The disease is characterized by acute inflammatory damage of a pancreas. Quite often hypostasis, a hemorrhagic and fatty necrosis from the outcome develops in suppuration (abscess) or fibrosis.
The important place in development of a disease belongs to alimentary disturbances: to reception of plentiful, fried, greasy, spicy food, alcohol abuse, insufficient use of protein. Diseases of bilious ways (cholelithiasis, cholecystitis, dyskinesia of bilious ways, a spasm and strictures of a sphincter of a hepatopancreas) and a duodenum are among other etiological moments (duodenitis); peptic ulcer, infectious diseases (typhoid, parotitis, scarlet fever, sepsis and so forth), vascular defeats (thrombembolia, thrombophlebitis, nodular periarteritis, atherosclerosis, idiopathic hypertensia and so forth), allergic diseases (small tortoiseshell, Quincke's edema and so forth), intoxications, pancreas injuries.
In a pathogeny of a disease intra pancreatic activation of trypsinogen in trypsin under the influence of fabric enzyme of a cytokinase which is released at damage of cells of a pancreas has crucial importance. Emergence of active trypsin leads to self-digestion of a pancreas that is promoted by also active intra pancreatic lipase. The phenomena of heavy intoxication of an organism active pancreatic enzymes (a gipertripsinemiya, a hyperlipasemia) and products of self-digestion (autolysis) of a pancreas develop. Due to the activation by prothrombin trypsin in thrombin and plasminogen in plasmin tendency to fibrinferments and hemorrhages appears.
Damage of the insulyarny device is shown by a hyperglycemia and a glycosuria. Persistent vomiting conducts to organism dehydration: the electrolytic exchange (a hypocalcemia, a hypochloraemia, a hypopotassemia etc.) is broken. Pathological interoceptive (reflex) influences can promote development of paresis of guts (meteorism), cause a spasm of coronary vessels (stenocardia, a myocardial infarction) and disturbance of functions of other bodies.
Problems of medical foods at acute pancreatitis are a creation of the maximum physiological rest of a pancreas, reduction of gastric and pancreatic secretion, trypsin inhibitor synthesis increase, alignment of exchange disturbances. In the first 2 — 4 days meal is forbidden. For a satisfying of thirst alkaline solutions are resolved in a small amount (drinks) ("Borjomi", "Yessentuki No. 4", "Smirnovskaya", "Slavyanovskaya", etc.). They promote suppression of gastric secretion by reduction of education in mucous a duodenum of the secretin stimulating pancreatic secretion. For fight against dehydration enter parenterally or in the form of drop enemas isotonic solution of sodium of chloride from 5% glucose solution (to 1,5 — 2 l a day) that also promotes desintoxication of an organism.
Further increase in volume of the liquid entered inside and meal with gradual increase of energy value of a diet is allowed.
Mainly proteinaceous and carbohydrate diet is used. Fats in food are considerably limited as are badly transferred by patients. Are resolved only in the form of seasonings vegetable and butter. Proteins promote reparative processes in a pancreas. They more stimulate products of inhibitor of the trypsin preventing gland self-digestion, than production of the trypsin. At the phenomena of a diabetes mellitus limit digestible carbohydrates (sugar, jam etc.).
Need of introduction of enough lipotropic factors (sincaline, methionine, lecithin, etc.) is connected with disturbance of products a pancreas of lipocainum possessing lipotropic activity.
The important role in stimulation of reparative processes and increase of protective forces of an organism is played by introduction of enough vitamins (ascorbic acid, Retinolum, bioflavonoids and vitamins of group B).
The amount of salt is limited that promotes reduction of hypostasis of a pancreas, a stomach and exerts decrease in production of hydrochloric acid antiinflammatory impact due to improvement of fixing of salts of calcium in the damaged fabric. Therefore the food within two weeks should be cooked without salt addition (not less).
Due to the existence of a hypocalcemia and hypopotassemia it is necessary to enrich a diet with potassium and calcium. Salts of calcium condense walls of vessels and reduce their permeability, desensitizations of an organism promote. Enrichment of a diet calcium especially pertinently in the presence of allergic manifestations (the small tortoiseshell, a Quincke's edema, etc.).
The food should be given in the liquid, semi-fluid, and then wiped and pyurirovanny look in the beginning. In the beginning mucous soups, kissels, kefir, curdled milk, liquid porridges (rice, buckwheat, oat, semolina) are allowed, to a souffle from low-fat grades of meat and fish, mashed potatoes, curd paste, mousse, dogrose broth, rather weak sweet tea, blackcurrant broth. Further the diet is gradually expanded at the expense of a proteinaceous omelet, carrot and beet puree, apple jelly, steam cutlets, quenelles, the boiled-down meat of low-fat grades (beef, chicken meat, veal), groat puddings, boiled fish, white crackers etc.
Therefore, at acute pancreatitis for digestive organs the mechanical, chemical and thermal shchazheniye which degree gradually decreases over time is provided. Food has to be fractional — 5 — 6 times a day. Food should be eaten in a warm look. For elimination of a lock reception for night of fresh kefir, curdled milk, beet juice is shown. Fried dishes, smoked products, pickles, marinades, canned food, fat, cream, sour cream, fancy pastry, hot spices, alcoholic beverages are excluded for a long time. It is impossible to allow an overeating. In connection with the stated above recommendations with 3 — the 5th day of a disease appoint to 5 — 7 days the I option of a diet No. 5p, and further the II of its option. All this serves as an important measure of the prevention of transition of acute pancreatitis in chronic.
Approximate one-day menu of a diet No. 5p (I option). 1st breakfast: an omelet proteinaceous steam (110 g), buckwheat cereal on water wiped, semi-viscous (280 g), tea (200 ml). 2nd breakfast: a souffle from dried apricots (100 g), tea (200 ml). Lunch: soup rice mucous (200 ml), a souffle fish steam (120 g), cherry juice jelly on xylitol (125 g). Afternoon snack: the cottage cheese fat-free (60 g), dogrose broth (200 ml). Dinner: a meat souffle from boiled meat (110 g), a souffle carrot steam (2,00 g). For the night: dogrose broth (200 ml). For all day: crackers (50 g), sugar (5 g).