Pancreatitis pseudotumorous: causes, symptoms and features of treatment

Pancreatitis pseudotumorous - one of the forms of long-existing pancreatitis with chronic course. This disease affects more than men, rather than women. The name of the pathology comes from the ancient Greek words "pancreas" - pancreas, "itis" - inflammation and "tumor" - tumor. That is, literally translate it can be so - inflammation of the pancreas, imitating the tumor process.

Psevdotumorozny pancreatitis: the causes, symptoms

The provoking factors in the development of this ailment are the pathologies of the hepato-biliary system (eg, GAD) and long-term intake of alcohol. Much less often - taking medications and other physical illnesses. More often pancreatitis pseudotumorous is a consequence of a chronic inflammatory process in the tissues of pancreas and much less (about 10% of cases) it is detected after acute inflammation.

The development of symptoms on the background of cholelithiasis is more often recorded in women. However, not only can it become a provoking factor, the developmental disadvantages of the biliary system, bile duct disease or the pharyngeal papilla are of great importance here. In these cases, inflammation develops as a result of the constant transfer of bile into the pancreatic duct.

One of the ways of development of pseudotumorous pancreatitis can become lymphogenous lesion of pancreas tissues (more often the gland head area), when the inflammatory process spreads from the gall bladder through the lymph node and vessel network.

In more rare cases, the pseudotumorous form of chronic pancreatitis can occur against the background of prolonged use of estrogens, acetaminophen and other drugs, or be hereditary. And with hereditary etiology, the disease is actively progressing, the likelihood of malignancy (malignancy) increases and the gland failure is rapidly increasing.

Clinical manifestations

Symptomatic of this form of pancreatitis is associated with compression of the biliary tract, endocrine insufficiency and lack of pancreatic enzymes that take part in digestion. In addition, among the clinical manifestations are symptoms of tumors and severe pain syndrome. The initial stage of the pseudotumorous form can be asymptomatic.

But most often the patients have the following signs of the disease:

• Mechanical jaundice;
• Circumcised pain that occurs after taking acute or fatty foods, any alcohol or overeating;

• Undigested food in the feces ;
• Nausea followed by vomiting, which brings relief;
• "Fat" feces (steatorrhea);
• Diarrhea alternating with constipation;
• Lowering of glucose tolerance;
• Causeless weight loss;
• At palpation - the condensed head of pancreas;
• Enlarged gland.

Mechanisms for the appearance of major symptoms

With the described disease, the pancreas increases, which is associated with the occurrence of cysts (chronic pseudotumorous pancreatitis, pancreatic cyst), development of lipomatosis and autoimmune lesions.

Inflammatory process, as a rule, affects the head of pancreas - the place of exit of the main pancreatic duct. As a result, the latter narrows, and the pancreatic juice stagnates in the organ. As a result, the flow is overflowing, and the pressure in it is increasing. Enzymes contained in the juice begin to digest pancreatic tissue, which causes the emergence of severe pain syndrome, which is often accompanied by a pseudotumorous form of pancreatitis.

Mechanical jaundice

In the mechanism of the development of this symptom, the predominant role is played by an enlarged gland head, compressing the holedoch (bile duct). As a result, the bile produced in the liver can not enter the duodenum, which causes the pressure in the duct to increase, and the bile gradually penetrates into the bloodstream.

The main complaints with mechanical jaundice are: discolored feces, severe itching, darkening of the urine and yellowing of the sclera and skin.

How to find out, pseudotumorous pancreatitis or cancer in a patient

The diagnosis described implies that all complaints and clinical manifestations of the ailment were taken into account and other diseases, not only of the pancreas (for example, cancer), but also of neighboring organs with similar symptoms were excluded. For this, the following are obligatory:

• Consultation of the gastroenterologist.
• Collection of anamnesis and complaints (previous pancreatitis, cholelithiasis, medication, complaints of pain in the right hypochondrium and epigastric region, and others).
• Examination of the patient with palpation (possible densification and tenderness in the pancreas region).
• Blood tests. This form of pancreatitis is characterized by a slight increase in the levels of trypsin, amylase and lipase, a violation of glucose tolerance.
• Determination of levels of oncomarkers and pancreatic polypeptide (to exclude cancer). With the increase in the number of cancer embryonic antigen, CA 125, CA 19-9, pancreatic polypeptide, the diagnosis of the tumor is confirmed, and with the decrease of the above-described substances, it is concluded that there is an inflammatory process, which confirms the diagnosis of pancreatitis pseudotumorous.
• Ultrasound pancreas (the presence of hypertrophy, changes in the structure of the ducts and gland tissue, the absence / presence of calcification).
• CT or MRI (to exclude malignant neoplasms).
• ERCP. Method of visualization of changes in the pancreatic duct.
• Selective goalscience (determination of the state of pancreatic vessels).

Therapy

Psevdotumorozny pancreatitis, whose treatment during periods of exacerbation is carried out in gastroenterology, is characterized by a wavy course (i.e. alternation of remissions and exacerbations).

Therapy of this pathology implies the appointment of a sparing diet (table number 5). Frequent meals are allowed (five to six times per day), but in small portions. Methods of cooking: cooking and baking, rarely - quenching. Prohibited fatty, fried foods, fried eggs, strong tea, coffee, strictly limited to the amount of meat (especially pork) and milk.

The main direction of therapy is etiotropic treatment, that is, the elimination of provoking factors (alcohol intake, drugs) and the reasons that caused this condition. For example, with cholelithiasis - a cholecystectomy, and so on.

Medication should be aimed at correcting intra- and exocrine gland failure. For this purpose, enzyme preparations are prescribed: "Pancreatin" in combination with "Solizim" or "Lipase". Antacids and calcium preparations are used to reduce steatorrhea.

Cholinolytics are prescribed to reduce discenezia. To relieve the severe pain syndrome, antispasmodics or "Atropine" are used. As an effective antispasmodic for the sphincter of Oddi, use "Mebeverin" or "Gimecromone." In the period of exacerbation, antibacterial drugs are included in the treatment. If drug therapy does not reduce the swelling of the gland and hypersecretion, then local hyperthermia (topically) or regional radiation exposure is prescribed.

In addition to the treatment methods described above, pseudotumorous pancreatitis is often performed endoscopically (eg, papillosphincterotomy) aimed at decompressing the duct system. Such interventions are especially effective in the strictures of the prepialillar region, papillostenosis, enlargement of the pancreas head accompanied by mechanical jaundice and compression of the choledochus.

Prevention

Preventive measures in the diagnosis of "pseudotemporous pancreatitis" are reduced, first of all, to the refusal to drink alcoholic beverages. It is also important to adequately and timely treatment of diseases that can provoke this pathology. It helps to avoid pathology and accurate, controlled by a specialist reception of potentially dangerous drugs.

Forecast

Forecasts for the occurrence of the described form of pancreatitis are relatively favorable. This disease occurs with rare exacerbations and slowly progresses, and endocrine insufficiency rarely leads to the development of kidney damage and angiopathy. The progress of the disease can be stopped with the appointment of timely treatment and the implementation of the recommendations of the doctor in remission. Be healthy!