The stones of the pancreas

The stones of the pancreas is a rare chronic disease and are more common in men than in women. Usually the rocks are light gray or gray-yellow color, rough surface, and are composed of carbonate and calcium phosphate with a small admixture of organic substances.
13 contrast gallstones they do not contain cholesterol and bile pigments. "Young" soft stones, the "old" more solid, more often multiple stones of various sizes (from sand or hazelnut). The stones are located primarily in the main duct, often getting their processes in its lateral branches than create obstacles for normal salootdelenie.
The etiology and pathogenesis. Causes of lithogenic not clear caused, apparently violation of metabolic processes, and leading them to the increase in the concentration solen of calcium in pancreatic juice. This explains the frequent combination of stones pancreas with formation in the salivary glands and the urinary tract. The Foundation stones are usually mass of closeplease and split epithelium ducts, around which forms contained in pancreatic juice mucus and calcium salts. The formation contributes stagnation secretion gland ducts, due to mechanical reasons (the formation of stones in the retention cysts), and inflammation of the ducts as a result of their infection. Most often the infection penetrates into the ducts of the biliary tract, but possible hematogenous and lymphogenous mechanisms of infection.
The possibility of the existence of pure forms of stone formation in the ducts of the pancreas no signs of chronic pancreatitis is questionable. On the contrary, in the final phase of chronic pancreatitis with the development of calcification in the thickness of the pancreas, the formation of stones and in the ducts. Thus, kamneobrazovaniu and inflammatory processes often interdependent. Section pathologists almost always find, besides stones, reactive pancreatitis with diffuse or focal atrophy glandular tissue and expressed fibrotic changes of the pancreas. The islets of Langerhans preserved better. Perhaps the formation of cysts, abscesses and necrosis of the authority.
Clinical symptomatology. The disease often asymptomatic (even with large stones) or accompanied by attacks colicky, intense pain in the epigastric region with irradiation, as a rule, in the left half of the body. Pain can occur suddenly in the midst of perfect health, usually at the height of intestinal digestion and last from several hours to a day or longer. Sometimes the attack is preceded by unpleasant sensations in xiphoid process. On character reminding hepatic colic, often accompanied by vomiting, fever, salivation and end occasionally discharge of stone in the intestines. Pain attacks recur; with the passage of the stone through Tatarov nipple may occur jaundice, Severe pain attacks can lead to shock. Blocked duct stones inhibits secretion, which is accompanied by indigestion (steatorrhea, creatore, amenorea) and the increase in the maintenance of enzymes in the blood and urine. There are periodic carbohydraturia and hyperglycemia, change glycemic curves under load glucose. Long blocked the main duct leads to atrophy of the pancreas, a drastic violation of the digestive process and the depletion of the patient.
When the differential diagnosis should be borne in mind kidney, liver and lead colic, stomach ulcer, tablichka crises, stenocardia. Significantly concrements detected x-ray study, and more successfully - radiography (without contrast) after the imposition of the pneumoperitoneum. The rocks form multiple shadows on one or both sides of the spine.
The prognosis of the disease depends on the nature of complications.
Treatment. During an attack of pain are appointed narcotic and antispastic drugs. Morphine and opiates should be avoided, as they cause spasm of the sphincter of Oddi. Applies novocaine blockade, intravenous novocaine, local heat. Outside attack spend duodenal intubation with the introduction of substances that stimulate pancreatic secretion (for example, 30 ml of 0.5% solution of hydrochloric acid) and causing a reduction of the gall bladder (30 ml 33% solution of magnesium sulfate).
When complications of infection give antibiotics and sulfa drugs. Depending on the degree of violation of the digestive process, designate one or another type of clinical nutrition.
When semischeme stone and long-lasting or frequently recurring pain showed operation virsungotomy. Duct probe remove sharp spoon in duct stones and reveal existing cysts and abscesses. Remove all the stones extremely difficult and not always possible. In related gallstone disease with infection biliary tract produce cholecystectomy with drainage hepatic duct.