biopsy material for the purpose of bacteriological examination, identifying the nature of necrosis, and the sensitivity of the infectious agent to groups of drugs.

Features of the treatment of acute and chronic pancreatitis

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Methods of therapy for acute and chronic forms of pancreatitis differ depending on the clinical symptoms, severity of pancreatitis, etiology, the presence of concomitant diseases, the general health of the patient and his age period.
Treatment of acute pancreatitis is carried out exclusively in stationary conditions. The first appointment for acute pancreatitis is complete fasting for several days without exception. Staying in a surgical hospital allows not only to control the diet and prescribe appropriate medication, but also, if necessary, to urgently or routinely use surgical methods in case of a severe course of the disease and a threat to the patient's life.
The methods of surgical treatment for pancreatitis include the removal of areas of necrotic tissue, the installation of a drainage system.

Drugs used in the acute stage of the disease

Drug therapy for the acute form of the disease includes courses of targeted drugs. These include the following groups of medicines:

• cytostatics to block inflammatory processes;
• painkillers, antispasmodics, anticholinergics, in acute pain attacks, drugs of the narcotic group can be used;
• antisecretory drugs, blockers of the production of pancreatic enzymes are used to reduce the likelihood of complications, necrotization of organ tissues;
• with the spread of the inflammatory process, the attachment of infection, the development of purulent foci, antibiotics are prescribed;
• the introduction of solutions of drugs aimed at reducing the level of intoxication of the body, provoked by the circulation of digestive enzymes in the blood, parenteral nutrition, the introduction of electrolyte solutions, essential amino acids intravenously.

Drug treatment of the chronic form of the disease

In chronic recurrent pancreatitis during remission, preparations of pancreatic enzymes are prescribed, which do not perform their functions effectively enough. The choice of what doctors prescribe to a patient with pancreatitis and at what dosage is based on the results of laboratory tests of blood, urine and feces. The course of drug therapy with enzyme preparations is supplemented with drugs to normalize digestion processes, enhance intestinal motility, and restore acid-base balance. Vitamin therapy is used: medicines and medicines with vitamins A, C, D, K, E and group B, prescribe lipoic acid, cocarboxylase, and so on according to indications.

An important component of treatment is a diet with the strict exception of fatty, spicy foods, alcohol is strictly prohibited. With an exacerbation of the chronic form, complete fasting for one to two days is recommended. Eliminating the symptoms of pancreatitis does not mean a complete cure and is not a reason to include prohibited foods in the diet.

First aid for acute pancreatitis

The appearance of the first signs of an acute form of the disease is the reason for the immediate call of a team of ambulance specialists. Before they appear, the following rules must be observed:

• it is absolutely impossible to eat and drink anything, as this provokes the production of pancreatic juice and can significantly aggravate the situation and increase the area of ​​​​damage to the pancreas, involve other organs in the inflammatory process;
• take a horizontal position (with bouts of vomiting - lie on your side), you can press your knees to your stomach if this relieves pain;
• try to relax the muscles of the abdomen, abdominals;
• put a cold object on the stomach: ice in a bag and a towel, a plastic bottle, a heating pad, etc., which will reduce the rate of inflammation.

It is highly not recommended to use drugs to relieve pain, firstly, at the beginning of an attack, they are ineffective, and secondly, such medications can reduce the information content of the clinical picture and make it difficult to diagnose. If necessary, you can use antispasmodic drugs to reduce the strength of spasm: drotaverine (Drotaverine, No-Shpa), Spasmalgon. It is necessary to inform specialists about taking medications.

With an exacerbation of chronic pancreatitis, the general rule of the first day is expressed in three words: cold, hunger and rest. This helps to reduce the development of inflammation, returning to a state of remission. However, in acute pancreatitis, treatment should take place exclusively in stationary conditions under the supervision of specialists.

Nutrition for pancreatitis

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Compliance with the prescribed diet for pancreatitis is the basis of therapy. It is impossible to both cure pancreatitis and slow down its development without following the rules of nutrition.
With the help of diet, it is possible to correct the functioning of the pancreas for the most part, to control how the disease proceeds. The diet is prescribed at the stage of remission, at the end of the period of exacerbation of pancreatitis. The chronic form of pancreatitis requires lifelong compliance with the rules of nutrition.

An attack of pancreatitis, depending on the severity of the course, requires strict fasting from 2 to 5 days. From the second day, you can begin to take warm alkaline water that reduces acidity, a weak decoction of rose hips, clean water. If there are improvements for 3-6 days, you can start using liquid cereal cereals without the addition of milk, sugar, butter and other taste improvers.

On the sixth day from the onset of an attack, the diet can be expanded to include low-fat broths, vegetarian vegetable soups, lean fish, weak tea, and other foods on the recommendation of a doctor. Next, a general diet is prescribed for pancreatitis, depending on the stage of the disease.
So, in chronic pancreatitis in remission, the diet is adjusted based on the analysis of the digestive system functioning under conditions of enzyme deficiency.

Diet during remission

The general rules of nutrition for chronic pancreatitis during remission include the following:

• the total amount of food consumed per day is divided into 5-6 small approximately equivalent parts to facilitate the functioning of the digestive system;
• food temperature should approximately correspond to body temperature and in no case exceed 60 ° C, the use of hot and cold dishes is excluded;
• the maximum restriction of the volume of fatty, spicy, fried foods, sausages, smoked meats, canned food, semi-finished products, seasonings and spices that can provoke an exacerbation of the disease, the exclusion of foods rich in coarse fiber (white cabbage, legumes, etc.), caffeinated and carbonated drinks, alcohol, chocolate, sweets with oily, fatty creams, and so on;
• replacement of rough food with soft ones: boiled or steamed grated vegetables and fruits, mashed soups, etc .;
• adhere to the daily intake of fats (no more than 60 g in total), proteins (60-120 g depending on body weight, age, physical activity, stage and characteristics of pancreatitis), carbohydrates (300-400 g).

The following foods should be included in the diet for chronic pancreatitis:

• slightly dried wheat bread made from flour of the first or second grade (fresh pastries are excluded);
• chopped vegetable puree soups;
• boiled cereals, cereals: rice, buckwheat, small pasta, oats;
• lean meats, fish, chicken, turkey, cooked by boiling or steaming;
• steamed or baked protein omelettes;
• boiled, baked vegetables (potatoes, pumpkin, beets, carrots, zucchini, squash);
• fresh natural dairy products with a low percentage of fat without dyes and preservatives, with low acidity (cottage cheese, yogurt, kefir), low-fat and non-spicy cheese, milk with a reduced percentage of fat (limited, only when added to dishes or tea);
• butter and sunflower oil in limited quantities;
• fruits and berries with a low level of acidity, sugar content, preferably non-acidic apples;
• honey, jam, jam, fruit and berry jellies, mousses and so on.

Prohibited foods and the principle of food processing

It is not recommended for patients at any stage of pancreatitis such types of products as pork, lamb, goose meat, ducks, mushrooms, garlic, sorrel, pickles and marinades in any form, radish, legumes, fresh cabbage, grapes and grape juice, margarine, coffee , cocoa, cinnamon, bananas, ice cream and sherbets. For any form of pancreatitis, the consumption of alcoholic beverages must be forgotten.

The correct methods of preparation and choice of products contribute to the remission of all forms of pancreatitis and reduce the likelihood of exacerbations and relapses in chronic pancreatitis or a single episode of the disease in history. A wide selection of culinary recipes allows you to diversify the diet, not experience the consequences of the restrictive principles of dietary nutrition, and avoid breakdowns.
With exacerbations of chronic forms of pancreatitis, complete fasting is prescribed on the first day, supplementing it as the severity of symptoms decreases with the use of heated alkaline water every two hours in small doses.
After the end of the stage of exacerbation of pancreatitis, they return to a sparing diet, starting with pureed liquid cereals, vegetable purees, low-fat varieties of fish.
With pancreatitis, it is not recommended to mix different types of protein during one meal, for example, eat fish and cheese, beef and chicken, etc.

The preferred method of cooking when heat treatment is required is to grind the product, followed by boiling, baking or steaming. On demand, grinding, pureeing is done twice, before cooking and after.

Prevention of pancreatitis

Pancreatitis is a disease that is easier to prevent than to cure. Prevention of inflammatory diseases of the pancreas includes the correct diet and diet, limiting or eliminating factors that contribute to disorders in the digestive system, other systems and organs, prevention of infectious diseases, a healthy lifestyle, as well as a timely visit to the doctor in case of any discomfort or pain.

The prevention of exacerbations in chronic pancreatitis in remission includes not only taking prescribed medications and dieting, but also spa treatment, as well as examination by a gastroenterologist at least twice a year.

Chronic pancreatitis is an inflammatory and degenerative disease of the pancreas, characterized by fibrotic processes in the parenchyma of the organ, followed by loss of functional activity.

The pancreas plays an important role in endocrine regulation and digestion. It produces hormones, insulin and glucagon, which carry out carbohydrate metabolism, secretes a number of enzymes involved in digestion. If symptoms of exacerbation of chronic pancreatitis are detected, treatment should be started to prevent the development of functional insufficiency.

The main mechanism for the occurrence of inflammatory changes in the tissues of the pancreas is the intraductal activation of pancreatic enzymes, in particular trypsin, leading to self-digestion of its tissues. Tissue edema occurs, leading to a secondary organ circulatory disorder with the development of ischemia, which contributes to the progression of inflammation. Gradually, the process becomes sluggish. With exacerbation, due to which functional activity decreases.

When symptoms of exacerbation of pancreatitis occur, most people have 2 questions:

1. How long will it last
2. What to do to get back in shape faster

In order to answer these questions, it is necessary to understand in detail the causes, the nature of the course, the symptoms and the treatment of this disease.

The reasons

Given the extensive list of functions performed by the pancreas, a violation of its work leads to serious health problems and a deterioration in the quality of life.

According to the modern classification, the following etiological and trigger causes of occurrence and progression are called:

1. Toxic use of alcohol, drugs, poisoning with salts of heavy metals, some drugs. There are also studies proving that smokers develop the disease more often.
2. Hereditary revealed a large number of chromosomal mutations leading to the development of early and rapidly progressive pancreatitis.
3. Obstruction of the ducts in mechanical damage, oncological diseases and insufficiency of the sphincter of Oddi.
4. Metabolic such as cystic fibrosis, chronic renal failure.
5. Immunological production of autoantibodies to one's own cells is manifested by primary autoimmune pancreatitis, and is a consequence of other systemic diseases.

All etiological factors are conditionally divided into controlled and uncontrolled. Among the reasons for the formation of chronic pancreatitis and its exacerbations, only the first group can be corrected. Therefore, a person who has a history of such a diagnosis, regardless of the frequency of exacerbations, must completely change his lifestyle, stop drinking alcohol and reduce the functional load on the organs of the digestive tract.

Symptoms

Chronic pancreatitis may be asymptomatic for many years, but the function of the gland will rapidly decline. Clinically significant functional disorders appear only when 90% of the tissues of the organ die.

Symptoms that develop during an exacerbation of pancreatitis include the following stages:

1. preclinical stage, characterized by the complete absence of symptoms.
2. stage is manifested by episodic exacerbations. A few years later, relapses are easier, but the symptoms persist in remission.
3. stage abdominal pain becomes chronic. Not only the exocrine, but also the endocrine function of the organ is disturbed.
4. the stage is manifested by complete atrophy of the gland with the loss of all its functions.

With exacerbation of pancreatitis, pain is the main syndrome. The epicenter of pain is located in the epigastric region and radiates to the back. Sometimes the pain takes on a girdle character. The intensity ranges from mild aching to unbearable dagger.

Most patients prefer to take a forced position, hugging their stomach with their hands and pulling their knees to their chest, as this relieves suffering.

As a rule, the pain is accompanied by nausea and a feeling of bitterness in the mouth, loss of appetite.

Many complain of loose stools of a fecal nature, with a characteristic greasy sheen and poorly washed off. This symptom indicates a far advanced process and severe exocrine insufficiency.

In some cases it is noted. It is rarely higher than subfebrile figures. However, purulent-septic complications such as an abscess or phlegmon become the cause of the development of hectic fever.

In the third and fourth stages of the disease, exacerbations do not manifest themselves so clearly. Patients begin to lose weight, develop malabsorption and changes in glucose tolerance.

With timely treatment started in the early stages, exacerbations last from 2 to 7 days.

Diagnostics

Often, the diagnosis of chronic pancreatitis and its exacerbations is very difficult, due to the anatomical location of the organ and its close functional relationship with other organs of the digestive system. Also, the symptoms of exacerbation that occur in the initial stages of the disease do not differ in specificity and occur when many digestive organs are affected.

Diagnosis during exacerbation

In case of exacerbation, first of all, it is necessary to consult a doctor. If exacerbations occur frequently, are manifested by vivid symptoms, and the acute phase lasts longer than 3-5 days, hospitalization may be required for a detailed examination.

Determination of pancreatic enzymes in blood serum and urine

This method, due to its simplicity and availability, is a screening method and is performed for all patients with abdominal pain. Most often, the content of amylase is determined

ultrasound

Another minimally invasive and affordable diagnostic method. Its accuracy reaches 60-85%. The main signs detected during an exacerbation of pancreatitis are an increase in the organ, the fuzziness of its contours and a change in the ECHO structure. However, the diagnostic value is manifested only with a comprehensive assessment of clinical data and ultrasound results. Isolated in the absence of symptoms cannot be the reason for the diagnosis.

CT (computed tomography)

The sensitivity of the method reaches 75-90%. The gold standard is multispectral CT with intravenous contrast.

Endoscopic retrograde cholangiopancreatography

The method is quite complex and is carried out in a hospital, but it gives reliable information in 95% of cases. During the study, a contrast agent is injected into the pancreas and the condition of the ducts is assessed, as well as the rate of their emptying using x-rays.

Coprogram

Allows you to evaluate the excretory function of the pancreas. During an exacerbation of chronic pancreatitis in the stool, the following are detected:

• Steatorrhea - the presence of neutral fats
• Creatorrhoea - the presence of muscle fibers and connective tissue, indicating a violation of protein digestion
• Amylorrhea - undigested extracellular starch is detected

Glucose tolerance test

According to its results, the safety of endocrine function is assessed.

Treatment

All patients with abdominal pain are shown to consult a surgeon before prescribing painkillers; in the absence of data for surgical pathology, they proceed to consistent conservative treatment.

The gold standard of first aid for acute exacerbations of chronic pancreatitis is "hunger, cold and rest." In the first three days, patients are assigned a complete hunger. All necessary nutrition is administered parenterally. They are also shown bed rest and cooling of the pain site.

• Anesthesia.
  Non-narcotic analgesics are used to relieve pain.
• Diet therapy.
  After stopping the acute phase, they gradually begin to expand the diet. In the early days, they prefer therapeutic nutrient mixtures. Subsequently, this is a high-protein diet with restriction of fats and carbohydrates.
• Replacement enzyme therapy.

It is prescribed to all patients with steatorrhea or a duration of pancreatitis for more than 5 years. They are also used in the treatment of chronic pancreatitis in the acute stage. The drug of choice in modern practice is Creon. The attending physician prescribes a dosage depending on the severity of the patient's condition. The effectiveness of medications for replacement therapy is higher if taken on time or immediately after a meal.

Surgery

Has very limited indications:

• Disability due to intractable pain
• Ineffectiveness of conservative therapy for more than six months
• Complications of the surgical profile
• Suspected pancreatic cancer

It is important to remember that if symptoms of exacerbation of chronic pancreatitis occur and the need to adjust treatment, consult a doctor. Treatment at home or taking inadequate doses of medication leads to a deterioration in the condition and the development of formidable complications.

Prevention

Prevention is lifestyle modification. All patients are advised to permanently stop drinking alcohol and smoking. It is also necessary to follow the diet and diet prescribed in the treatment of pancreatitis. Take replacement enzyme therapy on time, strictly in prescribed doses.

Complications

With untimely or complete lack of treatment of exacerbations of chronic pancreatitis, the risk of developing a number of life-threatening complications is high:

• with possible compression of neighboring organs.
• Obstructive jaundice, which, if left untreated, provokes the development of cirrhosis of the liver.
• Ductal adenocarcinoma.

All of the above complications are treated surgically, after which long-term antibiotics are required, especially with pancreatic necrosis.

The main sign of the development of complications is the inability to somehow remove the symptoms. No matter how the pain syndrome is relieved during an exacerbation, it cannot be completely stopped, even with the use of narcotic analgesics. This situation requires increased vigilance of the doctor and additional examinations.

Recovery prognosis

It is important to realize that the exacerbation itself usually does not last long, a maximum of a week, but the disappearance of symptoms does not mean recovery. It is impossible to achieve a complete cure for pancreatitis. The task of the patient and the doctor is to jointly prevent the occurrence of exacerbations and the development of functional insufficiency of the organ. This requires a complete rejection of bad habits, and periodic examination schedule.