For a long time it was thought that pancreatitis was caused by alcohol abuse. This false impression arose because it was first discovered and described using the example of alcoholics. But now it is already known that their most dangerous, acute stage is almost never found in them - this is the "prerogative" 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, form and stage of the course, it significantly disrupts digestion, threatens the state of the metabolic system, and sometimes the patient's life. Diet for pancreatitis is primarily protein-based (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 (or rather, their inactive precursors) dissolved in it. Pancreatic juice forms the digestive environment of the intestine. Bacteria inhabiting its various compartments play an important but supportive role.
The main bile ducts also run through the tissue of the pancreas. It leads from the gallbladder to the duodenum and, at the very exit, flows 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".
Within the tissues of the gland, cells of another type are also located in groups. They are called islets and do not synthesize alkali but rather insulin, a hormone responsible for absorbing carbohydrates from food. Abnormalities in the development, function or breakdown 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 of the gland, through which the pancreatic juice flows into the main duct, and then into the lumen of the duodenum. There is an effect of its "self-digestion" by the enzymes accumulated in it. Acute pancreatitis can be caused by the following reasons.
- gallstones. They arise 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 pathogen infects the cells of the gland, causes tissue swelling and disrupts its function.
- medication. The toxic effect of drugs for atherosclerosis, steroid drugs and some antibiotics.
- Deviations in structure or position. They can be congenital (buckling of the gallbladder, ducts that are too narrow, etc. ) or acquired (scarring after surgery or traumatic examination, swelling).
Chronic pancreatitis can most often be observed in drunk alcoholics and diabetics "with experience" of at least five years. What matters here is the autoimmune process in the gland that caused the inflammation or the use of antidiabetic drugs. But it can also accompany the following diseases.
- intestinal pathology. Especially the duodenum, including duodenal inflammation (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.
- injuries. Penetrating wounds, interventions, powerful blows in the abdomen.
The rarest cause of pancreatitis is spasm of the sphincter of Oddi, which terminates in the common gallbladder and pancreatic duct. Oddi's sphincter is located at the very exit into the duodenum. Normally, it regulates the "portioned" supply of pancreatic juice and bile into its cavity, making them almost stop between meals and sharply increasing when a person sits at the table. It also prevents the backflow of intestinal contents along with various pathogens (bacteria, foreign matter, worms) into the pancreas or gallbladder.
Oddi's sphincter is not prone to spasms, like all smooth muscle "separators" of this type. For a long time there was no specific dysfunction in medicine. It was replaced by various "biliary dyskinesias" and "postcholecystectomy" "syndromes" (a complication after removal of the gallbladder). In fact, however, his spasm is a rare thing only with normal functioning of the nervous system. But he often overtakes with neurological disorders or as a result of activation of pain receptors - when irritated by stones coming out of the gallbladder, his injury takes place.
The division of the causes of acute and chronic pancreatitis is conditional, since the first, even with high-quality treatment, in the vast majority of cases passes into the second. And what "feeds" it after the elimination of causal factors is unclear. In some cases (about 30%), none of these processes can explain the occurrence of pancreatitis in a patient.
sign
Acute pancreatitis begins and is accompanied by unbearable (up to the point of unconsciousness) girdle pain in the entire upper abdomen, under the ribs. Antispasmodics, painkillers and antibiotics do not eliminate it, and common drugs "from the heart" do not help either. Even a special diet will not relieve the pain - this is where a doctor is needed, not a diet. Usually, although not always, its irradiation is noted upwards, to the heart region, under the collarbone, to the thoracic spine, which allows patients to confuse the symptoms of pancreatitis with a heart attack or an exacerbation of osteochondrosis. This is also facilitated by the body's cascade responses to a critical strength stimulus:
- Jumps in blood pressure (hypertension and hypotension are equally likely);
- heart rate interruptions;
- fainting;
- cold, damp sweat.
A characteristic symptom of pancreatitis is soft stools - mushy, containing half-digested fragments of food and fat. It appears a few hours after the onset of the disease. By the end of the first day, discoloration of the feces with urine is noticeable. Normally, they are yellow-brown in color due to bilirubin from the bile, with the help of which digestion took place. And because of the blockage of the duct, it does not get into the intestines. On the second or third day, the sight of greasy or spicy food causes the patient to experience flatulence, "sucking" in the stomach, and vomiting.
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 intensified in the supine position, digestion is disturbed to the point of dyspepsia (when almost unchanged food comes out instead of feces).
One of the most famous victims of acute pancreatitis (many experts point to the likelihood of peptic ulcer perforation) was Princess Henrietta of England, wife of Duke Philip of Orleans, brother of the Sun King Louis XIV. Because of the typically painful course of the disease, she was surethat one of her husband's favorites had poisoned her. True, it turned out only during an autopsy to confirm or dispel this rumor.
effects
Acute pancreatitis becomes dangerous from rapid (two to three days) "eating" of pancreatic tissue through and through, allowing caustic alkali, bile and digestive enzymes to 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), the appearance of multiple erosions, and death.
Peritonitis is characteristic of many pathologies, including a perforated ulcer, cancer of the stomach or intestines, appendicitis, if it was accompanied by a rupture of the abscess (due to such a scenario, the magician Harry Houdini died). If the pancreatitis was caused not by a mechanical obstruction (spasm of Oddi's sphincter, stone, scar, tumor, etc. ) but by infection, purulent pancreatic abscess may develop. His premature treatment also ends with a breakthrough in the abdominal cavity.
Enzymes and digestive juices from the pancreas sometimes cause enzymatic pleurisy - an inflammation of the pleura of the same type as in the case of the peritoneum. In chronic pancreatitis, delayed complications are typical, but they more seriously disrupt their work and other organs.
- cholecystitis. And cholangitis is inflammation of the liver ducts. They themselves can cause pancreatitis due to the cholelithiasis that accompanies them, but they often form in the reverse order - as a result.
- Gastritis. The stomach is not as closely connected to the pancreas as the liver, although it lies just below it. His inflammation in pancreatitis occurs not so much due to foreign substances getting into his cavity from the inflamed gland, but due to the constant insufficiency of intestinal digestion, which he has to compensate for. The pancreatitis diet is designed to relieve all digestive organs, but the "interests" of a healthy stomach are less carefully considered. The more pronounced the breakdown of the pancreas, 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. For this reason, the pancreatitis diet should not include foods that require increased bile secretion. 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, which they simulate, arise due to the same difficulties in removing them into the duodenal cavity. Cysts tend to become inflamed and suppurate periodically.
- pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, since it causes irritation, accelerated destruction of the affected tissues and their increased reaction growth. And not always in good quality. The same applies to chronic pancreatitis.
- diabetes mellitus. It is far from the first "in line" complication of chronic pancreatitis. However, the faster and more markedly the entire gland is degraded, the more difficult it becomes for the surviving islet cells to compensate for the lack of insulin caused by the death of their "colleagues" inalready dead areas arises. They are exhausted and are also beginning to die out. The prospect of diabetes mellitus after seven to ten years (often even faster, depending on the prognosis and course characteristics of the pancreatitis) "experiences" more and more tangible for the average patient. but also consider simple carbohydrates.
Chronic recurring inflammation in the tissue of the gland leads to scarring and loss of function. A progressive insufficiency of the intestinal digestion is inevitable. But in general, you can live with pancreatitis for another 10-20 years. The prognosis for the course, quality and life expectancy of the patient is influenced by various "deviations" from the diet and its nature, 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 wide spectrum, since there is no time to establish the nature of the causative agent), and sometimes surgical intervention. It is necessary if the cause of the disease is a spasm of Oddi's sphincter, a stone stuck in the duct or some other obstacle (tumor). After completing treatment, 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 impede the synthesis and outflow of bile. But later the author himself changed it, creating diet No. 5p.
General Provisions
For adult patients with a mild course of the disease, a variant of table No. 5p without mechanical rest is suitable - there is no need to grind food into a homogeneous mass. And the menu for children most often has to be made from pureed products. Nutrition during the period of exacerbation of chronic pancreatitis (especially in the first three days after its onset) and in the acute stage, which appeared for the first time, has several binding 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" individually into the diet.
- Complete hunger for the first few days. With an exacerbation of the pathology, starvation is prescribed. That is, just a warm alkaline drink and intravenous injections (vitamins, glucose, sodium chloride).
- Only braising and boiling (on water, stewed). Tables #5 and 5p do not imply other methods such as baking and frying.
- Minimal fat. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. Vegetable and animal fats must also be strictly limited as they are broken down by the same agent, bile. 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 prohibited. These types of foods are high in vegetable oil and too difficult to eat even in powdered form.
- Salt to taste. Its consumption does not affect the course of pathology in any way, the daily intake of salt remains the same as in healthy individuals - up to 10 g per day.
- Less fiber. This component, usually valued by nutritionists and people with digestive problems, is strictly limited to use in inflammation of the pancreas. The secret of its "magical" effect on the intestines is that fiber is not digested, absorbed and irritates various parts of the intestine, stimulating peristalsis and water excretion. Fiber helps in the formation of feces, since it is excreted unchanged. With inflammation of the pancreas, allthese properties of fibers only aggravate the situation. You can only eat carrots, zucchini, potatoes, pumpkins, which are rich in starch and pulp, but relatively poor in hard fiber. White and red cabbage are forbidden, but cauliflower can be eaten (only inflorescences, branches and stems are excluded).
- Small portions. There are still portions three times a day with a total weight of half a kilogram or more, with pancreatic pathologies this is impossible. At least five meals a day should be eaten and the total weight of all food consumed at the same time should not exceed 300 g.
- Ban on soda, coffee, alcohol and kvass. These drinks are best eliminated from the diet forever. But if during the period of remission they simply should not be carried away, then during an exacerbation they are strictly forbidden.
Sour vegetables (e. g. tomatoes) and all berries and fruits are also prohibited. They will further stimulate the secretion of bile. The main focus in the diet should be acid-free and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). As a source of carbohydrates, pureed grains are used, mainly buckwheat, rice and oatmeal.
menu example
The diet menu for pancreatitis should contain enough proteins and carbohydrates. But "brute force" with the latter is best avoided by limiting the addition of sugar and honey to drinks and dishes. Buckwheat, a popular grain for diabetics, should be included in the diet more often because it is made up of complex carbohydrates. Sugar can be replaced with diabetic drugs - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant aftertaste), aspartame. This is what nutrition may look like during the period when the exacerbation or primary inflammation of the pancreas is already receding.
Monday
- First breakfast. Cooked chicken breast puree. pureed rice.
- Having lunch. Steamed Fish Cakes.
- Dinner. Rice soup in chicken broth diluted half with water. milk jelly.
- Afternoon tea. Two egg omelet.
- First dinner. Chicken Meatballs (Beef Meat with Rice). Pureed buckwheat with a tablespoon of butter.
- Second dinner. Lean, acid-free cottage cheese, shredded in a blender with a teaspoon of sour cream.
Tuesday
- First breakfast. Oatmeal. Boiled cauliflower.
- Having lunch. Lean beef pie 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 lean sour cream.
- First dinner. Steamed turkey breast soufflé. Pureed liquid buckwheat.
- Second dinner. Boiled shrimp puree with boiled rice.
Wednesday
- First breakfast. Fish cakes with rice (grind the rice together with the fish). Boiled carrot puree.
- Having lunch. Two tablespoons of grated low-fat hard cheese.
- Dinner. Soup made with pureed oatmeal, diluted chicken broth, and shredded breast. Pot noodles with sour cream.
- Afternoon tea. Several cooked cauliflower florets.
- First dinner. Mashed pasta with cottage cheese. Steam omelet from two eggs.
- Second dinner. pumpkin mash. Tea with some white crackers steeped in it.
Thursday
- First breakfast. Zucchini puree. Chicken Steam Chops.
- Having lunch. Two tablespoons of grated low-fat hard cheese.
- Dinner. Creamy potato soup with butter. Lean beef puree.
- Afternoon tea. Turkey breast soufflé.
- First dinner. buckwheat puree. Lean fish soufflé.
- Second dinner. Carrot Pumpkin Mash.
Friday
- First breakfast. Pot noodles with sour cream. Zucchini puree. Chicken meatballs (ground rice, like meat).
- Having lunch. Mashed potatoes with butter.
- Dinner. Milk soup with mashed potatoes. Two egg omelet steamed with grated cheese.
- Afternoon tea. Several cauliflower florets. Ricepudding.
- 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
- First breakfast. pumpkin mash. Lean beef soufflé.
- Having lunch. Fish Patties.
- Dinner. Rice soup with weak chicken broth and minced meat. Pasta puree with milk.
- Afternoon tea. Oatmeal.
- First dinner. Lean beef pie with butter. Mashed potatoes.
- Second dinner. Pumpkin and carrot mash. Tea with some white crackers
Sunday
- First breakfast. Cottage cheese pasta with sour cream. Omelette.
- Having lunch. Zucchini under a cheese crust. Tea with milk and white crackers
- Dinner. Buckwheat soup on diluted beef broth with cooked beef puree. Steamed turkey breast soufflé.
- Afternoon tea. Oatmeal pureed.
- First dinner. Mashed potatoes. chicken cutlet.
- Second dinner. Rice Pudding.
The diet for pancreatitis requires the exclusion from the diet of all confectionery and bakery products, including chocolate and cocoa. You need to limit your intake of fats, food acids, and fiber. Don't eat fresh bread either. Under the ban millet, wheat, corn. These cereals can't even be pureed in a blender. All legumes, including soybeans, are also eliminated. They are rich in plant-based protein, which is what vegetarians value them for. But they are also "to blame" for increased gas formation, an increase in stomach acid, which is highly undesirable in the acute phase.