Pseudotumor pancreatitis - causes, symptoms, diagnosis and treatment
Pseudotumor pancreatitis - Clinical and morphological form of chronic inflammation of the pancreas characterized by hypertrophy of the parenchyma and increasing body size. The clinical picture is dominated by symptoms of jaundice, endocrine disease, characterized by dyspeptic symptoms and pain. Diagnosis is based on an assessment of the patient's complaints, anamnesis, data instrumental examinations (ultrasound and CT scan of the pancreas), as well as methods of exclusion pancreas tumor. Treatment is based on relieving pain, normalization of outflow of pancreatic juice, the compensation of the external and endocrine insufficiency.
Pseudotumor pancreatitis
chronic pancreatitis which is characterized by inflammation, hypertrophy and fibrosis partially parenchyma. Hallmarks of this form is the presence of local, sometimes quite marked increase in the size of one of the parts of the pancreas, as well as the formation of high density lesions. That is why it is important to differentiate between pancreatitis pseudotumor with oncopathology body. Most often affects the head of the pancreas, so the clinic can prevail jaundice and obstructive variant of portal hypertension.
Accurate statistics on the epidemiology of pseudotumor no pancreatitis because lifetime gland biopsy material is extremely rare, but in the field of gastroenterology experts note an upward trend in incidence. Complete information on the prevalence of absent and due to different approaches to the evaluation of disease: many patients with pseudotumor pancreatitis treated as individuals with cholelithiasis, chronic intoxication with alcohol, duodenal papillitis and other diseases.
gallstone disease and other liver and biliary tract diseases) - more than 80% of all cases are caused by these reasons. Less pseudotumor pancreatitis is a consequence of taking certain medications, and other systemic diseases. It is believed that pseudotumor pancreatitis of alcoholic etiology develops after the acute process, only 10% of cases, while episodes of acute pancreatitis is diagnosed more often in the background of the prolonged chronic inflammation. It is proved that the probability of chronic significantly increased in smokers.
Pseudotumor Biliary pancreatitis (biliary pancreatitis) in about half of cases is the result of gallstones; often this form of disease is recorded in women, the risk of its development is determined by the duration of the underlying disease and the localization of stones. By etiological factors of biliary pancreatitis type also includes congenital biliary tract disease papilla of Vater and common bile duct. The pathogenesis of pancreatitis in this case is characterized by a constant reflux into the pancreatic duct bile aggressive. An important mechanism is also lymphogenous defeated pancreatic tissue, mainly of the pancreatic head, in which the inflammatory process with the gall bladder extends through the chain of lymph nodes.
Drug pseudotumor pancreatitis develops during chronic administration of acetaminophen, estrogen and other drugs. Also, chronic pancreatitis with hypertrophy of the parenchyma may have a genetic etiology: this form is characterized by a systematic progression, increase of endocrine and exocrine organ failure, a high risk of malignancy.
dyspeptic syndrome, steatorrhea).
Despite the fact that pain pathognomonic for pancreatitis, Pseudotumor form it only occurs in 30-40% of patients. The pain is usually localized in the epigastric and right upper quadrant occurs after a heavy meal, especially fat is stored for two to three hours. nature dyspeptic complaints include nausea, vomiting, as well as related to the deficiency of the enzyme and a violation of the digestive cavity weight loss and diarrhea.
cancer of the pancreas head. gastroenterologist consultation reveals some typical signs: as a feature of pseudotumor pancreatitis is an increase in body size, in most cases, pancreatic head can be palpated through the abdominal wall. Some patients have revealed local tenderness on palpation of the pancreas.
In laboratory analyzes are no clear signs of the disease: a possible increase in trypsin, lipase, amylase blood and urine during an exacerbation or during the pain episode. More than 90% of patients with pancreatitis Pseudotumor disturbed glucose tolerance, as determined in the analysis of fasting and after glucose load. All patients suspected of having this pathology is conducted to determine the level of tumor markers (CA 19-9 CA 125 carcinoembryonic antigen), which eliminates pancreatic cancer. With the same aim determined level of pancreatic polypeptide, which when reduced inflammation, and increased malignancy.
A highly informative diagnostic method pseudotumor pancreatitis - ultrasound of the pancreas. This study is to determine the degree of increase in the body, characteristic changes in the parenchyma and ducts, the presence or absence of calcifications. To clarify the changes and exceptions slowly growing carcinoma performed CT scan or MRI of the pancreas. For the purpose of visualization of the main pancreatic duct and clarify the nature of the changes it performed ERCP. In some cases, require angiography of the pancreas for further diagnosis (selective tseliakografiya).
cholecystectomy with cholelithiasis, papillostenoza removal and other activities).
The main purpose of medical treatment is the correction of exocrine and endocrine pancreatic insufficiency. Appointed enzyme preparations - pancreatin in combination with a lipase or solizimom. Insufficient secretion of bicarbonate is compensated by the use of antacids, which, when combined with calcium supplementation also reduces steatorrhea.
To reduce dyskinetic phenomena sphincter apparatus appointed anticholinergics. Pain relieved by the reception of atropine antispasmodics. A good antispasmodic effect in respect of the sphincter of Oddi have Odeston, duspatalin. During exacerbations of basic therapy also includes antibacterial drugs. When drug therapy ineffective gland swelling and hypersecretion of enzymes used Regional radiotherapy and local hypothermia.
In the treatment of pancreatitis pseudotumor highly endoscopic techniques. The indications for such intervention are to increase the head of the pancreas with compression of the common bile duct and obstructive jaundice and papillostenoz, stricture prepapillyarnogo department. In such cases, decompression is performed papillosphincterotomy ductal system.
Prediction and prevention of pancreatitis pseudotumor
The prognosis for this form of the disease relatively favorable: pseudotumor pancreatitis is characterized by infrequent exacerbations, slow progression; endocrine insufficiency (pancreatogenic diabetes) rarely leads to nephropathy and angiopathy. Early treatment, as well as compliance with the recommendations in the periods of remission can prevent progression. Prevention is to limit the use of alcohol, potentially dangerous drugs, timely treatment of diseases, which may cause pseudotumor pancreatitis.