Fibrosis of the pancreas - Causes, Symptoms, Diagnosis and Treatment
Fibrosis pancreatic - Diffuse peri- and intralobulyarnoe substitution healthy functioning pancreatic tissue connective centers. The main symptoms are severe exocrine (digestive disorders, weight loss, diarrhea) and endocrine organ failure (impaired carbohydrate metabolism). Diagnosis involves performing laboratory tests, ultrasound of the pancreas, CT biopsy. Treatment is aimed at correcting exocrine insufficiency (enzyme preparations), hyperglycemia. Prognosis is poor: a complete cure is not possible, if adequate treatment is achievable compensation pancreatic insufficiency.
fibrosis of the pancreas.
gastroenterology, internal medicine, surgery.
chronic pancreatitis. The specialists proved that the substitution of the centers operating elements of connective tissue formed during periods of acute inflammation, and their prevalence is dependent on the length of the disease. By the recurrence and progression of the underlying pathology of fibrosis of the pancreas often results in the use of alcohol, but contribute to factors such as the abundance of fat in the diet foods, lack of vitamins and antioxidants, trace elements. An important role in the development of fibrosis plays a tobacco that violates bicarbonate secretion by the pancreas and predispose to the growth of connective tissue.
Fibrosis of the pancreas can also occur with diseases involving increased pressure in the ductal system of the pancreas (the pathology of the bile ducts and gall bladder): pancreatic hypertension leads to disruption of the integrity of the ducts, damaged parenchyma inflammation. The rare reasons pancreatic fibrosis include hyperlipidemia, cystic fibrosis, exposure to toxic substances (including drugs: hydrochlorothiazide, acetylsalicylic acid and other), trauma.
Regardless of provoking factors, pancreatic fibrosis is a consequence of its autolysis parenchyma activation of proteolytic enzymes, edema, necrosis and infiltration. The pathogenesis of the disease when exposed to alcohol has the features: as a result of damage to the alcohol content decreases in pancreatic juice and bicarbonates increases the protein level, whereby the protein precipitates as small plugs obturating ducts, creating the conditions for the formation of fibrosis of the pancreas.
diarrhea up to eight times a day (while taking enzyme preparations and observance of the diet the patient the feature may be less pronounced or even absent), steatorrhea. Due bicarbonate secretion disorders intraduodenal pH value is reduced, which leads to activation of cAMP and intestinal wall cells secretory diarrhea: watery stool is observed. Weight loss is caused not only a violation of the digestion of food and its absorption in the intestine, but also limiting its scope in pain syndromes. Long steatorrhea in fibrosis of the pancreas leading to a deficiency of fat-soluble vitamins (C, A, E, D), which is manifested in violation of adaptation in dark conditions, bleeding disorders, osteoporosis.
The vast majority of patients has been a violation of carbohydrate metabolism, and two-thirds - signs of diabetes (dry mouth, thirst, weakness, pruritus, somnolence). As fibrotic changes affect all the cells of the islet apparatus gland secretion and decreased insulin, and glucagon. Diabetes in pancreatic fibrosis rarely accompanied hypoglycemic states, ketoacidosis, angiopathy.
gastroenterologist in fibrosis of the pancreas reveals some objective evidence of disease: degenerative changes (up to cachexia), dry skin, tongue, cyanosis, facial flushing, atrophy of subcutaneous fat in the projection of the pancreas. The pancreas is palpated as a thick strand. The laboratory analysis determined a pronounced decrease in blood protein, reducing albumin-globulin ratio. The activity of pancreatic enzymes including amylase, low (this is an unfavorable sign, indicating the total defeat of the pancreas).
An important method for diagnosis of fibrosis of the pancreas - ultrasound of the abdominal cavity (abdominal ultrasound). Determined diffuse increase in echogenicity body, heterogeneous structure, the dimensions are reduced; identify possible expansion Wirsung flow. More informative endoscopic ultrasonography, which allows you to identify the linear tyazhistye inclusion of different lengths and shapes, contours tuberosity, hyperechogenicity parenchyma. During the ERCP revealed changes ductal system, caused by scarring.
CT scan of the pancreas may be performed to confirm the diagnosis. If this diagnostic method does not provide the necessary information, it performed a biopsy of the pancreas, which is the "gold standard" for diagnosing fibrosis of the pancreas and allows you to get reliable data on the morphological changes of the body.
Cholecystectomy in cholelithiasis, surgical treatment, and so papillostenoza. d.).
With a view to the replacement of exocrine insufficiency appointed enzyme preparations: pancreatin, Creon, lipase, and others. When the absolute failure of the pancreas, these drugs are used constantly at maximum doses. The criteria for the effectiveness of substitution treatment is to stop the decline in body weight, reduction of dyspeptic symptoms, elimination of diarrhea. Correction of carbohydrate metabolism disorders is conducted with oral hypoglycemic agents; rarely require insulin therapy. Regardless of the underlying disease exacerbation episodes shown spa treatment.
When expressed pain syndrome, the ineffectiveness of conservative therapy, rapid weight loss, frequent relapses pancreatitis surgical treatment of fibrosis (pancreatectomy in varying amounts).
Prediction and prevention of fibrosis
pancreas.The prognosis of pancreatic fibrosis determined by the volume of functioning tissue, as well as compliance with the recommended treatment of the patient. A full life-long refusal of alcohol, the correct application of enzyme preparations possible prolonged course of the disease without significant progression. However, there are methods to eliminate fibrosis.
Prevention of disease is to avoid alcohol, timely treatment of diseases that can cause fibrosis of the pancreas. Patients diagnosed with fibrosis are subject to clinical examination. Twice a year, you must provide preventive care with the assessment of the presence or absence of progression and conduct therapy correction (if necessary).