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Chronic pancreatitis

Clinic



Chronic pancreatitis is a chronic inflammation of the pancreatic tissue leading to fibrosis, loss of exocrine tissue and, consequently, to gland dysfunction. The Marseille-Roman classification of chronic pancreatitis includes three types:

1. Chronic colifiable pancreatitis, accounting for 80% of all cases of chronic pancreatitis and arising from a background of chronic alcoholism. It is characterized by the formation of protein plugs or stones in the ducts of the gland. Stenosis and atrophy of pancreatic ducts may also be observed.

2. Chronic obstructive pancreatitis is the second most frequent type of chronic pancreatitis that occurs against the obstruction of the duct or Vater’s nipple with a tumor or during stricture.

3. Chronic inflammatory pancreatitis is the most rare form of pancreatitis, the etiology of which is not yet fully understood.

The clinical course of chronic pancreatitis usually has the following character. The first attack of pain in a patient develops in the third or fourth decade of life, and in the next two years, attacks of pain are repeated. The frequency of attacks increases, especially if the patient continues to drink alcohol. Finally, chronic pain syndrome, malabsorption syndrome, diarrhea are formed, and calcifications are formed in the gland tissue, which can be detected by a panoramic radiography of the abdominal cavity.



Etiology and pathophysiology

Throughout the world, alcoholism is the main cause of the development of chronic pancreatitis. With autopsy in the pancreas, more than 45% of alcoholics who did not have signs of chronic pancreatitis, revealed morphological changes characteristic of this disease, which are rare in non-drinkers. More than 50% of people with alcoholism have exocrine pancreatic dysfunction or a pancreatic stimulation test violation. Despite the fact that alcohol is considered the main cause of the development of chronic pancreatitis, the mechanism of its pathological action is unknown. A threshold amount of alcohol is not established, exceeding which leads to functional and structural changes in the pancreas. As with alcoholic liver damage, it all depends on individual sensitivity. Malnutrition, as well as the type of alcoholic beverage, do not significantly affect the incidence of chronic pancreatitis.

Studies in which pancreatic juice was collected after stimulation with secretin and cholecystokinin through a catheter located in the pancreatic duct showed that an increase in protein content and a decrease in bicarbonate content occur during alcohol abuse in secretion. These changes were observed even if the clinical manifestations of alcoholic pancreatitis were absent. Other studies have found that in the pancreas secretion of people who abuse alcohol, the ratio of trypsinogen to trypsin inhibitors is increased, which predisposes to in-duct activation of enzymes. It was also revealed a decrease in the secretion of protein concentration that can inhibit the formation of insoluble calcium salts (stones). A deficiency of this protein can lead to the formation of stones in the pancreas, which is a sign of chronic alcoholic pancreatitis. Moreover, citrates (which bind calcium) are secreted to a lesser extent in patients with alcoholism. A decrease in the secretion of citrates also contributes to the formation of protein plugs and stones in the ducts. Damage to the ductal system of the gland usually begins with the defeat of the smallest branches, and the gradual involvement of larger ducts in the process.
However, the mechanism of development of all these changes has not yet been clarified.

Hereditary pancreatitis is a rare form of the disease, manifested by attacks of acute pancreatitis with the outcome, ultimately, in chronic pancreatitis, often with calcification of the gland, resembling that of alcoholic pancreatitis. The disease is inherited in an autosomal dominant manner and is equally common in men and women. Most often, young people suffer from it, while the first attack of pancreatitis occurs before the age of 20 years (more than 80%).

Cystic fibrosis (polycystic) is a pancreatic disease with a variety of clinical manifestations and a frequent combination with lung diseases. This pathology is inherited in an autosomal recessive manner and is manifested by a violation of the secretion of chlorides due to a defect in the gene encoding the protein of the chlorine channels (transmembrane transfer regulator). Impaired functioning of this protein significantly reduces the secretion of chlorides and bicarbonates in the pancreas, intestines, and other organs. This leads to obstruction of the pancreatic ducts with a secret and dead cells and, in the end, to the insufficiency of exocrine pancreatic function. However, in most patients with cystic fibrosis, the endocrine function of the gland is preserved. Necrosis of duct cells and centroacinar cells gradually spreads through the acinus, leading to the formation of pancreatic cysts. With polycystosis, the concentration of enzymes and bicarbonates in the secretion of the gland is reduced, and, consequently, exocrine function deficiency, steatorrhea, develop.

The cause of pain in chronic pancreatitis is still not clear. Afferent nerve fibers conduct impulses from the gland to the celiac plexus, from where the right and left splanchnic nerves conduct impulses to the corresponding paravertebral sympathetic ganglia. One of the mechanisms of pain can be an increase in intraductal pressure. In some cases, the pain decreases after surgical reduction or after installing a stent in place of stricture (a plastic tube placed in the main pancreatic duct to improve drainage). At the heart of another mechanism for the occurrence of pain is inflammatory damage to the nerve membrane of the pancreas with rupture of its tissue or without it. Pain in chronic pancreatitis is usually dull, aching. It radiates to the back and lasts, as a rule, from several days to several weeks.

Symptoms of malabsorption are observed with a decrease in exocrine gland function by more than 90%. Fat malabsorption and steatorrhea precede protein malabsorption and creatorrhea. Impaired carbohydrate absorption is rarely a clinical problem, since it occurs only with almost complete inhibition of pancreatic enzyme secretion.

Unlike patients with malabsorption syndrome due to the pathology of the small intestine, patients with malabsorption due to chronic pancreatic insufficiency have a small amount of stool, since the absorption of water and electrolytes is usually preserved. Carbohydrate malabsorption is absent or slightly pronounced, deficiency of vitamins, iron and calcium rarely develops. However, in chronic pancreatitis, vitamin Biz deficiency may occur, since pancreatic proteases are required to break down the complex of vitamin Bia and R-protein. Only after that vitamin B,.; binds to Castle factor and can be absorbed.
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Chronic pancreatitis

  1. CHRONIC PANCREATITIS
    Chronic pancreatitis is a progressive chronic inflammatory disease of the pancreas, manifested by a chronic inflammatory and degenerative process of glandular tissue, which results in the development of sclerosis of the organ with the loss of its exo- and endocrine function. ETIOLOGY AND PATHOGENESIS Chronic pancreatitis is a polyetiological disease. Acute pancreatitis may
  2. 70. CHRONIC PANCREATITIS
    the basis of the disease is the development of an inflammatory-sclerotic process leading to a progressive decrease in the functions of external and internal secretion; there is a compaction of the pancreatic parenchyma (induction) due to the proliferation of connective tissue, the appearance of fibrous scars, pseudocysts and calcifications. Classification • Chronic calcifying pancreatitis • Chronic obstructive
  3. Chronic pancreatitis in children
    Protocol code: 07-075в Profile: pediatric Stage: hospital Purpose of stage: 1. achievement of clinical and laboratory remission; 2. relief of pain, dyspeptic and diarrheal syndromes; 3. normalization of blood and urine enzymes. Duration of treatment (days): 14 ICD codes: K86.0 Chronic pancreatitis of alcoholic etiology K86.1 Other chronic pancreatitis K86.2 Pancreatic cyst
  4. Chronic pancreatitis (ciphers K 86.0; K 86.1)
    Definition Chronic pancreatitis - damage to the pancreas, the characteristic morphological signs of which are relapses of inflammation with lesions of the glandular tissue, the outcome in the form of atrophy of glandular elements and their replacement with connective tissue; clinical equivalents - the development of exocrine and intrasecretory organ failure. Statistics. Acute frequency
  5. Chronic pancreatitis
    CHRONIC PANCREATITIS (CP) - an inflammatory-dystrophic disease of the glandular tissue of the pancreas with impaired patency of its ducts; the final stage is sclerosis of the organ parenchyma with the loss of its exocrine and endocrine functions. CP is a progressive, chronic disease of the pancreas. In the initial stage of the disease, the phenomena of edema predominate,
  6. Chronic pancreatitis
    Chronic pancreatitis is a progressive inflammatory disease characterized by increasing sclerosis (replacement of gland tissue with connective tissue) and progressive focal, segmented or diffuse destruction of exocrine tissue. Classification. 1. By origin: primary and secondary. 2. In the form of: 1) recurrent; 2) with constant pain; 3) latent. 3. By
  7. Nutrition for chronic pancreatitis
    Chronic pancreatitis occurs most often after acute, but it can also be primary, for example, in patients with cirrhosis of the liver, chronic hepatitis, with diseases of the duodenum, with stones in the bile ducts, sometimes with atherosclerosis and malnutrition in alcoholics, with allergic diseases, etc. The main thing in the treatment of chronic pancreatitis is a properly constructed
  8. 5.6. CHRONIC PANCREATITIS (HP)
    The goals of treatment during the period of severe exacerbation of CP: 1. Relieving pain 2. Suppressing pancreatic secretion 3. Suppressing pancreatic enzyme activity 4. Anti-inflammatory therapy 5. Reducing hypertension in the pancreatic duct 6. Fighting intoxication, dehydration, electrolyte disorders, vascular insufficiency
  9. ACUTE PANCREATITIS
    Clinic. Acute pancreatitis is an inflammation of the pancreas, which is based on a violation of its enzymatic function. It is provoked by chronic alcoholism, chronic diseases of the abdominal cavity, infections, intoxications. Sharp abdominal pains with radiation to the epigastric region, back, nausea, vomiting, fever, tachycardia are characteristic. Sometimes against this background, develop
  10. Acute pancreatitis
    Acute pancreatitis is an acute inflammation of the pancreas. ETIOLOGY AND PATHOGENESIS Causes of acute pancreatitis: ¦ abuse of alcohol and spicy or fatty foods; ¦ gallstone disease; ¦ pancreatic injury; ¦ non-traumatic strictures of pancreatic ducts; ¦ diseases of the duodenum (ulcer, duodenostasis). Acute destructive pancreatitis is primarily aseptic
  11. Pancreatic inflammation (pancreatitis)
    Pancreatitis is a polyetiological disease of the pancreas that occurs as a result of tissue self-destruction by its lipolytic and activated proteolytic enzymes. Inflammatory changes in the pancreas occur in response to necrosis of its tissue. There are acute and chronic pancreatitis, in addition, reactive pancreatitis, which represents
  12. Acute pancreatitis
    1. Describe the pathophysiology of pancreatitis. The exocrine pancreas produces a number of digestive enzymes necessary for the breakdown of proteins, fats and polysaccharides. These enzymes are synthesized in an inactive proenzyme form and are activated only after secretion into the small intestine. With pancreatitis, premature activation of enzymes is observed in the gland itself, and not in the intestine due to
  13. ACUTE PANCREATITIS
    In recent years, mortality in acute pancreatitis has significantly decreased, which is associated with increased treatment options. The prognosis for acute pancreatitis directly depends on the stage of the disease. In the first stage - the lowest mortality rate (1-3%), and in the third reaches 80-100% [Khartig V., 1982]. Thus, the sooner treatment is started, the better the prognosis. Pathophysiological changes.
  14. Pancreatitis
    Pancreatitis is an inflammation of the pancreas, a polyetiological disease, the causes of which can be divided into 3 groups - mechanical - biliary dyskinesia; neurohumoral - disorders of fat metabolism; toxico-allergic effects - infectious diseases, especially viral infections, allergic reactions, disorders of the immune system. Symptoms Exhaustion and volumetric
  15. Nutrition for acute pancreatitis
    The pancreas plays an important role in human life. It produces and secretes active juice into the duodenal lumen, the substances of which break down the components of food - proteins, fats, carbohydrates - into simple compounds, which are then absorbed by the intestinal mucosa, enter the bloodstream, are captured by the cells of organs, taking part in the cellular metabolism,
  16. Acute pancreatitis
    Acute pancreatitis is an acute inflammatory lesion of the pancreas, characterized by autolysis (due to the activation of its own enzymes) and gland dystrophy. Etiology: 1) damage to the pancreatic parenchyma; 2) obstructive disorders in congenital malformations of the pancreas; 3) dysmetabolic causes; 4) acute circulatory disorders; 5) toxic and
  17. ACUTE PANCREATITIS
    Acute pancreatitis is an acute polyetiological disease of the pancreas of an inflammatory and degenerative nature. It occurs in children of all age groups, but more often at 11-14 years of age. In the etiology of acute pancreatitis in children, the leading place is occupied by (J.P. Gudzenko, 1980) nutritional factors (violation of diet, abuse of extractive, fatty, carbohydrate dishes,
  18. Acute pancreatitis
    Acute pancreatitis means an acute inflammatory process of the pancreas of an enzymatic nature with the development of pancreatic necrosis, accompanied by increasing endogenous intoxication. The main causes are gallstone disease, alcohol use, trauma. The predisposing factor is obesity. Allocate: 1. The edematous form of acute pancreatitis. 2. Hemorrhagic pancreatic necrosis.
  19. Acute pancreatitis
    Acute pancreatitis means an acute inflammatory process in the pancreas of an enzymatic nature with the development of pancreatic necrosis, accompanied by increasing endogenous intoxication. The main causes are gallstone disease, alcohol use, trauma. The predisposing factor is obesity. The following forms of acute pancreatitis are distinguished: = edematous form; = hemorrhagic
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