Pancreatitis etiology and pathogenesis. gostry pancreatitis

Chronic pancreatitis is a progressively more intense disease of the debris, which is more likely to be affected by the deterioration of the function. Zakvoryuvannya counterparts with periodical sharpening on a number of non-new remissions.

Ethiology. The most common causes of chronic pancreatitis are the disease of the slunker, two-fingered intestine, liver, chewing gut and gallbladder (hepatitis, cirrhosis, cholecystitis, cholangitis, duodenitis, Virazkov's ailment, Especially the twists, penetrating into the slurry zone). Chronic pancreatitis is found in 30% of patients with cholecystectomy. A number of other reasons have led to an alimentary breakdown and a change in fat metabolism (child abuse, alcoholism); іntoksikatsії, detuning; changes in the duct system of the slurry zone (primary chickens, strictures, metaplasia of the epithelium of the ducts); zakritі traumas of a pidshlunkovoy zalozi; state and chronic infections. Infectious ear can serve as a source of angina, flu, typhus, scarlet fever, hepatitis, tuberculosis, malaria, syphilis and in.

In fact, the role in the pathogenesis of chronic pancreatitis is the internal organ activation of enzymes (proteases and lipases), which is responsible for the ear. At the moment before the development of chronic pancreatitis, it contains a secret, wicks with a mechanical junction in the її vivid ducts. Naybіlsh іstotnі value with a lot of ma the manifestation of ailments with duodenitis and lack of sphinkter Oddі. Seemingly the role of women in pancreatitis is diagnosed. Vvazhaєya, well gum acids and coagulative necrosis of the gall. In addition, lecithin is found in the mouth, which is used as an infusion of pancreatic phospholipase A transforms into lysolecithin, leading to self-digestion of the pancreatic phospholipase.

As a result of the folding complex, diffuse or atrophic igniters, necrotic and atrophic changes in the development with good fabrics... The order of the processes is to stimulate the regeneration of the organ in the eyes of the hyperplasia in the form of adenomas.

Pathogenesis. Chronic pancreatitis can lead to severe changes in moisture and near-wall etching, destruction of alcohol, fat and carbohydrates. Earlier, for all, there are signs of pancreatic lipasis - close to 70% of fatty tissue become unpicky, then fat metabolism breaks down, which manifests itself as flatulence, polyfecal disease, steatorrhea. The destruction of the protein exchange rate to hypoproteinemia, the change in the amount of albumin and the increase in the level of gamma-1 and gamma-2-globulin fractions.

Chronic pancreatitis is most often repaired from the distal part of the root and progressively widens to the proximal; To this, the secretary destructiveness develops more and more and rarely helps diagnostics in the cob stage of ailments. There is a decline in the acute part and compensatory increase in the proximal views of the area. Alcohol is reduced to a decrease in the pancreatic secretion and is reduced to duodenal reflux together with the filling of the Vater pump.

If the clutch in the duct system of the slurry closes up, a small amount of juice will soak into the roof, so that the enzymatic toxemia is vicious and can lead to tissue damage to the brain, myocardium, lesions, liver, etc.

Pathological anatomy. In the process of development of pancreatitis in the tissue of the dermal zone, the growth of the tissue grows, as a result of which fibrosis and sclerosis develop. The rest can be either peri or intralobular, to go to the one-hour atrophy of hairy tissue. As a result of the hardened development of the resulting fabrics, there is no risk and no change in society. Nadal develops svapninnya, rupture of the passage of pancreatic ducts. Microscopically, one hour at a time, with tissue fibrosis, it is susceptible to inflammation of the inflammation, lipomatosis, ignition changes in the walls of the ducts. In some cases, many other brushes were found, which were made in the course of the iteration of the ducts, adding calcium salts in the fabric of the layer.

See the onset of clinical and anatomical forms of chronic pancreatitis:

• chronic induratin pancreatitis;
• pseudotumorous pancreatitis;
• pseudocystic pancreatitis (chronic pancreatitis with the result in the cyst);
• chronic calculous pancreatitis (virungolitis, calcified pancreatitis).

Klinichna picture. Chronic pancreatitis is most often manifested by pain, which is localized in the supracranial area and irradiation in Lithuania or right to the edge for an offense pіdreber'ya, across a dilenku; In some cases the pain will take on an operative character; It is often the case that the irradiation is indicated in the area of ​​the heart, in the overlap, in the shoulder blade, in the clubs or in the groin areas, in the left steadily, in the area of ​​the cupric or the crotch.

More will be recognized in 1-3 years, or after receiving the reception, three years from the number of years up to 4-6 dB. can you provoke physical options, Scho tied from the raztyaguvannyam capsule zalozi. It is not often ailments are brought up to the reception of a child, for fear of being attacked. It is characteristic of the situation when a sick person is suffering from an hour of aggravated pancreatitis: sitting in front of it, splinters in the general position of being able to see the disease.

More can be permanent or recurrent in nature, being attacked, often in the other half of the day. At the earliest stage of ailments, remissions are trivial, in larger and smaller stages, they are interrupted by attacks until decile days.

Chronic pancreatitis is also seen with last pain... Win over the course of good (persistent) hepatitis. There is always a dullness in upper half belly, you will be able to accept the message.

The appearance of latent (painless) pancreatitis (5% of all types), which contradicts the damage of internal and external secretions.

In case of stone formation (calculous pancreatitis) in the head of the pancreatic cavity, the pain of the swelling itself in the designated organ is caused. In case of stone formation, in all cases of zalozychayyyyayutsya rapidly progressing exocrine deficiency (carrying, abdominal swelling), lack of internal secretion, ale pain, as a rule, mensh are strong.

Dyspeptic problems - nudota, bloating, sludge, nestiyky viporozhnennya (cherguvannya constipation with penetrations) - it is either permanently, or only in the period of sharpening.

Zhovtyanitsya, icterus shkiri and sclera are evident in half of the ailments. The stench can be both remitting and permanent. The zhovtyanitsa is affected in large ailments to go away from Ahola, є the result of the filling of the head of the fledgling zone, the hindering of the gallbladder ducts, during the indurative process in the zalos, cicatricial and ignition changes in the ducts of the

Skhudnennya іnodі reachє of the tricky steps. The reasons for this are the lack of virobulation and adequate pancreatic enzymes in the intestine, difficult during childbirth, fear of ailments to get rid of through pains. Some of the ailments have a pain to see if they receive a small number of children, but they are not volody of those who are in power.

Lack of internal secretion, i.e., Persh for all the insulin, is characterized by signs of sugar diabetes: dryness in mouth, sprag, intolerant of sugar, polyuria, second in body. In the cob period, the ailment is more likely to suffer from hypoglycemia for the growth of the disease and hyperfunction of the acute condition; for older periods, ailments are characterized by gross breakdown in carbohydrate consumption.

Thin temperature, as a rule, is normal;

diagnostics chronic pancreatitis is carried out on the premises of sub-active and active key symptoms ailment, given laboratory analyzes and results of special methods of preliminaries.

After a sick person was lying in the position, lying down with a roller in the position on the right boat, with the heel of the tulub forward at 45 °, standing with the heel of the tulub forward and left.

Sickness during palpation in the areas of Shoffar, Gubergrits - Skulsky and іn. Shoffar's zone is roztashovuєt on 5-b cm in the navel on the right side of the middle line and bisectrix of the umbilical kut (div. Figure); ailment in the central zone is especially characteristic for the burning head of the zalozi. In case of urezhennі tіla zolozi maximum sagging spite in the zoneі Gubergrits - Skulsky - right-handed from the navel (div. Malyunok). The Desjardins point is located at the center in cm from the navel on the line, from the bottom of the navel and the right groin; ailment in ts_y point is characteristic of zapalennya zalozi head. When localizing the process in the tail part of the zolozi, it means ailment in the Mayo - Robson point - on the cordon of the lower and middle third of the line, where the navel is in the middle of the small costal arch) (div.

Areas of shkіrnoї ailments with pancreatitis. 1 - Shoffard zone; 2 - zone of Gubergrits-Skulsky;
3 - Desjardins point; 4 - Mayo - Robson point.
A - line, scho z'єnu navel with groin depression;
B - line, scho z'єnu navel from the middle of the costal arch.

With palpation, it is possible to establish a sickly numbness in the area of ​​the middle line (on the level of the navel, about 2-4 cm).

In case of pseudotumorous forms, which run through zhovtyanitsyu, inodi develop Courvoise's syndrome, it is characterized by three signs: mechanic zhovtyanitsya, malleable and painless zhovchnym, mikhurom, Ahola.

When the process is aggravated, the pancreatic juice flows into the bloodstream and the pancreatic enzymes are not rapidly moving in place of pancreatic enzymes - diastasis, trypsin, lipase. In the period between attacks it is normal. The concentration of all the main enzymes in the duodenal cavity, navpaki, is lower, in the case of other ailments, the stench increases in the daytime.

The increase in bicarbonate blood puddles and in the place of amilase is a sign of an aggravated ignition process in the early period of ailment, and a progressive decrease in the level of amylase (even to an increased extent) is characteristic of advanced chronic pancreatitis.

Scatological dosage showing the presence of a great number of non-etched myad fibers (creatorrhea) and a drop of neutral fat (steatorrhea).

At the connection from the earliest time to the process of ostriches, the hyperspaces and changes of normal candied crooked are prevented by the infusion of the under-ground naphtha with reddish (two-humped reddish crooked).

When looking at X-ray black wastes In some cases, calcification begins in the course of the slurry. When rentgenologіchnomu doslіdzhennі dvanadtsyatipaloї guts Minds її gіpotonії ( "paralіtichna" duodenografіya) can be viyaviti nepryamі symptoms hronіchnogo pancreatitis: rozgornutu loop ( "pіdkovu") dvanadtsyatipaloї intestine bulged abo defect napovnennya on vnutrіshnomu contour її nizhіdnіy chastinі, zmіni relєfu folds slizovoї Ilya Obolonkov in oblastі roztashuvannya duodenal papilla and deformity of the rest.

Ultrasound monitoring i Computer tomography Allow in case of chronic pancreatitis to improve all areas of the head (pseudo-neoplastic pancreatitis), cystic snakes in your teeth. In a number of vypadkіv appear strong echostructures, roztasovanі right-handed and lіvoruch out of the ridge on the level of II-III transverse ridges, so that it can be found in the clear channels of stones and calcification in goods.

In case of radioisotope scanning, it appears: the formation of a scintigraphic baby due to a diffuse sclerotic process, a defect in the accumulation of an isotope, as well as to indicate about cystic changes in the disease

Retrograde pancreatography characteristic signs chronic pancreatitis: deformity of the cephalic duct, soreness of the duct, defect along the duct due to the presence of stones.

Angiographic dosage (celiac- and mesentericography) on early stages Chronic pancreatitis shows the zone of hypervascularization, and in the lower stages of advanced fibrosis - the diffusion of the kidney baby, changes in the architecture, changes in the shape of the foreseeable future

differential diagnostics guide us in front of wiry ailment, In case of pain, have a clear "hungry" character, localize in the center of the epicheral dilence and do not operate; cholecystitis When there is a slight ailment in the point of the malleus, a positive symptom of Ortrera and a phrenicus symptom (soreness when palpating between the legs of the right sternocleidomastoid nipple-like muscle). Do not go into oblivion, but pain in the epigastric zone, or in the middle of the border, when myocardial infarction, Especially the posterior diaphragmatic wall (so the titles of the abdominal variant). In general, the diagnosis is carried out on the basis of the EKG. Differentiation of chronic pancreatitis chubby tila pidshlunkovoy zalozi It is even more important to go to the stationary. Signs of cancer tila zalozi є: local swelling across, post_ine small pains in the area of ​​transverse ridges, surrounded by cancer metastases, which is confirmed radiologically.

lykuvannya in mіzhnapadu store for children, yak viklyuchaє greased, gostr, solon, fat їzhu, sokogonnye gravy. At the same time, the day is guilty of a high-calorie and fortune, there are a number of easy-to-use bills. A good race is guilty of storing 150 g of bottle, 30-40 g of fat, 350-400 g of carbohydrates.

For a substitute therapy for vikoristovyu form preparations dry podshlunkovoy zalozi, and to take away enzyme (pancreatin, Palizo, panzinorm), 1 tablet 3 times a day with dermal intake. Replacement therapy is prescriptive for deprivation key signs zovnіshnyosekretornoї inadequacies zalozi. In quiet cases, as long as the concentration of enzymes is not reduced, the sign of the drug is not valid.

Dozіlno in case of deteriorated feeding, add additional parenteral feeding, vicoristovuchi for the whole range of amino acids, concentrated glucose distribution. For polishing etching, we recommend that we take the ailment with the preparation, for revealing the ferments of the nutritive plant (pancreatin, festal, panzinorm). Periodically conduct a course of treatment with spasmolytics, and with mineral waters. Also, in the period of remission, the sanatorium-resort resort is shown in Zheleznovodsk, Asentuki, Borzhomi, Truskavts, in the gastroenterological sanatoriums of the local meaning.

Skin zagostrenia of chronic pancreatitis is seen as an attack on pancreatitis. Lіkuvannya in the period zagostrennya slіd to carry out the same principles, how and іkuvannya gosudarstny pancreatitis.

For the first 2 days, it was thoroughly reduced to the reception and the introduction of a small number of days. Allowed to drink non-alcoholic and non-malt warm tea, no more than 2-3 flasks for doba. Dietary mode in the phase of sharpening is indicated to the table No. 5a or 5 with an additional amount of 100-200 g bottle (No. 5a) and 140-150 g (No. 5). Zaboronyayutsya mint tea, kava, cocoa, chocolate virobi.

Drug therapy is guilty of being complex and is carried out in a hospital. For usunennya pain priznachayut analgesics. Preparations for morphine contraindications through the spasm of the sphinkter Oddi. Take bіl additionally help Novokain blockade: paranephral, ​​vagosympathetic, sacrospinal (inject 50 to 100 ml 0.25-0.5% of Novokain).

Suffocation of the secretary activity of being healthy is the sign of a hungry child, holinolitics (1 ml of 0.1% atropin or 1 ml of 0.2% of atropin). Mistsevo froze cold. Fight against self-digestion of zalozi to carry out for additional trasilol, countercala, tsalol 5000-10000 OD internally in drops.

For the production of toxic products and enzymes, pour electrolyte roschini (Ringer et al.). With the help of renewal of a broken cell exchange, I pour over the native plasma (400-800 ml in the fallow of heavy cells) or plasma exchangers. I mean antihistamines: diphenhydramine, pipolphene, suprastin in special doses.

Carry out antibacterial therapy for additional antibiotics wide range diy - tetracycline, which is kindly seen in the warehouse with the juice of the slurry; dose up to 1,000,000 OD per doba.

In case of endocrine (insulin) deficiency, as well as in case of decreased consumption, insulin-glucose therapy is indicated (8-10 OD for insulin supplementation and 10-20 ml of 20-40% glucose distribution internally). Dotally assigned anabolic drugs: nerobol (0.005 g 2-3 times a day), retabolil (1 ml 1 time per day internally), so as when pancreatic enzyme is used in the blood, it fizzles out in the back of the mind In chronic pancreatitis, a deficiency of vitamins is indicated, so that it is partially administered parenterally or per os vitamins A, C, E and group B in special doses.

In addition, chronic pancreatitis is more often on the background of pancreatic disease of susceptible organs (chronic cholecystitis, viral ailment of the shlunk or two-fingered intestines). When there is a pathology on the side of the youngsters, the slurry of the twelve-fingered intestine can be fed into the middle of the slurry. Shown before the operation, in such a way, will become the appearance of stones in the ducts of the clotting, cicatricial strictures of the ducts, the important form of painful pancreatitis. main goal surgical treatment- the stem of the brain for optimal flow of pancreatic juice into the intestinal tract.

Before the hour of the operation, a retinal intraoperative revision of the ducts of the underworld, the ducts and the twelve-fingered intestine is required. With the help of my mark, I can see the intraoperative cholegraphy, the advancement of the zhovchny mikhur. Before the hour of the operation, the retrograde pancreatography should be stashed by cannulating the duct through the duodenal papilla or by puncturing - by puncturing the widened ducts of the distal part through the tissue.

With small strictures of the end portion of the pancreatic duct, transduodenal papillosphincterotomy with transpapillary drainage of the duct of the pancreatic duct is indicated. In the case of the presence of prolonged strictures of the pancreatic duct, such an operation is not painful, the most thoroughly imposed anastomosis is also spread through the pancreatic duct through a small intestine.

If the significant part of the duct is sore in the area of ​​the head and tila, it is necessary to carry out a complete resection of the distal part of the duct and insert it into skinny gut, Vimknut on Ru. Meta of such an operation - open the mind for the flow of pancreatic juice in a retrograde direction. In quiet cases, if the functional parenchyma of the patient has become obstructed as a result of the pathological process, it is not reversed in the duct system, but the main symptoms of chronic pancreatitis do not develop rapidly. conservative methods lіkuvannya, to carry out a resection of the subcutaneous cavity (tail and til, subtotal pancreatectomy).

Version: Dovidnik zhvoryuvan MedElement

Chronic pancreatitis of alcoholic etiology (K86.0)

gastroenterology

General information

Short description

term " chronic pancreatitis"Poznachayut grupu hronіchnih zahvoryuvan pіdshlunkovoї zalozi (RV) rіznoї etіologії, perevazhno zapalnoї Nature Zahvoryuvannya suprovodzhuєtsya phase progresuyuchimi vognischevimi, segmental abo difuzno degenerative, destructive zmіnami ekzokrinnoї Chastain RV atrofієyu zalіzistih elementіv (pankreotsіtov) i zamіschennyam їh spoluchnoyu (fіbroznoї) tkaninoyu.; changes in the pancreatic duct system with cyst and calculi Concrements - stones, shielding illumination, which can be seen in the empty organs and in the ducts of the human worms.
, With a small step, the destruction of exocrine and endocrine functions.

Chronic alcoholic pancreatitis(Hap) was seen in the nosological unit for the recommendation of the WHO, including from such mirkuvan:
- alcohol і th surrogacy є is the most frequent cause of chronic pancreatitis;
- the reason (alcohol malignancy) can be and must be modified without a hundred vitrates on the side of the system and protect health.

Classification

The classification of chronic alcoholic pacreatitis (hap) in the morning is recognized. If necessary, you can speed up some of the options for the classification key manifestations chronic pancreatitis (CP).

I. Stage of gravity of CP

1.Easy relocation:

Zagostrennya rіdkіsnі (1-2 times per rіk), non-trivial, quickly stopping;

Pomirny bolovy syndrome;

Pose zagostrennyam self-feeling of a sick person polіpshutsya;

Vіdsutnya change masi tila;

The function of the slurry has not been disturbed;

Coprological analysis of the analysis in the boundaries of the norms.

2. Stretching out the middle step of gravity:

Sharpening 3-4 times per ric, contradicting a typical trivial pain syndrome;

Pancreatic hyperenzymemia appears;
- to support the lowering of the secretory function of the fodder and thinning in the same way;
- indicates steatorrhea Steatorrhea - alterations in the feces of neutral fat, fatty acids abo miv.
, creatorrhea Creatorrhea - alterations in place in the feces of non-etched meat and semi-tissue fibers
, amilorrhea Amilorrhea - a vision of an increased amount of non-etched starch, often with an increase in intestinal peristalsis
.

3. Important reboot:

Part and trivial aggravated pain syndrome;

Pancreatogenic carry;

Padynnya masi tila, right up to progressive visnazhennya;

Rise of the destruction of the secretary function;

Uskladnennya (hypochondriacal diabetes, pseudo-tissues, dysplasia of the two-fingered intestine with a malleable head).

II. In the event of a CP, it is possible to see the onset step by step:

1. Cob stage - length in the middle 1-5 rockiv (up to 10 rockiv). The most frequent manifestation is a range of different intensity and localization:
- at the upper part of the right half of the abdomen with a severe head of the pancreatic cavity (RV);
- in the epigastric period with severe pancreatic capacity;
- in the lіvuyu pіdraber'ї in case of the affected tail of the pancreas;
- more operative character (occur infrequently, tied with paresis Paresis - a change in strength і / or the amplitude of strong ruins, in the presence of damaged nerves (loss of nerves і link with the central nervous system) Current messages
transverse colon intestine).
With the manifestation of dyspeptic syndrome, it is obvious that I have a mutually supportive character and first stop at treatment.

2.the picture is fired ailments sposter a decrease, in the main after 5-10 years. The main manifestations are: bil, signs of secretory deficiency, elements of endocrine deficiency (hyperglycemia, hypoglycemia). On the first place, there are signs of secret secretory deficiencies.

3... acceleration options perebіgu HP (in any period). The slowdown of an active pathological process, or development, is more often seen after 7-15 years from the ear of ailment. In 2/3 of the sick, the morbidity of the pathological process for the adaptation of the sick person to CP (alcohol withdrawal Alcohol abstinence - a symptom complex of somatic, neurological and psychopathological problems in a person with alcoholism, which is the result of a rapid drinking or a decrease in alcohol doses
, Dotrimannya dієti), 1/3 develop faster. Sponsor the change in the intensity of the pain and the dynamics of the dynamics in the flow of love.

Ethiology and pathogenesis

The main ethological factor of chronic alcoholic pancreatitis is alcohol malignancy.
In the Danish hour of the day, there is an unambiguous thought about those, like the dose of alcohol to the development of the disease. Rizni authorize that chronic pancreatitis develops with implantation from 20 to 100 grams of alcohol for doba(In exchange for pure alcohol)stretching 2-20 rock_v.In economically rosy regionsin 60-70% of patients with chronic pancreatitis, it is trivialniyom (5-20 rokiv) alcohol in a dose of more than 150 mg / add.At the same hour, drug addicts and gastroenterologist established thatbefore the development of changes in the slurry zone (most often calcification and accumulated fat in acinar cells) produceimplantation to alcoholnavit in a dose of 80-120 ml for dobastretching 8-12 rock_v.

There are two stages of alcoholic pancreatitis:
1. ignition stage- find outthe ear of the epithelial cells of the pancreatic ducts, the ignition of the parenchyma of the pancreatic ducts.
2. calcific stage- fibrosis and obturation of the ducts develop, there is an expansion in the pancreatic parenchyma, stones are formed in the pancreatic ducts (calcific chronic pancreatic).

The main factors in the pathogenesis of hap:

1. Toxic-metabolic and high alcohol consumption on the pancreas. D Generative and hypoxic changes in acinar cells develop forNavigate a one-time intake of a great amount of alcohol. With trivial implantation of alcohol, degeneration in the cytoplasm forms in the cytoplasm of the acinar cells, ducts, necrosis, atrophy, fibrosis, calcification of the disease.

2. Disruption of the function of the sphinkter Oddi - a decrease in the amplitude of the speed and increase in the number of retrograde peristaltic diseases (duodenopancreatic reflux).

3. Disruption of the secretory function of the pancreas and precipitation of blood cells in the ducts. In the cob period, alcohol stimulates the function of the pancreas through the strengthening of the secretion, gastrin, and pancreozymin. With a trivial infusion of alcohol, the exocrine function of the PS is attributed, to prevent dissociated degradation - over a decrease in the secretion of water and bicarbonate with a decrease in the altered alteration of the secretion of herbal enzymes. As a result, there is a change in the obligation of a rare part to a secret, an increase in viscosity, and a precipitation of a bottle is present. Improvement of severe precipitates in a number of steps and in actions of a ruptured duct with more and more obstructions. With the continued secretory activity of the slurry zone, it is necessary to create a vice in the ducts of the pancreas and the embryo to a progressive reduction.

In such a rank, the pathogenesis of the hap of dressings with damage to the formation of rosin bilkovo-calcium associates. Already at the very early stages of the formation of hap in the ducts of the pancreas, bile precipitates appear, which represent an unrepentant fibrillary bile (lytostatin) with calcium deposited in the main calcite vigels) (carbonate). It means that there are three types of pancreatic stones: calcium-carbonate-protein, overly calcium-carbonate and protein (from organic material). Remain, as a rule, not tied With the intake of alcohol, it is formed due to the lack of food.

Epidemiology

Alcohol is a provincial cause of chronic pancreatitis - from 40 to 95% of all forms of illness. Restructuring in the main at the cholovikiv. It is important to recognize the nature of chronic pancreatitis, as when taking a history of ailment it is often said that it is "like all". For patients with chronic alcoholic pancreatitis, alcohol can be tolerated in significantly higher doses, not recommended by current medical postulates. Pidshlunkova zalosa is more sensitive to alcohol in a porridge with a stove (toxic dose for pidshlunkovaya zalosa is 1/3 less, lower for a liver). Type of alcoholic beverages and the way in which the implantation does not seem to be of the utmost importance in the development of the malaise.
Clinically, chronic alcoholic pancreatitis develops in females after 10-12 years, and in choloviks after 17-18 years, the ear is systematic malignant alcohol.

Factor i group riziku

Alcohol is one of the main ethological officials, which is associated with chronic pancreatitis, in the developed regions. The presence of a logarithmic abundance of chronic pancreatitis due to additional alcohol and alcohol and U-similar abundance of additional fat was brought to light. Typical characteristics of ailments: to achieve good social and economic life (the country of Europe, Japan, USA), the number of people to become, older than 30-40 years, a high level of living alcohol and fat, living 20 years old ethanol).
Rizik the development of chronic pancreatitis of growth in the presence of a disease, as a pre-existing pathological factor. In this vypadku characteristic development of pancreatitis in the greater early vіtsі... In individuals who burn chronic pancreatitis, it is reestablished 2 times more often in cases of non-smokers, while the development of pancreatitis grows in proportion to the number of cigarette smokers.

key picture

Symptomy, stretching

In the description of clinical manifestations of chronic pancreatitis (CP), there are some syndromes.

Exocrine deficiency syndrome. Appear as a second mass and indigestion. In the event of a lazy deficiency, there are more frequent styles of up to 2-4 and more times for additional, polyfecal, excess gas, abdominal pain, steatorrhea. In case of abnormal lipase deficiency in patients, it is called "pancreatic style" (a great deal with a siruvatic appearance, stinky). surface feces can be covered with thin fat. The soaking of fatty vitamins has been destroyed. Trophies (dryness of skin, darkness and lameness of nigths and hairs, cracks in the cocks of the lips, tongue) with the syndrome of broken empty pickling is very rare.

Incendiary-destructive syndrome. Inflammation, sclerosis and cyst formation can be superseded by the pressure of the common bile duct, the development of the zhovtyanitsa from Ahola, shkіrnim sverlyachkoy... Zhovtyanitsa has a relapsing character, or she is more likely to suffer from a painful attack. In 1/3 of the ailments, hyperbylirubinemia is referred to. With CP, the phenomenon of enzyme "cure" can be promoted: more efficient enzymes into the roof, depletion of damaged parenchyma, or duct hypertension.

Pain syndrome in the main reason for damage to the flow of pancreatic juice and ductal hypertension, as well as the development of chronic ignition processes of the parapancreatic cell line, scarring of the parapancreatic cell line and the sum of the organs.
Call pain persistent and often painful. More localized in the epigastric period, but operated; accommodate when you receive fat and hospitality.
Irradiation is found in the localization of the ignition-degenerative process in the flesh zone. When the head is severe, the pain is in the right direction, the head is in the epigastric period, the tail is in the liva pidreber'ya... Approximately 10% of the total number of cases of pain in the region of the heart.
Pain syndrome is due to the nature of the disease: in case of alcoholic pancreatitis, pain often occurs when the patient is welcomed and sour; with cholangiogenic pancreatitis - if you receive fatty tissue.

Endocrine deficiency syndrome characterized by frequent development of hypoglycemic stans as a result of a low level of glucagon in syrovatz blood or hyperglycemia, especially in the presence of an ignition-destructive syndrome. The syndrome is manifested by attacks of severe hunger and signs of diabetes with less need for insulin. The "pseudopancreatic process" develops: hyperglycemia, dryness in mouth and spraga without ketoacidosis.

Dyspeptic syndrome: change to appetite (right up to anorexia), up to fatty food, tediousness, bloating, do not bring lulling, slime, flatulence, intestinal swelling, carry it, as it is, and it is caused by constipation.

Astheno-vegetative syndrome to manifest weakness and decrease in prasezdatnost, drastic (especially "on a hungry slunk"), sleep disturbance.

(Paltsiv A.I., 2000)

diagnostics

Diagnosis of alcoholic pancreatitis will, in principle, be based on the diagnosis of chronic pancreatitis (CP) as such a manifestation of alcoholic ethiology.

anamnesis

Chronic pancreatitis is clinically characterized by two primary symptoms: recurrent or post-mortem abdominal disease and exocrine deficiency of fatigue (malabsorption syndrome, steatorrhea, trophological deficiency). In connection with the cym during the taking of the anamnesis, it is necessary to take an hour for the first symptoms to appear, to simulate the dynamics, to assess the effectiveness and adequacy of the earlier therapy.
A very important anamnestic aspect, which may be based on a clinical diagnosis - alcohol intake and previous relapsing pancreatitis, sometimes in this hour it is possible to increase the possibility of transforming hospitable pancreatitis into chronic prolonged use.
It is necessary to assess the family history, vivify the spectrum fellow sickness, Visibility, turniness and triviality in the pouring of alcohol, which can help with the established ethiology of ailments.

physical condition

Zagalny camp to lie in the form of the development of pain syndrome and symptoms of intoxication, the level of energy deficiency, central and peripheral hemodynamics. The connection from the tide is varied from the backward to the most important. The step I will become hungry is also variable. Mova plating, inodі sukhuvatiy.

In the region, there are rare types of symptoms for gastrointestinal pancreatitis that are tied to enzymes in the shelter.

often mean symptoms tied with a significant swelling of the lining(PZ):

Subicterity, for the recovery of mucous membranes ("early" zhovtyanitsya) and shkіri, as they grow less swelling and know the world of reduction of pain syndrome;

Vimushena kolinno-littove positivnya (changing the vice on the sleepyachne gossip);

Symptom Fitz - "vibuhne" epigastria in the presence of duodenostenosis;

Hykavka (expansion of the phrenic nerve).

Symptoms of energy deficiency:

Total myazova hypotrophy (marasmus);

M'yakі, pukhki nabryaki lower kintzivok, Kryzhiv, frontal black stinky, vipit in empty (kvashiorkor);

Symptom Grotto - atrophy of the pediatric cell line in the projection of the pancreas;

Bartelheimer's syndrome - pigmentation of the shkiri over the pancreas area;
- Edelmann's syndrome - cachexia, follicular hyperkeratosis, vitonization and diffusion of symptoms of the disease, parallel mucous membranes, vestibular disorders, polyneuritis, mental changes.

Palpation. With superficial palpation, there is a soreness in the epigastric state, in the middle of the skin; if palpation is too large - soreness in the pancreas projection. For visualization of the projection of the pancreas on the anterior cherevnaya wall, in the middle line from sword-like sprout up to the navel by a third. Between the upper and middle thirds, draw a horizontal line - left to the left costal arch, to the right - twice as small, below left (2/3 of the horizontal line is in the right direction, and 1/3 is right-handed). Oscillations of the pancreas were retrofitted retroperitoneally;
Sickness in the Chaoffard zone and Desjardin's point is cleverly aware of the pathology of the pancreas head, and the sickness in the Guberrits-Skulsky area (symmetric Schoffard's area) and at the Gubergrits point (symmetric to the Dejardin point) is the projection

Dodatkov value at palpation is given by the following symptoms:

When there is an onslaught in the left costal-spinal cut (Mayo-Robson point) to indicate the pathology of the tail of the pancreas;

Nidner's symptom - with palpation of all the heart, there is a pulsation of the aorta in the front of the rib through a vise on her pancreas;
- a symptom of Musse zlyva - when there is pressure between the sterno-clavicular-nipple-like meat at the attachment to the medial edge of the clavicle;

Voskresensky's symptom - pulsation of the cranial aorta; svidchit about the sign of the pancreas, yak "prikrivaє" aorta.

Evaluation of the exocrine function of the slurry

There are two groups of tests for assessing the exocrine function of the pancreas:
- probe methods, scho vimagayut the introduction of the intestinal probe;
- non-invasive probeless test.

Direct probe method- secretin-pancreaticinovy ​​(secretin-cholecystokinovy) test. The high diagnostic accuracy, sensitivity and specificity of the method are more than 90%. To become more familiar with the "gold standard" for the failure of the exocrine function of the pancreas (the same number of faults in the direct probe method will be necessary for diagnostics of CP).
For an additional test, it is unwise to carry out a differential diagnosis of the pancreatic cancer patients, scars in pancreatic cancer, cystic fibrosis and other pancreatic cancer patients, to reestablish pathological test results in 75-90% of cases.

Interpretation of the results of the probe dosage(Seeing pathological types of pancreatic secretion).

1. hyposecretory type: Decrease in the production of enzymes, bicarbonates with a normal secret sharing. Characteristic for diffuse pancreatic fibrosis (at the stage of CP) and cystic fibrosis (more commonly for pancreatic cancer).

2. hypersecretory type: Normal or increased secrets and debts of bicarbonates, increased activity of enzymes. Typical for cob ignition processes in the pancreas without signs of atrophy of acinar cells and swollen fibrosis. re-structure in cob stages CP, if the closure of the pancreatic secretion is nontrivial and insignificant (with a short-hour spasm of the sphincter of Oddi, acute ailments of the duodenal intestine, etc.).

3. obturation type dividing into 2 subtypes:

3.1 Lower block: reduction of the secret at normal concentration of bicarbonates and enzymes, so that it can be reduced to a decrease in the rate. Spasms with pancreatitis, which have developed as a result of processes that accelerate the secretion of the pancreas (stiff spasm of the sphincter Oddi, papillomas, obstruction of the head pancreatic duct with calculus, swelling of the head of the papillary nipple).

3.2 Upper block: reduction in the amount of secretion and adjustment of the concentration of enzymes (with a reduced flow rate), normal bicarbonate. An additional option is to inform about pancreatic enlargement and characteristic of pancreatic pancreatitis (hypertension of CP).

4. Ductular type: Reducing the secret, normal production of enzymes, increasing the increase in the concentration of bicarbonates. Such changes can be linked from fired ducts and damaged reabsorption of bicarbonates.

The shortcomings of the direct probe method are in the need for a duodenal probe (tightly for the patient), a great community of a robot and a laboratory assistant, a high frequency and low availability of pancreatic stimulants.

Indirect probe method - Lund test. Sensitivity to the method in patients with CP to become 90%. Some hybnopositive results can occur in patients with small bowel malabsorption, celiac disease, and diabetic diabetes. At the early stages of external secretory deficiency, Lund's test is less sensitive.
Perevagi method of polarity is that the wine is cheaper, it is simpler for the vicon and the better for the sick. There are few areas in the need for a duodenal probe, during the daytime, due to the amount of secretion and concentration of bicarbonates, as well as the fact that the results of the test are infused with intraduodenal acidity and endogenous

Indirect methods without duodenal probe
All probeless methods are based on oral administration of specific substrates for pancreatic enzymes. Pislya of interaction of substrates with pancreatic enzymes in the section of abnormal blood and start of split products. The number of split products is allowed to judge about the secretary deficiency of the PZ. The principle is short of non-invasive methods of polyagus in weakened sensitivity with a moderately varied degree of exocrine pancreatic insufficiency.

1. Bentiramidny test(NBT-PABA test) - sensitivity - 83%, specificity - 89%. The United States does not have a vicious method.

2. The value of the stage for the recovery of plasma amino acids podshlunkovyu zalozovuyutsya for advanced function of the pancreas in ailments with the importance of secretary deficiency. There is evidence for the fact that when stimulating the pancreas secretin, there is a large amount of amino acids from blood plasma, which are necessary for the synthesis of pancreatic enzymes. Sensitivity to the method - 69-96%, specificity - 54-100%.

3. Yakisne scrological dosage Zdіysnyuyut for such minds: it is sick to get a standard dіntu (for example, Shmіdt’s dієtu), and also in the whole period of an hour Polyenzyme preparations are not stagnant. Criteria of external secretory failure: alterations in the feces of neutral fat and microorganisms with little change in fatty acids. Allowances instead of meat fibers depend on the Creator's appearance.

4. Fat value in calories... In the norm, the intake of 100 g of fat permits up to 7 g of neutral fat and fatty acids. The increase in the amount of fat is indicative of the reduction of etching and wetting of fat, which is the most common pancreatic activity. Forgiveness of the severity of steatorrhea є we will forgive it as a supreme indicator of a rotated external secretory deficiency of the pancreas.
With an incomplete (incorrect) sampling of feces and inadequate performance, the reliability of the test will decrease. The test is nonspecific for a number of ailments, so it cannot be vicious for a pancreatic character of steatorrhea. Given the test may even go beyond the limits in case of severe club gut and bacterial contamination of the small intestine.

5. Enzyme-linked immunosorbent assay for elastasis 1 in calories the ailing HP had a wide spread for an hour. The sensitivity of an elastase test in ailments with an exocrine pancreatic deficiency of a severe and middle stage is close to such with a secretin-pancreatic test. For the data of the great foreign pre-ages, the sensitivity of the store is 90-100% (with an easy step - 63%), the specificity - 96%. It is a simple and quick method, which doesn’t need to be congested and allows for the initiation of the primary secretory function of the pancreas at large early stages.

Aboutgeneral blood analysis
In case of aggravated CP, leukocytosis can occur, leukocytosis, formulas vlyvo, neutrophilosis, and a decrease in SHOE.
On the other hand, there is a rapid increase in the reduction of leukocytosis, trochas normalize the value of SHOE (to be used with friendly classy familiarity).
A nonspecific marker of the development of an accelerated growth rate before the end of the construction period prevents leukocytosis from the beginning of the day and the growth of the SHOE number.
To achieve a rare occurrence of leukocytosis in ailments of CP with a secretory deficiency. Moreover, it is characteristic of leukopenia, which indicates the manifestation of trophological deficiency. In general, it means that the promotion of SHOE is likely to take place, most often it is accompanied by dysproteinemia.
In ailments with important forms of malabsorption syndrome, there may be present signs of malabsorption, in 6 -, in 12 - and folio-water deficiency anemia (most often - malabsorption anemia).

Biochemical analysis of blood:
1. Decrease in the level of blood cells, albumin, transthyretin, transferrin, feritin and other blood cells, which characterize the visceral pool of blood cells and stages of trophological deficiency.
2. Disproteinemia: a decrease in the albumin-globulin efficiency, usually a decrease in a 1 and a 2-globulin.
3. Frequently - increased indicators of blood transaminases, GGT, lactate dehydrogenase.
4. The syndrome of cholestasis is characterized by an increase in bilirubin, which is more direct, cholesterol and phosphatase. Tse can be booted with a block of common bile duct, a development of reactive hepatitis.
5. In ailments of alcoholic CP, an increase in the activity of liver enzymes in the blood can be explained by an independent liver pathology (toxic hepatitis, liver cirrhosis).
6. Frequently - hypocrisis, steps which can serve as one of the criteria for the severity of illness. When hyperparathyroidism is detected, hyperparathyroidism is a causative factor of CP.

Adoption of cancer markers(CA 19-9, carcinoambric antigen - KEA) is a value that is acceptable for burning, є indirect transformation of CP into pancreatic cancer. With CP, it is permissible to adjust CA 19-9 three times, KEA - two times. These tumor markers are not specific for pancreatic cancer and can be diagnosed with shunk cancer, cholangiogenic and colorectal cancer.

instrumental doslіgennya

1. Classical (transabdominal) ultrasound vvazhayut first line of diagnostics. In case of victorious possession in a large number of ultrasound diagnostics, it is necessary to complete for a clear visualization of all types of pancreas, parenchyma and duct system. The beauty of the ultrasound scan allows you to immediately look around the liver, gum michur, and the manifestations of gastrointestinal duodenostasis.

Pathognomonic signs:
- diffuse change in the size of the pancreas;
- the inconsistency and unclearness of the contours;
- hyperechogenicity of parenchyma (posture of interstitial changes);
- dilatation and draining of the walls of the head pancreatic duct;
- calcification of parenchymal and virungolitiasis.

Zbіg of histological picture in CP (calculous, cystic, induratic, fibrous and inn.) According to the results of autopsy with the surviving data of ultrasound to become 83.3%.

2. Endoscopic ultrasonography(EUS) is a highly informative method of ultrasound diagnostics of pancreatic disease. Scanning through the wall of the slurry and DPK. The method allows for a detailed imaging of the structure of the pancreatic tissue, the stance of the duct system, assessment of the size of the parapancreatic lymph nodes and the formation of calculi of the duct system, and also assists in the differential diagnosis of pancreatitis with pancreatic cancer.

In ailments of bilarious forms of pancreatitis, EUS is used for diagnostics of choledocholithiasis, oskilka volodya is significantly more sensitive, lower transabdominal ultrasound.
EUS allows for the great accuracy of the appearance of pancreatic necrosis and peri-pancreatic ridinnyh purchases, which can be very predictive for important forms of CP.
EUS volodya rivnoyu or more informative in terms of CT, MRI and CPG, ale mensh invasive, lower CPG.
Advancing the diagnostic value of the EUS can be carried out with a great accuracy of punctual aspirational biopsies of the pancreas, especially in all types of susceptibility to puffin. Sensitivity and specificity of the method outweigh 90%.

Intraductous ultrasound of the pancreas there is less information, and its diagnostic value is 100%. Adequately carrying out this dosage to determine the cause of the destruction of the secret: in case of adolescence for adenoma or cancer of the great duodenal papilla.

3. Computer tomography(CT) additional help when staging a diagnosis of pancreatitis at the stage of accelerated pancreatitis, if most often show calcification, pseudo-filaments, reduction of suspected organs, atrophy of pancreatic parenchyma and malignancy.
Sensitivity and specificity of CT become 80-90% and significantly increase in fallowness from the stage of discomfort.

spiral CT For internal bolus strengths of non-specific people with contrasting speech (Iopromid, iohexolu), they are used in folding diagnostic vials to clarify the pathology of the pancreas. Danish method Allows more accurate assessment of destructive behavior due to preservation of parenchyma, assessment of life expectancy with vessels, lymphatic universities, Parapancreatic cells, slurry walls and DPK.

The main transfer of KT, in the context of ultrasonic scanning, is due to the fact that the situation cannot be caused by such factors as the vastness of the ailments, the appearance of gas in the intestines and the smallest ones. Protective negative results are often identified on a parity basis.

With CP, it is effective to complete the ultrasound scan and CT scan. With the obviousness of the summaries, the ERCP is stagnated, which is a method that will be more highly diagnostic and informative.

4.Endoscopic retrograde cholangiopancreatography(KhPG) to become the "gold standard" for diagnostics of CP in most of the current scientific publications. This method allows stenosis of the cephalic pancreatic duct to occur and due to the localization of obstruction, structural changes in the ducts, internal calcification and bile plugs, as well as pathology of the posterior duct.

ERCP is an important method for differentiating CP from pancreatic cancer.
Sensitivity of variation in the boundaries of 71-93%, specificity - 89-100%.

Retrograde introduction of a sharp contrast into the pancreatic duct with ERCP can be the cause of the development of severe accelerated diseases (pancreatitis, cholangitis, sepsis, allergic reactions to iodine contrast, bleeding, perforation of hypogastric pain) The frequency of acceleration becomes 0.8 to 36.0%, the lethality is 0.15-1.0%.
In a number of patients with ERCPH, they promote the adjustment of laboratory markers for cholestasis and cytolysis of hepatocytes. For the achievement of good results, it is important to recognize the ailments with a high risk of acceleration and preoperative preparation of the patient.

CPH is less significant in diagnostics of autoimmune CP, it is possible for all ailments to develop segmental or diffuse irregular ulceration of the head pancreatic duct (typical sign of CP form).

5. MRI and magnetic resonance cholangiopancreatography(MRHPG) in conjunction with more high sensitivenessі specific, MRI can be viewed in the capacity of an alternative CT technique when performing differential diagnostics of CP with pancreatic cancer, in diagnosing cysts and pseudocysts, congenital anomalies in the development of the pancreas, including pancreas divisum (pancreas divisum)
The sensitivity of MRI is 92.2%, and the specificity is 97.1%.

In the quality of the primary method of diagnostics of MRCP in diagnostic situations (especially in case of intolerance to patients with iodine preparations and in case of decompensated sickness), you can replace ERCP, but more high risik quickening.

The informativeness of MRCP significantly changes the informativeness of other non-invasive techniques (ultrasound, CT, MRI). With MRCP, a standard MRI of a black empty is performed, with which it is possible to become a parenchymal pancreatic and susceptible organs.

In case of typical patterns of choledocholithiasis, as the cause of an important attack of CP (zhovtyanitsya, enlargement of the choledochus after ultrasound, cholangitis), it is shown practically before MRCPG. Most of the time, in this context, the ERCP is carried out, including volodya also and useful abilities (EPST, litoextraction and in.).
MRHPG can be a vibration procedure for diagnostics screening, if diagnostics indicate choledocholithiasis of a total (diameter of the posterior zhazhnoy duct is less than 10 mm, reduction of markers of cholestasis, osteoarthritis diagnostics)

6.duodenoscope allowing diagnostics of the pathology of the great duodenal papilla moody reason development of CP, viconuvati selective withdrawal of pancreatic juice for enzymatic and morphological dosage.

7. Sphinkter Oddi manometer method can be interconnected through the temple frequency with an acceleration of 9-33% of the drops (which means the attack of HP or VP), a high rate, as well as the connection of the system, which can be used only in special editions medical centers.

8. X-ray method. Revealing of pancreatic calcification during examination of radiographs of organs of black emptying is the most reliable radiologic symptom of CP, pathognomonic for all illnesses.

When carrying out fluoroscopy of organs breast cancer In some cases, pathognomonic signs of accelerating an important attack of CP: free (earlier double) exudative pleurisy or discoid atelectasis of the lower part of the left legacy, interfering with the collapse of the diaphragms.

Criteria for diagnostics and diagnostics algorithms

For the interpretation of the data, taken in the case of instrumental and laboratory conditions, by different groups of experts in the native lands, the propagation of the development criteria for diagnostics.

Tsurikh diagnostic criteria

Singing alcoholic CP. In addition to an alcoholic history and anamnesis (> 80 g / day), the diagnosticians use one or more advanced criteria:
- calcification of the pancreas;
- change in the pancreatic duct (cambridge criteria);
- the manifestation of exocrine deficiencies, such as the presence of steatorrhea (> 7 g of fat in the feces for a dobat), to rise, or it may change with the intake of polyenzyme drugs;
- a typical histological picture in the pancreas (with the preliminarily written operational material).

Ymovirny alcoholic CP. In addition to an alcoholic history and anamnesis (> 80 g / dose), the diagnosis of CP is possible with the presence of one or more diagnostic criteria:
- pomirnі protokovіy zmіni (cambridge criteria);
- recurrent or persistent pseudo-leaves;
- pathological secretion test;
- endocrine deficiency (within the limits of impaired tolerance to carbohydrates).

Diagnostic criteria for HP Japan Pancreas Society

Singing HP. With clinical adolescence on CP (chronic recurrent abdominal pain and signs of exocrine and endocrine deficiency) The diagnosis can be made when one or more of these signs are detected:
1. For ultrasound and CT data: Intrapancreatic calculus.

2. For the data of CPH: dilation of the expansion of other pancreatic ducts in all pancreatic parenchymal ducts or in the nervous expansion of the cephalic pancreatic duct and proximal ducts with other or irreparable impairments in the flow (concretions, congestion).

3. According to the secretin test: pathologically low concentration of bicarbonates in the result of decreased enzyme production or changes in secretion.

4. The histological picture: irregular fibrosis with ruinous and second exocrine parenchyma in fabric dylyankas.

5. Additional criteria: blue plugs, pancreatic stones, enlarged ducts, hyperplasia and metaplasia of ductal epithelium and cyst formation.

Ymovirny HP:

1. For the data of ultrasound: the growth of babies, roughly asymmetric enlargement of the pancreatic ducts, or deformation of the pancreas with an unclear contour.

2. For CT data: deformation of the pancreas with a fuzzy contour.

3. For the data of CPG: one by one incorrectly forming the dilatation of the head pancreatic duct; internal duct non-contrasting defects, similar to non-hardened pancreatic stones or white plugs.

4. For the secret of the test: pathological decrease in the concentration of bicarbonates or a decrease in the production of enzymes in a given amount of secretion.

5. For the tribute to Zondovy test: one-hour change to the RAVT test and the test for fecal chymotrypsin, which are made possible by stretching out decalcaps.

6. Histological picture: intralobular fibrosis in the present with one of such signs: loss of exocrine parenchyma; Isolation of Langerhans Islands; pseudo-leaves.

An early diagnosis of CP can be placed on the stage of the patient's experience.
In clinical practice, the diagnosis of tests on the combination of tests.
Ultrasonic scanning is recommended as the first step in diagnostics due to its wide breadth and availability.
With an elastase test for a supplement to ultrasound, a deterioration of the exocrine pancreatic function may occur. At bagatokh vipadkah direct assessment of pancreatic function can not be trivial hour, at the point of tsim straight test may be in the main science value.
Pislya otrimannya of clinical ultrasound signs of CP in a sick person with a clear clinical picture of a sick person, further down the line can not be carried out.
ERCP, CT, MRI borrow a friend a similar diagnostic algorithm. Stagnate when there is a diagnosis, or, if necessary, make a detailed statement:

ERHPG gives you the ability to edit detailed information about the duct system;
- CT scan: information about other approvals (bones, extra-pancreatic anomalies);
- MRI is sensitive for detecting early fibrotic changes, which can overwhelm Calcifications and rough morphological changes.
All technical advances are necessary for the differential diagnosis of CP and pancreatic cancer. Endo-ultrasound and ERCP, CT and MRI add one to one. The combination of endo-ultrasound, CT and CPG increases the sensitivity of diagnostics up to 95-97%, the specificity - up to 100%.
In case of adolescence for pancreatic cancer, late echinococosis, autoimmune pancreatitis, tuberculosis, it is necessary to carry out more early biopsies with the onset of histological abnormal cytological diagnoses.
Through the great rhizik accelerated at ERCP and a high number of times before the end of the day, you can begin to carry out the EUS, which also allows you to visit the biopsy of the pancreas.

Laboratory diagnostics

Laboratory diagnostics chronic pancreatitis is based on the significant activity of pancreatic enzymes in the blood and in the blood, diagnostics of exo and endocrine deficiencies. Dodatkovo conduct a complex biological and long-lasting blood supply.

Pre-treatment in the place of pancreatic enzymes in the blood and in the blood.

1.The value of amylazi in blood and slaughterє we will expand the diagnostic test. Lack of sensitivity due to the short-term hyperaemia and hyperaemia in pancreatitis.
The level of amylase of blood is repaired it will grow in 2-12 years from the ear of stinging disease, after 20-30 years it will reach the maximum and in 2-4 it will return to normal (at friendly perebіgu getting sick).
The zm_st of amilazi in the battle begins to move in 4-6 years from the ear of sharpening and in 8-10 years (for deyakim data - after 3 add) can be normalized.
With a severe interruption of acute CP in ailments with a trivial anamnesis in bagatokh vipaduyut normal or subnormal value of amylase.
The value of amilase in the village is more informative, not in the blood, so as hyperamilazuria is more stiff, not hyperactive. In a number of cases of direct symptoms, severe pancreatitis and amylase activity in the blood and in the middle of the day.

To increase the specificity of the amylase in the blood (especially in ailments with normal amylase), it should be noted that there is not a total versus the enzyme, but pancreatic isoamylase.
The specificity of the appearance of pancreatic amylasia in CP does not change 88.6% with a sensitivity of 40.0-96.9%.

2. Visnachennya sirovatkova lipazi insufficiently sensitive and informative. For syrovatkovy rіvnya lіpazi it is unfortunate because of the severity of the streaming aggravation of pancreatitis and the lowest prognosis. Dani about the terms of preserving hyperenzymemia vary, ale the stench is definitely more, less for amylase.

3. The value of the activity of elastasis 1 in the blood vvazhaєshis most "piznim" sensitive test for diagnostics of hypertension of CP. adjustments the enzyme takes 8-10 days to last for an attack. In the last period, the activity of elastasis 1 in the blood was diagnosed in 100% of the ailments, the level of lipasis - in 85%, pancreatic isoamylazi - in 43%, zalous a-amylazi - in 23% of the ailments.
The variability of hyperlastasis is not due to the degree of destruction of the tissue of the pancreas and is not volodya great diagnostic values in case of functional deficiency in ailments with bagatoric CP.

Differential diagnosis

If I need a differential diagnosis of chronic pancreatitis(Nair R.J., Lawler L., Miller M.R., 2007)

Naybils often:
- Gostry cholecystitis;
- Gostry pancreatitis;
- intestinal ischemia or necrosis;
- obstruction of the posterior zhazhnoy duct;
- chubby pidshlunkovoy zalozi;
- virazkov ailment;
- nirkova lack.

Ridko:
- gostry appendicitis;
- gostry salpingit;
- Crohn's ailment;
- Pozamatkova vagіtnіst;
- gastroparesis;
- intestinal obstruction;
- irritated bowel syndrome;
- rіznі ailing, Scho produce up to the development of malabsorption;
- bristle bones;
- papillary cystadenocarcinoma of the ovary;
- chest radiculopathy.

accelerating

Cholestasis (zhovtyanichny and bezhovtyanichny);
- bleeding (erosive esophagitis, Mellor-Weiss syndrome, gastroduodenal virazki);
- Infectious diseases (igniters, infiltrates, cholangitis, peritonitis, septic tanks);
- subhepatic portal hypertension;
- Thrombosis of the portal and splenic veins;
- hypoglycemic crises;
- vip pleurisy;
- obstruction of the duodenum;
- cancer of the pidshlunkovoy zalozi;
- pancreatic ascites;
- abdominal ischemic syndrome.

Likuvannya beyond the cordon

Chronic pancreatitis is a progressively more intense disease of the debris, which is more likely to be affected by the deterioration of the function. Zakvoryuvannya counterparts with periodical sharpening on a number of non-new remissions.

Ethiology. The most common causes of chronic pancreatitis are the disease of the shlunk, two-fingered intestines, the liver, the chewing gum and the gallbladder (hepatitis, cirrhosis, cholecystitis, cholangitis, duodenitis, blistering diseases) Chronic pancreatitis is found in 30% of patients with cholecystectomy. A number of other reasons have led to an alimentary breakdown and a change in fat metabolism (child abuse, alcoholism); іntoksikatsії, detuning; changes in the duct system of the slurry zone (primary chickens, strictures, metaplasia of the epithelium of the ducts); zakritі traumas of a pidshlunkovoy zalozi; state and chronic infections. Infectious ear can serve as a source of angina, flu, typhus, scarlet fever, hepatitis, tuberculosis, malaria, syphilis and in.

In fact, the role in the pathogenesis of chronic pancreatitis is the internal organ activation of enzymes (proteases and lipases), which is responsible for the ear. At the moment before the development of chronic pancreatitis, it contains a secret, wicks with a mechanical junction in the її vivid ducts. Naybіlsh іstotnі value with a lot of ma the manifestation of ailments with duodenitis and lack of sphinkter Oddі. Seemingly the role of women in pancreatitis is diagnosed. Vvazhaєya, well gum acids and coagulative necrosis of the gall. In addition, lecithin is found in the mouth, which is used as an infusion of pancreatic phospholipase A transforms into lysolecithin, leading to self-digestion of the pancreatic phospholipase.

As a result of the folding complex, a diffuse or atrophic firing, necrotic and atrophic changes in the flesh from the growing fabrics will be created. The order of the processes is to stimulate the regeneration of the organ in the eyes of the hyperplasia in the form of adenomas.

Pathogenesis. Chronic pancreatitis can lead to severe changes in moisture and near-wall etching, destruction of alcohol, fat and carbohydrates. Earlier, for all, there are signs of pancreatic lipasis - close to 70% of fatty tissue become unpicky, then fat metabolism breaks down, which manifests itself as flatulence, polyfecal disease, steatorrhea. The destruction of the protein exchange rate to hypoproteinemia, the change in the amount of albumin and the increase in the level of gamma-1 and gamma-2-globulin fractions.

Chronic pancreatitis is most often repaired from the distal part of the root and progressively widens to the proximal; To this, the secretary destructiveness develops more and more and rarely helps diagnostics in the cob stage of ailments. There is a decline in the acute part and compensatory increase in the proximal views of the area. Alcohol is reduced to a decrease in the pancreatic secretion and is reduced to duodenal reflux together with the filling of the Vater pump.

If the clutch in the duct system of the slurry closes up, a small amount of juice will soak into the roof, so that the enzymatic toxemia is vicious and can lead to tissue damage to the brain, myocardium, lesions, liver, etc.

Pathological anatomy. In the process of development of pancreatitis in the tissue of the dermal zone, the growth of the tissue grows, as a result of which fibrosis and sclerosis develop. The rest can be either peri or intralobular, to go to the one-hour atrophy of hairy tissue. As a result of the hardened development of the resulting fabrics, there is no risk and no change in society. Nadal develops svapninnya, rupture of the passage of pancreatic ducts. Microscopically, one hour at a time, with tissue fibrosis, it is susceptible to inflammation of the inflammation, lipomatosis, ignition changes in the walls of the ducts. In some cases, many other brushes were found, which were made in the course of the iteration of the ducts, adding calcium salts in the fabric of the layer.

See the onset of clinical and anatomical forms of chronic pancreatitis:

• chronic induratin pancreatitis;
• pseudotumorous pancreatitis;
• pseudocystic pancreatitis (chronic pancreatitis with the result in the cyst);
• chronic calculous pancreatitis (virungolitis, calcified pancreatitis).

Klinichna picture. Chronic pancreatitis is most often manifested by pain, as it is localized in the supracranial area and radiated in the left, either on the right side of the edge or on the side of the edge, across the wall; In some cases the pain will take on an operative character; It is often the case that the irradiation is indicated in the area of ​​the heart, in the overlap, in the shoulder blade, in the clubs or in the groin areas, in the left steadily, in the area of ​​the cupric or the crotch.

More will be recognized in 1-3 years, or after receiving the reception, three years from the number of years up to 4-6 dB. Can provokuvatsya physical navantazhennyam, which is tied to the raztyaguvannyam capsule zalozi. It is not often ailments are brought up to the reception of a child, for fear of being attacked. It is characteristic of the situation when a sick person is suffering from an hour of aggravated pancreatitis: sitting in front of it, splinters in the general position of being able to see the disease.

More can be permanent or recurrent in nature, being attacked, often in the other half of the day. At the earliest stage of ailments, remissions are trivial, in larger and smaller stages, they are interrupted by attacks until decile days.

See also chronic pancreatitis with persistent pain. Win over the course of good (persistent) hepatitis. There is a permanent dull pain in the upper half of the abdomen, so that the letter can be accepted.

The appearance of latent (painless) pancreatitis (5% of all types), which contradicts the damage of internal and external secretions.

In case of stone formation (calculous pancreatitis) in the head of the pancreatic cavity, the pain of the swelling itself in the designated organ is caused. In case of stone formation, in all cases of zalozychayyyyayutsya rapidly progressing exocrine deficiency (carrying, abdominal swelling), lack of internal secretion, ale pain, as a rule, mensh are strong.

Dyspeptic problems - nudota, bloating, sludge, nestiyky viporozhnennya (cherguvannya constipation with penetrations) - it is either permanently, or only in the period of sharpening.

Zhovtyanitsya, icterus shkiri and sclera are evident in half of the ailments. The stench can be both remitting and permanent. The zhovtyanitsa is affected in large ailments to go away from Ahola, є the result of the filling of the head of the fledgling zone, the hindering of the gallbladder ducts, during the indurative process in the zalos, cicatricial and ignition changes in the ducts of the

Skhudnennya іnodі reachє of the tricky steps. The reasons for this are the lack of virobulation and adequate pancreatic enzymes in the intestine, difficult during childbirth, fear of ailments to get rid of through pains. Some of the ailments have a pain to see if they receive a small number of children, but they are not volody of those who are in power.

Lack of internal secretion, i.e., Persh for all the insulin, is characterized by signs of sugar diabetes: dryness in mouth, sprag, intolerant of sugar, polyuria, second in body. In the cob period, the ailment is more likely to suffer from hypoglycemia for the growth of the disease and hyperfunction of the acute condition; for older periods, ailments are characterized by gross breakdown in carbohydrate consumption.

Thin temperature, as a rule, is normal;

diagnostics Chronic pancreatitis is carried out on the basis of sub-active and active clinical symptoms of illness, given laboratory analyzes and the results of special methods of pre-treatment.

After a sick person was lying in the position, lying down with a roller in the position on the right boat, with the heel of the tulub forward at 45 °, standing with the heel of the tulub forward and left.

Sickness during palpation in the areas of Shoffar, Gubergrits - Skulsky and іn. Shoffar's zone is roztashovuєt on 5-b cm in the navel on the right side of the middle line and bisectrix of the umbilical kut (div. Figure); ailment in the central zone is especially characteristic for the burning head of the zalozi. In case of urezhennі tіla zolozi maximum sagging spite in the zoneі Gubergrits - Skulsky - right-handed from the navel (div. Malyunok). The Desjardins point is located at the center in cm from the navel on the line, from the bottom of the navel and the right groin; ailment in ts_y point is characteristic of zapalennya zalozi head. When localizing the process in the tail part of the zolozi, it means ailment in the Mayo - Robson point - on the cordon of the lower and middle third of the line, where the navel is in the middle of the small costal arch) (div.

Areas of shkіrnoї ailments with pancreatitis. 1 - Shoffard zone; 2 - zone of Gubergrits-Skulsky;
3 - Desjardins point; 4 - Mayo - Robson point.
A - line, scho z'єnu navel with groin depression;
B - line, scho z'єnu navel from the middle of the costal arch.

With palpation, it is possible to establish a sickly numbness in the area of ​​the middle line (on the level of the navel, about 2-4 cm).

In case of pseudotumorous forms, which run through zhovtyanitsyu, inodi develop Courvoise's syndrome, it is characterized by three signs: mechanic zhovtyanitsya, malleable and painless zhovchnym, mikhurom, Ahola.

When the process is aggravated, the pancreatic juice flows into the bloodstream and the pancreatic enzymes are not rapidly moving in place of pancreatic enzymes - diastasis, trypsin, lipase. In the period between attacks it is normal. The concentration of all the main enzymes in the duodenal cavity, navpaki, is lower, in the case of other ailments, the stench increases in the daytime.

The increase in bicarbonate blood puddles and in the place of amilase is a sign of an aggravated ignition process in the early period of ailment, and a progressive decrease in the level of amylase (even to an increased extent) is characteristic of advanced chronic pancreatitis.

Scatological dosage showing the presence of a great number of non-etched myad fibers (creatorrhea) and a drop of neutral fat (steatorrhea).

At the connection from the earliest time to the process of ostriches, the hyperspaces and changes of normal candied crooked are prevented by the infusion of the under-ground naphtha with reddish (two-humped reddish crooked).

When looking at X-rays of the black emptying, the calcification begins in the course of the bottom hole. When rentgenologіchnomu doslіdzhennі dvanadtsyatipaloї guts Minds її gіpotonії ( "paralіtichna" duodenografіya) can be viyaviti nepryamі symptoms hronіchnogo pancreatitis: rozgornutu loop ( "pіdkovu") dvanadtsyatipaloї intestine bulged abo defect napovnennya on vnutrіshnomu contour її nizhіdnіy chastinі, zmіni relєfu folds slizovoї Ilya Obolonkov in oblastі roztashuvannya duodenal papilla and deformity of the rest.

Ultrasound for pre-examination and computer tomography allow for chronic pancreatitis to develop all diseases, such as heads (pseudo-neoplastic pancreatitis), cystic changes in comrades. In a number of vypadkіv appear strong echostructures, roztasovanі right-handed and lіvoruch out of the ridge on the level of II-III transverse ridges, so that it can be found in the clear channels of stones and calcification in goods.

In case of radioisotope scanning, it appears: the formation of a scintigraphic baby due to a diffuse sclerotic process, a defect in the accumulation of an isotope, as well as to indicate about cystic changes in the disease

Retrograde pancreatography allows for the development of characteristic signs of chronic pancreatitis: deformation of the cephalic duct, soreness of the ducts, defects along the duct, in the presence of stones.

Angіografіchne doslіdzhennya (tselіako- mezenterіkografіya i) at rannіh stadіyah hronіchnogo pancreatitis pokazuє Zoni gіpervaskulyarіzatsіya, and pіznіh stadіyah vnaslіdok poshirenogo fіbrozu - difuzno zbіdnennya sudinnogo malyunka, zmіni Yogo arhіtektonіki, zmіschennya abo vіdtiskuvannya sudin at formuyutsya kіstah zalozi.

differential diagnostics guide us in front of wiry ailment, In case of pain, have a clear "hungry" character, localize in the center of the epicheral dilence and do not operate; cholecystitis When there is a slight ailment in the point of the malleus, a positive symptom of Ortrera and a phrenicus symptom (soreness when palpating between the legs of the right sternocleidomastoid nipple-like muscle). Do not go into oblivion, but pain in the epigastric zone, or in the middle of the border, when myocardial infarction, Especially the posterior diaphragmatic wall (so the titles of the abdominal variant). In general, the diagnosis is carried out on the basis of the EKG. Differentiation of chronic pancreatitis chubby tila pidshlunkovoy zalozi It is even more important to go to the stationary. Signs of cancer tila zalozi є: local swelling across, persistent pain in the area of ​​the transverse ridges, amoused by cancer metastases, which is confirmed radiologically.

lykuvannya in mіzhnapadu store for children, yak viklyuchaє greased, gostr, solon, fat їzhu, sokogonnye gravy. At the same time, the day is guilty of a high-calorie and fortune, there are a number of easy-to-use bills. A good race is guilty of storing 150 g of bottle, 30-40 g of fat, 350-400 g of carbohydrates.

For a substitute therapy for vikoristovyu form preparations dry podshlunkovoy zalozi, and to take away enzyme (pancreatin, Palizo, panzinorm), 1 tablet 3 times a day with dermal intake. Replacement therapy is prescriptive in case of clinical signs of secretory deficiency. In quiet cases, as long as the concentration of enzymes is not reduced, the sign of the drug is not valid.

Dozіlno in case of deteriorated feeding, add additional parenteral feeding, vicoristovuchi for the whole range of amino acids, concentrated glucose distribution. For polishing etching, we recommend that we take the ailment with the preparation, for revealing the ferments of the nutritive plant (pancreatin, festal, panzinorm). Periodically conduct a course of treatment with spasmolytics, and with mineral waters. Also, in the period of remission, the sanatorium-resort resort is shown in Zheleznovodsk, Asentuki, Borzhomi, Truskavts, in the gastroenterological sanatoriums of the local meaning.

Skin zagostrenia of chronic pancreatitis is seen as an attack on pancreatitis. Lіkuvannya in the period zagostrennya slіd to carry out the same principles, how and іkuvannya gosudarstny pancreatitis.

For the first 2 days, it was thoroughly reduced to the reception and the introduction of a small number of days. Allowed to drink non-alcoholic and non-malt warm tea, no more than 2-3 flasks for doba. Dietary mode in the phase of sharpening is indicated to the table No. 5a or 5 with an additional amount of 100-200 g bottle (No. 5a) and 140-150 g (No. 5). Zaboronyayutsya mint tea, kava, cocoa, chocolate virobi.

Drug therapy is guilty of being complex and is carried out in a hospital. For usunennya pain priznachayut analgesics. Preparations for morphine contraindications through the spasm of the sphinkter Oddi. Take bіl additionally help Novokain blockade: paranephral, ​​vagosympathetic, sacrospinal (inject 50 to 100 ml 0.25-0.5% of Novokain).

Suffocation of the secretary activity of being healthy is the sign of a hungry child, holinolitics (1 ml of 0.1% atropin or 1 ml of 0.2% of atropin). Mistsevo froze cold. Fight against self-digestion of zalozi to carry out for additional trasilol, countercala, tsalol 5000-10000 OD internally in drops.

For the production of toxic products and enzymes, pour electrolyte roschini (Ringer et al.). With the help of renewal of a broken cell exchange, I pour over the native plasma (400-800 ml in the fallow of heavy cells) or plasma exchangers. I mean antihistamines: diphenhydramine, pipolphene, suprastin in special doses.

Antibacterial therapy should be carried out for additional antibiotics in a wide range of products - tetracycline, which is well seen in the storehouse for juices from the seedlings; dose up to 1,000,000 OD per doba.

In case of endocrine (insulin) deficiency, as well as in case of decreased consumption, insulin-glucose therapy is indicated (8-10 OD for insulin supplementation and 10-20 ml of 20-40% glucose distribution internally). Dotally assigned anabolic drugs: nerobol (0.005 g 2-3 times a day), retabolil (1 ml 1 time per day internally), so as when pancreatic enzyme is used in the blood, it fizzles out in the back of the mind In chronic pancreatitis, a deficiency of vitamins is indicated, so that it is partially administered parenterally or per os vitamins A, C, E and group B in special doses.

In addition, chronic pancreatitis is more often on the background of pancreatic disease of susceptible organs (chronic cholecystitis, viral ailment of the shlunk or two-fingered intestines). When there is a pathology on the side of the youngsters, the slurry of the twelve-fingered intestine can be fed into the middle of the slurry. Shown before the operation, in such a way, will become the appearance of stones in the ducts of the clotting, cicatricial strictures of the ducts, the important form of painful pancreatitis. The main meta of surgical treatment is the stem of the mind for the optimal flow of pancreatic juice into the intestinal tract.

Before the hour of the operation, a retinal intraoperative revision of the ducts of the underworld, the ducts and the twelve-fingered intestine is required. With the help of my mark, I can see the intraoperative cholegraphy, the advancement of the zhovchny mikhur. Before the hour of the operation, the retrograde pancreatography should be stashed by cannulating the duct through the duodenal papilla or by puncturing - by puncturing the widened ducts of the distal part through the tissue.

With small strictures of the end portion of the pancreatic duct, transduodenal papillosphincterotomy with transpapillary drainage of the duct of the pancreatic duct is indicated. In the case of the presence of prolonged strictures of the pancreatic duct, such an operation is not painful, the most thoroughly imposed anastomosis is also spread through the pancreatic duct through a small intestine.

If the significant part of the duct is sore in the area of ​​the head and til, it is necessary to carry out a complete resection of the distal part of the gullet and insert it into the bad intestine, I will insert it along the Roux. Meta of such an operation - open the mind for the flow of pancreatic juice in a retrograde direction. In quiet vipadkah, if funktsіonuє parenhіma zdebіlshogo zalozi in rezultatі patologіchnogo Process bezpovorotno zaginula in ductal sistemі Je difuznі sklerotichnі zmіni and osnovnі symptoms hronіchnogo pancreatitis rіzko virazhenі i do not pіddayutsya conservative methods lіkuvannya conducting rezektsіyu pіdshlunkovoї zalozi (tail i tіla, subtotal pankreatektomіya) ...

(OP) і chronic pancreatitis (CP) by one of the provincial mechanisms є activation of pancreatic enzymes, in the first place trypsin, і "self-digestion" of the tissue of the pancreatic cavity. Trypsin wiklikє coagulation necrosis of acinar tissue with leukocyte infiltration. In its own cell, A- and B-phospholipases destroy the phospholipid ball of membranes and clitin, elastase - on the elastic "frame" of the walls of the sudin. In addition, the activation of calcareous and other vasoactive sprays of the growth of the vertebral penetration can lead to hemorrhagic sagging of the tissue of the flesh.

Before the activation of trypsin from trypsinogen in the ducts of the pancreas. In the presence of a firing process in the slurry zone and the passage for the outflow of pancreatic juice, activation of trypsin, chymotipsin and elastasis can also be found in the zone itself.

First and second HP

• In the case of primary CP, the ignition-destructive process is localized in the cob in the middle zone. Primary CP develops on aphids, trauma, allergies, cranial duct ulceration, chronic alcoholism, impaired blood circulation.
• Secondary CP of the accumulation of pathological susceptible organs, which impairs the function of the flesh-throat (gum disease, twisting ailment, diverticulum of the two-fingered intestine, etc.).

HP, on the thought of bagatokh pre-slidnikiv, often є the legacy of the postponed OP. In most ailments of CP (60% - for P. Mallet-Guy), the phase of pancreatitis becomes unrepentant, since they have a grave substitute for OP to establish a diagnosis of grub toxicoinfections, gum ailment, Cholecystitis, appendicitis, etc. Inodi, for example, in the minds of chronic food, persh for all the troublesome, shortcomings, the diagnosis of the first CP without attacks of the OP in the anamnesis.

V.M.Danilov and V.D. Fedorov, (1995) vvazayut, that in most ailments of CP and OP є in cases of disease with the same pathogenesis, as a rule, in cases of infection, it is about the first stage of ignition-degenerative processes in food. The concept of looking at OP and CP as two independent incapacitation, characterized by a developmental pathogenesis, as shown by retrospectively carried out preliminaries Y. Kloppel, B. Maillet (1991), D.S. and a number of morphological signs, which are out of the ordinary for them, are described.

Y. Kloppel and B. Mailet (1986, 1992) at the presentation of retrospective anatomical, morphological and histological reports were launched, but CP is a lot of repeated OP episodes. For the data of їх doslіdzhen, macro- and microscopic changes of the underdogs in the sick with OP and CP, with alcohol even more sub-titled. One of the main changes in the tissues of the slurry cavity is the authorization of necrosis of the peri and intrapancreatic fatty base, which leads to the development of fibrous tissue, the formation of pseudocysts, stenosis of the duct of the slurry. Obstructions in the duct system of the slurry layer of thickening and precipitation of bilks in the juice of the slurry and in the ground - setting stones. Tsі danі pіdtverdzhenі prelіdzhennym held in Tsurіhu (R.W. Amman і spіvavt., 1994). In the presence of steatonecrosis in the ductus system, the formation of pancreatitis can lead to the development of scar tissue and obstructive lesions in the duct system. Vidminnoy special proponated hypotheses є the fact that was the first in the development of HP - pato morphological changes in the tissues of the underflow zone, which leads to the sounding and obstruction of the duct system, secondly - the education of precipitates and stones.

The pathomorphological basis of CP is based on the destruction of the acinar apparatus with a progressive chronic ignition process, which can lead to atrophy and damage in the duct system of the fodder zone, which is important for the development of microscopic growth. There are also difficult lymphatic outflows (sometimes - due to the growth, and later - the sclerotic changes of the acinar tissue), the destruction of the microcirculation for the failure of the establishment in the capillaries of the fibrin of the threads and the micro One hour, there will be a gap in the bottom of the slurry after the growth of the fabric, fibrosis.

In the world of progression of fiery-degenerative changes, sclerosis of parenchyma of the flesh-throat, obliteration of the ductal system and the possibility of collapsing exocrine, because of the endocrine function. The whole process, as a rule, is a phase, with the destructive periods of fire, which is supervised by the destructive tissue of the flesh, and during the period of general well-being, if the tissue of the parenchyma is detected by the body.

With CP, periodically there are signs of aggravation, how to guess at the morphological and pathophysiological pictures of the gastric pancreatitis, as they change with remissions. Skin also zagostrenny є the reason for the rapid progress of ill health. Before an hour of chronic pancreatitis, the lobular tissue of the pancreatic cavity can develop, which is good for the exocrine function. In case of fibrosis, there are small parts, and pancreatic islands, which will enhance the progressive deterioration of both exo- and endocrine functions. All pererakhovani vishche vyshiny gradually increase, in parallel, the functional reserves of the slurry will decrease, which then appear clinically in the viglyad and exo- and endocrine deficiencies.

According to the data (Stephen Holt, 1993), an extraordinary lack of evidence manifests itself clinically with the destruction of 90% of parenchyma. The three stages of CP are characterized by the following three stages:

• calcification of zalozi,
• tsukroviy diabet,
• steatorrhea.

Steatorrhea occurs when the production of lipase in the slurry plant falls below 16% of the normal level.

In such a rank, CP in the Danish hour is often seen not as self-inflicted illness, but as a continuation and the result of the OP, which is the so-called fibrous-necrotic theory of development of CP. In 10% of the CP ailments go to the CP without the middle of the first attack by the CP, in 20% - between the OP attack and the development of the CP є a trivial latency period (from 1 rock up to 20 years), in 70% of the CP ailments they appear to be attacked by the OP. Chronic alcoholism, choledocholithiasis, chronic malnutrition of the intestines (viral fever, papilitis, papillostenosis, duodenostasis), atherosclerotic lesions of the disease

Early stages of chronic pancreatitis

In case of pathological anatomical predictions at an altogether early stage of CP, there is a number of changes in the development of an early stage of the disease, there is apparently a small inconvenience of blood loss, tissue damage, an increase in Immediately, you will see signs of a hospitable zapalennya, invoke the authorities of the OP, as well as chronic, sprout, fibrosis of a small part or industrial tissue, turn a clique of infiltration from the folds of hemosiderin and small cells. The change extends to the ducts of the slurry zone, the epithelium, which is metaplastic, sloughing, clogging up the enlightenment. In the cob period, the pathological process can be of an encirclement (vognischevy) character and does not widen for the entire tree: free, right-handed, Paramedian CP (P. Mallet-Guy, 1960).

The first stage of chronic pancreatitis

At the lower stages of CP, the pseudocyst, as a rule, is unstable in thrombosis, scaly, inertly with pseudocysts, resembling a barren-free or jovto-brown baring of the root, paralyzed by the pseudocysts. The stroma of the organ is represented by the growth of wide spheres with the full tissue of the pink stage of maturity, in the part of the vipads and the opening of the wap in the lumen of the ducts near the view of the granular stones of the whitish-yellow color, so in the middle of the growth of the pink tissue. Osyag exocrine parenchyma of drastic changes.

Obliteration and attachment of the vaping duct to zoom in on the establishment of retention cysts. When the cephalic duct grows, the animal locks on itself, I respect the manifestation of the nervous sound and the expansion of its education. L. Leger (1961) vidіlyaє such prototypes of enlargement of the ducts of zalozi according to their important localization: dilatation on all limbs, ectasia in the region of the head, corporeal illumination of the pseudocyst.

Kintseva stage of chronic pancreatitis

At the endsevian stage of CP, the pidshlunkov zalosis is atrophic, it is changed in the community, it is woody. Often there are diffuse intralobular and internal ducts of calcification.

In such a rank, pathomorphological changes in CP are characterized by the same sclerotic, atrophic and regenerative processes, as it is not easy to supervise the parenchymal organs and the decisions of the old children. To that, there are several pathomorphological variants of CP:

• indurativny,
• cystic,
• pseudotumorous.

Induratus chronic pancreatitis

Inductive CP in large ailments develops without a bar of transferred OP and manifests itself in diffuse growths of the associated tissue and in one hour atrophic parenchyma and enlarged ducts. In the case of the state of the ignition process, blood thinning and burning fatty necrosis in general is organized in a large number of types of added calcium salts and hydroxide apatite in the middle of the midwinter growths.

Cystic chronic pancreatitis

Cystic CP is characterized by cicatricial ulceration of the ducts of the ductus dermatitis due to damage to the pancreatic juice flow and dilatation of the distal ducts of the cephalic duct in the ductus dermis, as well as the development of the pseudocyst zone.

Pseudo-neoplastic chronic pancreatitis

Pseudo-neoplastic CP of the accumulation of hyperplastic firing process and supervising the process of getting rid of the whole body or part of it. The hyperplastic process is often used to get the head of the slurry zone and go to the development in new fibrous valleys, in other areas of extraction and in small cysts.

At the cob stage of CP, there is an abdominal pain syndrome dominating, which develops persistently for all intraductal hypertension in the subdural zone and pancreatitis-associated neuritis. Characteristic and such acceleration, such as pseudocytosis, zhovtyanitsya, compression of the duodenal intestine with impassability, pancreatic ascites, pleural vipitis.

Klinicheskaya zhovtyanitsa can appear in 8% of the ailments (A.A. Shalimov і spіvavt., 1997). The reasons for the blame of zhovtyanitsi in the ailments of HP can be: compression distal view zagalnoy zhovnoy ducts, cholelithiasis, stenotic papilitis, toxic hepatitis. In children with ailments, there is a complication and thrombosis of the spleen and vortic veins of the portal hypertension. On aphids of long-term CP, it is possible to diagnose carcinoma of the papillary root.

In such a rank, the main pathogenetic factors with HP є:

• a chronic ignition process, which leads to the destruction of the destructive device in the first place and the obligatory destruction of the endocrine device at various stages of illness;
• non-reversible progressive atrophy and fibrosis of acini and endocrine apparatus of the dermal zone (P. Banks, 1988; J. Valenzuela, 1988; H. Sarles, 1989; J. Grendell, 1993; H. Spiro, 1994).

When looking at the pathogenesis of CP, they are guilty of seeing two main forms of illness:

1. chronic calcific pancreatitis i
2. chronic obstructive pancreatitis.

There are some of the greatest incidences of slurry in the land of Western Europe (G. Cavallini, 1993). Chronic igneous fibrous pancreatitis is more likely to occur. At the same hour, a number of fahivts (prof. Henri Sarles from Marseilles) vvazayut, but for the morphological changes and dvі form, there is little to be seen. The pathogenesis of primary and secondary CP, which is caused by obstruction of the duct system, can be even more similar.

Pancreatic siq reveals a small amount of calcium in addition to the high level of bicarbonate. Pathogenesis of CP in bagatio in the form of dressings and damage to the formation of high calcium-calcium associates and in the development of calcifications. Razr_znyayut 3 types of stones in the slurry zone:

• calcium-carbonate-protein,
• calcium carbonate i
• bіlkovі (organіchnі) - other intractable protein plugs from the outside or a weak amount of calcification.

According to the theory, proponated by Sarles (1991), in the pathogenesis of primary CP, the main role is the precipitation of proteins in the ducts of the subsoil. In 1979, a glycoprotein was developed - lytostatin (PSP - pancreatic stone protein), which is without interlocking for the establishment of calculi in the submarine zone. Before the warehouse of white internal ductal aggregates, fibrillar non-essential peptides (LS-H 2), including enzymes of protein lytostatin (LS-S), should be included. Lytostatin is produced by acinar cells. The main role of litostatin is associated with the induction of nucleation, aggregation and the establishment of crystals of calcium salts in pancreatic juice. Litostatin is viewed as the most important stabilizer for calcium in a variety of applications. The appearance of acinar cells in the pancreatic juice in healthy people, in the pancreatic juice in healthy people, in the hypodermic cells (D. Hay, 1979) and in the cells (Y. Nakagawa, 1983). Calcium precipitation and the establishment of calculi in the ductus of the lactic acidosis are associated with a deficiency in the synthesis of lytostatin (Horovitz, 1996). Already at the very early stages of the formation of CP in the other ducts of the bottom slurry layer, there appear bile precipitates, which represent an unrepentant fibrillary bile with embedded calcium in the vigells of carbonates. As a matter of fact, it’s like a factor, as well as addictions (alcohol malignancy, smoking) add to the secretion and stability of the lytostatin. Bilkovy precipitates and stones in the ducts are laid to wipe out the perductal ignition processes, to produce fibrous tissue before the development. Osvita bіlkovyh precipitatіv і stones іveda before obstruction of the ductal system, viciousness її stenosis, in general to produce new concretions in the ductal systemі. Alcohol and nikotin are poured into the biochemical warehouse of pancreatic juice and by themselves drink lithogenesis in the duct system of the underflow zone. In pre-adolescents, it has been established that alcohol is used to increase the secretion of blood cells, while the secretion of blood lactoferin is increased, and the secretion of blood is reduced to acidic secretion. The price of a reduction in the concentration of ingibitor to trypsin, which increases the instability of the trypsinogen (L.A. Scurro, 1990). In some cases, there is a deficiency in the synthesis of lytostatin of accumulation of genetic factors, which can lead to the development of congenital, family CP. A hypothesis is given for the practical determination of calcific calculi at the early stages of illness.

Radioimmunological analysis with monoclonal antibodies did not reveal any specific indications of lytostatin in the pancreatic juice of CP ailments in the control group (W. Schimigel, 1990). The concentration of lytostatin in pancreatic juice is not of a small value for the formation of precipitates, more than a hundred in the reduction of the potential for synthesis, so that the pool of lytostatin is overgrown (D. Giorgi, 1989). The third position of the pathogenesis of precipitation of protein-calcium aggregates is seen as the result of a decrease in the secretion of lytostatin in the minds of increased consumption. Such stan- The creation of a storehouse of organic matrix stones from the bottom slurry has shown that it includes modifications of lytostatin, albumin, globulin with a high molecular weight.

Horovitz (1996) developed 2 main pathogenetic types of CP - calcific and obstructive.

Calcific chronic pancreatitis

Calcific CP is characterized by the appearance in a zalos of stones with a high level of calcification and a clear connection with implantation of alcohol or deficient (uncommon) habits. At the cob stages of CP, there may be other non-destructive protein plugs from the outside of the calcification. Such "microcities" are X-ray reflective. The main nutritional factors for the pathogenesis of calcifying CP are seen in the given hour from the position of the mechanism of calcium and protein precipitation.

Calcific CP inflicts the most frequent form of CP, which occurs in the lands of Western Europe, on a part of the attack, from 36 to 95% of all CP (T.T. White, 1978; J. Bernard, 1994). In high-ruined lands, calcific CPs are associated with the evil of alcohol, hostile to the people from the possible vernaculars of the population of 30-40 years.

In the Asian and African regions, calcific CP, as a rule, does not have a connection with the implantation of alcohol;

Obstructive chronic pancreatitis

Another for the frequency of the form of CP is obstructive pancreatitis, which is characterized by apparent stenosis of the ducts of the ductus lumps in any case. In biopsy specimens of pidshlunkovaya zolozi, you develop atrophy of acinous tissue and in the form of fibrosis. Most often, obstruction is localized on the level of the ampullary viddil, at which there is distal internal duct hypertension with the development of dilatation of the duct system. In the case of obstructive CP, dilatation of the gut ducts may occur in the case of obstructive CP.

alcoholic pancreatitis

Bordalo from Portugal (1984) proposes a new hypothesis for the development of HP. For this data, we will start on anatomical and morphological preliminaries, HP winery with trivial intake of alcohol, until the accumulation of lіpіdіv in all the middle clines of pіdshlunkovoi zolozi and until the development of the first processes. The author has arrived to visnovka, which is similar to the development of liver cirrhosis of fibrosis of the lactic acidosis in the case of necrosis of cerebral cells and alcoholic chronic reflux. The hypothesis is seriously taken by the Marseilles school, and in 1983, alcoholic bran is taken into account in the tissues of the undergrowth, the accumulation of oxidative radicals, peroxidases, oxidizing agents. It has been reported that with a trivial intake of alcohol, the functions of the furnace and slurry will be destroyed, and that the accumulation of oxide radicals and a decrease in the level of such antioxidants as vitamins C, E, riboflavin, beta-carotene. According to the theory, changes in the function of the cells of the lactobacillus should be reduced to a decrease in the secretion of lytostatin and, in addition, to the establishment of concretions in the ducts. The given hypothesis is important that for the first time a toxic injection of alcohol was brought in for a three-hour period to the deterioration of the function of the pancreatic cavity, degeneration of cerebral cells, the development of intrapancreatic sclerosis, and stethosis.

In this day, the most vivid morphological and pathogenetic features of CP of alcoholic etiology (H. Sarles, 1981; Kloppel and Maillet, 1992; S.P. Lebedev, 1982), for which characteristic is particularly important. Naybіlsh vіrіgіdnym in case of malignant alcohol є primordial chronic overloading of malaise. Acceptance of ethyl alcohol for a trivial hour of viklikak holinergichesky effect, led to hypersecretory bile acinar cells.

An absolute factor in the development of CP is necrosis of interstitial adipose tissue, which leads to the development of perilobular fibrosis. With the growth of the full tissue between the small parts of the pancreatic layer, the pressure of the other ducts is observed and hypertension is formed in the duct system, as a result of the normal flow of pancreatic juice. The cych minds have a big secret, which is not balanced by the hyperproduction of water and bicarbonates, accumulates in other ducts in the blood precipitates, in which salts of calcium appear and concretions form. The process of changing the development of intra- and periductal sclerosis, local stenosis and obturation of the duct of the subcutaneous cavity with one-hour dilatation of the duct system.

Pathognomonic signs of alcoholic pancreatitis є:

1. enlargement of the duct of the sublimated zone, metaplasia and desquamation of the duct epithelium;
2. the inconsistency of pathological changes in the young dylyankas of the greenhouse (W. Boecker and spivavt., 1972; H. Sarles, 1974).

Previously, the third theory of the development of CP is shown to show the way to the reduction of acinar tissue and to the formation of debris in the duct system. Boros and Singer (1984) allow, trivially with alcohol, to go back to the destruction of the development of destructive changes in the epithelium of the ducts of the fodder with the further establishment of precipitates in them. On the models of CP in twins, the authors have shown (1991, 1992) that, with trivial alcohol intake in animals, there is a potential for development of obstructive processes in the ducts of the foster bed, in which case precipitates and calculi are deposited in them. Destroyed to the secret zalozi wiklikє the whole complex classic paintings HP. Adequacy of the morphological picture of periductal fibrosis in case of advanced types of CP to give thought to the role of autoimmune processes in development chronic heat creeping ground (J. Cavallini, 1997). Infiltration of tissue undergrowth by lymphocytes is a triggering process that cyclizes the fibroplastic process in the periductal area. From the point of view of the pathogenesis of CP viglyadє in the next rank: fouls from pancreatic juice to produce the precipitation of bile, the establishment of bilious clots and nadal - stones, as well as obstructive processes in the ducts. Such exogenous factors, such as alcohol and nikotin, are injected onto the lytogenetic health of the juices of the juvenile zone and the reduction of the epithelial curvature of the duct system and the secondary zone. All theories have been re-insured with a clear confirmation. So, R.P. Jalleh і spіvavt. (1993), Cavallini (1997) to influence the manifestation of genetic schilliness in the development of CP.

K. Hakamura (1982) in the morphogenesis of CP of the 2nd stage:

1. I will ignite - until the cob is approved of stones; we are typical є lobular і bagatochkovy character of widening of the igniting flares; i
2. calciferous - at the time of the discovery of the wine and the stones in the hall; visible on ultrasonic radiographs: the whole stage is characterized by the lack of penetration of the ducts of the underworld.

The deterioration of over-etching and wetting of grubs in CP should be reduced to a loss with feces from living cells, fat and vitamins. As a result, viscosity, asthenia, impaired metabolism may develop. knitted fabric, Blood circulation system.

A. A. Shalimov, V. V. Grubnik, Joel Horowitz, A. I. Zaichuk, A. I. Tkachenko / Chronic pancreatitis. Suchasnі concept of pathogenesis, diagnostics and treatment. 2000r

Vikoristani dzherela:

• Danilov M.V., Fedorov V.D. Hirurgiya pidshlunkovoy zalozi. - M .: Medicine, 1995 .-- 509 p.
• Dosvid vikoristannya sandostatin in patients with chronic pancreatitis / List of districts A.S., Sadokiv A.S. Sadokiv V.M. і spіvavt. // Ter.archiv. - 1995. - T.67. - S.60-62
• A.P. Radzikhovskiy The fistulas are covered with slurry. - K.: Nauk. dumka, 1987 .-- 222 p.
• Shalimov A.A., Shalimov S.A., Nichitaylo M.E., Radzikhovskiy A.P. Hirurgiya Podzho-ludochnaya zalozi. - Simferopol: Tavrida, 1997 .-- 553 p.
• Beger H.G., Buchler M. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis with inflammatori mass in the head // World J. Surg. - 1990. - Vol. 14, No. 1. - P.83-87.
• Beger H.G., Buchler M., Bittner R.R. Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis: early and late results // Ann. Surg. - 1989. - Vol. 209, No. 3. - P.273 - 278.
• Binmoeller K.F., Jue P., Seifert H. Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results // Endoscopy. - 1995. - Vol. 27. - P.638-644.
• Bornman P.C., Russell R.C.G. Endoscopic treatment for chronic pancreatitis // Br. J. Surg. - 1992. -Vol. 79, No. 12. - P.1260-1261.
• Buchler M.W., Friess H., Baer H. Surgical treatment of chronic pancreatitis: new standards // Dig. Surg. - 1996. - Vol. 13, No. 2.
• Carlin A., Fromm D. Pancreaticoduodenectomy for recurrent alcoholic pancreatitis associated with microabscesses // Surg. Gynec. Obst. - 1993. - Vol. 176, No. 4. - P.315-318.
• Coleman S.D., Eisen G.M., Troughton A.B. Endoscopic treatment in pancreas divisum // Am. J. Gastroenterol. - 1994. - Vol. 89, No. 8. - P.1152 - 1155 Not.
• Cremer M., Deviere J., Delhaye M. Non-surgical management of severe chronic pancreatitis. // Scand. J. Gastroenterol. - 1990. - Vol. 175, suppl. - P.77-84.
• Cremer M., Deviere J., Delhaye M. Stenting in severe chronic pancreatitis: results of medium-term follow-up in sewenty-six patients // Endoscopy. - 1991. - Vol. 23.- P.171-176.
• Crombleholme T.M., deLorimier A.A., Way L.W. The modified Puestow procedure for chronic relapsing pancreatitis in children // J. Pediatric Surg. - 1990. - Vol. 25, No. 7. - P.749- 754.
• Greenlee H.B., Prinz R.A., Arancha G.V. Long-term results of side-to-side pancreaticojejunostomy // World J. Surg. - 1990. - Vol. 14, No. 1. - P.70-76.
• Holt S. Chronic pancreatitis // Sout. Med. J. - 1991. - Vol. 86, No. 2. - P.201-207.

- firing pidshlunkovoy zalozi. Symptoms of gastrointestinal pancreatitis: gostra, unbearable beating in the abdomen. It is because of the fact that a part of it is hot, the localization of pain is possible in the right or in the lіvuyu pіdreberi, in the epicheral dіlyantsі, more likely to be operative. Chronic pancreatitis is accompanied by a second appetite, welcome the pains(Yak at state form), I will be able to find out about the fat, food and alcohol.

Country houses

Pancreatitis is a malaise, characterized by a development of fumes in the tissue of the undergrowth. Due to the nature of the pancreatitis, the pancreatitis is subdivided into hospitality and chronicity. gostry pancreatitis Loss of a third place in the middle of a sickness of an empty room of a state of emergency, which will require treatment in a surgical hospital. The first and the other place are the patients with appendicitis and cholecystitis.

According to the data of light statistics, in the Russian Federation we will be sick with pancreatitis from 200 to 800 people per million. Tse of getting sick is often seen at the choloviks. Vіk ailments are thrown in wide gaps і lie down for the reasons of development of pancreatitis. Gostry pancreatitis against the background of alcohol malignancy in the middle of the year is close to 39 rockets, and with pancreatitis, associated with gum disease, the middle age of patients is 69 rockets.

cause

pathogenesis

In the development of a state-of-the-art podshlunkovoy zapalenaya zhyposhyrenіshoy theory, the main factor in the development of the cultivation of cinnabar is often activated by enzymes. In normal minds, the ferments vibrate in the inactive form and become active in the herbal tract. Due to the flow of new and internal pathological factors, the mechanism of vibration breaks down, enzymes are activated in the greenhouse and repair the over-etching of tissue. As a result, it becomes fiery, grows a bunch of fabrics, and makes a lot of parenchyma.

The pathological process in case of gastric pancreatitis can be widespread on the suspicious tissue: retroperitoneal cell, omentum bursa, omentum, omentum, intestinal bridges and ligaments of the duodenal ulcer. An important form of gastrointestinal pancreatitis with a rapid admission of the level of biological active speech in the blood, even before the development of extravagant problems of life: secondary inflammation and dystrophies of the lungs in the tissues

Classification

Gostry pancreatitis is classified beyond the degree of severity:

1. easy form against the smallest variety of organs and systems, to rotate in the main interstitial swelling, it is easy to get therapy and a poor prognosis to a quick weariness;
2. important form Gastrointestinal pancreatitis is characterized by the development of swelling in the organs and tissues, or abdominal accelerations (tissue necrosis, inflammation, bruises, abscesses).

An important form of gastric pancreatitis can be supravodzhuvatisya:

• We will hospitality to the purchases of rіdiny vseredinі zolozi either in the near-pancreatic space, as there may not be mothers of granulation or fibrous walls;
• pancreatic necrosis with possible tissue infections (the winery is surrounded by a zone of parenchymal and peri-pancreatic tissue diseases, in case of infection and development of severe pancreatitis, the result of summer
• hospitable pomilkovoi kistoyu (we will buy pancreatic juice, we will squeeze out fibrous stinks, or granulations, like winyk, if we attack pancreatitis, shape it in a stretch of 4 or more);
• pancreatic abscess (buying up pus in the flesh or the adjacent tissues).

Symptoms of gastric pancreatitis

Characteristics of symptoms of gastric pancreatitis.

• Pain syndrome... More can be localized in the epigastria, in the left side of the border, have an operative character, in the form of a shoulder blade. Bіl bears a constant character, in the position lying on the back to do it. More pain relief from getting sick, especially fatty, greasy, greased, alcohol.
• Nudota blues... Blues can be non-streaky, take revenge on zhovch, do not bring lulling.
• Adjustable temperature.
• The sclera swells around... Ridko is an easy zhovtyanitsa shkіrnykh pokrivіv.

In addition, pancreatitis can be supravodzhuvatisya dyspeptic symptoms (flatulence, burning), shkіrny manifestations (cyanosis on the floor, blood in the navel).

accelerating

Nebezpeka gosstry pancreatitis polyagaє in high imovirnostі development of important acceleration. When inflammation of the tissue is inflamed, it is covered with bacteria that linger in the small intestine, and there may be necrosis of the small intestine and abscess formation. Tsei stan without a quick lіkuvannya (right up to surgical involvement) can end in death.

In case of severe interruption to pancreatitis, a shock stun may develop, such as inheritance, polyorganic deficiency. For the development of a severe pancreatitis in the tissue, there can be some form of pseudo-filaments (the purchase of ridin in parenchyma), which can change the structure of the clotting and gum ducts. When pseudo-flux is ruptured and the end is in the place of the ascites.

diagnostics

To diagnose pancreatitis, gastroenterologists should be aware of scarg, physical examination, and characteristic symptoms. at vimir arterial vise heart rate is often associated with hypotonia and tachycardia. To confirm the diagnosis, service laboratory dosage blood and slaughter, MSCT and ultrasound of organs in the void, MRI of the underdog.

• Biochemistry of blood. With continued blood in Zagalom analizі signs of inflammation (accelerated SHOE, adduction in the place of leukocytes), in the biochemical analysis of blood, may be detected in the activity of pancreatic enzymes (amilase, lipase), may be hyperactive Bilirubinemia and increased activity of liver enzymes may be indicated.
• Biochemistry of the battle. To carry out the value of the concentration of enzymes in the section. When diagnosing gastrointestinal pancreatitis, take a biochemical analysis of the disease and start the activity of the amylase.
• Instrumental methods. The visualization of parenchymal disease and adjacent organs (ultrasound, CT, MRI) allows the development of pathological changes in parenchyma, the development of an organ in general, the appearance of abscesses, bones, and manifestations

Differential diagnosis of gastric pancreatitis should be carried out with:

• we are hospitable with appendicitis and with cholecystitis;
• perforations of empty organs (perforation of the bowel and intestines);
• gastrointestinal imperfections;
• we will go to shlunkovo-intestinal bleeding (vyrazka shlunka і 12p. intestine, bleeding from varicose veins to the drain, intestinal bleeding);
• Hostry ischemic abdominal syndrome.

Likuvannya gostry pancreatitis

With a state of pancreatitis, a hospitalization is indicated. All patients are assigned a post-treatment regime. The main goals of the therapy are the knowledge of pain syndrome, reduction of pressure on the slurry, stimulation of mechanisms and self-renewal.

Therapeutic come in:

• novokainov blockade and antispasmodics for patients with severe pain syndrome;
• hunger, ice on the area of ​​projection zalozi (stem of local hypothermia for lowering functional activity), eating parenterally, aspirating mucus vst, recognize antacid and pyretic activity;
• deactivators of pancreatic enzymes (іngіbіtory proteolіzі);
• it is necessary to correct homeostasis (water-electrolyte, acid-base, and alcohol balance) for additional infusion of salt and alcohol;
• disintoxication therapy;
• antibiotic therapy (drugs of a wide range of diy at high doses) in the form of prevention of infectious diseases.

surgical treatment

Hirurgical tactics are shown in the development of:

• stones in the gum ducts;
• the collection of births in the hall or near her;
• pancreatic necrosis, cysts, abscesses.

Before operations, which are carried out in case of gastrointestinal pancreatitis with statements of cysts or abscesses, are carried out: endoscopic drainage, marsupialization of the brush, cystogastrostomy and inn. When necrosis is established, in the fallowness of the size, carry out necrectomy or resection of the debris. The appearance of stones is shown before the operations on the prototype of the bottom hole.

Before the surgical involvement, you can go to the point of being aware of the diagnosis and tolerance of the medical condition, as well as the diagnosis of the surgical treatment. period of operation MAKE ON YOUR INTENSIVE COME PROMOTION OF SEPTIC-SEPTIC ACCELERATED AND VIDNOVU THERAPY.

Likuvannya easy to form pancreatitis, as a rule, does not become difficult, and positive dynamics is meant to continue to stretch. For pancreatitis, it will take more than an hour to drink from an important form.

Forecast and prevention

The prognosis for gastric pancreatitis lies in the form, the adequacy of the therapy and the manifestation of the acceleration. Easy form pancreatitis give rise to a favorable prognosis, and in case of necrotic and hemorrhagic pancreatitis of the temporalis, there is a lethal result. Lack of treatment and lack of treatment lykarsky recommendations according to the day and the regime can lead to recurrences of illness and development of chronic pancreatitis.

Primary prophylaxis є rationally healthier eating, including alcohol, food, fatty fumes, food from home. Gostry pancreatitis can develop not only in particular, regularly malign alcohol, but as a result of a one-time intake of alcoholic beverages, I’m fat, greased and a gostrum snack in great quantities.