Diseases of the pancreas

The pancreas is very important in its functional significance for the body. It is difficult to imagine that the state of the whole metabolism, the process of digestion, depends on the work of an organ weighing 80-100 g. In one hour, iron produces 20 mg of enzymes. They are together with predecessors of more than 20 varieties.

Symptoms of pancreatic disease reflect a malfunctioning organ, so they are similar in pathology of a different genesis. Diseases differ with the flow, predominant manifestations, laboratory and other diagnostic features.

Statistics

The variety of diseases of this small organ, which is also the endocrine gland, worries doctors from different countries, the increase in prevalence for the decade is 4 times, almost 2 times among adolescents. And also a serious outcome: lethality from pancreatonecrosis persists in certain regions at a level of 90%.

Situation analysis draws attention to the increased connection of pancreatic diseases with alcoholism among people of working age, with cholelithiasis - in patients after 65 years of age.

The prevalence of cases of pancreatic dysfunction is not calculated, since this type of lesion occurs against the background of other major diseases of the digestive, nervous and endocrine systems.

The most common diseases are acute pancreatitis( 3.5-4 per 1000 people), chronic - up to 9% of all diseases of the gastrointestinal tract. Moreover, mortality from pancreatitis in all developed countries is kept at the level of 25-35%.

Cancer is defined in 10 cases per 100 thousand population. It is considered a rare disease, but is dangerous because of the difficulties of diagnosis and the lack of funds for radical treatment. From what anatomic structures of the pancreas depends the functioning of the organ?

The pancreas is located according to the name in the depth of the abdominal cavity and touches the zone of the duodenal head, and the tail - the spleen. A feature of morphology is a thin shell and weak partitions between the lobules.

The gland is surrounded by organs with which it is linked by joint blood supply and innervation. Direct contact with the common bile duct occurs through a common outlet in the pharynx of the papilla of the duodenum.

The main duct of the gland is infused with lobular branches

Smooth muscle fibers form the sphincter of Oddi, which regulates the joint release of the secretion of the pancreas and bile, and also protects the tissues from reflux( reverse) casting. For a day, iron produces up to 2 liters of juice. The composition includes: proteins, calcium, sodium, potassium, enzymes and water. From protein components up to 90% goes to enzyme systems.

On the rate of secretion, the organ is in second place after the lactating mammary gland. The acini and ducts form the exocrine part, and the islets from the four cell types( Langerhans) perform the endocrine role. The most important hormone is insulin. It affects the regulation of blood glucose.

In violation of production, the concentration of glucose in the blood grows, first of all, the carbohydrate metabolism suffers, which leads to a known disease - diabetes mellitus. Islets of Langerhans are able to disrupt hormone secretion in pancreatitis, tumors, injuries and other damaging factors. Therefore, in such cases, there is hyperglycemia.

Classification of pancreatic diseases

A single classification of all diseases of the gland does not exist. For each pathology, there is a clinical diagnostic system. According to the pathogenetic principle and taking into account the causes of diseases of the pancreas can be identified separately:

• functional disorders;
• inflammatory diseases( pancreatitis);
• vascular injury;
• calcification( calculous pancreatitis);
• cystic changes;
• professional intoxication;
• neoplasm;
• diabetes;
• specific processes with syphilis, tuberculosis;
• infection with parasites.

Causes of pathological disorders

Problems with the pancreas can arise for various reasons. An improper diet with excessive consumption of fatty and protein-rich foods gives a high constant load for the pancreas to produce the necessary enzymes, as a result, the exhaustion and malfunction of production, the destruction of the cells of the body occurs.

Alcoholism - a regular dose of ethanol in the blood requires its elimination, leads to increased liver function, disrupts the bile output. In this case, the tissues of the pancreas are exposed to toxic action.

A dysfunction of the sphincter causes overflow of the main duct and lobes. Enzymes begin to melt their own cells. In the same way, narcotic substances are affected.

Stresses and an increased nervous load contribute to the violation of the regulation of internal organs. Changes from functional ones turn into aseptic inflammation( pancreatitis).

Some drugs( antibiotics of the tetracycline group, corticosteroids, estrogens) differ in the toxic effect on the pancreas.

Alcohol, nicotine( smoking) are an important component of atherosclerotic lesions of the arteries. This process affects the nutrition of the pancreas, leads to oxygen deficiency( hypoxia), disrupts the functioning of cells.

Pregnancy is considered a normal physiological act. However, if a woman has a functional pancreas insufficiency, a disturbed diet, a predisposed heredity for the future mother's organism, it is difficult to provide an increased load. Vascular depression in the last stage of pregnancy aggravates the situation.

The blood supply to the body is affected by age-related changes. Severe atherosclerosis disrupts the nutrition of cells, contributes to the malfunction of the pancreas, secretion production.

Chronic infectious processes in tuberculosis, syphilis in prolonged course without treatment can cause specific changes in the gland tissue with subsequent inflammation and impaired functioning. Inflammation of the gland can occur with acute infection( influenza, in children against the background of chicken pox, measles, scarlet fever).In childhood, pathology is caused by worms.

Migrated abdominal trauma during a fight, sports training further promotes the formation of cystic cavities, tumor growth

Autoimmune processes in the human body are increasingly recorded in pancreatitis, require a complex approach to therapy.

Common symptoms of the pathology

Symptoms of pancreatic disease are caused by edema and organ enlargement, capsule stretching, stagnation, melting of tissues under the action of their own enzymes, attachment of infection with subsequent inflammation.

How intensively they are expressed depends on predisposing factors, the etiology of the disease. Any diseases in manifestations are related by the same symptomatology. Pain - refers to the prevailing symptom. They are localized in the upper part of the abdomen, irradiate into the interscapular region, the left shoulder, back, can take a shingling character.

Less often the pain is blunt constant. Typically, a decrease in intensity after applying cold and strengthening from a warmer. Patients are characterized by a pose lying on their side with their knees drawn. With palpation of the abdomen, pronounced tenderness is determined in the epigastric region, the hypochondrium on the left, is a positive symptom of Pasternatsky( loosening on the waist, usually used in the diagnosis of pyelonephritis).

Dyspeptic disorders with blunt pains come to the forefront. They can be the first( initial) signs of pancreatic damage, when a person after a drink with a snack of meat dishes and sharp salads, every time there is diarrhea, vomiting.

Symptoms are first taken for poisoning. But draw attention to the fact that none of those who took part in the feast did not suffer. With repeated manifestations, the reason becomes more understandable. The chronic process in the pancreas leads to persistent diarrhea, weight loss, and lack of appetite.

The patient feels disgust for food, smells. Feces with diarrhea contain a significant amount of unprocessed fat, therefore it has a characteristic foamy appearance with a brilliant shade. Because of a disturbed digestion, the patient is worried about heartburn, bloating. The defeat of the endocrine function of the pancreas is suspected when the patient complains of constant hunger, a desire to drink, a skin itch.

Methods of diagnosis

After finding out the clinical manifestations and examination, the doctor advises to undergo a survey to find out the nature of the pathological process in the gland. This will require the results:

• total blood analysis, for enzymes( lipase, amylase, protease), for glucose, protein fractions, liver tests;
• analysis of urine total, on bilirubin, diastase, sugar;
• stool analysis showing excess fat and undigested proteins;
• duodenal sensing with the detection of a high concentration of enzymes in the duodenum;
• ultrasound study.

To determine the patency of the bile duct, cholecystography is performed.

If a tumor is suspected, more accurate diagnosis is recommended using magnetic resonance imaging and computed tomography(

). Why do functional disorders arise?

Functional is the temporary signs of a violation of the secretion in the pancreas that arise:

• with exacerbation of chronic diseases of the stomach, liver, intestines, biliary tract;
• endocrine pathology - diabetes, changes in the thyroid gland, adrenal glands, pituitary gland.

Insufficient production of pancreatic enzymes( amylase - splits starch to glucose, lipase - fats fatty acids into glycerol and fatty acids, proteases - divide proteins into molecular compounds) causes temporary digestive difficulties. With prolonged action of the defeat factor, functional disorders become a disease of the gland.

Major diseases

Inflammatory diseases of the pancreas differ in duration and severity of symptoms( acute and chronic), the morphological form of the chronic process( obstructive, calcifying, fibrous).

There is a division according to the etiological character:

• on primary - include alcoholic, alimentary, ischemic, medicinal, idiopathic;
• secondary - parasitic, viral, with diseases of the liver and biliary tract, hereditary forms.

In addition, forms are distinguished for the revealed secretory insufficiency, complications. Acute pancreatitis - is caused by "self-digestion" of the gland tissue with its enzymes. The symptomatology is very pronounced. Patients, as a rule, enter the surgical department of the hospital with a diagnosis of "acute abdomen" and require constant monitoring and intensive care.

The general condition of the patient is seriously affected. With pancreatic necrosis, the release of enzymes into the blood is accompanied by a toxic shock with a sharp drop in blood pressure, a frequent weak pulse. Delay in emergency care is fatal.

Chronic inflammation takes a long time. Pancreatitis alternates with exacerbations and remissions. Gradually, part of the parenchyma is replaced by scar tissue. Signs are intensely expressed with exacerbations, in the period of remission, dull pains, diarrhea, nausea are possible. It is often accompanied by symptoms of diabetes mellitus.

Circulatory disorders

Vascular changes due to atherosclerosis, thrombosis cause pancreatic damage in hypertension, heart failure, endocarditis, elevated pressure in the portal vein system associated with cirrhosis of the liver.

Reduced blood flow leads to ischemia followed by necrosis of the sites. Thrombophlebitis promotes inflammation of the body. Clinically, manifestations do not differ from pancreatitis.

Calculous pancreatitis

Stones are formed when stagnation occurs in the ducts of the pancreas. Their dimensions can reach several centimeters. Most often they are formed from salts of phosphates and carbonates. The very stagnant symptoms are caused by chronic pancreatitis.

The disease is more typical of men. Congenital pathology of mineral metabolism or, for example, parathyroid tumor is important. The process of calcification of the parenchyma accompanies tissue necrosis in acute pancreatitis. It manifests paroxysmal pains. It is often complicated by diabetes mellitus. Treatment is only prompt.

Cystic changes

Cystic changes in the pancreas appear as a congenital malformation, then they are detected already in childhood, they are acquired, the consequences of injuries, parasitic diseases, inflammations. They can be single or multiple. They are saccular formations with liquid contents.

Signs of a pancreas problem with cysts are in addition to permanent abdominal pain suppuration, bleeding. The risk of switching to a cancerous tumor is high. Therefore, great importance is attached to timely diagnosis and surgical treatment.

Cystic changes can be combined with carcinoma

Occupational diseases

Pancreatic intoxication is noted in workers in the oil refining industry where there is contact with high concentrations of styrene and divinyl. They occur quite rarely simultaneously with cholecystitis.

Pain syndrome manifests itself moderately, a person complains of nausea, frequent diarrhea, bloating. With timely diagnosis, discontinuation of contact with occupational hazards and treatment, the recovery prognosis is favorable.

Neoplasms

To benign tumors of a gland concern: an adenoma, a fibroma, a lipoma, a hemangioma, a neurinoma, a myoma. They are formed from mature cells. Small sizes do not cause manifestations. If the tumor produces gastrin, the patient's acidity increases and a stomach ulcer develops. Large sizes help squeeze the vessels and ducts. To prevent consequences, you must delete them.

Cancerous tumors are characterized by persistent flow, intense pain, weight loss, when squeezing the bile duct appears jaundice of the skin and mucous, itching. Cure is possible only in the early stages. With late detection, the forecast is poor. Cancer with localization in the pancreas is on the fourth place in mortality from malignant neoplasms.

Specific inflammation in tuberculosis and syphilis

The development of a specific process is suspected by doctors if the patient has signs of pancreatitis against long-term pulmonary tuberculosis or chronic syphilis. The patient is depleted because of frequent diarrhea and impaired digestion of food. The probability of recovery is determined by the intensity of the main process.

Infection with parasites

Parasitic pancreatic lesions are rare. Ascaris capable of getting into the ducts cause plugging of the main course. Similarly, the pathogenesis of lesions with dwarf chain and trematodes develops. Inflammation develops in the tissues. Echinococcus promotes a picture of pancreatitis or a tumor. The patient needs specific drugs.

The drug showed good results in application before and during pancreatic surgery, helps to reduce the frequency of postoperative complications

Pancreas treatment

In the treatment of pancreatic diseases it is important to adhere to the basic tactics:

• to conduct a thorough examination to exclude a malignant tumor;
• is strictly forbidden to the patient to smoke and take alcohol;
• with severe pain syndrome for 1-3 days prescribed hunger, it is allowed only to drink water, broth of wild rose, further diet is agreed with the doctor;
• to relieve pain, antispasmodics are used, in tumors - narcotic analgesics;
• it is necessary to create conditions for "functional dormancy" of the pancreas, using H2-histamine receptor blockers( Ranitidine, Kwamatel), M-holinoblockers( Gastrotsepin), Octreotide secretagogue, which remove spasm of Oddi's sphincter;
• for the elimination of inflammation appoint antibiotics( aminopenicillins, macrolides, cephalosporins, aminoglycosides, metronidazole);
• in order to inhibit the production of excess enzymes as a cause of high pressure in the ducts, preparations containing proteases are prescribed;
• in a serious condition, it is necessary to remove intoxication with the introduction of solutions;
• in case of toxic shock, anti-shock therapy is performed;
• in case of cyst, tumor, stone, parasitic invasion should be faster to decide the expediency of surgical treatment;
• symptomatic therapy is connected after the elimination of acute symptoms.

Patients with pancreatic diseases should follow a diet all their lives. Maintain a functional state by taking enzyme preparations, medicinal herbs. Persistent or intense symptoms require a doctor. From the speed of diagnosis depends on the successful disposal of the disease.