Chronic pancreatitis refers to a pathological process of chronic progressive inflammation, destruction, and fibrosis of pancreatic acini and ducts, often accompanied by calcification, pseudocysts, and a decrease or atrophy of islet cells. Clinically, there are two types: chronic recurrent pancreatitis and chronic persistent pancreatitis. The main symptoms include recurrent or persistent abdominal pain, weight loss, diarrhea, or steatorrhea, and in the later stage, abdominal cystic masses, jaundice, and diabetes may occur.
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Chronic pancreatitis
- Table of Contents
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1. What are the causes of chronic pancreatitis?
2. What complications can chronic pancreatitis easily lead to?
3. What are the typical symptoms of chronic pancreatitis?
4. How to Prevent Chronic Pancreatitis?
5. What Laboratory Tests Should Be Performed for Chronic Pancreatitis?
6. Diet Restrictions for Chronic Pancreatitis Patients
7. Routine Methods of Western Medicine for the Treatment of Chronic Pancreatitis
1. What are the causes of chronic pancreatitis?
The causes of chronic pancreatitis are various, mainly related to biliary tract diseases or excessive alcohol consumption.
(1) Obstructive Factors.It is more common in Europe, Asia, and China. The most common cause of obstruction is gallstones. The reasons for the obstruction of the ampulla of Vater include gallstones passing through or lodging in the ampulla of Vater, ascariasis, edema of the duodenal papilla, spasm of the ampulla sphincter, stenosis of the ampulla, and obstruction of the common bile duct and pancreatic duct, leading to bile reflux into the pancreatic duct, causing pancreatic parenchymal injury induced by bile. Pure pancreatic duct obstruction is also sufficient to cause pancreatic damage.
(2) Chronic Alcoholism.Alcohol and its metabolites directly increase the secretion of lipoproteinase in pancreatic juice and the degradation of lipase; they also allow lipoproteinase to mix with pancreatic juice, activating trypsinogen to trypsin, leading to tissue damage.
(3) Other.① Hereditary Pancreatitis: Hereditary chronic pancreatitis accounts for 1%-2% of the total incidence of chronic pancreatitis, with an early onset age, generally before the age of 20, with obvious pancreatic calcification; ② Metabolic Factors: Both hypercalcemia and hyperlipidemia can lead to chronic pancreatitis; ② Chronic pancreatitis related to immune diseases: Systemic lupus erythematosus, Sjögren's syndrome, primary biliary cholangitis, and primary biliary cirrhosis can all be associated with chronic pancreatitis.
2. What complications can chronic pancreatitis easily lead to?
First, Gastric Ulcer It can reach up to 10-15%, caused by a decrease in the secretion of bicarbonate by the pancreas.
Second, Pancreatic Origin of Peritoneal, Pericardial, and Pleural Effusions - Abdominal effusions are more common, showing exudative characteristics with increased amylase concentration.This is caused by the leakage of fluid from the pseudocyst or dilated pancreatic duct into the peritoneal cavity.
Third, Formation of Splenic Vein Thrombosis Due to pancreatic fibrosis or compression by pseudocysts on the blood vessels, there can be splenic vein thrombosis, splenomegaly, and other conditions. Thrombosis can extend to the portal vein, causing varicose veins and gastrointestinal bleeding.
Fourth, Pseudocysts After the large pancreatic duct is blocked by pancreatitis, the small ducts and acinar lumens can dilate, leading to the accumulation of pancreatic juice, atrophy of epithelial cells, and the formation of pseudocysts. Alternatively, due to the destruction of the ducts, the secretion of pancreatic juice is obstructed, and the pancreatic juice along with inflammatory exudates is encapsulated by the peritoneum, serosa, or mesentery around it. Pseudocysts can occur within the pancreatic parenchyma or on the surface of the pancreas, mainly presenting as abdominal pain, low fever, an upper abdominal mass, and a few cases with jaundice. Ultrasound can diagnose cysts with a diameter of more than 2-3 centimeters.
Fifth, Pancreatic Cancer Extremely few cases of chronic pancreatitis can undergo malignant transformation.
3. What are the typical symptoms of chronic pancreatitis?
Chronic pancreatitis can present with varying degrees of symptoms. Some patients may show no clinical symptoms, while others may exhibit a variety of obvious clinical manifestations.
1. Abdominal pain Up to 90% of patients have varying degrees of abdominal pain, which occurs once every few months or years and is persistent in nature. The pain is usually located in the upper middle abdomen, presenting as dull or hidden pain. It can also be on the left or right side and often radiates to the back. The pain site is consistent with the inflammation site. According to experiments, when the head of the pancreas is stimulated, pain occurs in the upper right abdomen, and when the tail of the pancreas is stimulated, pain occurs in the upper left abdomen. In addition to radiating to the back, pain can also disperse to the lower chest, renal area, and testicles. If the diaphragm is involved, there may be shoulder radiation pain. The pain is persistent and deep-seated. Mild cases may only have a sense of pressure or heat. Drinking, high-fat, and high-protein diets can trigger symptoms, and severe pain may be accompanied by nausea and vomiting. Abdominal pain in these patients often has characteristic postural features. Patients prefer to curl up in a lying or sitting position or lean forward, and abdominal pain worsens when lying flat or standing up.
2. Diarrhea Mild patients may not have diarrhea symptoms, but severe patients with excessive acinar destruction and reduced secretion may show symptoms. The symptoms are bloating and diarrhea, with 3 to 4 bowel movements a day, large in amount, pale in color, with a shiny and bubbly surface, foul odor, and often acidic. Due to the obstruction of fat digestion and absorption, the amount of fat in the stool increases. In addition, there may be undigested muscle fibers in the stool. Due to the loss of a large amount of fat and protein, patients may show symptoms such as weight loss, fatigue, and malnutrition.
3. Other Symptoms of dyspepsia such as bloating, decreased appetite, nausea, fatigue, and weight loss are common in patients with severe pancreatic dysfunction. If the islets are significantly affected, it can affect glucose metabolism, with about 10% showing obvious symptoms of diabetes. In addition, patients with biliary tract diseases or bile duct obstruction may have jaundice. Patients with pseudocysts can feel abdominal masses. A few patients may develop pancreatic ascites. In addition, chronic pancreatitis can cause upper gastrointestinal bleeding. The cause is that fibrosis of the pancreas or the formation of cysts compresses the splenic vein, which can lead to portal vein thrombosis and portal hypertension. Moreover, the probability of gastric ulcer in patients with chronic pancreatitis is relatively high. Chronic heavy drinkers may develop alcoholic gastric mucosal damage. Patients with chronic pancreatitis may suffer from multiple episodes of fat necrosis. Subcutaneous fat necrosis often occurs in the extremities and can form hard nodules under the skin.
4. How to prevent chronic pancreatitis
1. Actively prevent and treat related diseases.Biliary tract diseases are common and frequent diseases in the elderly. Actively preventing and treating biliary tract diseases is an important measure for preventing chronic pancreatitis in the elderly. In addition, diseases related to the onset of this disease, such as hyperparathyroidism and hyperlipidemia, must also be actively prevented and treated.
2. Actively and thoroughly treat acute pancreatitis.A considerable number of elderly patients with chronic pancreatitis have a history of acute pancreatitis, suggesting that the onset of this disease may be related to incomplete cure of acute pancreatitis. Therefore, patients with acute pancreatitis must receive active treatment and be completely cured to avoid any future complications.
3. Do not drink heavily, and drink less alcohol.People who chronically drink alcohol are prone to chronic alcoholism, which is one of the important causes of chronic pancreatitis. Therefore, it is necessary to develop good habits of not drinking heavily or drinking only in small amounts from a young age. If someone has chronic pancreatitis, they must completely quit drinking to prevent the progression of the disease.
4. Maintain a moderate diet.Be cautious with diet, prevent overeating, which is very important for the prevention of this disease. At the same time, the elderly should have a light diet, eat less spicy, greasy, and sweet foods, and avoid strong drinks and heavy flavors to prevent gastrointestinal heat and the onset of this disease.
5. Maintain a pleasant mood and mood.The elderly should avoid negative emotional stimuli such as worry, anxiety, and anger, maintain a cheerful mood, so that the Qi can flow smoothly, Qi and blood circulation, and prevent this disease.
5. What kind of laboratory tests are needed for chronic pancreatitis?
Laboratory examination:
(1) Pancreatic enzyme measurement:Serum amylase determination is the most widely used diagnostic method. Elevated serum amylase can be detected within 24 hours after onset. The serum amylase level significantly increases (>500 U/dl, normal value 40-180 U/dl, Somogyi method) and gradually decreases to normal within 7 days after onset. Urinary amylase determination is also a sensitive indicator for the diagnosis of this disease. Urinary amylase increases later but lasts longer than serum amylase. The significantly elevated urinary amylase (normal value 80-300 U/dl, Somogyi method) has diagnostic significance. The higher the amylase measurement, the higher the accuracy of diagnosis, but the level of amylase does not necessarily correlate with the severity of the lesion.显著升高的血清脂肪酶 (normal value 23-300 U/L) is a relatively objective indicator for diagnosing acute pancreatitis. The determination of serum amylase isoenzymes improves the accuracy of diagnosis for this disease. When the serum amylase level is elevated but the P-isoenzyme is not, acute pancreatitis can be ruled out.
(2) Other items:Including elevated white blood cells, hyperglycemia, abnormal liver function, low blood calcium, blood gas analysis, and DIC index abnormalities, diagnostic puncture is occasionally used for diagnosis. The puncture fluid is bloody and turbid, with elevated amylase and lipase, which has diagnostic significance. Due to the invasiveness and possible complications of this method, it is not an ideal diagnostic method.
Radiographic imaging diagnosis:
(1) Chest X-ray:Atrophy of the left lower lobe of the lung, elevation of the left hemidiaphragm, and left pleural effusion reflect the inflammation around the diaphragm and retroperitoneum, supporting the diagnosis of acute pancreatitis, but lack specificity. It is an auxiliary diagnostic indicator.
(2) Abdominal plain film:Visible duodenal distension indicates paralysis and dilation of the proximal jejunum. Visible colonic cutoff signs indicate paralysis and dilation of the transverse colon, splenic flexure, and distal colon, without gas shadows or visible gallstones and pancreatic duct stones, as well as the disappearance of the lumbosacral muscle shadow, which are auxiliary diagnostic methods for acute pancreatitis.
(3) Abdominal ultrasound: It can help with diagnosis. Ultrasound scanning can detect pancreatic edema and the accumulation of peripancreatic fluid, and can also explore gallstones and bile duct stones, but is limited by local bowel gas loops.
(4) Enhanced CT scan:It is a sensitive diagnostic method for acute pancreatitis widely accepted in recent years. The changes in the pancreas include diffuse or focal enlargement of the pancreas, edema, necrosis, liquefaction, and blurring and thickening of the surrounding tissue. Fluid accumulation can also be seen, and complications of acute pancreatitis such as pancreatic abscess, pseudocyst, or necrosis can be detected. Enhanced CT scans show low-density areas in the necrotic areas.
(5)MRI:Can provide diagnostic information similar to CT
6. Dietary taboos for Chronic Pancreatitis patients
(1) When Chronic Pancreatitis has an acute attack, stop all food intake. During the non-acute attack period, adopt foods that do not have mechanical and chemical stimulation to the gastrointestinal tract, requiring high carbohydrate and low-fat semi-liquid diet.
(2) Provide 60 grams of protein per day, including an appropriate amount of high-quality protein.
(3) Strictly limit the intake of fat, 20 grams per day, and gradually transition to 40 grams per day.
(4) Prefer cooking methods such as steaming, boiling, braising, stewing, and blanching that use less oil.
(5) Minimize the use of foods that are prone to bloating, such as radish, onion, coarse grains, dried beans, etc. Avoid刺激性 foods, avoid alcohol and animal viscera, and geese, etc.
(6) Preferably use easily digestible carbohydrates, such as brown sugar, sucrose, honey, etc. Since carbohydrates are the main source of energy, more than 300 grams can be provided daily. Eat small and frequent meals, 4 or 5 times a day, to prevent overeating.
Example of one-day diet for Chronic Pancreatitis
Breakfast: Rice porridge (100 grams of rice), sugar steamed cake (40 grams of flour, 10 grams of sugar), a little bean curd in sauce.
Snack: Skimmed milk (250 grams of skimmed milk, 10 grams of sugar)
Lunch: Soup noodles (10 grams of minced lean meat, 50 grams of tomatoes, 100 grams of flour), steamed bun (50 grams of flour)
Snack: Congee (20 grams of lotus root starch, 10 grams of sugar)
Dinner: Rice porridge (100 grams of rice), small steamed buns (25 grams of flour, 20 grams of pork, 50 grams of cabbage), total daily oil 8 grams.
The above recipes contain 1894 kcal (7910 kJ) of energy
Therapeutic Diet for Chronic Pancreatitis
(1) Five-Spice Betel Nut: 200 grams of betel nut, 20 grams of chenpi, 10 grams of clove, 10 grams of cardamom, 10 grams of amomum, 100 grams of salt. Put betel nut, chenpi, clove, amomum, and salt in a pot, add an appropriate amount of water, bring to a boil with strong fire; then simmer with low fire until the liquid is dried up, turn off the fire and wait for it to cool. Take out the betel nut and chop it into pieces the size of soybeans. Chew a small piece of betel nut after meals.
(2) Hawthorn and Malt Drink: 10 grams of hawthorn, 10 grams of roasted malt. ① Wash the hawthorn and cut it into thin slices. ② Put the hawthorn slices and roasted malt in a cup, add boiling water, cover the cup with a lid, and soak for 30 minutes. It can be used as a tea substitute.
(3) Chenpi Clove Rice Porridge: 10 grams of chenpi, 5 grams of clove, 50 grams of glutinous rice. Cut the chenpi into pieces and boil it with the clove, then add the glutinous rice and cook until done. Take it twice a day, in the morning and evening.
(4) Amomum Cardamom Winter Melon Soup: 10 grams of amomum, 300 grams of winter melon. Boil the amomum first, then add the sliced winter melon. Add appropriate seasonings after the winter melon is cooked. It can be used as a post-meal drink or as a dish.
(5)Jinggao Rice Porridge: 750 grams of hawthorn cake (Jinggao), 25 grams of millet. Cut the hawthorn cake into strips or slices, and add it when the millet porridge is eighty percent cooked. It can be eaten when the millet porridge is hot.
7. Conventional methods for treating chronic pancreatitis in Western medicine
Western Medicine Treatment
(1) Chronic pancreatitis patients must absolutely abstain from alcohol and avoid overeating.
(2) Be cautious about using some drugs that may be related to the onset: sulfasalazine, estrogen, glucocorticoids, indomethacin, hydrochlorothiazide, methyldopa, etc.
(3) Chronic pancreatitis patients often suffer from decreased appetite, malabsorption, and diarrhea, especially steatorrhea, often show weight loss and malnutrition. High-calorie, high-protein, high-sugar, high-vitamin, and low-fat diets should be provided. The supplement of pancreatic enzyme preparations is the premise of ensuring the daily total calorie supply. 40% of the total calories should be provided by sugar, and the daily protein supplement should not be less than 100-200g, half of which should be animal protein, such as fish, meat, and eggs. The supply of fat should emphasize the supplement of water-soluble, easily absorbed medium-chain fatty acids, which enter the portal vein instead of the intestinal lymphatic system after absorption. Some long-chain fatty acids have a strong stimulatory effect and should not be used. For long-term steatorrheic patients, sufficient fat-soluble vitamins such as A, D, E, K, and B vitamins should be supplemented, and various trace elements should be supplemented appropriately. For a few patients with severely impaired exocrine function in the late stage of chronic pancreatitis, parenteral nutrition (TPN) can also be used as a treatment measure, that is, glucose, medium-chain fatty acid emulsion, amino acids, albumin, electrolytes, fat-soluble vitamins, and other substances are administered via the venous route to ensure the supply of calories. TPN treatment can last for several weeks or months, and there are also reports of maintenance for several years.
(4) During the acute attack phase, especially in patients with biliary tract infection, antibiotics should be used. If the acute attack shows severe symptoms, close monitoring should be carried out and somatostatin and other drugs should be used for active treatment.
Surgical Treatment
The main treatment for chronic pancreatitis in Western medicine is surgical treatment. Experts believe that since chronic pancreatitis is not formed in the near future, patients should not be too anxious during treatment, and this disease is also unlikely to be completely cured in the short term. Clinical practice shows that surgical treatment of this disease is not very effective, surgery works quickly, but it is not easy to eliminate the root, especially for such chronic diseases! Therefore, most doctors in clinical practice also do not recommend using this method for treatment!
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