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Gastroenterology / Заболевания поджелудочной железы и кишечника для иностранцев со звуком.PPT
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pain in CP:

1.Acute inflammation of the pancreas (damage

parenchyma and expansion of the pancreas capsule)

2.Intra-pancreatic complications:

a)obstruction of the pancreatic duct,

b)the development of pseudocysts,

c)perineural inflammation

3. Extra-pancreatic complications:

a)stenosis of the distal common bile duct,

b)stenosis of the descending duodenum 4. Pressure on the nerve plexus increased and inflamed pancreas

5. The presence of concomitant diseases.

II. Exocrine pancreatic insufficiency leads to disruption of the processes of intestinal digestion and absorption, to the development of intestinal dysbiosis. As a result, patients develop diarrhea, steatorrhea, weight loss, abdominal pain, belching, nausea, episodic vomiting, flatulence, loss of appetite, later symptoms characteristic of hypovitaminosis join.

"Fatty fetid diarrhea."

Exocrine pancreatic insufficiency is associated with the following mechanisms:

-destruction of acinar cells, as a result of which the synthesis and secretion of pancreatic enzymes decreases,

-obstruction of the pancreatic duct, disrupting the flow of pancreatic juice into the duodenum,

-decreased secretion of bicarbonates by the epithelium ducts of the pancreas, leading to acidification contents of the duodenum to pH 4 and below, resulting in denaturation of pancreatic enzymes and bile acid precipitation.

III. Endocrine insufficiency symptom

Disorders of carbohydrate metabolism in CP are detected in 2/3 of patients, and only half of them have clinical signs of diabetes (it is based on damage to all cells of the islet apparatus, resulting in a deficiency of not only insulin, but also glucogone).

Features of SD with CP:

-tendency to hypoglycemia,

-the need for low doses of insulin,

-rare development of ketocytosis, vascular and other complications.

-weight loss,

-on the skin of the abdomen, breasts there may be bright red spots, of the correct rounded shape, which do not disappear when pressed (symptom of "red droplets"),

-dryness and flaking of the skin,

= glossitis, stomatitis caused by hypo- and avitaminosis,

- jaundice of the skin and mucous membranes associated with the development of obstructive jaundice due to the involvement of the common bile duct process in the pathology is much less common.

There may be a symptom of "red droplets" or a symptom of Tuzhilin:

1) serum amylase level (after 2-12 hours from the onset of exacerbation, maximum to the end of 1 day and N for 2-4 days)

2) amylase in urine 6 hours later whey. But does not always indicate exacerbation of CP.

3) a combination of a triad (a reliable sign of exacerbation of CP)

amylase (2 or more times)serum lipase

trypsin

caused by:

-perforated ulcer F and duodenum

-small bowel obstruction

-ectopic pregnancy with tubal perforation

-diabetic ketoacidosis

-infectious paraitis

-renal failure

in the duodenal contents obtained by a double probe is investigated

5)coprogram: Schmidt's diet - 3 days standard diet 105 g protein, 135 g fat and 180 g carbohydrates

- polyfecal matter (more than 500 g per day)

- gray greasy and fetid feces - drops of neutrons. fat (steatorrhea) Undigested starch grains (amilorrhea) Undigested muscle fibers (creatorrhea)

6)Elastase in feces (is an important factor in the diagnosis of CP)

and GGTP (gamma-glutamyl transpeptidase) - partial or complete obstruction of the biliary tract (area of ​the large duodenal papilla - stenosis, papilitis, stone), and if ALP , and

GGTP - N - osteomalacia

8)In case of damage to the pancreatic islet apparatus, hyperglycemia and glucosuria are detected, sometimes a glucose load test.

9)"R" - relaxation duodenography, which can reveal the unevenness of the pancreas contours, duodenostasis, deformation of the duodenal window.

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