Symptoms and diagnosis of chronic pancreatitis

Clinical symptoms of chronic pancreatitis is polymorphism. Subjective symptoms characteristic little and are similar to other chronic gastrointestinal disease. This refers to pain in the upper abdomen and dyspeptic phenomena. The results of the physical examination may also be sufficient for diagnosis. Sometimes chronic pancreatitis long time runs almost asymptomatic.
M. M. Gubergrits (1934) drew attention to the primary diagnostic significance of the symptom of pain. Although pain there are many diseases of the abdominal cavity, however, combined with other symptoms in chronic pancreatitis they can acquire a certain specificity. Patients often complain of recurrent bouts of pain in the upper abdomen on the left or in the epigastric region with characteristic extending to the left. They can be surrounding and spread along the left costal margin to the spine. Sometimes the pain wear compressive nature, are located in the left side of the chest, spread on the area of the heart, the left arm, shoulder and neck, simulating angina. In addition, the radiation of pain possible and down along the descending colon, in the left iliac bone and sometimes along the ureter radiating to the left testicle or in the head of your penis. Often clinical manifestations remind bouts of esorediosa.
Objective examination is set tenderness to palpation in the area of soffera and symmetric field on the left (M M Gubergrits, 1934), as well as when using methods of pain on palpation Grott, which at corresponding skill researcher allows to differentiate pancreatitis from other similar diseases. Along with the pain detected disorders skin sensitivity (Zakharyin - Ged zone) in the form of hyperalgesia, and sometimes giperestesia in region VIII-X segments on the left, and the dissemination of these areas is not permanent. Violations of skin sensitivity have a direct link with independent pain, acute pain areas of altered sensitivity expanded.
Of considerable importance in the clinical picture of the disease have diarrhoeal phenomenon. They are not specific, but can be valuable for diagnosis when they are combined with other signs, such as the so-called pseudodementia triad: hunger, thirst, and loss of weight in the absence of glycosuria, and loss or mutilation of appetite, in particular aversion to fatty food intake which patients are often causes pain, nausea and vomiting. Sometimes there salivation. Weight loss could occur in a short period of time with a significant loss of body weight. When advanced pathological process exocrine pancreas failure more influence on digestive disorders. Diarrhea is not mandatory feature of chronic pancreatitis. Often the patients are observed and constipation. If food is poorly digested, the volume of Cala increases. This feature is especially significant in the absence of diarrhea.
For chronic pancreatitis is characterized by a large number of pasty, grayish, stinking rich and Kala (steatorrhea) with a high content of undigested muscle fibers (creatore). The amount of nitrogen and fat in it is increasing dramatically.
Disorder of carbohydrate metabolism in chronic pancreatitis is usually observed at late stages of the disease in the form of spontaneous hyperglycemia and glycosuria.
In malnourished patients with thin abdominal wall sometimes manage to probe the pancreas in the form of dense strand, sending a ripple of aorta (indurativnyy process).
X-ray examination is defined by the change of the functional state of the duodenum (spasm, increased peristalsis, duodenal stasis), expansion and warp its hinges, calcification and other signs.
Famous role in the diagnosis of chronic pancreatitis are indicators of laboratory research. In severe cases, the disease sometimes develops gipomagniemia anemia, neutrophilic leucocytosis, accelerated ROHE.
Special diagnostic interest are the various functional tests.
In the study received a thin probe duodenal contents, both spontaneous and separated in response to the introduction of those or other stimulants, can be found various violations in the course of pancreatic secretion.
With the introduction of stimulants with secretory mechanism of action (0.5% solution of hydrochloric acid, secretin, ether and others) can be installed reduction secreta, low numbers carbonate alkalinity, and the absence or perversion of reaction to introduction of stimuli.
When tests, stimulating fermentopathia (pancreozymin, fat, Mihail, prostigmin, urecholine and others), there is reduction in the maintenance of enzymes (trypsin, amylase and lipase).
In chronic pancreatitis exocrine process for a long time may remain normal, that is not possible on the basis of the study of duodenal contents to exclude the presence of the disease. Violation of secretory process, especially in the initial period of the disease may manifest itself in hypersecretion both fasting and after the introduction of stimulants. This separates a significant amount of pancreatic juice with high carbonate alkalinity, but normal enzymatic activity. However, in severe diffuse lesions of the pancreas is almost always observed hipocrecia.
Essential for the diagnosis of chronic pancreatitis have special teststo characterize the degree of disturbance of the digestive process, is associated with a deficiency of pancreatic secretion. In addition scatological research on the content of undigested food debris samples from food loads, known importance is attached to such samples, as krahmalnyj, with the introduction of iodized fat and protein and fat, labeled with radioactive isotopes of iodine.
In chronic pancreatitis sometimes there are also changes the content of the enzymes of blood and urine. They are most pronounced in case of exacerbation of the inflammatory process and sometimes reveal only after the application of various stimulants pancreatic secretion. In atrophic process in the pancreas enzyme content in the blood and urine, usually decreases.
Blood for terminologicheskii research must be taken on an empty stomach and at the height of the digestive process (in 3 hours after dinner). In the latter case, hyperfermentemia normally observed.
N. North samoshenko, S. A. Tuzhilin, V. A. Shaternikov (1964) is considered indicative of chronic pancreatitis increase of proteolytic activity in the blood. The decrease of activity inhibitor of tripsin was observed by them mainly in critically ill with frequent exacerbations of the disease.
Grott with TCS. (1971) attached great importance to the lipase blood in the diagnosis of exacerbations hidden flowing chronic pancreatitis. Recently this purpose they are used for determination of lipase micromethod Weber a, which was used before, after 1, 2, and 3 h after the trial Breakfast (200 g of milk, 10 g sugar, 20 g butter, and one egg yolk). The activity of lipase blood normally not exceed 100 ME, as at exacerbation of chronic pancreatitis, especially in the hours after taking Breakfast it many times. Combining the determination of lipase methods of pain on palpation, Grott demonstratively showed the relationship between the sensitivity of the pancreas and pathological curves lipase.
Chronic pancreatitis is sometimes accompanied by symptoms of the so-called small diabetes, manifested by moderate hypoglycemia, glycosuria and impaired nature glycemic curves in samples with a load of glucose. Unlike conventional diabetes, chronic pancreatitis is characterized by the instability increasing the level of sugar in the blood and urine, which is connected with the dynamics of the pathological process.
The results of laboratory studies cannot be considered strictly specific for chronic pancreatitis, and a diagnosis should be based on data of complex study of a patient with a basis of clinical presentation and course of the disease.
Chronic pancreatitis should be differentiated with cholecystitis, gastric ulcer, cancer of the pancreas, chronic enteritis, chronic dysentery, tuberculosis, intestinal, intestinal fistula and some other pathological processes in the abdominal cavity.
When setting differential diagnosis in favour of chronic pancreatitis are the following indications: 1) the radiation of pain to the left and above the navel; 2) the pain when pressure in the area of the projection of the pancreas in the abdominal wall; 3) high level diastase in newly urine; 4) carbohydraturia; 5) disorders in the digestion of protein and fat; 6) disorders of the pancreas, installed by means of functional tests.
Prognosis in chronic pancreatitis depends on the possibility of elimination of the reasons causing damage to the pancreas, the significance of the change of the authority, the General condition of the patient.