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Disorders of blood circulation in the pancreas
Last reviewed: 18.10.2021
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Disorders of blood circulation in the pancreas due to chronic venous stasis
Disturbances of venous outflow are observed with congestive heart failure, portal hypertension, "pulmonary heart" syndrome in chronic lung diseases.
Pathomorphology. In the early stages of the pancreas enlarged in volume, somewhat edematous, signs of venous stasis are expressed. In the future, atrophy of glandular elements and sclerotic changes in the gland develop.
Symptoms. The clinical picture is usually of little character, the symptoms of pancreatic lesions recede into the background and are obscured by the symptoms of the defeat of other organs, and also often the presence of ascites. However, with pronounced venous stasis and impaired production and outflow of pancreatic juice from it (due to swelling of the parenchyma of the gland and hypoxia), it can be assumed that the exocrine function of the pancreas is disrupted and the release of pancreatic juice into the duodenum is reduced. This is indirectly evidenced by dyspeptic symptoms, often observed with congestive heart failure or in patients with chronic lung diseases and "pulmonary heart" syndrome. However, the exocrine insufficiency of the pancreas in all these cases is also aggravated by the secretory deficiency of other digestive organs and intestinal peristalsis, since all the above-mentioned main causes (venous congestion, edema and hypoxia) have an effect not only on the pancreas, but also on the pancreas to other departments of the digestive system (and indeed to many other organs).
Diagnostics. The activity of amylase, trypsin, inhibitor of trypsin in the serum with venous congestion in the pancreas can increase, the activity of amylase in the urine is usually moderately elevated. Investigation of pancreatic enzymes in duodenal contents is usually not performed (not shown due to the severity of the underlying disease).
Coprological examination often allows to confirm the violation of digestive processes in the intestines, revealing creator, amylorea, steatori. These results are particularly indicative if more or less similar data are found in repeated studies. If in several repeated analyzes the prevalence of steatorrhoea is more or less clearly defined and the signs of disturbances in the digestion of carbohydrates and proteins (i.e., amylorrhea and createrorrhea) are less pronounced, then it can be assumed that the greatest significance in digestive disorders in this case is the insufficient allocation of pancreatic juice or low activity of enzymes in it. When ultrasound is marked edema of the pancreas.
Treatment. First of all, this treatment of the underlying disease. With pronounced dyspeptic phenomena, flatulence (especially painful when combined with ascites) additionally prescribed preparations of pancreatic enzymes. Undoubtedly, a salt-free diet of type 5a (with fractional meals, but in small amounts) is needed.
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