Gastroenterology / лекция №15 ATOLOGY AND DIAGNOSTICS CHRONIC

LECTURE 15 ATOLOGY AND DIAGNOSTICS CHRONIC PANCREATITIS of exocrine and endocrine functions in progressing of a pathological process. 2. Diseases of cholic pathes. 3. Diseases of nutis, hypotonia of sphin es: contamination (epidemic parotitis, hepatitis B, virus of Cocsaci). therosclerosis). etracyclinums, sulfanilamidums). eny of chronic pancreatitis riants: onic pancreatitis are shown on the picture 3. SYMPTOM

OF

Chronic pancreatites (CP) are chronic inflammatory — dystrophic dis-eases of pancreas causing impairment of permeability of its ducts, sclerosis of parenchyma and appreciable impairments

Etiology of chronic pancreatitis 1. Abuse with alcohol.

duodenum and papilla of Vateri (duode

cter of Oddi). 4. Nutritional fa

ctor: 1) Superfluous use of adipose nutrition. 2) Insufficient entering of protein with food.

3)Polyhypovitaminosis. 5. Infrequent caus

1)Virus infection

2)Change of pancreatic vessels (a

3)Hyperlipoproteinemia.

4)Hyperparathyroidism. 5) Acute pancreatitis. diseases (mucoviscidosis, hemochromatosis).

6)Genetical predisposition, inheritable

7)Medicamental influences (cytostatics, t

Pathog

Pathogenetic va

1. Nontryptic.

2. Tryptic.

Pathogenetic variants of chr

T

Difficulty of outflow

of pancreatic juice

Increased secretion activity of the pancreas

Breakage of basal membranes of acinusesVariousimpairments

metabolismActivation of enzymesFocal self-digestion of cellular Nontryptic variant

Pa

Neurocirculatorydisorders lcoholismDisbolism, lipidemia, A

Changes of duodenum and atrophy of mucosaImpairmentsvof hypercalcemia Deficiency of endoge

Duodenal hyperkinesia, Depression of function of pancreas, condensation of

rising of pressure pancreatic juice in ducts of pancreas

Deposition of protein a

pancreatitis

Picture 3 — Pathogenetic variants of chronic

n

Classification of chro

I. On etiological sign:

—initial chronic pancreatitis;

—secondary chronic pancreatitis.

clinic: tic form;

—polysymptoma— pain form; tum

—pseudo-

—dyspeptic form; — latent (asymptomatic) form. trophicity of stomach spastic

stricture of Oddi’s sphincter, Atrophy of acinuses and their changing with connecting tissue nd occlusion of ducts nic secretin thology of duodenal juice Difficulty of outflow of pancreatic juice Diseases of digestion organs Edema

of pancreas ic pancreatitis (A. L. Grebenev, 1982) II. On features of oral form; III. On flow of the disease: — mild degree (1st stage, initial); — average degree (2nd stage); — severe degree (3rd stage, terminal, cachectic). Clinic of chronic pancreatitis 1. Pains: — Localization — in the epigastric range, surrounding. — Conditions of originating — reception of meals, especially adipose, alcohol. — Day-night rhythm — is more expressed in the 2nd half of a day. — Character — intensive, acute, stinging. 2. Pancreatic dyspepsia: — increased salivation; — eructation with air or eaten meals; — persistent nausea; — vomiting, at times repeated, not invoking simplification of state, and at times — intensifying pains;

—loss of appetite; — disgust for adipose meals. 3. Intoxication and general signs: moderate, subfebric fever (in the expressed exacerbation of the disease), weakness, sweating, drop of work capacity, depression. Examination Position of the patient: lying on the abdomen; sitting, having bent forward; genucubital. «Color» dermal symptoms of exacerbation of chronic pancreatitis: — The syptom of the Grotto

—atrophy of hypodermic fatty tissue, brown or cyanotic shade of the skin in the area of projection of pancreas. — Mandor’s syptom — violet stain on the face. — Holsted’s syptom — cyanosis of the anterior abdominal wall. — The s of abdomen, especially the left one. — he skin in ar in points in pancreas diseases d pain points in pancreas diseases in shown in the pictu

yptom of Heating-Turner — cyanosis of lateral walls

The syptom of Culen-Johnson — yellow-cyanochroic shade of t

ea of umbilicus.

Palpatory phenomena and pa

Palpatory phenomena an re 4.

Picture 4 — Palpatory phenomena and pain points in pancreas diseases:АВС — zone of Shoffar — pain in lesion of the head of the pancreas;

СК — zone of Gubergrits-Sculsky — pain in les

Gubergrits's point — pain inА ion of the body of the pancreas; G — lesion of the tail of the pancreas; F — palpated pancreas

Syndrome of

1.Pancreatogenous diarrheas, polyexc

2.Signs of intestinal d

yspepsia. 3. Sprues and maldigestion, thinness, polyhypovitaminoses, deaquation, electrolytic impairments, ane

Syndrome of intrasecretory (incretory) failure of Laboratory and tool diagnostics

The general analysis of urine: in exacerbation there is rising of level of al-pha amylase (

Biochemical analysis of blood.

1.Diagnostics of activity of inflammatory process in the pancreas: а) amylase test — activity of amylase raises during the first h

ion of CP.

b) Lipase test — activity of lipase raises from the end of the 4th d

c) Augmentation of «proteins of acute phase of inflammation» — gammaglobulins, sialine acids,

2.Diagnostics of syndrome of intrasecretory failure of the pancreas — augmentation of gluco

Research of extrasecretory functions of pancreas:

а) Definition of lipase, alpha amylase, Trypsinum, bicarbonate causeticities in duodenal contents. b) Secretin — pancreozim

Rentgenologic examination of the pancreas: C alcinate of pancreas.

—The developed arch of the duodenum.

—Augmentation of retrogastric space. extrasecretory failure of pancreas rements, steatorrhea. mias. pancreas — diabetes. General analysis of blood: in

exacerbation — neutrophilic leukocytosis with deviation to the left, augmentation of ESR, anemia. diastase). ours of exac-erbat ay. seromucoid. se level. in test: definition of lipase, alpha amylase, Trypsinum, bicarbonate causeticities in duodenal contents on empty stomach (basal secretion) and after intravenous introduction of secretin and pancreozimin. c) Definition of elastase in feces. Tool diagnostics 1. Ultrasound research of pancreas: Signs of chronic pancreatitis: — Illegibility of pancreas frame with hyperechogenic areas. — Calcification of the pancreas and stones of its ducts. — Non-uniform dilating of ducts of the pancreas.

— Rough contour of the pancreas. — Diffuse rising of echogenic of the pancreas.