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 someone with alcoholism. But now it is already known that its most dangerous and acute stage is almost never found in them: this is the "prerogative" of people with a healthy attitude towards 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 patient's life. Nutrition for pancreatitis is mainly based on a protein basis (proteins are digested by the stomach) and involves careful grinding of food.
Organ functions
The pancreas is heterogeneous in the structure and function of its tissues. The main part of its cells produces pancreatic juice - a concentrated alkali with enzymes dissolved in it (or rather, their inactive precursors). Pancreatic juice makes up the digestive environment of the intestine. The bacteria inhabiting its various departments play an important but auxiliary role.
The main biliary tracts also pass through the pancreatic tissue. It leads from the gallbladder to the duodenum, flowing right to the exit in its lumen into the main duct 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 tissues of the gland, cells of different types are also found in clusters. They are called islets and do not synthesize alkali, but insulin, a hormone responsible for the absorption of carbohydrates from food. Abnormalities in the development, functioning or breakdown of these cells (usually inherited) are one of the scenarios for diabetes mellitus. 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 blockage of the small ducts of the gland, through which pancreatic juice flows into the main and then into the lumen of the duodenum. There is an effect of its "self-digestion" by the enzymes accumulated inside. Acute pancreatitis can be caused by the following reasons.
- Gallstones. They arise due to inflammatory pathologies 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, causes swelling of the tissues and disrupts its function.
- Medicines. The toxic effect of atherosclerosis drugs, steroid drugs and some antibiotics.
- Deviations in structure or location. They can be congenital (bending of the gallbladder, ducts that are too narrow, etc. ) or acquired (scarring after surgery or traumatic examination, swelling).
Chronic pancreatitis can be seen most often in drunk alcoholics and "experienced" diabetics of at least five years. Here, the autoimmune process in the gland, which caused inflammation or taking antidiabetic drugs, counts. But it can also accompany the following diseases.
- Intestinal pathology. Especially the duodenum, including duodenitis (inflammation of its walls) and erosion.
- Vascular diseases. All glands must be actively supplied with blood. Congenital anomalies and coagulation disorders (hemophilia, thrombosis) play a special role here.
- Injuries. Penetrating wounds, interventions, strong blows to the stomach.
The less common cause of pancreatitis is spasm of the sphincter of Oddi, which ends in the common gallbladder and pancreatic duct. The sphincter of Oddi is located right at the exit from it in the duodenum. Normally, it regulates the "portioned" supply of pancreatic juice and bile into its cavity, allows it to almost stop between meals and sharply increase when a person sits 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.
The sphincter of Oddi is not prone to spasms, like all smooth muscle "separators" of this type. For a long time, there was nothing like the same dysfunction as him in medicine. It has been replaced by various "biliary dyskinesia" and "postcholecystectomy" (a complication of gallbladder removal) "syndromes". But in reality, his spasm is a rare thing only with the normal functioning of the nervous system. But it often overtakes with neurological disorders or as a result of the activation of pain receptors: when it is irritated by stones emerging from the gallbladder, its injury occurs.
The division of the causes of acute and chronic pancreatitis is conditioned, since the first, even with high-quality treatment, in the vast majority of cases passes into the second. And what you "feed" him after the elimination of the causative factors is not clear. In some cases (about 30%), none of these processes can explain the appearance of pancreatitis in a patient.
signs
Acute pancreatitis begins and is accompanied by unbearable (up to loss of consciousness) girdle pain in the entire upper abdomen, below the ribs. Antispasmodics, pain relievers and antibiotics do not remove it, nor do common "heart" medications help. Even a special diet will not relieve pain - a doctor is needed here, not a diet. Usually, although not always, its irradiation is noted upwards, in the region of the heart, under the collarbone, in the thoracic spine, due to which patients can confuse the symptoms of pancreatitis with a heart attack or exacerbation of the osteochondrosis. This is also facilitated by the body's cascading reactions to a critical force stimulus:
- changes in blood pressure (hypertension and hypotension are equally likely);
- heart rate disruptions;
- fainting
- cold, wet sweat.
A characteristic symptom of pancreatitis is soft - mushy stools, containing fragments of semi-digested and fatty food. It appears a few hours after the onset of the disease. By the end of the first day, discoloration of stool with urine becomes noticeable. Normally, they are colored yellow-brown by bilirubin from bile, with the help of which 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, "sucking" in the stomach and vomiting at the sight of fatty or spicy foods.
Chronic pancreatitis also occurs with pain, but not as pronounced. They can intensify an hour after eating, especially if it was inappropriate: cold, fried, smoked, fatty, spicy, accompanied by alcohol. The pain is aggravated in the supine position, digestion is disturbed up to dyspepsia (when almost unchanged food comes out instead of feces).
One of the most famous victims of acute pancreatitis (many experts indicate the likelihood of perforation of a stomach ulcer) was Princess Henrietta of England, wife of Duke Philip d'Orléans, brother of the Sun King Louis XIV. Due to the typical painful course of the disease, she was sure that one of her husband's favorites had poisoned her. True, it turned out only during an autopsy, which was designed to confirm or dispel this rumor.
Effects
Acute pancreatitis is dangerous due to the rapid (two or three days) "eating" of pancreatic tissue in all respects, as a result of which caustic alkali, bile and digestive enzymes enter through this "fistula" directly into the cavity abdominal. This scenario ends with diffuse peritonitis (inflammation of the peritoneum, which rapidly spreads 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 it was accompanied by a breakthrough of the abscess (due to such a scenario, the wizard Harry Houdini died) . If pancreatitis was provoked not by a mechanical obstacle (spasm of the sphincter of Oddi, stone, scar, tumor, etc. ), but from an infection, a purulent pancreatic abscess can develop. His premature treatment also ends with a breakthrough in the abdominal cavity.
The enzymes and digestive juice of the pancreas sometimes cause enzymatic pleurisy - inflammation of the pleura of the same type as the peritoneum. For chronic pancreatitis, complications that are delayed in time are typical, but more severely disrupt its work and other organs.
- Cholecystitis. And cholangitis is inflammation of the hepatic ducts. They themselves can cause pancreatitis due to the accompanying cholelithiasis, but they often form in the opposite order, as a result of this.
- 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 due to foreign substances entering its cavity from the inflamed 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 pronounced the breakdown of the pancreas, the greater the risk of developing gastritis.
- reactive hepatitis. It also develops in response to constant stagnation of bile and irritation of the hepatic ducts. Sometimes the cholestasis that occurs during the subsequent exacerbation of pancreatitis is accompanied by jaundice. That's why the pancreatitis diet shouldn't include foods that require more bile separation. Among them are fatty, fried, spiced meat and fish, fish caviar, other animal by-products, smoked meats, alcoholic beverages - digestive stimulants.
- Cystosis and pseudocystosis. These benign neoplasms or foci of stagnation of pancreatic juice simulating them arise due to the same difficulties with its removal in the duodenal cavity. Cysts periodically tend to become inflamed and suppurated.
- 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-line" complication of chronic pancreatitis. But the faster and more noticeably the whole gland degrades, the harder it is for the surviving islet cells to compensate for the insulin deficiency that occurs as a result of the death of their "colleagues" in already dead areas. They are depleted and are also starting to die out. The prospect of diabetes mellitus after seven to ten years (often even faster, depending on the prognosis and course characteristics of pancreatitis) "experience" for the average patient is becoming increasingly tangible. Due to its threat, a pancreatitis diet should ideally take into account the reduced content of not only fat, but also simple carbohydrates.
Chronic recurrent inflammation in the tissues of the gland causes scarring and loss of function. Progressive failure of intestinal digestion is inevitable. But in general, you can live with pancreatitis for another 10-20 years. The prognosis for its course, the quality and life expectancy of the patient is influenced by various "deviations" from the diet and their type, especially in everything concerning alcoholic beverages.
diet therapy
The acute stage of the disease often requires urgent detoxification, the appointment of antibiotics (usually broad-spectrum, since there is no time to establish 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 duct or another obstacle (tumor). After its completion, the basis of treatment should be a special medical diet.
As a basis, gastroenterologists usually take diet number 5, developed by Manuil Pevzner in Soviet times for patients with cholecystitis and other pathologies that prevent the synthesis and outflow of bile. But later the same author changed it by creating diet No. 5p.
General provisions
For adult patients with a mild course of the disease, a variant of the table No. 5p without mechanical savings - does not require grinding food to a homogeneous mass. And the children's menu most often has to be prepared with mashed potatoes. Nutrition during the period of exacerbation of chronic pancreatitis (especially in the first three days after its onset) and in the acute phase, which occurred for the first time, has several mandatory general rules.
- Simplicity. The recipes should be as simple as possible: no stuffed breasts and meat salads, even if all the ingredients in their composition "fit" individually to the diet.
- Complete the hunger in the first few days. With an exacerbation of pathology, starvation is prescribed. That is, only a warm alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
- Only stewing and boiling (on water, steamed). Tables n. 5 and 5p do not involve other methods such as baking and frying.
- Minimum fat. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. Vegetable and animal fats with it must be equally strictly limited, since the same agent, bile, breaks them down. They can be consumed no more than 10 g per day, but in any proportion.
- No spices. Particularly hot and spicy.
- No nuts. Seeds are also banned. These types of foods are rich in vegetable oil and are too difficult to eat even in powder form.
- Salt to taste. Its consumption does not in any way affect the course of the pathology, the daily salt intake remains the same as in healthy individuals - up to 10 g per day.
- Less fiber. This component, usually appreciated by nutritionists and people with digestive problems, is strictly limited for use in inflammation of the pancreas. The secret of its "magical" effect on the intestine is that the fiber is not digested, absorbed and irritates various sections of the intestine, stimulates peristalsis and the excretion of water. Fiber helps to form stool, as it is excreted unchanged. With inflammation of the pancreas, all these properties of the fibers will only make it worse. You can only eat carrots, courgettes, potatoes, squash, rich in starch and pulp, but relatively low in hard fibers. White and red cabbage is prohibited, 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 consumed at a time should not exceed 300g.
- Ban on carbonated soft drinks, coffee, alcohol and kvass. These drinks are best excluded from the diet forever. But if during the period of remission they simply should not be taken away, then during an exacerbation they are strictly prohibited.
Sour vegetables (for example, tomatoes) are also prohibited, as are all berries and fruits. They will further stimulate the secretion 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). Pureed grains are used as a source of carbohydrates, mainly buckwheat, rice, and oatmeal.
Menu example
The diet menu for pancreatitis should contain enough proteins and carbohydrates. But it is best to avoid "brute force" with the latter 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 consists of complex carbohydrates. Sugar can be replaced with diabetes drugs: fructose, xylitol and sorbitol (when added to hot dishes they give an unpleasant aftertaste), aspartame. Diet during the period when the exacerbation or primary inflammation of the pancreas is already on the decline may look like this.
Monday
- Breakfast. Boiled chicken breast puree. Mashed rice.
- The lunch. Steamed fish patties.
- Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
- afternoon tea. Two egg omelette.
- First dinner. Chicken meatballs (grind the meat with rice). Buckwheat puree with a spoonful of dessert butter.
- Second dinner. Lean, non-sour cottage cheese, mashed in a blender with a teaspoon of sour cream.
Tuesday
- Breakfast. Oatmeal. Boiled cauliflower.
- The lunch. Lean beef pate with butter. Milk tea and a few crumbs of soaked white bread.
- Dinner. Fish soup made from lean fish with rice and water. Milk or fruit jelly without fruit.
- afternoon tea. Cottage cheese paste with lean sour cream.
- First dinner. Steamed turkey breast souffle. Liquid buckwheat puree.
- Second dinner. Boiled shrimp puree with boiled rice.
Wednesday
- Breakfast. Fish balls with rice (grind the rice together with the fish). Puree of boiled carrots.
- The lunch. Two tablespoons of grated low-fat hard cheese.
- Dinner. Soup made from oat puree, diluted chicken broth and shredded breast. Ricotta pasta with sour cream.
- afternoon tea. Several florets of boiled cauliflower.
- First dinner. Mashed pasta with cottage cheese. Steamed omelette from two eggs.
- Second dinner. Pumpkin porridge. Tea with some soaked white crackers.
Thursday
- Breakfast. Zucchini puree. Steamed chicken cutlets.
- The lunch. Two tablespoons of grated low-fat hard cheese.
- Dinner. Creamy potato soup with butter. Lean beef puree.
- afternoon tea. Turkey breast souffle.
- First dinner. Buckwheat puree. Lean fish souffle.
- Second dinner. Carrot and pumpkin porridge.
Friday
- Breakfast. Ricotta pasta with sour cream. Zucchini puree. Chicken meatballs (grind rice, like meat).
- The lunch. Mashed potatoes with butter.
- Dinner. Milk soup with mashed pasta. Steamed two egg omelette with grated cheese.
- afternoon tea. Several florets of cauliflower. Rice pudding.
- First dinner. Chopped shrimp in sour cream sauce. Buckwheat puree. Tea with white crackers.
- Second dinner. Carrot puree. Milk or fruit jelly without fruit.
Saturday
- Breakfast. Pumpkin porridge. Lean beef souffle.
- The lunch. Fish balls.
- Dinner. Rice soup with weak chicken broth and minced meat. Milk paste puree.
- afternoon tea. Oatmeal.
- First dinner. Lean beef pate with butter. Mashed potatoes.
- Second dinner. Pumpkin and carrot porridge. Tea with some white crackers
Sunday
- Breakfast. Cottage cheese paste with sour cream. Omelette.
- The lunch. Zucchini under a cheese hood. Tea with milk and white crackers
- Dinner. Buckwheat soup on beef broth diluted with boiled beef puree. Steamed turkey breast souffle.
- afternoon tea. Pureed oatmeal.
- First dinner. Mashed potatoes. Chicken cutlets.
- Second dinner. Rice pudding.
The pancreatitis diet requires that all sweets and pastries, including chocolate and cocoa, be excluded from the diet. It is necessary to limit the intake of fats, dietary acids and fibers. Also, don't eat fresh bread. Under the ban millet, wheat, corn. These cereals cannot be mashed even with a blender. Also deleted all legumes, including soy. They are rich in vegetable proteins, for which they are appreciated by vegetarians. But they are also "guilty" of increased gas formation, increased acidity of the stomach, which is highly undesirable in the acute period.