Pancreatitis - How Does It Manifest? What To Do With An Attack Of Pancreatitis And Its Exacerbation?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

How does pancreatitis manifest? What to do in case of an attack?

Content:

• What is pancreatitis?
• Pancreatitis reasons
• How does pancreatitis manifest?
• How does chronic pancreatitis manifest?
• Diagnostics
• Pancreatitis attack - what to do?
• Treatment methods
• Prevention of pancreatitis

What is pancreatitis?

Pancreatitis is an inflammation of the pancreas. The cause of pancreatitis is the blockage of the duct of the gland with stones from the gallbladder, a tumor or a cyst. In such a situation, the outflow of digestive juices with enzymes into the small intestine fails. These pancreatic enzymes accumulate over time and begin to affect the tissues of the gland itself. The result is that the pancreas digests itself.

Such enzymes can destroy not only all tissues of the gland, but also nearby blood vessels and other organs. The result can be death.

Pancreatitis reasons

The gland is influenced by the diet of a person and his lifestyle in general. In order for carbohydrates, fats and proteins to be absorbed by the body, certain enzymes must be present in it, for example, lipase for the absorption of fats, trypsin for the absorption of proteins. When a person enters into his diet foods in which harmful substances predominate, either when he abuses alcohol, or when he undergoes therapy with certain drugs, the work of the pancreas is disrupted. Such a slowdown leads to stagnation of juice in the organ and in its ducts. The process of digesting food fails, as a result, a person begins to suffer from inflammation of the gland - acute pancreatitis. Poisoning, overeating, trauma can provoke it.

Inflammation of the pancreas separately is an extremely rare phenomenon, almost always other digestive organs are involved in this pathological process. The difficulty in diagnosing its condition lies in the fact that it is located deep in the body and is small in size.

Scientists have identified a number of factors leading to the development of pancreatitis:

• Diseases of the gallbladder and biliary tract. This is the most common cause of inflammation. The fact is that with the formed obstruction of the biliary tract and with the throwing of bile, the pancreas gives a pathological chemical reaction. It accumulates substances that stimulate the work of the enzymes produced against the tissues of the organ itself. There is a gradual destruction of blood vessels, the tissues of the gland swell greatly, hemorrhages appear in it. According to available data, pancreatitis due to disruption of the gallbladder and its pathways develops in 70% of cases (if we exclude the alcoholic nature of the disease). Scientists attribute the rest of the causes of inflammation of the gland to idiopathic, that is, those that cannot be established.

• Diseases of the duodenum and stomach. The release of intestinal contents into the ducts of the gland can occur with insufficiency of the sphincter of Oddi. This occurs in diseases such as: gastritis and ulcers, decreased motor activity of the duodenum or inflammation.
• Intoxication of various etiologies. Poisoning by alcohol, chemicals, food, and even infection with worms can all lead to the formation of pancreatitis. In addition, the regular consumption of fruits and vegetables with pesticides, the inclusion of foods rich in chemical additives in the menu is harmful.
• Increased blood pressure, vascular atherosclerosis, gestation period, diabetes mellitus. Any disease leading to impaired blood circulation causes it to malfunction in the pancreas. As a result, there is a violation of its nutrition and the formation of inflammation. During the carrying of a child, a lack of blood circulation occurs due to the pressure of the uterus on the vessels of the organs, contributing to the development of his ischemia. Therefore, all pregnant women are at high risk for the development of pancreatitis.

• Binge eating. If the balance of fat metabolism is disturbed in the body, the gland begins to produce enzymes in greater quantities. If disorders of fat metabolism become chronic, then the risk of developing organ inflammation increases significantly. It is especially dangerous to include fried and fatty foods on the menu.
• Undergoing therapy and taking certain medications for this reason. The following drugs can adversely affect the work of the pancreas: Metronidazole, Furosemide, Azathioprine, Tetracycline, Estrogens, Glucocorticosteroids, Cholinesterase Inhibitors, Thiazide diuretics, Sulfonamides and NSAIDs.
• Organ trauma. Operations on the duodenum and gallbladder, blunt trauma to the abdomen, and injuries can lead to inflammation.
• Allergy. Some types of pancreatitis can be triggered by allergic reactions in the body. It begins to produce antibodies prone to autoaggression. Similar processes occur in pancreatitis, when the gland destroys itself. (Read also: Causes, Symptoms and Treatment of Allergies)
• Infections. Chickenpox, chronic tonsillitis, liver failure, hepatitis, mumps, inflammation of a purulent nature, localized in the peritoneal cavity and outside it, dysentery and intestinal sepsis - all these infections can provoke inflammation of the pancreas.
• Genetic predisposition. Possible genetic disorders that provoke the development of the disease in early childhood.

Pancreatitis statistics for reasons of occurrence

• 40% of all patients with inflammation of the pancreas are alcoholics. They usually reveal either organ necrosis or its destructive disorders.
• 30% of patients are patients with a history of cholelithiasis.
• 20% of patients are obese patients. (Read also: obesity: degrees of obesity and its causes)
• 5% of patients are patients who have suffered an organ injury or intoxication of the body, taking medications.

• Less than 5% of patients are patients with a hereditary predisposition to the formation of inflammation, or suffering from congenital defects in the development of the organ.

How does pancreatitis manifest?

Organ inflammation is accompanied by symptoms that overlap with signs of serious poisoning. Enzymes, with pancreatitis, remain in the ducts of the pancreas or in the organ itself and destroy it from the inside. In addition, they are absorbed into the bloodstream, which leads to the development of intoxication of the body.

So how does pancreatitis manifest? The following signs can be distinguished:

• Severe pain always accompanies inflammation of the gland. They torture the patient on an ongoing basis, their character is cutting or dull. Pain can be so severe that it can provoke a painful shock. The place of their localization is the right hypochondrium or left hypochondrium, or the area located slightly below the middle edge of the sternum. The exact location of the pain depends on which part of the organ is inflamed. If the entire gland is inflamed, then the pains are of a girdle nature.
• Increase in body temperature, drop or increase in pressure. The more intense the inflammation, the worse the patient will feel. Body temperature rises to high values, jumps in blood pressure are possible.
• Change in skin color on the face. First, the patient's facial features sharpen. Secondly, the skin turns pale, and then completely becomes earthy gray.
• Vomiting occurs. After the vomit comes out, the patient does not feel a sense of relief. The masses themselves contain undigested food, and subsequently bile masses. In this regard, fasting is an important point in the treatment of inflammation, which lays the foundation for further successful recovery.
• Nausea and hiccups. In addition, belching and dry mouth may occur.
• Constipation or diarrhea. Most often, the acute phase is accompanied by the appearance of a foamy, offensive stool, in which food particles are present. Constipation often becomes the first sign of the development of inflammation; in parallel, the patient experiences hardening of the abdominal muscles and bloating.
• Shortness of breath. This symptom is formed due to the loss of electrolytes during vomiting. A person has sticky sweat, a large amount of yellow plaque forms on the tongue.
• Bloating. Stopping the work of the intestines and stomach leads to bloating, which the doctor diagnoses when performing palpation.
• The appearance of cyanotic spots. They occur mainly in the lower back and around the navel. At the same time, the skin looks like marble, and in the groin area it can turn blue-green. The reason for this condition is the penetration of blood from the inflamed organ under the skin.
• Yellowing of the skin and sclera of the eyes. If sclerosing pancreatitis occurs, then the patient develops obstructive jaundice. It is formed against the background of clamping of the bile duct by an inflamed organ.

If the patient shows signs of acute pancreatitis, his condition will rapidly deteriorate. Therefore, it is so important to seek immediate medical attention.

The same signs that appear in both acute and chronic (during exacerbations) forms of pancreatitis are acute, severe pain in the abdomen. Localization depends on which part of the pancreas is covered by the inflammatory process.

The main constituents of the pancreas are the head, body and tail. If the process began in the head of the gland, then acute pain occurs in the right hypochondrium, if the body is affected, then the pain is noted in the epigastric region, and pain in the left hypochondrium indicates the development of inflammation in the tail. If the whole gland is involved in the process, then the pain syndrome is of a shingles in nature, it can radiate to the back, behind the sternum, to the scapula.

The pain syndrome in acute inflammation of the pancreas is considered one of the most severe. Acute, sharp pain that occurs in the abdomen or in the hypochondrium tends to spread to the back, to the area of the shoulder blades and behind the sternum.

In the acute form, stool disturbances from diarrhea to constipation are usually noted. Most often, patients note a mushy stool with impurities of undigested food, which has an unpleasant odor.

How does chronic pancreatitis manifest?

Chronic pancreatitis is accompanied not only by inflammation of the organ, but also by structural changes in its tissue. Experts say that the most significant difference between the chronic form of the disease and the acute one is the progression of pathological changes in the organ even after the provocateur has been eliminated. As a result, the patient experiences exogenous and endogenous insufficiency of the gland.

The initial period of chronic inflammation of the organ lasts, as a rule, up to several years. In this case, the symptoms of the disease appear and disappear. The second period starts from the moment when the symptoms of the disease begin to haunt a person constantly.

• For several decades, the patient can complain only of periodic pains that bother him after a quarter of an hour from eating. Pain can last from an hour to several days. The place of their localization is the upper abdomen, sometimes pains are felt in the heart, or in the left side of the sternum or lower back. In some cases, the pain is shingles. You can reduce their intensity by leaning forward or sitting down.
• Pain often does not occur spontaneously, but is the result of eating fatty, fried foods or alcohol. Chocolate or coffee can provoke an attack. If you eat several potentially dangerous foods at the same time, the pain can become unbearable. This is due to the fact that the gland is not able to cope immediately with various types of carbohydrates, fats and proteins. Therefore, those people who eat separately are less likely to suffer from pancreatitis.
• An attack of pain may be accompanied by diarrhea, nausea, vomiting, flatulence, and a person may begin to lose weight. However, these symptoms do not always bother the patient, and even when receiving symptomatic therapy, you can quickly get rid of dyspeptic disorders and continue to lead a normal life, but until the next attack.
• When pancreatitis becomes chronic and a person does not receive proper treatment, organ structures are destroyed. There are signs of enzymatic and hormonal deficiency. Moreover, such people may not suffer from pain at all. Symptoms of dyspeptic disorders prevail more often.
• The patient's skin acquires unexpressed yellowness. The same applies to the sclera. The yellowing of the skin periodically disappears.
• When an organ atrophies completely, a person develops diabetes mellitus. (Read also: Causes, Signs and Symptoms of Diabetes Mellitus)

The following types of chronic inflammation of the pancreas are based on the symptoms from which the patient suffers:

• Asymptomatic inflammation - for years the patient does not even suspect that he has a problem;
• Dyspeptic inflammation - diarrhea, flatulence, weight loss come to the fore in the patient;
• Painful inflammation - the patient suffers from severe pain that occurs after eating and drinking alcohol;
• Pseudo-neoplastic inflammation - the symptoms are similar to those of pancreatic cancer, while the patient's skin and sclera turn yellow.

Video: why drugs don't work? What to do to relieve pain?

What to do if you suspect chronic pancreatitis?

Passing a full examination after visiting a gastroenterologist - these are the correct actions of a person with suspected chronic inflammation of the organ.

The diagnosis is made after carrying out the following diagnostic techniques:

• Changing the amount of elastase in urine is the main method of laboratory examination of a patient;
• Identification of steatorrhea - the presence of undigested fats in the feces;
• Conducting a diagnostic test for organ stimulation;
• Ultrasonography;
• Computed tomography according to indications;
• Performing a blood glucose test and taking a glucose tolerance test.

If you use only ultrasound diagnostic data to make a diagnosis, then it may be unreliable. Often, pancreatitis does not give any specific signs and the specialist conducting the examination can detect only minor diffuse changes or swelling of the organ. Although even these indicators are visible on ultrasound only with an exacerbation of the disease.

Diagnostics

The diagnosis of pancreatitis is carried out by gastroenterologists. The patient is examined, his complaints are heard, the anamnesis is studied. During the initial intake, blood pressure is necessarily measured. With inflammation of the pancreas, it is often reduced, and the heartbeat, on the contrary, becomes more frequent.

To confirm the diagnosis, the patient is prescribed the following tests and procedures:

• Delivery of a general blood test. With pancreatitis, all signs of an inflammatory reaction are detected: ESR accelerates, the level of leukocytes rises.
• Blood donation for biochemical analysis. This will reveal an increase in pancreatic enzymes such as lipase and amylase. Hyperglycemia and hypocalcemia are common.
• Delivery of urine to determine amylase activity in it.
• Ultrasound of the pancreas is a fairly informative method in terms of detecting the disease. With its help, it will be possible to visualize the organ itself, the state of its parenchyma, the size of the gland. At the same time, other organs of the digestive system (gallbladder, liver, spleen) are examined, which makes it possible to identify the cause of pancreatitis.
• If a detailed examination is required, then the patient is referred for CT or MRI. As a rule, such a complex diagnosis is prescribed for patients with complicated pancreatitis.
• Endoscopic retrograde cholangiopancreatography (ERCP) is prescribed for biliary pancreatitis. In this case, a probe is introduced into the main bile duct, through which a contrast agent is supplied. Then, an image is taken on X-ray equipment. This technique allows you to assess the patency of the smallest ducts, to identify calculi in them, as well as other obstacles: strictures, kinks, adhesions.

Sometimes the symptoms of pancreatitis mimic those of other abdominal diseases.

Therefore, it is important to carry out differential diagnostics with such disorders as:

• Appendicitis and cholecystitis in the acute phase.
• Perforation of the intestine or stomach against the background of the ulcerative process.
• Bowel obstruction.
• Internal bleeding.
• Abdominal ischemic disease.

In general, the diagnosis of pancreatitis is not difficult; often the doctor can suggest inflammation of the pancreas in the patient even at the stage of questioning and examination.

Pancreatitis attack - what to do?

Exacerbation of organ inflammation is a serious problem that can endanger not only the health, but also the life of the patient. Treatment is carried out strictly in a hospital environment, since a person can die without timely qualified assistance.

Pain and other symptoms of an attack of pancreatitis

The pain is intense, not stopping. Appears in the abdomen, but can radiate to the back, lower back, under the shoulder blade. The nature of the sensations is dull or cutting.

Such a high intensity of pain is explained by the abundance of nerve endings in the pancreas, which, when it is inflamed, are involved in the pathological process. A person during an attack may even experience a painful shock.

Sharp pains similar to those of a dagger are a sign of destructive inflammation. Irritation of the peritoneum when stroking indicates its involvement in the process of inflammation. In this case, the pain recedes somewhat when pressing on the abdomen and intensifies when released. A person succeeds in lowering the pain threshold if he pulls his legs up to his stomach.

Loss of consciousness is the result of unbearable pain. If it does not have a tendency to decline, and continues to grow, then this is an extremely dangerous symptom that speaks of the manifestation of the process of organ destruction.

• Pain occurs against the background of vomiting (first food, and then bile), flatulence and a complete lack of appetite.
• Diarrhea has a fetid odor, undigested food is found in the masses. The stool is difficult to wash off, as it is high in fat. Constipation and diarrhea alternate, sometimes stool may not be for a long time.
• In the lying position, the pain becomes worse. Forced posture of a patient with an attack - seated, with a forward bend.
• Eructation, hiccups occur, dry mouth appears.
• Body temperature rises, shortness of breath and chills appear.
• The patient's tongue is coated with a whitish coating. After two days, the skin loses its elasticity, signs of vitamin deficiency develop, and weight loss occurs.
• Blood pressure drops, the skin becomes gray, and severe weakness appears.

Since such symptoms can accompany not only pancreatitis, but also other pathologies of the gastrointestinal tract, the doctor must determine the problem. This can be done only on the basis of diagnostic data.

What to do in case of pancreatitis attack?

• It is forbidden to take any food. Moreover, abstain from food for 3 days. This must be done to stop the production of enzymes that increase inflammation and pain. You can drink water without gas or additives.
• Cold is applied to the epigastric region - this allows you to reduce the intensity of pain, slightly remove swelling and inflammation. It is best if a hot water bottle filled with cold water is used instead of ice.
• The patient should be in bed and at rest. This will reduce blood flow to the diseased organ, which means it will reduce inflammation.
• Permitted drugs for self-administration are Drotaverin, Spazmalgon, No-shpa and Maxigan. They can be drunk before the arrival of the ambulance team. Meanwhile, it is necessary to call doctors even if the patient is not sure that he has an attack of acute pancreatitis. After all, this pathology is dangerous because it can subside for some time, and then rapidly relapse.

Especially often, a rapid relapse occurs with organ necrosis. Therefore, it is so important for the family that the patient (even despite his protests) undergo a comprehensive examination.

The three main words in the treatment of a patient with acute pancreatitis are Peace, Cold and Hunger. They are the rules of first aid for an attack.

Taking any digestive enzymes can only enhance the pathological process. Proton pump blockers, in particular, Rabeprazole and Omeprazole, are capable of alleviating the condition.

If it is known that the patient before the onset of the attack was exposed to at least one of the factors provocateurs of inflammation (alcohol intake, overeating, trauma, etc.), then an ambulance must be called without delay.

Treatment methods

Drug treatment

If you follow a strict diet, pain in the pancreas area practically does not bother, but if you just disturb it a little, you cannot do without pain medications.

1. In the case of severe pain in the pancreas, the doctor may prescribe antispasmodics such as No-Shpa, Drotaverin, they reduce inflammation and eliminate pain in the gland. At the moment, there is a fairly good myotropic antispasmodic that effectively eliminates gastrointestinal spasms - Mebeverin (Duspatalin, Sparex).
2. If it is necessary to relieve not severe pain, then for a short course the doctor may prescribe antisecretory drugs (Omeprazole or Diacarb in a tablet for three days, with an edematous form, it is also necessary to take Asparkam).
3. Octreotide. In addition, in the hospital, the doctor may prescribe the drug Octreotide, which inhibits the production of pancreatic hormones. Thanks to this drug, the hormones stop stimulating the pancreas and the pain goes away.

If pancreatitis becomes chronic, then the normal cells of the gland are replaced by connective tissue. In this case, the functions of the pancreas are disrupted, and as a result, digestive problems, up to diabetes mellitus, begin.

To relieve the stress on the pancreas and reduce pain, you must definitely take digestive enzymes:

1. Festal - take 1 tablet 3 times a day with meals, along with histamine blockers famotidine, cimetidine, which reduce acidity in the stomach.
2. "Pancreatin" ("Enzistal", "Gastenorm", "Biozyme", "Mezim", "Micrasim", "Pangrol", "Panzinorm", "Penzital", "Creon", "Hermital") - all the listed drugs represent Digestive enzymes (amylase, lipase and protease) that facilitate the digestion of carbohydrates, fats, and proteins.
3. When taking medications, it is imperative to remember about the activity of enzymes - 10,000 IU of lipase (Mezim-forte tablet) three times a day, which covers the body's daily need for replacement therapy.

If pancreatitis has entered the chronic stage, then problems with the pancreas will be observed for a very long time. And subsequently there is a risk of developing diabetes. If the patient has already been diagnosed with this disease, then you need to consult an endocrinologist to draw up a diet and treatment.

Useful articles on the topic of treatment:

• More about medical treatment for pancreatitis
• Treatment of pancreatitis with folk remedies - 7 most effective recipes
• Treatment of pancreatitis with herbs
• Diet for pancreatitis

Features of the treatment of acute and chronic forms of pancreatitis

Treatment of acute and chronic pancreatitis will differ depending on the symptoms of the disease, on the severity of its course and the reasons that provoked this disorder. The age of a person is of no small importance.

Therapy should be carried out exclusively in a hospital setting if the patient is diagnosed with acute pancreatitis. The patient is completely restricted in food for several days. When a person is in the hospital, recovery is faster, as doctors have full control over what they eat and what medications they take. If the patient is nauseous, or vomiting opens, then a probe is inserted to remove air and fluid from the stomach.

In case of deterioration of health, the patient will be provided with emergency assistance. Surgery may be required. Surgical intervention is resorted to only when there is a threat to the patient's life. During the operation, the area of the pancreas that has undergone necrosis can be removed. Installation of a drainage system is possible.

Drugs for the treatment of acute pancreatitis

In acute pancreatitis, medications are prescribed such as:

• Cytostatics (Fluorouracil, Cyclophosphamide). They are used to relieve inflammation.
• Pain relievers (Promedol, Ibuprofen, Analgin), antispasmodics (Papaverine, Drotaverin, Mebeverin), anticholinergics. All these funds are aimed at normalizing the patient's well-being and relieving him of pain. When conventional analgesics and antispasmodics do not help to cope with the problem, the patient is prescribed drugs.
• Antisecretory drugs, blockers of pancreatic enzymes (Trasilol, Contrikal) - these drugs are necessary in order to prevent the development of complications of pancreatitis and organ tissue necrosis. For this purpose, the patient may be prescribed proton pump inhibitors (Omeprazole, Pantoprazole, Esomeprazole).
• If the inflammation spreads to other organs, or purulent complications develop against the background of the infection, the patient is prescribed broad-spectrum antibiotics (Kanamycin, Monomycin).
• Colloidal solutions are administered to patients who experience a decrease in the level of albumin in the blood. If the hematocrit falls below 25%, then red blood cell transfusion is required.
• To relieve the symptoms of intoxication from the body, which develops when a significant amount of pancreatic enzymes enter the bloodstream, electrolyte solutions and amino acids are administered to the patient, without fail transferring him to parenteral nutrition.

Drugs for the treatment of chronic pancreatitis

In chronic pancreatitis, during the period of remission of the disease, the patient is prescribed drugs for the pancreas (Pancreatin), which is not able to cope with its function in full.

The drugs are selected based on the data that will be obtained after a comprehensive examination of the patient. It is imperative that such patients carry out regular sampling of blood, feces and urine.

In addition to enzymes, the patient is shown taking medications to normalize the digestive processes, to enhance intestinal motility, to stabilize the acid-base balance in the stomach.

The patient must be prescribed courses of taking vitamins A, C, K, E, D and group B, lipoic acid, cocarboxylase and other drugs.

The patient must follow a diet that involves the rejection of fatty and spicy foods, under the strict prohibition of any alcohol. When chronic pancreatitis worsens, the patient will have to fast for 1-2 days. He is allowed to drink water in small sips, or weak tea.

As a rule, after a course of treatment, the symptoms of pancreatitis disappear, but this does not mean that the person has completely got rid of the disease. The diet will always need to be followed in order to prevent a repeated exacerbation of the pathology.

Prevention of pancreatitis

Treatment of an acute attack of pancreatitis is carried out only in a hospital, since the patient may require surgery. Several attacks of acute pancreatitis can lead to the manifestation of a chronic form of the disease. In this case, the diseased organ gradually destroys itself.

Therefore, preventing pancreatitis is the best way to avoid serious health problems:

• Excessive physical activity, such as: exercising in the gym, running and jumping, visiting a bath, sauna, - all this can lead to an exacerbation of the disease. The best option for physical activity is the performance of medical and respiratory exercises and the passage of massage courses.
• Quitting bad habits (alcohol and smoking) will make it possible to reduce the load on the organ, which will allow you to achieve a stable remission.
• Timely treatment of pathology of the gallbladder and biliary tract. When stones have already formed in the bubble, their speedy removal is necessary.
• You need to eat right, the portions should not be large, but it is better to approach the table more often. You should not eat many different foods at a time - the principle of fractional nutrition greatly facilitates the work of the organ. Mixing carbohydrates and proteins should be avoided - this is the hardest combination for the gland. Fasting days will benefit the body. Simple food, cottage cheese and cereals are useful.
• Overeating is prohibited. In order not to burden your body with excess food, it is enough just to listen to it while eating.
• Coffee is the least favorite drink of a problem organ. It is better to either refuse to take it altogether, or drink no more than a cup a day. A person inflicts particular harm on himself by taking a drink on an empty stomach. The real blow to the iron is instant coffee.
• The diseased organ does not like foods containing coarse fiber, so vegetables are best baked or stewed. It is important to give up not only fatty and fried foods, but also to limit the intake of canned, salted and smoked foods as much as possible. Citrus fruits are also subject to the restriction. It is useful to drink mineral water, include seafood and dairy products with a small percentage of fat in the menu.

The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist

Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.