Acute pancreatitis ICD code. Reactive pancreatitis - when the pancreas becomes inflamed

ACUTE PANCREATITIS

ICD-10 code

K85. Acute pancreatitis.

Acute pancreatitis - acute illness pancreas, accompanied by necrosis and hemorrhage in the organ, due to enzymatic autolysis.

In children, acute pancreatitis is rare, its prevalence ranges from 0.4 to 1.0% of all surgical diseases.

Etiology and pathogenesis

The causes of the disease are the intake of fatty foods, causing hyperstimulation of the pancreas, alcohol consumption, cholelithiasis(GSD), leading to obstruction of the pancreatic duct. Metabolic, drug-induced damage, renal failure, infections (mumps, Coxsackie type B virus, cytomegalovirus, chicken pox, hepatitis B), surgical interventions are considered as etiological factors less frequently.

The disease occurs due to the early activation of zymogenic granules that release lipolytic enzymes phospholipase A and lipase, which digest pancreatic cells, resulting in fatty pancreatic necrosis. If, as a result of accumulation in pancreatocytes damaged by lipase, free fatty acids pH shifts to 3.5-4.5, then intracellular trypsinogen is transformed into trypsin. Trypsin activates lysosomal enzymes and proteinases, which leads to proteolytic necrobiosis of pancreatocytes. Elastase lyses the walls of blood vessels, interlobular connective tissue bridges. This contributes to the rapid spread of enzymatic autolysis (self-digestion) in the pancreas and beyond, i.e. acute pancreatitis is a toxic enzymopathy (Figure 5-1). The trigger mechanism is the release of activated pancreatic enzymes from acinar cells of the pancreas, usually present as inactive proenzymes. The severity of the disease depends on the balance between released proteolytic enzymes and antiproteolytic factors. The latter include an intracellular protein that inhibits pancreatic trypsin and circulating p2-macroglobulin, α-1-antitrypsin, and C1-esterase inhibitors.

In table. 5-1 presents the clinical and morphological classification of acute pancreatitis.

Table 5-1. Clinical and morphological classification of acute pancreatitis

Rice. 5-1. The pathogenesis of acute pancreatitis

Clinical picture

Regardless of the nature and course of the disease, pancreatitis has a number of common clinical manifestations combined into the following syndromes:

pain;

dyspeptic;

exocrine insufficiency;

endocrine insufficiency.

Pain syndrome characterized by pain in the upper abdomen, to the left and to the right of the midline of the body, which radiate to the lower back, left leg, are girdle in nature. The pains are aggravated by taking any food, relieved by hunger, cold and rest. The intensity of pain can be different, but most often they are intense, last for several hours, and are poorly stopped.

Dyspeptic syndrome manifested by nausea, vomiting that does not bring relief, flatulence.

Syndrome of exocrine (exocrine) insufficiency is associated with a deficiency of digestive enzymes: amylase (amilorrhea - excretion of starch with feces), trypsin (creatorrhoea - undigested muscle fibers), lipases (type I steatorrhea - excretion of more than 9% of neutral fat when the daily diet contains 100 g of fat) and is determined according to the data coprograms. Characterized by polyfecal matter (more than 400 g/day). There is no type II steatorrhea - the release of a large amount of fatty acids (pathology of the small intestine).

Syndrome of endocrine (intrasecretory) insufficiency manifested by hyperglycemia and ketosis.

Due to a change in the balance in the protease-antiprotease system, a systemic inflammatory response develops (SIRS - System Inflammatory Response Syndrome), causing multiple organ failure (as with extensive injuries, burns, sepsis), the main manifestations of which include:

respiratory failure;

Arterial hypotension;

prerenal azotemia;

tubular necrosis;

Disseminated intravascular coagulation

(ICE);

Pancreatic shock.

Diagnostics

AT general analysis blood, nonspecific changes are noted: leukocytosis, neutrophilia, increased ESR.

Biochemical studies include indicator (amylase, transaminases) and pathogenetic (lipase, trypsin) tests. The activity of amylase in the blood in acute pancreatitis increases sharply. Amylase excreted in the urine is called diastase, and its level is also increased, with the greatest amylase and diastasuria occurring with mumps infection.

Based on the activity of phospholipase A2 in the blood serum, abnormalities in the lungs are assessed; according to the level of serum ribonuclease (RNase) - the phase of acute destructive pancreatitis. An increase in alkaline phosphate, transaminases and bilirubin is a diagnostic criterion for obstruction of the biliary tract.

Other biochemical signs are hypercoagulability, hypoproteinemia, increased urea levels. 15% of children with pancreatitis develop hypocalcemia and up to 25% have hyperglycemia during an acute attack.

Unfavorable prognostic signs of acute pancreatitis:

. leukocytosis more than 15,000x10 9 /l;

Hypercoagulability (fibrinogen>6 g/l);

Amylasemia >6 norms;

Amylosuria >4 norms;

Hyperbilirubinemia >4 norms;

Hyperglycemia >2 norms;

Increase in urea >2 norms;

Hypoproteinemia<60 г/л.

An important diagnostic criterion is a test using monoclonal antibodies, which reveals a decrease in the activity of elastase-1 in the feces. Indicators: normal - 200 mcg / g of feces and more; moderate, mild degree of exocrine insufficiency - 100-200; severe degree - less than 100 mcg / g of feces.

Instrumental diagnostics includes ultrasound of the pancreas (decreased echogenicity - edema, increased echogenicity - proliferation of connective tissue), MRI and CT. The latter has an advantage over ultrasound, as it provides better specific visualization of pancreatic tissue and retroperitoneal formations. It allows you to assess the level of tissue metabolism, the presence of ischemia, necrosis of pancreatocytes, fluid in the surrounding tissues of the pancreas in acute pancreatitis (Fig. 5-2, a), while in chronic pancreatitis, for example, multiple calcifications (Fig. 5 -2, b).

Rice. 5-2. CT: a - acute pancreatitis (arrows indicate accumulations of fluid in the surrounding tissues); b - chronic pancreatitis (arrow indicates multiple calcifications in the pancreas)

Endoscopic examination of the upper gastrointestinal tract refers to additional instrumental research methods in acute pancreatitis and is used for differential diagnosis with diseases of the stomach and duodenum.

Laparoscopy allows you to clarify the form and type of the disease, to diagnose pancreatogenic peritonitis, parapancreatic infiltrate, concomitant destructive cholecystitis.

Pathomorphology

With pancreatic necrosis, there is a complete absence of pancreatic tissue - “minus tissue”: the absence of lobules, connective tissue septa, etc. (autolysis); interstitial edema, hemorrhages, fat and cellular necrosis (Fig. 5-3, a). Acute serous-purulent pancreatitis is represented by massive leukocyte infiltration of the stroma of the gland, the accumulation of purulent masses in the lumen of the large excretory duct (Fig. 5-3, b).

Rice. 5-3. Pathomorphology of pancreatic necrosis and pancreatitis: a - macropreparation of the pancreas: pancreatic necrosis; b - micropreparation: acute serous-purulent pancreatitis (hematoxylin-eosin staining; χ 100)

Differential Diagnosis

Radiological features of acute and chronic pancreatitis are presented in fig. 5-2. The main diseases from which acute pancreatitis is differentiated are:

acute cholecystitis, gastritis, food intoxication, perforated gastric and duodenal ulcer, acute appendicitis, intestinal obstruction, renal colic, myocardial infarction. It is necessary to take into account the possibility of mesenteric obstruction, ectopic pregnancy (in adolescent girls), lower lobe pneumonia and paranephritis.

Treatment

Emergency hospitalization. The therapy is complex, conservative. Assign strict bed rest, cold on the stomach.

Showing parenteral administration of liquids (saline solutions, 5-10% glucose solutions with insulin) up to 1-3 liters, potassium, calcium preparations, low molecular weight plasma substitutes, protein preparations.

With fermentemia and fermenturia, intravenous administration of anti-enzymatic drugs (antikinins), such as aprotinin (trasilol *, contrycal *, Gordox *), is indicated, the dose of which depends on the severity of the process. Antibacterial therapy is carried out with the threat of complications.

Regulatory peptides, somatostatins are effective. Octreotitis (sandostatin *) is used in RD 50-100 mcg 2-3 times a day subcutaneously, intramuscularly, intravenously for 3-5 days. If necessary, prescribe anti-inflammatory, antihistamine and diuretic drugs.

Anticholinergic, antispasmodic and ganglioblocking drugs are also prescribed to relieve pain and spasm of the sphincter of Oddi: drotaverine (no-shpa *), papaverine, mebeverine (duspatalin *), platyfillin, atropine, ganglefen (gangleron *), metamizole sodium (analgin *, baralgin *). Platifillin is prescribed in a 0.2% solution for injection No. 10, in tablets - 5 mg each.

The functional activity of the pancreas is inhibited by m-anticholinergic pirenzepine (gastrocepin *), which is prescribed in tablets of 25 and 50 mg. Children 4-7 years old are prescribed 12.5 mg (1/2 tablet), 8-15 years old - 25 mg 3 times a day for 2-3 weeks with gradual withdrawal.

Prevention

Secondary prevention includes the elimination of the etiological factor of the disease. Dispensary observation after acute pancreatitis continues for 5 years. After 3 years, the child is transferred to the risk group for chronic pancreatitis with an annual examination. Rational nutrition is of great importance, which is based on the principle of balance in terms of the main food ingredients, taking into account the physiological characteristics of childhood. It is necessary to absolutely exclude alcohol and alcohol-containing drinks, limit the use of tonic liquids with the addition of preservatives and dyes. Frequently ill children, as well as patients suffering from allergic diseases, deserve special attention.

Forecast

The prognosis is serious with the development of complications. Acute uncomplicated pancreatitis in children may have a favorable prognosis. With this form, mortality is about 10%, and in rare cases, with necrotizing or hemorrhagic pancreatitis, up to 90%. Recurrent episodes of acute pancreatitis lead to chronic pancreatitis.

CHRONIC PANCREATITIS

ICD-10 codes

K86.1. Pancreatitis.

K87. Chronic pancreatitis.

K86. Recurrent pancreatitis.

Chronic pancreatitis is a progressive disease of the pancreas, characterized by an increase in irreversible necrotic and inflammatory-destructive changes in the parenchyma, leading to a persistent violation of the exo- and endocrine functions of the organ.

Literature data on the prevalence of pancreatitis in children in the structure of diseases of the digestive system are extremely contradictory (from 5 to 25% of all patients with gastroenterological diseases).

Etiology and pathogenesis

In order to identify patients with early stages, with hereditary pancreatitis, a thorough analysis of the family tree is carried out. Often, pancreatitis develops with cystic fibrosis, Crohn's disease, NUC, PU. Often the cause of chronic pancreatitis in children is unknown.

Obstruction of the pancreatobiliary tract due to congenital (stenosis of the papilla of Vater, anomalies of the duodenum, arteriovenous compression) and acquired (GSD, opisthorchiasis, echinococcosis) causes is considered the main etiological factor in pancreatitis (Fig. 5-4). In childhood, blunt trauma to the abdomen is possible when hitting, falling from a height (for example, a swing - hitting the swing seat in the stomach), hitting an obstacle when riding a bicycle (trauma on the steering wheel). Currently, alcohol consumption, including in children, is of particular importance as a cause of pancreatitis. Among viral infections, mumps, herpes, mononucleosis are important, among bacterial infections - yersiniosis, salmonellosis, etc.

An increase in pressure in the ductal system, leading to tissue damage and triggering a cascade of reactions, causes the activation of enzymes in the gland. A significant role is played by changes in the microcirculation system, ultimately leading to hypoxia of the gland cells and an increase in the level of cAMP in them, which, in turn, promotes the activation of Ca 2 + transport into the cells. As a result of this pro-

Rice. 5-4. The pathogenesis of chronic pancreatitis

excessive saturation of cells with calcium, its excessive accumulation in mitochondria, which leads to uncoupling of oxidation and phosphorylation. Next comes the phase of deenergization of cells and the growth of dystrophy processes.

Classification

Great difficulties are caused by the diagnosis of pancreatitis against the background of gastroduodenal pathology. In the absence of organic changes and the appearance of pancreatic abdominal pain and a slight increase in the level of amylase, it is recommended to diagnose dysfunction of the sphincter of Oddi, the pancreatic variant. Dysfunctional disorders of the biliary tract (K82.8) are divided into 2 types: dysfunction of the gallbladder and dysfunction of the sphincter of Oddi. Often, the terms "reactive pancreatitis" or "dyspancreatism" are used, although they are not in the ICD-10. Apply the following working classification of pancreatitis in children (Table 5-2).

Table 5-2. Classification of chronic pancreatitis in children

Clinical picture

The clinical picture during an exacerbation of chronic pancreatitis is similar to that of acute pancreatitis, regardless of etiology. A significant place is occupied by the symptoms of intoxication, asthenovegetative manifestations: increased fatigue, frequent headaches, emotional lability, irritability. In some patients, severe pain syndrome is accompanied by an increase in body temperature for several days, changes in the clinical analysis of blood.

Diagnostics

The diagnosis of chronic pancreatitis is made on the basis of the following symptoms.

The presence of episodes of abdominal pain for more than 1 year with localization in the upper left quadrant, epigastrium, a strip from hypochondrium to hypochondrium (shingles).

Identification of signs of violation of the exocrine function of the pancreas.

Changes in the structure of the organ according to ultrasound, CT or MRI, magnetic resonance cholangiopancreatography, retrograde cholangiopancreatography.

Pathomorphology

Chronic inflammatory process in the pancreas is characterized by irreversible morphological changes. There is atrophy of the glandular elements (pancreocytes) with the expansion of the ducts and their replacement with connective tissue, calcification, cysts. On fig. 5-5, a shows a microscopic picture of moderate mixed-cell infiltration in the stroma and proliferation of connective tissue along the septa (stromal fibrosis).

Differential Diagnosis

Similar symptoms can be observed in many diseases, primarily in the most common pathology of children.

age - chronic gastritis and / or CHD. Significance in the recognition of chronic pancreatitis is the pathology of the postbulbar duodenum and the major duodenal papilla (Fig. 5-5, b), determined using endoscopy, as well as measuring pressure in the duodenum. With CHD, changes concern only the mucous membrane of the stomach and duodenum.

Rice. 5-5. Pathomorphology of pancreatic diseases: a - micropreparation for chronic pancreatitis (hematoxylin-eosin staining; χ 250); b - anatomical elements of the sphincter of Oddi; c - normal acini of the pancreas; d - cystic fibrosis; e - chronic pancreatitis (arrows indicate the expansion of intercellular spaces)

Chronic pancreatitis is differentiated from cystic fibrosis, in which the viscosity of mucus accumulating in the ducts increases, and the expansion of the ducts and their terminal sections leads to atrophy and fibrous replacement (Fig. 5-5, d). In pancreatitis, there is an expansion of intercellular spaces, resulting in the release of enzymes to the outside, a violation of the permeability of the acini up to fatty degeneration of cells (Fig. 5-5, e) (comparison with the norm - Fig. 5-5, c).

Treatment

An individual therapeutic approach is needed, but the following principles of therapy are generally accepted:

Relief of pain;

Functional rest of the pancreas;

Decreased secretory activity of the pancreas;

Correction of exocrine and endocrine insufficiency.

During the period of exacerbation, the child's stay in the hospital, the creation of physiological rest and sparing of the diseased organ are shown, which is ensured by the appointment of bed rest, hunger. Constantly using a nasogastric tube, it is recommended to aspirate gastric contents.

To eliminate the pain syndrome from medications, cholinergic and antispasmodics, analgesics,

blockers of pancreatic secretion, antacids, which allows you to eliminate spasm of the sphincter of Oddi, reduce intraductal pressure and ensure the passage of pancreatic juice and bile into the duodenum.

Traditionally and successfully during exacerbation of pancreatitis, anticholinergic agents are used to inhibit gastric and pancreatic secretion: 0.1% atropine solution, 0.2% platyfillin solution, 0.1% metacin solution, etc.

In recent years, in order to suppress gastric secretion, modern antisecretory agents have been used: PPI omeprazole, selective H2 receptor blockers (for example, famotidine). Omeprazole IV (losek*) is prescribed at 20-40 mg for 3-5 days, then they switch to taking omeprazole orally (omez*, ultop*) for 4-6 weeks.

Reducing the stimulating effect of hydrochloric acid is achieved by prescribing antacids for 3-4 weeks (almagel *, maalox *, phosphalugel *, rutacid *, etc.).

Violations of the motor function of the duodenum, biliary tract with the phenomena of duodenostasis and hypomotor dyskinesia are stopped by the appointment of prokinetics (dommperidone, cisapride *).

One of the main directions in the treatment of chronic pancreatitis is the use of regulatory peptides - analogues of endogenous somatostatin, which include octreotide and somatostatin - humoral inhibitors of exocrine and endocrine secretion of the pancreas and intestines. Octreotide causes a pronounced inhibition of the secretion of the pancreas, stomach, liver and small intestine, inhibits motility, reduces intraductal hypertension, and suppresses the secretion of biologically active substances. The anti-inflammatory effect of octreotide is also associated with the stabilization of cell membranes, the blockade of cytokinogenesis, and the production of prostaglandins.

Octreotide (sandostatin *) 0.01% solution is available in ampoules of 50 or 100 mcg, the course of treatment does not exceed 5-10 days. RD for preschool children is 25-50 mcg, for schoolchildren - 75-100 mcg 2-3 times a day. The drug is administered intravenously and subcutaneously. The duration of the drug action is up to 10-12 hours. No pronounced side effects were noted.

The antikinin drug aprotinin (Kontrykal*, Gordox*) is now giving way to somatostatin preparations.

Of particular importance during the period of pronounced exacerbation of pancreatitis is infusion therapy aimed at eliminating metabolic disorders against the background of endogenous intoxication. For this purpose, the patient is administered dextran (rheopolyglucin *), 5% glucose solution, 10% albumin solution, fresh frozen plasma, glucosone-vocaine mixture.

During the period of relief of exacerbation against the background of restriction of nutrient intake, nutritional support is important - the appointment of parenteral and enteral nutrition. Amino acids for parenteral nutrition (aminosteril KE *, aminosol-neo *, etc.), polyamine, electrolyte solutions are administered intravenously, taking into account acid-base balance indicators. Along with them, fat emulsions are used to immobilize active lipase and compensate for the deficiency of fatty acids in the blood: 10-20% solution of intralipid * or lipofundin * with heparin IV drip at a rate of 20-30 drops per minute at the rate of 1-2 g of fat per 1 kg body weight.

Enteral nutrition can be carried out with therapeutic mixtures - protein hydrolysates, as in children of the first year of life, but with pancreatitis, these mixtures can be used at any age. The mixtures are administered intraduodenalally through a probe in a warm form.

Antibacterial therapy is indicated to prevent secondary infection, with the threat of the formation of cysts and fistulas, the development of peritonitis and other complications. Protected penicillins (amoxiclav*, augmentin* 100 mg/kg IV) or third-generation cephalosporins (cefotaxime*, ceftriaxone* 50-100 mg/kg IM or IV) are used.

Apply sodium pentoxyl, which has antiproteolytic and anti-inflammatory effects, 50-100 mg 3 times a day after meals for 3-4 weeks under the control of a blood test.

A difficult issue in the treatment of pancreatic insufficiency is the choice of enzyme replacement therapy (Table 5-3), which is aimed at eliminating violations of the absorption of fats, proteins and carbohydrates. After the termination of the starvation diet, preference is given to non-combined pancreatin preparations, then, after 3-4 weeks, when the exacerbation subsides, enzymes with the addition of bile acids and / or hemicellulase are used.

Table 5-3. Classification of enzyme preparations

Enzyme activity is determined by lipase. Assign enzymes 3-4 times a day during meals, courses of 2-3 weeks with a 3-4-week break, only 4-5 courses per year. Pancreatin at a dose of 250 mg is prescribed for children under 3 years old, 1/2 tablet, 3-7 years old - 1 tablet, 8-9 years old - 1.5 tablets, 10-14 years old - 2 tablets 3 times a day. Pancreatin with lipolytic activity 3500 IU (mezim forte *) in tablets is also prescribed, the doses are the same as for pancreatin. In mezim forte 10,000 * (10,000 IU), the dose of lipase is 3 times higher than that in mezim forte.

Among the many enzyme preparations, microgranular enzymes with an acid-resistant shell have the best effect: licrease*, pancitrate*, Creon*, etc. Creon* in capsules of 10,000 IU (by lipase) contains 150 mg of highly purified porcine pancreatin. The drug is prescribed at a dose of 1000 IU / kg per day for pancreatitis. Creon * 25,000 and 40,000 units are used for cystic fibrosis. Creon 10,000 children under 2 years of age are prescribed 1/3 capsule, 2-5 years - 1/2 capsule, over 5 years - 1 capsule 3 times a day. For infants, 1/3-1/4 capsules (it is convenient to divide on a notebook sheet into a cage, after pouring out of the capsule) are added to 120 ml of milk formula, the daily dose is not more than 10,000 IU (1 capsule). Pancytrate * in capsules is prescribed from 6 years of age. Wobenzym* is prescribed at a dose of 1 tablet per 6 kg of body weight per day, divided into 3 doses.

In the recovery period, the use of essential phospholipids and other hepatoprotectors, vitamin complexes, choleretic agents (immortelle, choleretic tea, sorbitol, xylitol), calcium preparations, parenteral and oral antioxidants is recommended. Physiotherapy, physiotherapy exercises, mineral water intake of low and medium mineralization are widely used. Against the background of a pronounced pain syndrome, local hypothermia is prescribed, and as the pain syndrome and enzyme activity decrease, ultrasound, diathermy, inductothermy, sinusoidally modulated currents, paraffin, and ozokerite are prescribed.

In most children, complex therapy can improve the condition and compensate for impaired functions.

In severe cases, against the background of the development of complications, surgical treatment is indicated, the tactics of which are determined jointly with surgeons.

Prevention

Prevention of chronic pancreatitis involves a number of steps. They are presented below.

Forecast

The prognosis is favorable, but chronic pancreatitis is a recognized risk factor for the development of pancreatic adenocarcinoma.

• Tactics of treatment of chronic pancreatitis

  Improvement of methods of conservative treatment (drug treatment and diet therapy) in recent years has contributed to a significant increase in the effectiveness of conservative treatment of the disease and reduce the suffering of most patients. However, about 10% of patients with chronic pancreatitis go to the doctor when they already have gross anatomical changes in the ducts or around the pancreas. Some of them have to recommend surgical treatment, which in recent years has been resorted to somewhat more often.

  • Tactics for exacerbation of chronic pancreatitis

    In most cases, exacerbation of chronic pancreatitis is stopped with the help of conservative therapy: agents are used to reduce the functional activity of the pancreas by indirect methods; in the presence of peripancreatitis, antibacterial agents are indicated. As the exacerbation subsides, enzyme preparations are used (Creon, Pantsitrat).

    Slightly more than 20% of patients admitted to the hospital due to exacerbation of chronic pancreatitis are not sensitive to conservative therapy. Half of them do not follow diets and withdrawal regimes, even in a hospital. They should not be offered surgery. The other half follow all or most of the recommendations and still no improvement is achieved. This group of patients has indications for surgical treatment.

  • Tactics in the presence of pseudocysts of the pancreas

    If a small cyst (less than 4 cm in diameter) is detected, observation with repeated ultrasound is usually established.

    With medium-sized pseudocysts (4-5 cm in diameter), one has to take into account the possibility of developing complications - rupture of the cyst, bleeding from it, suppuration of the cyst, in which case an observation lasting 4-8 weeks is established. If the cyst is stable in size (spontaneous regression is relatively often observed), then the question arises of its drainage. Drainage is performed either with the help of an endoscope transgastric or transduodenal or percutaneous. Radical improvement is achieved in 80-85% of patients, complications occur in 5-8%, recurrence of pseudocysts is observed in 5%.

    Surgical procedures that are used in the treatment of pseudocysts include resection, internal and external drainage. Resection is the treatment of choice, but it is only possible for cysts located in the tail of the pancreas.

    External drainage (which in some cases can be performed by percutaneous drainage) is reserved for cases where an anastomosis between the cyst wall and the intestine is not possible, or the patient has developed an acute comorbidity.

    Internal drainage involves anastomosis of the cyst wall with the colon, stomach, or duodenum.

    Complications (bleeding, infection, or fistula) develop in 30% of patients with external drainage and 15% with internal drainage.

• Evaluation of the effectiveness of treatment

  The criterion for the effectiveness of enzyme therapy is the reduction of dyspeptic syndrome (cessation of diarrhea and stabilization of body weight). A dramatic reduction in steatorrhea is desirable but not an absolute requirement.

  Complex conservative treatment of exacerbations of chronic pancreatitis in a specialized department gives an immediate positive effect on average in 80-85% of patients. The remaining 15-20% of patients whose treatment turned out to be ineffective are divided into approximately two groups of equal size:

  • Patients whose conservative treatment has led to a slight improvement due to non-compliance with the diet and withdrawal regimen, even in a hospital setting. It is not advisable to offer them surgical treatment in the absence of gross anatomical changes in the main pancreatic duct, the zone of the ampulla of the major duodenal papilla, and also the celiac trunk.
  • Patients with proven gross anatomical changes in the main pancreatic duct, the zone of the ampulla of the major duodenal papilla and the celiac plexus. These patients require surgical treatment.
  • Reasons for the lack of effectiveness of conservative treatment

    Reasons for the low effectiveness of conservative treatment	Complication rate, %
    Gross deformities of the main pancreatic duct or the area of ​​the major duodenal papilla	50-70
    Severe peripancreatitis	15-20
    Compression of the celiac trunk and celiac nerve plexus	5-15
    Subhepatic form of portal hypertension	2-3

• Follow-up of a patient with chronic pancreatitis

  Patients with chronic pancreatitis are observed in the clinic, where at least 2 times a year, even in the absence of signs of an exacerbation of the disease, they are examined by a gastroenterologist (therapist) and laboratory tests are performed (general blood and urine tests, amylase and blood glucose, coprogram, urine diastasis) and instrumental (ultrasound of the gland, biliary tract, liver at least 1 time per year, radiography of the stomach and duodenum or esophagogastroduodenoscopy if indicated) examinations.

  A complex of health-improving measures is being carried out, the content of which is determined by the form and course of the disease - compliance with dietary recommendations, refraining from drinking alcohol and smoking, drug therapy (antispasmodics, enzyme preparations) according to indications.

Chronic pancreatitis is an inflammatory reaction that caused irreversible changes. This disease appears at any age in both sexes. It is more common in men between 40 and 55 years of age.

The concept and code of the disease according to ICD-10

A progressive inflammatory-destructive lesion leads to a violation of the external and intrasecretory function. With exacerbation, a feeling of pain appears, yellowness of the skin may be noted. In this case, the wrinkling of the gland occurs, in some places the disappearance of the acini is noted.

Chronic pancreatitis according to ICD-10 has the code K86.

Etiology

Among the variety of causes, alcohol intoxication, pathology of the OBD zone, and other diseases of the biliary tract come first. Alcohol is the cause of direct toxic effects on the body.

With daily use of 80-120 ml for two years, a decrease in bicarbonate secretion is observed. There is an increase in the viscosity of the juice, blockage of the ducts.

Doctors note that the cause may be the intake of a large amount of fried, fatty, meat foods. Pancreatic hypertension also plays an important role. It occurs due to an obstruction in the final section of the large bile duct.

Pathogenesis

The basis of the pathogenesis in most people is damage to the tissue of the gland by digestive enzymes. They are secreted in an inactive state, but after entering the duodenum, they are activated.

Many modern scientists say that there are three main factors due to which autoaggression of enzymes is noted:

• obstruction of the outflow of secretion of the gland;
• high volume and enzymatic activity;
• reflux into the ductal system of the contents of the duodenum and bile.

Often the cause is chronic cholecystitis. Such patients often require surgical treatment.

The buildup of pancreatic juice can lead to the formation and growth of calcifications, cause spasms, stenosis,.

Because of this, the contents are thrown into the pancreatic duct. Due to all violations, the enzymatic liquid thickens, the amount of protein increases, and traffic jams appear.

Classification of chronic pancreatitis

Depending on the etiology and pathogenesis, several types of chronic pancreatitis are distinguished:

• biliary-dependent;
• parenchymal;
• recurrent;
• calculous;
• alcoholic.

billiary addict

In this form, the gland loses its functionality completely. The disease is often associated with congenital pathologies. Pathology develops slowly.

In half of the cases, pancreatitis of this type is a consequence of the features of the gallbladder ducts, which are anatomically close to the pancreas.

paranchymatous

Often develops against the background of other diseases, for example, with. May appear due to irregular meals, unbalanced nutrition. Pathology proceeds in waves.

Remissions are replaced by exacerbations, the latter lead to the appearance of scars. This causes a violation of the patency of the flows, causes changes in the secretory and endocrine functions. As a consequence, there may be a violation of the synthesis of insulin.

recurrent

The disease is characterized by exogenous deficiency, inadequate production of glandular substances. Occurs after an acute form of the disease, in which a pseudocyst is formed. Fluid accumulates in it, which leads to an increase in the size of the formation.

There is a squeezing of neighboring organs, a pain syndrome occurs. The progression of the disease leads to thinning of the glandular tissue, replacement of the connective tissues of the pancreatic parenchyma.

calculous

With this form, calcium salts are deposited in the tissues of the organ. This occurs due to violations of the chemical composition of the juice. As a result, a fireplace is formed, consisting of lime. Often they are small in size, have a porous structure. This form appears at the age of 50 years.

Alcoholic

Alcohol and its decay products poison the pancreas. Proteins actively begin to appear in the juice, and the production of a special acid increases in the stomach. Proteins in the pancreatic fluid lead to sludge and protein blockages.

There is a violation of the natural outflow of secretion into the intestines. Active enzymes begin to penetrate into the tissues of the pancreas. The latter turn out to be oversaturated with enzymes, due to the lack of other food, they begin to digest the tissues of the organ. Necrosis starts, which is very difficult to stop.

stages

There are several clinical stages of chronic pancreatitis depending on the severity of symptoms:

• Initial. Lasts up to 10 years. There are symptoms, but the functions of the organ are not impaired.
• External secretory insufficiency. Appears after 10 years. It is characterized by a violation of the processes of digestion.
• Complications. Inflammation is joined by infectious processes, cysts appear, endocrine pancreatic insufficiency appears.

Symptoms in children and adults

Initial changes are asymptomatic or have few specific signs. When the first pronounced exacerbation appears, pathological disorders are already significant.

During the remission period, a person feels normal. With exacerbation, pain appears in the upper abdomen, in the left hypochondrium. Sometimes it has an encircling character. Discomfort can be given to the area of ​​​​the projection of the heart, accompanied by heartburn, flatulence.

In the chronic form, vomiting can be frequent, debilitating. Diarrhea alternates with constipation.

As the disease progresses, the frequency of exacerbations increases. On external examination, patients become yellow sclera and skin. There are red spots on the chest and abdomen that do not disappear after pressure.

Children have the same symptoms. Pay attention to the pain of a dull, aching nature in the upper abdomen. In children under 8 years of age, the upper abdomen often hurts after eating. The pain may increase in the evening, especially with emotional overload and physical activity.

Note that chronic pancreatitis in childhood is rare. If it appears, it proceeds in parallel with diseases of the hepatobiliary system.

Complications

The appearance of early complications is associated with a massive release of excess enzymes and tissue decay products into the bloodstream. Late complications usually develop at 2-3 weeks from the onset of the disease, are infectious in nature.

In chronic pancreatitis, other organs that are functionally related to the gland often suffer. Usually there is damage to the liver and biliary tract. Reactive hepatitis, cholestasis and others can be observed.

It has already been noted that pseudocysts and may appear. With chronic inflammation, the outflow of pancreatic juice is difficult. Pseudocysts occur in 80% of cases. In addition, the relationship between chronic pancreatitis and cancer has been proven.

Diagnostics

The diagnostic process causes significant difficulties that are associated with the anatomical location of the organ. The method is often used. Especially if it is carried out repeatedly and at short intervals.

Thanks to this technique, it is possible to draw correct conclusions about the features of the entire digestive system, since it depends on the state of the digestive process.

Simple and labor-intensive methods are methods for determining pancreatic enzymes in blood and urine. They enter the blood from secretory passages and flows, acinar cells.

An increase in their level in the biological fluid occurs due to the occurrence of an obstacle to the outflow of pancreatic secretions and an increase in pressure in the pancreatic ducts.

Today, the method with the use of pancreatic secretion stimulants is also actively used.

In chronic pancreatitis, there is a decrease in bicarbonates and all enzymes. Especially in severe forms. Additionally may apply.

Sometimes even on survey pictures it is possible to detect areas of calcification in the pancreas.

Video program about chronic pancreatitis:

How to treat?

Treatment of chronic pancreatitis requires a lot of effort. Be sure to pay attention to proper nutrition and drug therapy, especially during periods of exacerbations. As an auxiliary method of exposure, folk remedies based on herbs can be used.

Nutrition

The menu should be dominated by protein dishes. With their help, the pancreas will be able to recover faster. At the same time, daily salt intake is limited to 10 g.

Be critical of the list of allowed products. It is best to focus on your well-being. If you feel worse, you should refuse to eat or introduce new products until the condition stabilizes.

What can and cannot be eaten?

If discomfort occurs in the digestive system, then it is necessary to cook the meat in minced form, steamed or boiled. Low-fat fish is also useful, which also helps prevent fatty degeneration of the liver. This is an important point in chronic pancreatitis.

It is better not to drink milk, but on its basis you can cook cereals, soups and jellies. Sour milk has a beneficial effect, but only fresh.

Perhaps there is rice, yesterday's bread and crackers, cereals, pasta. Steamed vegetables, sweet apples, dried fruits in the form of juices, compotes are allowed in a pureed form. You can eat potatoes, carrots, beets, pumpkins, zucchini, cauliflower.

Diet number 5

Diet No. 5P was developed specifically for people suffering from chronic inflammation of the pancreas. It is prescribed for 3-4 days after the exacerbation or for 5-6 days after the first diet.

It is designed to restore pancreatic function. For mechanical and chemical sparing, dishes are prepared in pureed or chopped form on water or steam.

A feature is the reduced energy value of 6280-7118 kJ. The restriction applies to fat carbohydrates. Products that are rich in active substances are excluded. They stimulate the secretion of the digestive glands.

Menu for the week

You can make your own menu for the week. In this case, there is a wiped and non-worn version.

Pureed food diet:

• First breakfast: porridge on the water, by the end of the week you can have milk, tea with milk.
• Second tomorrow; cottage cheese, jelly, mousse.
• Lunch: vegetable soup, meat soufflé, mashed potatoes, compote.
• Snack: rosehip broth, crackers, baked apple.
• Dinner: protein omelette, different types of porridge.

With an unmashed type of diet, you can eat boiled meat products, potatoes, cottage cheese, pasta. It is possible to drink non-carbonated mineral water before going to bed.

Herbal folk remedies

You can make a tincture of barberry. For this 100 gr. berries are poured with a liter of vodka. The tincture should be aged for two weeks. You need to drink a teaspoon 2 times a day. The course is 14 days. If necessary, the course is repeated.

A decoction of rosehip berries, which must be crushed and poured with a liter of boiling water, has a good effect. Half of the decoction is divided into 5 parts, which are drunk throughout the day.

Some herbalists offer to make an herbal collection. Plantain, mint, chamomile and calendula are taken in equal amounts. Corn roots are added to them. The whole mixture is poured with a liter of boiling water. It is necessary to take 50 gr. in a day.

Preparations

Drug treatment is based on a complex effect. Spasmolytic drugs are used, which can be combined with analgesics, enzyme and anti-enzyme drugs. They are used in medium doses and subcutaneously for severe pain.

Pancreatic enzyme inhibitors are prescribed. They are needed to reduce the activity of proteases, which often cause inflammation. The basis of such funds are the components of the lung parenchyma of animals.

To reduce inflammation, antibiotics are prescribed. Thanks to them, the development of complications can be avoided. Broad-spectrum antibiotics are usually prescribed.

Standard of care in the acute stage

The standard of care aims to:

• the fight against pain;
• elimination of digestive disorders and enzyme deficiency;
• elimination or reduction of the inflammatory process in the gland;
• preventing complications.

The standard includes a phased relief of pain with the use of myotropic antispasmodics. With exacerbations, the drug is drunk constantly, in courses.

After stopping the acute phase, enzymes and enzyme preparations are prescribed. As an adjunctive therapy, patients are prescribed vitamins of groups A, D, E.

The International Code and Classification of Diseases assigns ICD code 10 K.85 to acute pancreatitis, which is an inflammation of the pancreas. This rapidly developing disease is characterized by damage to the organ by its own enzymes. Pathology threatens the life of the patient if timely medical care is not provided. This dysfunction of the pancreas is very common and occurs with the same frequency in men and women.

The pancreas is a vital organ that produces a secret, which contains enzymes that ensure normal digestion. In addition, this organ produces insulin and glucagon, which control blood sugar levels. Most cases of acute pancreatitis are associated with alcohol consumption or with a history of gallstone disease.

There are a number of factors that contribute to the emergence and development of this acute pathology. These include:

• herpes viruses;
• infection with campylobacter or mycoplasma;
• operations on the abdominal organs;
• taking hormonal drugs that negatively affect the pancreas;
• pancreatic injury;
• developmental defects of the organ;
• hereditary predisposition;
• cholecystitis;
• gastroduodenitis;
• hepatitis;
• cystic fibrosis.

Acute inflammation of the pancreas causes damage to the functioning of the enzymes that are produced by this organ. If normally they are activated only in the digestive tract, then with such a pathology, the mechanism of their work is disrupted, and they begin their activity in the pancreas itself, which leads to the digestion of the organ's own tissue. The result of this complex process is inflammation of the pancreas, accompanied by edema of the organ tissue and damage to the vessels of the parenchyma.

Clinical manifestations

The symptoms of the disease depend on whether it is mild or severe. With a mild form, minimal damage to the organ is observed. The disease is expressed mainly by edema, which is easily treated and has a favorable outcome. In the case of a severe course, pronounced disorders and local complications develop in the form of necrosis, infection, abscess or cyst formation.

Most often, the symptoms appear unexpectedly, they are as follows:

1. Sharp intense pain in the navel. It can radiate to the lower back and resemble heart pain in nature, as it shoots into the shoulder. This syndrome increases gradually and can cause pain shock.
2. Indomitable nausea and vomiting, which does not bring relief to the patient. In some cases, vomit may contain blood.
3. Incessant hiccups. It is the result of irritation of the phrenic nerve.
4. Marked bloating. Occurs due to dysfunction of the transverse colon. When probing, pain is noted.
5. Chair change. It can be frothy, with a strong unpleasant odor, and contain food particles. But constipation with bloating also occurs.
6. Loss of consciousness, severe pallor.
7. Fever and rapid pulse.

In its development, acute pancreatitis goes through 3 phases. The first is enzymatic, it includes the initial 5 days of the disease. During this period, pancreatic necrosis may develop. Then comes the 2nd phase, lasting the next 7 days. It is characterized by the formation of a peripancreatic infiltrate. The third phase begins from 3 weeks from the onset of the disease and can last for months. It is characterized by the development of sequestration - a purulent complication.

Diagnosis and treatment of pathology

Diagnosis of acute pancreatitis is carried out on the basis of various methods: patient complaints, physical examination, laboratory tests, instrumental examination. According to the results of a clinical blood test, an increase in erythrocytes, a decrease in hemoglobin levels, an increase in leukocytes and ESR can be detected.

With the help of ultrasound examination of the abdominal organs, swelling of the pancreas and stones in the ducts are detected. To confirm the diagnosis, magnetic resonance imaging of the pancreas is performed. During the diagnosis, it is necessary to differentiate acute pancreatitis from acute appendicitis or cholecystitis, perforated ulcer of the stomach or intestines, intestinal obstruction, or gastrointestinal bleeding.

The disease in question requires urgent hospitalization of the patient. The primary therapeutic goal is to reduce pain and reduce the load on the diseased organ. Then it is necessary to achieve regeneration of the pancreas. Conservative treatment includes the restoration of acid-base, protein and water-electrolyte balance. For this, salt and protein infusions and detoxification therapy are carried out. For the prevention of infectious complications, broad-spectrum antibiotics are indicated. To relieve the pain syndrome, novocaine blockades are carried out and antispasmodics are prescribed.

During the acute period, the patient must observe hunger. In addition, proton pump inhibitors and pancreatic enzyme deactivators are prescribed.

Surgical treatment is carried out in the following cases:

• the formation of a cyst or abscess in the pancreas;
• the formation of foci of necrosis;
• detection of stones in the ducts;
• accumulation of fluid in or around the pancreas.

In the postoperative period, intensive restorative therapy is carried out, aimed at preventing and preventing purulent-septic complications. Severe pancreatitis can lead to death of the patient. Therefore, the prognosis of the disease directly depends on the form in which it proceeds, how quickly medical care was provided, and whether the pathology is accompanied by complications.

The amount of information about various ailments has led to the need for an international classification. For example, the ICD-10 code for chronic pancreatitis is K86.1. Scientists engaged in medical research sought to facilitate the search for a description of diseases and use not only their own experience, but also the achievements of foreign colleagues. All these circumstances contributed to the international association and the creation of a single system, which, after some time, requires updating the data. Therefore, the International Statistical Classification of Diseases arose, which has already gone through 10 revisions and today is a regulatory document called ICD-10.

Description of the disease according to the classification

Considering diseases of the pancreas, in particular chronic pancreatitis, using the international code for ICD-10, you can find two subsections K86.0 and K86.1, the first of which refers to alcoholic etiology, and the second tells about other causes of this disease. Pancreatitis itself in chronic form manifests itself as a constant inflamed condition of the pancreas. And over time, this disease can lead to duct strictures and fibrosis, along with impaired endocrine and exocrine function. And damage to the gland is permanent structural. When chronic pancreatitis is not associated with the systematic use of alcohol in large portions, doctors speak of an idiopathic disease.

Among the main symptoms of this disease are the following:

• recurrent attacks of pain in the left side;
• malabsorption;
• glucose intolerance (the initial stage of diabetes mellitus).

Most of the cases of the disease in question in the US adult population are associated with alcohol dependence, and only 16-24% of patients suffer from pancreatitis for other reasons. Chronic pancreatitis is rarely the result of specific heredity, hyperparathyroidism, pancreatic duct obstruction syndrome. Children and young people in India and some other tropical countries develop chronic idiopathic pancreatitis due to the local climate.

A dangerous continuation of the disease in the absence of proper treatment for 10-15 years is the development of diabetes mellitus. But 70-80% of patients manage to avoid the appearance of glucose intolerance.

This disease sometimes excludes attacks of pain in the left side, but is characterized by progressive malabsorption. If unpleasant strong sensations are present, then their sudden disappearance usually occurs after 7-10 years as a result of the destruction of acitic cells that contribute to the normal production of digestive enzymes. The stool in such patients becomes greasy.

Research Methods

In the early stages of the disease, it is very difficult to make a diagnosis, since the concentration of lipase and amylase may be normal, because the functionality of the pancreas is significantly reduced. However, patients who abuse alcohol for a long time and suffer from frequent attacks of acute pancreatitis with increased pain, when examining the abdominal cavity with a radiograph immediately after such a procedure, an accurate diagnosis is made. Everything is explained by the presence of calcification in the body with significant violations of the gland.

When patients with chronic pancreatitis do not have a typical history associated with the presence of alcohol, it is more appropriate to perform an abdominal CT scan. This diagnostic technique helps to detect calcification, dilated ducts, or pseudocyst. Although the early stages of the disease may not be accompanied by the above symptoms. Then specialists resort to ERCP and analyzes of the secretory functioning of the pancreas. These studies are highly sensitive, and sometimes there are even attacks of acute pancreatitis after them. To protect the patient from negative consequences, doctors offer MRCP.

In cases where medical professionals assume a later stage of the disease, stool fat tests show steatorrhea and exocrine pancreatic function becomes altered. Not every specialized medical center performs a secretin test, since the main procedure consists in taking a certain amount of pancreatic secretion using a duodenal probe. Urinalysis is done after taking bentiromide and pancreolauril to determine the breakdown products with these substances. Taken orally, these pancreatic enzymes help carry out the necessary chemical reactions. Endoscopic ultrasonography and ERCP are considered the most reliable, especially in the early stages of the disease.

Thus, it is necessary to conduct an examination of the pancreas using ultrasound, take an x-ray of the affected organ and diagnose it using various methods.

And if chronic pancreatitis is suspected, the doctor generally gives direction to:

• Analysis of urine;
• determination of glucose in the blood;
• general blood analysis;
• study of pancreatic amylase in the blood and urine;
• total bilirubin in the blood;
• determination of pancreatic elastase-1 in feces;
• study of amylase in the blood and urine;
• stool analysis.

Chronic pancreatitis is usually treated by a gastroenterologist.

Therapeutic measures for the chronic form

Treatment of this disease depends on the manifestation of the patient's symptoms and is necessarily accompanied by a certain diet, enzymes and analgesics. Surgery is also performed if there is no other way out.

Acute periods of chronic pancreatitis require fasting and intravenous fluids.

Naturally, the use of alcohol is out of the question, and with the resumption of nutrition, you can only eat low-fat foods. This diet allows you to reduce the secretion of pancreatic enzymes. To reduce the stimulation of pancreatin secretion, special inhibitors and blockers are used.

But it is more difficult to fight the pain syndrome, since an increase in the dose of drugs used leads to addiction. Chronic pancreatic pain is stopped using pancreatic enzymes, removing cholecystokinin. However, this technique helps with idiopathic pancreatitis, which is not so successful in this disease of alcoholic etiology.

The enzymes in question may additionally help in case of steatorrhea. A dose containing 30,000 units of lipase is quite effective for treatment. The tablets themselves must be protected by a coating that prevents the rapid penetration of acid, and the intake of such drugs is prescribed with food. In addition, treatment should be supplemented with proton pump inhibitors to prevent acid destruction of enzymes.

The positive impact of the treatment is evidenced by a decrease in steatorrhea, weight gain and an overall improvement in the patient's well-being. If, as a result of compliance with all prescribed prescriptions, a severe form of steatorrhea still remains, then they speak of medium chain triglycerides, which are not affected by pancreatic enzymes. Then you additionally need to take vitamins of certain groups to relieve inflammation and dissolve these drugs in fats.

Surgical intervention in the case of chronic pancreatitis is used for severe severe pain.

A pancreatic pseudocyst may be drained to the stomach or a loop of the jejunum, as this is often the source of pain. This surgical treatment includes Roux-en-Y cystojejunostomy. And the expansion of the pancreatic duct by more than 5 mm in many cases requires a Puestow operation, which is called a lateral pancreaticojejunostomy. Partial resection is used when the duct does not increase in size. In case of damage to the head of the pancreas, doctors recommend performing the Whipple operation. Distal pancreatectomy is prescribed for problems with the tail of the organ in question.

Additional measures

It should be emphasized that surgical operations are performed only in cases of complete refusal to drink alcohol, as well as when it is possible to control the manifestations of secondary diabetes that develops under the influence of the pancreas.

If diabetes occurs in chronic pancreatitis, then insulin must be taken with caution, since then there is a high probability of developing hypoglycemia.

When there is an increase in the number of symptoms that characterize chronic pancreatitis, doctors refer patients for a cytological analysis. Especially such studies are indicated in the development of stricture of the pancreatic duct. Naturally, in most cases, a predisposition to pancreatic cancer is suspected.

Due to the fact that medicine has more than forty different classifiers of pancreatitis, there is a significant difficulty in the process of diagnosis, clinic, pathogenesis and treatment of this disease. In this regard, it was adopted (ICD 10), which is used for the exchange of experience by specialists from different countries in the diagnosis and treatment of the disease.

In accordance with the rules of the international classification, pancreatitis is divided into acute (K85) and chronic (K86).

Acute forms of the disease according to ICD 10 include diseases such as:

1. Abscess of the gland;

2. Acute and infectious necrosis;

3. Recurrent (acute), subacute, purulent, hemorrhagic pancreatitis and NOS (without further specification).

Acute pancreatitis is subdivided into idiopathic (K85.0), biliary (K85.1), alcoholic (K85.2) and drug-induced (K85.3) pancreatitis.

Chronic pancreatitis (CP), according to ICD 10, refers to other diseases of the pancreatic organ (K86).

It includes such pathologies as CP of alcoholic etiology (K86.0) and other CP (K86.1).

Acute pancreatitis

This is an inflammatory process that occurs in the pancreas due to the activation of digestive pancreatic enzymes. Most often, this disease occurs in patients suffering from cholelithiasis or chronic cholecystitis, as well as due to alcohol abuse.

The main symptoms of the acute form of the disease include nausea, vomiting and cutting pain in the upper abdomen.

Chronic pancreatitis

This is a chronic destructive process directly in the pancreas, as a result of which the internal and external tissues of the organ are replaced by connective tissue, due to which its main functions are lost (ICD 10).

Causes and prerequisites of a chronic disease: alcoholism, excessive use of drugs, malnutrition and chronic diseases of other organs of the digestive tract.

Symptoms of the chronic form of the course of the disease are similar to those of the acute form of the disease: vomiting, nausea, pain in the upper abdomen and a rapid decrease in total body weight.

This disease is quite unpleasant and painful, so you will have to make a lot of effort to neutralize its negative effects on the body.

Pancreatitis is an inflammation of the pancreas, accompanied by spasms of the ducts, a violation of their conduction.

As a result of digestion, the juices of the pancreatic gland must enter the small intestine.

But due to the blockage of the passages, the juices accumulate in the gland, and it digests itself.

There are many factors that affect the functioning of the pancreas in adults. First of all, among the most important, one should name an unbalanced diet, bad habits.

In general, they negatively affect the general well-being, and in particular, form pancreatic dysfunction.

ICD-10 pancreatitis

In ICD-10, pancreatitis is classified by codes K00-K93, K80-K87. Among them, acute pancreatitis under the class K85 stands out. ICD-10 includes types of pancreatitis of different course:

• recurrent;
• hemorrhagic;
• subacute;
• purulent.

In order for the juices of the pancreatic gland to be able to participate normally in the digestive process and be absorbed in certain parts of the tract, a normal synthesis of pancreatin, lipase, and trypsin is needed.

If there is a violation in the functions of the pancreas, and especially if its ducts are damaged, the enzymes produced do not enter the digestive process, but accumulate in the capsules of the gland. Because of this, it develops inflammation.

It is caused in adults for reasons:

• food or alcohol poisoning;
• constant overeating, overload of the digestive tract;
• eating fatty and spicy foods.

Significant factors in the development of inflammation of the pancreas are injuries of the anterior wall of the peritoneum, bruises of internal organs.

Acute pancreatitis rarely develops in the form of an independent pathology, it often accompanies damage to other organs of the gastrointestinal tract.

It is difficult to make an accurate diagnosis, because the pancreas is located deep in the peritoneum, has a small size.

Inflammation of the organ is accompanied by symptoms similar to the manifestation of other pathologies.

Disposing factors provoking the development of pancreatitis:

• the accumulation of calculi in the gland, which block the bile ducts;
• accumulation of substances that stimulate the synthesis of enzymes; but they begin to work against the tissues of the gland;
• swelling of the gland due to the accumulation of excess enzymes leads to damage to the blood vessels, which causes internal hemorrhage.

Diseases of the duodenum and stomach cause a reverse reflux from the stomach into the passages of the pancreas, this is a clear factor in the onset of acute inflammation in the gland.

These phenomena accompany gastritis, ulcers, gastroduodenitis. The danger of the disease threatens with possible complications:

• the development of purulent inflammation;
• blockage of the ducts of the gland;
• stenosis of the sphincter of Oddi;
• the development of a postnecrotic cyst;
• violation of the portal blood supply to the liver;
• the development of diabetes;
• pancreatic necrosis.

One has only to think about the possibility of developing pancreatic necrosis, as it becomes clear that the pancreas should be treated in a timely manner.

Otherwise, inflammation leads to severe violations of the functions of the pancreas, the rapid death of the cells of the organ.

After such changes, the pancreas, subject to tissue destruction, is unable to perform its tasks.

Pancreatic necrosis is considered one of the complicated stages of acute pancreatitis, when the clinical picture of the disease progresses rapidly and becomes the most severe.

Signs of pancreatitis in adults

Without a qualified diagnosis, it is difficult for even an experienced doctor to immediately identify signs of acute pancreatitis, since it is accompanied by symptoms very similar to ordinary poisoning.

The condition of an unexpectedly ill person is determined by:

• severe pain in the epigastric region of the abdomen; pains are girdle in nature, spread to the lower back, kidneys;
• high temperature, jumps in blood pressure, tachycardia, general deterioration in the condition of a sick person, confusion;
• indomitable vomiting, after the release of the stomach, nausea and vomiting persist, and do not bring relief, bouts of vomiting are repeatedly repeated;
• after vomiting, heartburn torments, the stomach swells, a red rash appears;
• the onset of diarrhea of ​​a frothy form, green in color, with the remnants of undigested food;
• pale skin, shortness of breath.

The acute form of pancreatitis is characterized by the rapid progress of the disease, a sharp deterioration in the well-being of a person.

If the symptoms of acute pancreatitis in adults begin to appear at home, then you can not delay the time, and you must urgently call an ambulance to provide first aid and determine the sick person in the inpatient department.

Until the ambulance arrives, you can not give the sick person any medicines, water, food. This can blur the picture of the disease, increase vomiting.

Dagger pains, indomitable vomiting indicate an acute condition in which immediate surgical intervention is required.

The special structure of the pancreas causes different symptoms. The gland consists of a head, body and tail. From the place of localization of inflammation, symptoms manifest themselves in different ways:

• inflammation of the head of the gland gives pain under the right hypochondrium;
• inflammation in the body pain is localized in the epigastric zone;
• inflammation of the tail gives pain under the left hypochondrium.

When the inflammation covers the entire gland, the patient complains of sharp girdle pains. If the inflammation becomes chronic, the manifestations of the disease also change.

Now it is not only inflammation of the organ with damaged tissues, but also concomitant pathologies of the digestive tract.

Chronic pancreatitis in adults is characterized by a sharp exacerbation of symptoms, and their gradual subsidence, gradually the pain in the pancreas becomes permanent, acute, with clinical symptoms:

• dagger pains in the epigastric zone, with a tendency to girdle the whole body;
• indomitable vomiting without signs of relief;
• diarrhea with a high content of fatty components;
• increase in signs of intoxication;
• drop in BP.

The patient cannot lie down, in the prone position the pain increases sharply, because of this, the person sits with an inclination forward, with his stomach clasped with his hands.

Symptoms of acute pancreatitis in adults cannot be missed, it is dangerous for the development of pain shock, death in the absence of medical care.

Pancreatitis is diagnosed in adults on the basis of complaints, examination by a doctor, a series of tests and examinations:

• urine analysis shows a change in elastase;
• urinalysis for the determination of trypsinogen-2, clearly confirming the specificity of acute pancreatitis;
• stool analysis shows the presence of steatorrhea - undigested fats and parts of food;
• tests for the ability to stimulate organ functions;
• Ultrasound of the gland and internal organs;
• blood test - glucose tolerance test;
• study of water and electrolyte balance;
• a test for the presence of gland enzymes in the blood;
• radiography in the supine and standing position;
• MRI or CT.

Ultrasound and CT are not very useful in diagnosing pancreatitis, but they are used to assess abdominal pain.

Ultrasound is performed to determine cholelithiasis. At the same time, dilatation of the bile ducts can be seen, confirming the obstruction of the biliary tract.

Puffiness of the pancreas can be visualized only if the examination of the organ is not interfered with by gases in the intestines that obscure the pancreas.

The tests and examinations carried out give the doctor the opportunity to assume the degree of damage to the pancreas in order to justify the prescribed treatment.

The main indicator is the symptoms and treatment in adults is mainly based on their removal. In severe cases, endoscopy, laparoscopy are performed. Their use is justified by the patient's condition and the decision of specialists.

Treatment of pancreatitis in adults

The main principle of treatment of acute pancreatitis is starvation. Exacerbation of the disease requires for 1-2 days to exclude food and water.

To avoid dehydration, the patient is prescribed an intravenous rehydration infusion of saline solutions, glucose with vitamins.

Droppers help relieve bouts of vomiting, cure diarrhea. A heating pad with ice is placed on the area of ​​acute pain, the cold reduces pain, relieves swelling of the gland.

The patient is prescribed bed rest to create complete rest for the whole body.

In such ways, doctors achieve a reduction in acute inflammation, and only when the pain subsides, with persistent indicators of improvement in well-being, the patient is prescribed a strict diet against the background of drug treatment.

The main drugs used in the acute stage of the disease are enzymes, antispasmodics, probiotics.

The diet is based on cereals and vegetable dishes, which are prepared by boiling, stewing, with a small addition of vegetable oil.

• Festal;
• Creon;
• Pancreatin;
• Mezim forte.

Acute pancreatitis is usually accompanied by diarrhea, so taking drugs that restore the intestinal microflora is required.

For this purpose, the doctor prescribes the intake of probiotics:

• Linex;
• Biogay;
• Lactofiltrum;
• Beefy form.

There are many similar drugs in the arsenal of doctors, they are selected in accordance with fecal microflora tests, so that the drug is most effective.

The acute form of pancreatitis in adult patients is treated in a hospital setting. Traditional drug therapy includes:

• intravenous administration of saline solutions, plasma substitutes, these are Reopoliglyukin, Reosorbilact;
• relief of pain attacks with antispasmodics, these are No-shpa, Ketanov, Papaverine, Platifillin along with Papaverine;
• removal of edema of the gland with diuretic drugs - Lasix, Diacarb, Furosemide; when prescribing Diakarba, parallel intake of calcium-containing drugs is recommended;
• stopping vomiting by intramuscular administration of Cerucal, Metoclopramide;
• restoration of the enzymatic balance by the appointment of inhibitors, these are Trasilol, Contriven;
• restoration of secretory functions is achieved by taking Kvamatel, Omeprazole.

In addition, maintenance vitamin therapy is carried out. According to the signs of acute pancreatitis in adults, the doctor regulates the diet of each patient.

At this time, fat emulsions, hydrolysates of protein compounds are dripped into patients.

The first products that will be allowed to the patient are kefir, cottage cheese. Gradually, the patient is transferred to the dietary table No. 5.

When conservative therapy does not give the expected effect, doctors choose surgery.

Treatment of chronic pancreatitis in adult patients, depending on their condition, is limited to a diet with a minimum inclusion of fats and carbohydrates.

Undoubtedly, smoking and drinking alcohol, including beer, should be permanently abandoned.

If the doctor's instructions are violated, exacerbations are inevitable. In this case, the doctor prescribes:

• antibiotic Amoxicillin to quickly stop the onset of inflammation;
• strong analgesics, antispasmodics to relieve pain, these are Tramadol, Papaverine, Drotaverine;
• enzymes to normalize digestion - Mezim, Pancreatin, Festal;
• preparations for normalizing acidity - Almagel, Maalox, Rennie.

And again - a starvation diet, which has to be returned to in case of exacerbation of chronic pancreatitis.

It is allowed to drink a little mineral non-carbonated water. Proper nutrition in small portions with a minimum of fat is the basis of treatment for exacerbations.

Patients should forever forget about spicy, sweet, fried foods. Their diet is now made up of:

• boiled or steamed vegetables, excluding tomatoes;
• fruits with a neutral taste - apricots, pears;
• low-fat steam or boiled fish;
• meat of chicken, rabbit, veal;
• pasta in limited quantities;
• kefir;
• cereal crops;
• low-fat cottage cheese;
• herbal teas, still water.

A fairly extensive diet from which you can make interesting and nutritious menus for every day.

Traditional medicine against pancreatitis

Take care of your health - save the link

In contact with

Under the chronic form of pancreatitis, a constant inflammatory process of the pancreas is observed. During the period of the acute course of the disease, there is a replacement of the cellular elements of the organ with connective tissue and the formation of exo- and endocrine insufficiency of the functions of the organ.

Classification of pancreatitis according to ICD 10

Healthcare, in order to systematize and manage, developed a classification of diseases (ICD), which is reviewed once every 10 years. This is a normative document that provides a unified approach to the classification of diseases and serves as a mandatory classifier when making a diagnosis.

There are more than 40 pancreatitis classifiers, which significantly complicates the communication of doctors when voicing the patient's diagnosis. In order for experts from different countries to be able to easily share skills and understand each other, an international systematization of diseases (ICD) was established. At the moment, the system of the 10th revision (ICD-10) is in effect, according to which the diagnosis of the disease is carried out.

According to the international classification, pancreatitis according to ICD 10 is divided into:

1. K85 Acute pancreatitis.
2. K86.0 Chronic pancreatitis of alcoholic etiology.
3. K86.1 Other chronic pancreatitis.

Share 3 key types of chronic pancreatitis μb code 10:

• Chronic calcifying inflammation, often caused by alcoholism. In this inflammatory process, changes in the structure of the organ ducts, thickening of secretion are observed, which leads to blockage of the ducts.
• Chronic obstructive inflammation. It is characterized by narrowing of the main ducts of the gland or its large branches.
• Acute inflammation of pancreatitis is not common and is an exacerbation of chronic pancreatitis.

In some cases, biliary or biliary-dependent pancreatitis is observed, which develops against the background of existing diseases - pathologies of the liver, gallbladder or biliary tract.

Etiology

The prerequisites for the occurrence of chronic pancreatitis according to ICD 10 are quite diverse. The formation of pain syndrome is caused by a number of factors:

• pathologies of the digestive system (ulcer and gallstone disease, cholecystitis, duodenitis, gastritis);
• excessive intake of alcoholic beverages, lack of protein in the food taken;
• viral lesions, allergic reactions and toxic poisoning;
• surgical interventions;
• pathology of metabolic and hormonal processes;
• heredity.

Xp pancreatitis microbial 10 (K86.0) often occurs with chronic alcoholism. In second place in terms of the purity of the detection of this disease are - a violation of the function of the biliary tract, duodenum and stomach disease.

Diagnosis of pancreatitis code for mkb 10

Often, patients see a doctor if they have the following symptoms and signs:

• the presence of pain;
• with nausea;
• vomiting
• with rapid weight loss;
• with unstable stool;
• manifestation of odor from the mouth.

The doctor conducts and prescribes a number of studies if he suspects a person has a pancreatic disease:

1. Initial examination of the patient. The course of the disease in this type of disease, as a rule, is not pronounced. There is moderate bloating. On the skin of the abdomen, small protruding formations of red color are visible. On palpation, the organ can be felt in severely malnourished patients. With cystic disease of the pancreas, the organ is easily palpable due to pathological changes that lead to its increase. In severe forms of this disease, there is often a slight tension in the abdomen.
2. In the acute course of the disease, an increase in phospholipase A 2 is observed.
3. The doctor prescribes laboratory tests for diagnosis, one of which is a general analysis of blood, feces and urine. With a severe course of the disease, an increase in the number of leukocytes and ESR is noted. In other forms of the course of the disease, blood counts remain normal.
4. A person is given glucose to drink, and if after a couple of hours its level exceeds 8 mmol / l, then this indicates the presence of diabetes mellitus, which is often a comorbidity of this disease.
5. The study of enzymes. In acute exacerbation of chronic pancreatitis, according to microbial 10, an increase in amylase is observed. The study of this enzyme is rather non-specific. That is why another enzyme test, elastase, is also being studied.
6. Conduct a study of the activity of lipase.
7. Study of blood elastase. This figure increases with acute exacerbation.
8. The study of blood trypsin. A reduced indicator indicates an insufficiency of the exocrine function of the gland, which manifests itself in the chronic form of the disease.
9. The study of the mass of feces produced per day. External secretory insufficiency of the organ (polyfecalia) leads to an increase in fecal mass. This indicator is observed in the later stages of the disease.-00
10. Carrying out tests to study the external secretory function using special probes. With their help, secretin and pancreozymin are injected, as a result of which the pancreatic secretion of a different nature is secreted by the gland. The combination of both stimuli makes it possible to judge the external secretory insufficiency of the organ.
11. ultrasound.
12. X-ray of the pancreas.
13. CT scan of the pancreas.
14. Organ MRI.

Treatment of chronic pancreatitis

If pancreatitis is not treated in a timely manner, it will lead to dysfunction of other organs. If you have been diagnosed with chronic pancreatitis and its symptoms worsen, then therapy should be carried out immediately.

The patient is treated in a hospital, where he is prescribed a set of measures:

1. Following a strict diet. For the first time, fasting is practiced. When the patient is allowed to eat, then food should be taken fractionally, in small portions.
2. Elimination of pain and spasms.
3. Normalization of the digestive process.
4. Replenishment of enzyme deficiency.
5. Stop the inflammatory process.
6. Restore the affected tissues of the organ.
7. Implement preventive measures.

In the treatment of the chronic form, antibiotics are used, in the presence of an infection. This course is designed for approximately 7 days. With inflammation of the ducts, in order to facilitate the outflow of bile, "Amoxicillin" is prescribed, this allows you to stop the inflammatory focus and prevent it from developing further.

Pain can be controlled with anti-inflammatory drugs. Only a doctor can competently choose the dose of the drug.

With spasms, "No-shpa", "Drotaverin" will help to cope.

Chronic pancreatitis code for microbial 10 is accompanied by a digestive pathology, for this reason the patient must strictly adhere to a diet and take enzymes.

With complex treatment, medications are prescribed to reduce the level of acidity (Almagel, Maalox).

If therapeutic measures do not have the desired effect, then the patient is prepared for surgery.

Disease prevention

If you do not want to have pancreatitis in the future, then it is recommended to take preventive measures for those people who are predisposed to this disease and like to treat themselves to smoked, spicy, fried and fatty foods. Prevention of pancreatitis includes:

• prevention of organ inflammation;
• prolongation of the remission period;
• improving the quality of life;
• reduction of risk factors;
• nutrition normalization.

Prevention measures
Do not abuse alcohol.	Pancreatitis is a disease of adults and is often diagnosed in adherents of alcohol. Constant alcohol consumption causes significant damage to the pancreas, since ethyl alcohol destroys the cells of this organ and causes changes in its work. This leads to pancreatitis.
Smoking is a negative effect.	The composition of the smoke of cigarettes or cigars is shown negatively, affecting all human organs without exception, and in the combination of tobacco with alcoholic beverages, the negative effect increases many times over. The smoke from cigars, penetrating the body, disrupts the functioning of gland cells, affects and provokes inflammation of the gastrointestinal tract, leads to increased stimulation of gastric secretion. If you have been diagnosed with pancreatitis, then it is better to quit smoking forever.
Ensuring proper nutrition.	Basically, pathologies with the pancreas occur if a person loves spicy, fatty, fried and salty dishes. These foods overload and deplete the gland. Therefore, one of the preventive measures is to review your diet. It is advisable to supplement the menu with vegetables, cereals, fruits, legumes, cereals.

Also preventive measures include:

• prevention of stressful situations;
• occasional walks in the fresh air;
• proper rest and sleep;
• active lifestyle.

If you follow these recommendations, then you can increase immunity, improve health, increase the endurance of the body. All this will help you significantly reduce the risk of developing this disease, which millions of people fall victim to every year.