It has long been believed that inflammation of the pancreas is caused by alcohol consumption. This false impression arose because it was first discovered and described on the example of those suffering from alcoholism. But it is now known that the most dangerous, acute stage is almost never found in them - it is the "prerogative" of people with a healthy attitude to strong drinks.
The cause of pancreatitis can be overeating (now it can be considered a form of addiction), pathologies of other digestive organs, endocrine disorders. Irrespective of the etiology, form, and stage of the course, it greatly disrupts digestion, endangers the state of the metabolic system, and sometimes the life of the patient. The diet for pancreatitis is mainly protein-based (proteins are digested by the stomach) and involves careful grinding of food.
Organ functions
It is heterogeneous in the structure of the pancreas and in the function of its tissues. Most of its cells produce pancreatic juice - a concentrated alkali in which enzymes (or rather their inactive precursors) dissolve. The juice of the pancreas forms the digestive environment of the intestine. Bacteria living in its various departments play an important but ancillary role.
The main bile duct also passes through the pancreatic tissue. It leads from the gallbladder to the duodenum and flows into the lumen of the gland itself at the exit. As a result, the alkali, enzymes, and bile do not enter the gut separately, but as a finished "mixture. "
Different types of cells are also grouped in the tissues of the gland. They are called islands and do not synthesize alkali, but insulin, a hormone responsible for the absorption of carbohydrates from food. Anomalies (usually inherited) associated with the development, function, or degradation of such cells are a scenario of diabetes mellitus. The second is to increase the resistance of the body's cells to the normal insulin they produce.
Causes of the disease
In the acute stage, inflammation of the pancreas leads to blockage of the small channels in the gland through which pancreatic fluid flows into the lumen of the main and then duodenum. It is "self-digested" by the enzymes that accumulate in it. Acute inflammation of the pancreas can be caused by the following causes.
- Gallstones. They are caused by inflammatory pathology of the liver or gallbladder, anomalies in the composition of the bile (caused by sepsis, atherosclerosis, diabetes, the same liver diseases).
- Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The pathogen affects the cells of the gland, causes swelling of the tissues and disrupts its function.
- Medicines. Toxic effects of atherosclerosis drugs, steroid drugs, and some antibiotics.
- Deviation in structure or location. They may be congenital (bending of the gallbladder, too narrow channels, etc. ) or acquired (scarring, swelling after surgery or traumatic examination).
Chronic pancreatitis is most common in drunk alcoholics and diabetics with at least five years of experience. Here, the autoimmune process of the gland that caused the inflammation or the intake of antidiabetic drugs counts. But it can also accompany the following diseases.
- Intestinal pathology. Especially the duodenum, including duodenitis (inflammation of the walls) and erosion.
- Vascular diseases. All glands must be actively supplied with blood. Congenital disorders and coagulation disorders (haemophilia, thrombosis) play a key role here.
- Injuries. Penetrating wounds, interventions, strong stomach blows.
The least common cause of pancreatitis is spasm of the Oddi sphincter, which ends in the common gallbladder and pancreatic duct. The Oddi sphincter is located at the exit to the duodenum. It normally regulates the "dosed" entry of pancreatic juice and bile into its cavity, allowing it to almost stop between meals and suddenly increase when a person sits down at the table. It also prevents the backflow of intestinal contents with various pathogens (bacteria, foreigncompounds, worms) into the cavity of the pancreas or gallbladder.
The Oddi sphincter is not prone to cramps like all smooth muscle "separators" of this type. For a long time, there was no such thing as a dysfunction of its own in medicine. It has been replaced by various "biliary dyskinesias" and "postcholecystectomy" "syndromes" (a complication of gallbladder removal). But in reality, seizures are rare only with the normal functioning of the nervous system. But it is often preceded by nervous system disorders or by the activation of pain receptors - if irritated by stones leaving the gallbladder, it is damaged.
The division between the causes of acute and chronic pancreatitis is conditional, as the first, even with good quality treatment, passes into the second in the vast majority of cases. And what "feeds" after eliminating the causal factors is not clear. In some cases (about 30%), none of these processes explain the appearance of pancreatitis in the patient.
signs
Acute inflammation of the pancreas begins and is accompanied by unbearable (until loss of consciousness) belt pain in the entire upper abdomen under the ribs. Anticonvulsants, painkillers, and antibiotics do not remove it, nor do the usual medications from the "heart. "No special diet relieves pain - here you need a doctor, not a diet. Usually, though not always, radiation is detected upward in the region of the heart, below the collarbone, in the thoracic spine, as a result of which patients may confuse the symptoms of pancreatitis with a heart attack or worsening of osteochondrosis. This is also facilitated by the body's cascade of responses to critical stimuli:
- blood pressure spikes (high blood pressure and hypotension are equally likely);
- arrhythmias;
- faint;
- cold, damp sweat.
A characteristic symptom of inflammation of the pancreas is loose stools - a pasty, half-digested piece of food and fat. It appears a few hours after the onset of the disease. By the end of the first day, discoloration of the stool with urine becomes noticeable. Bilirubin from the bile usually turns yellowish brown, which helps digestion. It does not get into the gut due to the blockage of the canal. On the second or third day, the patient develops bloating, "sucking in" the stomach when he sees fatty or spicy foods.
Chronic inflammation of the pancreas is also painful, but not so pronounced. They can get up to an hour after eating, especially if it wasn’t right - cold, fried, smoked, greasy, spicy, along with alcohol. In the supine position, the pain intensifies, digestion disturbing all the way to dyspepsia (when almost unchanged food comes out instead of stool).
One of the most famous victims of acute pancreatitis (many experts point to the possibility of perforation of the gastric ulcer) is the wife of Princess Philip of Orléans, English Princess Henrietta, XIV. Brother of King Louis the Sun. Because of the typical painful course of the illness, she was sure one of her husband's pets had poisoned her. True, this was only revealed during an autopsy designed to reinforce or dispel this rumor.
Effects
Acute pancreatitis is dangerous to "eat" quickly (two to three days) through the pancreatic tissue, causing the caustic, bile, and digestive enzymes to enter the abdominal cavity directly through this "fistula. "This scenario ends with diffuse peritonitis (inflammation of the peritoneum that spreads rapidly to the abdominal organs), the appearance of multiple erosion, and death.
Peritonitis is characteristic of many pathologies, including perforated ulcer, gastric or intestinal cancer, appendicitis when accompanied by an abscess rupture (such a scenario has resulted in the death of a magician Harry Houdini). If the inflammation of the pancreas is not caused by a mechanical barrier (spasm of Oddi's sphincter, stone, scar, tumor, etc. ) but by an infection, a purulent pancreatic abscess may develop. Premature treatment also ends with a breakthrough in the abdominal cavity.
Pancreatic enzymes and digestive juices sometimes cause enzymatic pleurisy, the same type of pleurisy. Chronic inflammation of the pancreas is characterized by complications that are delayed in time but more severely disrupt the work of other organs.
- Cholecystitis. Cholangitis is an inflammation of the liver ducts. They themselves can cause inflammation of the pancreas due to the gallbladder that accompanies them, but they often develop in the opposite order as a result.
- Gastritis. The stomach is not as closely connected to the pancreas as the liver, although it is located just below it. Inflammation in pancreatitis is caused not so much by foreign substances entering the cavity from the inflamed gland, but by persistent insufficiency of intestinal digestion, which is forced to compensate. The diet for pancreatitis is designed to reduce the strain on all digestive organs, but the "interests" of a healthy stomach are less taken into account. The more pronounced the degradation of the pancreas, the greater the risk of developing gastritis.
- reactive hepatitis. It also develops due to constant stagnation of bile and irritation of the liver ducts. Sometimes cholestasis at the next exacerbation of inflammation of the pancreas is accompanied by jaundice. Therefore, the diet for pancreatitis should not include foods that require increased bile secretion. Including fatty, fried, spicy meat and fish, caviar, other animal by - products, smoked meats, alcoholic beverages - digestive stimulants.
- Cystosis and pseudocystosis. These benign tumors, or foci of pancreatic congestion that simulate them, are caused by the same difficulties in removing them into the duodenal cavity. Cysts sometimes become inflamed and swollen.
- Pancreatic cancer. Any chronic inflammation is considered a carcinogen because it causes irritation, accelerated destruction of the affected tissues, and an increased response. And not always good quality. The same is true for chronic pancreatitis.
- Diabetes. This is far from the first "serial" complication of chronic pancreatitis. But the faster and more noticeably the entire gland breaks down, the harder it is for surviving islet cells to compensate for the lack of insulin that occurs in already dead areas due to the death of their "colleagues. "They're exhausted and they're starting to die out. After seven to ten years (often even faster, depending on the prognosis and characteristics of the pancreatitis), the chances of diabetes mellitus become more and more palpable to the average patient. , but also the reduced content of simple carbohydrates.
Chronic recurrent inflammation of the glandular tissues causes scarring and loss of function. Progressive intestinal indigestion is inevitable. But you can usually live with pancreatitis for another 10 to 20 years. The prognosis of the course, quality, and life expectancy of the disease is influenced by various "differences" in diet and their type, especially in everything related to alcoholic beverages.
diet therapy
The acute stage of the disease often requires urgent detoxification, prescription of antibiotics (usually broad-spectrum because there is no time to determine the type of pathogen), and sometimes surgery. It is necessary if the cause of the disease is a spasm of Oddi's sphincter, a stone stuck in the channel, or another obstruction (tumor). Upon completion of treatment is based on a special medical diet.
Gastroenterologists usually use Diet No. 5, which was developed by Manuil Pevzner in Soviet times for patients with gallbladder inflammation and other pathologies that prevent bile synthesis and outflow. Later, however, the author himself changed the 5p. with diet number.
General provisions
For adult patients with a mild course of the disease, the non-mechanical version of Table 5p is adequate - it is not necessary to grind the food into a homogeneous mass. And the menu for children is most often made from mashed products. During the period of exacerbation of chronic pancreatitis (especially in the first three days from the onset) and in the acute stage, which first occurred, there are a number of mandatory general rules of nutrition.
- Simplicity. Recipes should be as simple as possible - no stuffed breasts and meat salads, even if all of their ingredients are "fit" into the diet separately.
- Total hunger in the first days. As the pathology worsens, hunger is prescribed. That is, only a warm alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
- Steaming and boiling only (on water, steamed). Figures 5 and 5p. table does not include other methods such as baking and baking.
- Minimum fat content. Especially if the seizure is accompanied (or caused) by cholangitis, an inflammation of the gallbladder. Vegetable and animal fats are just as strictly restricted as they are broken down by the same drug, bile. It can be consumed up to 10 g per day, but in any proportion.
- There are no spices. It is especially spicy and spicy.
- No nuts. Seeds are also prohibited. These types of foods are rich in vegetable oils and are too difficult to eat even in powder form.
- Salt to taste. Its consumption does not affect the course of the pathology in any way, the daily salt intake remains the same as in healthy individuals - up to 10 g per day.
- Less fiber. This ingredient, which is commonly evaluated by nutritionists and those with digestive problems, is severely restricted in pancreatitis. The secret of the "magical" effect on the intestine is that the fibers are not digested, absorbed and irritate the various sections of the intestine, stimulating peristalsis and water excretion. The fibers help to form stool as it is excreted unchanged. Only carrots, zucchini, potatoes, pumpkins can be eaten, they are rich in starch and pulp, but relatively poor in hard fibers. White and red cabbage is forbidden, but cauliflowers can only be eatenand the stems are not).
- Small portions. As before, in doses weighing half a kilogram or more three times a day, this is impossible with pancreatic pathologies. Eat at least five times a day and the total weight of foods consumed at one time should not exceed 300 g.
- Prohibition of soda ash, coffee, alcohol and kvass. It is best to exclude these drinks from your diet forever. But if they are simply not to be taken away during the period of remission, it is strictly forbidden at the time of exacerbation.
Sour vegetables (such as tomatoes) and all berries and fruits are also prohibited. They further stimulate bile selection. In the diet, the emphasis should be on non-acidic and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Purified cereals are used as a source of carbohydrates, mainly buckwheat, rice and oatmeal.
Menu example
The diet menu for pancreatitis should include enough protein and carbohydrates. But with the latter, "gross violence" is best avoided by restricting the addition of sugar, honey to beverages and food. Buckwheat, a diabetic’s favorite cereal, should be included more often in the diet because it is made up of complex carbohydrates. Sugar can be replaced with diabetic drugs - fructose, xylitol and sorbitol (when added to hot foods give an unpleasant aftertaste), aspartame. Diet at a time when pancreatic exacerbation or primary inflammation is already declining may look like this.
Monday
- First breakfast. Boiled chicken breast puree. Mashed rice.
- Lunch. Steamed fish cakes.
- Dinner. Rice soup in chicken soup, diluted in half with water. Milk jelly.
- afternoon tea. Omelet of two eggs.
- First dinner. Chicken meatballs (grind meat with rice). Buckwheat puree in a dessert spoon with butter.
- Second dinner. Lean, non - acid curd, crushed in a blender with a teaspoon of sour cream.
Tuesday
- First breakfast. Cereal. Boiled cauliflower.
- Lunch. My lean beef pate with butter. Tea soaked in milk and some white breadcrumbs.
- Dinner. Lean fish fish soup with rice and water. Milk or fruit jelly without fruit.
- afternoon tea. Cottage cheese pasta with lean sour cream.
- First dinner. Stewed turkey breast souffle. Mashed liquid buckwheat.
- Second dinner. Cooked shrimp puree with boiled rice.
Wednesday
- First breakfast. Fish stew with rice (grind the rice with the fish). Puree of boiled carrots.
- Lunch. Two tablespoons grated low-fat hard cheese.
- Dinner. Soup made from mashed oatmeal, diluted chicken broth and grated breast. Cottage cheese pasta with sour cream.
- afternoon tea. Several roses cooked cauliflower.
- First dinner. Pasta with cottage cheese. Steamed omelette with two eggs.
- Second dinner. Pumpkin porridge. Tea soaked in some white biscuits.
Thursday
- First breakfast. Zucchini puree. Chicken steam.
- Lunch. Two tablespoons grated low-fat hard cheese.
- Dinner. Creamy potato soup with butter. Lean beef puree.
- afternoon tea. Turkey breast souffle.
- First dinner. Buckwheat broke. Lean fish souffle.
- Second dinner. Carrot-pumpkin porridge.
Friday
- First breakfast. Cottage cheese pasta with sour cream. Zucchini puree. Chicken meatballs (grind rice like meat).
- Lunch. Mashed potatoes with butter.
- Dinner. Milk soup with puree. Omelet of two eggs with steamed grated cheese.
- afternoon tea. Several cauliflower flowers. Rice pudding.
- First dinner. Minced shrimp in sour cream sauce. Buckwheat puree. Tea with white biscuits.
- Second dinner. Carrot puree. Milk or fruit jelly without fruit.
Saturday
- First breakfast. Pumpkin porridge. Beef juice from beef.
- Lunch. He caught fish.
- Dinner. Rice soup with weak chicken broth and minced meat. Pasta with mashed milk.
- afternoon tea. Cereal.
- First dinner. My lean beef pate with butter. Potato puree.
- Second dinner. Pumpkin-carrot porridge. Tea with some white biscuits
Sunday
- First breakfast. Cottage cheese pasta with sour cream. Omelette.
- Lunch. Zucchini under a cheese jacket. Tea with milk and white biscuits
- Dinner. Buckwheat soup with beef puree cooked in diluted beef broth. Stewed turkey breast souffle.
- afternoon tea. Porridge with oatmeal.
- First dinner. Potato puree. Chicken slices.
- Second dinner. Rice and cottage cheese pudding.
A diet for inflammation of the pancreas requires the exclusion of all sweets and pastries from the diet, including chocolate and cocoa. The intake of fats, food acids and fiber should be restricted. Also, do not eat fresh bread. Millet, wheat, corn under the ban. These cereals cannot even be mashed with a blender. All legumes, so the soybeans are also wiped. They are rich in vegetable protein, which is why they are appreciated by vegetarians. But they are also "guilty" of increased gas production, an increase in stomach acidity, which is highly undesirable in the acute period.