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Pancreatitis


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Pancreatitis is an inflammation of a pancreas. This disease is characterized by overshoot of a pancreat duct stones from a gall bladder, a tumor or a cyst. Such overshoot promotes failure of outflow of digestive juices with enzymes in a small intestine. Pancreatic enzymes gradually accumulate and begin to influence tissues of the gland. A result is what the pancreas digests itself. This process can lead to the death of the patient.

Classification of pancreatitis

There is a set of classifications of pancreatitis. Here the most clear will be described for the ordinary person.

Pancreatitis can be divided on the nature of a course of the disease into sharp and chronic.

Acute pancreatitis

In acute pancreatitis develops swelled a pancreas, its size increases, the activity of production of enzymes increases. All this is followed by pain, fever, weakness, symptoms of poisoning of an organism with toxic substances of inflammation appear.

The final of acute pancreatitis optimistic - after treatment all symptoms, signs of the desease, data of analyses confirming the diagnosis of a disease disappear.

Chronic pancreatitis

In chronic pancreatitis of change in a pancreas remain  also after treatment. Atrophic and inflammatory and degenerative processes progress over time. Normal tissue of a pancreas is substituted cicatricial which cannot produce enzymes and hormones necessary to an organism. The patient feels almost constant pains at disturbance of a diet. Chronic pancreatitis is in turn subdivided into hyper fermental and hypofermental options. 

 Also depending on symptoms and features of the course of the disease, pancreatitis shares on:

  1. painful  - pains disturb almost constantly;
  2. recuring - pains disturb often (frequent aggravations);
  3. opukholevopodobny - as a rule is shown by jaundice;
  4. latent - a bezbolevy form of pancreatitis.

Besides pancreatitis can be primary or secondary. In primary pancreatitis the inflammation develops in the pancreas. In secondary pancreatitis the inflammation develops in the next body.

Pancreatitis symptoms

Constant and leading symptom of pancreatitis - an abdominal pain, most often constant, stupid or cutting, in process of development of a disease accrues to strong, leading sometimes to shock, is localized highly in the pit of the stomach, in right or left hypochondrium, at damage of all gland has the surrounding character. The frequent vomiting which is not giving relief in emetic masses bile impurity.

Dryness in a mouth, nausea, a hiccups, an eructation. At the progressing course the general condition of the patient quickly worsens: temperature begins to increase, pulse becomes more frequent, there is short wind, arterial blood pressure goes down, clammy sweat acts, language becomes dry with a plentiful plaque, integuments turn pale, further gain earthy-gray color, features are pointed.

At survey the stomach is blown up, there are symptoms of paresis (lack of reductions) of a stomach and intestines. Against the background of severe pains in a stomach at its palpation the muscle tension long is not defined, and only in later terms symptoms of irritation of a peritoneum are designated.

In acute pancreatitis complications as are observed from abdominal organs, and the bodies located beyond its limits. In the first group abscesses and phlegmons of an omental bursa, intraperitoneal, peritonitis, acute erosion and ulcers of digestive tract, enter the second - a fluid lungs, pneumonia and abscesses of lungs, exudative pleurisy (accumulation of liquid in a pleural cavity).

Often the disease is accompanied by hepatitis, disturbance of carbohydrate metabolism - increase in level of sugar in blood and its emergence in urine.

Causes of pancreatitis

The pancreas emits special enzyme the trypsin which is taking part in proteopepsis. It is usually not active, does not reach intestines yet. Being activated directly in a pancreas, he tries "to digest" fabrics of body, causing irritation and inflammation. 

It can occur under the influence of alcohol. About a third of cases of acute pancreatitis appear at those people who regularly drink. Consumption of alcoholic beverages is the reason about 70% of cases of chronic forms of pancreatitis. 

The number of the people having pancreatitis constantly grows, and physicians explain it with growth of volumes of the taken alcohol. About 30% of cases are called idiopathic pancreatitis. In this case the reason of appearance of a disease did not manage to be defined. This form usually develops at teenagers or people to whom for 50. 

There are also more rare reasons of appearance of pancreatitis:

- the cystous fibrosis causing destruction of internals;

- in an organism autoimmune processes which force own immune system to attack a pancreas of the person are activated;

- genetic disorders because of which the disease begins to develop with the birth.

When attacks of pancreatitis of acute form often repeat, they can provoke development of a chronic form of a disease and cause irreversible injuries of a pancreas. When these damages are caused by effect of alcohol, the disease is given the name of chronic alcoholic pancreatitis. 

Symptoms of chronic pancreatitis

The main symptom of a disease is the pain at the top of a stomach giving to a back. After meal and also at inclinations forward this bolyusilivatsya. Gradually business is complicated by appearance of nausea and vomiting. Together with development of chronic pancreatitis the ability of a pancreas to produce enzymes worsens, and new symptoms appear: 

- fat and fetid kcal;
-  enterospasms;
- abdominal distension;
meteorism

Because of destruction of the fabrics the pancreas loses ability to produce insulin therefore develops diabetpervy type. 

Diagnosis of pancreatitis

To diagnose pancreatitis rather difficult, for this purpose it is necessary to use a number of methods:

  • gastroscopy
  • Ultrasonography of abdominal organs
  • X-ray analysis of abdominal organs
  • computer tomography
  • complete blood count test
  • biochemical analysis of blood
  • analysis of urine

Gastroscopy allows to define degree of the involvement of a stomach and duodenum into inflammatory process. By means of the gastroscope the doctor can not only investigate digestive tract, but also take material for a biopsy. As a rule, this procedure is made under local anesthesia, but use and the general anesthesia is possible. In day of carrying out a research it is necessary to refuse food.

Ultrasonography of abdominal organs is performed to identification of changes in bodies of digestive tract including in a pancreas: narrowing of large vessels, presence of liquid in an abdominal cavity, etc. The computer tomography gives the chance to estimate a condition of abdominal organs. For its carrying out it is necessary to accept special contrast agent. Complete blood count test undertakes for inflammation existence identification. In pancreatitis the quantity of leukocytes will be increased. Biochemical analysis of blood allows to define whether internals well work and also to confirm the diagnosis. At damage of a pancreas the level of enzyme of amylase will be increased.

Treatment of pancreatitis

There are three rules of treatment of a bad attack of pancreatitis: hunger, cold and rest. This algorithm gives an idea of tactics of the doctor.

1. The first three days after development of a bad attack of pancreatitis the total rejection of food is necessary. Drink in unlimited number, mainly, clear water is allowed.

2. For removal of hypostasis and inflammation on area of a pancreas put a hot-water bottle with ice.

3. Bed rest and absolute rest. It reduces intensity of a blood-groove in all bodies including in a pancreas.

For stopping of a pain syndrome use narcotic analgetics. Saline solutions intravenously by drop infusion, infusions of plasma, albumine.

At a prompt course of a disease perform surgical treatment of pancreatitis: removal of a part of a pancreas, peritoneal lavage (washing of an abdominal cavity), etc.

After hungry days diet No. 5p on Pevznera is appointed to a week. Food in pancreatitis has to be fractional, is no more than 300 g are necessary to 8 times a day, portions. In the menu it is necessary to use food boiled, steamed, in a semi-fluid look, puree. Food temperature – 20-52C. Daily amount of proteins – 80 g, fats – 60 g, carbohydrates – 280 g.

Diet in pancreatitis

In pancreatitis it is extremely important to eat fractionally – the diet has to be broken into 5-6 small portions (it is impossible to overeat). It is the most preferable the wiped products – they do not irritate a mucous membrane of a stomach. On the chemical composition the diet has to include enough proteins (140-160 g) and only a minimum of fats (60-80 g). The share of carbohydrates also should be limited. Any products having sokogonny effect are subject to an exception (these are strong broths, cabbage broth and so forth). During exacerbation of pancreatitis it is desirable to refuse completely food (for 1-2 days). At any stage of a disease it is impossible to use hot and cold dishes.

Diet diet in pancreatitis

• Stale white bread
• Soups on weak vegetable or chicken broth
• The fast grades of meat and a dish prepared from them (souffle, meatballs, quenelles, etc.)
• Fish (sea, river)
• Steam omelets
• Any dairy products of low fat content
• Unsalted butter (in limited quantity)
• The refined vegetable oils
• Vegetables dishes (fresh vegetables – only in the ground look)
• Baked apples and pears
• Pasta and grain
• Compotes, kissels and other drinks (weak tea, broth of bran or dogrose and so forth)
• Jelly

Products which are under a ban:

• Strong fish and beef-infusion broths
• Millet and dishes with its participation
• Fat grades of a bird, meat and fish
• Any fried and hot dishes
• Refractory fats (mutton, beef)
• Garden radish, radish, cabbage, turnip, swede, sorrel and spinach
• Fancy bread and rye bread
• Sausages, canned food, smoked products
• Alcohol
• Ice cream

The drugs used at treatment of this disease:

Amikacin sulfate (Amikacini sulfas)
Ampioxum
Ampicillinum
Ampicillin sodium salt (Ampicillinum-natrium)
Ampicillinitrihydras
Amphoglucaminum
Amphotericinum in (Amphotericinum B)
Atropinum
Beclomethasone Dipropionas (Beclometasoni dipropionas)
Benzylpenicillin potassium salt (Benzylpenicillinum-kalium)
Benzylpenicillin sodium salt (Benzylpenicillinum-natrium)
Benzylpenicillin novocainic salt (Benzylpenicillinumnovocainum)
Betamethasonum
Bicillinum-1 (Bicillinum-1)
Bicillinum-5 (Bicillinum-5)
Halometasone
Heliomycinum
Gentamycini sulfas
Hydrocortisonum
Hydrocortisoni acetas
Hydrocortisone gemisuktsinat (Hydrocortisoni hemisuccinas)
Homatropine hydrobromide (Homatropini hydrobromidum)
Gordox
Gramicidinum
Cortexone acetate (Desoxycorticosteroni acetas)
Cortexone trimetilatsetat (Desoxycorticosteroni trimethylacetas)
Dexamethasonum
Depersolon
Doxycycline hydrochloride (Doxycyclini hydrochloridum)
Imipenem
Ingitrilum
Iruxol
Kanamycinum
Karbenitsillina disodium salt (Carbenicillinum-dinatricum)
Carfecillin
Clindamycin
Contrykal
Cortisonum
Laevovinisolu
Laevomycetinum
Levomycetinum stearate (Laevomycetini stearas)
Levomycetinum succinate soluble (Laevomycetini succinas solubile)
Levorinum
Levorinum sodium salt (Levorinum-natrium)
Lincomycin hydrochloride (Lyncomycini hydrochloridum)
Leaves of a henbane (Folia Hyoscyami)
Leaves of a dope (Folia Daturae stramonii)
Methylprednisolonum
Methioninum
Mycoheptinum
Microcidum
Monomycinum
Neomycinum sulfate (Neomycini sulfas)
Nigedaza
Nystatinum
No-Spa
Oxacillinum sodium salt (Oxacillinum-natrium)
Oxytetracyclinum hydrochloride (Oxytetracyclini hydrochloridum)
Oxytetracyclinum dihydrate (Oxytetracyclini dihydras)
Oleandomycinum phosphate (Oleandomycini phosphas)
Oletetrinum
Pancreatinum
Pancurmen
Pantrypinum
Papaverinum
Pentoxylum
Platyphyllinum
Polymyxin in sulfate (Polymyxini B sulfas)
M polymyxin sulfate (Polymyxini M sulfas)
Prednisolonum
Prednisolonhemisuccinas
Drugs of a belladonna (Folia Atropae belladonnae)
Primycin
Ristomycinum sulfate (Ristomycini sulfas)
Rifamycin SV
Sisomicin sulfate (Sisomycini sulfas)
Synaflanum
Synthomycinum
Scopolaminum
Somilasum
Tetracyclinum
Tetracycline hydrochloride (Tetracyclini hydrochloridum)
Tienam
Tobramycinum
Triamcinolonum
Triamcinolonum acetonide (Triamcinoloni acetonidum)
Unasyn
Phenoxymethylpenicillinum
Festal
Flumethasonum pivalat (Flumethasoni pivalas)
Fluodrocortisone acetate (Fludrocortisone acetate)
Fusidinum-natrium
Cephazolin
Cefalexinum
Cefaloridinum
Cefalotin sodium salt (Cephalotinum-natrium)
Cefoxitin
Cefoperazone
Cefotaxim
Ceftazidime
Ceftriaxon
Cefuroxim
Erythromycinum
Erythromycin phosphate (Erythromycini phosphas)
Eritsiklin 0.25 in capsules (Erycyclinum 0.25 in capsulis)

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