For a long time, pancreatitis was thought to be caused by alcohol abuse. This false impression was formed because it was first discovered and described using the example of those suffering from alcoholism. But now it is already known that its 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, shape and stage of the course, it greatly disrupts digestion, threatens the condition of the metabolic system and sometimes the patient's life. Nutrition for pancreatitis is mainly built on a protein basis (proteins are digested by the stomach) and involves careful grinding of food.
Organ functions
The pancreas is heterogeneous in structure and function of its tissues. The majority 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 its various departments play an important but helpful role.
The major bile ducts also run through the tissues of the pancreas. It leads from the gallbladder to the duodenum and flows at the very exit into its lumen into the main duct of the gland itself. As a result, alkali, enzymes and bile enter the intestine not separately, but in the form of a ready-made "mixture".
Inside the glandular tissue, cells of another type are also located in groups. They are called islands, and they do not synthesize alkali, but insulin, a hormone responsible for the absorption of carbohydrates from food. Anomalies in the development, function or degradation of such cells (usually they are hereditary) 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 the small ducts in the gland, through which the pancreatic juice flows into the head and then into the lumen of the duodenum. There is an effect of its "self-digestion" of the enzymes that have accumulated inside. Acute pancreatitis can be caused by the following causes.
- Gallstones. They occur due to inflammatory pathology of the liver or gallbladder, abnormalities in the composition of bile (they are caused by sepsis, taking drugs for atherosclerosis, diabetes mellitus, the same liver diseases).
- Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causing swelling of the tissues and disrupting its function.
- Drugs. The toxic effect of atherosclerotic drugs, steroid drugs and some antibiotics.
- Deviations in structure or location. They may be congenital (bending of the gallbladder, too narrow ducts, etc. ) or acquired (scarring after surgery or traumatic examination, swelling).
Chronic pancreatitis can most often be observed in intoxicated alcoholics and diabetics "with experience" of at least five years. Here, the autoimmune process in the gland, which caused inflammation or taking antidiabetic drugs, is important. But it can also accompany the following diseases.
- Intestinal pathology. In particular, 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 here.
- Injuries. Penetrating wounds, surgery, powerful blows to the stomach.
The least common cause of pancreatitis is spasms of the sphincter of Oddi, which end in the common gallbladder and pancreas. The sphincter of Oddi is located at the very exit from it into the duodenum. Usually, it regulates the "portioned" supply of pancreatic juice and bile into its cavity, causing it to almost stop between meals and increase sharply when a person sits down at the table. It also prevents the backflow of intestinal contents along with various pathogens (bacteria, foreign compounds, worms) into the cavity of the pancreas or gallbladder.
Sphincter of Oddi is not prone to spasms, as all smooth muscle "separators" of this type. For a long time, there was no such thing as his own dysfunction in medicine. It was replaced by various "bile dyskinesias" and "post-cholecystectomy" "syndromes" (a complication of gallbladder removal). But in fact, his spasm is only a rare thing with the normal functioning of the nervous system. But he often overtakes with neurological disorders or as a result of activation of pain receptors - when he gets irritated by stones coming out of the gallbladder, his injury occurs.
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 into the second. And what "feeds" it after elimination of causal factors is unclear. In some cases (approximately 30%), none of these processes can explain the appearance of pancreatitis in a patient.
sign
Acute pancreatitis begins and is accompanied by unbearable (up to loss of consciousness) belt pain throughout the upper abdomen, below the ribs. Anticonvulsants, painkillers and antibiotics do not remove it, and common drugs "from the heart" do not help either. A special diet will not relieve the pain either - here you need a doctor, not a diet. Usually, but not always, its radiation is noted upward, to the area of the heart, below the collarbone, to the thoracic spine, due to which patients may confuse the symptoms of pancreatitis with a heart attack or exacerbation of osteochondrosis. This is also facilitated by the body's cascading reactions to a stimulus of critical strength:
- jumps in blood pressure (hypertension and hypotension are equally likely);
- heart rate interruptions;
- fainting;
- cold, clammy sweat.
A characteristic symptom of pancreatitis is loose stools - the porridge, containing half-digested food fragments and fat. It shows up after a few hours from the onset of the disease. At the end of the first day, discoloration of feces with urine becomes noticeable. Usually the yellow-brown ones are stained by bilirubin from bile, by means of which the digestion took place. And due to the blockage of the duct, it does not enter the intestine. On the second or third day, the patient develops flatulence, "sucks" in the stomach and vomits at the sight of fatty or spicy food.
Chronic pancreatitis also occurs with pain, but not so pronounced. They can intensify an hour after eating, especially if it was inappropriate - cold, fried, smoked, fatty, spicy, accompanied by alcohol. Pain worsens in supine position, digestion is disturbed up to dyspepsia (when almost unchanged food comes out instead of stool).
One of the most famous victims of acute pancreatitis (many experts point to the likelihood of perforation of a gastric ulcer) was Princess Henrietta of England, wife of Duke Philippe of Orleans, brother of Sun King Louis XIV. Because of the typical painful course of illness, she was sure that one of her husband's favorites had poisoned her. True, it appeared only during an autopsy, designed to confirm or deny this rumor.
Effects
Acute pancreatitis is dangerous by 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 quickly spreads to the stomach organs), the occurrence of multiple erosions and death.
Peritonitis is characteristic of many pathologies, including a perforated wound, cancer of the stomach or intestines, appendicitis, if it was accompanied by a breakthrough of the abscess (due to such a scenario, the magician Harry Houdini died). If pancreatitis was not caused by a mechanical obstruction (spasms in the sphincters of Oddi, stones, scars, tumor, etc. ), but by an infection, a purulent pancreatic abscess may develop. His untimely treatment also ends with a breakthrough in the abdominal cavity.
Enzymes and digestive juices of the pancreas sometimes cause enzymatic pneumonia - inflammation of the pleura of the same type as in the case of the peritoneum. For chronic pancreatitis, complications that are delayed in time are typical, but they disrupt its work and other organs more severely.
- Cholecystitis. And cholangitis is inflammation of the liver ducts. They can even cause pancreatitis due to the cholelithiasis that comes with them, but they are often formed in reverse order - as a consequence.
- Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it is located directly below it. Its inflammation in pancreatitis occurs not so much because of foreign substances entering its cavity from the inflamed gland, but because of the constant inadequacy of the intestinal digestion for which it is forced to compensate. The pancreatitis diet is designed to reduce the strain on all digestive organs, but the "interests" of a healthy stomach are taken into less care. The more pronounced the breakdown of the pancreas is, the higher the risk of developing gastritis.
- reactive hepatitis. It also develops in response to the constant stagnation of bile and irritation of the liver ducts. Sometimes cholestasis, which occurs during the next exacerbation of pancreatitis, is accompanied by jaundice. Therefore, the pancreatitis diet should not include foods that require increased bile separation. Among them are fatty, fried, spicy meat and fish, fish caviar, other animal by-products, smoked meat, alcoholic beverages - digestive stimulants.
- Cystosis and pseudocystosis. These benign neoplasms or foci of stagnation of pancreatic juice that simulate them occur due to the same difficulties with its removal into the duodenal cavity. Cysts tend to periodically become inflamed and suppurate.
- Cancer of the pancreas. Any chronic inflammation is considered a carcinogenic factor because it causes irritation, accelerated destruction of the affected tissues and their increased response growth. And it's not always of good quality. The same goes for chronic pancreatitis.
- Diabetes. It is far from the first "in a row" complication of chronic pancreatitis. But the faster and more noticeably the entire gland breaks down, the harder it is for the surviving islet cells to compensate for the insulin deficiency that occurs due to the death of their "colleagues" in already dead areas. They are depleted and also begin to die out. The prospect of diabetes mellitus 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. Because of its threat, a diet for pancreatitis should ideally take into account the reduced content of not only fat but also simple carbohydrates.
Chronic recurrent inflammation of the glandular tissue causes scarring and loss of functionality. Progressive insufficiency of intestinal digestion is inevitable. But in general, one can live with pancreatitis for another 10-20 years. The prognosis for its course, quality and life expectancy of the patient is influenced by various "deviations" from the diet and their type, especially in total related to alcoholic beverages.
diet therapy
The acute stage of the disease often requires acute detoxification, appointment of antibiotics (usually a 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 in the sphincter of Oddi, a stone stuck in the canal or another obstruction (tumor). Upon its completion, the basis of treatment should be a special medical diet.
As a basis, gastroenterologists usually take diet number 5, developed by Manuil Pevzner back in Soviet times for patients with cholecystitis and other pathologies that inhibit the synthesis and outflow of bile. But later the author himself changed it by making diet No. 5p.
General provisions
For adult patients with a mild disease course, a variant of table no. 5p without mechanical saving is suitable - it does not require grinding food to a homogeneous mass. And the menu for children usually has to be made from mashed products. Nutrition in the period of exacerbation of chronic pancreatitis (especially in the first three days from 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 - no stuffed breasts and meat salads, even if all the ingredients in their composition individually "fit" into the diet.
- Complete hunger in the first days. With an exacerbation of the pathology, hunger is prescribed. That is, only a hot alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
- Only stew and boil (on water, steamed). Tables Nos. 5 and 5p do not suggest 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 should be equally strictly limited as the same remedy, bile, breaks them down. They can not be ingested more than 10 g per day, but in all conditions.
- No spices. Especially hot and spicy.
- No nuts. Seeds are also prohibited. These types of foods are rich in vegetable oil and are too difficult to eat even in powder form.
- Salt to taste. Its consumption does not affect the course of the pathology in any way, the daily salt intake remains the same as in healthy individuals - up to 10 g per day.
- Less fiber. This component, which is usually appreciated by nutritionists and people with digestive problems, is strictly limited to use in inflammation of the pancreas. The secret behind its "magic" effect on the intestines is that fibers are not digested, absorbed and irritate different parts of the intestine, stimulating peristalsis and the excretion of water. Fiber helps to form feces as it is excreted unchanged. With inflammation of the pancreas, all these properties of the fibers will only aggravate the situation. You can only eat carrots, zucchini, potatoes, pumpkins, rich in starch and pulp, but relatively poor in hard fiber. White and red cabbage are forbidden, but cauliflower can be consumed (only inflorescences, twigs and stems are excluded).
- Small portions. There are, as before, three times a day in portions with a total weight of half a kilogram or more, with pancreatic pathologies it is impossible. 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.
- Prohibition of sodas, coffee, alcohol and kvass. These drinks are best excluded from the diet forever. However, if during the remission period they simply should not be carried away, then during an exacerbation they are strictly forbidden.
Sour vegetables (for example tomatoes) as well as all berries and fruits are also prohibited. They will further stimulate the excretion of bile. The emphasis in nutrition should be on non-acidic and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Mossy grains are used as sources of carbohydrates, mainly buckwheat, rice and oatmeal.
Menu example
The diet menu for pancreatitis should contain enough protein and carbohydrates. But "brute force" with the latter is best avoided by limiting the addition of sugar, honey to beverages and dishes. Buckwheat, a favorite grain for diabetics, should be included in the diet more often as it is made up of complex carbohydrates. Sugar can be replaced by diabetic drugs - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant aftertaste), aspartame. The diet during the period when the aggravation or the primary inflammation of the pancreas is already in decline may look like this.
Monday
- First breakfast. Boiled chicken breast puree. Rice mashed.
- Lunch. Steamed fish cakes.
- Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
- afternoon tea. The omelet from two eggs.
- First dinner. Chicken meatballs (grind meat with rice). Pureed buckwheat with a dessert spoon of butter.
- Second dinner. Lean, non-acidic cottage cheese, crushed in a blender with a teaspoon of sour cream.
Tuesday
- First breakfast. Oatmeal. Boiled cauliflower.
- Lunch. Lean beef pie with butter. Tea with milk and a few white breadcrumbs soaked in it.
- Dinner. Fish soup made from lean fish with rice and water. Milk or fruit jelly without fruit.
- afternoon tea. Cottage cheese pasta with lean sour cream.
- First dinner. Steamed turkey breast soufflé. Pureed liquid buckwheat.
- Second dinner. Boiled shrimp puree with boiled rice.
Wednesday
- First breakfast. Fish meatballs with rice (grind the rice together with the fish). Puree from boiled carrots.
- Lunch. Two tablespoons grated low-fat hard cheese.
- Dinner. Soup made from mashed oatmeal, diluted chicken broth and shredded breast. Curd with sour cream.
- afternoon tea. Several bouquets of boiled cauliflower.
- First dinner. Mash pasta with cottage cheese. Steam the omelet from two eggs.
- Second dinner. Pumpkin porridge. Tea with a few white biscuits soaked in.
Thursday
- First breakfast. Puree zucchini. Chops with steam with chicken.
- Lunch. Two tablespoons grated low-fat hard cheese.
- Dinner. Creamy potato soup with butter. Lean beef puree.
- afternoon tea. Turkey breast soufflé.
- First dinner. Mossy buckwheat. Lean fish souffle.
- Second dinner. Carrot-pumpkin porridge.
Friday
- First breakfast. Curd with sour cream. Puree zucchini. Chicken meatballs (crushed rice, like meat).
- Lunch. Mashed potatoes with butter.
- Dinner. Milk soup with mashed pasta. Omelette from two eggs steamed with grated cheese.
- afternoon tea. Several cauliflower bouquets. Rice porridge.
- First dinner. Chopped shrimp in sour cream sauce. Buckwheat puree. Tea with white biscuits.
- Second dinner. Carrot puree. Milk or fruit jelly without fruit.
Saturday
- First breakfast. Pumpkin porridge. Lean beef soufflé.
- Lunch. Fish meatballs.
- Dinner. Rice soup with weak chicken broth and minced meat. Mash pasta with milk.
- afternoon tea. Oatmeal.
- First dinner. Lean beef pie with butter. Mashed potatoes.
- Second dinner. Pumpkin-carrot porridge. Tea with a few white biscuits
Sunday
- First breakfast. Cottage cheese pasta with sour cream. Omelet.
- Lunch. Zucchini under a layer of cheese. Tea with milk and white biscuits
- Dinner. Buckwheat soup on diluted beef broth with boiled beef puree. Steamed turkey breast soufflé.
- afternoon tea. Oatmeal pureed.
- First dinner. Mashed potatoes. Chicken chops.
- Second dinner. Risost pudding.
The diet for pancreatitis requires exclusion from the diet of all confectionery and cakes, including chocolate and cocoa. You need to limit your intake of fats, food acids and fiber. Also, do not eat fresh bread. Under the ban millet, wheat, corn. These grains can not be mashed even with a blender. All legumes, including soybeans, are also canceled. They are rich in vegetable protein for which they are valued by vegetarians. But they are also "guilty" of increased gas formation, an increase in the acidity of the stomach, which is very undesirable in the acute period.