The diagnosis of chronic pancreatitis is based on the performed ultrasound. However, the results of ultrasound alone are insufficient to diagnose this disease by 100%.The possibilities of ultrasound in diagnosis are somewhat limited in comparison with the diagnosis of the acute form of the disease. This is due to the main echopriznakami chronic form of the disease.
Echoes of chronic pancreatitis
The main echoes of the ultrasound examination are:
- areas of increased echogenicity in the structure of the pancreas;
- major pancreatic flow is unevenly expanded;
- in the pancreatic flow found stones, and in the parenchyma - calcifications;
- pancreas has a deviation from the norm in size;
- echogenicity of the pancreas is unevenly elevated;
- the outline of the gland is uneven, often jagged;
- when the sensor is pressed from the ultrasound device, the patient has painful sensations;
- presence of such echoes as the presence of pseudocysts, retention cysts, squeezing of choledochus and large vessels.
The initial sign of the onset of the disease is pain in the left hypochondrium and epigastric region, which are given in the back or under the left scapula. Pain often intensifies after drinking alcohol, fried and fatty foods. Painful sensations grow in warmth and somewhat weaken in the cold. With the progression of chronic pancreatitis, other symptoms will appear, such as bloating, vomiting, nausea, loss of appetite, weight loss, diarrhea or constipation. If the patient began to complain of a constant thirst and increased urination, this may serve as a sign that chronic pancreatitis is progressing and the gland has ceased to produce insulin, which means that diabetes begins to develop. Another characteristic feature of chronic pancreatitis is pancreatic diarrhea, in which the feces are mushy, have a fetid odor and a greasy shine. According to the results of the coprological study, symptoms of chronic pancreatitis will include: kitarinorea, creatorrhea and steatorrhoea.
After performing a blood test, you can observe signs of a disease such as moderate to moderate hypochromic anemia, neutrophilic leukocytosis, increased ESR, increased number of globulins, leading to dysproteinemia and hypoproteinemia. Symptoms of the development of diabetes mellitus in chronic pancreatitis are glucosuria and hyperglycemia, and in extremely severe conditions - hyponatremia and other disorders of electrolyte metabolism. In cases where the outflow of pancreatic juice does not occur due to any obstacles or during an exacerbation of chronic pancreatitis, an increased content of antitrypsin, trypsin, lipase and amylase will be found in the blood. Similar symptoms of exacerbation can be observed by analyzing the patient's urine.
Symptom of the initial stage of the disease is an increased concentration of enzymes on the analysis of duodenal contents, and a sign of an atrophic sclerotic process in the pancreas will be the manifestation of pancreatic hypoecretion.
The problem of recognizing symptoms of a patient with signs of chronic pancreatitis is a difficult task for any doctor. The fact is that the main symptoms of this disease can be regarded as signs of most other diseases of the gastrointestinal tract. Therefore, it is impossible to be guided only by symptoms, it is necessary to carry out ultrasound and see what disease is indicated by echolineses, which is indicated by computed tomography and radiography of the pancreas.
Complaints for chronic pancreatitis
Complaints in patients with chronic pancreatitis at the onset of the disease may be absent. In the unregistered case of the disease, pain can begin to manifest after a few years or even a decade from the onset of pancreatic pathologies. In case of neglected form of the disease, the patient complains of pains of cutting and burning character in the left subcostal area, which indicates the presence of an inflammatory process in the tail of the pancreas. If the pains are disturbed in the epigastric region, the gland's body is affected, and in the right hypochondrium - its head. If abdominal pain occurs at the top of the abdomen( often with irradiation into the left shoulder blade or back), it is worthwhile predicting inflammation of absolutely all parts of the pancreas, or as a consequence of a transverse colon. Often, complaints arise after eating, after about an hour and when consuming fatty, sharp, fried and alcoholic foods. With chronic pancreatitis, nocturnal and hungry pains are possible that increase in the horizontal position of the body, but decrease in the patient's sitting position, with a tilted body or in the knee-elbow position. In addition to the pain symptom, most patients complain of heaviness in the stomach, nausea and vomiting after eating.
Chronic pancreatitis chair
Chronic pancreatitis stools are frequent( up to 7 times a day), mushy or watery, abundant - this is one of the signs of impaired pancreatic gland function( its exocrine part).Because of the sharp decrease in the absorption process and intestinal digestion, the titer of microbial bodies in the small intestine increases, which results in flatulence, steatorrhea( drops of fat in the stool), diarrhea, hard-to-treat constipation, belching, nausea, recurrent vomiting, loss of appetite,rapid reduction in body weight. These disorders in wall digestion and absorption lead to hypovitaminosis of vitamins A, D, E, K, which is the cause of skin peeling, its dryness, glossitis( inflammatory process on the tongue mucosa), stomatitis( relatively small ulcers of inflamed character on the mucosa inoral cavity).
How is chronic pancreatitis manifested?
There are several periods in the manifestation of chronic pancreatitis:
- initial period. Characterized by a change in the period of remission exacerbation. In this case, the pains are of different localization and intensity with concomitant dyspeptic disorders, which are immediately stopped by appropriate treatment.
- period of pancreatic insufficiency( exocrine part)( occurs usually after the expiry of 10 years of the disease).During this period of chronic pancreatitis, pain sensations become dulled or may even disappear, but they are replaced by duodeno- and gastrostasis( stopping or slowing the functions of the duodenum and stomach).As a result, gastroesophageal reflux appears, which causes regurgitation and heartburn, as well as impaired suction function in the small intestine with the above-described consequences( loose stools, nausea, vomiting, diarrhea or constipation, etc.).
- complicated. For this period, a characteristic feature is the transition from blunted pain to progressive and constant pain with irradiation to different parts of the body. In addition to the pain syndrome, the dyspeptic symptom complex begins to manifest itself more intensively, hypoglycemia develops and pseudocysts of the pancreas can form.
There are following complications with xp pancreatitis: mechanical jaundice( as a result of obturation of the bile ducts), duodenal obstruction, hypoglycemic crisis, complications of an infectious nature, esophagitis erosive, ischemic abdominal syndrome, portal hypertension.