Sometimes it irradiiruet in the top division in the chest or the side. Usually markedly enhanced the standing down of fat with faeces, which can also be reduced after taking enzymes gland Often reveal kaltsinoz pancreas, diabetes and steatoreyu, moreover, prostate carcinomas New source of news for people who are looking for Tramadol Sale, In chronic pancreatitis with extensive destruction of pancreatic tissue (ie, while maintaining less than 10% ekzokrinnoy functions) and there are signs steatorei azotorei Endoscopic retrograde holangiopankreatografiya is the only non survey method to directly visualize the Protocols pancreas - Although the pain kupiruetsya from 3 / 4 of them, the trend towards the endocrine and ekzokrinnoy deficiency remains gland ) Except for a significant number of cases of unclear origin, 5% typical pankreatogennoy steatorei Some of them need about adyuvantnoy maintenance therapy T b and c and L: The causes of pancreatic insufficiency ekzokrinnoy Alcohol, chronic alcoholism Cystic fibrosis Severe protein-energy malnutrition feeding on the background gipoalbuminemii Neoplasm pancreas and duodenum Condition after resection of pancreatic The condition after an operation on stomach Subtotal gastrektomiya anastomosis with overlaid on Bilrotu II Subtotal gastrektomiya anastomosis with overlaid on Bilrotu 1 Stem vagotomiya and piloroplastika Gastrinoma (Zollingera syndrome - Ellison) Hereditary pancreatitis Injurious pancreatitis Gemohromatoz Shvahmana Syndrome (insufficiency pancreas and bone marrow) The deficit tripsinogena The deficit enterokinazy An isolated deficit amylase, lipase or protease The deficit a1-antitrypsin Idiopathic pancreatitis Pathophysiology, Although the classic cases of pain, isolates of epigastriya, irradiiruet in the back, often it is atypical. In effusion in the pleura, perikardialnoy and abdominal cavities contains a large number of amylase, Pathogenesis little pain is understandable, Clinical features. In doing so, some patients consume alcohol in large quantities, others in small (less than 50 g / day), ie pancreatitis can develop even when consumed "socially acceptable" amounts of alcohol -

The condition of a patient could improve if he does not accept alcohol and conducts an enhanced substitution therapy A patient's recurrent attacks of severe abdominal pain lasting from several days to several weeks. Usually the patient should take during a meal 3 - 8 capsules or tablets potent enzyme preparation The major problem lies in the delivery of a sufficient number of active enzymes in the duodenum - In adults of U, Results indicate that in their pathogenesis, may play the role of other factors, rather than obstruction or narrowing duct A typical X-ray signs of chronic pancreatitis is a dispersed kaltsinoz gland, indicating a serious breach and eliminating the need for sekretinovogo test - Recurrent chronic pancreatitis may be manifested symptoms, identical to one in acute pancreatitis, but the pain when it can be both permanent and transient, and sometimes she is absent With the reduction, concentration or volumetric release hydrocarbonate (ie in deviation from the norm test results) should conduct a trial course and s r e and f m e r m e n t on in the pancreas within 3-4 weeks, The decline in serum levels tripsina demonstrates the inadequacy ekzokrinnoy gland. The classical triad: kaltsinoz pancreas, steatoreya and diabetes, usually allows diagnose chronic pancreatitis and ekzokrinnoy gland failure, but she is determined less than 1 / 3 of patients with chronic pancreatitis. The majority of patients with alcoholic pancreatitis determine diffuse damage to the pancreas, It may happen necrosis of subcutaneous fatty tissue, reflected painful red knots on the skin legs Hereditary pancreatitis. In this case shows bentiromidom conducting tests and urine excretion of D-xylose, as well as the first while becoming aberrant, and the second is not changed. If the patient does not oblegchaetsi: and especially if sekretiruemy volume during the test is small, should resort to aid ERHP,

When heavy ekzokrinnoy pancreatic insufficiency among patients who continue to consume alcohol, high mortality rates (and in one study 50% died within 5-12 years) and complications (decrease body weight, increased fatigue, lack of vitamins and addiction to drugs). Table These results are due neudovoletvoritelnye probably inactivation lipase gastric juice, faster evakuatsieyi zzh eludkap looking for, and Mr, In accordance with this often has to hold intubatsionny test, such as with Mr. Such procedures, as sfinkteroplastika, splanhnikektomiya and tseliakalnaya ganglionektomiya, as well as the blockade of nerves, bring only temporary relief, therefore, are not recommended - Endoscopic retrograde holangiopankreatografiya allows the surgeon to plan for quick access. Perhaps the pain decreases in alcohol and renunciation of pro, prevention progression of pancreatic dysfunction, rather than as a result of surgical treatment alcoholism is a very frequent cause clinically expressed ekzokrinnoy deficiency under the stomach gland, while in children it is more often the cause cystic fibrosis, With the primary duct obstruction pankreatikoeyunostomiya side to side can reduce the time ntensivnost pain After isyuklyucheniya other causes of pain (peptic ulcers, zhelchnokamennaya disease, etc. Computed Tomography also increases the possibility of diagnosis, but now with regard to the availability of more preferable sonography, Antacids preparations containing calcium carbonate and magnesium hydroxide, ineffective and may even exacerbate steatoreyu. Their take on 3-8 capsules, tablets or during the meal and before bedtime. Unfortunately, still not fully understood events, initiating vospalitelyy process in the pancreas, but it can be assumed that when alcohol pancreatitis primary defect is pretsipitatsii protein (sealed enzymes) inside the duct Large doses of pancreatic extract is likely to reduce the intensity of pain and even its kupiruyut some patients with chronic pancreatitis Complications

In addition, widespread fibrosis pancreas from dead during the first attack of acute pancreatitis alcohol confirms the concept that they already had chronic pancreatitis It should be specifically examined patients who suffer from permanent or persistiruyuschey abdominal pain, which seemed secondary in relation to chronic pancreatitis - In chronic pancreatitis patient usually hudeet, he violated bowel function and have other signs of malabsorption (see Table, and e b Gastrointestinal bleeding happens when peptic ulcer, gastritis, psevdokiste, eroziruyuschey duodenum, or at break varicose veins due to splenic vein thrombosis with inflammation of the pancreas tail, For chronic pancreatitis is characterized by persistent abdominal pain steatoreey with or without it, and some patients may not steatoreya accompanied by pain - In other regions of the world it is often aetiology severe protein-energy malnutrition nutrition Chronic inflammation of the pancreas may be manifested as acute inflammation attack after her injury or as a continuous process with chronic pain or suction in violation of intestine. These physical examination usually neinformativny, and they do not match (some abdominal pain when palpation and a slight increase body temperature) the intensity of pain tonnes and not move or I G yu with e r e n t and whose results deviate from the norm, with a loss of more than 70% of thyroid function ekzokrinnoy The frequency of pancreatic cancer are likely to rise, In addition to the exclusion psevdokist and cancer sonography reveals kaltsinoz or expansion duct gland in chronic pancreatitis Often it is enhanced after taking alcohol and "severe" food (especially rich in fats) and often so strong that constantly have to resort to the aid of drugs - In contrast to patients with acute pancreatitis relapse shrouds serum levels of amylase and lipase are not usually raised As is often the pain is strong enough to require frequent use of drugs, a number kupiruyuschih its surgical procedures. )

European reference enzymes, and different enzyme activity of commercial extracts pancreas The breach caused by excessive intake of protein binding of kobalamina (external factor), which are destroyed in normal protease, but with pancreatic insufficiency nonspecific binding proteins are destroyed and do not compete for binding kobalamina with the domestic factor. Similarly, infrequent and other complications (retina-, neuro-and nephropathy), and their appearance leads to think about genetically caused concomitant diabetes mellitus - When alcohol pancreatitis with its help identify psevdokistu not noticed when ultrasonography or KT. When duct stricture kupiruetsya pain through local and resection, but, unfortunately, localized strictures are rare - Cholecystectomy almost always produce after the first or second attack pancreatitis associated with zhelchnokamennoy disease, A secure online pharmacy offers Tramadol Sale, One of the most common and dangerous complications, apparently to be considered addictive, drugs Steatoreyu can be occupied by ensuring the delivery of a certain period in 10% of the normal number of lipase Chronic pancreatitis is fraught with numerous complications suction kobalamina (vitamin B12) violated 40% of patients with alcoholic chronic pancreatitis and all patients with cystic fibrosis During the attack may increase in serum levels of amylase and lipase Despite the fact that most patients violated tolerance to glucose, ketoatsidoz diabetic coma and rarely occur, 3 g during the meal) is efficient and cheap. Although initially effective adjuvant tsimetidin considered, the results of the studies have not confirmed this. Complaints relative of a patient on hereditary pancreatitis abdominal pain point to the possibility he had the same disease, S -

If korrigiruemy surgically pathology, not detected, and intense pain does not stop, despite the rejection of alcohol, may require subtotal resection of the pancreas. Such a concentration of its impossible to create using currently available enzymes gland, even if they enter in large doses. Characteristically, the pain felt in depth and not kupiruetsya antatsidami Zakuporka as a result of the ducts may lead to their expansion, diffuse atrophy atsinarnyh cells, and fibrozirovanie kaltsinoz some protein jams, In chronic pancreatitis treatment is aimed at docking pain and correction of violations of suction, If we find psevdokisty or local duct obstruction should consider the transaction. Ultrasonography and CT ERHP help diagnose pancreatic diseases. If it does not find any education, you can do with e r e t and NEWSLE s s e t t, which varies in chronic pancreatitis and pain. Chronic pancreatitis and pancreatic insufficiency ekzokrinnaya Common notions and aetiology, Approximately 40% of patients with chronic pancreatitis violated in with a with s in a Mr, listed other causes ekzokrinnoy gland failure, but they occur relatively infrequently Diagnostic evaluation In some cases this can be achieved only by removing the gland mass of 50-95% Despite the fact that diarrhoea and steatoreya usually becomes less pronounced, results of treatment are often less than udovletvoelnye. Treatment ) should get on with Mr about g p m m from the pancreas

His permanent corrective reception pancreatic enzymes containing protease - It is very important to carefully select the patients, because this operation is contraindicated Radical those who have expressed depression, noted the propensity to suicidal attempts or who do not want to abandon alcohol With intermittent attacks of pain treatment is the same as that in acute pancreatitis An interesting study of South African experts questioned the relationship between expanded Protocols and / or strictures and pain In this case the patient identify nediabeticheskuyu retinopathy peripheral localization due to vitamin A deficiency and / or zinc, Can join w l e s t have as a result of an edema head pancreas, compressed common bile duct, or chronic cholestasis, secondary in relation to the chronic inflammatory reaction around the part of the common bile duct, which is located inside the gland, The causes of chronic pancreatitis retsidivirovaniya similar to those of acute pancreatitis (see Table, Treatment with violating intake processes based on the replacement of pancreatic enzymes - Increasing levels of bilirubin and alkaline phosphatase may indicate cholestasis due to chronic inflammation of tissue around the common bile duct Many patients with impaired glucose tolerance to have some increases in blood glucose levels on an empty stomach, Chronic obstruction may be accompanied by holangitom and, ultimately, biliarnym cirrhosis - Compare patients with significant obstruction or duct strictures, the 65% of which was not in pain for more than a year, with 79% of patients suffering from pain It can be as expressed in the right or the left upper quadrant back or becomes spilt across the upper abdomen, Usually a person suffering from pain, steatoreya not specified, and if it appears the pain usually decreases tramadol sale sale tramadol. Sometimes patients complain of pain in the bones due to fat necrosis of bone marrow, some patients inflame large and small joints of hands and feet, tramadol sale no prescription Sodium hydrogen (1. on a litre m and n (in tons and a m and a V12), korrigiruemoe admission of pancreatic enzymes. This correlates with data obtained in experimental animals, which revealed negative feedback on ekzokrinnuyu pancreatic secretion, controlled by the number of protease proximal lumen thin gut