Herald of Pancreatic Club

TREATMENT OF ACUTE PANCREATITIS IN THE EMERGENCY DEPARTMENT: STRATEGIES IN THE FIRST HOURS OF THE DISEASE

2026-08-10T00:40:20+03:00

The diagnosis of acute pancreatitis (AP) is established in the presence of at least two of the following signs: 1) typical pancreatic pain; 2) an increase in serum amylase and/or lipase levels more than 3 times above the upper limit of normal; and/or 3) characteristic changes in the pancreas according to radiological examination methods. Gallstones and alcohol consumption are the two most common causes of AP. It is believed that gallstones are the cause of the disease in 40–70% of cases. In this regard, all patients with AP admitted to the emergency department should undergo a transabdominal ultrasound examination. Alcohol consumption is the second most common cause, occurring in 25–40% of patients.

It is extremely important to identify patients who require admission to the intensive care unit, as opposed to the therapeutic ward, as well as those who need to be referred to specialists.

Early initiation of adequate infusion therapy to prevent hypovolaemia and organ hypoperfusion is a critical element in the management of patients with AP. Current clinical guidelines recommend a strategy of “targeted infusion therapy”, which involves administering intravenous fluids while monitoring heart rate, mean arterial pressure, central venous pressure, diuresis, blood urea nitrogen concentration, and hematocrit. Ringer’s solution with lactate has advantages. Currently, routine prescription of antibiotics to patients with AP is not recommended. Mild abdominal pain can be relieved by intravenous administration of acetaminophen or tramadol, but most patients require opioid analgesics for effective pain control.

Early enteral nutrition has been shown to be associated with a lower incidence of infectious complications and a reduced risk of adverse clinical outcomes compared to parenteral nutrition.

PANCREATIC DAMAGE IN ECHINOCOCCOSIS

2026-08-10T00:42:53+03:00

Echinococcosis of the pancreas is extremely rare. The literature reports only about 200 cases of echinococcal cysts localized in the pancreas. The frequency of this localization is about 0.5% of echinococcosis cases.

The most common form is hydatid echinococcosis of the liver, which is usually combined with liver damage. It is believed that for every seven cases of liver echinococcosis, there is one case of its combination with echinococcosis of the pancreas.

Diagnosis of echinococcosis can be significantly complicated in some cases due to its unusual location. For example, the described localization of an echinococcal cyst in the main pancreatic duct. With a diagnosis of “pancreatic tumour”, the patient underwent pancreatoduodenal resection with removal of the “tumour”. Intraoperatively, the cysts were represented by fibrous tissue, with multiple septa on incision, but histological examination of the removed material confirmed the diagnosis of echinococcosis.

Cysts are usually located in the head of the pancreas, causing compression of the common bile duct. As a result of the toxic and sensitizing effects of the parasite and impaired outflow of pancreatic secretions due to compression of the pancreatic ducts by an echinococcal cyst, chronic pancreatitis develops, and less frequently, acute pancreatitis. The clinical picture of the disease is determined by both the compression of the common bile duct and the pancreatitis itself. Characteristic symptoms include abdominal pain, nausea, vomiting, a feeling of heaviness in the epigastrium, and a feeling of a lump in the left and/or right hypochondrium. The enlarging cyst compresses the pancreatic tissue, leading to its atrophy and decreased function, resulting in the development of hyperglycemia and glucosuria. Possible complications include rupture of the cyst into the abdominal cavity with the development of an acute abdomen, suppuration, and cyst petrification. When it gets really big, an echinococcal cyst can squeeze not only the common bile duct and pancreatic duct, but also the stomach, small intestine, and large intestine.

Pancreatic echinococcosis can usually be suspected on the basis of ultrasonography, computed tomography, and magnetic resonance imaging, which reveal a cyst with homogeneous contents and dense, often calcified walls. Medical history, eosinophilia, and especially cyst fluid analysis are of great importance. Scoleces are found in this fluid. The diagnosis of echinococcosis can be confirmed by indirect haemagglutination, latex agglutination, and basophil degranulation reactions with echinococcal antigen. When fluid is obtained from the cyst, a polymerase chain reaction is performed. When the cyst becomes infected, it transforms into a pancreatic abscess. In cases of hydatid echinococcosis, differential diagnosis with tumour cystic formations must be performed.

Pancreatic alveococcosis has a more severe course because the parasite is characterized by infiltrative growth and exogenous reproduction by budding. Alveococcal nodules usually invade the pancreas from the liver. Isolated pancreatic involvement is described as a rare or exotic manifestation. The disease is often accompanied by pancreatic and hepatic abscesses, cholangitis, and obstructive jaundice. The diagnosis is the same as for hydatid echinococcosis. Treatment is surgical in combination with antiparasitic agents and sarcolysin.

A clinical case of isolated pancreatic echinococcosis is presented. The described clinical observation and literature data justify the inclusion of isolated forms of echinococcosis not only of the liver, but also of other organs in the differential diagnosis in cases of an ambiguous picture of tumour or tumour-like formations.

THE CLINICAL SIGNIFICANCE OF PANCREATIC EXOCRINE INSUFFICIENCY IN THE COURSE OF CHRONIC PANCREATITIS (Considering the Provisions of the European Guideline on the Diagnosis and Treatment of Pancreatic Insufficiency, 2024)

2026-08-10T00:45:56+03:00

In accordance with the United European Gastroenterology concept for the development of high-quality clinical guidelines, the European multidisciplinary guideline on the diagnosis and treatment of pancreatic exocrine insufficiency (PEI) (2024) has been developed. This guideline validates an approach to defining chronic pancreatitis not only in terms of inflammation and the decline in the gland’s exocrine function but also from the perspective of nutrient digestion.

Experts emphasize the definition of PEI as a reduction in pancreatic exocrine function to a level that prevents normal nutrient digestion. The authors highlight a crucial clinical distinction: reduced pancreatic secretion should not be considered synonymous with PEI, as threshold values for PEI can be influenced by factors characteristic of other conditions and diseases. In many cases, reduced secretion may remain sufficient for normal digestion or may even be reversible. In such instances, the condition can be defined as pancreatic exocrine dysfunction.

The authors review the causative factors of decreased pancreatic exocrine function and several pathogenetic aspects. It is underscored that the European guideline views PEI as a maldigestion syndrome rather than an isolated organ defect. Furthermore, experts believe that PEI should be regarded not only as enzyme secretion deficiency but also as a failure of pancreatic digestion, including malnutrition. PEI can lead to malabsorption symptoms and nutrient deficiencies, which negatively impact the quality of life and increase morbidity and mortality.

To clarify the role of pancreatic exocrine function in pancreatic and intestinal digestion, the authors present the interrelated physiological and pathophysiological mechanisms of these processes. Significant attention is paid to the causes and mechanisms of digestive disorders resulting from PEI.

The study highlights that experts in the European guideline (2024) acknowledge the possibility of diagnosing PEI based on a comprehensive assessment of symptoms, nutritional status, and secretion studies (e. g., fecal elastase-1). The authors discuss the expert group’s recommendations for a structured assessment, including clinical symptoms, nutritional status, and biochemical parameters (in accordance with the recommended parameters for long-term follow-up of patients with PEI and chronic pancreatitis, as per the guidelines of the UK, European Society for Clinical Nutrition and Metabolism, DGVS, and United European Gastroenterology). Experts maintain that pancreatic enzyme replacement therapy, combined with dietary advice and support, remains the cornerstone of management for this condition.

NON-MEDICINAL STRATEGIES (NATUROPATHY) IN SUPPORTING PANCREATIC HEALTH

2026-08-10T00:48:39+03:00

A healthy pancreas is an organ with a homogeneous structure, normal dimensions, and ducts with a uniform lumen, performing key functions in digestion (enzymes) and metabolism (hormones). You can maintain your health by eating right (fiber, protein, less fat/sugar/salt), avoiding alcohol and smoking, controlling your weight, managing stress, and getting regular check-ups to avoid pancreatitis and diabetes. Signs of a healthy pancreas include: size — length 14–22 cm, weight 70–80 g; the head, body, and tail are within normal limits, without abnormal thickening; structure — homogeneous, with smooth ductal walls; and function — regular production of digestive enzymes to ensure proper digestion and insulin to regulate blood glucose levels.

Let’s pay attention to healthy eating, the basic principles of which are outlined on the website prozdorove.com.ua. To maintain pancreatic health, it is important to follow these dietary principles: minimize fatty, fried, sweet, and smoked foods, and avoid alcohol and overeating. Foods rich in protein, vitamins, minerals and antioxidants, with low fat, and simple sugar content, are recommended. A high-fat diet contributes not only to the development of steatosis but also to the progression of pancreatic fibrosis, and thus to the onset of chronic pancreatitis.

Herbal therapy plays an important role in maintaining pancreatic health. Medicinal plants have anti-inflammatory, antispasmodic, and choleretic effects, help normalise digestion and reduce the risk of developing chronic diseases of the pancreas. Studies show that herbal medicine and natural products (flavonoids, polyphenols, alkaloids, terpenoids) have potential for the prevention and treatment of pancreatic diseases, including pancreatitis and cancer. The most studied are turmeric, ginseng, eucalyptus, moringa, as well as complex herbal formulations. Mechanisms of action: antioxidant protection, reduction of inflammation, modulation of glycaemic response, improvement of insulin sensitivity.

The most important focus of naturopathy is reducing the risk of pancreatic cancer. Regarding pancreatic cancer, it has been shown that the risk is increased in individuals who abuse alcohol and smoke, and decreased in those who consume large amounts of vegetables and fruits. Cruciferous vegetables play a special role in the prevention of pancreatic cancer. According to the www.health.gov/DietaryGuidelines, it is necessary to adhere to the principles of moderation, proportionality, individualisation, dietary diversity, and combining diet with physical activity. The risk of pancreatic cancer is increased with a higher body mass index, consumption of red and processed meats, foods and beverages containing fructose, products high in saturated fatty acids, as well as with alcohol abuse.

Morphological features of gastric mucosa in patients with combination of chronic pancreatitis with erosive-ulcerous lesions of stomach and duodenum and overweight

2026-08-10T00:51:00+03:00

A total of 136 patients with a combination of chronic pancreatitis (CP), erosive, and ulcerative changes in the gastroduodenal zone, against a background of excess body weight, were examined. A comparison of morphological changes in the gastric mucosa in CP with and without Helicobacter pylori infection revealed a higher frequency of moderate and severe glandular atrophy in the antrum of the stomach in erosive and ulcerative lesions of the gastroduodenal zone without Helicobacter pylori.

The extreme rarity of intestinal metaplasia in the gastric mucosa in CP has been established. This may be due to a decrease in the neutralizing effect of pancreatic secretions, while the acidic environment prevents the development of intestinal metaplasia. However, G-cell hyperplasia was also found in the antrum of the stomach, a characteristic of Helicobacter pylori infection, accompanied by hyperplasia of acid-producing parietal cells in the fundus of the stomach.

Differences were found in the localization of erosions and ulcers in the group with CP and Helicobacter pylori in the gastric mucosa, mainly in the gastric antrum; in the group with CP without Helicobacter pylori, predominantly in the gastric fundus. In cases involving the use of non-steroidal anti-inflammatory drugs in these groups, differences in the localization of erosions and ulcers also persisted, although in the gastric fundus (in the CP group without Helicobacter pylori), they were shifted closer to the gastric antrum and localized in the prepyloric region or lower third of the stomach. A combination of CP and erosive-ulcerative lesions of the gastroduodenal zone against a background of excess body weight is characterized by a decrease in mucin production. A characteristic feature of chronic gastritis in combined diseases is a decrease in mucin production, which was well corrected by taking the drug rebamipide. This restored mucin production by the epithelium and reduced inflammatory cell infiltration.

EFFECTIVENESS OF MAGNESIUM PREPARATION IN PATIENTS WITH CHRONIC PANCREATITIS AND CHRONIC BRONCHITIS

2026-08-10T00:54:58+03:00

The article presents the results of own research. The study involved 128 patients with chronic pancreatitis in the combination with non-obstructive (simple) chronic bronchitis. The control group consisted of 30 individuals who were generally healthy.

All patients were divided into two groups depending on the treatment used: the main group (64) and the comparison group (64). Patients in the comparison group received treatment according to standardised protocols. In addition to this treatment, patients in the main group were prescribed magnesium preparation and Bacillus clausii spores. The benefits of treatment in the main group were manifested in the effect on pain and dyspeptic syndromes. The inclusion of magnesium in therapy contributed to a significant reduction in uroamylase levels and endogenous pancreatin induction coefficients after a meal, restoring the correct balance between them. According to the results of a direct probe study of the exocrine function of the pancreas, it was found that the volume of duodenal contents, hourly output of trypsin, and lipase after treatment were significantly higher in the main group than in the comparison group.

During therapy involving magnesium preparation, according to sonography and ultrasound histography data, the frequency of expansion of the duct of Wirsung decreased; under the influence of both treatment options, the homogeneity of the tissue and the histographic coefficient increased significantly.

Under the influence of treatment, the dynamics of magnesium levels in the blood were not reliable. The magnesium content in the hair of patients in the main group increased significantly, while in the comparison group, there was only an insignificant tendency for this indicator to increase.

After the main treatment option, small intestinal bacterial overgrowth syndrome persisted in only 26.6% of cases in the main group and 45.3% of cases in the comparison group, according to hydrogen breath test data.

Treatment with magnesium resulted in significantly better quality of life (both physical and mental health) than in the control group.

ON ERRORS IN THE RECOGNITION OF MALIGNANT TUMORS OF INTERNAL ORGANS

2026-08-10T00:57:33+03:00

The name of Mykola Dmytrovych Strazhesko is not just a page in the history of Ukrainian medicine. It is a school of clinical thinking. A prominent Ukrainian physician, internist, academician, and one of the founders of domestic cardiology, M. D. Strazhesko belonged to those clinicians for whom a diagnosis was not a matter of "luck" or a set of tests, but the result of thorough intellectual analysis.

His article, written almost a century ago, is striking in its precision. We are accustomed to thinking that diagnostic errors are related to inaccuracies in instrumental and laboratory studies. However, Academician M. D. Strazhesko proves the opposite: technologies can reduce uncertainty, but they do not replace thinking. Moreover, even in the terminal stages of cancer, when symptoms seem "sufficient," doctors make mistakes more often. And this happens not because of a lack of knowledge, but because of traps in interpretation.

We present to the modern physician a master class on what are now called "cognitive errors" that lead to a false diagnosis. In every clinical case, Academician M. D. Strazhesko demonstrates how easy it is to fall into "template thinking": to assign absolute value to a single symptom or even an instrumental examination result, to forget about the dynamics of the process, to begin explaining all facts using one convenient scenario — and to lose sight of the truth.

This article gives the physician a rare opportunity to look at themselves from the outside. Not in the ideal conditions of protocols, but in a real clinic — where symptoms can be masked, diseases can coexist, and data can "conflict" with each other.

More than a diagnosis: the evolution of medical service and clinical communication in the era of patient-centeredness

2026-08-10T00:59:50+03:00

The article explores the fundamental transformation of relationships in the medical sphere, specifically the shift from the outdated paternalistic "doctor–patient" model to the modern paradigm of partnership and patient-centeredness. Attention is focused on the fact that amid the crisis of trust in the healthcare system (according to the Edelman Trust Barometer), the quality of communication becomes a key factor that correlates with the level of trust more significantly than technological equipment. The direct influence of professional clinical communication skills is analyzed not only on the clinical effectiveness of treatment (through increasing compliance — the patient's adherence to recommendations) but also on the financial performance of medical institutions. Studies, particularly from the Deloitte Center for Health Solutions, confirm: hospitals with a higher patient satisfaction rating demonstrate a profitability (Net Margin) that is 4.8% higher. Thus, Soft Skills (communication) are recognized as an inseparable part of Hard Skills (clinical expertise). A diagnosis not explained to the patient automatically leads to low compliance and nullifies the doctor's academic knowledge. It is noted that communication training was historically absent from medical education, but this changed with the development of the Calgary-Cambridge Guide in 1996, which is the "gold standard" and proves that communication is a skill that can be trained. The experience of Cleveland Clinic (USA) is cited as a global benchmark; in 2009, it was the first medical institution to create an "Office of Patient Experience" under the "Patients First" principle, emphasizing that empathy and inclusion are part of patient safety. The article details the matrix of doctor's competencies, integrating professional and psychological skills across six stages of a medical visit. The expectations of the modern Ukrainian patient (2025) are systematized, including demands for speed and digitalization, a partnership position from the doctor, pricing predictability, empathy as a basic condition, and absolute inclusivity (the inadmissibility of discrimination on any grounds). Based on the analysis of Google Reviews 2025, the Top 6 reasons for negative reviews are identified, among which dominate: a low level of empathy, long waiting times, administrative chaos, hidden fees, and ethical violations. The HEART Algorithm (Hear, Empathize, Apologize, Respond, Thank) is proposed for conflict resolution. In conclusion, a "roadmap for change" is proposed on two levels: at the level of state policy and at the level of the medical institution.

NEUTROPHILS: AREN’T THEY A MIRACLE?

2026-08-10T01:01:37+03:00

This review focuses on neutrophils and provides a modern answer to the question: why does the bone marrow release 45 billion neutrophils into the bloodstream every day, where they remain for several hours, then migrate into tissues and die within 24 hours? The review discusses neutrophil death pathways, including apoptosis and NETosis. The architecture of epithelial tissue in the normal state and the changes occurring during tumor growth are presented.

The most appropriate form of neutrophil cell death in malignant neoplasms is apoptosis, because in this case the cellular contents are not released into the extracellular environment and therefore do not provoke inflammation; instead, apoptosis activates innate lymphoid cells and the adaptive arm of the immune response.

One of the functions of the immune system is to maintain homeostasis of both lymphoid and non-lymphoid tissues of the macroorganism. During tumor growth, two competing programs of development and repair coexist: those of normal tissue and tumor tissue.

In malignant disease, both mononuclear cells and neutrophils are overloaded with double-stranded nucleic acids. This may interfere with their ability to cross the blood-tissue barrier.

The effect of chemotherapy in malignant neoplasms is mediated not only by the direct impact of cytotoxic drugs on malignant cells, but also by their influence on neutrophils, which — through an avalanche of apoptotic bodies — activate both innate and adaptive immunity, thereby restoring damaged tissue architecture.