Cholecystopancreatitis: clinical presentation, causes, therapy and rehabilitation measures

2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14

The term "cholecystopancreatitis", from the point of view of official medicine, is not entirely correct. Since the international classification of diseases does not distinguish this disease. But sometimes this term appears, especially not in medical sources.

It means inflammation of the gallbladder and pancreas at the same time. Although these pathologies arise separately, during development they can influence each other.

Cholecystopancreatitis - symptoms

The symptoms of cholecystopancreatitis consist of signs of cholecystitis and pancreatitis.

At the same time, they seem to "overlap" each other, which is why the symptomatology turns out to be "own". Symptoms include the following symptoms: abdominal pain, dyspeptic disorders.

Symptoms such as abdominal pain are dull, persistent. Depending on which organ is affected first in acute cholecystopancreatitis, painful symptoms begin to appear from the right or left hypochondrium. Very soon (within hours) the pains become shingles. Often, painful symptoms radiate (radiate) to the spine and / or chest.

The chronic type is characterized by a lower intensity of pain symptoms. However, they rarely radiate to the back and / or chest. Most often, painful symptoms spread to the paraumbilical (near the navel) area. Sometimes pain can only be here.

The duration of pain depends on the severity of the pathology. Usually, without treatment and the absence of complications, pain syndrome lasts about 5-7 days. When complications join (and they join in 50-60% of cases in the absence of treatment), this symptom gradually begins to give way to signs characterizing complications (they will be discussed below).

Along with the pain syndrome, signs of dyspepsia appear (a disorder of the gastrointestinal tract):

• nausea, up to vomiting;
• stool disorders.

The pathogenesis of nausea is associated with two main mechanisms. In acute cholecystopancreatitis, there is irritation of the gastric mucosa with bile and pancreatic enzymes that digest its own cells.

The first is especially characteristic when damage to the biliary tract prevails in the structure of the pathology. Or they are hit first. The mechanism of the ingress of bile on the gastric mucosa is associated with an increase in the ingress of bile from the biliary tract into the lumen of the duodenum.

This amount does not have time to pass through the underlying parts of the intestine, which increases the pressure in the duodenal cavity. And this creates conditions for the passage of bile through the gastro-duodenal sphincter. In addition, the high pressure of bile on the mucous membrane itself is an irritating factor.

Digestion by enzymes of the pancreas of its own tissue leads to the development of intoxication syndrome. When the toxins obtained after the digestion of the gland enter the general bloodstream, they have a direct irritating effect on the trigger zone of the vomiting center.

In addition, 2 more mechanisms are involved in the occurrence of nausea, indirectly associated with pancreatic enzymes:

• The lack of enzymes in the duodenum significantly slows down the digestion of food, if not to say that it is not completely digested. The evacuation of the next portion from the stomach slows down, which leads to irritation of its mucous membrane;
• The second mechanism is associated with all the same toxins - their effect on the small vessels of the vomiting center. They narrow, which disrupts the functioning of neurons.

Vomiting with cholecystopancreatitis develops both in response to hyper-irritation of the receptors of the stomach, duodenum, and due to the action of toxins. Therefore, it does not bring relief. The first few hours in the vomit are dominated by food debris and other gastric contents. Gradually they are replaced by bile, mucus.

Stool disorders join later than the rest of the symptoms, which is the difference between both types, both acute and chronic. Almost 99% of cases of acute cholecystopancreatitis, as well as 60% of exacerbations of this type, such as chronic, are accompanied by loose stools. The frequency does not exceed 1-3 times per day. The nature of the stool is colitis: liquid feces are brown without impurities with varying amounts of mucus.

The mechanism of stool disturbance is associated with an imbalance of pancreatic enzymes and bile. As a rule, the former are in deficit, while there is an excess of bile, due to which parietal digestion suffers.

This is especially true of fats and carbohydrates, as well as protein polymers, since their final breakdown into components is carried out precisely by pancreatic enzymes. In this case, emulsification (roughly speaking - crushing into separate drops) is carried out quite well. At the same level, many fats are broken down into polymers.

The changes described above negatively affect not only the digestion in the duodenum. The digestion of food at the lower levels of the small intestine is impaired. As a result, the large intestine receives a large amount of undigested polymers. For its inner surface, they are a direct irritant. Excessive mucus production begins, the secretion of water into the lumen of the large intestine, which leads to the development of diarrhea.

Causes and pathogenesis of cholecystopancreatitis

The development of pathology is associated with a number of reasons:

• Violation of the diet, for example, the front - this is especially true for fatty, fried foods;
• Alcohol abuse;
• Parasitic diseases of the gastrointestinal tract.

The alimentary factor associated with nutrition ranks first in the structure of causes. Food is the main stimulant for the work of both the pancreas and the gallbladder. But fatty, fried and spicy foods have a stronger effect. The first is the most powerful stimulator of gallbladder contractility. Bile is a major factor in the digestion of fats.

Fried, spicy food reflexively affects the sphincters of the biliary tract. This is especially true of the large duodenal papilla, which regulates the secretion of not only bile, but pancreatic secretion. As a rule, this type of food leads to an increase in the muscle strength of the sphincters. Therefore, they are closed.

This is how dissonance occurs. On the one hand, food stimulates the pancreas and biliary tract. On the other hand, it also negatively affects the release of bile and pancreatic juice into the duodenal cavity.

This increases the pressure in these pathways, creating conditions for the mutual penetration of bile into the pancreas and vice versa. Further, the mechanisms of aseptic inflammation (not associated with infectious agents) are triggered, organ dysfunction occurs, and cholecystopancreatitis develops.

Gallstone disease also belongs to nutritional factors.

Most often, it develops due to a violation of the metabolism of bile acids, which itself is directly related to two factors:

• deviations from nutritional norms;
• chronic diseases of the biliary tract.

The effect of alcohol is more on the pancreas. This is due to the direct toxic effect of ethanol on its tissue. The development of the pathology of the biliary tract is directly related to the violation of its production in the liver.

Parasitic diseases have a direct effect on the biliary tract and the pancreatic duct. Most often we are talking about lamblia and opisthorchs, since they can have a significant mechanical effect. And it already triggers the mechanisms of inflammation and disruption of the biliary tract, pancreas.

Treatment and rehabilitation

Treatment of cholecystopancreatitis cannot always be started by eliminating its cause. Sometimes urgent intervention is required to eliminate its complications. It is with them that most often the treatment of cholecystopancreatitis begins.

Emergency treatment:

• Anesthesia. 70-75% of acute cholecystopancreatitis begins with sharp pain in one or another hypochondrium. Usually, treatment is carried out with antispasmodics (no-shpa, drotaverine, papaverine, platifillin, atropine). Sometimes they resort to combined drugs (contain a direct analgesic and antispasmodic): spazgan, buscopan, novigan, etc.
• The golden rule for the first day: "cold, hunger, peace." The first 24 hours complete hunger, it is advisable not even to drink water, no heat on the abdomen. Therefore, these patients should be treated in a hospital, where it is possible to carry out infusion therapy (intravenous administration of solutions).

The next step in the treatment of cholecystopancreatitis is drug therapy in combination with diet. The choice of medicines depends on the specific clinical situation. But most often, treatment is performed with enzyme preparations (mezim, pancreatin), choleprotectors (allochol, ursosan) and hepatoprotectors (Heptral, Essentiale, Veroshpiron).

If the cause of the development of cholecystopancreatitis is parasitic diseases, special drugs must be included. These are anthelmintic agents such as delagil, metronidazole, praziquantel, etc.

Diet is an essential component in the treatment and prevention of cholecystopancreatitis.

Its important aspects are fragmentation of nutrition, regularity, balance, limitation of fats, refusal of fried and smoked foods. The diet for cholecystopancreatitis is lifelong.