What Is the Connection between Pancreatitis and Diabetes?

Pancreatitis is a disease of the pancreas caused by the self-digesting effect of trypsin. Pancreas has edema, congestion, or bleeding or necrosis. Clinical symptoms include abdominal pain, bloating, nausea, vomiting, and fever. Blood tests and elevated amylase levels in urine.

Basic Information

English name: pancreatitis
Visiting department: Gastroenterology
Multiple groups: Hyperlipidemia, hypercalcemia
Common causes: Biliary disorders, alcohol and overeating, surgery and injuries, infections

Common symptoms: The patient developed abdominal pain, bloating, nausea, vomiting, and fever
Contagious: no

Causes of pancreatitis

Under normal circumstances, pancreatic juice contains inactive trypsinogen in its glandular tissue. Pancreatic juice continuously flows into the duodenum through the common bile duct sphincter along the pancreatic duct. Due to the presence of bile in the duodenum, and the duodenal wall mucosa secretes an enterokinase, under the action of the two, Trypsinogen began to transform into a highly active digestive enzyme. If the outflow tract is blocked and excreted poorly, pancreatitis can be caused.

When Oedipal sphincter spasm or increased pressure in the bile ducts, such as stones or tumor obstruction, bile flows back into the pancreatic ducts and into pancreatic tissues. Decomposed into lysolecithin, which can cause toxic effects on the pancreas. Or when the biliary tract is infected, the bacteria can release the kinase to activate pancreatin, which can also become an active substance that can damage and dissolve pancreatic tissue. These substances convert trypsinogen contained in pancreatic juice into trypsin. This enzyme has strong digestive activity, penetrates into pancreatic tissue to cause self-digestion, and can also cause pancreatitis.

Acute pancreatitis

It is an acute inflammation caused by trypsin digestion of the pancreas and its surrounding tissues, mainly manifested as edema, bleeding and necrosis of the pancreas. The common causes are as follows:

(1) Diseases of the biliary tract system Biliary duct inflammation, stones, parasites, edema, spasm and other lesions cause obstruction of the ampulla, and bile flows back into the pancreatic duct through a common channel, activating pancreatinogen, thereby causing pancreatitis.

(2) Alcohol and overeating Alcohol and overeating make the pancreatic juice strong, and the drainage of the pancreatic ducts is not smooth, causing the pressure of the pancreatic juice in the pancreaticobiliary system to increase, leading to the excretion of high concentrations of protease, and finally causing the pancreatic vesicles to burst and become ill .

(3) Surgery and injury Abdominal surgery such as stomach and biliary tract is squeezed to the pancreas, or the pressure of the pancreaticobiliary duct is too high.

(4) Infections Many infectious diseases can be complicated by acute pancreatitis, and the symptoms are not obvious. If the tapeworm enters the bile duct or pancreatic duct, it can bring in bacteria, which can cause pancreatic enzyme activation to cause pancreatic inflammation.

(5) Hyperlipidemia and hypercalcemia Hyperlipidemia, fat embolism of pancreatic blood vessels causes ischemia, dilation of capillaries, damage to blood vessel walls, resulting in difficulty in excretion of pancreatic juice; stones can block pancreatic ducts and cause pancreatitis.

2. chronic pancreatitis

A disease of chronic progressive destruction of the pancreas caused by repeated episodes of acute pancreatitis.

Clinical manifestations of pancreatitis

Acute pancreatitis

Before the onset, there was a history of overeating or biliary disease. Acute pancreatitis can be divided into ordinary type and hemorrhagic necrosis type. Hemorrhagic necrosis is rare, but the condition is severe and the mortality rate is high.

(1) Shock symptoms often occur in patients with shock, such as paleness, cold sweat, pulse width, and blood pressure drop. There are many reasons for shock, such as pancreatic fluid overflow, which causes severe pain in the peritoneum; pancreatic tissue and intra-abdominal bleeding; tissue necrosis, Poisoning caused by proteolysis. Those with severe shock can be killed if they are not rescued in time.

(2) Abdominal pain Abdominal pain is often located in the mid-upper abdomen, sometimes radiating to the waist and back, which can be reduced by bending or leaning forward. It often occurs suddenly after heavy drinking or full meals. The degree is different. The milder is dull pain. In severe cases, persistent colic.

(3) Nausea and vomiting Most patients vomit stomach contents and even vomit bile.

(4) Fever Most patients with acute pancreatitis develop moderate fever, which usually lasts 3 to 5 days.

(5) Water electrolyte and acid-base imbalance Patients have varying degrees of dehydration. Metabolic alkalosis can occur in those who frequently vomit. Severe pancreatitis is often accompanied by metabolic acidosis, hypocalcemia, elevated blood sugar, hypokalemia, Low blood magnesium.

2. chronic pancreatitis

(1) Abdominal pain is mostly located in the upper abdomen and is diffuse. It can be radiated to the back and ribs. It can be relieved by sitting up or leaning forward.

(2) Pancreatic insufficiency Symptoms of indigestion such as abdominal distension, poor appetite, anorexia, weight loss, and fatty diarrhea; half of patients develop diabetes due to endocrine dysfunction.

(3) Signs There are few positive signs in mild chronic pancreatitis, and some cases have mild tenderness in the upper abdomen; advanced chronic pancreatitis may have malnutrition due to fatty diarrhea; if it is acute, it may appear moderate to severe Abdominal tenderness.

Pancreatitis examination

White blood cell count

If the infection is severe, the total number of white blood cells will increase and a significant nuclear leftward shift will occur. Some patients have increased urine glucose, and severe cases have protein, red blood cells, and casts.

2. Determination of blood and urine amylase

It has important diagnostic significance. Normal value: Serum: 8 to 64 Winslow units, or 40 to 180 Somogyi units; Urine: 4 to 32 Winslow units.

In patients with acute pancreatitis, pancreatic amylase overflows from the pancreas, is quickly absorbed into the blood, and is excreted by the urine. Therefore, the blood urinary amylase is greatly increased, which is an important laboratory test to diagnose the disease.

In cases of severe necrosis, the amylase value is not increased due to the severe destruction of the acinus and little amylase production. If the amylase value drops and rises again, it indicates that the condition is repetitive, and if it continues to increase, complications may occur. When the measured value is> 256 Wen units or> 500 Su units, the diagnosis of acute pancreatitis is meaningful.

3. Determination of serum lipase

The reason for its increase is the same as that of amylase. It starts to rise 24 hours after the onset and can last for 5 to 10 days. Measuring its value for later patients can help diagnosis.

4. Determination of serum calcium

The normal value is not lower than 2.12mmol / L (8.5mg / dl). Serum calcium began to decrease two days after the onset, and was significant after 4 to 5 days, and the severe cases could fall below 1.75mmol / L (7mg / dl), suggesting that the condition is serious and the prognosis is poor.

5. Determination of serum ferritin (MHA)

MHA comes from the hemoglobin released by the destruction of red blood cells in blood pancreatic juice. It is converted into heme by the action of lipase and elastase, which is absorbed into the blood to combine with albumin to form methaemoglobin. Severe patients often develop MHA 12 hours after onset. They are positive in patients with severe acute pancreatitis and negative in edema.

6.X-ray inspection

Local or extensive intestinal paralysis can be seen in the abdomen. Fluid accumulation in the omentum sac. There are calcifications around the pancreas. It can also be seen that the diaphragm is elevated, pleural effusion, and occasionally discoid atelectasis. When ARDS occurs, the lung field is "ground glass".

7.B ultrasound and CT

Can show the outline of pancreatic enlargement, the amount and distribution of exudate.

Pancreatitis complications

There are very few complications in mild acute pancreatitis, and many complications often occur in severe acute pancreatitis, such as pancreatic abscesses, pancreatic pseudocysts, shock, and organ failure. Secondary symptoms include abdominal cavity, Infections such as urinary tract, the spread of infection can cause sepsis. A few can evolve into chronic pancreatitis.

Chronic pancreatitis is mainly manifested by chronic abdominal pain and pancreatic endocrine and exocrine dysfunction, which is related to the occurrence of pancreatic cancer. The most common complications are the formation of pseudocysts and mechanical obstruction of duodenum and common channels.

Pancreatitis treatment

(A) acute pancreatitis

General treatment

In the early stages of acute pancreatitis, patients with mild pancreatitis and those without infection should be treated non-surgically.

(1) Fasting and decompression of nasogastric tube Continuous gastrointestinal decompression to prevent vomiting and aspiration. Give full gastrointestinal power medicine can reduce abdominal distension.

(2) Replenishing body fluids, preventing and treating shock All patients should be supplemented with fluids, electrolytes and heat intravenously to maintain circulation stability and water-electrolyte balance. Prevent hypotension and improve microcirculation.

(3) Antispasmodic and analgesic For those with a clear diagnosis, analgesics can be given symptomatically in the early stages of onset. But should give antispasmodics at the same time. Disable morphine to avoid causing Oddis sphincter spasm.

(4) Inhibition of pancreatic exocrine secretion and pancreatic enzymes. Gastric tube decompression, H2 receptor blockers, anticholinergic drugs, somatostatin, etc. are generally used in patients with more severe illness. Trypsin inhibitors such as aprotinin, gabexate, etc. have a certain effect of inhibiting trypsin.

(5) Nutritional support Early fasting mainly relies on complete parenteral nutrition (TPN). When abdominal pain, tenderness and intestinal obstruction are reduced, diet can be resumed. In addition to hyperlipidemia patients, fat emulsions can be used as a heat source.

(6) Application of antibiotics Early treatment with antibiotics. In severe pancreatitis with pancreatic or peripancreatic necrosis, intravenous application of broad-spectrum antibiotics or selective enteral antibiotics can prevent bacterial infections caused by intestinal flora shift. .

2. Surgical treatment

Pancreatic abscess, pancreatic pseudocyst, and pancreatic necrosis combined infection are serious life-threatening complications of acute pancreatitis. If the diagnosis is uncertain; secondary pancreatic infection; biliary tract disease; although the clinical symptoms continue to worsen after reasonable support treatment, surgical treatment should be performed.

In severe cases, there are two main surgical methods: laparotomy to remove necrotic tissue, place multiple porous drainage tubes for continuous lavage after surgery, and then suture the incision. Laparotomy to remove necrotic tissue and open the wound for drainage. During the operation, gastrostomy, jejunostomy (for enteral nutrition support) and biliary drainage can be performed at the same time. Occasionally a single abscess or infectious pancreatic pseudocyst can be treated with percutaneous puncture and drainage.

In patients with severe biliary pancreatitis accompanied with ampulla incarcerated stones, combined with biliary obstruction or biliary tract infection, emergency surgery or early (within 72 hours) surgery to remove biliary obstruction, remove the stones, clear drainage, and choose according to the needs of the disease For cholecystectomy or drainage of the pancreatic area of the small omentum. Under the conditions, fibroduodenoscope Oddis sphincterotomy can be used for stone removal, which has significant curative effect and few complications.

(Two) chronic pancreatitis

Chronic pancreatitis should be treated for the cause, such as the treatment of biliary diseases, abstaining from alcohol; diet therapy, small meals, high protein, high vitamin, low fat diet; supplementation of pancreatic enzymes; control of diabetes; If necessary, pancreatic duct drainage and pancreatic surgery were performed.

Pancreatitis prevention

Acute pancreatitis is a very serious disease. Acute hemorrhagic necrotizing pancreatitis is particularly dangerous, with a sharp incidence and a high mortality rate. It is known that the onset of pancreatitis is mainly due to pancreatic juice reflux and pancreatic enzyme damage to the pancreas, and these factors can be prevented.

Biliary disease

Avoid or eliminate biliary diseases. For example, prevent intestinal roundworms, treat biliary stones in time, and avoid causing acute attacks of biliary diseases.

Alcoholism

Normally alcoholics suffer from chronic alcoholism and malnutrition, causing damage to the liver, pancreas and other organs, reducing their ability to fight infection. On this basis, acute pancreatitis can be caused by a heavy drinking.

3. Overeating

It can lead to gastrointestinal dysfunction, impede normal intestinal activity and emptying, prevent normal drainage of bile and pancreatic juice, and cause pancreatitis.