To elucidate the alcoholic etiology of chronic pancreatitis (CP), it is necessary to pay attention to social, job-related, mental, medical factors, “minor signs” warning about alcohol abuse, use questionnaires FAST, CAGE, as well as laboratory tests indicating frequent alcohol consumption. Functional pancreatic insufficiency develops faster in patients with alcoholic CP than in biliary CP, therefore they are often thin, with symptoms of hypovitaminosis, edema, etc. In some cases, traces of insulin injections are visible. In addition, there may be symptoms of liver failure (yellowness, subcutaneous hemorrhage, “drumsticks”-shaped fingers, etc.). Patients with biliary CP are in most cases women who have complaints and history of biliary tract pathology, mainly cholelithiasis. Risk factors for gallstone disease are determined by the Deaver (“5F”) and Torek (“7F”) formulas. The patient with biliary CP is usually a full blonde over 40, with children, with a flabby belly due to both excess fat and flatulence. Patients with autoimmune CP are mostly men over 50, whose disease, at first glance, is idiopathic, i. e. there is no connection with alcohol intake and biliary pathology. In many cases, jaundice occurs, as well as secondary bacterial cholangitis, weight loss. An increase in CA 19-9 in the blood is often detected. Typically, the doctors suspect pancreatic cancer. In hereditary CP, attention is drawn to the young (or children’s) age of the patient. Pancreatitis is often idiopathic, i. e. not associated with alcohol intake or biliary pathology. However, the pathogenesis of the disease consists in a predisposition to pancreatitis, and its occurrence starts “from a match brought up”, i. e. from taking even small doses of alcohol, smoking, etc. In young patients with CP, it is imperative to carry out genetic testing for mutations in the gene of cationic trypsinogen, the Casal inhibitor, and cystic fibrosis if there is an association with respiratory pathology. Hypertriglyceridemic pancreatitis is a rare variant of CP associated with familial lipoprotein lipase deficiency. It is a genetic disorder characterized by severe hypertriglyceridemia (>1000 mg/dL) and chylomicronemia with recurrent episodes of acute pancreatitis. In the anamnesis, attention is paid to the hereditary nature of the disease, resembling a course of the recurrent acute pancreatitis. Obstructive CP is not an etiological, but a pathogenetic form of the disease and denotes CP with complicated outflow of pancreatic secretion into the duodenal lumen. Such a complication can occurin alcoholic, biliary, autoimmune, hereditary and other (more rare) etiological variants of the disease. Obstructive CP can be suspected if the patient has constant pain; the main thing is the expansion of the main and/or lateral pancreatic ducts during imaging of the pancreas. Timely recognition of the obstruction is very important as it is impossible to eliminate it with medication — the patient must be referred to an endoscopist or surgeon for endoscopic (papillotomy, stenting, etc.) or surgical decompression (drainage surgeries). Functional pancreatic insufficiency develops in any variant of CP, requiring the appointment of replacement therapy. The “gold standard” of enzyme replacement therapy is the minimicrospherical drug Creon®.
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