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Chronic pancreatitis — slowly progressing pancreas inflammation which is characterized by focal necroses in combination with diffusion or segmented fibrosis followed by disturbances of its exocrine and endocrine functions proceeding with the periods of an aggravation and remission. Conditionally tell about chronic pancreatitis when inflammatory process in a pancreas continues more than 6 months.
Approximately at 5% of people the main channel opens in a duodenum separately from a bilious channel. Still 5% have an extended ampoule at which Oddi's sphincter closes only its terminal part. As a result of these anatomic features duodenum contents (in the first case) and bile (in the second) can be thrown in the pancreatic canal that creates premises for development of pancreatitis.
Risk factors of development of chronic pancreatitis
The major etiological factors of chronic pancreatitis are an alcohol and diseases of a gall bladder. Rather often pancreatitis at pathology of a big duodenal nipple meets (a stenosis, strictures, an inflammation, tumors). Chronic pancreatitis can arise at a pancreas injury, at metabolic disturbances (an azotemia, a lipidemia, etc.); hereditary diseases (mucoviscidosis, hemochromatosis, etc.); use of some drugs (Azathioprinum, tiazida, etc.); toxic influences (poisonings with lead, mercury, etc.). Developing of chronic pancreatitis is promoted by a metabolic acidosis, gland ischemia, hormonal frustration. chronic pancreatitis can develop at infectious parotitis and other viral infections (Koksaki, etc.). Development of chronic pancreatitis can be promoted by parasitic invasions, especially an opisthorchosis.
In case of development of purulent complications of chronic pancreatitis (pancreas abscesses) most often allocate enterokokk, golden staphylococcus, colibacillus.
Signs of an exacerbation of chronic pancreatitis
At an exacerbation of chronic pancreatitis of the patient nausea, the repeated vomiting which is not giving relief, the expressed abdominal pains disturb. Pains are often localized in left hypochondrium with irradiation in the left half of a thorax or a shovel; pains can be also localized in right hypochondrium, and sometimes have the surrounding character. Integuments are pale, wet. Language can be dry. The muscle tension of a front abdominal wall is insignificant and does not correspond to weight of manifestations. In blood the expressed increase of concentration of amylase, a leukocytosis is defined. Usually at patients arterial hypotension — owing to intoxication, a pain syndrome, and also at the expense of a hyperpermeability of vessels is observed (allocation in blood of kinin and kallikrein). Development of shock, multiorgan insufficiency is possible.
The lethality at an exacerbation of chronic pancreatitis depends on a clinical form — from 1% at parenchymatous (recurrent) forms to 15% at cystous and almost to 30% at hyperplastic (pseudo-tumorous) chronic pancreatitis.
The forecast of chronic pancreatitis without treatment, especially at the proceeding alcohol abuse, adverse.
Chronic pancreatitis is risk factor of development of a pancreatic cancer.