COMPLEX VISUAL ASSESSMENT OF STRUCTURAL CHANGES IN PANCREAS IN THE PATIENTS WITH CHRONIC PANCREATITIS.Georgian Med News 2019 Jul-Aug; (292-293):39-44GM
Chronic pancreatitis is one of the leading gastroenterologic disorders which is characterised by polymorphism of clinical manifestations, polyetiologic course and, usually, polymorbidity. The presence of such a combination of signs makes both diagnosis and treatment more difficult. This is why nowadays it is necessary to use a range of clinical, laboratory and instrumental methods of a diagnostic endeavour in order to make a diagnosis and determine the state of the pancreas. The aim of this study - to investigate and analyse structural changes in the pancreas in chronic pancreatitis in the anamnestic and clinical dimensions. In the present study, in order to achieve our aim 102 patients with chronic pancreatitis underwent general physical and laboratory examination. All the patients experienced hypertension II as a comorbid condition. In the formed group, female patients prevailed (55,9%) with the average age being 51,0±10,0 years. The duration of chronic pancreatitis was within a range of 7,0±3,0 years, whereas the hypertension duration range was 5,0±2,0 years. The following instrumental examination procedures were performed: sonographic examination of the abdominal cavity, esophagogastroduodenoscopy, duodenal drainage and endoscopic retrograde cholangiopancreatography (ERCP). Apart from hypertension, the patients with chronic pancreatitis belonging to the treatment group were diagnosed with other morphological and functional disorders related to the endocrine system, the digestive system and cardiovascular system which were revealed with the use of additional laboratory and instrumental methods. When the clinical picture was assessed on admission to hospital, all the patients presented with pain dyspeptic syndrome and exocrine pancreatic insufficiency in different proportions. 12 patients with chronic pancreatitis, whose clinical picture showed a marked pain abdominal syndrome, the intensity of which did not subside during 3 weeks of background therapy, and the absence of dynamic changes according to the ultrasound examination of the pancreas, underwent the additional diagnostic procedure ERCP to identify structural changes of the pancreatic ducts and parenchymatous parameters of the pancreas. The findings were as follows: the signs of the dilation of the major pancreatic duct were identified in all examined patients (100%), which did not coincide with the data provided by the ultrasound examination; the dilation of the small pancreatic ducts was found in 2 (16,7%) patients, lithiasis of Wirsung's duct in 3 (25,0%) patients; the combination of cystic transformation and calcinosis of the major pancreatic duct in 1 patient (8,4%); and cystic transformation in combination with the dilation of the duct of Wirsung in 2 (16,7%) patients. The imaging of structural changes in the pancreas requires the combination of instrumental and diagnostic methods, in particular EGD and ultrasound examination, as well as ERCP in order to make accurate assessment of the pancreatic ducts and parenchymatous parameters of the pancreas in case of a relapsing course of disease. The analysis of the identified disorders of the pancreatic ducts and parenchyma makes it possible to adjust treatment protocols to provide proper clinical care to patients with chronic pancreatitis.