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Despite its small size and weight, it plays an important role in the digestion process. The complex structure of substances entering the human body is not absorbed on its own, and then the enzymes produced by the gland and pancreatic juice come to the rescue.

But often in this well-coordinated and complex work there are serious failures that endanger human life. One such failure is pancreatic atrophy.

What is atrophic pancreatitis

This pathology is expressed by a decrease in the volume of the mucosa of the organ with complete or partial damage to its active areas. The production of digestive enzymes, exocrine secretory synthesis of glucogan and insulin, as well as bicarbonates and enzymes worsens.

Causes of atrophic pancreatitis

There are several reasons for the disease:

• Natural aging of the body.
• abuse and.
• - a violation of the metabolism of fats in the body, in which functional cells are replaced by fat.
• Outwardly, this manifests itself in the appearance of benign neoplasms on the pancreas, accompanied by severe pain in the right side, vomiting and diarrhea.
• Severe diabetes mellitus.
• Overlapping of the outflow streams with stones.
• Progressive systemic sclerosis.
• Cirrhosis of the liver.
• Excessive consumption of fried, fatty, smoked and salty foods.
• Removal of part of the pancreas.

Factors and risk groups

Structural changes in the body occur gradually. Provoking factors include:

1. Oncology of neighboring organs.
2. Unhealthy lifestyle, including the development of alcoholism.
3. Abdominal trauma.
4. Infectious diseases of the internal organs.
5. Calculous cholecystitis, at a progressive stage, atrophy of the glandular tissue and fibrosis is noted.

The risk group includes patients with a genetic predisposition. Males predominate.

Symptoms of the disease

Symptomatic signs that can give a complete clinical picture are determined by the source that provoked the disease. The classic signs of organ atrophy are endocrine and exocrine insufficiency. The first symptom is increased excretion of undigested fats in the stool.

Gradually, the balance of the microflora of the gastrointestinal tract is disturbed, the neutral gastric environment changes to aggressive, pathogenic particles become more active. Due to a violation of the digestive process, there is a relaxation of the “stool”, a decrease in appetite and body weight. The protracted nature of the pathology provokes the development of persistent beriberi.

There are also changes in the appearance of a person. The skin becomes pale and dry, flaky, the tongue becomes bright red or crimson. The patient is concerned about the average intensity of pain on the left side, in the hypochondrium, frequent urge to urinate, unquenchable thirst and dry mouth. Gradually comes general weakness, dizziness against the background of rapid fatigue. Vomiting often occurs.

Diagnosis, differential diagnosis

Different types of pancreatic pathologies can have similar symptoms. The differential diagnosis is determined by the method of discarding the symptoms of an unlikely disease. The staging scheme is as follows:

• The doctor identifies the underlying syndrome and generates a list of possible diseases.
• An anamnesis and data on heredity are collected, all changes in well-being, the general condition of the patient are recorded.
• To identify the differences and similarities of diseases, the previously prepared list is studied by comparing the way the syndrome manifests itself, the accompanying symptoms and their manifestations.
• As a result of logical reasoning and careful analysis, item by item is gradually deleted from the list.
• At this stage, one variant of the pathology remains. The diagnosis is established and the appropriate treatment is prescribed.

Laboratory diagnostics

1. First of all, a visual examination of the patient is carried out. Appearance is evaluated: the nature of the skin, body mass index, palpation is carried out.
2. A general and biochemical blood test is carried out. The degree of anemia, the concentration of glucose, the level of pancreatic enzyme are determined.
3. Urinalysis is examined for the content of amino acids and amylase in it. Atrophy is diagnosed, among other things, by an overestimated concentration of these substances.
4. A scatological study is prescribed - a study of the fecal mass for the concentration of excreted fats in it.
5. Thanks to the method, it is possible to study the size and shape of the organ, the density of the structure, to assess the condition of the ducts and bile ducts.
6. For more clear information, instead of ultrasound, you can It indicates the severity of the disease and the extent of the spread of atrophic processes.
7. Pancreatic tissue samples are sent for biopsy. With the help of a microscopic assessment, it is possible to identify whether an inflammatory process is present, to distinguish a benign neoplasm from a malignant one, and to determine the type of tumor. Based on the results, a forecast of fatty degeneration and the degree of destruction of the elements of the organ (Langerhans striae, parenchymal part) are obtained.
8. Contrast X-ray (RCPG) demonstrates the degree of tortuosity and narrowing of the channels of the ductal system, the position of the walls. This is the most informative of the existing methods of instrumental examination.
9. ERCP or contrast X-ray reveals the condition of the walls, the degree and cause of the narrowing of the channels in the ductal system of the gland, their tortuosity, the presence of stones and protein plugs.

Treatment of atrophic pancreatitis

Treatment includes:

• Diet prescription. The description of the diet is in the memo that the doctor gives to the patient. The amount of fat consumed is minimized, the volume of proteins, on the contrary, increases (to replenish the energy reserve). The diet should include a large amount of fresh vegetable juices - cucumber, potato, carrot. It is allowed to eat meat and fish of low-fat varieties, porridge cooked on water (rice, oatmeal, buckwheat), scrambled eggs, boiled or stewed vegetables, dairy products, baked apples, jelly from berries and fruits. Oven baked pumpkin is especially useful.
• Patient quitting smoking. The patient must definitely give up this bad habit, otherwise the treatment will not bring results. Nicotine blocks the process of bicarbonate synthesis, due to which the acidity of the environment in the duodenum increases.
• Replenishment of internal and external secretion of the pancreas artificial means based on enzymes. A lasting effect is given by drugs that are resistant to gastric juice and with the limiting activity of lipase, a digestive enzyme that promotes the breakdown and dissolution of fats. The use of drugs such as "Mikrazim", "Creon", "Festal" leads to an increase in the concentration of elastase, an acceleration of carbohydrate metabolism.
• Correction of endocrine function through insulin therapy. Taking into account the daily indicators of sugar in the blood test, the severity of the disease, the etiological parameters, the doctor determines the dosage, its frequency and mode of administration.
• Detoxification of the digestive tract. The removal of toxins from the body is given special attention. Preparations based on herbal preparations or directly mixtures from pharmacies restore acid-base and hydroionic balance.
• Normalization of the gastrointestinal tract rely on probiotics.
• To combat vitamin deficiency polypreparations are prescribed in oral form. Copper, zinc, magnesium are injected.
• In cases of severe pathologies and irreversible with irreversible changes, surgical intervention cannot be avoided. After transplantation of the islets of Langerhans and removal of the organ, replacement therapy with artificial enzymes is performed.

Non-traditional methods of treatment are effective, but they can be used only after a complete examination of the body and in consultation with your doctor. The most common options:

• Herbal preparations from a pharmacy, which include chamomile, succession, St. John's wort, stems of wormwood and oregano, hazel.
• Natural propolis activates the regenerative function, has anti-inflammatory and bactericidal properties. A small piece is chewed after each meal and washed down with a glass of warm water. Course - 2 weeks.
• 1 st. a spoonful of flax seeds is brought to a boil in a pot of water, infused for 1.5 hours and drunk at a time. Removes toxins well.
• Oats are boiled until thick and mixed with milk. The decoction normalizes water-lipid metabolism and activates food processes. It is taken twice a day.

REFERENCE! For pain relief, antispasmodics and analgesics are prescribed in injectable form: Papaverine, Analgin, No-shpa.

Possible Complications

It should be said that with timely detection of pathology and competent treatment, complications practically do not arise. But if the patient put off going to a specialist for a long time and did not pay due attention to his health, you will have to forget about a favorable prognosis.

Most often, atrophy of the gland leads to, the complications of which are:

1. mechanical jaundice.
2. With this disease, steatorrhea and hypovitaminosis occur, and the absorption of fats is impaired. The stool becomes discolored, and the urine becomes dark. A person sharply loses weight, he is tormented by skin itching, vision deteriorates, signs of a nervous breakdown may appear.
3. Diabetes.
4. The transition of chronic diseases to a more complex stage.
5. Purulent complications - fistulas, abscesses, cysts.
6. Internal ulcers and bleeding caused by organ deformities.
7. In especially neglected cases - sepsis, the growth of malignant tumors, the death of sections of the pancreas.

Prognosis and prevention of the disease

• Rational, balanced diet.
• Refusal of alcoholic and carbonated drinks, cigarettes, fast food.
• Regular physical activity.
• Control and timely therapeutic measures in case of complications of chronic diseases and protracted ailments.
• Regulation of enzyme activity and maintaining it at a sufficient level.

Conclusion

Pancreatic diseases number in the dozens, but there is no disease that cannot be stopped. The main thing is to do it on time. To combat atrophy, it is important to strictly follow all the recommendations of the attending physician and, of course, not to lose the presence of mind.

Version: Directory of Diseases MedElement

Other specified diseases of pancreas (K86.8)

Gastroenterology

general information

Short description

This subheading includes conditions that differ both in morphological features, and in etiology and pathogenesis. They are most commonly associated with, but not limited to, acute or chronic pancreatitis (including alcoholic chronic pancreatitis).

Atrophy of the pancreas(RV) - a condition expressed in the loss of masses of the pancreas and atrophy of acinar cells, accompanied by secretory insufficiency. Atrophy of the pancreas is often associated with fibrosis Fibrosis is the growth of fibrous connective tissue, which occurs, for example, as a result of inflammation.
PZh. Externally, the pancreas is reduced in size and flattened. Fatty atrophy of the pancreas with massive accumulation of adipose tissue in combination with pancreatic tissue atrophy is also described.
Atrophy of the pancreas should be distinguished from atrophy of the cells of the islets of Langerhans The islets of Langerhans are small collections of cells scattered throughout the pancreas that secrete the hormones insulin and glucagon.
with diabetes.

Underdevelopment (immaturity, infantilism) of the pancreas- a congenital form of insufficiency in the secretion of pancreatic hormones and insulin (excluding - Q45.0).

Fibrosis of the pancreas- excessive accumulation of extracellular matrix Matrix is ​​a fine-grained, semi-liquid, viscous substance that fills intracellular structures and spaces between them.
(densification of connective tissue) in the pancreas.

cirrhosis of the pancreas Cirrhosis of the pancreas - a figurative term introduced in 1887 by a visual analogy of a lesion of the pancreas with cirrhosis of the liver
* - proliferation of connective tissue in the form of dense strands and at the same time atrophy of the parenchyma Parenchyma - a set of basic functioning elements of the internal organ, limited by the connective tissue stroma and capsule.
glands, can occur diffusely throughout the gland, in connection with which the pancreas decreases in size and becomes very dense with an uneven and bumpy surface. Macroscopically, the pancreas (or part of it) looks like liver tissue in cirrhosis - nodular, dense, rich in wide and dense connective tissue constrictions.

Necrosis of the pancreas(pancreanecrosis**) - a destructive form of pancreatitis with massive simultaneous death of a large number of pancreatic cells. Distinguish:
- unspecified necrosis;
- aseptic necrosis - necrosis without the participation of microorganisms ("self-digestion" of the pancreatic tissue due to failure of protective mechanisms in pancreatitis);
- fatty necrosis - steatonecrosis with the formation of calcium salts and fatty acids both in the pancreas itself and beyond.

pancreatic stones is a rare chronic disease. More common in men than in women. Stones, as a rule, have a light gray or gray-yellow color, an uneven surface and consist of calcium carbonate and calcium phosphate with a slight admixture of organic substances. Unlike gallstones, pancreatic stones do not contain cholesterol or bile pigments. "Young" stones are soft, while "old" ones are harder. More often there are multiple stones of various sizes (from a grain of sand to the size of a hazelnut).
Stones are predominantly localized in the main duct and often penetrate with their processes into its side branches, which creates obstacles to normal sap secretion.

* Figurative term introduced in 1887 by visual analogy of pancreatic lesions with cirrhosis of the liver.

** The term "pancreatic necrosis" is more pathoanatomical than clinical, which is why it is not entirely correct to use it as a clinical diagnosis. The term "total-subtotal pancreatic necrosis" refers to the destruction of the pancreas with damage to all departments (head, body, tail). Absolutely total pancreatic necrosis does not occur.

Etiology and pathogenesis

Atrophy of the pancreas is a consequence (stage) of chronic pancreatitis (including obstructive, non-calculous and calculous chronic pancreatitis). Atrophy can be combined with fibrosis of the pancreas.
Also, atrophy or fibrosis of the pancreas can occur due to the following reasons:
- atherosclerosis;
- senile changes in the pancreas;
- diabetes;
- surgical interventions on the pancreas;
- malnutrition.

Pathological and physiological atrophy differ in etiology and quality features. Atrophy is based on the predominance of dissimilation processes over assimilation processes, which is associated with a decrease in the activity of cytoplasmic enzymes.

Underdevelopment (infantilism) of the pancreas(clinical Clark-Hadfield syndrome) is a congenital form of insufficient secretion of pancreatic hormones, including insulin. The etiology is not known for certain. Young children suffer.

Fibrosis of the pancreas is a consequence of chronic pancreatitis of any etiology (including alcoholic, tropical, hereditary chronic pancreatitis).
A rare cause of fibrosis is hemosiderosis, which is an increase in tissue levels of ferritin and hemosiderin. These pigments are deposited in organs (liver, pancreas, myocardium), which causes the progressive death of parenchymal elements, their replacement with coarse fibrous connective tissue (liver cirrhosis, pancreatic fibrosis, cardiosclerosis) and the development of functional organ failure (chronic liver and heart failure, diabetes mellitus).

cirrhosis of the pancreas mainly occurs as a result of chronic pancreatitis, the progressive development of which leads to cirrhosis of the pancreas: it decreases in size, its surface wrinkles, and the consistency becomes cartilaginous.
The figurative description of "cirrhosis" for the pancreas was introduced by analogy with cirrhosis of the liver in alcoholic liver disease.
Cirrhosis of the pancreas occurs not only in chronic alcoholic pancreatitis, but also in the so-called "tropical" pancreatitis (fibrocalculous pancreatitis, fibrocalculous pancreatic diabetes - FCPD), as well as in syphilitic pancreatitis.

Necrosis pancreas- necrosis, death of pancreatic cells, usually due to severe forms of acute pancreatitis (pancreatic necrosis). With pancreatic necrosis, self-digestion of the pancreas with enzymes that are produced in it (trypsin and lipase) is observed. Intraorganic activation of these enzymes is associated with the entry into the lumen of the ducts of natural activators of pancreatic excretion - gallbladder bile or its individual components (for example, bile acids).

Pancreatic necrosis occurs in several forms:

1. Unspecified necrosis - no morphological data.

2. Aseptic necrosis - occurs without the participation of microorganisms and is not accompanied by the breakdown of fats. Appears, as a rule, due to blunt abdominal trauma.

3. Fat necrosis (enzymatic fat necrosis) - in most cases due to hemorrhagic acute pancreatitis, when pancreatic enzymes exit the ducts into the surrounding tissues. Pancreatic lipase breaks down triglycerides in fat cells into glycerol and fatty acids. When interacting with plasma calcium ions, these elements form calcium soaps, which are deposited in the form of needle-like crystals next to dead cells. This process is accompanied by steatonecrosis - the appearance of opaque, white plaques and nodules in the adipose tissue surrounding the pancreas.
With pancreatitis, lipase may enter the bloodstream. In the future, it is widely distributed and causes fatty necrosis in many parts of the body (most often in the subcutaneous adipose tissue and bone marrow). Microscopically, in the affected tissues, the absence of a nucleus with the presence of fat crystals and salt lime is revealed.

pancreatic stones have not fully elucidated etiology and pathogenesis. It is assumed that stone formation is due to a violation of metabolic processes, which leads to an increase in the concentration of calcium salts in the pancreatic juice. This fact explains the frequent combination of pancreatic stones with the formation of stones in the salivary glands and urinary tract.
The basis of the stones, as a rule, consists of masses of desquamated and decayed epithelium of the ducts, around which mucus and calcium salts present in the pancreatic juice are deposited.

The formation of stones contributes to the stagnation of secretions in the ducts of the gland, caused by mechanical causes (the formation of stones in retention cysts) and / or inflammation of the ducts when they become infected. Most often, the infection enters the ducts from the bile ducts, but hematogenous and lymphogenous mechanisms of infection are possible.

The existence of pure forms of stone formation in the pancreatic ducts, without signs of chronic pancreatitis, is doubtful. On the contrary, the formation of stones in the ducts of the pancreas is possible with the development of calcification in the thickness of the pancreas, that is, in the final phase of chronic pancreatitis.
Stone formation is characteristic of alcoholic chronic pancreatitis or pancreatitis associated with malnutrition (tropical pancreatitis, idiopathic pancreatitis, fibrocalculous pancreatic diabetes).

Factors and risk groups

- heredity;
- unbalanced nutrition;
- alcoholism;
- abdominal trauma;
- infections;
- calculous cholecystitis Calculous cholecystitis - inflammation of the gallbladder, in which stones are found in the gallbladder
.

Clinical picture

Symptoms, course

Atrophy of the pancreas manifested by the development of severe exocrine and endocrine insufficiency. Patients have steatorrhea, weight loss and, in the final, clinical diabetes. The intensity of chronic pain decreases and acute attacks stop. Possible development of severe systemic complications of chronic pancreatitis and adenocarcinoma Adenocarcinoma is a malignant tumor originating and built from glandular epithelium.
PZh.

Infantilism of the pancreas clinically described by Clark-Hadvild syndrome. Characteristic manifestations:
- lag in physical development (small growth, reduction or absence of the subcutaneous fat layer);
- steatorrhea Steatorrhea - increased content in the feces of neutral fat, fatty acids or soaps.
(secretory insufficiency);
- hepatomegaly Hepatomegaly is a significant enlargement of the liver.
;
- vitamin A deficiency;
- malabsorption syndrome Malabsorption syndrome (malabsorption) - a combination of hypovitaminosis, anemia and hypoproteinemia, caused by malabsorption in the small intestine
.

Fibrosis and cirrhosis of the pancreas present with classic signs of secretory insufficiency. In the later stages, symptoms of diabetes develop.

Pancreatic necrosis- an acute condition, characterized by all the signs of acute pancreatitis (for details, see - K85).
The frequency of clinical symptoms of pancreatic necrosis:
- pain - 94%;
- nausea and / or vomiting - 77%;
- flatulence - 89%;
- rigidity Rigidity - numbness, stiffness.
muscles - 80%;
- paresis Paresis - a decrease in the strength and / or amplitude of voluntary movements, due to a violation of innervation (providing with nerves and communication with the central nervous system) of the corresponding muscles
intestines - 66%;
- hyperglycemia - 71%;
- hypocalcemia - 50%;
- jaundice - 43%;
- pulmonary insufficiency - 68%;
- renal failure - 50%;
- shock - 38%;
- sepsis - 31%;
- encephalopathy Encephalopathy is the general name for brain diseases characterized by its degenerative changes.
- 11%;
- gastrointestinal bleeding - 9%.

pancreatic stones
Even in the presence of large stones, the disease is often asymptomatic.
Possible attacks of colicky, intense pain in the epigastric region with irradiation Irradiation - the spread of pain outside the affected area or organ.
usually on the left side of the body.
Pain can appear suddenly in full health (usually at the height of intestinal digestion) and last from several hours to a day or more. In some cases, the attack is preceded by discomfort in the xiphoid process.
The nature of the pain resembles hepatic colic; they can often be accompanied by vomiting, fever, and salivation. Sometimes a painful attack can end with the passage of a stone into the intestines. When the stone passes through the Vater nipple, pain attacks recur; jaundice may occur. Due to severe pain attacks, shock is possible.
When the ducts are blocked with stones, an obstacle is created to the secretion of juice, which is accompanied by a violation of digestion (steatorrhea Steatorrhea - increased content in the feces of neutral fat, fatty acids or soaps.
, creatorrhoea Creatorrhoea - increased content in the feces of undigested muscle and connective tissue fibers
, amylorrhea Amylorrhea - excretion with feces of an increased amount of undigested starch, more often with increased intestinal motility
) and an increase in the content of enzymes in the blood and urine. Intermittent glycosuria observed Glycosuria (syn. glycuria, melituria) - the presence of sugars in the urine in high concentrations
and hyperglycemia Hyperglycemia - high blood glucose
, changes in glycemic curves during glucose loading. As a result of prolonged blockage of the main duct, atrophy of the pancreas, a sharp violation of the digestive process and exhaustion of the patient are observed.

Tropical pancreatitis manifests at the age of about 20-40 years, although earlier cases of the first manifestations have been described. Patients present with abdominal pain, enlargement of the abdomen, bluish discoloration of the lips, swelling of the legs, and enlargement of the parotid salivary glands, in combination with increasing signs of diabetes mellitus. However, about a quarter of patients do not have such signs during the manifestation period.

Diagnostics

I. Ultrasound- is the starting method of instrumental diagnostics for diseases of the pancreas (PJ) referred to this subheading.

Atrophy of the pancreas:
- a decrease in the size of the pancreas (not always detected in the early stages of the process);
- uneven change in echogenicity in the early stages and increased in the later;
- induration.

In the case of total atrophy, there is a decrease in the size of all sections of the pancreas. If there is a picture of isolated atrophy of the tail of the pancreas (the head looks normal), a tumor of the pancreatic head should be suspected. In this situation, a thorough examination of the pancreatic head is necessary, since chronic pancreatitis in the body and tail can be combined with a slowly growing tumor of the pancreas.

Elderly patients (especially those with long-term diabetes) may develop pancreatic lipomatosis. On ultrasound, lipomatosis is characterized by an increase in echogenicity, the pancreas is usually of normal size, significant induration Induration - compaction of an organ or part of it as a result of some pathological process
missing.

Reducing the size of the pancreas in older people without signs of pancreatic pathology may be considered a variant of the norm and not have clinical significance.

Fibrosis of the pancreas:
- increased echogenicity;
- increase in the density of the pancreas;
- Prostate size is usually normal.

Cirrhosis of the pancreas:
- hyperechoic structure of irregular shape (fibrosis after episodes of acute inflammation);
- jagged edges and reduced size of the pancreas;
- micro- and macrocysts, calcifications (with an acoustic shadow), expansion of the duct are possible.

Pancreatic necrosis:
- hypoechogenicity in comparison with the adjacent liver;
- an increase in the pancreas in size;
- blurry uneven contour;
- presence of effusion An effusion is an accumulation of fluid (exudate or transudate) in the serous cavity.
in the omentum;
- Foci of fat necrosis in the omentum and subcutaneous fat.

PJ stones. On ultrasound, calcifications inside the pancreas may produce an acoustic shadow, but with small calcifications, they may appear as a separate bright echostructure without an acoustic shadow. Ultrasound is not the most effective way to detect calcification of the pancreas (X-ray of the upper abdomen with the patient in the supine position in direct projection is more preferable).

Possible reasons for the detection of calcification in the pancreas:

1. Chronic pancreatitis: calcifications are diffusely distributed throughout the pancreas.

2. Stones in the pancreatic duct: calcifications are located along the duct.

Gallstones in the distal choledochus may be mistaken for calcifications in the pancreas. During the study, an expansion of the proximal common bile duct is revealed. The maximum internal diameter of a normal pancreatic duct is 2 mm. The duct is better visualized with transverse scanning in the middle third of the body of the pancreas. To make sure that the duct is visualized, it is necessary to see the pancreatic tissue on both sides of it. If such a picture is not observed, then it is possible that the splenic vein posteriorly or the wall of the stomach anteriorly were falsely interpreted as a pancreatic duct. The walls of the pancreatic duct should be smooth and the lumen clean. With an expanded duct, its walls become uneven. The entire biliary tract should be scanned.

Possible reasons for the expansion of the pancreatic duct:
1. Tumor of the head of the pancreas or ampulla of Vater's nipple. Tumors associated with jaundice and dilatation Dilatation is a persistent diffuse expansion of the lumen of a hollow organ.
biliary tract.
2. Stones of the common pancreatic duct. To confirm, a study should be performed to detect gallstones and dilatation of the bile duct.
3. Stone in the intrapancreatic duct: the biliary tract should be normal.
4. Chronic pancreatitis.
5. Postoperative strictures Stricture - a sharp narrowing of the lumen of a tubular organ due to pathological changes in its walls
after Whipple surgery or partial pancreatectomy Pancreatectomy - a surgical operation: removal of the pancreas, for example, in case of a malignant tumor, acute pancreatitis
. For confirmation, clarification of the patient's history is required.

II. Plain radiography - this method has no diagnostic value, except in cases of stone formation. X-ray examination allows you to reliably detect calculi Calculi - stones, dense formations found in the abdominal organs and excretory ducts of the human glands.
, and more successfully on radiography (without contrast) after the imposition of pneumoperitoneum Pneumoperitoneum - 1. The presence of gas in the peritoneal cavity. 2. Gas filling of the retroperitoneal space
. Stones form multiple shadows on one or both sides of the spine.

III. CT and MRI are the most reliable imaging methods, however, the obtained images do not allow to accurately assess the degree and stage of morphological changes in the pancreas.

IV. Morphological study.

Atrophy of the pancreas:
- Outwardly, the pancreas is reduced in size and flattened;
- the number of acinar cells is reduced;
- there is an accumulation of adipose tissue (lipomatosis).
It should be noted that pancreatic atrophy is less pronounced in children than in adults; Round cell infiltration and a delicate structure of the connective tissue are revealed.

Infantilism of the pancreas:
- atrophy of acini;
- fibrocystic tissue degeneration;
- islet tissue, as a rule, is preserved, however, with the course of the disease, its amount also decreases.

fibrosis, cirrhosis. The acinar tissue becomes wrinkled and atrophic. In the later stages of the disease, signs of lipomatosis are noted. Lipomatosis is a pathological condition in which there is a focal proliferation of fat cells in body tissues as a result of a metabolic disorder. This pathology belongs to fatty degenerations.
, complete death of acinar tissue and its replacement by fibrous tissue.
Dense areas of fibrosis and nodularity of the gland on visual assessment correspond to such a descriptive term as "cirrhosis" of the pancreas.

In tropical pancreatitis or chronic alcoholic pancreatitis, cirrhosis of the pancreas is usually combined with stone formation. At the same time, the ducts are dilated, with several strictures and obliteration. Obliteration is the infection of the cavity of an internal organ, canal, blood or lymphatic vessel.
side branches. Stones within the ducts are diffusely located throughout the pancreas. The number of islet cells for a long time can remain normal (their hypertrophy - pseudonesidioblastosis can even be observed), and the development of atrophy occurs only at a late stage.

Microscopically detectable ductal lesions, necrosis and inflammatory infiltrates Infiltrate - a tissue area characterized by an accumulation of cellular elements that are usually not characteristic of it, an increased volume and increased density.
less common in tropical pancreatitis than in alcoholic pancreatitis.

In all cases, atrophy of the glandular elements and proliferation of connective tissue with the development of fibrosis and cirrhosis of the pancreas are observed.

Laboratory diagnostics

Signs and tests that reveal secretory insufficiency in atrophy, infantilism, stone formation correspond to those described in the following headings:
- K86.1;

K90.3;
- - Q45.0.

General laboratory signs:
- anemia;
- hypoalbuminemia;
- hypocholesterolemia;
- a slight increase in serum amylase against the background of pain;
- analysis of feces: high content of fat and undigested fibers, decreased elastase-1 and fecal chymotrypsin;
- in the later stages, laboratory signs of type 1 diabetes are detected.

Necrosis of the pancreas
For hemorrhagic pancreatic necrosis are typical:

Short-term amylasemia, combined with lipasemy, which is allowed only for 3-5 days;
- in the peritoneal effusion (if it is possible to obtain it), the activity of amylase and trypsin is extremely increased, with a sharp decrease in the level of trypsin inhibitor.
Signs of violation of the coagulation potential of circulating blood with the phenomena of intravascular coagulation are revealed. Paracoagulation tests are strongly positive, concentrations of fibrinogen degradation products and blood plasmin activity are increased by 2-3 times. Indicators of coagulation potential remain, as a rule, high.

Fat necrosis is characterized by:
- a pronounced and prolonged increase in the activity of blood alpha-amylase (5-10 times in the range of 7-10 days), lipase (1.6-3.0 times over 10-14 days);
- increased activity of trypsin (more than 2 times for several days);
- reduced levels of blood trypsin inhibitor (significant reduction - rare);
- increased activity of pancreatic enzymes in peritoneal and pleural effusion by 10-20 times;

A sharp increase in plasma triglycerides against the background of a drop in plasma calcium below 2 mmol / l.

Blood amylase and lipase levels may be normal or even low in the following cases:
1. With edematous or destructive pancreatitis that occurs against the background of chronic pancreatitis, which is accompanied by severe fibrosis of the parenchyma.
2. In severe destructive acute pancreatitis, when most of the parenchyma is subject to necrotic changes.

Thus, there is no clear relationship between the severity of acute pancreatitis and severe pancreatic fermentemia. Therefore, in the scales for determining the severity and prognosis of acute pancreatitis (Ranson, Glasgow), tests for determining the activity of pancreatic enzymes in the blood and urine (amylase, lipase, trypsin) are not taken into account. Due to the inaccessibility, these scales also do not take into account more specific tests - trypsinogen activation peptide, phospholipase, elastase.

Differential Diagnosis

1. Chronic pancreatitis and focal diseases of the pancreas are primarily differentiated from functional disorders of the pancreas. The etiology of functional disorders of the pancreas can be different, in particular, the possibility of viscero-visceral reflexes from diseased organs, neurosis, and so on should be borne in mind.

For the functional nature of the lesion of the pancreas, the absence of permanent clinically pronounced symptoms of the disease, as well as signs of morphological changes in the pancreas, is typical.
In relatively mild cases of functional disorders of the pancreas of neurogenic origin, the changes are insignificant: moderate dyspeptic symptoms, a feeling of rumbling or "transfusion" in the abdomen, rapid stools of a formed or semi-formed consistency.
Psychogenic and neurogenic decreases in pancreatic function, as a rule, are not isolated and are accompanied by a decrease in gastric secretion, secretion of intestinal glands, and absorption disorders are also possible. The resulting functional disorders of the pancreas cannot be considered a minor deviation from the norm, because with prolonged exposure to a negative, inhibitory factor, even some atrophy of the pancreas parenchyma is possible.

An increase in the exocrine function of the pancreas occurs extremely rarely and, as a rule, is not accompanied by any unpleasant sensations. In some cases, there may be spastic intestinal pain and the urge to defecate, which are not directly related to the condition of the pancreas.

2. congenital syphilis. In congenital syphilis, the picture of fibrosis differs from that in chronic pancreatitis. The pancreas is usually enlarged and thickened, compacted, on cuts it is smooth, less often granular. Histologically, the proliferation of connective tissue is revealed, which contains a large number of round and spindle-shaped cells, often small gummas, as well as pale treponemas.
In especially severe cases, as a result of severe sclerosis, atrophy of the pancreatic tissue (acini, ducts, and, to a lesser extent, pancreatic islets) is observed. In some cases, with congenital syphilis, relatively large single solitary gummas are found.
Thus, the morphological picture of congenital pancreatic syphilis is variable. Usually, the following forms of the disease are distinguished:
- diffuse interstitial (sometimes combined with the presence of miliary gums);
- gummy;
- congenital syphilis, occurring with a predominant lesion of the pancreatic ducts.

3. Tumors of the pancreas.

- diabetes;
- tumors of the pancreas;
- development of cysts and abscesses of the pancreas;
- development of severe secretory insufficiency;
- obstructive obstruction of the common duct;
- spastic obstruction of the small intestine;
- the formation of areas of necrosis of adipose tissue outside the pancreas;
- sepsis and shock in pancreatic necrosis.

Treatment abroad

In this case, we are talking about atrophic pancreatitis, in which atrophy of all pancreatic tissues in humans or only part of them can be detected.

Most often, these processes affect the tail and head of the organ, leaving the body of the gland unchanged. In this case, the affected tissues and cells of the pancreas cease to perform their functions (their atrophy occurs), the gland itself becomes dense and increases in size.

Atrophy of the pancreas in humans is accompanied by its swelling, circulatory disorders, the appearance of hemorrhages on its surface, as well as fatty necrosis and cysts. The process of atrophy begins with the proliferation of connective tissue and can first affect the vessels and be intralobular in nature, then becoming interlobular. Or, on the contrary, it may be interlobular in nature, then spreading deep into the tissues, which entails almost complete atrophy of the cells of the pancreatic parenchyma. At the same time, the islets of Langerhans, which produce insulin, are preserved and can hypertrophy, which inevitably leads to hyperinsulinemia.

Atrophy of the pancreas may be partial, which usually occurs during the development of the process as a result of gastric ulcer or duodenal ulcer.

In the final stage of chronic atrophic pancreatitis, the pancreas decreases in size, its tissues become cartilaginous, and cirrhosis develops.

In the case when chronic atrophic pancreatitis in humans was caused by alcoholic pancreatitis, deposits of stones in the pancreas in the form of calcium salts can be observed, blocking the ducts and completely blocking its activity.

The prognosis for the development of atrophic pancreatitis is unfavorable. The treatment of this disease should be comprehensive, and should be directed, first of all, to the elimination of the cause that caused it. It is mandatory to carry out therapy to eliminate inflammatory processes and relieve pain.

Of considerable importance in the treatment of pancreatic atrophy is proper nutrition, as well as a healthy lifestyle that excludes the use of alcoholic beverages in any quantities, smoking and overeating.

Treatment of atrophic changes in the pancreas is carried out by a gastroenterologist. The prescribed treatment depends on the severity of the disease, concomitant disorders, symptoms, age of the patient, etc. Treatment of an atrophied organ is aimed at eliminating adverse factors and general therapy of the disease. The main goals of therapy are:

• Reducing pain symptoms. To achieve the desired result, analgesics and antispasmodics are used (no-shpa, papaverine, etc.)
• Removal of toxins from the body
• Achievement of acid-base and hydroion balance

If during the treatment of an atrophic pancreas the necessary diet is not observed, then it is extremely difficult to achieve the necessary results. Violations of exocrine function leads to a lack of enzymes, as a result of which the digestive process is disturbed. It is prescribed to take drugs that include these enzymes (pancreatin, festal, etc.).

If therapy does not help and the disease worsens, then surgery is indicated.

Atrophy of the caudal pancreas often leads to the death of insulin-producing cells, resulting in the development of secondary diabetes mellitus. In this case, an endocrinologist is involved in further treatment.

What is an atrophic pancreas?

Atrophic changes in the pancreas occur against the background of chronic pancreatitis. Atrophy is accompanied by the onset of a pathological process in the tissues of the mucosa, which are gradually replaced by inert connective components.

The concept of atrophic changes in glands

As a result of atrophic pancreatitis, there is a complete or partial replacement of active sites in the pancreas with inert ones. Atrophy of the pancreas leads to a reduction in the volume of the mucosa with a thickening of the membrane. A characteristic sign of the beginning of the process is functional insufficiency:

• with exocrine disorders, the synthesis of digestive enzymes and bicarbonates is disrupted;
• with intrasecretory pathology, the synthesis of insulin with glucagon slows down.

The process can be initiated due to the peculiarities of physiological development, against the background of debilitating diseases, tumor compression, damage to the filling mass (parenchyma), disruption of the system of supplying the vascular plexus of the organ with blood.

The total mass of the gland normally reaches 90 g. If the mucous membrane is atrophic, its mass decreases sharply up to 30 g.

Atrophy of the pancreas.

Structural changes in the pancreas are characterized by the formation of an excess of connective tissue. This inert material proliferates around the lobules of the organ, suggesting perilobular sclerosis. If the process is diffuse, then intralobular sclerosis is diagnosed. Subatrophy can be of different types, for example, with lipomatosis, part of the parenchyma is converted into fat masses.

Causes

1. Physiological changes occur during aging of the body with the natural destruction of glandular tissues. In severe forms of exhaustion, a cachectic stage is observed.
2. Complicated chronic pancreatitis, when fibrous cells replace part of the stroma, the general functional insufficiency of the organ progresses.
3. Complicated diabetes mellitus, in which the concentration of iron decreases sharply, and the tissues become bumpy. Reduced in size atrophic gland with a significant compaction weighs 18-20 g. The capsule gradually fuses with the surrounding adipose tissue and neighboring organs. Intraacinous sclerosis and subatrophy begin, with the cells of the glandular parenchyma dying.
4. Lipomatosis, which is characterized by the replacement of functional cells with inert fat. The functionality of the islets of Langerhans is partially preserved, as is the endocrine part of the organ, but the synthesis of glucagon is disrupted.
5. The last stages of alcoholic pancreatitis.
6. The development of oncological processes with compression by the neoplasm of the densified gland of nearby organs and the mucosa itself.
7. Blocking the excretory ducts with stones.

Rare causes of the disease:

• cirrhosis of the liver tissues;
• systemic scleroderma.

Symptoms

Symptoms that give a complete clinical picture are determined by the source that provoked the disease. We are talking about diabetes, chronic pancreatitis. The first symptoms of atrophic lesions:

1. Exocrine or exocrine gland deficiency, resulting in a decrease in the concentration of bicarbonates, digestive enzymes, and electrolytes. The balance of the microflora of the gastrointestinal tract is disturbed, the neutral environment in the stomach changes to a more aggressive one, which provides a favorable flora for the destructive work of pathogenic particles. The main signs: liquefaction of the stool, loss of appetite and body weight. If the secretion has decreased by 10% of the norm, the amount of undigested fats in the feces of patients increases. This indicates the development of steatorrhea. Weight loss indicates a violation of the process of digestion, absorption of food components in the intestine. With a protracted form of pathology, persistent beriberi develops.
2. Endocrine or intrasecretory deficiency is explained by disorders of carbohydrate metabolism with signs of hyperglycemic syndrome. The symptomatology of diabetes mellitus accompanies atrophy in half of the cases. Against this background, there is a deficiency of insulin with glucagon. The patient feels severe weakness, dizziness, dry mouth with intense thirst.

Diagnostics

1. A visual examination, in which the condition of the patient's skin and general appearance is assessed, the body mass index is determined, an anamnesis and data on heredity are collected. When examining the skin, dryness and peeling can be detected. If the pancreas decreases in size, its palpation is difficult. With pancreatic inflammation, which has become a source of atrophy, probing the abdomen causes pain.
2. A blood test that detects a decrease in pancreatic enzymes, anemia, high glucose concentration.
3. The coprogram allows you to analyze feces for the presence of excreted fats. In the results of the coprogram for steatorrhea, the parameter exceeds 9% of the daily fat intake. With creatorrhea, muscle fibers will be present in excess in the feces.
4. Ultrasound, which reveals the degree of reduction in the size of the gland, compaction of the organ. Ultrasound is performed in order to establish echo-signs of atrophic changes in the pancreas, the degree of size reduction, compaction of the structure, irregularities in outline.
5. Biopsy provides data on the extent of atrophy, which facilitates prediction. The method helps to assess the degree of fibrosis and destruction of the parenchymal part of the organ and other elements, such as the islets of Langerhans. With lipomatous atrophy, fatty degeneration of the gland occurs. Based on the results of the biopsy, a prognosis of this disease is obtained.
6. MRI allows you to see a more detailed picture of the severity and spread of atrophic processes.
7. ERCP or contrast X-ray reveals the condition of the walls, the degree of narrowing and tortuosity of the channels in the ductal system of the gland. Angiography looks at whether there are neoplasms in the pancreas.

Treatment

When diagnosing an atrophic lesion of the pancreas, the patient is primarily prescribed a diet. The diet contains a minimum amount of fat, but the menu has been expanded to compensate for the protein-energy deficiency, correcting hypovitaminosis. Without fail, a patient with atrophy must quit smoking, otherwise nicotine will disrupt the synthesis of bicarbonates, which will lead to an increase in the acidity of the medium in the duodenum.

The second principle of treatment of a gland reduced due to atrophy is the use of replacement therapy methods aimed at replenishing the external and internal secretion of the pancreas. For this purpose, the patient is prescribed a drug with enzymes that improve digestion.

To increase the effectiveness of drug treatment, products with high lipase activity are recommended to support band digestion, resistance to the effects of gastric juice, immediate release of enzymes from the small intestine. Examples of drugs: Creon, Mikrazim. Such an appointment is necessary because of the rapid loss of lipase activity due to the development of an atrophic process, aggravated by severe steatorrhea.

Treatment will be effective if the level of fat in the feces decreases and the concentration of elastase increases. Enzyme preparations relieve pain, contribute to the normalization of intestinal microbiocenosis, improve carbohydrate metabolism.

Insulin therapy is necessary for the correction of endocrine function. Despite the safety of the islets of Langerhans, synthesized insulin in the body is not enough. Treatment, doses and regimen of injection or infusion are determined by the doctor according to the severity of the course of the disease, based on etiological parameters, indicators of daily fluctuations in blood sugar. The order of insulin therapy is selected based on the doses of replacement drugs used and their effectiveness.

Probiotics with prebiotics are prescribed to stabilize the microbiocenosis in the intestine, where a favorable flora has already been created by enzymes.

Vitamin injection therapy is carried out, during which magnesium, zinc, and copper are introduced into the body. Surgical intervention is rare, so its use will depend entirely on the severity of atrophy, the degree of damage to the insular areas. After excision of the gland, a course of artificial enzymes is mandatory.

Prevention

It is difficult to predict the consequences of the development of atrophic processes. It all depends on the degree of damage to the external and internal secretory zones of the organ. Due to the partial preservation of the functions of the islet apparatus, insulin continues to be produced with a lack of glucagon. The risk of developing ketoacidosis in this case is minimal, but hypoglycemia occurs. Effective results are achieved in determining the etiology of the disease, selecting a way to eliminate it.

Main preventive measures:

• timely treatment of chronic and protracted ailments that can lead to atrophy of the pancreas;
• quitting smoking, alcohol;
• dieting;
• maintaining the required level of enzymatic activity;
• maintaining an active and healthy lifestyle.

Early diagnosis allows you to achieve the maximum effect of treatment.

Atrophic pancreatitis

Pancreatic atrophy - pathogenetic features of the disease, symptoms, diagnosis and treatment tactics.

Chronic pancreatitis can cause the development of pancreatic atrophy, as a result of which the pancreas is significantly reduced in volume, its glandular cells undergo pathological changes and over time, mostly during the period of remission, are replaced by growing connective tissue. With atrophic pancreatitis, the secretory function of the pancreas is suppressed, as a result, enzymes are produced in insufficient volume - trypsin, amidase, lipase, pancreatic juice. The activity of the islets of Langerhans, which produce the main hormone - insulin, which regulates the formation of glucose and carbohydrate metabolism in the body, on the contrary, increases. This process can lead to hyperinsulinemia.

Atrophy of the pancreas can affect all tissues of the organ, or a certain part of it. In medical practice, in most clinical cases, atrophic processes of the head and tail of the pancreas are recorded, while the tissues of the body of the organ are not subject to pathological changes. Previously, atrophic pancreatitis mainly affected the elderly. However, at present, due to mass obesity, excessive alcohol consumption, including beer, as well as smoking and a sedentary lifestyle, pancreatic atrophy is also diagnosed in relatively young people.

Reasons for the development of atrophic pancreatitis

The disease can develop as a result of exposure to the following pathogenic factors:

• fatty degeneration;
• body aging;
• consequences of diabetes;
• abuse of alcohol and tobacco;
• peptic ulcer of the duodenum or stomach;

The main preventive measure to prevent the development of atrophic pancreatitis is a healthy lifestyle, including a proper diet and diet, as well as a complete rejection of alcohol and smoking.

Symptoms of the disease

Pancreatic atrophy develops years after a patient is diagnosed with chronic pancreatitis. This type of disease is characterized by the following main symptoms:

• dyspeptic phenomena;
• vomiting, nausea, poor appetite;
• pale and dry skin;
• in the initial stage of the disease, obesity is possible, with the development of the disease - low weight;
• steatorrhea - excess fat in the feces;
• crimson or red color of the tongue;
• pain in the left hypochondrium of moderate intensity.

If the tail of the pancreas is affected by atrophic processes, symptoms characteristic of diabetes mellitus are observed, namely: frequent and profuse urination, itching of the skin, and a constant feeling of thirst.

The final phase of atrophic pancreatitis may be characterized by a decrease in the size of the pancreas, the tissues of which acquire a cartilaginous appearance, and the development of organ cirrhosis.

Treatment of atrophic pancreatitis

Primary therapeutic measures are aimed at subsiding the pain syndrome and stopping inflammatory processes in the pancreas. Further treatment is carried out against the background of diet therapy and complex drug therapy. A gastroenterologist treats atrophic pancreatitis in a specialized clinic. Only a doctor prescribes a therapeutic diet and a course of medications to the patient, taking into account his anamnesis, analysis of laboratory tests, individual characteristics of the organism and the clinical picture of the disease.

Significant for the effective treatment of pancreatic atrophy is the correct and timely diagnosis of concomitant diseases. For these purposes, doctors of other specializations, primarily endocrinologists, can be involved.

Reduction of pain syndrome is achieved through the appointment of antispasmodics and analgesics. To improve the functioning of the main pancreatic duct and relax the smooth muscles of the sphincters, drugs such as Papaverin, No-shpa, Odeston, Drotaverin are used.

After stopping the inflammation of the pancreas, the doctor performs detoxification procedures for the organs of the digestive and excretory systems. As a result, hydroionic and acid-base balance is achieved. As prescribed by a doctor, infusions and decoctions of medicinal herbs can be used as additional means to remove toxins from the body.

To restore the secretory function of the pancreas, therapy with enzyme preparations is carried out: Festal, Mezim, Creon, Ermital, Pancreatin. These medications are taken exclusively on prescription and under the supervision of the attending physician. The key to the effectiveness of treatment lies in the regularity of their intake, compliance with the dosage prescribed by the gastroenterologist.

In severe and very severe stages of atrophic pancreatitis, conservative therapy may be powerless. In this case, urgent surgical intervention is necessary.

Atrophy of the pancreas

Atrophy of the pancreas is a decrease in its volume, manifested by insufficiency of exocrine (production of digestive enzymes, bicarbonate) and intrasecretory (synthesis of insulin, glucagon) function. The most common causes of pathology are: chronic pancreatitis, diabetes mellitus, somatic diseases with severe malnutrition, as well as cirrhosis of the liver, impaired blood supply, tumor compression. Diagnosis is based on laboratory findings showing enzyme deficiency and low insulin levels, ultrasound of the pancreas confirming organ shrinkage and parenchymal changes, and biopsy results. Treatment consists in the appointment of replacement therapy: enzyme preparations, insulin; restoration of intestinal flora; correcting nutrient deficiencies.

Atrophy of the pancreas

Atrophy of the pancreas is a condition characterized by a decrease in the size of the organ, compaction of its structure and insufficiency of functions. This process can develop as a result of physiological age-related changes, as well as diseases accompanied by damage to the parenchyma, compression, impaired blood supply, and long-term debilitating diseases. At the same time, the weight of the gland, which is normally about 100, decreases to below. The structure of the pancreas changes, characterized by excessive development of connective tissue, which can proliferate around the lobules (perilobular sclerosis) or diffusely (intralobular sclerosis). A peculiar type of atrophy is lipomatosis, in which most of the parenchyma of the organ is replaced by adipose tissue.

Causes of pancreatic atrophy

This condition can be physiological, developing as a result of the natural aging processes of the body. It accompanies severe debilitating diseases (cachectic form). Also, atrophy is the outcome of all forms of chronic pancreatitis, while a significant part of the stroma is replaced by fibrous tissue, which is accompanied by the progression of endocrine and exocrine insufficiency.

A separate place is occupied by atrophy of the pancreas in diabetes mellitus. This pathology is accompanied by a significant decrease in the size of the gland - mastiff, the consistency is significantly compacted, the surface of the organ is bumpy, the capsule is fused with the surrounding adipose tissue, as well as neighboring organs. At the microscopic level, the lesion is characterized by diffuse proliferation of fibrous tissue (intraacinous sclerosis), death of cells of the glandular parenchyma.

Lipomatosis of the pancreas is also its atrophy. Despite the fact that this condition is characterized by the preservation or even increase in the size of the organ (pseudohypertrophy), most of it is replaced by adipose tissue, in which there are separate glandular areas. In most cases, with lipomatosis, the islet apparatus and the endocrine function of the organ are preserved. Rarer cases of the disease in gastroenterology include atrophy of the gland with cirrhosis of the liver, systemic scleroderma, tumor compression, blocking of the excretory ducts with stones.

Symptoms of pancreatic atrophy

The clinical picture of the disease is determined by the cause of its development (diabetes mellitus, chronic pancreatitis, and others). However, in any case, the characteristic symptoms are exocrine and endocrine insufficiency. Exocrine (exocrine) insufficiency of the gland is characterized by reduced production of digestive enzymes, as well as bicarbonates and other electrolytes, which neutralize the contents of the stomach, providing an environment favorable for the action of pancreatic enzymes. Typical symptoms are loose stools, loss of appetite, and weight loss.

An early symptom of insufficiency of exocrine function is steatorrhea (increased excretion of fats with feces). This symptom develops with a decrease in secretion by 10% of the norm. Weight loss occurs due to impaired digestion of food, absorption of substances in the intestine, loss of appetite. With a long-term pathology, signs of vitamin deficiency develop.

Endocrine (intrasecretory) insufficiency is manifested by disorders of carbohydrate metabolism, occurring according to the type of hyperglycemic syndrome. At the same time, only half of patients develop symptoms of diabetes mellitus. This is explained by the fact that insulin-producing cells have the ability to be better preserved in pathology in comparison with acinar ones. Deficiency of insulin and glucagon develops. The patient may be disturbed by severe weakness, dizziness, thirst.

Diagnosis of pancreatic atrophy

The examination determines the lack of body weight. The skin is dry, flaky. With a decrease in the size of the gland, it is not possible to palpate it. If pancreatitis has become the cause of the condition, pain may be felt on probing. When conducting biochemical blood tests, a decrease in the activity of pancreatic enzymes is determined. The characteristic symptoms are steatorrhea (detection in feces of more than 9% of fats from daily intake) and creatorrhoea (high content of muscle fibers in feces) detected during the coprogram. Often, an increase in blood glucose levels is diagnosed, which is the reason for consulting an endocrinologist or diabetologist.

With ultrasound of the pancreas, a decrease in its size, compaction of the structure, increased echogenicity, uneven contours are determined. For a more detailed visualization of the organ, to determine the cause of atrophy, an MRI of the pancreas is performed. In order to assess the state of the ductal system, changes in which are characteristic of chronic pancreatitis, ERCP is shown - endoscopic retrograde cholangiopancreatography (contrast X-ray examination). With its help, you can identify the narrowing of the main pancreatic duct, uneven walls, tortuosity. Angiography is performed to rule out neoplasms of the pancreas.

An important diagnostic method is a biopsy of the pancreas. When examining a biopsy, the degree of fibrosis and destruction of the parenchyma, the degree of damage to the glandular elements, the islets of Langerhans (insulin-producing zones) are assessed. In the case of lipomatosis, fatty degeneration of the organ is detected. A biopsy allows you to assess the prognosis of the disease.

Treatment of pancreatic atrophy

With atrophy of the pancreas, diet therapy is mandatory. Food should be low in fat. Sufficient attention should be paid to protein-energy deficiency, correction of hypovitaminosis. A mandatory measure is the complete cessation of smoking, since nicotine disrupts the production of bicarbonates by the pancreas, as a result of which the acidity of the contents of the duodenum increases significantly.

The main direction of therapy for this pathology is the replacement of exocrine and endocrine secretion of the pancreas. To compensate for disturbed processes of abdominal digestion, the gastroenterologist prescribes enzyme preparations. To achieve a clinical effect, drugs must have high lipase activity, be resistant to the action of gastric juice, provide rapid release of enzymes in the small intestine, and actively promote abdominal digestion. Enzymes in the form of microgranules meet these requirements. Since it is lipase of all pancreas enzymes that loses activity most quickly, the correction is made taking into account its concentration in the preparation and the severity of steatorrhea. The effectiveness of treatment is assessed by the content of elastase in the feces and the degree of reduction of steatorrhea. The action of enzyme preparations is also aimed at eliminating pain, reducing secondary enteritis, creating conditions for the normalization of intestinal microbiocenosis, and improving carbohydrate metabolism.

Correction of endocrine insufficiency is carried out by insulin therapy. With atrophy of the pancreas, the islets of Langerhans are partially preserved, so insulin is produced in the body, but in small quantities. The dosage and regimen of insulin administration are determined individually depending on the course of the pathology, the etiological factor, and the data of daily monitoring of blood glucose. The appointment of enzyme preparations significantly improves the function of the pancreas in general and carbohydrate metabolism as well. Therefore, the regimen of insulin therapy is determined depending on the dosage and effectiveness of enzyme replacement therapy.

An important condition for the effective correction of digestive functions is the normalization of intestinal microbiocenosis, since favorable conditions are created for the colonization of pathogenic flora against the background of enzyme intake. Probiotics and prebiotics are used. Be sure to prescribe vitamin therapy by injection, as well as preparations of magnesium, zinc, copper.

Surgical treatment of this pathology is carried out in specialized centers. Transplantation of the islets of Langerhans is carried out, followed by removal of the gland and enzyme replacement therapy. However, since atrophy is often the result of serious diseases with a pronounced violation of the general condition of the patient, such treatment is rarely performed.

Forecast and prevention of pancreatic atrophy

The prognosis for this pathology is determined by the degree of damage to the exocrine and endocrine structures of the organ. Since the islet apparatus is partially preserved, there is also residual insulin synthesis. In view of this, ketoacidosis rarely develops, but hypoglycemic conditions often occur. Determination of the etiology of the disease, elimination of the underlying pathology, timely initiation of treatment can achieve good results.

Prevention consists in the timely treatment of diseases that can cause atrophy of the pancreas. In the presence of chronic pancreatitis, a complete rejection of alcohol, diet, maintenance of a sufficient level of enzymatic activity of the gland is mandatory.

Atrophy of the pancreas

A prolonged course of chronic pancreatitis can provoke atrophic changes in the pancreas, which will result in a significant decrease in the volume of the affected organ and a decrease in the level of its functionality. The glandular structures of the organ begin to undergo a pathogenic effect aimed at replacing them with connective tissues that grow in the cavity of the gland. Chronic atrophic pancreatitis is formed. In the presented material, we will take a closer look at what pancreatic atrophy is, the causes and symptoms of its occurrence, how it is diagnosed and treated, and also how dangerous this pathology is and possible preventive measures.

What is atrophic pancreatitis

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Atrophic pancreatitis is a pathology in which atrophy of all tissue structures of the gland develops or a partial form of organ damage.

Local atrophy of the pancreas often affects the tail and head of the organ, and the body of the gland remains intact. Under the influence of atrophic processes in the cavity of the affected tissue structures of the gland, their functionality is completely terminated, and the gland is also compacted and increases in volume.

The development of pancreatic atrophy in humans is characterized by the development of its edema, pathologically altered circulatory processes, the occurrence of hemorrhages, cystic lesions and the development of necrotic lesions of the fatty type.

The development of atrophic processes originates from the moment of formation of the connective tissue and its further distribution in the area of ​​the vessels of the gland with an intralobular nature of the lesion, which over time and a large spread of connective tissues is transformed into an interlobular one.

But, another clinic of pathology can also be observed, in which atrophic processes immediately acquire an interlobular form of development, after which, during the progression of the disease, they spread to deeper structures of the gland, which is a consequence of the almost complete atrophy of the parenchyma of the gland. But, at the same time, hypertrophy of the islets of Langerhans, secreting the hormone insulin, is observed, which leads to the development of hyperinsuclinemia.

It should be noted that atrophic processes in the pancreatic cavity can be of a partial nature of the lesion, which usually occurs against the background of ulcerative lesions of the duodenum and gastric cavity.

The last stages of pancreatic hypotrophy in an adult contribute to:

• reduction of the affected organ in size;
• transformation of tissue structures of glandular etiology into cartilaginous tissues;
• as well as cirrhosis.

With the alcoholic etiology of pancreatitis, the formation of calcifications can occur, which are deposited in the gland in the form of stones, ensuring complete blockage of the pancreatic ducts, ensuring complete blocking of their functionality and the performance of the gland.

Reasons for the development of the disease

The reasons for the development of this disease may be the presence of the following factors in human life:

• the formation of fatty type dystrophy;
• old age;
• due to complications of a pathology such as diabetes mellitus;
• excessive smoking and alcohol abuse;
• ulcerative lesions of the duodenum and stomach cavity;
• pancreatic lesion of the gland of a chronic type, with alcoholic etiology;
• chaotic diet with excessive consumption of fried foods, as well as foods with high levels of fat, salt and spiciness;
• canned and smoked meats can also lead to this type of disease;
• autoimmune diseases in the abdominal cavity.

Among other things, the development of atrophic processes in the gland may be due to a complication after resection of this organ.

Factors and risk groups

1. hereditary factor.
2. The development of alcoholism.
3. Traumatization of the abdominal cavity.
4. Infectious lesions of internal organs.
5. Progressive stage of calculous cholecystitis.

Symptoms of pathology

The duration of the development of atrophic processes can reach 12 years after the diagnosis, indicating the presence of a chronic form of pancreatic pathology. This type of disease has the following symptomatic features:

• pathological dysfunction of the dyspeptic organ system;
• loss of appetite;
• feelings of nausea leading to vomiting;
• pallor and dryness of the skin;
• the formation of steatorrhea, characterized as an excessive concentration of fats in the feces;
• the surface of the tongue acquires a red or rich crimson hue;
• the appearance of moderate pain in the hypochondrium, mainly on the left side.

With the development of atrophic processes in the region of the tail of the gland, symptoms appear that are inherent in the development of such a pathology as diabetes mellitus, characterized by frequent urges and processes of urination, the appearance of thirst and itching.

Diagnostics

Diagnostic procedures begin with a visual examination of the patient and a palpation examination of the abdominal cavity. With atrophy of the gland, it is rather difficult to detect it by palpation, which contributes to the formation of painful sensations in the patient.

After collecting a complete history of the patient and his hereditary predisposition, the attending physician prescribes laboratory and differential diagnostics to distinguish between atrophic lesions of the gland and the development of diabetes mellitus, calculous cholecystitis and other pathologies related to the digestive system of organs.

Laboratory diagnostics

Blood tests are prescribed to determine the level of pancreatic enzyme, the degree of anemia, and the concentration of glucose.

Conducting a coprological study will allow you to examine the structure of feces for the concentration of organic fats in them.

Ultrasound diagnostics is also prescribed, which allows to detect the level of reduction of the gland in size, as well as the presence of compaction in the cavity of the organ, the level of sclerosis and the unevenness of its contour outlines.

To assess in more detail the degree of damage to the gland and the spread of atrophic processes, MRI, biopsy and contrast X-ray examination will help.

Differential Diagnosis

The differential diagnosis is initially carried out with functional pathologies of the gland itself, the etiology of which may be the development of an acinar tumor, a sclerotic process, and neuroses and viscero-visceral reflexes from other affected organs of the digestive system are also taken into account, for example, with the development of gastritis.

The final diagnosis is made on the basis of a complete clinical picture of the development of the disease, taking into account all diagnostic procedures and anamnesis during the initial examination of the patient.

Treatment Methods

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An important role in the treatment of pathology is occupied by the patient's diet, adherence to the rules of a healthy lifestyle, in which there are no factors such as alcohol, tobacco products and overeating.

The treatment regimen completely depends on the degree of damage to the parenchymal organ, the symptoms and age of the patient, since even a child can undergo the development of this pathology.

Treatment of atrophic processes consists in general therapy and the elimination of adverse factors. The goal of treatment is to:

• elimination of the painful syndrome, through the use of a macropreparation of analgesic and antispasmodic spectrum of action, in the form of No-shpa, Papaverine, and so on;
• cleansing the body of harmful toxins and toxins through a special diet with table number 5;
• normalization of hydroionic and acid-base balance.

A necessary aspect of treatment is insulin therapy, which is necessary to correct the endocrine functionality of the gland.

It is also prescribed to take enzymatic preparations in the form of pancreatitis or festal, as a general strengthening therapy, it is necessary to take micropreparations that include vitamin complexes of groups B, A, P, PP and mineral microelements.

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In the absence of the desired effect of conservative treatment and exacerbation of the pathology, surgical intervention is prescribed.

Possible Complications

In the absence of appropriate treatment, atrophy of the gland can lead to the development of pancreatic necrosis, characterized by the death of sections of the gland and the subsequent development of purulent complications, in the form of sepsis, phlegmon, abscess.

Prognosis and prevention of the disease

The prognosis of the pathology depends on how much the tissue structures of the gland have time to atrophy during the period of progression of the disease. Even with partial preservation of the islet apparatus and insulin secretion, provided that the pathology is treated in a timely manner, it is possible to cure atrophy and restore the functionality of the affected organ as much as possible.

Preventive methods include:

• in the use of folk remedies, such as decoctions, teas and infusions based on medicinal herbs that help maintain the functionality of the pancreas;
• exclusion of bad habits in the form of alcohol and cigarettes;
• in following a diet, which consists in the regular use of various cereals from millet, as well as buckwheat, corn, etc .;
• in maintaining life activity.

It is also necessary to remember that when the first uncomfortable sensations appear in the epigastric region, it is necessary to immediately seek medical help for timely diagnosis and the appointment of optimal treatment, which can be carried out at home in the early stages.

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concept "Healthy lifestyle"(HLS) appeared quite recently, in the 70s of the last century. Interest in this topic is associated with a significant increase in life expectancy, changes in the environment and the person himself. Modern man began to move less, consume more food, be subjected to constant stress and have more free time. The number of diseases, the predisposition to which is inherited, is revealed every year more and more. How about this stay healthy and live a long active a life?

Genetics, ecology, stress undoubtedly affect a person's well-being, but decisive role here plays a lifestyle. What is meant by healthy lifestyle about which there is so much talk now?

It should immediately be noted that a clear definition of this concept has not yet been formulated. It can be said that this human activities to improve their health and prevent various diseases. Healthy lifestyle is a prerequisite and foundation for success in all spheres of human existence. The German philosopher A.Shopegrauer wrote: “Nine-tenths of our happiness is based on health. With it, everything becomes a source of pleasure, while without it absolutely no external benefits can give pleasure, even subjective benefits: the qualities of the mind, soul, temperament weaken and die in a diseased state. that we, first of all, ask each other about health and wish it to each other: it is truly the main condition for human happiness.

So what makes up a healthy lifestyle?

One of the most important components is physical activity. Various achievements of scientific and technological progress have greatly facilitated the life of modern man. But at the same time, we began to move less and less. To maintain health, you need to exercise at least 30 minutes a day. What exactly to do depends on your desire, opportunities, preparation, temperament. You can even start with just walking after work. The main thing to remember: Movement is life!

Balanced diet equally important in maintaining health. Short "hungry" diets and plentiful feasts between them are not for those people who have chosen a healthy lifestyle for themselves. Nutrition should provide the body with everything necessary and meet the needs of a particular person. A lot has been written and said about proper nutrition, and its basic rules are known to everyone: more vegetables and fruits, less fat and sweets, if possible, eat natural and environmentally friendly products. In addition, it is preferable to eat small meals every 3-4 hours.

Proper daily routine and healthy sleep. In order to lead an active life and achieve success, it is necessary to restore strength in time. Full sound sleep is one of the most important conditions for good health. It is advisable to go to bed at the same time and sleep at least 6-7 hours. Before going to bed, it’s good to take a short walk or at least ventilate the room well.

Rejection of bad habits. Smoking and alcohol significantly shorten a person's life expectancy. Therefore, a healthy lifestyle is simply incompatible with them.

hardening. This is not necessarily swimming in the hole or pouring cold water on the snow. A contrast shower will bring no less benefit, while the temperature difference may be small at the beginning. Hardening not only strengthens the immune system, but also trains blood vessels, the autonomic nervous system and raises the overall vitality.

The physiological state of a person is greatly influenced by his psycho-emotional state. Therefore, a healthy lifestyle also applies ability to deal with stress, optimism, interest in new, the ability to establish close relationships, positive thinking, active intellectual activity, creativity and self-realization.

No matter how perfect medicine is, it cannot rid everyone of all diseases. Man is the creator of his own health, for which sometimes you even have to fight. Human health is more than 50% determined by his lifestyle. Health is life itself with its joys, anxieties, creative ups and downs.

Starting a healthy lifestyle is easy: even small steps in this direction give certain results. Therefore, why not today, for example, take a walk from work on foot? The main thing is to start taking concrete actions, and the result will not be long in coming. It is known that if all people on the planet led a healthy lifestyle, then average human life expectancy would increase up to 100 years. It's worth the effort, isn't it?

A healthy lifestyle helps us fulfill our goals and objectives, successfully implement our plans, cope with difficulties, and, if necessary, with colossal overloads. Good health, maintained and strengthened by the person himself, will allow him to live a long and full of joys life. In this article, you will learn how to properly treat your body and keep it in good shape. To a certain extent, these tips will suit every conscious person who decides to take the path of recovery and put his life in order. If you have useful experience in this area, feel free to share your tips in the comments, take part in the discussion. The article contains links to other useful materials that talk about proper nutrition, the benefits of vegetables and fruits, as well as about sports and their importance.

Health is an invaluable wealth of each person individually, and of the whole society as a whole. When meeting and parting with people close to us, we always wish them good health, because this is the main condition for a full and happy life. In our country, more than 30 million people annually suffer from ARVI and the seasonal virus. The reason for this is that more than 80% of the population has a weak immune system. In order for the immune system to work like clockwork, it must be maintained daily, and not just during flu epidemics! How to recharge your immunity? The answer is simple - lead

A person's immunity is the ability of his body to defend itself against various "enemies", i.e. foreign genetic information. On the one hand, the immune system protects the body, and on the other hand, its condition depends on the general health of a person. If the individual is active, strong, mobile, and cheerful, then his immunity will be in order, and if he is weak and passive, then the immune system will be appropriate

The immune system protects us from the influence of external negative factors, it is a kind of line of defense against the negative effects of bacteria, fungi, viruses and the like. Without a healthy and effective immune system, the body becomes weak and more likely to suffer from various infections.

The immune system also protects the body from its own cells with a disturbed organization that have lost their normal properties. It detects and destroys such cells, which are possible sources of cancer. It is well known that vitamins are necessary for the formation of immune cells, antibodies and signaling substances involved in the immune response. One of the main aspects of a healthy lifestyle is

In addition to proper nutrition, here are fifteen more great ways to charge your immunity, live healthy and live healthy!

1. Go in for sports.

Physical activity improves the general condition of the body and the functioning of the lymphatic system, which removes toxins from the body. According to studies, people who exercise regularly are 25% less likely to get a cold than those who do not lead a healthy lifestyle. However, don't be too zealous. Just 30-60 minutes of exercise a day allows you to become healthier, while more strenuous exercise will make you weaker. Be sure to include push-ups in your program - they contribute to better lung and heart function. Be sure to do exercises on the press - this will improve the functioning of the gastrointestinal tract and the genitourinary system.

Daily - a mandatory minimum of physical activity per day. It is necessary to make it the same habit as washing your face in the morning.

Jennifer Cassetta, a martial arts instructor from New York, says she never gets sick. “I believe that a global approach to exercise calms the mind and helps to release stress,” says Jeniffer. “And cardio, strength training in general helps boost the immune system.” According to Cassette, her health has changed dramatically since she started practicing martial arts eight years ago. Before that, she was a smoking girl who ate late in the evenings and drank a lot of coffee in the mornings. In my 20s...

2. More vitamins

We all need vitamin D, which is found in salmon, eggs and milk. Research has shown that many people don't get enough vitamin C, says Elizabeth Polity, director of nutrition at the Duke Diet & Fitness Center. Citrus fruits are a great source of vitamin C. “It's a myth that vitamin C prevents colds,” she says. “But getting the right amount of vitamin C from fruits and vegetables energizes the immune system.”

Zinc is also very important for strengthening the immune system - it has an antiviral and antitoxic effect. You can get it from seafood, from unrefined grains and brewer's yeast. In addition, drink tomato juice - it contains a large amount of vitamin A.

3. Temper yourself!

Hardening of the body can become your assistant in maintaining a healthy lifestyle. It is best to start from childhood. The easiest way to harden - air baths. Water procedures also play a huge role in the hardening process - strengthening the nervous system, favorably affecting the heart and blood vessels, normalizing blood pressure and metabolism. First of all, it is recommended to rub the body with a dry towel for several days, and later move on to wet rubdowns. You need to start wiping yourself with warm water (35-36 C), gradually moving to cool water, and then to dousing. In summer, it is better to take water procedures in the fresh air after charging.

4. Eat protein

Protective factors of immunity - antibodies (immunoglobulins) - are built from protein. If you eat little meat, fish, eggs, dairy products, nuts, then they simply cannot be formed.

5. Drink tea.

Just 5 cups of hot tea a day will significantly strengthen your body. From ordinary black tea, L-theanine is released, which is broken down by the liver to ethylamine, a substance that increases the activity of blood cells responsible for the body's immunity. It should be noted that all this applies only to high-quality varieties of tea.

6. Have fun!

According to research, people who have a positive emotional style are happy, calm and enthusiastic, and are also less prone to colds. Fun and a healthy lifestyle are inseparable from each other

Cohen and researchers at Carnegie Mellon University interviewed 193 healthy people for two weeks daily and recorded information about the positive and negative emotions they experienced. After that, they exposed the “guinea pigs” to cold and flu viruses. Those who experienced positive emotions had few cold symptoms and greater resistance to developing diseases.

7. Meditate

Santa Monica, a yoga therapist, believes in her meditation to improve her physical and emotional health. “Meditation helps calm my nervous system and allows my immune system to function with less interference,” she says. "A calm mind, a calm body." “The greatest change is peace of mind and a sense of relief,” says Santa. “I got sick a lot when I was young. My sleep has improved, and it has become easier for me to cope with constant stress.” In a study published in the journal Psychosomatic Medicine in 2003, researchers found that volunteers who participated in meditation training for eight weeks had significantly higher flu antibodies than those who did not meditate.

8. Do not be nervous!

Prolonged stress causes a powerful blow to the immune system. By increasing the level of negative hormones, it suppresses the release of hormones that help maintain health. By learning how to deal with stress, you will stop the flow of excess hormones that just make you fat, irritable and forgetful.

9. Move away from depression

Apathy and indifference are one of the main enemies of strong immunity. American scientists have found that women suffering from depression experience changes in the functioning of the immune system, and they are more susceptible to viral diseases than those who enjoy life.

10. Minimum alcohol

According to numerous studies, alcohol stops the work of white blood cells that identify and destroy infectious cells and viruses themselves. Remember that alcohol and a healthy lifestyle are incompatible

11. Sleep

A good night's sleep strengthens the immune system. The fact is that during a night's sleep, the level of melatonin increases, which improves the functioning of the immune system.

12. Wash your hands!

When you wash your hands, do it twice. When scientists at Columbia University studied this problem in volunteers, they found that washing their hands once had little to no effect, even if people used antibacterial soap. So wash your hands twice in a row if you want to ward off a cold.

13. Go to the sauna

Go to the sauna once a week. What for? Because, according to a 1990 Austrian study, volunteers who went to the sauna often had half as much cold as those who didn't go to the sauna at all. Most likely, the hot air inhaled by a person destroys the cold virus. Most gyms already have their own saunas.

14. Gifts of nature

Natural remedies that strengthen the immune system are: echinacea, ginseng and lemongrass. Taking herbal decoctions is worth both for therapeutic purposes and for prevention.

15. Probiotics

It is useful to eat foods that increase the number of beneficial bacteria in the body. They are called probiotics and include onions and leeks, garlic, artichokes and bananas.

If you want to be healthy, lead a healthy lifestyle. Your new motto: no more lying on the couch, more exercise and fresh air! Stress is the main enemy of immunity, drive away all sorts of experiences and be less nervous. Try to get as many positive emotions as possible and take care of proper nutrition. Go ahead and good luck!!!