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FEATURES OF METABOLIC DISORDERS AND DEGESTIGS IN PATIENTS WITH CHRONIC PANCREATITIS WITH LIVER CIROSIS OF ALCOHOL ETHIOLOGY (ORIGINAL RESEARCH)

Authors: Mischuk V.G., Skoropad K.M.

Pages: 264-270

Abstract


Alcohol abuse is the most common cause of chronic pancreatitis in Western countries, the disease is characterized by progressive damage of the pancreas which finally leads to a significant infringement of exo- and endocrine functions. In the pathogenesis of chronic pancreatitis distinguish direct toxic effects of alcohol and indirectly through pathologically modified digestive organs, including the liver. On the other hand, in alcoholic liver cirrhosis  often develop metabolic failure and dysregulation of energy metabolism, metabolism of carbohydrates, aminoacids, serum protein and coagulation factors synthesis, ammonia neutralization, biosynthesis of lipids and lipoproteins, bile acids occurs.

The purpose of research was to study the state exocrine pancreatic function, protein synthetic function of the liver and trofolohichnyy status in patients with chronic pancreatitis combined with alcoholic cirrhosis class A, B by Chald-Pugh.

It was examined 49 patients: 15 – with chronic alcoholic pancreatitis, 15 - with alcoholic cirrhosis class A, B by Chald-Pugh and 19 - with a combination of both diseases. Alcoholic etiology of diseases was based on medical history, previous medical records, including narcologists surveillance, questionnaires CAGE, MAST, scales Le Go. Anthropometric indicators scatological analysis, determining the activity of elastase and chymotrypsin in stool was carried out and the levels of total protein, prothrombin, cholinesterase were determined.

The study showed that the combination of these diseases occurred fairly significant disorder of exocrine pancreatic function that manifestated as a diarrhea, flatulence, steatorrhea, a more pronounced decrease in activity of chymotrypsin and elastase in the faeces. In particular, the chymotrypsin activity in feces of patients suffering from combined alcoholic liver disease and chronic alcoholic pancreatitis was 3.9 times lower compared with those of healthy people and elastase level was 1.8 times lower. Also, the comorbidity caused significantly decreased levels of total protein, albumin, cholinesterase. Somatometric indicators (shoulder circumference, thickness of subcutaneous fat folds, body mass index) were also reduced the most, in cases of combined alcohol-induced cirrhosis and pancreatitis compared with isolated chronic pancreatitis and cirrhosis.

Keywords:chronic alcoholic pancreatitis, alcoholic liver cirrhosis, exocrine pancreatic function, trophological status.

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