Enzyme pancreatic insufficiency - Causes, Symptoms, Diagnosis and Treatment
Enzyme deficiency pancreas. - Limited secretion or low activity of pancreatic enzymes, leading to a breach of digestion and absorption of nutrients in the gut. Manifested progressive weight loss, bloating, anemia, steatorrhea, polifekaliey, diarrhea and polyhypovitaminosis. Diagnosis is based on laboratory research methods exocrine pancreas, carrying coprogram, determining the level of enzymes in the feces. Treatment includes treatment of the underlying disease, normalization of nutrients entering the body, the introduction of substitution of pancreatic enzymes, symptomatic treatment.
Enzyme deficiency
pancreas.chronic pancreatitis. However, the pancreatic enzyme insufficiency production is a serious condition that can lead to a marked depletion and even death of the patient in the absence of adequate treatment. Practical research in the field of gastroenterology focus on the development of modern enzyme preparations that can fully replace the exocrine function of the pancreas and provide normal course of digestion.
pancreatic cancer, cystic fibrosis, fatty degeneration of the pancreas on the background of obesity surgery on the pancreas, congenital deficiency of enzymes Shvahmana syndrome, agenesis or hypoplasia of the prostate, Johanson-Blizzard syndrome. Pathogenic mechanisms of exocrine pancreatic insufficiency include: atrophy and fibrosis of the pancreas (as a result of obstructive, alcohol, or nekalkuleznogo calculous pancreatitis, atherosclerosis, age-related changes, systematic malnutrition, diabetes, surgeries on the pancreas, hemosiderosis); pancreatic cirrhosis (is the outcome of certain forms of chronic pancreatitis - syphilitic, alcoholic, fibro-calculous); pancreatic necrosis (death of part or all of the cells of the pancreas); the formation of stones in the pancreatic ducts.
Secondary pancreatic enzyme insufficiency develops when lesions of the mucous membrane of the small intestine, gastrinoma, operations on the stomach and the intestine, suppression of secretion of enterokinase, malnutrition, diseases of the hepatobiliary system.
Specific enzyme pancreatic insufficiency due to suppression of secretion of enzymes and bicarbonate to reduce the amount of background organ parenchyma. Relative insufficiency is associated with a decrease in revenues of pancreatic juice into the intestine due to obstruction of the lumen of the pancreatic duct stones, tumors, scars.
maldigestion syndrome (digestion depression in the lumen of the intestine). The undigested fat, getting into the lumen of the colon, stimulate the secretion of colonocytes - formed polifekaliya and diarrhea (liquid stools, increased in volume), stool is fetid odor, color gray, the surface is greasy, shiny. The chair may be visible clumps of undigested food.
Maldigestion of proteins leads to the development of malnutrition, manifested by progressive weight loss, dehydration, lack of vitamins and minerals, anemia. On the ongoing weight loss is greatly influenced by adherence to diet with reduced fat and carbohydrates, as well as the fear of eating, emerging in many patients with chronic pancreatitis.
Dysmotility of the stomach (nausea, vomiting, heartburn, feeling of fullness) may be associated with exacerbation of pancreatitis, as well as an indirect influence exocrine pancreatic insufficiency due to violations of gastro-intestinal regulation of duodeno-gastric reflux and others.
celiac disease, hepatitis, after resection of the stomach.
Indirect Lund test probe is similar to the previous method, but the stimulation of pancreatic secretion produced by the introduction of a test probe food. This research is easier to hold (does not require the injection of expensive drugs), but the results are largely dependent on the composition of the test meal. False positive result is possible when a patient has diabetes, celiac disease, gastrostomy.
In tubeless based methods is the introduction of certain substances in the body that can interact with the enzymes in serum and urine. Investigation of metabolic products of the interaction makes it possible to evaluate the exocrine function of the pancreas. For tubeless tests include bentiramidny, pancreatitis-lauryl, yodolipolovy, trioleinovy and other methods.
In addition, to determine the level of pancreatic secretion can and indirect methods: by the degree of absorption of plasma amino acids pancreas by qualitative analysis coprogram (to be increased content of neutral fats and soap on a background of normal fatty acid level), the quantitative determination of fecal fat, fecal chymotrypsin and trypsin elastase-1.
Instrumental diagnostic techniques (radiography of the abdomen, MRI, CT, ultrasound of the pancreas and hepatobiliary system, ERCP) are used to identify the main and concomitant diseases.
smoking.