For a long time, it was thought that alcoholism was caused by alcohol abuse. This misconception was first revealed and described in the case of alcoholics. But now it is known that it is almost never seen in its most dangerous, acute stage - this is the "advantage" of people who are alert to strong drinks.
Pancreatitis can be the result of overeating (now it is a form of dependence), pathology of other digestive organs, endocrine disorders. Regardless of the etiology, form and stage, it severely impairs digestion, the state of the metabolic system, and sometimes threatens the patient's life. The nutrition of pancreatitis is mainly protein-based (proteins are digested in the stomach) and involves careful digestion of food.
Functions of the body
Heterogeneous in structure and function of pancreatic tissue. Most of its cells secrete pancreatic juice — a concentrated alkali containing dissolved enzymes (that is, their inactive precursors). Pancreatic juice forms the digestive tract of the intestines. Bacteria that live in different parts of it are important, but play a supporting role.
The main bile ducts also pass through the pancreatic tissue. It travels from the gallbladder to the duodenum, where it is injected into the main duct of the gland. As a result, alkali, enzymes and bile enter the intestine in the form of a ready-made "mixture", not separately.
Other types of cells are also found in groups in the glandular tissue. They are called islets and they synthesize a hormone that is responsible for digesting carbohydrates from food, not alkali. Abnormalities in the development, function, or breakdown of such cells (usually hereditary) are one of the scenarios for diabetes. Second, it increases 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 of the pancreas, through which the juice of the pancreas flows into the main, and then into the lumen of the duodenum. In particular, the accumulated enzymes have a "self-digesting" effect. Acute pancreatitis can occur for the following reasons.
- Gallstones. They occur due to inflammatory pathology of the liver or gallbladder, abnormalities in the composition of the bile (they are caused by taking drugs for sepsis, atherosclerosis, diabetes, the same liver disease).
- Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The pathogen affects the cells of the gland, causes swelling of the tissues and impairs its function.
- Medications. Toxic effects of drugs for atherosclerosis, steroid drugs and some antibiotics.
- deviations in structure or location. They can be congenital (bending of the gallbladder, very narrow ducts, etc. ) or acquired (scars after surgery or traumatic examination, tumors).
Chronic pancreatitis can often be observed in alcoholics and diabetics with "experience" of at least five years. Here it is important to take anti-diabetic drugs or autoimmune processes in the gland that cause inflammation. However, it can also accompany the following diseases.
- Intestinal pathology. Especially the duodenum, including duodenitis (inflammation of its walls) and erosion.
- Vascular diseases. All glands must be actively supplied with blood. Congenital anomalies and blood clotting disorders (hemophilia, thrombosis) play a special role.
- Injuries. Speech ulcers, interventions, severe blows to the stomach.
The least common cause of pancreatitis is spasm of the sphincter of Oddi, which ends in the common gallbladder and pancreatic duct. Oddi's sphincters are located at the point where the duodenum enters. Normally, it regulates the flow of pancreatic juice and bile into the gallbladder, stopping almost in the middle of the meal, allowing the person to increase sharply as they sit at the table. It also prevents various pathogens (bacteria, foreign compounds, worms) from leaking into the pancreas or gallbladder.
Oddi's sphincters are not inclined spasms, like all smooth muscle "separators" of this type. For a long time there was no such thing as dysfunction in medicine. Instead, various "biliary dyskinesia" and "postcholecystectomy" "syndromes" (complications from gallbladder removal) have emerged. However, in reality, his spasms are rare only with the normal functioning of the nervous system. However, it is often driven by neurological diseases or as a result of activation of pain receptors - when it is irritated by stones from the gallbladder, its injury occurs.
The distribution of the causes of acute and chronic pancreatitis is conditional, because the first, even with high-quality treatment, often passes into the second. It is unclear what "feeds" it after the causal factors are eliminated. In some cases (approximately 30%), none of these processes can explain the appearance of pancreatitis in a patient.
symptoms
Acute pancreatitis begins and is accompanied by unbearable (until fainting) low back pain in the upper abdomen and under the ribs. Antispasmodics, painkillers, and antibiotics do not eliminate it, and generic drugs do not help the "heart. "A special diet does not cure the disease - here you need a doctor, not a diet. Although not always constant, its radiation is directed upwards, to the heart area, under the neck, and to the thoracic spine, as a result of which patients may confuse the symptoms of pancreatitis with an exacerbation of a heart attack or osteochondrosis. The body's cascade reactions to the stimulus of the critical force also contribute to this:
- blood pressure jumps (hypertension and hypotension are equally likely);
- interruptions of the heartbeat;
- loss of consciousness;
- cold, moist sweat.
A characteristic symptom of pancreatitis is a loose stool containing mucous, partially digested food fragments and fats. It occurs a few hours after the onset of the disease. At the end of the first day, the color of urine and feces changes. Typically, they have a yellow-brown color with bile bilirubin, with the help of which digestion takes place. However, it does not enter the intestine because the ducts are blocked. On the second or third day, the patient develops flatulence and vomits when he sees a fatty or spicy food that is "sucked" in the stomach.
Chronic pancreatitis also occurs with the disease, but is less pronounced. Cold, fried, smoked, greasy, bitter, especially when accompanied by alcoholic beverages, they may intensify after an hour after eating. The disease is exacerbated, digestion is impaired to the point of dyspepsia (when almost unchanged food comes out instead of feces).
One of the most notorious victims of acute pancreatitis (many experts point to the possibility of a stomach ulcer) was Princess Henrietta of England, wife of Philip, Duke of Orleans, brother of Louis XIV, King of the Sun. She believed that one of her husband's loved ones had poisoned her because of the pain. True, this became known only during the examination to confirm or refute the rumors.
Effects
Acute pancreatitis is dangerous to get through the pancreatic tissue and "eat" quickly (two to three days), as a result of which the alkaline, bile and digestive enzymes enter the abdominal cavity directly through this "fistula". This scenario ends with diffuse peritonitis (inflammation of the peritoneum, which quickly spreads to the abdominal organs), resulting in multiple erosions and death.
Peritonitis is characteristic of many pathologies, including perforated ulcers, gastric or intestinal cancer, appendicitis, if it is accompanied by the discovery of pus (this scenario killed the magician Harry Hudney). If pancreatitis is not caused by mechanical obstruction (spasm of the sphincter of Oddi, stones, scars, tumors, etc. ), its untimely treatment also ends in penetration into the abdominal cavity.
Pancreatic enzymes and digestive juices sometimes cause enzymatic pleurisy — inflammation of the pleura, as in the peritoneum. Complications associated with delayed onset of chronic pancreatitis are common, but significantly impair its function and other organs.
- Cholecystitis. Cholangitis is an inflammation of the liver ducts. They can lead to pancreatitis due to cholelithiasis, but they often occur in the opposite order - as a consequence.
- Gastritis. The stomach is not as closely connected with the pancreas as the liver, but it is located directly beneath it. Its inflammation in pancreatitis is not caused by the entry of foreign substances from the inflamed gland into its cavity, but by a persistent lack of digestive processes in the intestine, which it has to compensate for. The pancreatitis diet is designed to reduce the burden on all digestive organs, but the "interests" of a healthy stomach are not taken into account very carefully. The more pronounced the damage to the pancreas, the greater the risk of gastritis.
- reactive hepatitis. It is also developing in response to persistent bile stasis and irritation of the hepatic ducts. Sometimes cholestasis, which occurs in the later stages of pancreatitis, is accompanied by jaundice. Therefore, the diet of pancreatitis should not include foods that require increased bile secretion. These include fatty, fried, spicy meats and fish, fish caviar, other animal by-products, smoked meats, and alcoholic beverages — digestive stimulants.
- Cystosis and pseudocystosis. These benign tumors, or foci of pancreatic juice stagnation, are caused by the same difficulty in imitating them and expelling it into the duodenum. Cysts occasionally become inflamed and purulent.
- Pancreatic cancer. Any chronic inflammation is a carcinogenic factor, as it causes irritation, rapid destruction of damaged tissues and an increase in their response. And this is not always in good quality. This also applies to chronic pancreatitis.
- Diabetes mellitus. This is far from the first "line" complication of chronic pancreatitis. However, the more rapidly and noticeably the whole gland degrades, the harder it will be for the surviving islet cells to compensate for the insulin deficiency caused by the deaths of their "colleagues" in the already dead areas. They run out and start to die as well. After seven to ten years, the future of diabetes (often even faster, depending on the prognosis and characteristics of the course of pancreatitis) is becoming increasingly important for the average patient "experience". Because of its risk, the diet of pancreatitis should take into account not only the reduced content of fats, but also simple carbohydrates.
Chronic recurrent inflammation in the glandular tissues causes scarring and loss of function. Progressive digestive insufficiency is inevitable. But in general, you can live another 10-20 years with pancreatitis. The prognosis affects the patient's rate, quality and life expectancy of any "deviations" from the diet and their type, especially all relevant alcoholic beverages.
diet therapy
The acute phase of the disease often requires immediate detoxification, antibiotics (usually because there is no time to identify the type of pathogen), and sometimes surgery. If necessary, the cause of the disease is spasm of the sphincter of Oddi, a stone stuck in the canal or other obstruction (tumor). Upon completion, the basis of treatment should be a special medical diet.
Basically, gastroenterologists usually take the №5 diet, developed by Manuil Pevzner during the Soviet era for patients with cholecystitis and other pathologies that interfere with bile synthesis and drainage. However, the author later created the No. 5p diet and changed it.
General provisions
For adult patients with a mild course of the disease, a mechanically inefficient version of Table №5n is suitable - it does not require grinding the food into a homogeneous mass. And for children, the menu should be mostly pureed products. In the exacerbation of chronic pancreatitis (especially in the first three days after its onset) and in the acute stage, which occurs for the first time, eating has several mandatory general rules.
- Simplicity. Recipes should be as simple as possible - no stuffed breasts and meat salads, and even all the ingredients in their composition "stand" on a separate diet.
- Full starvation in the first days. As the pathology progresses, starvation is observed. In other words, only warm alkaline drinks and intravenous injections (vitamins, glucose, sodium chloride).
- Cooking and boiling only (boiled in water, steam). Tables №5 and 5b do not mention other methods such as baking and frying.
- Minimum fat. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. At the same time, the same agent breaks them down in the bile, because vegetable and animal fats must be equally severely restricted. They do not exceed 10 g per day, but can be eaten in any proportion.
- No spices. Especially hot and bitter.
- No nuts. Seeds are also prohibited. Such foods are rich in vegetable oils and are difficult to eat even in powder form.
- Salt to taste. Consumption does not affect the course of pathology, the daily intake of salt remains the same as in healthy people - up to 10 g per day.
- It will be less. This ingredient is usually evaluated by nutritionists and people with digestive problems, and is strictly limited for use in pancreatitis. The secret of its "magical" effect on the intestines - it is not digested, does not absorb fiber, stimulates various parts of the intestine, stimulates peristalsis and secretion of water. Fiber helps in the formation of feces, because it is excreted unchanged. With inflammation of the pancreas, all these properties of the fibers worsen the condition. You can eat only carrots, squash, potatoes, and pumpkin, which are rich in starch and cellulose, but poor in fiber. White and red cabbage are prohibited, but cauliflower can be eaten (flowers, twigs and stems are removed).
- Small portions. There are still, in portions with a total weight of half a kilogram or more three times a day, this is not possible with pancreatic pathology. There should be five meals a day, the total weight of all meals eaten at one time should not exceed 300 g.
- Prohibition of soda, coffee, alcohol and kvass. These drinks are removed from the diet forever. And if they don’t just have to be taken away during remission, they are strictly forbidden when they get worse.
Sour vegetables (such as tomatoes), as well as all fruits, are also prohibited. They further stimulate bile production. The emphasis in the diet should be on low-acid and low-fat dairy products, shrimp, eggs (daily, raw or not fried). Pure grains are used as a source of carbohydrates, mainly buckwheat, rice and oats.
Menu example
The diet menu of pancreatitis should contain enough protein and carbohydrates. And with the latter, the "dark power" is better avoided by limiting the addition of sugar and honey to beverages and utensils. Buckwheat, a favorite cereal for diabetics, should be included in the diet more often because it contains complex carbohydrates. Can be replaced with drugs for diabetes - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant taste), aspartame. This may look like a diet at a time when pancreatic inflammation or primary inflammation is declining.
Monday
- First breakfast. Cooked chicken breast puree. The rice is crushed.
- Lunch. Baked fish cakes.
- The dinner. Rice soup with chicken broth and water diluted in half. Milk net.
- afternoon tea. An omelette made of two eggs.
- The first dinner. Chicken (mincing meat with rice). fresh buckwheat with a dessert spoon of sour cream.
- Second dinner. Non-fat, sour cheese, ground in a blender with a teaspoon of sour cream.
Tuesday
- First breakfast. Oatmeal. Cooked cauliflower.
- Lunch. Butter of greasy beef. Tea with milk and a few white bread crumbs soaked in it.
- The dinner. Fish soup made from lean fish with rice and water. Fruitless milk or fruit jelly.
- afternoon tea. Cottage cheese pasta with sour cream.
- The first dinner. Baked turkey breast souffle. Purified liquid buckwheat.
- Second dinner. Boiled shrimp puree with boiled rice.
Wednesday
- First breakfast. Fish cutlets with rice (we grind rice with fish). Cooked carrot puree.
- Lunch. Two tablespoons chopped low-fat hard cheese.
- The dinner. Soup made from oatmeal, diluted chicken broth and minced breast. cheese pasta with sour cream.
- afternoon tea. A few flowers of boiled cauliflower.
- The first dinner. mashed pasta with cottage cheese. Omelet cooked from two eggs.
- Second dinner. Pumpkin porridge. Tea with a few white crackers soaked in it.
Thursday
- First breakfast. Zucchini puree. Steamed chicken cutlets.
- Lunch. Two tablespoons chopped low-fat hard cheese.
- The dinner. Creamy potato soup with butter. Lean beef puree.
- afternoon tea. Turkey afternoon souffle.
- The first dinner. Buckwheat puree. Lean fish souffle.
- Second dinner. Carrot-pumpkin porridge.
Friday
- First breakfast. cheese pasta with sour cream. Zucchini puree. Chicken (rice minced like meat).
- Lunch. Mashed potatoes with butter.
- The dinner. Milk soup with mashed pasta. An omelet made of two eggs is steamed with shredded cheese.
- afternoon tea. A few cauliflower. Rice pudding.
- The first dinner. Shrimp chopped in sour cream sauce. Buckwheat puree. Tea with white crackers.
- Second dinner. Carrot puree. Fruitless milk or fruit jelly.
Saturday
- First breakfast. Pumpkin porridge. Soup made from lean beef.
- Lunch. Fish cutlets.
- The dinner. Weak chicken broth and rice soup with minced meat. Shredded pasta with milk.
- afternoon tea. Oatmeal.
- The first dinner. Butter of greasy beef. Mashed potatoes.
- Second dinner. Pumpkin-carrot porridge. Tea with a few white crackers
Sunday
- First breakfast. cottage cheese pasta with sour cream. Omelet.
- Lunch. Zucchini under a coat of cheese. Tea with milk and white crackers
- The dinner. buckwheat soup on beef broth diluted with boiled beef puree. Baked turkey breast souffle.
- afternoon tea. Oatmeal.
- The first dinner. Mashed potatoes. Chicken cutlets.
- Second dinner. Rice pudding.
The pancreatitis diet requires the elimination of all confectionery and confectionery products, including chocolate and cocoa from the diet. You need to limit your intake of fats, dietary acids and fiber. Also, do not eat fresh bread. Prohibited cereals, wheat, corn. These cereals should not be crushed in a blender. All legumes, including soybeans, are eliminated. They are rich in vegetable protein and are valued by vegetarians for them. However, they are also "guilty" of increased gas formation, increased gastric acidity, which is very undesirable in the acute period.