Chronic pancreatitis: diagnosis and treatment
Chronic pancreatitis is a group of diseases (chronic pancreatitis variations), which are characterized by different etiological factors, the presence of pancreatic necrosis, focal segmental fibrosis at the background of the development of functional insufficiency of varying severity. Progression of chronic pancreatitis leads to the emergence and development of glandular tissue atrophy, fibrosis and connective tissue replacement of the cellular elements of the pancreatic parenchyma. According to a number of recent publications, the disease has the following stages: the initial period, the stage of exocrine (exocrine) pancreatic insufficiency and complicated variant of chronic pancreatitis - tumors of the body; but, apparently, there are other options of chronic pancreatitis that can be considered.
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In principle, for the diagnosis of acute exacerbations of chronic pancreatitis, including the possible complications of this disease, the following methods are typically taken advantage of:
- to assess the activity of the inflammatory process in the pancreas the levels of amylase, lipase, various ‘inflammatory’ cytokines (interleukins I, II, VI and VIII, tumor necrosis factor (TNF-a), platelet-activating factor (PAF), etc.) are determined;
- elastase test (enzyme immunoassay) is conducted;
- to determine the state of exocrine pancreatic insufficiency an analysis of clinical data to assess the amount (volume) of the selected patients feces is carried out, also aiming at determination of the presence/absence of steatorrhea and creators;
- in order to identify organic lesions of the pancreas and nearby organs instrumental methods: survey radiography, ultrasonography (US), computed tomography, esophagogastroduodenoscopy with endoscopic cholangiopancreatography, radionuclide cholecystography and/or intravenous cholangiography are used;
- to identify tumors of the pancreas the study of tumor markers (CA 19-9, EEA), aiming laparoscopic or operating (open) so-called "fine needle" biopsies are made.
The treatment of patients with chronic pancreatitis is largely dependent on the severity of its complication (including the presence or absence of various complications), exhibits different, more or less pronounced symptoms in pain, dyspeptic, hypoglycemic, so-called ‘metabolic’ and/or icteric variants. It is oftentimes hardly possible to find out a particular clinical reason.
The basic approach to the treatment of patients with chronic pancreatitis in order to improve their condition involves, if necessary, the following therapeutic measures:
- elimination of pain and dyspeptic disorders, including clinical manifestations of endocrine and exocrine pancreatic insufficiency;
- elimination of inflammatory changes of the pancreas and other organs associated lesions, allowing in some cases prevent the occurrence of complications;
- surgical treatment;
- prevention of complications and rehabilitation of patients;
The appearance of complications of chronic pancreatitis is largely determines the progression of the disease, and often significantly alters (increases) the clinical manifestations of chronic pancreatitis.
In marked exacerbation of chronic pancreatitis in the first 2-3 days the patient is recommended to stick to a diet, taking hydro-chloride liquids (mineral waters) 200-250 ml 5-7 times a day (in order of inhibition of secretion pancreas). In the case of treating patients in need apply means intended for enteral and parenteral nutrition. After getting back to normality, patients are not recommended to use fatty and spicy foods, sour apples and fruit juices, alcoholic and soft drinks.
In principle, the treatment of chronic pancreatitis, depending on their condition, different medicines: reducing pancreatic secretion, often antacids (Aluminium phosphate gel, Maalox, Almagel); antagonists, histamine H2-receptors (zantac, quamatel); proton pump inhibitors (omeprazole, rabeprazole, esomeprazole, lansoprazole, etc.); anticholinergics (gastrotsepin, atropine, platifillin et al.); enzyme preparations (in exacerbation of chronic pancreatitis), in the absence of exocrine pancreatic insufficiency - panzytrat 20,000 or 25,000 creon, one capsule every three hours or 2 capsules 4 times a day during the period of fasting (within the first three days) and one capsule at the beginning and end of the resumption of food intake after ingestion. At equivalent doses other enzyme preparations that do not contain in its composition bile acids can be used.
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