For a long time, pancreatitis was thought to be caused by alcohol abuse. This misconception was formed because it was first discovered and described in the example of people suffering from alcoholism. But now it is known that the most dangerous, acute stage of it is almost not found in them - this is the "privilege" of people who have a healthy attitude to strong drinks.
Pancreatitis can be the result of overeating (still considered a form of addiction), pathologies of other digestive organs, endocrine disorders. Regardless of the etiology, form and stage of the course, it greatly disrupts digestion, threatens the state of the metabolic system, and sometimes the patient's life. Nutrition for pancreatitis is mainly protein-based (proteins are digested by the stomach) and involves careful grinding of food.
Organ functions
It is heterogeneous in terms of structure and function of pancreatic tissues. The main part of the cells produces pancreatic juice - concentrated alkali (or rather, their inactive precursors), which contains dissolved enzymes. Pancreatic juice forms the digestive environment of the intestine. Bacteria living in its various branches play an important but auxiliary role.
The main bile ducts also pass through the pancreatic tissue. It travels from the gallbladder to the duodenum, where it flows into the lumen of the gland itself. As a result, alkali, enzymes and bile enter the intestine in the form of a ready-made "mixture", not separately.
Different types of cells are also located in groups in the tissues of the gland. They are called islets, and they are not alkaline, but synthesize the hormone insulin, which is responsible for the absorption of carbohydrates from food. Abnormalities in the development, functioning, or degradation of such cells (usually inherited) are one of the scenarios for diabetes mellitus. The second is to increase the body's cells' resistance to the normal insulin they produce.
Causes of the disease
In the acute stage, pancreatitis leads to blockage of small ducts of the pancreas, through which pancreatic juice flows into the main, and then into the lumen of the duodenum. It has the effect of "self-digestion" by enzymes accumulated in it. Acute pancreatitis can occur for the following reasons.
- Gallstones. Inflammatory pathology of the liver or gallbladder, caused by abnormalities in the bile (caused by taking drugs for sepsis, atherosclerosis, diabetes, the same liver disease).
- Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The agent affects the cells of the gland, causes swelling of the tissues and disrupts its function.
- Medications. Toxic effects of drugs, steroids and some antibiotics for atherosclerosis.
- Deviations in structure or location. They can be congenital (bending of the gallbladder, very narrow ducts, etc. ) or acquired (scars, swelling after surgery or traumatic examination).
Chronic pancreatitis can be seen in most drunken alcoholics and in diabetics with at least five years of "experience. "Here, the autoimmune process in the gland, which causes inflammation or takes antidiabetic drugs, is important. However, it can be accompanied by the following diseases.
- Intestinal pathology. Especially duodenum, including duodenitis (inflammation of the walls) and erosion.
- Vascular diseases. All glands must be actively supplied with blood. Congenital anomalies and coagulation disorders (hemophilia, thrombosis) play a special role here.
- Injuries. Penetration wounds, interventions, severe blows to the stomach.
The least common cause of pancreatitis is a spasm of the common gallbladder and sphincter of Oddi ending in the pancreatic duct. The sphincter of Oddi is located at the outlet of the duodenum. Normally, it regulates the "divided" supply of pancreatic juice and bile to its own cavity, allowing it to almost stop between meals and increase sharply when a person sits at a table. It also prevents various intestinal pathogens (bacteria, foreign compounds, worms) from flowing back into the pancreatic or gallbladder cavity.
This type of sphincter of Oddi is not prone to spasms like all smooth muscle "separators". For a long time in medicine there was no such thing as his own dysfunction. It was replaced by various "biliary dyskinesias" and "postcolysyctomy" "syndromes" (complications of gallbladder removal). But in fact, his spasm is rare only with the normal functioning of the nervous system. However, it is often caused by neurological disorders or as a result of activation of pain receptors - it is damaged when irritated by stones from the gallbladder.
It is necessary to distinguish between the causes of acute and chronic pancreatitis, because the former, even with high-quality treatment, often passes into the latter. It is not clear what "feeds" him after the causal factors are eliminated. In some cases (about 30%), none of these processes can explain the appearance of pancreatitis in the patient.
symptoms
Acute pancreatitis begins and is accompanied by unbearable (until fainting) abdominal pain in the entire upper abdomen, below the ribs. Antispasmodics, painkillers and antibiotics do not eliminate it, and "heart" drugs do not help. A special diet will not eliminate the pain - here you need a doctor, not a diet. Although not always the case, its radiation is directed upwards, to the heart region, under the clavicle, to the thoracic spine, so patients may confuse the symptoms of pancreatitis with an exacerbation of a heart attack or osteochondrosis. This is also facilitated by the body's cascade reactions to a stimulus of critical force:
- jumps in blood pressure (hypertension and hypotension are equally likely);
- heart rate breaks;
- fainting;
- cold, moist sweat.
A characteristic symptom of pancreatitis is loose stools - mucous, semi-digestible food particles and fat. Appears a few hours after the onset of the disease. At the end of the first day, the faeces become discolored in the urine. Normally, they are yellowish-brown in color by bilirubin from the bile in which the digestive process takes place. And it does not enter the intestine due to blockage of the canal. On the second or third day, when the patient sees fatty or spicy foods, "sucking" and vomiting occur in the stomach.
Chronic pancreatitis also occurs with pain, but it is not so obvious. Cold, fried, smoked, greasy, spicy, accompanied by alcohol, especially if inappropriate, can intensify an hour after a meal. The pain intensifies in the supine position, digestion is disrupted to the point of dyspepsia (when almost unchanged food comes out of the stool).
One of the most famous victims of acute pancreatitis (many experts note the possibility of perforation of the stomach ulcer) was Prince Henrietta of England, wife of the Duke of Orleans Philip, brother of King Louis XIV of the Sun. Because of the typical painful course of the disease, she was convinced that one of her husband's loved ones had poisoned her. True, this only occurred during an autopsy prepared to confirm or disprove this rumor.
Effects
Acute pancreatitis is dangerous by rapid (two or three days) "eating" of pancreatic tissue, as a result of which caustic alkali, bile and digestive enzymes enter the abdominal cavity directly through this "fistula". This scenario ends in diffuse peritonitis (inflammation of the peritoneum that spreads rapidly to the organs of the abdominal cavity), the appearance of numerous erosions, and death.
Peritonitis is characteristic of many pathologies, including perforated ulcers, gastric or intestinal cancer, appendicitis, if accompanied by a rupture of the abscess (according to such a scenario, the magician Harry Houdini died). If pancreatitis is triggered by an infection rather than a mechanical obstruction (spasm of the sphincter of Oddi, stones, scars, tumors, etc. ), a purulent abscess of the pancreas may develop. His untimely treatment also ends with a leap into the abdomen.
Pancreatic enzymes and digestive juices sometimes cause enzymatic pleurisy - an inflammation of the pleura of the same type as in the case of the peritoneum. Chronic pancreatitis is characterized by delayed complications, but more severely impairs its function and other organs.
- Cholecystitis. Cholangitis is an inflammation of the hepatic ducts. They themselves can cause pancreatitis due to the accompanying cholelithiasis, but they often occur in the opposite way - as a result.
- Gastritis. Although the stomach is not as closely connected to the liver as the pancreas, it is located directly below. In pancreatitis, its inflammation is not due to the entry of foreign substances from the inflamed gland into its cavity, but due to a constant lack of intestinal digestion, which has to compensate. The pancreatitis diet is designed to reduce the burden on all digestive organs, but the "interests" of a healthy stomach are less carefully considered. The more pronounced the degradation of the pancreas, the higher the risk of developing gastritis.
- reactive hepatitis. It also develops in response to constant stagnation of bile and irritation of the hepatic ducts. Sometimes cholestasis, which occurs during the next exacerbation of pancreatitis, is accompanied by jaundice. That is why the diet for pancreatitis should not include foods that increase bile secretion. Among them are fatty, fried, spicy meat and fish, fish caviar, other animal additives, smoked meats, alcoholic beverages - digestive stimulants.
- Cystosis and pseudocystosis. These benign neoplasms or foci of stagnation of pancreatic juice occur due to the same difficulties as they are transported to the duodenal cavity, which simulates them. Cysts become inflamed and purulent from time to time.
- Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, as it causes irritation, accelerated destruction of affected tissues and an increase in their response. And not always quality. The same goes for chronic pancreatitis.
- Diabetes. This is far from the first "next" complication of chronic pancreatitis. However, the faster and more noticeably the whole gland breaks down, the more difficult it is to compensate for the insulin deficiency caused by the death of the "colleagues" of the surviving islet cells in the already dead areas. They are depleted and also begin to deplete. After seven to ten years (often more rapidly, depending on the prognosis and characteristics of the course of pancreatitis), the likelihood of diabetes is becoming more and more "experimental" for the average patient. Because of the danger, a diet for pancreatitis should ideally take into account not only the reduced content of fats, but also simple carbohydrates.
Chronic recurrent inflammation in the glandular tissues causes scarring and loss of function. Progressive insufficiency of intestinal digestion is inevitable. But in general, you can live with pancreatitis for another 10-20 years. Its course, quality and prognosis of the patient's life are affected by various "deviations" from the diet and their type, especially everything related to alcohol.
diet 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 surgical intervention. The cause of the disease is spasm of the sphincter of Oddi, a stone stuck in the canal or another obstruction (tumor). Upon completion, treatment should be based on a special medical diet.
Basically, gastroenterologists usually adopt diet No. 5, developed by Manuel Pevzner during the Soviet era for patients with cholecystitis and other pathologies that interfere with the synthesis and flow of bile. However, later the author himself created a diet number 5p and changed it.
General Provisions
For adult patients with a mild course of the disease, a mechanically careless version of Table 5p is suitable - it does not require grinding the food to a homogeneous mass. The menu for children should be prepared from most puree products. During the exacerbation of chronic pancreatitis (especially in the first three days after its onset) and in the acute phase, which occurs for the first time, nutrition has several mandatory general rules.
- Simplicity. Recipes should be as simple as possible - no stuffing breast and meat salads, even if all their ingredients "fit" into the diet individually.
- Full hunger in the first days. With the aggravation of the pathology, starvation is determined. That is, only hot alkaline drink and care intravenous injections (vitamins, glucose, sodium chloride).
- Just cook and boil (in water, steam). Table № 5 and 5p do not cover other methods such as baking and frying.
- Minimum fat. Especially if the attack is accompanied by (or causes) cholangitis, cholecystitis. Along with it, vegetable and animal fats should be equally limited, because the same agent, bile, breaks them down. They do not exceed 10 g per day, but can be consumed in any proportion.
- No spices. Especially hot and spicy.
- No nuts. Seeds are also prohibited. These foods are rich in vegetable oil and are very difficult to eat even in powder form.
- Salt to taste. Its consumption in no way affects the course of the pathology, the daily salt intake remains the same as in healthy people - up to 10 g per day.
- Less fiber. This component, which is usually evaluated by nutritionists and people with digestive problems, is severely restricted for use in inflammation of the pancreas. The secret of the "magic" effect on the intestines is that the fiber is not digested, absorbed and irritates various parts of the intestine, stimulates peristalsis and excretion of water. As the fiber is excreted unchanged, it helps in the formation of feces. With inflammation of the pancreas, all these properties of the fibers will only worsen the condition. You can only eat carrots, squash, potatoes, squash, which are rich in starch and pulp, but are relatively weak in hard fibrous fibers. White and red cabbage is prohibited, but cauliflower can be consumed (except inflorescences, twigs and twigs).
- Small portions. As before, there are parts with a total weight of half a kilogram or more three times a day, this is not possible with pancreatic pathologies. There should be at least five meals a day, and the total weight of all foods eaten at one time should not exceed 300 g.
- Soda, coffee, alcohol and kvass are prohibited. These drinks are best eliminated from the diet forever. However, if they simply cannot be taken during remission, they are strictly forbidden during exacerbations.
Sour vegetables (eg tomatoes), as well as all berries and fruits are prohibited. They will further stimulate bile secretion. The emphasis in the diet should be non-acidic and low-fat dairy products, shrimp, eggs (every day, not raw or fried). Grain puree is used as a source of carbohydrates, mainly as buckwheat, rice and oatmeal.
Menu example
For pancreatitis, the diet should include enough protein and carbohydrates. But with the latter, "brute force" can best be prevented by limiting the addition of sugar and honey to drinks and utensils. Buckwheat, a favorite cereal of diabetics, should be included in the diet more often because it contains complex carbohydrates. Sugar can be replaced by diabetic drugs - fructose, xylitol and sorbitol (when added to hot foods, they give an unpleasant taste), aspartame. The diet may look like this at a time when the pancreas is exacerbated or the initial inflammation has already subsided.
Monday
- The first breakfast. Boiled chicken breast puree. Rice puree.
- Lunch. Steamed fish cakes.
- Supper. Rice soup in chicken broth is diluted in half with water. Milk jelly.
- afternoon tea. Omelet from two eggs.
- First lunch. Chicken meatballs (chop the meat with rice). Mashed buckwheat with a dessert spoon of butter.
- Second lunch. Low-fat, non-acidic cottage cheese is crushed in a blender with a teaspoon of sour cream.
Tuesday
- The first breakfast. Oatmeal. Boiled cauliflower.
- Lunch. Lean beef paste with butter. Milk tea and a few white bread crumbs soaked in it.
- Supper. Fish soup made from lean fish with rice and water. Fruitless milk or fruit jelly.
- afternoon tea. Cottage cheese pasta with non-fat sour cream.
- First lunch. Steamed turkey breast soufflé. Mashed liquid buckwheat.
- Second lunch. Boiled shrimp puree with boiled rice.
Wednesday
- The first breakfast. Fish meatballs with rice (chop rice with rice). Boiled carrot puree.
- Lunch. Two tablespoons fried low-fat hard cheese.
- Supper. Oatmeal, diluted chicken broth and chopped breast soup. Cottage cheese pasta with sour cream.
- afternoon tea. A few flowers boiled cauliflower.
- First lunch. Puree pasta with cottage cheese. Steam omelet from two eggs.
- Second lunch. Pumpkin porridge. Tea with a few white crackers soaked inside.
Thursday
- The first breakfast. Pumpkin puree. Steamed chicken cutlets.
- Lunch. Two tablespoons fried low-fat hard cheese.
- Supper. Creamy potato soup with butter. Lean beef puree.
- afternoon tea. Turkey breast souffle.
- First lunch. Buckwheat puree. Lean fish souffle.
- Second lunch. Carrot-pumpkin porridge.
Friday
- The first breakfast. Cottage cheese pasta with sour cream. Pumpkin puree. Chicken meatballs (chop rice like meat).
- Lunch. Mashed potatoes with butter.
- Supper. Milk soup with pasta puree. Omelet with two eggs steamed with fried cheese.
- afternoon tea. A few cauliflower flowers. Rice pudding.
- First lunch. Shrimp chopped in sour cream sauce. Buckwheat puree. Tea with white crackers.
- Second lunch. Carrot puree. Fruitless milk or fruit jelly.
Saturday
- The first breakfast. Pumpkin porridge. Lean beef soufflé.
- Lunch. Fish meatballs.
- Supper. Rice soup with weak chicken broth and minced meat. Milk pasta puree.
- afternoon tea. Oatmeal.
- First lunch. Lean beef paste with butter. Mashed potatoes.
- Second lunch. Pumpkin-carrot porridge. Tea with a few white crackers
Sunday
- The first breakfast. Cottage cheese pasta with sour cream. Omelet.
- Lunch. Zucchini under a cheese coat. Tea with milk and white crackers
- Supper. Buckwheat soup in beef broth diluted with boiled beef puree. Steamed turkey breast soufflé.
- afternoon tea. Oatmeal.
- First lunch. Mashed potatoes. Chicken cutlets.
- Second lunch. Curd pudding.
The diet for pancreatitis requires the elimination of all confectionery and pastries, including chocolate and cocoa. It is necessary to limit the intake of any fats, food acids and fiber. Also do not eat fresh bread. Millet, wheat, corn under the ban. These grains can not even be crushed with a blender. All legumes, including soybeans, are eliminated. They are rich in vegetable proteins, which is why they are valued by vegetarians. However, they are also "guilty" of increased gas production, increased gastric acidity, which is very undesirable in the acute period.