It has long been believed that pancreatitis was caused by alcohol abuse. This misconception was created because it was first discovered and described using the example of alcoholics. But it is now known that the most dangerous, acute stage is almost never found in them - this is the "privilege" of people with a healthy attitude to strong drinks.
Pancreatitis can be the result of overeating (now also 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 life of the patient. The diet for pancreatitis is mainly based on protein (proteins are digested by the stomach) and includes careful grinding of food.
Instrument functions
The pancreas is heterogeneous in structure and function of its tissues. The bulk of its cells produce pancreatic juice - a concentrated alkali with enzymes dissolved in it (or rather, their inactive precursors). Pancreatic juice forms the digestive environment of the intestine. Bacteria that live in different parts of it play an important but helpful role.
The main bile duct also runs through the pancreatic tissue. It leads from the gallbladder to the duodenum, flowing at the very exit to its lumen in the main pore of the gland itself. As a result, alkalis, enzymes and bile enter the intestine not separately, but in the form of a ready-made "mixture".
Within the glandular tissues, cells of different types are also found in groups. They are called islets and do not synthesize alkalis, but insulin, a hormone that is responsible for the absorption of carbohydrates from food. Abnormalities in the growth, function or degradation of such cells (usually inherited) are one of the scenarios for diabetes. 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, pancreatitis leads to obstruction of the small ducts of the gland, through which the pancreatic juice flows to the main and then to the duodenum. There is an effect of its "self-esteem" from the enzymes that accumulate inside. Acute pancreatitis can be caused by the following reasons.
- Gallstones. They occur due to inflammatory pathology of the liver or gallbladder, abnormalities in the composition of bile (caused by sepsis, taking drugs for atherosclerosis, diabetes, the same liver diseases).
- Contamination. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causes swelling of the tissues and disrupts its function.
- Medicines. The toxic effect of atherosclerosis drugs, steroids and certain antibiotics.
- Deviations in structure or position. They can be congenital (gallbladder flexion, very narrow pores, etc. ) or acquired (scars after surgery or traumatic examination, edema).
Chronic pancreatitis can be more commonly seen in intoxicated alcoholics and diabetics "with experience" of at least five years. Here, the autoimmune process in the gland, which caused inflammation or taking anti-diabetic drugs, is important. However, 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 abnormalities and coagulation disorders (hemophilia, thrombosis) play a special role here.
- Injuries. Piercing injuries, surgeries, strong blows to the stomach.
The least common cause of pancreatitis is the spasm of the Oddi sphincter, which ends in the common gallbladder and pancreatic duct. The Oddi clamp is located at the very exit from it to the duodenum. Normally, it regulates the "portion" of pancreatic juice and bile supply in its cavity, allowing it to stop almost between meals and increase sharply when a person is sitting at the table. It also prevents the reverse flow of intestinal contents along with various pathogens (bacteria, foreign compounds, worms) into the cavity of the pancreas or gallbladder.
The Oddi clamp is not prone to spasms, like all smooth muscle "dividers" of this type. For a long time, there was no such thing as his own dysfunction in medicine. It was replaced by various "biliary dyskinesias" and "metacolocystectomy" "syndromes" (complication of gallbladder removal). But in reality, his spasm is something rare only with the normal functioning of the nervous system. But it often passes with neurological disorders or as a result of the activation of pain receptors - when it is irritated by stones emerging from the gallbladder, it becomes injured.
The division of the causes of acute and chronic pancreatitis is conditional, as the first, even with high quality treatment, in the vast majority of cases passes to the second. And what "feeds" it after the elimination of the causal factors is unclear. In some cases (approximately 30%), none of these procedures can explain the onset of pancreatitis in a patient.
signs
Acute pancreatitis begins and is accompanied by unbearable (up to loss of consciousness) pain in the area throughout the upper abdomen, below the ribs. Anticonvulsants, painkillers and antibiotics do not remove it, nor do common heart medications. Not even a special diet will relieve the pain - here you need a doctor, not a diet. Usually, although not always, the radiation is directed upwards, in the area of the heart, under the key, in the thoracic spine, due to which patients may confuse the symptoms of pancreatitis with myocardial infarction or exacerbation of osteochondrosis. . This is also facilitated by the body's successive reactions to a critical stimulus:
- spikes in blood pressure (hypertension and hypotension are equally likely).
- cardiac arrest;
- faint?
- cold, soft sweat.
A characteristic symptom of pancreatitis is loose stools - porous, containing semi-digested food debris and fat. It appears a few hours after the onset of the disease. By the end of the first day, the discoloration of the stool with the urine is felt. Normally, they are colored yellow-brown by bilirubin from bile, with the help of which digestion took place. And because of the obstruction of the pore, it does not enter the intestine. On the second or third day, the patient shows flatulence, "sucks" in the stomach and vomits when he sees fatty or spicy foods.
Chronic pancreatitis also occurs with pain, but not as severe. They can intensify an hour after eating, especially if it was inappropriate - cold, fried, smoked, greasy, spicy, accompanied by alcohol. The pain worsens in the supine position, digestion is disturbed until indigestion (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 Philippe of Orleans, brother of King Louis XIV. Because of the typical painful course of the disease, she was sure that one of her husband's favorites had poisoned her. It is true that it was only proven during an autopsy, which was designed to confirm or dispel this rumor.
Belongings
Acute pancreatitis is dangerous with the fast (two or three days) "eating" of pancreatic tissue through and through, causing caustic alkalis, bile and digestive enzymes to 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 a perforated ulcer, stomach or intestinal cancer, appendicitis, if accompanied by a rupture of the abscess (because of such a scenario, the magician Harry Houdini died). If the pancreatitis was not caused by a mechanical obstruction (Oddi sphincter spasm, stone, scar, tumor, etc. ), but by infection, a purulent pancreatic abscess may develop. His untimely treatment also ends with a major breakthrough in the abdominal cavity.
Enzymes and the digestive fluid of the pancreas sometimes cause enzymatic pleurisy - inflammation of the pleura of the same type as in the case of the peritoneum. For chronic pancreatitis, time-delayed complications are typical, but more serious ones disrupt its work and other organs.
- Cholecystitis. Cholangitis is also an inflammation of the liver. They themselves can cause pancreatitis due to the cholelithiasis that accompanies them, but they often form in the opposite order - as a consequence.
- Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it is located just below it. Its inflammation in pancreatitis occurs not so much due to the entry of foreign substances into its cavity from the inflammatory gland, but due to the constant insufficiency of intestinal digestion, which it is forced 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 severe the degeneration of the pancreas, the greater the risk of gastritis.
- reactive hepatitis. It also develops in response to the constant stagnation of bile and irritation of the liver pores. Sometimes cholestasis that occurs during the next flare-up of pancreatitis is accompanied by jaundice. That is why the pancreatitis diet should not include foods that require increased bile separation. Among them are fatty, fried, spicy meats and fish, fish caviar, other animal by-products, smoked meats, alcoholic beverages - digestive stimulants.
- Cystosis and pseudocystosis. These benign tumors or foci of stagnation of the pancreatic juice that simulate them occur due to the same difficulties as its removal in the duodenal cavity. The cysts tend to become periodically inflamed and swollen.
- Pancreatic cancer. Any chronic inflammation is considered a carcinogen, because it causes irritation, accelerated destruction of the affected tissues and increased development of the response. And it is not always of good quality. The same goes for chronic pancreatitis.
- Diabetes. It is far from the first "consecutive" complication of chronic pancreatitis. However, the faster and more noticeably the entire gland degrades, the more difficult it is for surviving islet cells to compensate for the insulin deficiency that results from the death of their "colleagues" in already dead areas. They become exhausted and also begin to die. The prospect of diabetes after seven to ten years (often even faster, depending on the prognosis and characteristics of the course of pancreatitis) "experience" for the average patient becomes more and more tangible. Due to its threat, a diet for pancreatitis should ideally take into account the reduced content not only of fats, but also of 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. The prognosis for its course, quality and life expectancy of the patient is affected by various "deviations" from their diet and type, especially with regard to alcoholic beverages.
diet therapy
The acute stage of the disease often requires urgent detoxification, the appointment of antibiotics (usually broad-spectrum, as 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 sphincter of Oddi, a stone stuck in the pore or other obstruction (tumor). Once completed, the basis of treatment should be a special medical diet.
Gastroenterologists usually take as a basis the diet number 5, developed by Manuil Pevzner in Soviet times for patients with cholecystitis and other pathologies that prevent the synthesis and outflow of bile. Later, however, the author himself changed it by creating diet No. 5p.
General supplies
For adult patients with a mild course of the disease, a variant of Table No. 5p is suitable without mechanical savings - it does not require grinding food to a homogeneous mass. And the menu for children most of the time must be made of mashed products. The diet during the period of exacerbation of chronic pancreatitis (especially the first three days after its onset) and in the acute stage, which first appeared, has several mandatory general rules.
- Simplicity. Recipes should be as simple as possible - not stuffed breasts and meat salads, even if all the ingredients of their composition separately "fit" into the diet.
- Complete hunger in the first days. With worsening of the pathology, hunger is prescribed. That is, only a hot alkaline drink and conservative intravenous injections (vitamins, glucose, sodium chloride).
- Only baking and boiling (in water, steam). Tables Nos. 5 and 5p do not imply other methods such as baking and frying.
- Minimal fat. Especially if the infection is accompanied (or caused) by cholangitis, cholecystitis. The vegetable and animal fats with it must be equally strictly limited, since the same factor, bile, breaks them down. They can be consumed no more than 10 g per day, but in any proportion.
- No spices. Extremely hot and spicy.
- No nuts. Seeds are also prohibited. These types of foods are rich in vegetable oils and are very difficult to consume 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, commonly valued by nutritionists and people with digestive problems, is strictly restricted to use in inflamed pancreas. The secret of its "magic" action in the intestines is that the fiber is not assimilated, not absorbed and irritates various parts of the intestine, stimulates peristalsis and water excretion. Fiber helps to form stools, as they are excreted unchanged. With inflammation of the pancreas, all these properties of the fibers will only worsen the condition. You can eat only carrots, zucchini, potatoes, pumpkin, rich in starch and pulp, but relatively poor in hard fiber. White and red cabbage is forbidden, but cauliflower can be eaten (excluding inflorescences, twigs and stalks).
- Small portions. There are, as before, three times a day in portions weighing a pound or more, with pancreatic pathology is impossible. There should be at least five meals a day and the total weight of all foods consumed at a time should not exceed 300 g.
- Prohibition of soda, coffee, alcohol and kvass. These drinks are best left out of the diet forever. But if during the recession just do not have to get carried away, then during an outbreak they are strictly prohibited.
Sour vegetables (for example, tomatoes), as well as all berries and fruits, are also prohibited. They will further stimulate bile secretion. Emphasis on nutrition should be given to non-acidic and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Mashed cereals are used as sources of carbohydrates, mainly buckwheat, rice and oatmeal.
Example menu
The diet menu for pancreatitis should contain enough protein and carbohydrates. But "brutal violence" with the latter is best avoided by limiting the addition of sugar, honey to drinks and dishes. Buckwheat, a favorite cereal for diabetics, should be included in the diet more often, as it is composed of complex carbohydrates. Sugar can be replaced with diabetic drugs - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant aftertaste), aspartame. Diet at a time when the flare-up or primary inflammation of the pancreas is already in decline may look like this.
Monday
- First breakfast. Boiled chicken breast puree. Mashed rice.
- Lunch. Steamed fish cake.
- Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
- afternoon tea. Omelette from two eggs.
- First dinner. Chicken meatballs (grated meat with rice). Mashed buckwheat with a spoonful of sweet butter.
- Second dinner. Lean, non-acidic cottage cheese, crushed in a blender with a teaspoon of sour cream.
Tuesday
- First breakfast. Oatmeal. Cauliflower boiled.
- Lunch. Lean beef pate with butter. Tea with milk and a few crumbs of white bread soaked in it.
- Dinner. Lean fish fish soup with rice and water. Fruit milk or jelly without fruit.
- afternoon tea. Pasta with cottage cheese with lean cream.
- First dinner. Souffle with steamed turkey breast. Mashed liquid buckwheat.
- Second dinner. Puree boiled shrimp with boiled rice.
Wednesday
- First breakfast. Fish meatballs with rice (grind the rice together with the fish). Mashed boiled carrots.
- Lunch. Two tablespoons grated hard cheese with low fat.
- Dinner. Oatmeal puree soup, diluted chicken broth and grated breast. Curd pasta with sour cream.
- afternoon tea. Several boiled cauliflower flowers.
- First dinner. Mashed pasta with cottage cheese. Steam omelette from two eggs.
- Second dinner. Pumpkin porridge. Tea with some white crackers soaked in it.
Thursday
- First breakfast. Zucchini puree. Chicken steamed cutlets.
- Lunch. Two tablespoons grated hard cheese with low fat.
- Dinner. Creamy potato soup with butter. Mashed lean beef.
- afternoon tea. Souffle turkey breast.
- First dinner. Mashed buckwheat. Lean fish souffle.
- Second dinner. Carrot-pumpkin porridge.
Friday
- First breakfast. Curd pasta with sour cream. Zucchini puree. Chicken meatballs (grated rice, like meat).
- Lunch. Mashed potatoes with butter.
- Dinner. Milk soup with pasta puree. Omelette from two steamed eggs with grated cheese.
- afternoon tea. Several cauliflower flowers. Rice pudding.
- First dinner. Minced shrimp in cream sauce. Buckwheat puree. Tea with white crackers.
- Second dinner. Carrot puree. Fruit milk or jelly without fruit.
Saturday
- First breakfast. Pumpkin porridge. Lean beef souffle.
- Lunch. Fish meatballs.
- Dinner. Rice soup with weak chicken broth and minced meat. Mashed pasta with milk.
- afternoon tea. Oatmeal.
- First dinner. Lean beef pate with butter. Mashed potatoes.
- Second dinner. Pumpkin-carrot porridge. Tea with a few white crackers
Sunday
- First breakfast. Pasta with cottage cheese with sour cream. Omelette.
- Lunch. Zucchini under a cheese coat. Tea with milk and white crackers
- Dinner. Buckwheat soup in diluted beef broth with boiled beef puree. Souffle with steamed turkey breast.
- afternoon tea. Mashed oatmeal.
- First dinner. Mashed potatoes. Chicken cutlets.
- Second dinner. Rice pudding.
The diet for pancreatitis requires the exclusion from the diet of all types of confectionery and pastries, including chocolate and cocoa. You need to limit your intake of fats, acidic foods and fiber. Also, do not eat fresh bread. Under the ban millet, wheat, corn. These cereals can not be mashed even with a blender. All legumes, including soybeans, are also discarded. It is rich in vegetable protein, for which it is appreciated by vegetarians. But they are also "guilty" of increased gas formation, increased stomach acidity, which is especially undesirable in the acute period.