The diagnosis “atrophy of the pancreas” means that the volume of the internal organ has decreased, which is manifested by exocrine (digestive enzymes) and intrasecretory (production of insulin and glucagon) lack of functionality.
In most pictures, the pathogenesis is due to the chronic form of pancreatitis, diabetes mellitus, somatic pathologies with severe exhaustion, cirrhosis of the liver, and impaired blood circulation. Sometimes a tumor is the cause.
Differential diagnostics is carried out to make an accurate diagnosis. Take into account laboratory results that show a lack of digestive enzymes and a low concentration of insulin.
An ultrasound examination is mandatory, which confirms a decrease in the gland, a pathological change in the parenchyma. Therapy consists in the appointment of substitution treatment. They recommend enzymatic drugs, insulin, tablets to restore intestinal microflora.
Pathogenesis of atrophic changes in the pancreas
Atrophic changes in the pancreas are physiological when they develop as a result of the natural aging process of the body. They are accompanied by severe debilitating diseases.
In addition, atrophy is the outcome of any form of chronic pancreatitis, while a significant part of the stroma is replaced by fibrous tissues, which leads to a sharp increase in endocrine and exocrine insufficiency.
Normally, the weight of an internal organ varies from 80 to 90 g. If abnormal changes are observed in it, then it decreases to 30-40 g and below. There is a change in the very structure of the organ. The disease is characterized by the appearance of an excess amount of connective tissue.
Pancreatic atrophy occurs for the following reasons:
- The emergence of fatty degeneration of the organ.
- Complication of diabetes mellitus.
- Alcohol abuse, smoking.
- Duodenal ulcer, stomach.
- Improper nutrition.
- Autoimmune pathologies affecting the abdominal cavity.
- Resection of the pancreas.
A separate place is occupied by atrophic pancreatitis against the background of diabetes mellitus. This disease is characterized by a significant decrease in the organ up to 20 g, its consistency becomes denser, the surface becomes bumpy, the capsule is fused with adipose tissues, nearby organs.
Lipomatosis is also an atrophic form of pancreatic disease. Although this disease is characterized by the normal size of the organ or its enlargement, most of it is replaced by adipose tissue, in which individual glandular segments can be traced. In 80% of pictures with such a disease, the islet apparatus and endocrine function are preserved.
The risk group includes patients who have a genetic predisposition, alcohol dependence, abdominal trauma, infectious diseases of internal organs, calculous cholecystitis.
Clinical manifestations of atrophy
Having considered the diagnosis of pancreatic atrophy, what it is, and what can atrophy an organ, we will find out what symptoms indicate pathology. Symptoms are due to the etiology of the development of a pathological process in the body (impaired absorption of glucose, chronic pancreatitis, etc.).
Regardless of the cause and provoking factors, all patients have endocrine and exogenous insufficiency. Exocrine insufficiency is accompanied by a decrease in the production of digestive enzymes, electrolytes, which help to neutralize the contents of the stomach, helping to provide a normal environment for pancreatic enzymes.
Patients complain of disruption of the digestive tract, which is most often manifested:
- Diarrhea.
- Decreased appetite.
- Decrease in body weight.
The earliest symptom of exocrine insufficiency is increased excretion of fat along with feces. This symptom is detected against the background of a decrease in production by 10% of the normal value.
The patient begins to lose weight quickly. This is due to the fact that the process of food digestion, absorption of nutrients in the gastrointestinal tract is disrupted, and appetite decreases. If a person has chronic atrophic pancreatitis, then laboratory tests show a significant deficiency of vitamins and minerals.
Endocrine insufficiency is detected by a disorder of carbohydrate metabolism, which proceeds like a hyperglycemic syndrome.
However, only half of the patients complain of diabetes symptoms (frequent urination, dry mouth, frequent toilet visits, etc.).
Differential diagnosis
When examining a patient, weight deficit is diagnosed in 90% of clinical pictures. The skin becomes thinner, becomes excessively dry. Flaky elements are often present. In this case, palpation does not allow you to “feel” the decrease in the internal organ.
When the pathogenesis is based on the occurrence of pancreatitis, then on palpation the patient complains of painful sensations or severe discomfort. The results of a biochemical blood test show that the activity of digestive enzymes has decreased.
The coprogram helps to identify fat in feces (steatorrhea). As a rule, more than 10% of the daily consumption is found in the feces. The number of muscle fibers in the stool significantly increases, which is a deviation from the norm.
In most cases, a study on the concentration of glucose indicates a significant increase, which requires additional visits to doctors such as an endocrinologist or diabetologist.
Other methods for determining the disease:
- An ultrasound examination of the pancreas shows a pathological decrease in the internal organ. The structure becomes dense, echogenicity increases, the contours are uneven.
- MRI is recommended in cases where ultrasound did not provide complete information and additional detail is required to determine the optimal tactics of therapy.
- RCPH is prescribed to assess the condition of the ducts, to find the changes that usually accompany chronic pancreatitis. Thanks to such medical manipulation, it is possible to diagnose a decrease in pancreatic ducts, tortuosity and unevenness of the walls.
- Angiography is necessary when a medical professional suspects a tumor process. The procedure allows you to refute or confirm the assumption.
A biopsy of the pancreas is mandatory. In a laboratory study of a sample taken, the degree of fibrosis and destruction of the parenchyma, the state of the glandular elements and areas that produce insulin are assessed.
This diagnostic method allows you to voice the prognosis of the disease.
Medical treatment of pancreatic atrophy
At the first signs of atrophic changes in the pancreas, a diet is first of all recommended. The patient needs to reduce the consumption of foods that contain animal fats.
It is required to pay attention to the lack of protein substances in the body, energy deficit, to correct the lack of vitamins and minerals. Since nicotine contributes to the disruption of the production of bicarbonates in the internal organ, cigarettes should be discarded.
The main focus of conservative treatment is replacement therapy for the functionality of exocrine and intrasecretory secretions. To compensate for these processes, enzyme medicines are recommended.
To obtain the desired therapeutic effect, medications must be characterized by a high degree of lipase activity and must not be destroyed by the action of gastric juice. In this case, the tablets must promote the rapid release of enzyme substances in the small intestine, actively promote the digestive process.
Microgranules meet all the requirements described. Since it is lipase that loses activity most quickly, therefore, correction is carried out taking into account its content in the medication and the intensity of steatorrhea (fat content in feces).
The effectiveness of the recommended therapy is determined by: the degree of reduction of steatorrhea and the concentration of elastase in feces. Enzyme preparations help to achieve the following therapeutic result:
- Reduce secondary enteritis.
- They normalize the intestinal microflora.
- Improve carbohydrate metabolism.
To reduce the severity of painful sensations, prescribe medications that relate to analgesics and antispasmodics. The dosage is determined on an individual basis, depending on the intensity of the pain syndrome. Recommended injections are Papaverine, No-shpu, Analgin and other drugs.
To correct endocrine insufficiency, insulin administration is necessary. With atrophic changes, islet cell death is not observed, so the hormone is produced, but in low concentration. The dose and frequency of use of insulin therapy depend on the course of the disease, the etiology of the disease, and the results of daily glucose testing in the body.
An important condition is the correction of digestive functions, in particular, the normalization of the intestinal microflora. Therefore, probiotics and prebiotics are used.
Additionally, we recommend preparations containing vitamins. You also need to make up for the deficiency of the following mineral components:
- Magnesium.
- Zinc.
- Copper.
Dietary supplements can be prescribed in the form of several drugs, or one agent, which simultaneously includes the necessary substances in its composition.
Surgical intervention is carried out in specialized clinics. The procedure involves transplantation of the islets of Langerhans, followed by resection of the pancreas and enzyme replacement therapy.
Since atrophic changes in the pancreas are a consequence of severe pathologies with severe disorders of the general condition of the patient, surgical treatment is rarely prescribed.
Forecast and prevention
The prognosis of the outcome of the disease is based on the degree of damage to the exocrine and intrasecretory functions. Since the islet cells are partially retained, there is accordingly residual insulin production. Therefore, a ketoacidotic state is rarely diagnosed, but a sharp drop in blood sugar often develops.
Determination of the pathogenesis of the pathological process, elimination of the “primary source” – the underlying disease, timely initiation of therapy – all these moments allow achieving good therapeutic results and a favorable prognosis.
As a preventive measure, patient reviews recommend using traditional medicine methods. They help to improve the functionality of the pancreas, improve digestion, and prevent serious disorders in the body.
For therapy, medicinal plants are used – hawthorn, dill, peppermint, pharmacy chamomile, etc. The following recipe helps to support the organ’s work: mix three tablespoons of dill seeds and the same amount of mint, add 2 tablespoons of hawthorn, one tablespoon of pharmacy chamomile. Pour boiling water over. Filter out. Take 100 ml four times a day. The course of treatment is two weeks.
As a preventive measure, it is recommended to adhere to the recommendations:
- Quitting smoking, alcohol.
- Timely therapy for existing chronic diseases.
- Balanced and rational nutrition.
- Maintaining the required level of enzyme activity.
- Leading an active lifestyle. Moderate exercise for pancreatitis, especially yoga and walking, will be very beneficial.
Pancreatic atrophy is a serious disease, therefore, if painful sensations appear in the epigastric region, you should visit a medical institution. The earlier treatment is started, the more favorable the prognosis.