What causes pain in pancreatitis and why?

One of the important organs of the human body is the pancreas, which performs mixed functions in the digestive system:

Exocrine (external) - digestive enzymes are secreted in pancreatic juice, which are involved in the digestion of food.

Enzymes break down fats, proteins and carbohydrates. Every day, the pancreas produces 500-1000 ml of this juice with substances that neutralize the acidic environment of gastric juice and protect the gastric mucosa from damage.

Inflammation of the pancreas

Causes of inflammation of the pancreas

About 50–60% of patients suffering from pancreatitis abuse alcohol. At risk are people who lead a sedentary lifestyle and eat mainly processed foods, fatty, fried foods, and sausages.

Inflammation of the pancreas often develops against the background of cholecystitis, cholelithiasis, dysfunction of the sphincter of Oddi, and after surgical operations on the abdominal organs.

Other causes of pancreatitis:

• taking hormonal drugs, thiazide diuretics, hypothiazide;
• mechanical injuries of the pancreas;
• cystic fibrosis;
• genetic predisposition;
• viral infections: mumps, Coxsackie virus, cytomegalovirus;
• chronic, viral hepatitis, liver cirrhosis;
• duodenitis, gastritis, duodenal ulcer;
• unbalanced diet;
• parasitic infestations;
• metabolic disease;
• bacterial, fungal infections: mycoplasma, campylobacter, Helicobacter pylori;
• congenital pathologies of the pancreas;
• hormonal imbalance during pregnancy and menopause in women;
• tumors of the hepatopancreatoduodenal region;
• autoimmune reactions.

Pancreatitis is a polyetiological disease, the development of which is caused by several factors simultaneously. For example, chronic cholecystitis, trauma and infectious agent.

With gastritis, duodenitis, cholecystitis, intestinal contents and bile are thrown into the pancreatic ducts, provoking the development of the inflammatory process.

Causes

The purulent type of pancreatitis can occur for a number of reasons. Among the main ones, doctors identify congenital pathologies of the pancreas and inflammatory processes in the digestive organs.

The following factors may also cause the development of purulent pancreatitis:

1. drinking alcohol over a long period of time, alcoholism;
2. general intoxication of the body;
3. infection with viral infections;
4. gallbladder disease;
5. diseases of the gastrointestinal tract and liver;
6. various operations on the pancreas;
7. long-term use of medications;
8. inflammation of appendicitis.

Acute form of pancreatitis

In acute pancreatitis, an inflammatory-degenerative process occurs in the tissues of the pancreas, caused by the activation of proteolytic enzymes inside the organ. Under the influence of various factors, the excretory ducts become clogged, the pressure in them increases, and the outflow of secretions is disrupted.

The digestive juice produced by the gland begins to digest healthy cells of the pancreas itself, resulting in acute inflammation.

Forms of acute pancreatitis, taking into account the prevalence of necrotic tissue damage:

• Edema . With edematous pancreatitis, pronounced swelling of the interstitial space of the pancreas is observed in the absence of destructive processes. Pathology is the initial stage of the disease; it can resolve on its own or go into the stage of necrotic changes.
• Sterile pancreatic necrosis. Pancreatic necrosis is characterized by the death of cells of the digestive organ. There are sterile and infected types of pathology. In the first case, aseptic inflammation develops, and in the second, the addition of a bacterial infection is diagnosed, which significantly complicates the course of the disease and worsens the prognosis for recovery. Sterile pancreatic necrosis is classified into hemorrhagic, fatty and mixed: In the hemorrhagic form, the pathology rapidly progresses, causing internal bleeding.
• The fatty type develops slowly and is accompanied by the death of lipid tissues.
• Mixed pancreatic necrosis includes signs of the two previous forms.

Purulent complications lead to peritonitis, sepsis, infectious-toxic shock, multiple organ failure, and cause death.

Chronic form of pancreatitis

Chronic pancreatitis occurs after an acute form or against the background of other concomitant diseases of the liver, gall bladder, and biliary disorders. The disease is characterized by periods of remission and exacerbations.

Let's take a closer look at the symptoms:

1. There are no symptoms of acute inflammation , but there is progressive weight loss, diffuse abdominal pain, worsening after a heavy meal or intense physical activity, jaundice, and itchy skin.
2. Attacks occur several times a year , their duration varies from half an hour to 5 days.
3. Patients quickly get tired, feel general weakness , increased salivation, and complain of unstable stools (alternating constipation and diarrhea).
4. It is difficult for a person to find easily digestible food ; even a sip of cold water can trigger a relapse.

The main forms of chronic pancreatitis:

• Calcifying CP is characterized by uneven tissue damage, causes atrophy and stenosis of the ducts, and the formation of pancreatic stones.
• Obstructive CP develops as a result of blockage of the duct. Atrophy and fibrosis of the exocrine part of the gland is observed, there are no calcifications. The pathology is treated surgically.
• Inflammatory CP is accompanied by atrophy of the parenchyma and replacement of affected cells with fibrous tissue.
• Pancreatic fibrosis is characterized by progressive secretory failure of the organ and is the outcome of other forms of the disease.

A distinctive feature of acute and chronic pancreatitis is the complete restoration of the tissue of the affected organ in the acute course. With a recurrent form of pathology, irreversible structural and functional disorders develop.

Stages of chronic pancreatitis

Classification of the disease according to the severity of endogenous toxicosis:

1. Light (enzymatic) stage.
2. Moderate weight (reactive).
3. Severe stage of sequestration.
4. An extremely severe stage of the disease outcome.

Let's look at the stages in more detail:

• At the initial stage, limited areas of necrosis form in the pancreas, and swelling of the parenchyma predominates. Enzymes enter the systemic bloodstream, causing symptoms of general intoxication. Only 5% of patients experience extensive necrotic tissue damage with severe toxicosis and multiple organ failure. Exacerbations are rare and occur without severe pain.
• During the reactive stage, the body’s response to pathological processes in the pancreas occurs. An infiltrate forms around the digestive organ. Relapses occur 3–4 times a year, patients lose weight, suffer from digestive problems, and note the appearance of symptoms of diabetes mellitus and metabolic disorders.
• Then comes the stage of sequestration , accompanied by the melting of the inflamed tissues. Cystic cavities and fistulas form in the parenchyma. The pathological process occurs aseptically or with the addition of a bacterial infection.
• At the stage of outcome of the disease, reverse development occurs, replacement of the affected tissues with connective tissues. Exacerbations occur very often and have a protracted course. If treatment is started in a timely manner, it is possible to maintain the functioning of the gland, otherwise severe complications develop. The outcome of chronic pancreatitis can be gland failure, metabolic disorders, insulin-dependent diabetes, the formation of a malignant tumor, or death.

Symptoms of pancreatic inflammation

Acute pancreatitis

Clinical manifestations of acute pancreatitis:

• cutting, girdle pain in the epigastrium;
• nausea, vomiting, diarrhea, flatulence, heartburn;
• yellowness of the sclera, skin;
• lowering blood pressure;
• the tongue is dry, covered with a white or yellow coating;
• itchy skin;
• increased body temperature, general weakness;
• loss of appetite.

The main symptom of acute inflammation is severe pain.

• During an attack, unpleasant sensations radiate from the epigastric region to the right, left hypochondrium, back, and sternum.
• The pain occurs suddenly , is constant, is not relieved by anesthetics, and forces a person to take an unnatural body position, pressing his knees to his stomach.
• Patients are bothered by uncontrollable vomiting mixed with bile; emptying the stomach does not bring relief.
• Obstructive jaundice develops when the bile ducts are compressed by the enlarged head of the pancreas. The patient's skin and sclera of the eyes become stained, the urine darkens, and the feces, on the contrary, become discolored. Pigmented areas of skin and pinpoint telangiectasias may appear on the front or side surfaces of the abdomen, around the navel. Brown spots also appear on the skin of the face.

Chronic pancreatitis

• In chronic pancreatitis, the pain is girdling , but less intense, lasting from several hours to several days. Discomfort increases if the patient lies on his back and passes in a sitting position, when bending forward.
• An increase in discomfort is observed 20–40 minutes after eating, especially if a person has consumed fatty, fried, spicy foods or alcoholic drinks.
• Additionally, dyspeptic disorders occur (heartburn, flatulence, constipation or diarrhea), feces become greasy, acquire a sharp, putrid odor, and contain undigested food particles.
• The person gradually loses weight and loses his appetite.
• The frequency of exacerbations depends on the stage of the disease, the nature of the diet, and the patient’s lifestyle.

What happens when the pancreas becomes inflamed?

The cells of the pancreas produce digestive enzymes that are involved in the breakdown of fats, proteins and carbohydrates. The release of proteolytic substances occurs during the entry of food into the intestines.

When the excretory ducts of the gland are blocked (for example, by gallstones), intraorgan activation of trypsin and lipase occurs, provoking self-digestion of the parenchyma.

Damaged cells are replaced by rough connective tissue, scars are formed, the gland shrinks, becomes deformed, sclerosis and atrophic processes develop.

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  With autoimmune etiology of pancreatitis, the immune system malfunctions. Lymphocytes begin to perceive healthy pancreatic cells as foreign bodies and actively destroy them. This mechanism of organ damage is observed in the chronic course of the disease.
• Infectious pancreatitis develops due to the penetration of bacteria into the gland from the duodenum and bile ducts along the ascending path. Pathological processes are observed with bile reflux, spasm of the hepatopancreatic ampulla, and insufficiency of the sphincter of Oddi.
• The chronic inflammatory process leads to atrophy of the small intestinal mucosa, increased pressure in the pancreatic ducts, and thickening of pancreatic juice. The outflow of fluid becomes difficult, and protein plugs form.

After eating fatty foods, the secretion cannot exit into the intestines and accumulates in the interstitial tissue of the gland, causing swelling and autolysis of the parenchyma.

Signs of chronic inflammation of the pancreas:

- aching pain in the depths of the abdomen, in the left hypochondrium, a feeling of fullness

- belching, dry mouth

- bloating, diarrhea or constipation

- decreased appetite

The disease is mild, long-term in nature with periodic exacerbations, while the symptoms may be similar to those of the acute form. Often a person does not pay attention to these signs, but the disease slowly begins to destroy the organ, replacing healthy cells with connective tissue.

Diagnosis of inflammation

To establish a diagnosis, the doctor conducts a visual, physical examination and questioning of the patient. The patient has a coated tongue, rapid heartbeat, and low blood pressure.

What tests are done for pancreatitis?

• clinical analysis of blood, urine;
• blood chemistry;
• enzyme-linked immunosorbent test (ELISA);
• glucose level test;
• stool analysis.

Diagnostic results:

• The results of a clinical blood test reveal an increase in ESR and an increased concentration of leukocytes.
• During a biochemical study, high levels of amylase, lipase, trypsin, increased activity of C-reactive protein, and a decrease in the amount of albumin are detected.
• In acute pancreatitis, amylase is also present in the urine . An increased concentration of sugar in the blood indicates damage to the cells of the islets of Langerhans, a lack of insulin and the development of diabetes mellitus. If the inflammatory process affects the urinary system, urea, protein, and red blood cells are found in the urine.
• To assess the condition of the pancreas, bile ducts, and gallbladder, an ultrasound examination of the abdominal cavity is performed.

• 
  To accurately localize degenerative areas, computed tomography (CT) or magnetic resonance imaging (MRI) is prescribed.

• Gastroscopy is required to examine the stomach and duodenum. If a cancerous tumor is suspected, a fragment of gland tissue is taken for histological examination.
• X-rays of the pancreas are performed to identify stones in the parenchyma and ducts.
• When making a diagnosis is difficult, laparoscopic examination is performed . Differential diagnosis is carried out with acute cholecystitis, appendicitis, perforated ulcer, myocardial infarction, intestinal obstruction, bleeding, mesothrombosis.

Possible causes of inflammation

Inflammation of the pancreatic parenchyma, possibly for several reasons. Alcoholism is considered the most likely - this is 70% of cases of acute and chronic pancreatitis and cholelithiasis, accounting for 20% due to blockage of the bile ducts with stones. The remaining 10% of cases of inflammation occur due to the development of so-called triggering cause-and-effect factors:

• bacterial or viral infection;
• the result of food poisoning;
• trauma affecting the pancreas;
• malfunction of the pancreaticoduodenal artery;
• fungal infection.

In addition, there are frequent cases of inflammation of the pancreas after direct unsuccessful surgical intervention in the abdominal cavity or through endoscopic manipulation. Also, an inflammatory reaction can occur as a result of hormonal imbalance, leading to impaired insulin production. Inflammation of the pancreas can also be associated with acute or chronic clinical pathology.

Exacerbation of chronic pancreatitis

Pancreatitis

The most common type of disease of the digestive system is acute and chronic pancreatitis . The disease is characterized by an enzyme deficiency in the production of pancreatic juice into the duodenum. Enzymes are activated in the body of the gland and begin to destroy it, that is, self-digestion of nutrients occurs. The toxins released during this process are released into the bloodstream, which can lead to damage to other vital anatomical organs - kidneys, liver, heart, lungs and brain. You can slow down the inflammatory symptoms of acute pancreatitis by applying cold to the painful area. However, treatment of inflammation of the pancreas in acute pancreatitis requires hospitalization. Chronic pancreatitis is an advanced condition of the acute form. The gradation between the recurrent acute form and chronic pancreatitis is very arbitrary.

Diagnosis and treatment for inflammation of the pancreas

Stones in the pancreas

Inflammatory pain symptoms can be caused by pancreatic stones , which form in chronic pancreatitis. The accumulation of enzymes and toxins forms a certain phosphorus-calcium sediment, which, when thickened, becomes calcified and ensures the deposition of stones. Pancreatic stones can only be identified using instrumental diagnostics:

• computed and/or magnetic resonance imaging;
• cholangiopancreatography;
• endoscopic and ultrasound examination.

To date, there is no effective therapeutic and/or drug removal of stones from the pancreas. Only surgical intervention in specialized clinics can save a person from this problem.

Pancreatectomy

Pancreas cancer

Chronic disruption of the glandular epithelium and pancreatic ducts contributes to the formation of various tumors, including malignant ones. The tumor in 50% of cases affects the head of the pancreas; the development of pancreatic cancer in the body and tail accounts for 10% and 5%, respectively. Metastasis of pancreatic cancer has four stages:

1. Damage to the pancreaticoduodenal lymph nodes of the gland.
2. Involvement of retropyloric and hepatoduodenal nodes in the cancer process.
3. Spread of cancer to the superior mesenteric and celiac zone.
4. Damage to the retroperitoneal lymph nodes.

Metastasis affects distant anatomical organs of vital activity - these are the kidneys, lungs, liver, bones and joints of the skeletal frame. Only radiation and surgical diagnosis of pancreatic cancer will reliably determine the painful manifestation of the oncological disease.

Treatment of pancreatic inflammation

Patients with acute pancreatitis are hospitalized and prescribed bed rest. The main goal of therapy is to relieve pain , reduce the load on the inflamed organ, and stimulate regeneration mechanisms.

To ensure rest of the pancreas, patients are prescribed fasting for 3 days. In severe cases, parenteral nutrition may be required.

Medicines

Drugs for the treatment of inflammation of the pancreas:

• Painkillers : No-shpa, Papaverine, Mebeverine, Platiphylline. Medicines relieve spasm of smooth muscles, inflamed Wirsung's duct.

No-shpa

Papaverine

Mebeverine

Platyfillin

• Drugs that suppress pancreatic secretion : Omeprazole, Cimetidine, Ranitidine.

Omeprazole

Cimetidine

Ranitidine

• Means for reducing the acidity of gastric juice : Almagel, Phosphalugel.

Almagel

Phosphalugel

• Proteolytic enzymes : Creon, Pancreatin, Festal.

Creon

Pancreatin

Festal

• Antibiotics for infectious pancreatitis : Ampicillin, Tsiprolet.

Ampicillin Tsiprolet

• Prokinetics for sphincter of Oddi insufficiency, gastrointestinal motility disorders : Domperidone, Cerucal.

Domperidone

Cerucal

• Vitamins B, C, E, nicotinic acid.

A nicotinic acid

• If the water-salt balance is disturbed, intravenous infusions of colloidal solutions are given.
• Additionally, choleretic agents may be prescribed : Allochol, Osalmid, herbal pharmaceutical preparations (with the exception of cholelithiasis).
• Patients with autoimmune pancreatitis are prescribed Prednisolone, the corticosteroid drug is started with a large dose and is gradually reduced.
• To suppress the activity of the immune system, immunosuppressants are used : Azathioprine, Chloroquine. When blood glucose levels are elevated, patients are prescribed insulin medications.

Allohol

Prednisolone

Azathioprine

Chloroquine

When is surgery necessary?

Surgical treatment of pancreatitis is carried out if conservative treatment methods do not produce results, with symptoms of peritonitis, or a rapid increase in signs of intoxication.

The indication for surgical intervention is a combination of pancreatic inflammation with destructive cholecystitis, the formation of a cyst, abscess, phlegmon, fistula, and arrosive bleeding.

The goal of therapy is to ensure passage of pancreatic juice into the small intestine and eliminate pain.

Based on the timing, early, late and delayed interventions are distinguished. Early ones are performed in the first 7–8 days, late ones after 2–4 weeks during the period of sequestration, and delayed ones a month after the manifestation of the disease in order to prevent exacerbations.

Methods of surgical treatment for acute inflammation:

• Distal resection is the partial removal of damaged tissue. The body and tail of the gland are excised. The operation is performed for tumors, injuries and pancreatic necrosis.
• Subtotal removal by resection of the body, tail and part of the head of the pancreas. A small fragment of the organ is left located near the duodenum.
• Necrosequestrectomy is a puncture and drainage of cavities in the pancreas. With the help of installed drainages, fluid and necrotic masses drain out.
• Donor organ transplantation for diffuse necrotic lesions of all gland tissues.

For painful forms of chronic pancreatitis, an operation (neurotomy, neurolysis) is performed to block the reflex arc passing from the celiac nerve endings to the pancreas.

The procedure is performed by cutting the nerve fibers along the arterial branches or around the hepatic or splenic artery.

Methods of surgical treatment of pancreatic stones:

• Shunting is the creation of an additional path for the outflow of bile and enzymes.
• Endoscopic retrograde cholangiopancreatography is a diagnostic and surgical procedure that allows you to remove stones from the ducts of the gland, common bile duct.
• Extracorporeal shock wave lithotripsy - crushing stones using electromagnetic waves.

After the operation, patients are placed in the intensive care unit and the functioning of vital organs and systems is monitored for several days.

The most common complications of surgical intervention include pancreatic necrosis, postoperative pancreatitis, duodenal stasis, bleeding, peritonitis, and hepatic renal failure.

Treatment of purulent pancreatitis

Treatment of purulent pancreatitis should be carried out only in a hospital setting, under the strict supervision of medical personnel. When treating this disease, doctors are guided by the principle “hunger, cold and rest will help cope with inflammation.”

Treatment of a patient with purulent pancreatitis consists of ensuring complete rest, washing the stomach through a special tube with cold water.

Also, sometimes the patient is advised to apply ice to the pancreas area, this helps reduce inflammation and relieve some symptoms of the disease. The patient is advised to take as much alkaline fluid as possible and follow a strict diet.

In mild cases of the disease, the patient is prescribed intravenous injections with painkillers and diuretics to reduce swelling. The use of novocaine, heparin is effective to relieve pain, to reduce pancreatic secretion - almagel, trasylol and rinisan.

In severe cases of purulent pancreatitis, hemorrhages and the formation of numerous foci of purulent inflammation, urgent surgical intervention is necessary. The main goal of surgery is to prevent the spread of toxins throughout the body, blocking their spread, preventing destruction of the pancreas and dehydration of the body.

A contraindication for surgery can only be an extremely serious condition of the patient and a high risk of death during surgery.

Today, laparotomy is considered the optimal method of surgical intervention. This method allows you to reach the foci of inflammation without opening the abdominal cavity, but only through small holes in it and carefully remove them. During the operation, its progress is constantly monitored through a special device and the pancreas is scanned.

Complications of the inflammatory process

Acute pancreatitis can cause early and late complications. In the first case, the pathology develops due to the entry of digestive enzymes and breakdown products into the systemic bloodstream.

Such complications include:

• gastrointestinal ulcers;

• renal, hepatic, cardiovascular failure;
• toxic shock;
• diabetes;
• pancreatic cysts and pseudocysts;
• intravascular disseminated blood coagulation syndrome;
• intoxication psychosis.

Late complications appear 2–3 weeks after the onset of the disease.

Characteristic symptoms develop against the background of a bacterial infection and the development of purulent-necrotic processes. Patients are diagnosed with purulent pneumonia, pleurisy, parapancreatitis, sepsis, phlegmon, abdominal abscesses, fistulas, pancreatic cysts.

Complications of chronic pancreatitis:

• duodenal stenosis;
• pancreatic fistulas;
• obstructive jaundice;
• abscess, ascites of the abdominal cavity;
• multiple organ failure;
• avitaminosis;
• endotoxemia;
• pancreas cancer;
• gastrointestinal bleeding due to rupture of cysts.

Most often, complications are caused by alcoholic pancreatitis; such diseases are severe. Untimely treatment of the acute stage of inflammation can lead to death. A particularly high mortality rate occurs among elderly patients.

Other possible diseases

Inflammation of the pancreas can occur with benign and malignant tumors. In 80% of cases, all neoplasms are of epithelial origin.

Types of pathologies:

• benign : adenomas, cystadenomas;
• malignant : adenocarcinoma, scirrhus, acinar cell, squamous cell and anaplastic pancreatic cancer.

Cystadenoma
Features of the disease:

• Endocrine tumors form from cells of the islets of Langerhans or affect the entire organ. Tumor-like conditions are also diagnosed - hyperplasia, cell ectopia, polyendocrine neoplasia syndrome.
• The inflammatory process with pancreatic tumors occurs only in the later stages, when the tumor reaches a large size and begins to compress the pancreatic ducts, bile ducts, and nerve endings.
• Patients complain of abdominal pain, dyspeptic disorders, general weakness, and severe weight loss. If neighboring organs are involved in the pathological process, obstructive jaundice and ascites develop.
• The formation of stones in the ducts and parenchyma of the organ leads to disruption of the secretory function of the pancreas. Eating fatty foods and alcohol can trigger an attack. The pain is very strong, radiating to the shoulder blade, back, and chest area, making it easy to confuse it with a heart attack. If the stone moves into the bile duct, obstructive jaundice and acute colic develop. Stones form against the background of pancreatitis, so the pathology has similar symptoms: nausea, uncontrollable vomiting;
• burning, girdle pain in the epigastrium;
• hyperthermia;
• fat in stool.

• Cysts can form in the parenchyma of the pancreas - these are hollow formations filled with fluid. The cause of their appearance is inflammation or injury to the organ. Clinical manifestations depend on the size and location of the tumor.
• When a cyst compresses the bile ducts, obstructive jaundice develops ; entrapment of the portal vein is accompanied by the formation of edema of the lower extremities. In rare cases, formations partially or completely close the intestinal lumen, causing obstruction. If the cyst compresses the solar plexus, a burning pain occurs, radiating to the back. It becomes easier for a person only in the knee-elbow position.

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  After suffering acute or chronic pancreatitis, mechanical injuries, pseudocysts can form in the tissues of the pancreas , which are an accumulation of pancreatic juice in parenchymal tissues or outside the organ, enclosed in a fibrous membrane.

• Retention cysts appear as a result of obstruction of the duct with subsequent expansion of its distal part. The disease occurs without pronounced symptoms. Rarely, abdominal pain occurs, stool disorder (constipation or diarrhea), and flatulence are observed. In 40% of cases, pseudocysts resolve on their own; in other patients, infection and suppuration of the capsule contents are observed.

A serious danger for the patient arises when fistula tracts form or the tumor ruptures. Its contents can enter the intestines, stomach, and pericardium, which leads to abscess formation and other serious consequences.

Pancreatitis in children

Inflammation of the pancreas in children occurs differently than in adults. Most often, the disease is asymptomatic and is accompanied by gastritis and intestinal dysbiosis.

The development of pancreatitis can be provoked by helminthic infestation, blunt abdominal trauma, disorders of the digestive tract, and toxic-allergenic factors.

Excessive stimulation of the pancreas occurs with overeating, unbalanced, irregular nutrition, consumption of fast food, sweet carbonated drinks, and fatty foods.

Pancreatitis affects obese children, those suffering from cystic fibrosis, hypothyroidism of the thyroid gland, those who have had mumps, and chickenpox.

Nutrition for inflammatory processes

1. 
   

   In the first days of exacerbation of pancreatitis need to abstain from eating, you are only allowed to drink warm water and rosehip decoction. Therapeutic fasting should be carried out under the supervision of a physician. Later, you can use mucous decoctions, pureed milk porridges without sugar.
2. Starting from days 6–7, other dishes low in animal fats and carbohydrates are added to the diet .
3. After 3 weeks, patients are transferred to treatment table No. 5; for chronic pancreatitis, it is necessary to follow the 5 P diet.
4. You should eat in small portions, 5–6 times a day . The dishes must be served warm and ground. Meat and fish must be steamed, stewed or baked with vegetables in the oven. You can add a little vegetable oil (olive, flaxseed) to salads.
5. The patient should consume 80 g of fats and proteins per day , of which 60% should be products of plant origin. The permissible amount of carbohydrates in the diet is 400 g, table salt is no more than 10 g.
6. It is important to maintain a drinking regime ; daily you need to drink 1.5–2 liters of clean, still water.
7. The daily energy value is 2400–2600 kcal.
8. For people with excess body weight, caloric intake is reduced to 1800-2200 kcal/day.
9. The duration of the diet depends on the patient’s condition and is determined individually. It is necessary to adhere to the correct diet for at least 3–6 months; in severe forms of chronic pancreatitis, dietary restrictions must be observed for life.

Diet for purulent pancreatitis

During the treatment period, be sure to follow a diet.
Following a special diet complements the treatment process, increasing the chances of recovery:

• The most important thing is the absence of any alcohol.
• Complete refusal to eat during exacerbation of the disease.
• Low-calorie, balanced nutrition during remission. Food is taken in small portions 5-6 times a day.
• Be sure to drink plenty of fluids. The patient drinks at least 1.5 liters of water per day (green tea, still mineral water, rose hip decoction).
• The patient's main product is vegetables. Boiled, raw, baked, steamed vegetables contain vitamins, beneficial microelements and restore impaired pancreatic function.
• Ban on smoked, fried, flour, glucose.

Treatment with traditional methods and herbal medicine

In addition to drug and diet therapy, it is allowed to use traditional medicine:

• Milk thistle gives good results in the treatment of pancreatitis . The plant has a pronounced choleretic effect, enhances diuresis, and normalizes intestinal function.
• To relieve inflammation of the pancreas, use meal, seeds, dry grass and milk thistle oil; tablets are sold in any pharmacy.
• Adults and children over 12 years of age should drink ½ teaspoon of the herb 2 times a day with meals. The course of treatment is 1 month; if necessary, it can be repeated after 60 days.
• Black cumin oil helps with chronic pancreatitis . This folk remedy normalizes stomach acidity, speeds up food digestion, and eliminates symptoms of flatulence. It has antioxidant, antibacterial, choleretic properties, and lowers the level of bad cholesterol in the blood. The oil should be taken on an empty stomach, 1 teaspoon in the morning and evening, the course duration is 2-4 months.

Anti-inflammatory collection

Recipe for an anti-inflammatory preparation for inflammation of the pancreas:

• celandine – 10 g;
• bird knotweed – 10 g;
• dandelion root – 5 g;
• common anise fruits – 10 g;
• corn silk – 5 g.

The ingredients are mixed, take 2 tablespoons of the mixture, add 0.4 ml of boiling water and let it brew for 6 hours. Then the composition is filtered and drunk warm, 1 glass 3 times a day, half an hour before meals.

Infusion for pain and spasms

An infusion that relieves spasms and pain during pancreatitis:

• peppermint – 3 teaspoons;
• hawthorn fruits – 2 tsp;
• chamomile – 1 tsp;
• immortelle flowers – 3 tsp.

Four tablespoons of the herb are poured into a liter of warm water and boiled in a steam bath for 10 minutes. Cover the dish with a lid and leave for 4 hours.

The strained infusion is taken 1/3 cup 3 times a day an hour after meals.

Against symptoms of intoxication

Decoctions of elecampane, valerian, cinquefoil, common mantle, wormwood flowers, yarrow, and string help relieve symptoms of intoxication in the body The regeneration of pancreatic tissue is accelerated by St. John's wort, calendula, horsetail, tansy, and birch leaves.

For infectious pancreatitis, it is recommended to brew barberry, large plantain, lingonberry leaves, and meadow geranium.

Chicory

One of the effective treatments for chronic pancreatitis is chicory . The root of the medicinal plant contains vitamins A, B, C, essential microelements, and pectins.

A special substance - inulin normalizes metabolism, helps lower blood sugar levels, normalizes digestion, blood pressure, and helps get rid of flatulence.

For inflammation of the pancreas, chicory is brewed with boiling water or milk (1 teaspoon per 250 ml) and drunk warm, the drink can be sweetened a little.

How to relieve pain with chronic pancreatitis

If the diagnosis is firmly established, you can provide assistance at home yourself. Non-narcotic analgesics - Analgin or isopropionic acid derivative - Ibuprofen have a good effect.

The pyrazolone derivative Maxigan is an analgesic-antispasmodic, has an effective combined effect, and is suitable for pain relief.

To relieve pain from pancreatitis, you can use atropine drugs - Bellastesin and Bellataminal. Their side effects are dry mucous membranes and rapid heartbeat.

Taking myotropic antispasmodics (Duspatalin, No-shpa, Papaverine, Drotaverine) and neurotropic (Buscopan) relieves spasms, reduces pain and normalizes stomach function.

A nitroglycerin tablet under the tongue relieves spasms and pain well.

Drugs that reduce the secretion of hydrochloric acid: Omez and Omeprazole (proton pump inhibitors), Almagel (antacid). They also relieve pain.

Cimetidine and Famotidine also reduce acid production in the stomach by blocking the release of histamine. But recently they have begun to be used much less frequently due to a pronounced “withdrawal syndrome” when stopping treatment with these drugs.

Enzymes – Mezim and Mezim-forte, Enzistal, Panzinorm and Creon. Take two tablets three times a day during or after meals. You can drink it with alkaline mineral water.

Important. During fasting, use is contraindicated!

These products stimulate the breakdown of proteins, fats and carbohydrates. Enzyme preparations containing bile - Festal, Enzistal, Digestal - are not recommended.

To improve gastrointestinal motility - Cerucal and Motilium. Cerucal can also be used to relieve nausea and vomiting.

Alkaline mineral water – Borjomi, Essentuki, Narzan.

Lipoic acid and vitamins of all groups.

Herbal medicine: herbs for pain in pancreatitis

Pour 50 grams of chopped chicory root into one and a half cups of boiling water. Leave for two hours. Divide into several steps. Drink before meals. Instant store-bought chicory can be used instead of coffee - it tastes great. In addition, it has a sedative effect.

Using the same recipe, prepare an infusion of dandelion root.

Prepare a mixture of equal quantities of dried chamomile, dried flowers, calendula, St. John's wort and horsetail. Brew one teaspoon of the mixture with a glass of boiling water. Divide into several steps. Drink before meals.

Pour two teaspoons of cumin seeds into a glass of boiling water, leave for two hours, drink before meals during the day.

Brew a tablespoon of a mixture of equal parts of motherwort, immortelle and calendula with a glass of boiling water. Take during the day before meals.

Folk remedies for pain with pancreatitis

Freshly squeezed juices from vegetables with a low content of organic acids work well.

Squeeze juice from one carrot and two potatoes. Drink on an empty stomach in the morning for ten days.

Drink 50 ml of potato juice in the morning before meals for ten days.

Take pumpkin juice using the same recipe.

Boil oatmeal jelly in water. Use as a main dish or drink one third of a glass three times a day before meals.