For a long time it was thought that pancreatitis was caused by alcohol consumption. This misconception arose because it was first discovered and illustrated by the example of those suffering from alcoholism. But it is already known that its most dangerous, acute stage is almost never felt by them - this is the "privilege" of people with a healthy attitude to strong drinks.
Pancreatitis can be the result of overeating (now also considered addiction), pathology of other gastrointestinal tract, endocrine diseases. Regardless of the cause, form and stage of the course, it greatly disrupts digestion, threatens the state of the metabolic system and sometimes the life of the patient. Nutrition for pancreatitis is mainly based on protein (proteins are digested in the stomach) and involves the gentle grinding of food.
Organ functions
The pancreas is different in the structure and function of its tissues. The bulk of its cells produce pancreatic juice - an unmixed base with enzymes that are dissolved in it (or rather, their inactive precursor). Pancreatic juice forms the digestive environment of the intestines. Bacteria that live in its various departments play an important but helpful role.
The main bile duct also runs through the pancreas. It runs from the gallbladder to the duodenum, flowing at the exit into its cavity into the main channel of the gland itself. As a result, alkalis, enzymes and bile enter the intestine not specifically, but in the form of a synthetic "mixture".
Inside the glandular tissue, cells of another type are also present in groups. They are called islets and they do not make alkali, but insulin, a hormone that is responsible for the absorption of carbohydrates from food. Abnormalities in the development, function or degradation of such cells (they are usually hereditary) are one of the scenarios of diabetes. Another 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 a blockage in the small ducts of the gland, where the pancreas juice flows into the main and then into the cavity of the duodenum. It is the effect of its "self-digestion" of enzymes that accumulate inside. Acute pancreatitis can be caused by the following reasons.
- Gallstones. They occur due to inflammatory diseases of the liver or gallbladder, abnormalities in the composition of bile (they are caused by sepsis, take drugs for atherosclerosis, diabetes, the same liver disease).
- Infection. Virus (mumps, hepatitis, etc. ) or parasites (helminthiasis). The causative agent affects the cells of the gland, causing inflammation in the tissues and disrupting its function.
- Medicines. Toxicity of atherosclerotic drugs, steroids and some antibiotics.
- Deviations in structure or location. They can be congenital (bending of the gallbladder, too narrow ducts, etc. ) or acquired (scar after surgery or injury, inflammation).
Chronic pancreatitis can most often occur in drunken alcoholics and "experienced" diabetics for at least five years. Here, the autoimmune process in the gland, which caused inflammation or the intake of antidiabetic drugs, is important. But it can also be accompanied by the following diseases.
- Intestinal pathology. Especially duodenum, including duodenal inflammation (inflammation of its walls) and erosion.
- Vascular diseases. All glands must be active for blood. Congenital abnormalities and coagulation disorders (haemophilia, thrombosis) play a special role.
- Injuries. Intrusive wounds, surgery, severe blow to the stomach.
The most common cause of pancreatitis is a spasm in the sphincter of the Oddur, which ends in a common gallbladder and pancreas. Oddi's sphincter is located at the exit from it into the duodenum. It usually controls the "dose" supply of pancreatic juice and bile into its cavity, allows it to stop almost between meals and increases significantly when one sits at the table. It also prevents the reflux of intestinal contents along with various germs (bacteria, exotic compounds, worms) into a hollow pancreas or gallbladder.
Oddi's sphincter is not prone to cramps, as all smooth muscle "separators" of this type. For a long time, there was no such thing as his own inactivity in medicine. It was replaced by a variety of "biliary dyskinesia" and "postcholecystectomy" "syndrome" (complication due to gallbladder removal). when he is irritated by stones coming out of the gallbladder, his trauma occurs.
The division of the causes of acute and chronic pancreatitis is conditional, as the former, even with high-quality treatment, passes in the vast majority of cases to the latter. And what "feeds" it after the causal factors have been eliminated is unclear. In some cases (about 30%), none of these processes can explain the appearance of pancreatitis in a patient.
label
Acute pancreatitis begins and is accompanied by unbearable (almost unconscious) belt pain in the entire upper abdomen, below the ribs. Anticonvulsants, painkillers and antibiotics do not remove it and common medicines "from the heart" do not help either. A special diet will not relieve the pain either - this requires a doctor, not a diet. Usually, but not always, its radiation is seen upwards, to the heart area, below the collarbone, to the thoracic spine, where patients may confuse the symptoms of pancreatitis with a heart attack or worsening of osteoporosis. This is also facilitated by the body's cascading response to stimuli of critical strength:
- blood pressure jumps (hypertension and hypotension are equally likely);
- arrhythmias;
- fainting;
- cool, cool sweat.
The hallmark of pancreatitis is loose stools - soft, containing half-digested food and fat. It occurs a few hours after the onset of the disease. At the end of the first day, the discolouration of urine in the urine will be noticeable. They are usually colored yellow-brown from bilirubin from bile, with the help of which digestion took place. And due to a blockage in the duct, it does not enter the intestine. On the second or third day, the patient gets flatulence, "sucks" in the stomach and vomits when he sees fatty or spicy food.
Chronic pancreatitis also occurs with pain, but not as noticeable. They can intensify an hour after eating, especially if it was inappropriate - cold, fried, smoked, greasy, spicy, along with alcohol. Pain worsens in supine position, digestion is disturbed into indigestion (when almost unchanged food comes out instead of faeces).
One of the most famous victims of acute pancreatitis (many experts point to the possibility of perforation of gastric ulcer) was Princess Henrietta of England, wife of Duke Philippe of Orleans, brother of Louis XIV the Sun King. Because of the typical painful course of the disease, she was sure that one of her favorite husbands had poisoned her. Admittedly, only an autopsy, which is intended to confirm or dispel these rumors, was revealed.
Impact
Acute pancreatitis is dangerous with rapid (two or three days) "eating" on the pancreatic tissue through and through, as a result of which corrosive alkalis, bile and digestive enzymes pass through this "fistula" directly into the abdominal cavity. This scenario ends with diffuse peritonitis (inflammation of the abdomen, which spreads quickly to the abdomen), the appearance of multiple erosion and death.
Peritonitis is characteristic of many pathologies, including perforated wounds, cancer of the stomach or intestines, appendicitis, if followed by a revolution in abscesses (because of such a scenario, the magician Harry Houdini died). If pancreatitis was not caused by a mechanical obstruction (spasm of the sphincter of Oddi, stone, scar, tumor, etc. ), but due to an infection, burrowing of the pancreas may occur. His untimely treatment also ends up breaking into his abdomen.
Enzymes and digestive juices in the pancreas sometimes cause enzyme inflammation - inflammation of the pleura of the same type as in the abdomen. For chronic pancreatitis, complications that are delayed in time are typical, but disrupt its function and other organs more severely.
- Gallbladder inflammation. And cholangitis is an inflammation of the liver. They can themselves cause pancreatitis due to the bile inflammation that accompanies them, but they often form in reverse order - as a result.
- Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it is located directly below it. Its inflammation in the pancreas is not so much due to foreign substances entering its cavity from the inflammatory gland, but due to the constant insufficient digestion in the intestine, which it is forced to compensate for. The pancreatic diet is designed to reduce the stress on all the digestive system, but the "interests" of a healthy stomach are not taken into account. The greater the breakdown of the pancreas, the greater the risk of gastritis.
- reactive hepatitis. It also develops in response to constant stagnation of bile and irritation in the liver. Sometimes there is a biliary obstruction that occurs with the next exacerbation of pancreatitis jaundice. Therefore, dietary pancreatitis should not include foods that require increased bile duct separation. These include fatty, fried, spicy meats and fish, fish caviar, other animal by-products, smoked meats, alcoholic beverages - digestive stimulants.
- Cystitis and artificial cystitis. These benign tumors or stasis juices that mimic them arise from the same difficulty in removing them into the duodenum. Blisters tend to become inflamed and swell regularly.
- Pancreatic cancer. Every chronic inflammation is considered a carcinogenic factor, because it causes irritation, faster destruction of the affected tissues and increased their response rate. And it's not always good quality. The same goes for chronic pancreatitis.
- Diabetes. It is far from being the first "in a row" complication of chronic pancreatitis. But the faster and more noticeable the whole gland breaks down, the harder it is for the surviving islet cells to make up for the insulin deficiency caused by the death of their "colleagues" in already dead areas. They are exhausted and also begin to die out. Prospects for diabetes after seven to ten years (often even faster, depending on the prognosis and symptoms of the pancreatic process) The "experience" for the average patient is becoming more tangible and tangible. Due to the threat, the diet for pancreatitis should preferably take into account the reduced content not only fat, but also simple carbohydrates.
Chronic recurrent inflammation of the glandular tissue causes scarring and loss of function. Constant inadequate digestion in the intestine is inevitable. But in general you can live with pancreatitis for another 10-20 years. The patient's prognosis, quality of life and life expectancy are affected by various "deviations" from their diet and type, especially in everything related to alcoholic beverages.
diet therapy
The acute stage of the disease often requires urgent detoxification, the appointment of antibiotics (usually a broad spectrum, as there is no time to determine the type of bacterium) and sometimes surgery. It is necessary if the cause of the disease is a spasm in Oddi's sphincter, a stone stuck in the canal or another obstruction (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 during the Soviet era, for patients with gallbladder inflammation and other pathologies that prevent the formation and outflow of bile. But later the author changed it himself by creating diet no.
General provisions
For adult patients with a mild disease process, a variant of table no. 5p without mechanical savings - there is no need to grind food into a homogeneous mass. And the menu for children usually has to be made of mashed products. Nutrition during the exacerbation period of chronic pancreatitis (especially the first three days from the beginning) and in the acute stage, which occurred for the first time, has some 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 "fit" into the diet.
- Total hunger for the first few days. With the worsening of the pathology, hunger is prescribed. It is only a hot alkaline drink and intravenous maintenance syringes (vitamins, glucose, sodium chloride).
- Only fry and boil (on water, steamed). Tables no. 5 and 5p do not indicate other methods such as baking and frying.
- Minimum fat. Especially if the attack is accompanied by (or caused by) cholecystitis, gallbladder inflammation. Vegetable and animal fats with it must be equally strictly limited, as the same substance, bile, breaks them down. They should not consume more than 10 g per day, but in any proportion.
- No spice. Especially hot and spicy.
- No nuts. Seeds are also prohibited. These types of foods are rich in vegetable oils 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, daily salt intake is the same as in healthy individuals - up to 10 g per day.
- Less fiber. This component, usually evaluated by nutritionists and people with digestive problems, is strictly restricted to use in inflammation of the pancreas. The secret of its "magic" effect on the gut is that fiber is not digested, absorbed and irritates various parts of the intestine, stimulates peristalsis and water excretion. Fiber helps to form feces where they are excreted unchanged. you can eat only carrots, zucchini, potatoes, pumpkin, rich in starch and pulp, but relatively poor in hard fiber. Cabbage and red cabbage are prohibited, but cauliflower can be consumed (only cauliflower, twigs and stems are excluded).
- Small doses. There are, as before, three times a day in doses with a total weight of half a kilogram or more, with pancreatic diseases 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 soda, coffee, alcohol and kvass. These drinks are best excluded from the diet forever. But if they simply should not be moved away during the remission period, then they are strictly prohibited during the aggravation.
Sour vegetables (eg tomatoes) as well as all berries and fruits are also prohibited. They will stimulate bile secretion even further. The emphasis in nutrition should be on acid-free and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Puree is used as a source of carbohydrates, mainly buckwheat, rice and oatmeal.
Example menu
The diet menu for pancreatitis should include plenty of protein and carbohydrates. But it is best to avoid the "brute force" of the latter by limiting the addition of sugar, honey to drinks and dishes. Buckwheat, a favorite grain for diabetics, should be included more often in the diet, as it consists of complex carbohydrates. to replace with antidiabetic drugs - fructose, xylitol and sorbitol (when added to hot dishes they give an unpleasant aftertaste), aspartame.
Monday
- The first breakfast. Boiled chicken breast puree. Mashed rice.
- Lunch. Steamed fish balls.
- Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
- afternoon tea. Omelette made of two eggs.
- First dinner. Chicken meatballs (minced meat with rice). Mashed buckwheat with a spoonful of butter.
- Another dinner. Lean, acid-free cottage cheese, crushed in a blender with a teaspoon of sour cream.
Tuesday
- The first breakfast. Oatmeal. Boiled cauliflower.
- Lunch. Lean beef pâté with butter. Tea with milk and some 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 low-fat sour cream.
- First dinner. Steamed turkey breast souffle. Mashed liquid buckwheat.
- Another dinner. Boiled shrimp puree with boiled rice.
Wednesday
- The first breakfast. Fish balls with rice (grind the rice together with the fish). Boiled carrot puree.
- Lunch. Two tablespoons of grated low-fat hard cheese.
- Dinner. Soup made from mashed oatmeal, diluted chicken broth and grated breast. Cheese pasta with sour cream.
- afternoon tea. A few drops of boiled cauliflower.
- First dinner. Mashed pasta with cottage cheese. Steam egg cake from two eggs.
- Another dinner. Pumpkin porridge. Tea with some white biscuits wet in it.
Thursday
- The first breakfast. Zucchini puree. Chicken steam chops.
- Lunch. Two tablespoons of grated low-fat hard cheese.
- Dinner. Creamy potato soup with butter. Magurt nautamauk.
- afternoon tea. Turkey breast soufflé.
- First dinner. Mashed buckwheat. Lean fish souffle.
- Another dinner. Carrot-pumpkin porridge.
Friday
- The first breakfast. Cheese pasta with sour cream. Zucchini puree. Chicken meatballs (ground rice, like meat).
- Lunch. Mashed potatoes with butter.
- Dinner. Milk soup with mashed pasta. Omelette of two eggs steamed with grated cheese.
- afternoon tea. A few cauliflower flowers. Rice pudding.
- First dinner. Chopped shrimp in sour cream sauce. Buckwheat puree. Tea with white biscuits.
- Another dinner. Carrot puree. Milk or fruit jelly without fruit.
Saturday
- The first breakfast. Pumpkin porridge. Lean beef souffle.
- Lunch. Fish balls.
- Dinner. Rice soup with weak chicken broth and minced meat. Mashed pasta with milk.
- afternoon tea. Oatmeal.
- First dinner. Lean beef pâté with butter. Mashed potatoes.
- Another dinner. Pumpkin-carrot porridge. Tea with some white biscuits
Sunday
- The first breakfast. Cottage cheese pasta with sour cream. Omelette.
- Lunch. Zucchini under the cheese skin. Tea with milk and white biscuits
- Dinner. Buckwheat soup in diluted beef broth with boiled beef puree. Steamed turkey breast souffle.
- afternoon tea. Oatmeal mashed.
- First dinner. Mashed potatoes. Chicken chops.
- Another dinner. Rice pudding.
Diet for pancreatitis requires exclusion from the diet of all sweets and pastries, including chocolate and cocoa. You need to limit your intake of all kinds of fats, fatty acids and fiber. Do not eat fresh bread either. Under the ban millet, wheat, corn. This grain can not be mashed even with a blender. All legumes, including soybeans, are also being discontinued. They are rich in vegetable protein, for which they are valued by vegetarians. But they are also "guilty" of increased gas production, an increase in gastric acidity, which is highly undesirable in the acute period.