Стандарт діагностики та лікування хронічного панкреатиту – Аптека медичної академії

Стандарт діагностики та лікування хронічного панкреатиту – Аптека медичної академії

хронічний панкреатит (ХП) – запально-дистрофічних захворювань залізистої тканини підшлункової залози (ПЗ) з порушенням прохідності її проток, фінальною стадією якого є склероз паренхіми органу з втратою його екзокринної і ендокринної функції. В анамнезі у хворих ХП – зловживання алкоголем, постійне вживання жирного, смаженого, копченого, гострого, вказівки на билиарную патологію, виразку шлунка або 12-ПК, гиперпаратиреоз та ін.

КЛІНІКА . Больовий синдром (ліве підребер’я, рідше – ліва, права або обидві половини епігастрію; іррадіація в ліву половину грудної клітки, в ліву половину по типу «лівого полупояса» або по типу «повного пояса», рідше – в ку, під ліву лопатку, за грудину, в прекардіальну обл.). Болі посилюються після їжі, провокуються надмірною, жирної, смаженої, копченої, гострої їжею, свіжими овочами та фруктами, газованими напоями, солодким, свіжоспеченим, шоколадом, какао, кава, алкоголем. Диспепсический синдром (нудота, блювання, що не приносить полегшення, метеоризм, відрижка та ін.).

Прояви екзокринної недостатності і мальдигестії – кашіцеподобний стілець 2-3 рази на добу. «Великої панкреатичний стілець» (надмірний, смердючий, сіруватого кольору, з блискучою поверхнею – жирний), ліентерея (макроскопічно видні залишки їжі в калі), втрата маси тіла, прояви гіповітамінозів (особливо A, D, E, K), здуття, бурчання в животі.

Прояви ендокринної недостатності – в початкових стадіях ХП явища гіперінсулінізма – епізоди гіпоглікемії з характерними слабкістю, холодним потом, нервово-психічним збудженням, тремтінням у тілі і кінцівках; в більш пізніх стадіях ХП – прояви панкреатогенного цукрового діабету.

ЛАБОРАТОРНА ДІАГНОСТИКА:

Обов’язковий асортимент: # 945; – амилаза крові, сечі (чутливість не більше 30%), білірубін, лужна фосфатаза (для встановлення зв’язку з біліарної патологією), рівень цукру в крові, вміст еластази-1 в калі, копроскопія.

Визначення еластази-1 в калі – «золотий стандарт» неінвазивної діагностики ХП, чутливість при середньо-і важкої зовнішньосекреторної недостатності (ВСН) -88-95%; критерії –

150-200 мкг / г – легка, 100-150 мкг / г – середньої тяжкості, lt; 100 мкг / г – важка ВСН; при показнику еластази-1 gt; 200 мкг / г функцію ПЖ вважають збереженою.

Інструментальна діагностика ХП (обов’язковий асортимент): трансабдоминальное УЗД (чутливість – 80-85%), комп’ютерна томографія (КТ). Екскреторна ретроградна холагіопанкреатографія (ЕРХПГ), яка вважається “золотим стандартом” діагностики, віднесена за наказом № 271 до переліку додаткових методів обстеження.

ЛІКУВАННЯ . немедикаментозне (відмова від алкоголю, дієта №5 з виключенням продуктів – стимуляторів секреції; зменшення тваринних жирів, часте дробове харчування) і медикаментозне.

Медикаментозне лікування ХП

Планове лікування

Етіотропне лікування застосовують при вторинних ХП, наприклад, лікування пептичних виразок. Патогенетичне лікування застосовують з метою поліпшення відтоку панкреатичного секрету: при дисфункції сфінктера Одді використовують селективні антагоністи Са, при дуоденостазе – прокинетики.

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