Biliary pancreatitis - A chronic inflammatory disease of the pancreas, that results from liver damage and ZHVP (bile ducts). Manifested biliary colic, dyspepsia, jaundice, diabetes, and weight loss. Diagnosis is made after the hepatobiliary ultrasound, CT scan or MRI of the abdomen, a series of functional tests. Conservative therapy is the introduction of anti-inflammatory and pain medications, enzyme replacement therapy, blood sugar level correction. A prerequisite for treatment is the observance of a strict diet and avoiding alcohol. Surgery is carried out in the presence of stones in the gallbladder. The lack of timely assistance in this disease can lead to serious complications, so patients with biliary pancreatitis must always be under the supervision of a gastroenterologist.
Chronic pancreatitis is a gallstone (cholelithiasis) - pancreatitis when it is detected in 25-90% of cases. Exacerbations of the disease is usually associated with migration for biliary stone paths. In this situation, the patient is recommended surgery. If the patient refuses surgery, it should be warned that the volume of intervention may be much wider after repeated colic. Timely treatment of diseases of the bile ducts leads to a decrease in the frequency of pancreatitis of biliary origin.
Gastroenterology opened another mechanism of the inflammatory process in the biliary pancreatitis - the formation of biliary sludge. In cholecystitis and subsequent dysfunction of the gall bladder is disturbed physical and chemical state of the bile, some of its components precipitate out to form a mikrokamney - this is the biliary sludge. In moving on ZHVP this precipitate traumatize mucosa, causing a narrowing of the duct and the papilla of Vater. Stenosis of the latter leads to disruption of bile flow in 12-duodenum, and it has thrown in the pancreatic ducts, as well as the secretion stagnation in the ducts of the pancreas. As a consequence of stagnation secret contained in the activation of pancreatic enzymes did not occur in the intestinal lumen and in the ducts. Damages the protective barrier of the pancreas, and the infection can easily penetrate into the prostate tissue.
Large gallstones can cause blockage of the common bile duct or sphincter of Oddi, which also lead to reflux of bile into the pancreatic duct.
Thus, biliary pancreatitis may develop in the following diseases: cholelithiasis, abnormal structure of the biliary and pancreatic ducts, gallbladder dyskinesia, DZHVP, chronic cholecystitis, liver cirrhosis, pathology papilla Vater (inflammation, spasm, stricture, obstruction of stone). To provoke the exacerbation of chronic pancreatitis may receive food or medication, has choleretic action, dramatic weight loss.
gastric ulcer and duodenal ulcers, intestinal tumors, antral gastritis, hepatitis, tumors of the pancreas, chronic calculous cholecystitis and others. Therefore, in the presence of the following symptoms should first eliminate these diseases, besides they can maintain a chronic inflammation of the pancreas.
In 90% of cases the dominant pancreatitis is a painful syndrome. Abdominal pain can be localized in the epigastric, radiate both hypochondria, right shoulder back. Usually pain appear after 2-3 hours after eating or at night, sometimes immediately after drinking carbonated beverages, triggering a spasm of the sphincter of Oddi. Most often the pain occurs after the breach diet - eating fatty, fried, spicy food and extractive. Pain may be accompanied by fever, nausea, occurrence of bitterness in the mouth. When complete blockage of the major duodenal papilla stone appears jaundice - colored skin, mucous membranes.
With the development of inflammation in the pancreas tissues violated its endo- and exocrine function. Endocrine disorders characterized by impaired carbohydrate metabolism (hyperglycemia or hypoglycemia during an attack), and exocrine - enzyme pancreatic insufficiency and subsequent failures in digestion. The patient noted stools several times a day, with grayish stool color, bold, offensive. Worried increased flatulence, rumbling in the abdomen. Dyspeptic symptoms also include belching, heartburn, loss of appetite. Against diarrhea, increased fat loss, digestive disorders there is a decrease in body weight. Are growing phenomenon deficiency of vitamins and minerals.
Biliary pancreatitis in the absence of proper treatment can have a number of complications. By early include dysfunction of other organs and systems (shock, acute liver failure, acute renal failure, respiratory failure, encephalopathy, gastrointestinal bleeding, bowel obstruction, abscess, pancreas, pancreatic, diabetic coma, jaundice mechanical origin) and late complications (pseudocyst, ascites , fistulas, bowel narrowing).
Biochemical analysis of blood in chronic pancreatitis of biliary origin marked inflammatory changes, increased levels of bilirubin, alkaline phosphatase and cholesterol, and decrease the ratio of the violation of essential proteins. The level of amylase in urine and blood increases in 3-6 times. Changes in coprogram usually occur after loss of function in more than 90% of the exocrine cells: muscle fiber is undigested, starch, neutral fat. It held a series of tests with the introduction of substances in the stomach, which under the action of pancreatic enzymes should be cleaved to release the specific markers. In the presence of these markers in the blood are judged on the exocrine function of the pancreas.
Pancreatic holding ultrasound of the hepatobiliary system, and ultrasound to evaluate the presence of stones in the GVP and pancreatic ducts, the general condition of the pancreas. The most efficient in detecting intraductal stones or endoscopic ultrasound. A more informative method (90%) is a CT biliary tract, especially if it is carried out with the introduction of contrast medium. ERCP and MRPHG also widely used in the diagnosis of diseases of the biliary and pancreatic ducts.
Gastroenterologist, endoscopist and surgeon. The main condition for stopping the progression of the disease and prevention of exacerbations is a cure the underlying disease. If necessary the removal of the stones or the improvement of the major duodenal papilla (preferably endoscopic method).
At an exacerbation of the disease treatment should include removal of pain (analgesics and antispasmodics), correction of internal and external secretory function of the pancreas, detoxification, prevention of infectious complications (antibiotics). Usually in the first three days of exacerbation recommended fasting should drink carbonated alkaline mineral water. Upon the resumption of the power should be limited to the amount of fat in the diet is strictly take into account the intake of carbohydrates. Food should be taken frequent meals, subject to mechanical and thermal schazheniya. In order to reduce the destructive effects of activated pancreatic enzymes assigned somatostatin, proton pump inhibitors, protease inhibitors. To restore enzyme dysfunction pancreatic enzymes microspheres are assigned, and to normalize the blood sugar level - hypoglycemic agents. Surgical treatment is carried out only in the presence of stones and pathology of the sphincter of Oddi.
Prediction and prevention of biliary pancreatitis
The prognosis for timely treatment of calculous cholecystitis and cholangitis favorable. Failure to timely surgery may lead to a deterioration of the process, it may take an extended surgery with subsequent exacerbation. Failure to comply with dietary recommendations, refusal of treatment, the use of alcohol a poor prognosis.
Prevention of this form of chronic pancreatitis is a timely diagnosis and treatment of diseases of the hepatobiliary system, if necessary - surgical removal of the stones. If you have symptoms of biliary pancreatitis for the prevention of exacerbations should be a diet, avoid the use of choleretic Food and Drug Administration. It should be regularly examined by a gastroenterologist (annually).