Pancreatic Calculi

　　Pancreatic calculi disease, also known as pancreatolithiasis, is caused by poor living habits. The main risk factors include the following points:

　　1. Excessive alcohol consumption

　　Excessive alcohol consumption is the most important risk factor for pancreatolithiasis. Long-term heavy drinkers have significantly higher concentrations of protein in pancreatic juice, which forms protein deposits and then calcifies to form stones.

　　2. Smoking

　　Smoking is one of the risk factors for pancreatolithiasis, and the incidence of pancreatolithiasis in smokers is 2-3 times higher than that in non-smokers.

　　3. Diet

　　People with high-fat, high-protein, and low-fiber diets are prone to develop pancreatolithiasis. Excessive fat intake leads to fat metabolism disorders, increased cholesterol and free fatty acids in the blood, which can suppress the body's immune function; high-fat and high-protein diets increase bile secretion, and bile salts and fatty acids in bile can form stone-forming substances under the action of anaerobic bacteria in the intestines, thereby triggering pancreatolithiasis.

　　Due to the significant pancreatic damage caused by pancreatic calculi, it is easy to cause a series of complications, such as diabetes and pancreatic cancer. The most common complications include the following points.

　　1. Symptoms of surrounding organs affected by pancreatic calculi in pancreatic disease

　　The hard nodules of pancreatic enlargement or fibrosis compress the common bile duct and splenic vein, or lead to the formation of splenic-gate vein thrombosis, resulting in secondary portal hypertension. It can be regional hypertension or systemic, depending on the extent of thrombosis.

　　2. Benign complications of pancreatic calculi

　　Diabetes is the most common, as well as myocardial, renal, retinal, and obstructive arteriosclerosis caused by diabetes. Liver disease and peptic ulcers may also occur occasionally.

　　3. Malignant complications

　　Malignant complications of pancreatolithiasis include the pancreas itself and other malignant tumors outside the pancreas. The relationship between pancreatolithiasis and pancreatic cancer is extremely close. Generally, pancreatic calculi occur first, followed by pancreatic cancer. Those with concurrent pancreatic cancer are mostly large stones, about half of which are in the pancreatic head. The incidence of pancreatic cancer with pancreatolithiasis varies among reports. Western literature records it as 3.6-25%, and the Japanese report of Osamu Koganei indicates 31 cases of concurrent pancreatolithiasis and pancreatic cancer (accounting for 14.8%). The general Japanese report is 5.3%-10%.

　　The etiology of pancreatic calculi is not yet clear. Studies suggest that it may be related to long-term excessive alcohol consumption and heredity. The symptoms of this disease include:

　　1. Early symptoms

　　(1) Abdominal pain

　　It is the most common symptom, with varying degrees of severity, mainly caused by the obstruction of pancreatic ducts and the result of pancreatic fibrosis. It often manifests as upper abdominal pain, and if it is alcohol pancreatitis, it often presents with severe pain and frequent recurrence with a long duration. In cases with unknown etiology, severe pain is rare, and it is mostly characterized by dull pain or hidden pain in the upper abdomen.

　　(2) Weight loss, steatorrhea

　　It is due to the decreased exocrine function of the pancreas caused by calculous chronic pancreatitis. The condition of steatorrhea varies depending on the degree of pancreatic damage.

　　(3) Jaundice

　　About 1/4 of the patients can have jaundice. It is caused by the compression of the fibrosis and hard pancreas head on the lower end of the common bile duct, which can be persistent or intermittent, and the latter is more common.

　　2. Late symptoms

　　The late symptoms of pancreatic calculi are mainly manifested as complications caused by progressive chronic damage to the pancreas.

　　Pancreatic calculi, also known as pancreatic duct calculi, are one of the clinical manifestations of chronic pancreatitis, with an onset age of 30-50 years old, and the incidence in Westerners and Europeans is higher than that in Easterners. Pancreatic calculi are mainly caused by poor living habits, so to prevent pancreatic calculi, it is necessary to eliminate these bad habits first. It mainly includes the following points:

　　1. Quit smoking and drinking

　　In clinical practice, the occurrence of pancreatic calculi is mainly related to long-term and excessive alcohol consumption. Those with long drinking time and large amount are more likely to form pancreatic calculi. The incidence of pancreatic calculi in smokers is 2-3 times higher than that in non-smokers. Therefore, to prevent pancreatic calculi, it is necessary to quit smoking and drinking first. The pain of abdominal pain in patients after surgery still needs to quit smoking and drinking, otherwise it is easy to relapse.

　　2. Diet Adjustment

　　In addition to giving up alcohol, daily diet should be reasonably balanced, try to eat less high-fat, high-oil, and high-salt foods, and use coarse grains such as grains, beans, sweet potatoes, etc. as the main body of diet. The intake of fat should be strictly limited, not exceeding 40 grams per day. More easily digestible carbohydrates such as brown sugar, sucrose, and honey should be chosen. Since carbohydrates are the main source of energy, more than 300 grams can be given per day. Eat fresh vegetables and fruits every day, increase the intake of fiber, carotene, vitamin E, and necessary minerals. More cooking methods such as boiling, stewing, and steaming should be used, and oil-frying and stir-frying methods should not be used.

　　3. Physical Exercise

　　Participate in moderate physical activities, avoid overweight and obesity, which helps to reduce the incidence of pancreatic calculi. Physical activities include running, walking, swimming, playing ball, dancing, climbing stairs, cleaning the room, etc.

　　Pancreatic calculi, also known as pancreatic lithiasis, have been increasing in recent years due to the increasing incidence of chronic pancreatitis and the increase of various imaging examination methods, so there is a trend of increasing examination rate for pancreatic calculi. To diagnose this disease, the following examinations need to be done:

　　1. Laboratory examination

　　Serum GPT, GOT, cholesterol, triglycerides, etc., may show slight abnormalities. A few patients with AKP can be elevated. To differentiate whether there is concurrent pancreatic cancer, cancer embryonic antigen (CEA) should be detected. The staining of cancer embryonic antigen in pancreatic cancer tissue is moderately positive or above, and the pancreatic duct epithelial cells are lightly to moderately positive.

　　2. X-ray film

　　Pancreatic calculi can be displayed as three types on X-ray films:

　　(1) Diffuse type It is a series of calculi of different sizes, scattered on the pancreas.

　　(2) Solitary type It consists of one or more calculi, mostly in the main pancreatic duct.

　　(3) Mixed type Granular and mass-like calculi can be seen on the same X-ray film.

　　Pancreatic calculus often occurs most in the head of the pancreas, less in the tail, and centrally in the body. Large calculi block the main pancreatic duct more severely, and the vast majority are accompanied by pancreatic duct blockage, and complications are also common.

　　3. Ultrasound and CT examination

　　The sensitivity of pancreatic calculus is over 90%. If combined with a positive CT scan, the positive rate is particularly high. CT scan can improve the positive detection rate for pancreatic cancer diagnosis. When pancreatic calculus and concurrent pancreatic cancer are present, calcification, pseudocysts, pancreatic duct dilation, irregular shape of the pancreas, localized enlargement of the pancreas, and disappearance of peripancreatic fat can be seen.

　　The etiology of pancreatic calculus is not yet fully understood, and it may be related to long-term excessive drinking and smoking. Treatment can be done by surgical methods, traditional Chinese medicine, or dietary therapy. The following introduces two dietary therapies for this disease:

　　1. Mulberry and chrysanthemum and Lycium barbarum drink

　　Morus alba leaves, chrysanthemum flowers, and Lycium barbarum each 9 grams, Cassia obtusifolia 6g. Boil the above four herbs with water and drink as tea. It can be taken continuously and has the effect of clearing the liver and reducing fire.

　　2.扁豆莲肉粥

　　White bean 30g, lotus seed 20g, Job's tears 40g, glutinous rice 50g, jujube 10 pieces, Citrus reticulata 10g. The above six ingredients can be added to a pot with an appropriate amount of water, cooked into porridge, and taken at will.

　　The greatest characteristic of traditional Chinese medicine in treating diseases is syndrome differentiation and treatment, overall regulation, and fewer side effects than Western medicine treatment. Most diseases can be cured. Pancreatic calculus disease can also be treated by traditional Chinese medicine methods. The main treatment formulas are:

　　Formula One

　　Herbs: Dahuang (fermented) 6g, Safflower 6g, Corydalis 6g, Prepared Xiangfu 6g, Foshou 6g, not included in the dosage, Jing Sanlie 3g, Pogostemon cablin 3g, Citrus reticulata 4.5g, Citrus reticulata 4.5g, Atractylodes macrocephala 4.5g, Cyperus rotundus 12g.

　　Applicable for pancreatic calculus, anorexia, fatigue, tenderness under the left ribcage, and abdominal Qi not flowing smoothly. Pulse is wiry, tongue is purple and red. Syndrome differentiation belongs to blood stasis and Qi stagnation.

　　Take with water decoction, one dose per day.

　　Formula Two

　　Herbs: Codonopsis (or Taizi Shen), Fried Baizhu, Poria, Licorice, Poria cocos, Alisma orientale, Plantago asiatica, Moutan bark, Flos lonicerae, Prepared Bixie, Prepared Guizha, Scolopendra, August herb, Spatholobus suberectus, Red vine, Trichosanthes, Curcuma, etc. in appropriate amounts.

　　Applicable for pancreatic calculus.

　　Take with water decoction, one dose per day.