Pancreatitis has long been thought to be caused by alcohol abuse. This false impression was formed because it was first discovered and described on the example of alcoholics. But now it is already known that they almost never have its most dangerous, acute phase - it is the "prerogative" of people with a healthy attitude towards strong drinks.
Pancreatitis can be the result of overeating (now considered a form of addiction), pathology of other digestive organs, endocrine disorders. Regardless of the etiology, shape and stage of the flow, it greatly impairs digestion, endangers the state of the metabolic system, and sometimes the life of the patient. The diet for pancreatitis is mainly built on protein (proteins are digested in the stomach) and includes careful grinding of food.
Organ functions
The pancreas is heterogeneous in the structure and function of its tissues. The main part of its cells produces pancreatic juice - a concentrated alkali in which enzymes are dissolved (or rather, their inactive precursors). The juice of the pancreas forms the digestive environment of the intestine. Bacteria that inhabit its various departments play an important but helpful role.
The main biliary tract also passes through the pancreatic tissue. It leads from the gallbladder to the duodenum, flowing at the very exit into its lumen into the main canal of the gland itself. As a result, alkalis, enzymes and bile enter the intestine not separately, but in the form of a finished "mixture".
Within glandular tissue, cells of different types are also found in groups. They are called islets, and they do not synthesize alkalis, but insulin, the hormone responsible for absorbing carbohydrates from food. Anomalies in the development, functioning or degradation of such cells (usually hereditary) are one of the scenarios for diabetes mellitus. The second is to increase the body's resistance to the normal insulin they produce.
Causes of disease
In the acute stage, pancreatitis leads to obstruction of the small ducts of the gland, through which pancreatic juice flows into the main and then into the lumen of the duodenum. There is an effect of its "self-digestion" with enzymes accumulated inside. Acute pancreatitis can be caused by the following reasons.
- Gallstones. They occur due to inflammatory pathology of the liver or gallbladder, anomalies in the composition of bile (caused by sepsis, taking drugs for atherosclerosis, diabetes mellitus, the same liver disease).
- Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causes swelling of the tissue and disrupts its function.
- Medications. Toxic effect of atherosclerosis drugs, steroid drugs and some antibiotics.
- Deviations in structure or location. They can be congenital (gallbladder flexion, narrow canals, etc. ) or acquired (scars after surgery or traumatic examination, swelling).
Chronic pancreatitis can most often be seen in drunk alcoholics and diabetics "with experience" of at least five years. The autoimmune process in the gland that caused the inflammation or taking antidiabetics is important here. But it can also accompany the following diseases.
- Intestinal pathology. Especially the duodenum, including duodenitis (inflammation of its walls) and erosion.
- Vascular diseases. All glands must be actively supplied with blood. Congenital anomalies and coagulation disorders (hemophilia, thrombosis) play a special role.
- Injuries. Penetrating wounds, interventions, strong blows to the abdomen.
The rarest cause of pancreatitis is a spasm of the Oddi sphincter, which ends in the common gallbladder and pancreatic duct. The ode sphincter is located at the very exit from it into the duodenum. Normally, it regulates the "portioned" supply of pancreatic juice and bile into its cavity, allows it to almost stop between meals and increase sharply when a person sits down at a table. It also prevents the return flow of intestinal contents together with various pathogens (bacteria, foreign compounds, worms) into the cavity of the pancreas or gallbladder.
Odi's sphincter is not prone to cramps, like all "separators" of smooth muscles of this type. For a long time there was no dysfunction of his own in medicine. It has been replaced by various "biliary dyskinesias" and "postcholecystectomy" "syndromes" (a complication of gallbladder removal). But in fact, his spasm is a rare thing only with the normal functioning of the nervous system. But it often catches up with him with neurological disorders or as a result of activation of pain receptors - when he is irritated by a stone coming out of the gallbladder, he is injured.
The division of the causes of acute and chronic pancreatitis is conditional, because the former, even with high-quality treatment, in the vast majority of cases passes into the latter. And what "feeds" him after the elimination of causal factors is unclear. In some cases (about 30%), none of these processes can explain the occurrence of pancreatitis in a patient.
signs
Acute pancreatitis begins which is accompanied by unbearable (until loss of consciousness) pain in the waist throughout the upper abdomen, below the ribs. Antispasmodics, painkillers and antibiotics do not eliminate this, nor do common heart medications. Even a special diet will not alleviate the pain - a doctor is needed here, not a diet. Usually, although not always, its radiation is recorded upwards, in the area of the heart, below the collarbone, to the thoracic spine, which is why patients may confuse the symptoms of pancreatitis with a heart attack or worsening osteochondrosis. This is also facilitated by the body’s cascading reactions to a critical power stimulus:
- blood pressure spikes (hypertension and hypotension are equally likely);
- interruptions in heart rate;
- unconsciousness;
- cold, sticky sweat.
A characteristic symptom of pancreatitis is a rare stool - porridge, which contains half-cooked parts of food and fat. It appears a few hours after the onset of the disease. By the end of the first day, a change in the color of the feces with urine becomes noticeable. They are usually colored yellow-brown by bilirubin from the bile, with the help of which digestion takes place. And because of the blockage of the canal it does not enter the intestine. On the second or third day, the patient experiences bloating, "sucking" in the stomach and vomiting when looking at fatty or spicy foods.
Chronic pancreatitis also occurs with pain, but not as severe. They can intensify an hour after a meal, especially if it was inappropriate - cold, fried, smoked, greasy, spicy, with alcohol. The pain intensifies in the supine position, digestion is disturbed to dyspepsia (when almost unchanged food comes out instead of feces).
One of the most famous victims of acute pancreatitis (many experts point to the possibility of perforation of a stomach ulcer) was Princess Henrietta of England, wife of Duke Philip of Orleans, brother of the Sun King Louis XIV. Because of the typical painful course of the disease, she was sure she had been poisoned by one of her husband’s favorites. True, it was shown only during the autopsy, designed to confirm or disprove this rumor.
Effects
Acute pancreatitis is dangerous due to the rapid (two or three days) "eating" of pancreatic tissue through and through, as a result of which caustic alkali, bile and digestive enzymes enter through this "fistula" directly into the abdominal cavity. This scenario ends with diffuse peritonitis (inflammation of the peritoneum, which spreads rapidly to the abdominal organs), the appearance of multiple erosions and death.
Peritonitis is characteristic of many pathologies, including perforated ulcer, cancer of the stomach or intestines, appendicitis, if accompanied by a breakthrough abscess (because of such a scenario, the magician Harry Houdini died). If pancreatitis is not caused by a mechanical obstruction (Oddi's sphincter spasm, calculus, scar, tumor, etc. ), but by an infection, a purulent abscess of the pancreas can develop. His untimely treatment ends with penetration into the abdominal cavity.
Enzymes and digestive juice of the pancreas sometimes cause enzymatic pleurisy - inflammation of the pleura of the same type as in the case of the peritoneum. Chronic pancreatitis is characterized by complications that are delayed with time, but more seriously disrupt its work and other organs.
- Cholecystitis. And cholangitis is an inflammation of the liver ducts. They themselves can cause pancreatitis due to cholelithiasis that accompanies them, but they often form in the opposite order - as a consequence.
- Gastritis. The stomach is not as closely connected to the pancreas as the liver, although it is located just below it. Its inflammation in pancreatitis occurs not so much due to foreign substances entering its cavity from the inflamed gland, but due to the constant insufficiency of intestinal digestion, which is forced to compensate. The diet against pancreatitis is designed to reduce the load on all digestive organs, but the "interests" of a healthy stomach are less carefully taken into account. The more pronounced the degradation of the pancreas, the greater the risk of developing gastritis.
- reactive hepatitis. It also develops in response to constant bile stagnation and irritation of the liver ducts. Sometimes cholestasis that occurs with the next worsening of pancreatitis is accompanied by jaundice. Therefore, the diet for pancreatitis should not include foods that require increased bile secretion. Among them are fatty, fried, spicy meat and fish, fish caviar, other by-products of animal origin, smoked meat, alcoholic beverages - stimulants of digestion.
- Cystosis and pseudocystosis. These benign neoplasms or foci of stagnation of pancreatic juice that simulate them arise due to the same difficulties with its removal into the duodenal cavity. Cysts tend to become inflamed and purulent from time to time.
- Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor because it causes irritation, accelerated destruction of affected tissues and their increased growth of responses. And it is not always of good quality. The same goes for chronic pancreatitis.
- Diabetes. This is far from the first "next" complication of chronic pancreatitis. But the faster and more noticeably the whole gland degrades, the harder it is for the surviving islet cells to make up for the lack of insulin caused by the death of their "colleagues" in already dead areas. They are exhausted and are also starting to die out. The prospect of diabetes mellitus after seven to ten years (often and faster, depending on the prognosis and characteristics of the course of pancreatitis) "experience" for the average patient becomes increasingly tangible. Due to its danger, the diet for pancreatitis should ideally take into account the reduced content of not only fat, but also simple carbohydrates.
Chronic recurrent inflammation in glandular tissues causes scarring and loss of functionality. Progressive intestinal indigestion is inevitable. But in general, you can live with pancreatitis for another 10-20 years. The prognosis of its course, quality and life expectancy of patients is influenced by various "deviations" from the diet and their type, especially in everything related to alcoholic beverages.
dietary therapy
The acute phase of the disease often requires urgent detoxification, the appointment 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 the Oddi sphincter, a stuck stone in the canal or another obstacle (tumor). After its completion, the basis of treatment should be a special medical diet.
As a basis, gastroenterologists usually take diet number 5, which was developed by Manuil Pevzner in Soviet times for patients with cholecystitis and other pathologies that interfere with the synthesis and outflow of bile. But later the author himself changed that by creating diet no. 5p.
General provisions
For adult patients with a mild course of the disease, the variant of table no. 5p without mechanical savings - does not require grinding food to a homogeneous mass. And the menu for children usually has to be made from puree products. Diet in the period of exacerbation of chronic pancreatitis (especially in the first three days of its onset) and in the acute stage, which occurred for the first time, has several mandatory general rules.
- Simplicity. Recipes should be as simple as possible - without stuffed breasts and meat salads, even if all the ingredients in their composition individually "fit" into the diet.
- Complete hunger in the early days. With worsening pathology, starvation is prescribed. That is, only warm alkaline drinks and maintenance of intravenous injections (vitamins, glucose, sodium chloride).
- Just stewing and cooking (on water, on steam). Table no. 5 and 5p do not include other methods such as baking and frying.
- Minimum fat. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. Vegetable and animal fats with it must be equally strictly limited, because they are broken down by the same agent, bile. They can be consumed no more than 10 g per day, but in any proportion.
- No spices. Especially spicy and spicy.
- No nuts. Seeds are also banned. These types of foods are rich in vegetable oil and are too difficult to eat even in powder form.
- Add salt to taste. Its consumption in no way affects the course of pathology, daily salt intake remains the same as in healthy people - up to 10 g per day.
- Less fiber. This component, which is usually appreciated by nutritionists and people with digestive problems, is strictly limited for use in inflammation of the pancreas. The secret of its "magical" effect on the intestines is that the fibers do not digest, absorb and irritate different parts of the intestine, stimulate peristalsis and water excretion. Fibers help form feces, because they are excreted unchanged. You can only eat carrots, zucchini, potatoes, pumpkin, rich in starch and pulp, but relatively poor in hard fiber. White and red cabbage is prohibited, but cauliflower can be consumed (excluding only inflorescences, twigs and stems).
- Small portions. There are, as before, three times a day in portions with a total weight of half a kilogram or more, with pathologies of the pancreas this is impossible. There should be at least five meals a day, and the total weight of all foods eaten should not exceed 300 g.
- Prohibition of carbonated drinks, coffee, alcohol and yeast. It is best to exclude these drinks from the diet forever. But if they simply should not be taken away during the remission period, then they are strictly forbidden during the exacerbation.
Sour vegetables (for example, tomatoes), as well as all berries and fruits, are also forbidden. They will additionally stimulate the secretion of bile. The emphasis in the diet should be on low-fat and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Pureed cereals are used as sources of carbohydrates, mainly buckwheat, rice and oatmeal.
Example menu
The diet for pancreatitis should contain enough protein and carbohydrates. But the "brute force" of the latter is best avoided by limiting the addition of sugar, honey to drinks and meals. Buckwheat, a favorite cereal of diabetics, should be included more often in the diet, because it consists of complex carbohydrates. Sugar can be replaced by drugs for diabetes - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant taste), aspartame. The diet in the period when the deterioration or primary inflammation of the pancreas is already declining may look like this.
Monday
- First breakfast. Cooked chicken breast puree. Rice puree.
- Lunch. Steamed fish cakes.
- Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
- afternoon tea. Omelet of two eggs.
- First dinner. Chicken meatballs (grind meat with rice). Strained buckwheat with a dessert spoon of butter.
- Another dinner. Lean, non-sour cream cheese, chopped in a blender with a teaspoon of sour cream.
Tuesday
- First breakfast. Oatmeal. Cooked cauliflower.
- Lunch. Lean beef pate with butter. Tea with milk and a few crumbs of white bread soaked in it.
- Dinner. Lean fish soup with rice and water. Milk or fruit jellies without fruit.
- afternoon tea. Fresh cheese pasta with lean sour cream.
- First dinner. Steamed turkey breast souffle. Pureed liquid buckwheat.
- Another dinner. Cooked shrimp puree with cooked rice.
Wednesday
- First breakfast. Fish meatballs with rice (grind rice together with fish). Mashed carrots.
- Lunch. Two tablespoons grated low-fat hard cheese.
- Dinner. Soup of mashed oatmeal, diluted chicken soup and chopped breast. Curd pasta with sour cream.
- afternoon tea. A few flowers of boiled cauliflower.
- First dinner. Pureed pasta with fresh cheese. Steamed omelette of two eggs.
- Another dinner. Pumpkin porridge. Tea with a few white crackers soaked in it.
Thursday
- First breakfast. Zucchini puree. Chicken steamed cutlets.
- 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 puree. Lean fish souffle.
- Another dinner. Carrot and pumpkin porridge.
Friday
- First breakfast. Curd pasta with sour cream. Zucchini puree. Chicken meatballs (grind rice, like meat).
- Lunch. Mashed potatoes with butter.
- Dinner. Milk soup with puree paste. Omelette of two steamed eggs with grated cheese.
- afternoon tea. A few cauliflower flowers. Sutlijaš.
- First dinner. Ground shrimp in sour cream sauce. Buckwheat puree. Tea with white crackers.
- Another dinner. Carrot puree. Milk or fruit jellies without fruit.
Saturday
- First breakfast. Pumpkin porridge. Lean beef soufflé.
- Lunch. Fish meatballs.
- Dinner. Rice soup with weak chicken soup and minced meat. Pureed pasta with milk.
- afternoon tea. Oatmeal.
- First dinner. Lean beef pate with butter. Mashed potatoes.
- Another dinner. Pumpkin and carrot porridge. Tea with a few white crackers
Sunday
- First breakfast. Fresh cheese pasta with sour cream. Omelet.
- Lunch. Zucchini under the coat. Tea with milk and white crackers
- Dinner. Buckwheat soup on diluted beef broth with cooked beef puree. Steamed turkey breast souffle.
- afternoon tea. Oatmeal puree.
- First dinner. Mashed potatoes. Chicken chops.
- Another dinner. Rice curd pudding.
A diet for pancreatitis requires the exclusion from the diet of all sweets and pastries, including chocolate and cocoa. You need to limit your intake of any fats, dietary acids and fiber. Also, do not eat fresh bread. Under the ban millet, wheat, corn. These cereals cannot be crushed even with a blender. All legumes, including soybeans, are also abolished. They are rich in plant proteins, which is why they are valued by vegetarians. But they are also "guilty" of increased gas production, increased stomach acidity, which is very undesirable in the acute period.