CHRONIC PANCREATITIS

Chronic pancreatitis - polietiologicheskoe disease of the pancreas with progressive course,

degenerative and destructive changes in the glandular tissue of focal or diffuse nature, reduced
exocrine and endocrine functions of the Authority.

Etiology

For most children, chronic pancreatitis is secondary in nature and associated with other diseases
of the digestive system (gastroduodenitis pathology pair beat the system). As the primary disease
of chronic pancreatitis occurs in children only 14% of cases, mostly due fermentopathy or acute
abdominal trauma. Can not exclude the toxic effect of drugs.

Pathogenesis

The mechanism of development of the disease may be due to two factors: the difficulty of the
outflow of pancreatic enzymes and causes, acting directly on the gland cells. As with acute
pancreatitis, a pathological process in the ducts and parenchyma of the pancreas leads to edema,
necrosis, and with prolonged duration - to sclerosis and fibrosis of tissue organ. Powerful
inhibitory systems and protective factors

Table 15.7. Classification of chronic pancreatitis *

Origin Primary Secondary

The course of the disease Recurrent Monotone

The severity (Form) Light

Middle-Heavy

Frequency disease Exacerbation Stihanie exacerbation Remission

Functional state of the A. Vneschnesekretornaya function: giposekretornaya, gipersekretornaya,

pancreas obstructive, normal

BA endocrine function: hyperfunction or hypofunction insular apparatus

Complications Pseudocyst, pankreolitiaz, diabetes mellitus, pleurisy, etc.

Osteohondrotis Peptic ulcer, gastroduodenitis, cholecystitis, hepatitis, enterocolitis, colitis,

ulcerative colitis

* From: Baranov AA et al. Pediatric Gastroenterology. - M., 2002

Clinical picture

The clinical picture of chronic pancreatitis depends on the duration of the process, its stages,
forms, and the degree of disorder of foreign and endocrine gland function. Have value and
violations of other organs of the digestive tract. The main clinical manifestation of chronic
pancreatitis - pain syndrome. Paroxysmal pain frequently localized in the upper half of the
stomach - the epigastrium, right and left hypochondrium. Sometimes they are aching to be
increasing after meals and in the afternoon. The most common occurrence of pain associated
with errors in the diet (consumption of fatty, fried, cold, sweet food). Sometimes the attack can
be triggered by significant physical exertion or infectious disease. Duration of pain

cancer can stop the pathological process at the stage of edema that occurs in most cases of
reactive pancreatitis.

Classification

The current classification of chronic pancreatitis is shown in table 15.7.

different - from 1-2 hours to several days. The pain often radiating to the back, right or left half
of the chest, in a sitting position weaken, especially in the torso forward. The most typical for a
patient with chronic pancreatitis Bozeman's position (in the pancreas it is like in "limbo" state).

From the pathological symptoms during the exacerbation of the disease often exhibit symptoms
Mayo-Robson, Kacha, de Musset, George, Grotta. Most children can be palpated dense and
painful head of the pancreas.

Chronic pancreatitis characterized by dyspeptic disorders: decreased appetite, nausea,

vomiting, occurring at an altitude of pain attack, belching, heartburn. More than one-third of
patients noted constipation, diarrhea shifting during exacerbation of the disease.

Common symptoms of chronic pancreatitis: the loss of body weight, astheno-vegetative

disturbances (fatigue, emotional instability, irritability).

Severity of clinical symptoms related to the severity of the disease. Overburden during the
process of accompanying organic changes in the duodenum (duodenostasis, diverticula) and
zhelchevydelitel-tion system (chronic cholecystitis, cholelithiasis).

Diagnosis

Diagnosing is based on clinical-laboratory and instrumental data.

In studying the content pankreozimina and secretin detect pathological types of pancreatic
secretion.
 Provocative tests with glucose, neostigmine methylsulfate, pankreoziminom detect changes in
the content of amylase, trypsin.

With the help of ultrasound determine the structure of the gland. If necessary, use of CT and
endoscopic retrograde cholangiopancreatography.

Treatment

The mainstay of treatment of chronic pancreatitis - diet, reduces pancreatic and gastric
secretion. In the patient's diet should be sufficient amount of protein while limiting fat (55-70 g /
day) and carbohydrates (250-300 g / day). To relieve pain appoint Drotaverine, papaverine
hydrochloride, bentsiklan (galidor).

The negative impact of the impact of hydrochloric acid is neutralized by the appointment of
antisecretory drugs - blockers, H 2-receptor antagonists, as well as other drugs of this series (eg,
omeprazole). Given dysmotility duodenum and biliary dyskinesia, prescribe metoclopramide,
Domperidone (motilium).

In the period of exacerbation of chronic pancreatitis the first 3-4 days is recommended hunger,
allow unsweetened tea, alkaline mineral water, broth hips. By means of pathogenetic therapy are
inhibitors of proteolytic enzymes, which include aprotinin, octreotide. Drugs injected
intravenously in 200-300 ml of isotonic sodium chloride solution. Doses are selected
individually.

Recently, for the suppression of pancreatic somatostatin secretion proposed. The most effective
was the drug octreotide. He has multiple effects on the gastrointestinal tract: reduce abdominal
pain, eliminates intestinal paresis, normalizes the activity of amylase, lipase, trypsin in the blood
and urine. Octreotide prescribed to children in a dose of 25-150 mg 2-3 times daily by
subcutaneous injection or intravenous course of 5-7 days.

Is also important enzyme replacement therapy drugs (pancreatin, pankurmen, etc.). Indications
for their use - signs-term exocrine pancreatic insufficiency. Often used pancreatin dose 0,25-0,5 g
after each meal for 3-4 weeks. If exacerbation of chronic pancreatitis accompanied by increased
body temperature, increased ESR, neutrophilic left shift of leukocyte formula, prescribed broad
spectrum antibiotics.

After discharge from hospital patients with chronic pancreatitis are subject to dispensary
observation, they hold courses antirecurrent treatment. Sanatorium treatment is recommended in
Zheleznovodsk Essentuki, Borjomi, etc.