The pancreas is an organ located in the abdominal cavity. It is part of the digestive system and produces important substances that help break down food. These are hormones and enzymes. The pancreas is one of the main organs of the endocrine system, because its hormones, which enter the bloodstream immediately, play a large role in carbohydrate, fat and protein metabolism.
Where is the pancreas in humans? Why are all diseases of this organ, especially tumors and cancer processes, diagnosed at a late stage? Why the size of the pancreas can not be determined during the study? All this is because it is located deep in the abdominal cavity, and therefore various pancreatic lesions are rarely palpated. This explains why most of the symptoms of cancer of this organ do not appear until the tumor grows large enough to affect the function of the gland itself or other nearby organs, such as the stomach, upper small intestines, and liver.
The pancreas, which measures about 25 in length, is located behind the stomach.
How does she look?
The pancreas incorporates a head, body and tail. The dimensions of the pancreas are as follows: in length - 18-25 cm, in diameter - from 3 cm in the head region and 1.5 cm in the tail region. Where is the pancreas in a person, how does it compare with other organs in terms of location and function - a surgeon or gastroenterologist can give you a clear answer to this question. These specialists deal with the diseases of this important gland for the body.
The internal structure of the pancreas is spongy, in shape it is vaguely reminiscent of a fish, which is located horizontally across the abdomen. The head is the most voluminous part, it lies on the right side of the abdomen, near the place where the stomach passes into the initial part of the small intestine - the duodenum. It is here that the chyme - a partially digested food that enters the intestine from the stomach, mixes with the juice from the pancreas.
The body is located behind the stomach, and the tail deviates posteriorly and is in contact with the spleen, left kidney and adrenal gland.
There is a pancreatic duct that runs in the thickness of the pancreas from the tail to the head. It collects ducts from all groups of glandular tissue cells. Its end is connected to the bile duct, coming from the liver and delivering bile to the duodenum.
The internal structure of the pancreas
There are two main types of tissue that are found in the pancreas: exocrine and endocrine. About 95% of the gland tissue is exocrine tissue, which produces enzymes to aid digestion. Normal food processing is not possible without the pancreas working productively. The rate of juice production is about 1 liter every day.
5% of the pancreas are hundreds of thousands of endocrine cells called islets of Langerhans. These clustered cells produce important hormones that not only regulate pancreatic secretion, but also control blood sugar.
What does it produce?
What does the pancreas do? Enzymes, or the digestive juice produced by this organ, are needed in the small intestine to further break down food after it leaves the stomach. The gland also produces hormones such as insulin and glucagon, and releases them into the blood in order to regulate the level of glucose or sugar in the body.
The pancreas is capable of producing the right substances at the right time and in the right amount in order to properly digest the food we eat.
• trypsin and chymotrypsin - for the digestion of proteins,
• amylase capable of breaking down carbohydrates,
• lipase - for the breakdown of fats into fatty acids and cholesterol.
The endocrine tissue of the pancreas, or islets of Langerhans, consists of several cells that secrete hormones directly into the bloodstream. Insulin is a hormone secreted by the beta cells of the gland in response to an increase in blood sugar. The hormone also helps in delivering glucose from the blood to muscles and other tissues so that they can use it as a source of energy. In addition, insulin helps to absorb glucose by the liver, store it in the form of glycogen in case the body needs energy during stress or exercise.
Glucagon is a hormone secreted by the alpha cells of the gland when there is a decrease in sugar in the bloodstream. Its main task is the breakdown of glycogen into glucose in the liver. This glucose then enters the bloodstream in order to restore the sugar level to normal.
There are few pancreatic diseases: pancreatitis, benign tumors and cancer.
Intense pancreatic pain is often associated with acute pancreatitis. In any case, it is difficult to identify and evaluate the state of this organ, if you know where the pancreas is in humans. Other signs of pancreatitis include jaundice, itchy skin, and unexplained weight loss, increased pancreas with additional studies. If you experience pain in the pancreas, consult your doctor. The very definition of the term "pancreatitis" is an inflammation of the organ when the enzymes begin to digest the pancreas itself. It can be acute or chronic, but both forms must be diagnosed in time, as this can lead to additional health problems.
This disease is a prolonged inflammation (more than three weeks) of the pancreas, which leads to the fact that its permanent damage occurs. One of the common conditions is the constant use of alcohol in large quantities or drugs. There are other reasons that cause attacks of acute pancreatitis. They can be cystic fibrosis, high levels of calcium or fat in the blood, obstruction of the bile duct with stones or a tumor, and autoimmune disorders.
Symptoms include upper abdominal pain, nausea, vomiting, weight loss, and oily stools. Such stools, or steatorrhea, do not appear until more than 90 percent of the pancreatic tissue is damaged.
Chronic pancreatitis requires a low-fat diet and cessation of alcohol and smoking. If chronic pancreatitis is not treated, then it tends to worsen over time, and drugs will only be needed for pain relief. Treatment of such pancreatitis is possible only surgically: this is stenting or removal of the pancreatic head due to the fact that tumors occur most often in it.
There is a link between pancreatitis, most often chronic, and pancreatic cancer. Recent studies have shown that the incidence of pancreatic cancer increases 2-5 times in patients with chronic pancreatitis with the addition of various adverse factors.
It is difficult to diagnose this disease in the early stages. Unfortunately, the symptoms of cancer can be vague: abdominal pain, jaundice, severe itching, weight loss, nausea, vomiting, and other digestive problems. An enlarged pancreas is detected only with ultrasound and MRI.
It is impossible to determine changes in the pancreas due to the fact that this organ is inaccessible to palpation. Even tumors, as a rule, cannot be felt by touch. Due to the difficulty of early diagnosis and the spread of cancer, the prognosis is often poor.
Risk factors for the development of oncology are: smoking, long-term diabetes and chronic pancreatitis. The cancer process usually begins in cells that produce digestive juices, or in cells that line the ducts. In rare cases, the oncological process of the pancreas begins in the cells that produce hormones. To diagnose cancer, doctors usually do physical examinations, blood tests, tomography, endoscopy, ultrasound, and biopsy. Treatment options include surgery, radiation, and chemotherapy to purposefully attack cancer cells without harming normal tissues.
Where is the pancreas located?
The anatomical location of the pancreas is in the abdominal cavity, at the level I - II of the lumbar vertebrae. The organ fits snugly to the back of the stomach. The duodenum goes around the pancreas in the form of a “horseshoe”. In an adult, the size of the pancreas is 20 - 25 cm, weight - 70 - 80 grams. The organ has 3 departments: the head, body and tail. The head is located near the bile duct, the body is behind the stomach and slightly below it, near the transverse colon, the tail is near the spleen. When projected onto the front surface of the abdominal wall of iron, it is located above the navel of 5 to 10 cm. The head is on the right side of the midline, the tail goes under the left hypochondrium. The two most important pancreatic functions are exocrine and endocrine. The exocrine function consists in the production (secretion) of pancreatic juice necessary for the digestion of food in the duodenum. Digestive enzymes of pancreatic juice secreted by the pancreas:
- trypsin and chymotrypsin involved in protein digestion,
- lactase and amylases necessary for the breakdown of carbohydrates,
- lipases that break down bile fats already exposed to bile.
In addition to enzymes, pancreatic juice contains substances that neutralize the acidic environment of gastric juice to protect the intestinal mucosa from acid exposure. The endocrine function of the gland consists in the production of insulin and glucagon - hormones that are involved in carbohydrate metabolism. Under the influence of insulin, glucose in the blood decreases, under the influence of glucagon it rises. At the norm of insulin and glucagon, carbohydrate metabolism proceeds adequately, with shifts - diabetes can occur. Pain in the abdomen and symptoms of digestive disorders occur with various diseases. It is important to understand when painful manifestations are associated with pathology of the pancreas, and take the necessary measures in time.
What is the pancreas?
The pancreas is an important organ of the digestive system that has a mixed function: external (exocrine) and internal (endocrine). The function of external secretion is the secretion of pancreatic juice, which contains digestive enzymes necessary for complete digestion of food. The endocrine function consists in the production of appropriate hormones and the regulation of metabolic processes: carbohydrate, fat and protein.
Pancreas and its enzymes
One of the key organs of the gastrointestinal tract - pancreas (pancreas) - is “hidden” behind the stomach and duodenum (the next section of the digestive system after the stomach), has an elongated shape and small size, about 15–20 cm in length. The only duct departs from the pancreas, through which pancreatic juice containing enzymes enters the duodenum. The excretion of digestive juice is called exocrine function (or exocrine, from the Greek. "Exo" - "out"). The feature of the pancreas is that it is able to perform not only exocrine, but also endocrine work (from the Greek. "Endo" - "inside"). In the pancreas, there are cells that produce insulin, glucagon and other hormones. They immediately enter the bloodstream and control glucose metabolism. Insulin deficiency or insulin receptor insensitivity causes diabetes.
In digestion, the pancreas requires its juice. Many components are involved in the digestion of food: this is saliva, and the secret of the stomach, and bile, and pancreatic juice. However, gastric juice also helps to protect the body thanks to hydrochloric acid, and as part of bile, the liver throws away waste unnecessary for a person, which will then be removed from the body with feces. Pancreatic secretion performs exclusively digestive tasks. It contains enzymes - substances that break down proteins, fats and carbohydrates into tiny fragments. After such a breakdown, food-derived nutrients are absorbed into the intestines. Without cleavage, most of the chewed food will pass through the intestines without any benefit.
The most important of pancreatic enzymes are:
- lipase - helps digest fats,
- amylase - responsible for carbohydrates,
- chymotrypsin and trypsin - break down protein chains.
To work these enzymes need a slightly alkaline environment. Since acidic contents come from the stomach, pancreatic juice contains a large amount of bicarbonates to neutralize hydrochloric acid. Fats and acids irritate the wall of the duodenum and cause the pancreas to work actively. Isolation of pancreatic enzymes is conditionally divided into three phases: in the first half hour to an hour, a peak in secretion occurs, its activity gradually decreases and after about three to four hours it returns to its initial level. Enzymes are produced in the pancreas in non-working form and only after they enter the intestine are activated to break down food. Unfortunately, if the cells of the pancreas are damaged, then the enzymes can be activated ahead of schedule, and as a result, acute inflammation of the gland - pancreatitis.
The pancreas consists of three sections: head, body, tail. There are no clear boundaries between departments; division occurs on the basis of the location of neighboring formations relative to the organ itself. Each department consists of 3-4 shares, which in turn are divided into segments. Each lobule has its own excretory duct, which flows into the interlobular. The latter are combined into equity. Combining, lobar form the common duct of the pancreas.
The opening of the common duct is optional:
- Along the way, the common duct combines with the common bile duct, forming a common bile duct, opening with one hole at the apex of the duodenal papilla. This is the most common option.
- If the duct does not combine with the common bile duct, then it opens with a separate hole at the apex of the duodenal papilla.
- Fractional ducts may not be combined into one common from birth, their structure is different from each other. In this case, one of them combines with the common bile duct, and the second opens with an independent hole, called the additional duct of the pancreas.
The importance of the pancreas
The pancreas performs exocrine and intrasecretory functions. It secretes pancreatic juice and hormones involved in carbohydrate metabolism, regulates sugar levels, and promotes the formation of phospholipids in the liver.
Pancreatic juice produced by the iron is involved in the process of splitting proteins, carbohydrates and fats into major components. This organ is an important regulator of digestive processes, in case of pancreatic dysfunction, diseases such as pancreatitis, diabetes mellitus, heart disease, kidney disease, spleen can develop, and immunity decreases, since it forms in the duodenum.
Pancreas anatomy and its location
The pancreas is a dense, parenchymal organ, which is located behind the peritoneum, and behind the stomach (hence its name). the pancreas begins from the descending part of the duodenum and reaches right up to the spleen, which is located in the left hypochondrium.
The pancreas is approximately 24-27 cm long. 4-6 cm wide and 3-4 cm thick. The pancreas consists of three sections: the head of the pancreas (1), the tail (3) and the body (2). The head of the pancreas enters the descending part of the duodenum, where it secretes its enzymes and secretion.
Iron itself is made up of many lobules that form acini. In the caudal region of the gland there are islets - islets of Largenhans, which secrete a number of enzymes that are most important for humans, we will talk about them a little further.
Acini go into the lumen of the parenchymal ducts, which flow into the main pancreatic duct. The main pancreatic duct passed along the entire gland and reaches 22-24 cm in length. In diameter, this duct reaches 3-5 mm. In the head of the pancreas, this duct connects to the common bile duct (duct from the gallbladder and liver) and enters the lumen of the duodenum in the large duodenal papilla.
The pancreas is supplied with blood as follows: the head is from the pancreatoduodenal artery, which comes from the superior mesenteric artery, and the body and the tail from the splenic artery.
The main symptoms of pancreatic disease
Any problems associated with decreased pancreatic enzyme production are accompanied by typical symptoms. The most common symptoms are pain and indigestion. In women and men, the symptoms are the same. Depending on the severity of the process, the intensity of pain, as well as the severity of dyspeptic phenomena, can be different. The most indicative disorders in violation of the pancreas:
- the presence of pain, localization of pain - the upper part of the abdominal cavity, left hypochondrium, pain can be associated or not related to food intake,
- frequent nausea, vomiting is possible,
- impaired appetite downward until the complete absence,
- bloating and rumbling in the stomach (flatulence),
- disorders of the stool, more often - diarrhea, in the feces there may be impurities of undigested fibers, fat,
- signs of intoxication (heart palpitations, fatigue, general weakness, sweating, headaches),
- enlarged liver
- discoloration of the skin (jaundice), often in the area of the projection of the pancreas.
Diseases associated with decreased production of enzymes:
- acute pancreatitis (inflammation of the pancreas, often accompanied by edema),
- chronic pancreatitis,
- tumor processes in the pancreas,
- development of diabetes
- pancreatic necrosis.
Most pancreatic diseases start with pancreatitis, which can be acute or chronic.
Acute pancreatitis manifested by severe pain, which is sometimes called pancreatic colic. The upper abdomen hurts, the pain surrounds the person and gives to the back, under the shoulder blades, to the area behind the sternum. Unlike cholecystitis or appendicitis, the pain does not increase with a deep breath or with coughing. But the relationship of the attack with food intake is characteristic. Along with the pain, there may be nausea and vomiting, which does not bring relief.
Acute pancreatitis (OP) can be of three types:
- edematous, or interstitial, - in the form of severe edema of the gland, lasts three to seven days, and residual changes in the gland pass in 10-14 days. This is a relatively mild form of the disease,
- sterile pancreatic necrosis - patches of dead cells appear in the gland, but without infection,
- infected pancreatic necrosis is a much more dangerous condition. It is characterized by the multiplication and penetration of microorganisms from the retroperitoneal space into the tissues surrounding the pancreas. Toxins from foci of necrosis enter the bloodstream. The temperature rises, pulmonary or renal failure, thrombosis or bleeding, phlegmon or sepsis may develop. Currently, infection of foci of pancreatic destruction is considered the main factor leading to high mortality in acute pancreatitis. Over 80% of patients with pancreatic necrosis of this type die due to infectious complications.
Chronic pancreatitis(HP) - This is a prolonged inflammation of the pancreas, which leads to its irreversible changes and manifests itself in the form of pain or persistent dysfunction of the pancreas. In Russia over the past 30 years, the incidence of both acute and chronic pancreatitis has almost doubled - 50 out of 100,000 people have chronic pancreatitis. Usually, people of mature age - 35-50 years, suffer from it.
The most common sign of chronic pancreatitis (in 80–90% of cases) is shingles in the upper abdomen. The pain can be either constant or paroxysmal, which occurs or intensifies after eating. In 10–20% of cases, pancreatitis develops without pain attacks, and it can be detected only by beginning complications. This is primarily an insufficient production of enzymes and impaired glucose tolerance.
A condition in which secreted enzymes are not enough for digestion is called exocrine pancreatic insufficiency (ESF), or pancreatic enzyme deficiency.
Body position and projection
The organ is located retroperitoneally, in the upper part of the retroperitoneal space. Pancreas is reliably protected from injuries and other injuries, since in front it is covered by the anterior abdominal wall and abdominal organs. And behind - the bone base of the spinal column and powerful muscles of the back and lower back.
The pancreas is projected onto the anterior abdominal wall as follows:
- The head is in the left hypochondrium,
- The body is in the epigastric region,
- The tail is in the right hypochondrium.
To determine where the pancreas is located, it is enough to measure the distance between the navel and the end of the sternum. Its bulk is located in the middle of this distance. The lower edge is 5-6 cm above the navel, the upper edge is 9-10 cm even higher.
Knowledge of the projection areas helps the patient determine where the pancreas hurts. With its inflammation, the pain is localized mainly in the epigastric region, but can give off in the right and left hypochondria. In severe cases, pain affects the entire upper floor of the anterior abdominal wall.
The functions of this body can be divided into two large groups: external and internal excretion.
External excretion - secretion into the lumen of the duodenum. The secret consists of 98% water, it also includes calcium, potassium, sodium, protein, bicarbonates and enzymes. Bicarbonates are needed to protect the duodenal mucosa. The secretion of the pancreas provides the alkalization of the intestinal medium. Normally, pH 7.5-9 - alkaline environment provides optimal conditions for digestion in the intestine.
Among the enzymes, lipase can be distinguished, which breaks down fats into fatty acids and glycerol. Amylase - breaks down carbohydrates to dextrins. The trypsin and chymotrypsin enzymes break down the protein into amino acids.
Internal secretion is that the tail of the gland secretes insulin and glucagon. The more glucose (sugar) in the blood, the more pancreas secretes insulin and the less glucagon is secreted.
How does the pancreas hurt in humans?
Pain arising from changes in the pancreas can be of a different nature - pulling blunt or cutting acute, up to dagger (with peritonitis). It depends on the nature and extent of the lesion of the gland, as well as on the involvement of the peritoneal sheets (peritonitis) in the inflammatory process. Acute pancreatitis with edema is characterized by a sharp sudden pain, often encircling, spreading to the upper abdomen, left side and lumbar region. Because of the edema, a feeling of fullness appears in the location of the pancreas, pressure on the inner surface of the ribs. In such cases, the use of antispasmodics is ineffective. The pain can be slightly reduced only in a sitting position with the body tilted forward and to the bottom. At the height of the pain (and sometimes even before it occurs), vomiting can begin, which is repeated several times and does not always bring relief. The contents of the vomit may be eaten by food or bile (in the case of an empty stomach), the taste may be sour or bitter. Similar symptoms (sharp pain, vomiting) can be observed with exacerbations of osteochondrosis in the lumbar spine, with kidney diseases and shingles. An additional study will help determine the suspicion of pancreatitis. With lumbar osteochondrosis, soreness of the vertebrae during palpation is observed, with problems with the kidneys - an increase in pain when striking the lower back, with shingles on the skin there is a characteristic rash. Pancreatitis is characterized by the absence of all of these symptoms. Chronic pancreatitis is characterized by pain of somewhat lesser intensity, and they occur most often due to violations of the diet. The danger of exacerbations of chronic pancreatitis is the occurrence of pancreatic tumors, including malignant (cancer).
Every day, the pancreas produces 500-1000 ml of pancreatic juice, consisting of enzymes, salts and water. The enzymes produced by the pancreas are called “proenzymes” and are produced by it in an inactive form. When a lump of food gets into the duodenum, hormones are secreted, with the help of which a chain of chemical reactions that activate pancreatic juice enzymes is launched. The strongest stimulant of pancreatic secretion is hydrochloric acid of gastric juice, which, when it enters the small intestine, activates secretion and pancreosimine by the intestinal mucosa, which in turn affect the production of pancreatic enzymes.
These enzymes include:
Trypsin and chymotrypsin involved in the process of protein digestion, which begins in the stomach,
Lipase, responsible for the breakdown of fats that have already been exposed to bile from the gallbladder.
Additionally, pancreatic juice contains trace elements in the form of acid salts, providing its alkaline reaction. This is necessary to neutralize the acidic component of the food received from the stomach, and create suitable conditions for the absorption of carbohydrates.
The secretion of pancreatic juice is regulated by the nerve mechanisms and is associated with food intake, i.e., a variety of food composition stimulates the production of juice with different volume and content of enzymes. It accumulates in the interlobular ducts, which flow into the main excretory duct, flowing into the duodenum.
Signs and symptoms of pancreatic enzyme deficiency
With a lack of enzymes, two main interrelated processes occur:
- violation of digestion of food (maldigestion),
- insufficient absorption of nutrients in the intestines (malabsorption).
Usually, first of all, there are signs of a decrease in lipase production, which is responsible for the digestion of fats. Undigested fats pass through the intestines, irritating its walls and causing symptoms of pancreatic disease such as flatulence, bloating, pain and diarrhea. The release of large amounts of fat with feces is called steatorrhea. This manifests itself in a plentiful unformed stool with an oily sheen that is poorly washed off, the presence of undigested particles in the feces, bloating and non-localized abdominal pain.
Since the breakdown of not only fats, but also proteins with carbohydrates is disrupted, not enough nutrients enter the intestines. Sometimes a person himself tries to eat less so as not to provoke a pain attack. As a result, the so-called trophological insufficiency occurs: the level of necessary substances in the blood decreases. A person is losing weight, muscle hypotrophy begins, loose edema, exhaustion. Due to the deficiency of fat-soluble vitamins (A, D, E and K), osteoporosis can develop, skin and hair problems occur. The risk of infections and heart problems increases.
Due to the large "margin of safety", exocrine pancreatic insufficiency does not immediately manifest itself. Symptoms of the disease occur only when the gland is disturbed by 90% or more. On average, clinical signs become noticeable ten years after the onset of the disease. This is the danger of chronic pancreatitis: a person may not be aware of the disease, although with the elimination of some causes, the likelihood of complications is significantly reduced. Let's talk about the causes and risk factors for pancreatitis.
Pancreatic removal is called pancreatectomy. Often you can not do without it with malignant tumors of the pancreas. The duration of such an operation is 408 hours. When removed, general anesthesia is performed, after which the damaged part of the gland and other affected organs are removed through an incision in the abdominal region. Before surgery, you may have to undergo a course of radiation or chemotherapy.
It is worth considering the possible complications after surgery, including: infections, excessive bleeding, leakage of pancreatic enzymes into the abdominal cavity, damage to other digestive organs. The risk of complications increases if the patient is obese, malnourished, dependent on nicotine, has heart or lung disease.
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Treatment should be prescribed by a specialist doctor after a thorough diagnosis. In case of a pain attack, you must contact a medical institution for qualified help. It is necessary to carry out: 1. Laboratory studies:
- general and detailed blood test,
- the level of pancreatic enzymes in the blood serum,
- biochemical blood tests for glucose, the activity of liver enzymes and bilirubin,
- analysis of urine for amylase level,
- analysis of feces for the level of enzymes and fats.
2. Ultrasound examination of the abdominal cavity to identify the state of the structure, determine the contours of the pancreas, patency of the bile ducts, the presence or absence of stones in the gallbladder or ducts. 3. Radiography - in the absence of the ability to conduct an ultrasound for the same purpose. 4. Computed tomography or MRI to obtain more accurate data on the state of the abdominal organs.
The internal secretory function of the gland is to release the hormones insulin and glucagon into the blood. They are produced by groups of cells interspersed between lobules and lacking excretory ducts - the so-called islets of Langerhans, located in significant numbers in the tail of the gland. Langerhans islands consist mainly of alpha cells and beta cells. Their number in healthy people reaches 1-2 million.
Insulin is produced by beta cells and is responsible for the regulation of carbohydrate and lipid (fat) metabolism.Under its influence, glucose enters from the blood into the tissues and cells of the body, thereby lowering the level of sugar in the blood. Beta cells make up 60-80% of islets of Langerhans.
Glucagon is produced by alpha cells and is an insulin antagonist, i.e., it increases the level of glucose in the blood. Alpha cells are also involved in the production of lipocaine, which prevents fatty degeneration of the liver. Their share in the islets of Langerhans is about 20%.
Langerhans islands also contain small amounts of other cells, for example, delta cells (1%), which secrete the hormone ghrelin, which is responsible for appetite and stimulates food intake. PP cells (5%) produce a pancreatic polypeptide formed by 36 amino acids and inhibit pancreatic secretion.
The destruction of beta cells leads to inhibition of insulin production, which can trigger the development of diabetes. Symptoms of this are constant thirst, skin itching, and increased urine output.
The pancreas is in close relationship with other organs of the digestive tract. Any damage to it or interruptions in the activity negatively affect the entire digestive process.
Causes of pancreatic enzyme deficiency
Exocrine pancreatic insufficiency has clinical manifestations when secreted enzymes are not enough for normal digestion. There are several reasons for this:
- the pancreas cannot produce the necessary amount of enzymes, as it is affected by the disease (pancreatitis of various nature), destroyed or removed,
- there is a congenital deficiency of enzymes or their hereditary defect,
- the pancreas does not receive the necessary signals to start secretion, which happens when the stomach is removed,
- enzymes are produced, but cannot enter the intestine due to obstruction of the duct: the cause may be a stone in the duct or a tumor that compresses the surrounding tissue,
- the entry of food and enzymes into the intestine is divided in time.
Most often, absolute enzyme deficiency occurs with pancreatitis, malignant tumors and after removal of the pancreas. Depending on the causes of inflammation, primary and secondary pancreatitis are distinguished. In the primary cause (poisoning, heredity) acts immediately on the pancreas. And the secondary one arises as a result of diseases such as, for example, diseases of the biliary tract. Often several factors are combined.
Alcohol is a leader among the causes of pancreatic damage, it causes up to 70% of cases of chronic pancreatitis. If you consume 60–80 ml of alcohol per day, the development of pancreatitis is inevitable within 10-15 years.
Smoking is an additional factor provoking the development of pancreatitis. The more and more people smoke, the higher the risk. Perhaps this is due to the effect of nicotine on the viscosity of secreted fluids.
Pancreatic inflammation can be caused by cystic fibrosis, trauma, or autoimmune diseases. In addition, the development of pancreatitis is facilitated by hyperparathyroidism and chronic renal failure, as well as atherosclerosis. Sometimes the cause of the disease cannot be determined.
Syntopia is the location of the organ relative to other entities. The gland is located in the retroperitoneal tissue, deep in the abdomen.
Due to the anatomical features, pancreas has a close interaction with the duodenum, aorta, common bile duct, superior and inferior vena cava, superior abdominal aortic nerves (superior mesenteric and splenic). Pancreas also interacts with the stomach, left kidney and adrenal gland, spleen.
Important! Such close proximity with many internal organs creates the risk of the spread of the pathological process from one organ to another. With inflammation of any of the above formations, the infectious process can spread to pancreas and vice versa.
The head is completely covered by the bend of the duodenum, and here the common bile duct opens. The transverse colon and superior mesenteric artery lie in front of the head. Behind - the inferior vena cava and portal veins, kidney vessels.
The body and tail are covered in front by the stomach. The aorta and its branches are adjacent behind, the inferior vena cava, the nerve plexus. The tail can come into contact with the mesenteric and splenic arteries, as well as with the upper pole of the kidney and adrenal gland. In most cases, the tail is covered with fatty tissue on all sides, especially in obese people.
How to treat pancreatic diseases?
After a thorough examination, even if emergency surgery is not required, hospitalization is necessary. An acute attack of pancreatitis is treated in a hospital by creating rest in compliance with bed rest. Complete fasting is prescribed for 1 to 2 days. Injectable solutions of painkillers and antispasmodics (Baralgin, Platifillin), anticholinergics (Atropine) are introduced. An ice bladder is applied several times for 0.5 hours to the epigastric region. Which medications to take is decided by the attending physician. Preparations that reduce the enzymatic activity of the pancreas (Trasilol, Contrical, Gordox, Aprotinin) are administered intravenously. For the prevention of dehydration, special saline solutions are administered dropwise at the dosage prescribed by the doctor. After the removal of the acute symptoms, a gentle special diet and enzyme replacement therapy are prescribed - oral preparations that improve digestion (Creon, Mezim-forte, Pancreatin, Panzinorm, Festal, Enzistal).
Where is the pancreas in humans?
The pancreas is located in the abdominal cavity behind the stomach, adjacent to it and the duodenum, at the level of the upper (first or second) lumbar vertebrae. In the projection onto the abdominal wall, it is 5-10 cm above the navel. The pancreas has an alveolar-tubular structure and consists of three departments: head, body and tail.
The head of the pancreas is located in the bend of the duodenum so that the intestine covers it in the shape of a horseshoe. It is separated from the body of the gland by a groove along which the portal vein passes. The blood supply to the pancreas is through the pancreas-duodenal arteries, the outflow of blood occurs through the portal vein.
In the body of the pancreas, the front, rear and lower surfaces are distinguished. It also distinguishes the upper, front and lower edges. The front surface is adjacent to the posterior wall of the stomach, slightly below. The back surface is adjacent to the spine and abdominal aorta. The spleen vessels pass through it. The lower surface is lower than the root of the transverse colon. The tail of the gland has a conical shape, directed up and to the left and reaches the gates of the spleen.
The pancreas consists of 2 types of tissue that perform different functions (endocrine and exocrine). Its main tissue is made up of small lobules - acini, which are separated from each other by layers of connective tissue. Each lobule has its own excretory duct. Small excretory ducts are interconnected and merge into a common excretory duct, which runs in the thickness of the gland along its entire length, from the tail to the head. At the right edge of the head, the duct opens into the duodenum, connecting with the common bile duct. Thus, pancreatic secretion enters the duodenum.
Between the lobules are groups of cells (islets of Langerhans) that do not have excretory ducts, but are equipped with a network of blood vessels and secrete insulin and glucagon directly into the blood. The diameter of each island is 100-300 microns.
How to eat?
In the acute period of the disease, weak broths and decoctions, cereals on the water are allowed, food is either boiled or steamed:
In the future, for cooking, you should use meat, fish, poultry with a low fat content. Sour-milk products, eggs, compotes, jelly are gradually introduced into the diet. A strict diet is prescribed for 3 months. During periods of remission of chronic pancreatitis, the diet should also be followed. Individual recommendations are best obtained from your doctor. Recommended meat dishes from lean meats, poultry, especially - rabbit meat, veal. Dairy products should be low in fat. Soups are best prepared on vegetable broths. Of the drinks, herbal decoctions, compotes, teas, jelly are useful. In chronic pancreatitis, as well as after an acute illness, fractional nutrition is necessary: from 6 to 8 times a day in small portions.
By its size, the pancreas takes the second place after the liver among the organs that produce enzymes. Its formation begins already in the fifth week of pregnancy. In a newborn child, iron has a length of up to 5 cm, in a year-old - 7 cm, by 10 years of age its dimensions are 15 cm in length. It reaches its final size in adolescence, to 16 years.
The head of the pancreas is its widest part, its width is up to 5 cm and more, the thickness varies from 1.5 to 3 cm. The body of the gland is the longest part, its width is on average 1.75-2.5 cm. Tail length - up to 3.5 cm, width about 1.5 cm.
Due to the deep location, the diagnosis of pancreatic pathologies is very difficult. Therefore, an important point of diagnosis is an ultrasound study that allows you to determine the shape and size of the gland, based on which you can draw the appropriate conclusions about its condition.
All sizes of the organ, as well as the possible causes of their changes, are recorded in detail in the ultrasound protocol. In an unchanged state, iron has a uniform structure. Small deviations from the normal sizes of the head, body and tail are permissible only with good biochemical blood counts.
How to make up for pancreatic enzyme deficiency?
With enzyme deficiency, treatment should eliminate the symptoms and help the food to be fully absorbed. Enzyme replacement therapy (PST) is the main way to deal with exocrine pancreatic insufficiency, and ideally, taking drugs mimics the natural secretion of the pancreas. However, it is worth starting with lifestyle changes.
It is important
Alcohol reduces lipase production in the stomach and impairs fat absorption. This negates all the successes of treatment, therefore, with any form of ESR, alcohol will have to be abandoned. It has not been fully established whether this measure allows the normal functioning of the pancreas to return. However, it is known for sure that those who continue to drink alcohol, enzyme deficiency develops faster.
Often people with pancreatitis try to eat less fatty foods so as not to cause a pain attack. However, for the normal functioning of enzyme preparations, a person needs to take a sufficient amount of fat. On average, they should be 30% of the total calorie content of food. Eating fat-rich foods helps to restore body weight faster and better absorb fat-soluble vitamins. The Russian Association of Gastroenterologists to increase the nutritional value of dishes recommends:
- add soft fats to the diet - cheese, peanut butter, butter,
- eat more nuts, seeds - a source of healthy fats,
- choose cream-based desserts - ice cream, cream, cheesecakes,
- as the main dish use protein products - meat, fish, poultry, eggs or soy,
- consume dairy products of normal fat content,
- to increase protein content use fortified milk, that is, add milk powder to fresh,
- use nutritional supplements if body weight is not normal.
When organizing meals, it is recommended to divide the food into six meals or more. The smaller the portion, the lower the load on the pancreas. In addition, small portions are better mixed with enzymes and absorbed. The diet must necessarily contain all the vitamins and nutrients necessary for a person. A nutritionist can help with assessing nutritional deficiencies and nutrition.
Modern enzyme preparations are available in the form of tablets or capsules and contain the main pancreatic enzymes: lipase, amylase and protease. However, not all drugs work the same way. The effectiveness of treatment depends on:
- dose of the enzyme
- enteric coating
- particle size of the drug
- the time of taking the medicine.
When choosing a dosage, usually begin with small doses and gradually increase them to the desired response. Unfortunately, there is no direct dependence of the effectiveness of therapy on the amount of enzyme preparation, so the selection is always individual. Adults are recommended to start with 25–50 thousand units of lipase per meal and gradually increase the dose to a maximum level of 75–80 thousand units of lipase per main meal and 10–25 thousand units per snack.
An enteric coating is necessary in order to protect the enzymes from acidic gastric contents. Under the influence of an aggressive acidic environment, enzymes lose their activity and become useless. The shell is designed in such a way that it dissolves only in the alkaline environment characteristic of the duodenum. Then the enzymes are released and begin their work.
When studying the work of enzyme preparations, it was found that the smaller the particle size of the drug, the better they mixed with food and with it entered the intestines. When taking large particles, the drug stayed in the stomach a little longer, and the food already entered the intestine and remained undigested. The optimal particle size was about 1.4–1.7 mm.
There is no need to take enzyme preparations with fruits or juices. But with a full meal, their reception is required. Researchers compared the effect of therapy in patients who received the medicine before, during, or after a meal. As a result, it turned out that those who took enzymes with food or immediately afterwards had better digestion of fats.
Taking antisecretory drugs
Six months after the start of treatment with enzymes, the doctor must re-evaluate the patient's condition, determine if he is gaining weight and muscle mass. Sometimes a person follows the rules of nutrition, takes enough enzyme preparations, but there is no effect from treatment. In these cases, the doctor may advise adding drugs that reduce the secretion of gastric juice, the so-called proton pump inhibitors. If the work of the pancreas is disturbed very much, then its capabilities and the produced bicarbonates are not enough to neutralize stomach acid. Therefore, the taken enzymes are not included in the work. The addition of antisecretory agents significantly improves the patient's condition in such cases.
But in order for all the symptoms of enzyme deficiency to appear, several years must pass from the onset of the disease. And if a person pays attention to the signals of his body in time, goes to the doctor, starts treatment, he may preserve the efficiency of his pancreas, and most likely he will need only a little enzyme support.
Histological and microscopic structure
If you look at the slice under magnification, you can see that the tissue of the gland (parenchyma) consists of two elements: cells and stroma (areas of connective tissue). In the stroma are blood vessels and excretory ducts. It carries out the connection between the slices and contributes to the conclusion of the secret.
As for the cells, there are 2 types of them:
- Endocrine - secrete hormones directly into the adjacent vessels, performing an intracretory function. Cells are combined among themselves in several groups (islets of Langerhans). These pancreatic islets contain four types of cells, each of which synthesizes its own hormone.
- Exocrine (secretory) - synthesize and secrete digestive enzymes, thereby performing exocrine functions. Inside each cell there are granules filled with biologically active substances. Cells are collected in terminal acini, each of which has its own excretory duct. Their structure is such that subsequently they merge into one common duct, the end section of which opens at the apex of the duodenal papilla.
What to exclude from the diet?
The following foods and drinks are strictly contraindicated with pancreatic problems:
- carbonated drinks,
- coffee and cocoa
- sweet juices
- smoked meats
- spicy, salty, pickled, fried foods,
- chocolate and pastries, especially those with a high fat content (pastries and cream cakes).
Pancreatic enzymes for the pancreas
Pharmacies offer a lot of enzyme preparations, and choosing the right one can be difficult. What you should pay attention to? As already mentioned, the drug should have a protective shell and small particles.
For example, Mikrasim® meets these requirements. It contains microgranules with highly active enzymes: lipase, amylase and protease, which break down fats, carbohydrates and proteins. Due to the small size of the capsules, the enzymes are immediately evenly distributed in the food and together with it enter the duodenum and further into the intestine. Here they exit the protective membrane and are included in the digestion. Already 30 minutes after dissolution of the membrane, the highest enzymatic activity is manifested. Mikrasim® acts only in the intestinal lumen, without penetrating the blood.
Mikrazim® is used as a replacement enzyme therapy in cases of insufficiency of the external secretion of the pancreas, if the processes of the breakdown of nutrients and their absorption are disrupted. It can help with chronic pancreatitis, after removing the pancreas. The drug can be used for dyspepsia, flatulence, diarrhea in people with nutritional errors. It is available in capsules of 10,000 and 25,000 units (packs of 3 to 50 capsules) and is suitable for use at any age, including children from birth and the elderly. Capsules should be taken during or after meals with water or acidic juice. The doctor will help you choose the right dosage.
Contraindications for use are acute pancreatitis, exacerbation of chronic pancreatitis and individual intolerance to individual components of the drug.
The registration number of the drug Mikrazim® in the State Register of Medicines is LS-000995 dated October 18, 2011, renewed indefinitely on January 16, 2018.The drug is included in the list of Vital and Essential Drugs.
When food enters the cavity of the stomach and during its subsequent evacuation into the cavity of the small intestine, the pancreas begins to actively secrete digestive enzymes. These metabolites are initially produced in an inactive form, as they are active metabolites that can digest their own tissues. Once in the intestinal lumen, they are activated, after which the abdominal stage of digestion of food begins.
Enzymes performing intracavitary digestion of food:
After the digestion is over, the split nutrients are absorbed into the blood. Normally, in response to an increase in blood glucose, pancreas will instantly respond with the release of the hormone insulin.
Insulin is the only sugar-lowering hormone in our body. This is a peptide whose structure is a chain of amino acids. Inactive insulin is produced. Once in the bloodstream, insulin undergoes several biochemical reactions, after which it begins to actively fulfill its function: to utilize glucose and other simple sugars from the blood into the cells of the tissue. With inflammation and other pathologies, insulin production decreases, a state of hyperglycemia occurs, and subsequently insulin-dependent diabetes mellitus.
Another hormone is glucagon. The rhythm of its secretion is monotonous throughout the time of day. Glucagon releases glucose from complex compounds, increasing blood sugar.
Functions of the digestive enzymes of the pancreas
The exocrine function is to produce the following enzymes that make up pancreatic juice: trypsin, lipase, and amylase:
Trypsin breaks down peptides and proteins. Initially, it is produced by the pancreas in the form of inactive trypsinogen, which is activated by enterokinase (enteropeptidase), an enzyme secreted by the intestinal mucosa. The pancreas is the only organ in the body that produces trypsin, so determining its level is more significant in the study of the pancreas than the analysis of other enzymes. Determination of trypsin activity is an important point in the diagnosis of acute pancreatitis and the detection of its pathogenesis.
Lipase is a water-soluble enzyme that digests and dissolves triglycerides (neutral fats). It is produced in the form of inactive prolipase, and then under the influence of other enzymes and bile acids passes into the active form. Lipase breaks down neutral fats into higher fatty acids and glycerin. Also, this enzyme is involved in energy metabolism, providing delivery to the tissues of polyunsaturated fatty acids and the assimilation of certain fat-soluble vitamins. In addition to the pancreas, lipase is produced by the liver, intestines, lungs, and each type of lipase is a catalyst for the breakdown of a certain group of fats. With hypofunction of the pancreas, lipase activity is primarily reduced. The first sign of this is a greasy stool of gray-yellow color.
Amylase (alpha-amylase) is necessary for the processing of carbohydrates entering the body. It is secreted by the pancreas and (to a lesser extent) by the salivary glands. Changes in the content of this enzyme in the blood are characteristic of many diseases (diabetes mellitus, hepatitis, etc.), however, this primarily indicates acute or chronic pancreatitis.
Unlike other substances involved in the digestion process, pancreatic enzymes are excreted only during meals - their active secretion begins 2-3 minutes after the food enters the stomach and lasts 12-14 hours. Enzymes can perform their functions only if there is a sufficient amount of bile produced by the gall bladder. Bile activates enzymes, and also breaks down lipids into smaller droplets, i.e., prepares them for cleavage. Pancreatic enzymes are produced in an inactive form and are activated only in the lumen of the duodenum under the action of enterokinase.
Functions and role in metabolism
The pancreas is an organ of the endocrine system related to the glands of mixed secretion. It performs exocrine functions (production of digestive enzymes in the small intestine cavity) and intrasecretory (synthesis of sugar-regulating hormones into the bloodstream) functions. Playing an important role in our life, pancreas performs:
- Digestive function - participation in the digestion of food, the breakdown of nutrients to simple compounds.
- Enzymatic function - production and isolation of trypsin, chymotrypsin, carboxypeptidase, lipase, elastase, amylase.
- Hormonal function - continuous secretion of insulin and glucagon into the bloodstream.
Symptoms of pancreatic enzyme deficiency
Violations of secretion, its decrease and deficiency of pancreatic enzymes in an adult are usually the result of chronic pancreatitis - inflammation of this organ, which is accompanied by a gradual degeneration of glandular tissue into connective tissue.
In the first place among the causes leading to pancreatitis is alcohol abuse, among other causes can be identified improper, irrational nutrition, concomitant diseases (cholelithiasis), infections, injuries, taking some medications.
Lack of trypsin, lipase and amylase causes serious digestive disorders.
Common symptoms of pancreatic problems:
pain in the upper left abdomen under the ribs, which often occur after eating, but may not be associated with eating,
decreased or complete loss of appetite,
rumbling in the abdomen, flatulence,
changes in color and consistency of the stool.
The severity of these symptoms depends on the degree of damage to the gland. As a result of poor digestion, the body lacks nutrients, and metabolic disorders can lead to osteochondrosis, osteoarthritis, and vascular atherosclerosis.
Steatorrhea is characteristic of lipase deficiency (excessive release of fat with feces), the stool may have yellow or orange color, sometimes there is a release of liquid fat without feces, the stool is liquid, oily.
With a lack of amylase, intolerance to foods rich in carbohydrates is observed, frequent, loose, watery bulky stool due to excess starch, malabsorption (malabsorption of nutrients in the small intestine, accompanied by diarrhea, vitamin deficiency, weight loss), high content of conditionally pathogenic microflora in intestines.
Trypsin deficiency is expressed in moderate or severe creatorrhea (increased content of nitrogen and undigested muscle fibers in the feces, i.e. protein), stools are mushy, fetid, anemia may develop.
Since the process of splitting complex food molecules is disrupted, and it is not fully absorbed by the body, even with enhanced nutrition, a decrease in body weight, vitamin deficiency, dry skin, brittle nails and hair can be observed. When poorly processed food arrives from the small intestine into the large intestine, flutulence occurs (increased gas formation and exhaust gas), rapid bowel movements.
With a decreased secretion of enzymes by the pancreas, replacement therapy is prescribed, however, enzymes of plant origin cannot fully compensate for the insufficiency of its external secretion.
If the outflow of enzymes into the intestine is impaired, this can lead to irritation of the gland tissue and its edema, and subsequently to destruction and necrosis.
With the defeat of the islets of Langerhans, insulin production is suppressed and the clinical symptoms of type 1 diabetes mellitus are observed, the severity of which will depend on the number of preserved and fully functioning beta cells. Glucagon secretion deficiency is not felt so much, since there are other hormones that have a similar effect: for example, steroid hormones produced by the adrenal glands and increase blood glucose levels.
The role of individual enzymes
Trypsin. It is allocated initially in the form of a proenzyme. It is activated in the cavity of the small intestine. After activation, other digestive enzymes begin to activate. Trypsin breaks down peptides to amino acids, stimulates the cavity digestion of food.
Lipase. Breaks down fats to monomers of fatty acids. It is secreted as a proenzyme, activated by bile and bile acids. Participates in the absorption of fat-soluble vitamins. Lipase level is determined by inflammation and other pathologies.
Amylase. Marker of pancreas cell damage, an organ-specific enzyme. Amylase level is determined in the first hours in the blood of all patients with suspected inflammation of the pancreas. Amylase breaks down complex carbohydrates into simple ones, and helps in the absorption of glucose.
Elastase. An organ-specific enzyme that indicates cell damage. The function of elastase is participation in the breakdown of dietary fiber and collagen.
How does the pancreas hurt?
The most common pancreatic pathologies are pancreatitis (acute or chronic), stones in the excretory ducts, pancreatic adenocarcinoma, diabetes, necrosis.
With inflammation (pancreatitis) and damage to the pancreas, the following symptoms are noted:
Pain in the left side under the ribs,
Yellowness of the skin and eye proteins,
In some cases, a state of shock.
In acute pancreatitis, the pain is severe, acute, begins suddenly, can have a girdling character, that is, cover the entire left side and go behind the back. The pain is not relieved by antispasmodics, decreases in a sitting position or when leaning forward. In some cases, an increase in the pancreas is physically felt: there is a feeling of bursting from the inside, pressure on the area of the ribs, which interferes with normal breathing.
The stronger the pain, the more the vomiting reflex increases. Sometimes attacks of vomiting begin earlier than the pain syndrome: usually it occurs in the morning or during meals, as a result of a stomach cramp. Vomiting has a bitter or sour taste, after it comes temporary relief. It can be either periodic or systematic. In the case of an acute attack of pancreatitis, you need to see a doctor and treatment in a hospital, since this disease alone will not go away. With continuous vomiting, the stomach is cleaned with a probe and special enzymes are introduced to calm the excessive aggressiveness of the stomach and pancreas.
Symptoms of pancreatitis are sometimes similar to signs of osteochondrosis of the lumbar spine, an attack of pyelonephritis or shingles. Pancreatitis can be differentiated as follows: with osteochondrosis, palpation of the vertebrae is painful, with shingles (herpes virus), a rash appears on the skin, with acute pyelonephritis, the pain intensifies when you tap on the back in the projection of the kidneys, and then blood appears in the urine. All these signs are absent in pancreatitis.
In case of chronic pancreatitis, the pain is less severe, exacerbations usually occur after a diet violation (eating large amounts of fatty foods) and alcohol abuse. To date, it has not been precisely established how alcohol affects the pancreas: either it prevents the outflow of pancreatic juice, or changes its chemical composition, thereby provoking an inflammatory process. Another reason may be blockage of the excretory flow of the gland by gallstones. In chronic pancreatitis, the risk of developing an oncological process in the pancreas increases: a cancer tumor occurs in 4 out of 100 cases in patients with pancreatitis.
With a constant pain syndrome, a sense of addiction may appear, and a person will no longer feel pain so acutely. This is dangerous because you can skip the development of necrosis or serious complications. The human body has a certain margin of strength and resistance and can independently regulate metabolic processes for a long time even in the presence of some disorders, but with the depletion of internal resources, the process of development of pancreatic tissue necrosis can be very fast and irreversible.
Pancreatic inflammation (pancreatitis)
A common pathology among the adult population, in which there is an inflammatory lesion of the stroma and pancreas parenchyma, accompanied by severe clinical symptoms, pain and a violation of the structure and functions of the organ.
How does the pancreas hurt and other symptoms of inflammation characteristic of pancreatitis:
- Pain of herpes zoster with radiation to the right or left hypochondrium. Less commonly, pain occupies the entire upper floor of the abdominal cavity. The girdle nature of the pain is due to the proximity of the superior mesenteric nerve plexus. Due to its structure, irritation of one part of the nerve leads to the spread of a nerve impulse to all neighboring nerve fibers. Pain like a hoop compresses the upper abdomen. Pain occurs after a heavy meal or after a greasy one.
- Dyspeptic disorders: nausea, vomiting, loose stools (diarrhea) with an admixture of fat. There may be a decrease in appetite, bloating, rumbling.
- Symptoms of intoxication: headache, weakness, dizziness. In the acute process, subfebrile body temperature is observed. Febrile fever is not characteristic for pancreatitis.
These signs are characteristic of an edematous (initial) form of inflammation. As the disease progresses, the inflammation affects deeper tissue sections, which ultimately leads to necrosis and necrosis of individual lobules, a violation of the structure and functions of the organ. The clinic of this condition is bright, the patient needs immediate medical attention. This is due to the fact that the pain is more pronounced, the patient rushes about and cannot find a comfortable position.
How to identify pancreatic inflammation
To identify one or another pathology of the pancreas, including inflammation, one symptom of pain is not enough. Laboratory and instrumental examination methods are prescribed.
Laboratory methods include:
- Clinical blood test for signs of inflammation and intoxication. In favor of inflammation, they say an acceleration of the erythrocyte sedimentation rate, an increase in the number of leukocytes, and qualitative changes in the leukocyte formula.
- Blood chemistry. Inflammation is indicated by an increase in the total protein, qualitative changes in the protein composition of the blood. If a high content of amylase and other organ-specific enzymes is found in the blood, then it is possible to speak with full confidence about damage and destruction of glandular cells.
- Biochemical analysis of urine. Damage and inflammation of the gland are indicated by the appearance of diastase (amylase) in the urine.
- Functional tests that evaluate the pancreas by the level of secretion of hormones and enzymes.
- Fecal analysis to detect impurities of undigested fats and soaps - steatorrhea. This is an indirect sign of inflammation and impaired pancreas.
- Ultrasound examination of the abdominal organs. Visual examination method to assess the structure and structure of pancreas. With inflammation in the parenchyma of the gland, structural changes will occur that the specialist will be able to clearly see even with the naked eye.
- Magnetic resonance imaging is an X-ray examination method based on contrasting areas of lower density. MRI is performed before surgery to assess the degree of damage and the structure of the organ, the volume of surgical intervention.
- Fibrogastroduodenoscopy (FGDS). Allows you to assess the condition of the stomach, duodenum and structure of the duodenal papilla. It is also carried out for differential diagnosis and more accurate diagnosis.
If necessary, laparoscopy, ERCP, abdominal x-ray, MSCT can be performed. These methods are necessary for differential diagnosis and more accurate establishment of the etiology and topical diagnosis of the disease.
Pancreatic endocrine role
The role of the gland in diabetes is also important. With this pathology, the level of insulin production decreases, the level of glucose in the blood rises. This leads to the formation of glycated hemoglobin. Ultimately, all transport and metabolic processes are disrupted in the body, immunity and defenses are reduced. Parenteral or enteral administration of exogenous insulin, which makes up for the deficiency of its own hormone, can compensate for this condition.
Thus, pancreas, performing important functions in our body, contributes to normal digestion and digestion. Maintains blood sugar at a constant level, participates in metabolic processes. With its defeat, serious violations of homeostasis occur, the level of health and lifestyle is reduced. Monitor the state of the pancreas and do not let the course of possible diseases drift to avoid unpleasant consequences.
With an attack of acute pancreatitis, complete fasting is necessary for 1-2 days, since pancreatic juice in this case will be produced in a minimal amount, and the load from the gland will be removed. Usually, appetite decreases or disappears altogether a few days before an exacerbation. During this period, you need to drink alkaline water (mineral water without gas, a solution of baking soda) or a rosehip broth.
If you have severe abdominal pain, severe vomiting, or moderate pain for several days, you should definitely contact a medical institution, as these symptoms can also be signs of cholecystitis, appendicitis, peptic ulcer or intestinal obstruction.
In case of acute pancreatitis, hospitalization and treatment in a hospital are necessary. To prevent dehydration and normalize pressure, a dropper is placed. Painkillers and drugs that suppress the secretion of enzymes are prescribed. In the first 3-4 days, they are administered intravenously, and after some relief are taken in the form of tablets. In order to reduce pain in the pancreas, ice may be applied.
The most commonly used antispasmodics: Baralgin, No-Shpa, Papaverin, Drotaverin, with moderate pain, you can use Acetaminophen or Ibuprofen. Analgesics are sometimes used: Aspirin, Paracetamol. Cholinolytic and antihistamines can also be used: Atropine, Platifillin, Diphenhydramine.
To relieve pain and prevent irritation and ulceration of the gastric mucosa, drugs are used in the form of suspensions and gels that neutralize hydrochloric acid (Almagel, Fosfalugel) and drugs that reduce its production (Kontralok, Omez, Omeprazole, Gastrozole, Proseptin, Ocid). In hospitals, H2-blockers Ranitidine, Famotidine or their analogues Acidex, Zoran, Gasterogen, Pepsidin are prescribed.
In order to reduce the production of enzymes, Contrical or Aprotinin are used. After the removal of the acute attack and in chronic pancreatitis, enzyme therapy is prescribed to maintain the functions of the pancreas and improve digestion. The most common drugs are Pancreatin, Mezim, Festal, Creon, Panzinorm. However, they are made on the basis of pork protein, therefore, in the presence of an allergic reaction to pork, they can not be taken. In children, such an allergic reaction can cause intestinal obstruction. In this case, herbal preparations based on rice fungus or papain are prescribed: Unienzyme, Somilase, Pepfiz.
Enzymes are taken immediately after eating, the dose is prescribed by a doctor individually. The course of treatment is long, often supporting therapy becomes necessary throughout life.
Of the other drugs, pancreatic secretion is stimulated by pilocarpine, morphine, vitamin A, magnesium sulfate, and histamine and atropine are lowered. In violation of exocrine function, insulin preparations are prescribed to regulate blood sugar levels. Self-medication for damage to the pancreas is unacceptable. This may result in necrosis, diabetes, or blood poisoning.
Complications of chronic pancreatitis can be an obstruction of the blood vessels of an organ, bile ducts, gland cyst, infection or necrosis of its tissues (necrosis).
The pancreas is a very delicate and sensitive organ, so any surgical intervention is highly undesirable. The operation may be required when the ducts of the gland are blocked, in the presence of a cyst, with stones in the gallbladder (sometimes the gallbladder itself is removed), if necessary, remove part of the pancreas due to the development of pancreatic necrosis.
The role of diet in the treatment of pancreas
Dieting is a very important element in the treatment and prevention of exacerbations of pancreatitis. If you neglect this, any medication may be powerless. Since the qualitative and quantitative ratio of the enzymes produced by the iron varies depending on the composition of the products consumed at one meal, it is recommended to switch to separate nutrition in order to reduce the load on the iron, i.e., consume proteins and carbohydrates in different meals. Also, one should not overeat: the daily caloric intake of the diet should not exceed the norm corresponding to age, sex and the cost of physical energy.
Fatty foods, fried foods,
Sausages, canned food, smoked meats, pickles,
Strong tea and coffee
Confectionery (cakes, pastries), ice cream,
Spicy spices, spices and seasonings, mustard, horseradish.
Chicken, turkey, rabbit, from fish - cod, bream, pike perch, pike,
Sour curd, fresh cheese,
Boiled or baked vegetables,
Vegetable, cereal, vermicelli soups,
Rice, oatmeal, buckwheat, pasta,
Butter and vegetable oil without heat treatment,
Kissel, compote, jelly.
Education: A diploma in the specialty "General Medicine" was obtained at the Russian State Medical University. N.I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.
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The spread of chronic pancreatitis occurs as a result of a protracted inflammatory process that occurs in the pancreas. Men over 40 are most susceptible to the disease, but in recent years there has been an increase in cases of chronic pancreatitis in women and in younger people.
The pancreas is an internal organ that is necessary for the absorption of glucose that enters the human body with food. It secretes hormones such as glucagon and insulin, as well as other enzymes and hormones necessary to properly absorb food. Inflammation of this organ is called pancreatitis. If the enzymes stagnate in.
One of the most important organs of the digestive system, which allows it to function smoothly, is the pancreas. It produces both digestive enzymes and hormones (insulin and glucagon), which, in turn, regulate blood sugar levels. In order for the body to function normally, it is necessary to properly "feed" it.
Pancreatitis is not a disease that you can safely forget about and wait for an independent recovery of the pancreas. If there is even a suspicion of this pathology, then you should immediately consult a doctor. Depending on the severity of the disease, it can be treated both at home and in the hospital.
The most common cause of pancreatitis is poor nutrition with an excess of fatty and spicy foods and alcohol abuse. This disease is characterized by girdle pains in the epigastric region of the abdomen, which can give back to the lower back. Unlike stomach ulcers, pain is not accompanied by heartburn, does not increase.
The pancreas is an internal secretion organ that produces glycogen, insulin and pancreatic juice. The first is a reserve nutrient for the body. It represents a kind of reserve of energy, which is used by the body when necessary.
Pancreatic inflammation, or simply pancreatitis, is one of the most unpleasant and difficult to treat diseases of the gastrointestinal tract. Bad habits and an unhealthy diet, oversaturated with fats and food additives, contribute to its occurrence. That is why under the influence of a modern urban image.