Biliary chronic pancreatitis
Introduction
Introduction to biliary chronic pancreatitis The diseases of the biliary system can not only cause acute pancreatitis, but also cause progressive inflammatory changes and fibrosis of diffuse or localized recurrent episodes of the pancreas. It is called biliary chronic pancreatitis or biliary chronic recurrent pancreatitis. . basic knowledge The proportion of illness: the incidence rate is about 0.006%-0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: cirrhosis jaundice
Cause
Causes of biliary chronic pancreatitis
(1) Causes of the disease
The etiology of biliary chronic pancreatitis has something in common with biliary acute pancreatitis, but the pathogenesis is different. Many diseases of the biliary system, such as stones, infection, and stenosis, can cause chronic pancreatitis. Most patients Due to the prolongation of acute pancreatitis, some patients have a slow onset and are chronic progressive.
1. Biliary stones: biliary system stones cause common bile duct, pancreatic duct, or obstruction of the abdomen, obstruction of pancreatic juice, and fibrosis of the pancreas.
2. Inflammation of the biliary system: When the biliary system is inflamed, the inflammation spreads to the pancreas, and the pancreas is slightly infected with chronic inflammation to form chronic inflammation.
3. The basic pathological change of this disease is replaced by fibrous tissue after destruction of pancreatic cells.
(two) pathogenesis
1 The stone is invaded in the ampulla, and the bile flows back into the pancreatic duct through a common conduit, and the infection is brought into the pancreatic duct.
2 During the excretion of gallstones, the Oddi sphincter is paralyzed, and the contents of the intestines flow back into the pancreatic duct, leading to pancreatitis.
3 toxic substances on pancreatic tissue damage, including: free bile acids, bacteria, unconjugated bilirubin and lysolecithin, free bile acids are toxic, can damage the pancreatic duct mucosal barrier; bacteria can secrete glucuronidase ( -glucuronidase), which can decompose and bind bilirubin to unconjugated bilirubin, but not bilirubin to the pancreas; patients with acute cholecystitis have lysolecithin in the bile, which can directly damage pancreatic tissue.
Prevention
Biliary chronic pancreatitis prevention
1. Active prevention and treatment of related diseases: biliary diseases are common and frequently-occurring diseases in the elderly. Active prevention and treatment of biliary diseases is an important measure to prevent chronic pancreatitis in the elderly.
2. Actively and thoroughly treat acute pancreatitis: The incidence of chronic pancreatitis may be related to the incomplete cure of acute pancreatitis. Therefore, people with acute pancreatitis must actively treat a complete cure, so as not to leave behind.
3. Diet with a careful diet: Preventing overeating is very important to prevent this disease. At the same time, the elderly should eat light and eat less spicy.
4. The mood is comfortable and comfortable: avoid the bad mental stimulation such as worry and anger.
Complication
Complications of biliary chronic pancreatitis Complications cirrhosis jaundice
1. Diabetes performance: It can be expressed as polydipsia, weight loss, and generally progressive aggravation.
2. Liver cirrhosis: hepatosplenomegaly, ascites and so on.
3. Astragalus: Obstructive jaundice may occur when the head of the pancreas is fibrotic, constrictive papillitis, and common bile duct stones.
Symptom
Biliary chronic pancreatitis symptoms Common symptoms Gallbladder enlargement Hepatosplenomegaly Gallbladder common calculus Astragalus Ascites Loss of appetite Nausea Severe abdominal infection Intrapannal calcification Gallbladder contractile dysfunction
The disease can be caused by the prolongation of acute pancreatitis, and it can also be repeated and acute. In the acute attack period, its clinical manifestations are basically the same as acute pancreatitis. The following manifestations are found in the chronic process. The main manifestations and symptoms of specific cases may be different. .
Symptom
(1) Abdominal pain: It is the most common symptom of this disease. It starts 1 or 2 times a day, and the episodes gradually become frequent. Finally, there is persistent pain. The pain is located under the upper abdomen and slightly left, and the part is deep and radiates to the back. Drinking and eating more fatty foods can induce and aggravate, often wake up in the middle of the night, abdominal pain can be relieved in the sitting position, and general painkillers are ineffective.
(2) indigestion: after pancreatic fibrosis, its exocrine deficiency, plus the original biliary tract disease, generally manifested as loss of appetite, fullness, anorexia greasy, nausea, steatorrhea, weight loss.
(3) Diabetes performance: When the pancreatic endocrine function is destroyed, it can be expressed as polydipsia, weight loss, generally progressive aggravation, more sensitive to insulin, and less sensitive to other hypoglycemic agents.
2. Signs
The disease often lacks specific signs. In the acute attack period, there may be signs of peritoneal irritation, intestinal obstruction, etc. In the intermittent period, only the upper abdomen is tender and tender, and patients with wasting may sometimes enlarge and enlarge the hardened pancreas. When the pseudo-pancreatic cyst is formed. The upper abdomen can be covered with an unclear mass. If accompanied by cholelithiasis, biliary tract infection, cirrhosis, Murphy sign, gallbladder enlargement, hepatosplenomegaly, ascites, etc., jaundice in acute attack Period may occur, pancreatic head fibrosis, constrictive papillitis, common bile duct stones, obstructive jaundice may occur.
Examine
Examination of biliary chronic pancreatitis
1. Laboratory tests during an acute attack
Basically the same as acute pancreatitis, but most patients due to pancreatic secretion dysfunction, serum amylase does not increase, intermittent determination of neutral fat content in the feces, fat absorption rate, or directly under the microscope to find muscle fiber, fat content, It is often found in steatorrhea.
2. Pancreatic function test
Can determine the pancreatic exocrine function, there are secretin (trypsin) test, BT-PAB (a synthetic peptide) test, dye fluorescence test and so on.
3. Glucose tolerance test
The endocrine function of pancreatic enzymes can be judged.
4. Other
Pleural effusion, ascites can be used to determine the amylase content and cytology, pancreatic biopsy and selective angiography.
5.B type ultrasound examination
Can show pancreas shape, volume, pancreatic cyst, pancreatic stone, biliary lesions.
6. Abdominal plain film
Pancreatic calcification or stone shadow can be seen.
7. Barium meal check
Can understand the gastroduodenal lesions, duodenal hypotonic angiography, can show the duodenal descending inner edge straightening, or the emergence of most thorns, sometimes indentation.
8. Endoscopic retrograde cholangiopancreatography (ERCP)
It can show pancreatic duct dilatation, stenosis, obstruction or pancreatic stone and gallstone, and common bile duct changes.
9. Computed tomography (CT)
It can show pancreatic volume, uneven fibrous hyperplasia, pseudocyst and peripancreatic fascia changes.
Diagnosis
Diagnosis and diagnosis of biliary chronic pancreatitis
The clinical manifestations of this disease are complex and diverse. It is not difficult to diagnose the history of repeated acute attacks. However, for patients with atypical clinical manifestations, comprehensive analysis should be based on medical history, clinical symptoms, signs and auxiliary examinations, so that a correct diagnosis may be made.
The differential diagnosis of this disease should consider the gastroduodenal, liver, biliary diseases and other endocrine disorders. The clinical manifestations of non-biliary chronic pancreatitis are basically the same as the disease, but the medical history is obviously different, and there is no biliary disease. Symptoms and signs, it is not difficult to identify, this disease and pancreatic cancer, pancreatic cysts are sometimes confused, need to be carefully identified.
