Acute pancreatitis
- Sudden intense pain in the upper abdomen, often girdling, radiating to the back
- The pain intensifies when lying on your back and decreases when sitting and bending forward.
- Repeated vomiting without relief
- Bloating, stool and gas retention
- Possible increase in temperature, rapid pulse, drop in blood pressure
First aid before the ambulance arrives: hunger, rest, cold on the upper abdomen. You cannot take painkillers (they blur the picture), eat or drink, or apply a heating pad. Treatment only in a hospital: infusion therapy, pain relief, and for biliary causes, stone removal.
Reasons
- Gallstone disease - a stone blocks the common duct; the most common cause in women
- Alcohol is the most common cause in men
- High triglyceride levels in the blood
- Abdominal injuries, surgeries, endoscopic interventions on the ducts
- Some medications
- Increased blood calcium, autoimmune pancreatitis
- Tumors, narrowing of the duct
После первого эпизода острого панкреатита обязательно нужно установить причину. Если это камни — желчный пузырь удаляют, иначе приступ повторится. Если алкоголь — полный отказ является условием выздоровления.
Chronic pancreatitis
It develops with long-term damage to the gland: the tissue is replaced by scar tissue, and the organ ceases to cope with its work. What comes to the fore is not pain, but lack of function.
- Exocrine insufficiency: copious fatty, poorly flushed stools, bloating, weight loss, deficiency of vitamins A, D, E, K
- Intrasecretory insufficiency: development of diabetes mellitus
- Pain in the upper abdomen, worse after eating; may decrease over time as tissue dies
- Gradual weight loss and weakness
Diagnostics
- Амилаза и липаза крови — при остром панкреатите повышены в разы; липаза более специфична.
- УЗИ органов брюшной полости — поиск камней как причины.
- КТ с контрастом — оценка тяжести и осложнений при остром панкреатите.
- МРТ-холангиография — состояние протоков.
- Эластаза-1 в кале — оценка ферментной недостаточности при хроническом панкреатите.
- Глюкоза и гликированный гемоглобин — выявление диабета.
Treatment of the chronic form
- Complete cessation of alcohol and smoking - smoking accelerates progression no less than alcohol
- Enzyme preparations in sufficient doses, always DURING meals, and not before or after
- Small meals 5–6 times a day, moderate amount of fat, enough protein
- Replenishment of fat-soluble vitamins in case of their deficiency
- Pain relief as prescribed by a doctor
- Treatment of concomitant diabetes
- Endoscopic and surgical interventions - for narrowing of the duct, stones, cysts
Частая ошибка — принимать ферменты «курсами» или до еды. Они работают только тогда, когда перемешиваются с пищей, поэтому принимаются с каждым приёмом пищи и с перекусами, а доза подбирается врачом.
