(1) medical treatment
① Etiological treatment: Patients with cholecystitis and cholelithiasis should deal with biliary tract diseases; Patients with alcoholic pancreatitis should abstain from alcohol; Some people used octapeptide to treat chronic pancreatitis, and found that the pancreatic secretion function was obviously improved and the symptoms were obviously alleviated.
② Control symptoms: mainly to relieve pain, and the following measures can be taken: a. Use painkillers; Application of pancreatin; Application of c receptor blockers; Abdominal plexus block; Endoscopic exclusion of protein embolus from pancreatic duct.
③ Treatment complications: Pancreatic calcification can be treated by oral citric acid. When the exocrine function of pancreas is insufficient, a diet with high protein, high carbohydrate and low fat should be adopted. Commonly used pancreatin preparations, such as multi-enzyme tablets, Viokase or Catazym, 3 ~ 6 g/d, in addition to vitamins A, D, E, K and B 12. Diabetic patients are treated as diabetes and often use insulin.
(2) Surgical treatment: Patients with chronic pancreatitis have no obvious curative effect after 3 ~ 6 months of medical treatment, so early surgery should be considered. The indications for operation are: ① those who can't relieve abdominal pain with medical treatment and are complicated with malnutrition; ② Pseudocyst or abscess of pancreas; ③ those who may be complicated with pancreatic cancer swelling; ④ Fistula; (5) Obstructive jaundice caused by pancreatic enlargement pressing the common bile duct; ⑥ Hemorrhage caused by splenic vein thrombosis and portal hypertension.
The available surgical methods are: ① pancreatectomy; ② decompression and drainage of pancreatic duct; ③ Vagus nerve and celiac ganglion resection; ④ Surgical treatment of biliary tract diseases and portal hypertension.
1
Small organs of pancreas "shoulder heavy responsibilities"
There is a very small organ deep in our upper abdomen, that is, the pancreas. Although the pancreas is small, it plays an extraordinary role. It can be said to be one of the most important organs of the human body. The reason why the pancreas is one of the most important organs in human body is that it is a gland with both internal and external secretion functions, and its physiological function and pathological changes are closely related to life.
The pancreas "lives in seclusion" behind the peritoneum, and its popularity is far less than that of its neighboring stomach, duodenum, liver and gallbladder. However, several digestive enzymes secreted by pancreas play a leading role in food digestion, especially in fat digestion.
In terms of secretion, although the pancreas is small, it contains endocrine cells with multiple functions, such as secreting glucagon, insulin, gastrin and motilin. The hormones secreted by these cells not only participate in the digestion and absorption of substances, but also regulate the physiological functions of the whole body. If these cells are pathological and secrete too much or too little substance, symptoms will appear.
2
Dieting, dredging and preventing diseases
Wang Zaitong, director of general surgery department of Beijing Hospital, told reporters that the incidence of pancreatitis in China is lower than that in foreign countries, which is because of different eating habits.
The main causes of pancreatitis are alcoholism, trauma and biliary tract diseases. Alcoholism is the main cause of pancreatitis abroad, but in China it is mainly due to the poor drainage and reflux of pancreatic juice caused by gallstones, which makes the pancreas inflamed. In recent years, the incidence of pancreatitis in China has increased. Among them, pancreatitis caused by gallstones, that is, biliary pancreatitis, accounts for more than 50% of patients.
The causes of bile formation are also very complicated, and there are differences at home and abroad. For example, the formation mechanism of cholesterol stones and bile pigment stones is very different. Now with the improvement of living standards of residents, gallstones caused by improper diet have also increased. Therefore, the methods to prevent gallstones are very clear. One is to improve the hygiene level, and the other is to eat less foods with fat and high cholesterol.
In addition to gallstones, overeating is also an important pathogenic factor of acute pancreatitis. Overeating promotes pancreatic juice secretion, and alcohol directly stimulates pancreatic juice secretion. When alcohol enters the duodenum, it will cause papilla edema and Oddi's sphincter spasm, so there is no way for pancreatic juice to "digest" the pancreas itself. Patients with cholelithiasis can also have acute pancreatitis due to bile reflux or poor pancreatic juice. Clinically, most patients with acute pancreatitis have the experience of overeating. Therefore, whenever meat and vegetables are mixed, the diet is reasonable.
To sum up, in order to prevent pancreatitis, the most important thing is to reduce alcohol consumption, prevent or treat biliary tract diseases in time, avoid overeating to reduce the burden on pancreas and avoid trauma.
three
Catch that vicious killer! -Be alert to acute and chronic pancreatitis.
Director Wang Zaitong said that acute pancreatitis can be divided into edema type and hemorrhagic necrosis type. Edema is characterized by sudden and persistent pain in the upper abdomen after overeating, which is gradually relieved after 3 ~ 5 days of treatment. Hemorrhagic necrosis is serious, and even a few patients go into shock when the symptoms of upper abdominal pain are not manifested, and suddenly die of respiratory failure, with a mortality rate of more than 40%! Chronic pancreatitis has three obvious characteristics, one is emaciation, the other is fatty diarrhea, and the third is pain, manifested as epigastric pain. The pain is mild and heavy, and it is persistent. The pain is more severe after eating. In addition, because the pancreas belongs to the retroperitoneal organ, it also has pain, that is, low back pain. Suffering from pancreatitis, there are generally surgical and non-surgical treatments. Surgical treatment includes ampulloplasty, Oddi sphincter plasty, biliary and intestinal drainage, gallstone removal and total pancreatectomy. Non-surgical treatment, that is, drug treatment, includes: analgesia; Correct malnutrition; Abstinence from alcohol; Adjust diet, limit fat intake, supply exocrine enzymes and endocrine of pancreas. Although the cure rate of acute severe pancreatitis has been improved, the treatment cost is very high, which requires hundreds of thousands of yuan and takes a long time to recover. It belongs to the most serious necrosis in acute abdomen.
four
Shut up, be vigilant and strengthen nutrition.
Even if patients with acute pancreatitis have returned to normal diet after treatment, it does not mean that their bodies have fully recovered. Therefore, postoperative recovery, conditioning and follow-up are very important. Eliminate the reasons in time. In China, most acute pancreatitis is caused by biliary tract diseases. Therefore, after the condition of acute pancreatitis is stable and the patient's general condition gradually improves, biliary calculi should be actively treated. Alcoholic pancreatitis patients, the first thing is to ban alcohol, if you drink again, it is undoubtedly a chronic suicide. Those who overeat and lead to pancreatitis should avoid repeating the same mistakes. Patients with pancreatitis caused by hyperlipidemia should take lipid-lowering drugs for a long time and have a low-fat and light diet. Regular follow-up to prevent complications. In the recovery period of pancreatitis, inflammation only subsides, and inflammatory exudates often take 3 ~ 6 months to be completely absorbed. During this period, some patients may have complications such as pancreatic cyst and pancreatic fistula. If the patient finds that the abdominal mass is enlarged, and there are symptoms such as abdominal pain, bloating, hematemesis and vomiting. He needs to see a doctor in time. Strengthen nutrition and promote recovery. If the exocrine function of the pancreas is not obviously damaged, you can eat some foods mainly containing carbohydrates and protein to reduce the intake of fat, especially animal fat. If the exocrine function of the pancreas is impaired, nutrition can be properly strengthened with the help of pancreatin preparation.
There are many dietary taboos.
For patients with acute pancreatitis, special attention should be paid to diet. In the acute phase, you should completely fast, and when the symptoms are gradually relieved, you can eat lipoprotein-free liquids, such as juice, lotus root starch, rice soup, vegetable juice, noodle soup and so on. And then you can gradually switch to low-fat semi-liquid liquid. In addition, patients must avoid greasy foods, such as fat, peanuts, walnuts, sesame seeds, cakes, etc., avoid irritating and spicy foods, and absolutely ban alcohol. The treatments for acute pancreatitis include radish juice, water chestnut juice, honeysuckle juice and fresh potato juice. Such as fresh potato juice: wash and chop, mash, wrap with gauze and juice, and take 1 ~ 2 spoonfuls on an empty stomach.
five
Pancreatitis leads, followed by diabetes.
Protein is one of the important nutrients necessary for human body, especially animal protein, and it is a high-quality protein. However, if a large amount of protein is ingested in one meal, it may cause severe acute pancreatitis. If you eat a lot of protein food and drink too much wine at the same time, you will have a greater chance of causing acute pancreatitis. Dr. Sun Meizhen from the Department of Endocrinology, Beijing Hospital said that if you eat a lot of protein and fatty foods at one time in a short time, it will stimulate the pancreas to secrete a lot of pancreatic juice quickly, and the pancreatic duct will not be able to discharge so much pancreatic juice into the duodenum for a while. In addition, if the original pancreatic duct is not smooth, pancreatic juice will flood and flow into pancreatic tissue. If you add the stimulation of wine, it will aggravate the situation of pancreatic juice flooding. This will lead to the digestion of the pancreas itself, leading to death. In mild cases, part of the pancreas will also be irreversibly damaged. After suffering from acute pancreatitis, the internal and external secretion function of pancreas is often damaged to varying degrees. Exocrine dysfunction is characterized by decreased digestive function, especially the ability to digest fat and protein. Patients with loss of appetite, weight loss, abdominal distension, diarrhea, and often accompanied by characteristic steatorrhea. This damage to exocrine function is usually not easy to recover, so pancreatin replacement therapy can only be used in treatment. And impaired pancreatic endocrine may lead to diabetes. The possibility of diabetes depends on the degree of inflammation of pancreatitis. If it is edematous pancreatitis, it will recover quickly, while if it is acute necrotizing pancreatitis, it will affect the function of pancreatic insulin secretion, making insulin secretion too little or even no, which will lead to diabetes. This kind of diabetes caused by other diseases is called secondary diabetes. Therefore, it is also very important to protect the pancreas if you want to avoid diabetes.