How is acute pancreatitis different from chronic?

Pancreatitis is a group of diseases and clinical manifestations, against which inflammatory processes in the pancreas are observed. The main "victims" of pathology include people who abuse fatty foods, alcoholic beverages.

Experimentally proved that the acute form of the disease develops due to the influence of harmful factors. The pathophysiology is represented by mechanical or chemical injury of the pancreas, arising from the damaging agent — salt crystals, bile, a hypertonic solution, and other substances entering the tissues of the internal organ.

Statistics indicate that the inflammatory process is most often diagnosed in women than in men. Patients with a history of gastrointestinal disease, overweight are susceptible to the disease.

Consider the classification and types of pancreatitis, as well as find out the difference between acute pancreatitis and chronic inflammation.

Classification of pancreatitis

The mechanism of development of pancreatitis is based on increasing the load in the ducts, and the enzymes, entering the tissues of the internal organ, stimulate the process of destruction. If severe pancreatitis is observed (in this case we are talking about tissue necrosis), then the disease is accompanied by the death of a significant part of the pancreas.

Ignoring the symptoms and the lack of adequate therapy leads to subsequent necrosis of the fatty tissue surrounding the pancreas, as a result, the pathological process spreads to other organs localized in the peritoneal region.

If digestive enzymes enter the abdominal cavity, peritonitis may develop. In this condition, the lack of therapy leads to an unfavorable prognosis - a lethal outcome.

In medical practice, isolated types and forms of pancreatitis. Depending on the nature of the course of the pathological process, the disease is acute, acute recurrent, subacute, chronic and exacerbation of the chronic type.

Forms of acute pancreatitis:

  • Interstitial form is characterized by swelling of the pancreas;
  • Hemorrhagic appearance proceeds against the background of hemorrhage in the gland;
  • Acute pancreatic necrosis is accompanied by a thickening of the internal organ, the centers of tissue breakdown are formed.

In some pictures, acute chronic pancreatitis occurs along with an acute inflammatory process in the gallbladder - in this case cholecystopancreatitis is diagnosed. The purulent form is characterized by the formation of pus in the area of ​​the pancreas.

Any form of acute pancreatitis tends to transform, so it can move from one to another. For example, the hemorrhagic type can be transformed into tissue necrosis with the subsequent formation of purulent masses.

Acute pancreatitis leads to various complications - abscesses, multiple hemorrhages, fibrosis, tissue atrophy, etc. If there are complications, the prognosis can be unfavorable, even if adequate medical treatment is carried out.

Chronic pancreatitis refers to inflammation that progresses relatively slowly. As a result, there is fibrosis of soft tissues or calcification of the tissues of the pancreas. Against this background, remission gives way to aggravation. Patients often develop diabetes.

Chronic form is divided into the following types of pathological process:

  1. Asymptomatic (latent) type is characterized by a relatively normal state of health of the patient for a long period of time.
  2. Pain is accompanied by constant pain in the abdomen, which increases significantly during the period of exacerbation of the disease.
  3. Recurrent view. Pain syndrome occurs solely against the background of exacerbation of the disease.

This kind of chronic form as cystic pancreatitis occurs along with the formation of cysts. They are true (extremely rarely diagnosed) and false (found in most clinical pictures).

The diagnosis of reactive pancreatitis implies an acute course of the inflammatory process, combined with exacerbation of diseases of the duodenum 12, liver, and organs of the gastrointestinal tract.

Symptoms of acute pancreatitis

The pancreas is a small body that performs the most important functions in the human body. This includes the production of digestive enzymes, which ensures a normal and complete digestive process. As well as the production of insulin, the lack of which leads to the development of diabetes.

The difference between the chronic and acute types of the disease is that in the latter case, clinical manifestations of the disease are extremely pronounced against the background of an attack. The patient complains of the strongest and persistent pain syndrome, painkillers do not help to stop the pain.

The mechanism of development of an acute attack is due to the delay of enzymes in the pancreas and the ducts of the internal organ, which leads to destruction of the gland itself. When they enter the circulatory system, symptoms of body poisoning manifest.

In addition to the patient's pain, the following symptoms are observed:

  • High temperature conditions of the body, low or high blood pressure. With the rapid development of inflammation, the patient's condition deteriorates rapidly, the temperature can rise to 40 degrees, lability of arterial parameters is noted;
  • The patient has sharpened facial features, pale skin. In the absence of assistance, the skin color becomes gray and sallow. The skin is cold to the touch, covered in sticky sweat;
  • An attack of nausea, hiccups, vomiting. Often these symptoms are accompanied by dryness in the mouth, belching. Vomiting does not bring relief; there is bile / lumps of undigested food in the vomit;
  • Lack of appetite. Eating provokes indomitable vomiting. At the onset of the acute phase of the disease there can be no talk of food, since the main condition for easing the patient’s well-being is fasting;
  • Disruption of the digestive tract, manifested by frequent and loose stools or prolonged constipation. On the background of pancreatitis, fecal masses in most of the paintings are liquid, with admixture of foam, there are particles of undigested food;
  • Dyspnea develops due to loss of electrolytes during vomiting. Additionally, increased sweating is manifested, there is a rich bloom of yellow color in the human tongue.

Other symptoms of an acute attack include bloating, increased flatulence, cyanosis of the skin, yellowness of the sclera. With such signs the score goes on for minutes, immediate medical help is required.

Treatment of acute pancreatitis

Acute and chronic pancreatitis have certain differences not only in the severity of symptoms, but also in treatment. The difference lies in the fact that an acute attack should be stopped in stationary conditions, otherwise the consequences can be fatal.

First aid to the patient is provided at home before the arrival of medical specialists. To relieve pain on the abdomen put cold. Allowed the use of antispasmodic drugs, for example, papaverine. Be sure to refuse any food.

The basis of successful therapy is hunger, peace and cold. It is not recommended to engage in self-treatment, since there is a high probability of developing various complications of the disease.

Emergency assistance upon arrival of the medical team consists of the following actions:

  1. The introduction of the dropper with saline.
  2. Antiemetic medicine, for example, Reglan at a dosage of 10 mg.
  3. Injection of anesthetic drug - Ketanov.
  4. Prick antisecretory drugs in a dosage of 250 mg.

The patient must be hospitalized. As a rule, in the case of an acute attack, differential diagnosis is not carried out, since it is quite simple to distinguish it from other diseases. If there is a suspected destructive type of pancreatitis, surgery is required. Further treatment is carried out in the department of surgery.

The indications for a laparoscopic procedure are suspected abdominal fluid or symptoms of peritonitis. This manipulation can be carried out in order to clarify the complications of an acute attack.

Treatment of pancreatitis in the hospital includes:

  • Use of diuretic drugs to prevent swelling of the internal organ and remove digestive enzymes from the blood. Assign Furosemide or Diakarb (tablet form);
  • Recommend the drug Omez at a dosage of 80 mg per day;
  • If vomiting is present, intravenous administration of metoclopramide is recommended;
  • In the acute period of the inflammatory process, inhibitors of digestive enzymes must be prescribed. Representatives of the group - Gordox, Kontrikal.

Approximately 3-6 days the patient is prescribed hunger and drink warm water. In severe illness, fasting lasts 7-14 days.

In the latter case, parenteral nutrition is required - the introduction of protein hydrolysates and fat emulsions.

Features of chronic pancreatitis

In the chronic form of the disease, structural changes in the pancreatic tissues are revealed. Most medical specialists believe that the main difference between CP and an acute attack is the progression of pathological changes in the organ even after the removal of the source factor.

Against the background of a sluggish inflammatory process, exocrine and intrasecretory organ failure is often diagnosed.

Several periods are distinguished in the development of the chronic form of the disease. The early can last for years, sometimes manifests itself as characteristic signs, and the period when the disturbances are accompanied by an intensive clinic that significantly reduces the patient’s quality of life.

Signs of chronic inflammation are intense and mild. Usually during exacerbation, clinical manifestations are observed, which manifest themselves during an acute attack of the disease.

The patient is advised to constantly follow a certain diet, drink medicines for pancreatic secretory insufficiency, antispasmodic drugs. Recommended spa treatment twice a year.

The most difficult item treatment is diet. Not every patient can refuse their favorite delicacies and dishes. Principles of nutrition:

  1. Fractional meals in small portions up to 6-7 times per day. You can eat up to 230 g of food at a time.
  2. Refusal from fat, sharp, salty and spicy food.
  3. Refusal / Restriction of Spirits.

Errors in nutrition are manifested by pain. It is worth a little to eat the forbidden product, as after a few hours there are painful sensations in the stomach. To relieve pain, use medications:

  • Drotaverinum - an antispasmodic that helps to stop inflammation in the pancreas, respectively, decreases pain syndrome;
  • Sparex - antispasmodic, characterized by myotropic action. Stops spasms in the gastrointestinal tract;
  • When edematous form, you can assign Omez 1 tablet for three days. Reception is carried out only by short courses and as prescribed by the treating doctor.

With a long course of the disease, the normal tissues of the pancreas are replaced by fatty and connective layers, which provokes the loss of the functionality of the internal organ, as a result, diabetes mellitus develops, the full digestive process is disturbed.

To alleviate the pain and reduce the load from the damaged organ, the use of digestive enzymes is required. Prescribe medicines:

  1. Pancreatin.
  2. Festal.
  3. Panzinorm.
  4. Mezim and others

The measures of prevention of acute and chronic disease include proper and regular diet. It is recommended to limit the consumption of alcoholic beverages, especially in combination with fatty foods.

About chronic and acute pancreatitis described in the video in this article.

Watch the video: Acute and Chronic Pancreatitis. O. Joe Hines, MD. UCLA Digestive Diseases (April 2020).