Circulatory disorders of the pancreas

Circulatory disorders in the pancreas due to chronic venous congestion

Disturbances of venous outflow are observed in congestive heart failure, portal hypertension, and pulmonary heart syndrome in chronic lung diseases.

Pathomorphology. In the early stages, the pancreas is enlarged in volume, somewhat edematous, and signs of venous congestion are expressed. Later, atrophy of the glandular elements and sclerotic changes in the gland develop.

Symptoms. The clinical picture is usually uncharacteristic, the symptoms of pancreatic damage recede into the background and are obscured by the symptoms of damage to other organs, and often by the presence of ascites. However, with pronounced venous congestion and impaired production and outflow of pancreatic juice (due to edema of the gland parenchyma and hypoxia), it can be assumed that the exocrine function of the pancreas is impaired and the secretion of pancreatic juice into the duodenum decreases. This is indirectly evidenced by dyspeptic symptoms, often observed in congestive heart failure or in patients with chronic lung diseases and "pulmonary heart" syndrome. True, exocrine pancreatic insufficiency in all these cases is also aggravated by secretory insufficiency of other digestive organs and intestinal peristalsis disorders, since all the above-mentioned main causes (venous congestion, edema and hypoxia) in all the above-mentioned conditions affect not only the pancreas, but also other parts of the digestive system (and in general, many other organs).

Diagnostics. Serum amylase, trypsin, and trypsin inhibitor activity may increase in pancreatic venous congestion; urine amylase activity is usually moderately elevated. Pancreatic enzyme testing in duodenal contents is usually not performed (not indicated due to the severity of the underlying disease).

Coprological examination often allows confirming the disturbance of digestive processes in the intestine, revealing creatorrhea, amylorrhea, steatorrhea. These results are especially indicative if more or less similar data are found in repeated studies. If several repeated analyses more or less clearly reveal the prevalence of steatorrhea and to a lesser extent the signs of disturbances in the digestion of carbohydrates and proteins (i.e. amylorrhea and creatorrhea), then it can be assumed that the greatest significance in digestive disorders in this case is insufficient secretion of pancreatic juice or low activity of enzymes in it. Edema of the pancreas is noted in ultrasound.

Treatment. First of all, this is the treatment of the underlying disease. In case of severe dyspeptic symptoms, flatulence (especially painful when combined with ascites), pancreatic enzyme preparations are additionally prescribed. Undoubtedly, a salt-free, gentle diet of type No. 5a is necessary (with fractional meals, but in small quantities).

[ 1 ], [ 2 ]