Vitamin deficiency

Chronic pancreatitis

The clinical picture

For alcoholic pancreatitis is characterized by severe morphological changes of the parenchyma and ducts of the pancreas, including pancreatic duct stones and calcified areas in its parenchyma. The time interval between the onset of regular alcohol consumption and onset of CP is for men from 6 to 17 years and for women from 3 to 13 years [8]. A single dose of alcohol and fatty foods, especially after fasting may be an important factor in the development of CP.

Alcoholic CP arises because of the excessive use of high protein brand viagra and fat food with alcohol, which promotes intrapankreaticheskoy hypertension, or on the background of a diet poor in fat and protein, which causes the elimination of protein from acinar cell cancer, leading to atrophy of its parenchyma and a violation of synthesis inhibitors proteases [8]. This increases the concentration of proteins and enzymes in pancreatic secretions, reduced bicarbonate concentration and emissions of protease inhibitors, pH changes, increasing the content of lactoferrin in the acinar cells, which causes a disturbance of the functional patency of duct gland, it stimulates calcification.

Character of the flow of alcoholic CP is unstable in the early years is often noted for its recurring and the progression of pancreatitis, the death of parenchymal disease of the pancreas gets over the disease-free with constant pain and functional disorders.

Violations of the outflow of pancreatic secretion and development of the secondary CP may be due to intrapapillyarnymi polyps with hyperplasia papillary glands so-called forked RV, which is characterized by incomplete fusion duct systems ventral and dorsal primordia cancer, often in combination with stenosis of the small papilla DC.

Chronic pancreatitis clinically near pathological conditions: pain syndrome, exocrine pancreatic insufficiency, latent or apparent diabetes mellitus, at least - hypoglycemic syndrome, symptoms of cholestasis, impaired duodenal patency; segmental portal hypertension, inflammatory and suppurative complications.

Treatment

Possibilities of conservative treatment in the chronic phase of pancreatitis are limited; of drugs that specifically affect the pathogenesis of CP, are virtually absent. Therefore, major efforts should be aimed at easing pain, rational diet therapy, correction of the external and endocrine insufficiency of the pancreas, as well as the elimination of etiological factors of pancreatitis by arresting the inflammatory process in the biliary tract, anti-alcohol dependent patients.

The need to diet due to the decrease in CP patients body weight, a vitamin deficiency, it is also important in preventing relapses of pancreatitis.
K. Morgenroth et al. [3] recommend the following scheme of dietetics at HP: _ frequent meals with a total energy value of 2500-3000 kcal against adequate enzyme therapy; _ reducing the amount of fat to 60 grams per day (540 kcal) _ the amount of carbohydrates - 300-400 g / day (1200-1600 kcal), if necessary with the introduction of an adequate dose of insulin; _ the amount of protein - 60-120 g / day (320-480 kcal).

Signs of exocrine pancreatic insufficiency (weight loss, steatorrhea, increased flatulence) requires replacement therapy. In addition to the traditionally used pancreatin used modern drugs with a high content of lipase, facilitating the correction of steatorrhea and malabsorption of fat-soluble vitamins. Use of microgranular preparations in capsules that are protected by special coating prevents the deactivation of lipase in the acidic environment of the stomach.

Acceptance of enzyme preparations, increasing the viagra help with premature ejaculation content of proteases in the lumen of the initial part of the intestine, can reduce the secretion of the intestinal wall gastrojejunal hormones to relieve the pressure in the ductal system and pancreatic tissue and to arrest the pain syndrome [9].

Depending on the severity of pain in CP can distinguish four levels of possible analgesic effects [3]: abstinence from alcohol, the maximum limitation of animal fats in the diet, receiving enzyme preparations; taking antispasmodics (papaverine) and salicylates (paracetamol) use of neuroleptics and analeptics; appointment of opiate analogues (pentazocine).

Ineffectiveness of such measures is an indication for surgical treatment of patients with CP.

The objectives of surgical treatment of CP are: elimination of the etiologic factors of the secondary, inter alia, holangiogennogo pancreatitis easing pain, the elimination of complications (pseudocyst, pancreatic fistula, bile duct stenosis, pancreatic ascites and pleurisy, septic complications), preservation of RV function, especially the island apparatus [2].

Although surgical treatment can not eliminate the damage pancreas [7], selection of appropriate interventions provides stabilization of the pathological process, slowing down its progression.

Operations on the biliary tract on the cholecystitis and choledocholithiasis, papillostenoza, eliminating the pathogenic mechanisms of secondary holangiogennogo CPs contribute to its regression. In patients with primary alcohol HP complicated by stenosis of the common bile duct, the main task of the operation is to decompress the biliary tract by imposing zhelcheotvodyaschego anastomosis.

Operation of internal drainage duct and pancreatic cysts - pathogenetically substantiated method of correcting intrapankreaticheskoy hypertension, the most important factor of the pathogenesis of primary pancreatic can cut symptoms of CPs (especially pain) and to eliminate its complications (pseudocyst, pancreatic fistula resistant).

Surgical reduction of pressure in the pancreatic duct in patients with CP from 17 to 10.7 mm Hg relieves patients' pain [10]. Although there is no conclusive evidence to improve drainage after pancreatic duct of the exocrine and endocrine functions, possibly partial stabilization gland function and course of pancreatitis. Internal drainage is more justified when stored in one degree or another gland function in the absence viagra can not at all of cachexia, which is expressed steatite and creators; operation is more efficient than the fully discharging ductal system.

Chronic stages
diabetes mellitus
Various nations