It has long been believed that pancreatitis was caused by alcohol abuse. This misconception is created because it was first discovered and described using the example of alcoholics. But it is now known that its most dangerous, acute stage is almost not found in them - it is the "prerogative" of people with a healthy attitude to strong drinks.
Pancreatitis can be the result of overeating (now also considered a form of addiction), pathologies of other digestive organs, endocrine disorders. Regardless of the etiology, form, and stage of the course, it greatly disrupts digestion, endangers the state of the metabolic system, and sometimes the patient's life. In pancreatitis, nutrition is based primarily on protein (proteins are absorbed by the stomach) and involves careful digestion of food.
Functions of the body
The pancreas is heterogeneous in the structure and function of its tissues. The main part of its cells produces pancreatic juice - concentrated alkali with enzymes dissolved in it (or rather, their inactive precursors). Pancreatic juice creates an intestinal digestive environment. Bacteria living in its various compartments play an important but helpful role.
The main bile ducts also pass through the pancreatic tissue. It flows from the gallbladder to the duodenum, flowing through its lumen to the main duct of the gland itself. As a result, alkalis, enzymes and bile enter the intestine not separately but in a ready-made "mixture".
Inside the glandular tissues, different types of cells are also arranged in groups. They are called islands and they synthesize not alkali but insulin, the hormone responsible for the absorption of carbohydrates from food. Abnormalities in the development, functioning, or degradation of such cells (usually they are inherited) are one of the scenarios of diabetes. The second is to increase the resistance of the body's cells to the normal insulin they produce.
Causes of the disease
In the acute stage pancreatitis causes blockage of the small ducts of the gland through which the juice of the pancreas flows into the main, and then into the lumen of the duodenum. There is an effect of its "autoimmune" by enzymes accumulated inside. Acute pancreatitis can be caused by the following reasons.
- Gallstones. They arise due to inflammatory pathology of the liver or gallbladder, abnormalities of the composition of the bile (caused by sepsis, atherosclerosis, diabetes mellitus, receiving the same treatment for liver disease).
- Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the glandular cells, causing swelling of the tissues and disrupting its function.
- Drugs. Toxic effects of atherosclerosis, steroid drugs and some antibiotics.
- Deviations in structure or location. They can be congenital (gallbladder flexion, excessively narrow ducts, etc. ) or acquired (scars after surgery or traumatic examination, swelling).
Chronic pancreatitis can most often be observed in drunken alcoholics and diabetics who have at least five years of experience. Here the autoimmune process in the gland is important, which led to inflammation or taking antidiabetic drugs. But it can also be accompanied by the following diseases.
- Intestinal pathology. Especially the duodenum, including the duodenum (inflammation of its walls) and erosions.
- Vascular diseases. All glands must be actively supplied with blood. Congenital anomalies and clotting disorders (hemophilia, thrombosis) play a special role here.
- Injuries. Piercing wounds, interventions, strong blows to the stomach.
The least common cause of pancreatitis is spasm of the ode sphincter, which ends in the common gallbladder and pancreatic duct. The Odyssey sphincter is located at the exit from it to the duodenum. Normally, it regulates the "partial" supply of pancreatic juice and bile into its cavity, allowing it to almost stop between meals and increase dramatically when a person sits at a table. It also prevents the intestinal contents along with various pathogens (bacteria, foreign compounds, worms) from flowing back into the pancreas or gallbladder cavity.
The ode sphincter is not prone to spasms like all the "dividers" of this type of smooth muscle. For a long time there was no self-dysfunction in medicine. It has been replaced by various "gallbladder dyskinesias" and "post-cholecystectomy" syndromes (complication of gallbladder removal). Irritated, his injury occurs.
The division of causes of acute and chronic pancreatitis is conditional, because the first, even with high-quality treatment, in most cases passes to the second. And what "feeds" him after eliminating the causal factors is unclear. In some cases (approximately 30%), none of these processes can explain the appearance of pancreatitis in a patient.
Signs
Acute pancreatitis begins and is accompanied by unbearable (before losing consciousness) pain in the entire upper abdomen, below the ribs. Antispasmodics, painkillers and antibiotics do not remove it, nor do they relieve the usual "heart". The pain will not be relieved by a special diet - a doctor is needed here, not a diet. Therefore, patients may experience symptoms of pancreatitis with a heart attack or exacerbation of osteochondrosis, which is also facilitated by the body's cascading reactions to critical stimuli:
- Jump in blood pressure (hypertension and hypotension are equally likely);
- Heart palpitations;
- Gabrueba;
- Cold, cloudy sweat.
A characteristic symptom of pancreatitis is loose stools - the content of crushed, semi-digested food fragments and fat. It manifests itself a few hours after the onset of the disease. At the end of the first day, the color changes with the stool urine. They are usually yellowish-brown in color due to bile bilirubin, which helps digest food. And because of the blockage of the duct it does not enter the intestine. On the second or third day, the patient develops flatulence, stomach cramps, and vomiting on fatty or spicy foods.
Chronic pancreatitis is also manifested by pain, but not so pronounced. They may intensify within an hour of eating, especially if it was inappropriate - cold, fried, smoked, greasy, spicy, accompanied by alcohol. The pain is exacerbated in the supine position, digestion is impaired before dyspepsia (when almost unchanged food comes out instead of feces).
One of the most famous victims of acute pancreatitis (many experts point to the likelihood of perforation of a stomach ulcer) was Princess Henrietta of England, wife of Duke Philip of Orleans, brother of King Louis XIV of the Sun. Because of the typical painful course of the disease, she was convinced that one of her husband's favorites had been poisoned. Admittedly, this only turned out to be an excuse designed to confirm or disprove this rumor.
Effects
Acute pancreatitis is dangerous by rapid (two to three days) "eating" and passing through pancreatic tissue, causing caustic alkaline, bile and digestive enzymes to enter directly into the abdominal cavity through this "fistula". This scenario results in diffuse peritonitis (inflammation of the peritoneum that rapidly spreads to the abdominal organs), multiple erosions, and death.
Peritonitis is characteristic of many pathologies, including perforated ulcer, cancer of the stomach or intestines, appendicitis, if it was accompanied by the rupture of an abscess (because of such a scenario died the magician Harry Houdin). If pancreatitis was provoked not by a mechanical obstruction (odd sphincter spasm, stone, scar, tumor, etc. ) but by infection, a purulent pancreatic abscess may develop. Its untimely treatment also ends with a rupture in the abdominal cavity.
Pancreatic enzymes and digestive juices sometimes cause enzymatic pleurisy - inflammation of the pleura of the same type as the peritoneum. Chronic pancreatitis is characterized by complications delayed in time, but more seriously disrupts its functioning and other organs.
- Cholecystitis. And cholangitis is an inflammation of the hepatic ducts. They can cause pancreatitis due to concomitant cholelithiasis, but often they form in the opposite sequence - as a result.
- Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it is located directly below it. Its inflammation during pancreatitis occurs not so much due to the penetration of foreign substances into the inflammatory gland in its cavity, but due to the constant failure of intestinal digestion, which is forced to compensate. The pancreatitis diet is designed to reduce the load on all organs of the digestive system, but the "interests" of a healthy stomach are less carefully considered. The more pronounced the degradation of the pancreas, the higher the risk of developing gastritis.
- Reactive hepatitis. It also develops in response to persistent bile stagnation and irritation of the hepatic ducts. Sometimes cholestasis, which occurs during the subsequent exacerbation of pancreatitis, is accompanied by jaundice. Therefore the diet for pancreatitis should not include foods that require increased bile secretion. These include fatty, fried, spicy meats and fish, fish caviar, other animal by-products, smoked meats, alcoholic beverages - digestive stimulants.
- Cystosis and pseudocystosis. These benign neoplasms or their simulated foci of pancreatic juice stagnate arise in the duodenum due to the same difficulties of its removal. Cysts periodically become inflammatory and purulent.
- ᲞCancreatic tumor. Any chronic inflammation is considered a carcinogenic factor because it causes irritation, accelerated destruction of damaged tissues, and an increase in their enhanced response. And not always of good quality. The same goes for chronic pancreatitis.
- Diabetes mellitus. It's far from the first "land" complication of chronic pancreatitis. But the faster and more noticeably the whole gland disintegrates, the harder it is for surviving islet cells to compensate for the insulin deficiency that results from the death of their "colleagues" in already dead areas. The prospect of diabetes in seven to ten years (often faster, depending on the prognosis and characteristics of the course of pancreatitis) becomes more and more tangible "experience" for the average patient.
Chronic recurrent inflammation in glandular tissues leads to scarring and loss of function. Progressive intestinal failure is inevitable. But in general, with pancreatitis you can live another 10-20 years. Its prognosis, quality, and patient's lifespan are affected by various "deviations" from the diet and their type, especially in everything related to alcohol.
Diet therapy
The acute stage of the disease often requires urgent detoxification, the appointment of antibiotics (usually broad-spectrum, as there is no time to determine the type of pathogen), and sometimes surgical intervention. It is necessary if the cause of the disease is a spasm of the ode sphincter, a stone stuck in the duct, or another obstruction (tumor). After its completion the basis of treatment should be a special medical diet.
As a basis, gastroenterologists usually take diet number 5, which Manuel Peusner developed in the Soviet period for patients with cholecystitis and other pathologies that inhibit bile synthesis and drainage. But later the author himself changed it by creating diet No5p.
general provisions
For adult patients with a mild course of the disease, version No5p of the table is suitable without mechanical savings - it does not require grinding of food to a homogeneous mass. And for children the menu should most often be made from ground products. Nutrition during the period of exacerbation of chronic pancreatitis (especially during the first three days after its onset) and the acute phase, which first occurred, has a few mandatory general rules.
- ᲡSimple. Recipes should be as simple as possible - not stuffed with breasts and meat salads, even if all the ingredients in their composition "fit" individually in the diet.
- Complete starvation in the first days. With exacerbation of pathology is prescribed starvation. That is, only warm alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
- Only stew and boil (boiled in water, steamed). Tables No. 5 and 5p do not cover other methods such as baking and roasting.
- Minimal fat. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. Along with it vegetable and animal fats should be equally strictly restricted because the same agent, bile, destroys them. They can be consumed no more than 10 g per day, but in any proportion.
- Without spices. Especially spicy and spicy.
- No nuts. Seeds are also prohibited. This type of food is rich in vegetable oil and is difficult to eat even in powder form.
- Salt to taste. Its consumption does not affect the course of the pathology in any way, the daily intake of salt remains the same as in healthy people - up to 10 g per day.
- Less fiber. This component, which is usually appreciated by nutritionists and people with digestive problems, is strictly restricted for use during inflammation of the pancreas. The secret of its "magic" effect on the intestines is that the fiber is not absorbed, is not absorbed and irritates various parts of the intestine, stimulates peristalsis and water secretion. Situation. You can eat only carrots, zucchini, potatoes, pumpkin, rich in starch and pulp, but with relatively poor solid fiber. White and red cabbage is forbidden, but cauliflower can be eaten (excluding flowers, twigs and stalks).
- In small portions. There, as before, three times a day, weighing half a kilogram or more, with pathologies of the pancreas is impossible. There should be at least five meals a day, and the total weight of all foods should not exceed 300 g.
- Ban soda, coffee, alcohol and quasi. It is better to exclude these drinks from the diet forever. But if during the remission they just do not have to score, then during the aggravation they are strictly forbidden.
Sour vegetables (e. g. tomatoes) as well as all berries and fruits are also prohibited. They further stimulate bile secretion. The diet should focus on low-fat and non-fat dairy products, shrimp, eggs (every day, not raw or fried). Ground grains are used as a source of carbohydrates, mainly buckwheat, rice and oatmeal.
Menu example
The diet menu for pancreatitis should include sufficient proteins and carbohydrates. But it is better to avoid "brute force" with the latter by limiting the addition of sugar and honey in drinks and dishes. Buckwheat, a favorite cereal for diabetics, should be included in the diet more often because it is composed of complex carbohydrates. Gives an unpleasant taste when added to hot dishes), aspartame. Diet in the period when the exacerbation or primary inflammation of the pancreas is already subsiding, may look like this.
Monday
- First breakfast. Boiled chicken breast puree. Rice ground.
- Lunch. Steamed fish cakes.
- Dinner. Rice soup in chicken broth half diluted in water. Milk jelly.
- Afternoon tea. Omelet from two eggs.
- The first dinner. Chicken meat balls (mince the meat with the rice). Grate the buckwheat with a dessert spoon of butter.
- Second dinner. Low-fat, non-sour cottage cheese, crushed in a blender with a teaspoon of sour cream.
Tuesday
- First breakfast. Oatmeal. Boiled cauliflower.
- Lunch. Lean beef pate with butter. Tea with milk and a few slices of white bread soaked in it.
- Dinner. Fish soup made from lean fish with rice and water. Milk or fruit jelly without fruit.
- Afternoon tea. Cottage cheese pasta with lean sour cream.
- The first dinner. Steamed turkey breast soup. Ground liquid buckwheat.
- Second dinner. Puree of boiled shrimp with boiled rice.
Wednesday
- First breakfast. Fish meat balls with rice (grate the rice with the fish). Puree from boiled carrots.
- Lunch. Two tablespoons of grated low-fat hard cheese.
- Dinner. Soup made with oatmeal, diluted chicken broth and grated breast. Cottage cheese pasta with sour cream.
- Afternoon tea. A few flowers of boiled cauliflower.
- The first dinner. Ground pasta with cottage cheese. Steam omelette from two eggs.
- Second dinner. Pumpkin porridge. Tea with a few white crackers soaked in it.
Thursday
- First breakfast. Zucchini puree. Chicken steamed cutlet.
- Lunch. Two tablespoons of grated low-fat hard cheese.
- Dinner. Creamy potato soup with butter. Lean beef puree.
- Afternoon tea. Turkey breast soup.
- The first dinner. Ground buckwheat. Lean fish soup.
- Second dinner. Carrot-pumpkin porridge.
Friday
- First breakfast. Cottage cheese pasta with sour cream. Zucchini puree. Chicken meat balls (grate the rice, like meat).
- Lunch. Mashed potatoes with butter.
- Dinner. Milk soup milled pasta. Omelette with two eggs boiled in grated cheese.
- Afternoon tea. A few flowers of cauliflower. Rice pudding.
- The first dinner. Milled shrimp in sour cream sauce. Buckwheat puree. Tea with white crackers.
- Second dinner. Carrot puree. Milk or fruit jelly without fruit.
Saturday
- First breakfast. Pumpkin porridge. Low fat beef soup.
- Lunch. Fish meat balls.
- Dinner. Rice soup with lean chicken broth and minced meat. Ground pasta with milk.
- Afternoon tea. Oatmeal.
- The first dinner. Lean beef pate with butter. Potato Puree.
- Second dinner. Pumpkin-carrot porridge. Tea with some white crackers
Sunday
- First breakfast. Cottage cheese pasta with sour cream. ლეMlet.
- Lunch. Zucchini under a cheese coat. Tea with milk and white crackers
- Dinner. Buckwheat soup with beef puree diluted in beef broth. Steamed turkey breast soup.
- Afternoon tea. Oatmeal.
- The first dinner. Potato Puree. Chicken cutlet.
- Second dinner. Rice cottage cheese pudding.
The pancreatitis diet requires the exclusion of all confectionery products, including chocolate and cocoa. You should limit your intake of any fats, dietary acids and fiber. Also, do not eat fresh bread. Millet, wheat, corn are banned. You can not grind this grain with a blender. All legumes, including soybeans, have also been canceled. They are rich in plant proteins, which is why they are valued by vegetarians. But they are also "culprits" in the production of increased gas, an increase in gastric acidity, which is highly undesirable during the acute period.