Pancreas and heart, pain in pancreatitis
Author Ольга Кияница
Pancreas (PZ) is part of the digestive system and its role is to regulate mineral and lipid (carbohydrate) metabolism. Uneasy arrangement of the body often does not allow to conduct diagnostics of diseases at early stages of development. When examining a patient, usually more attention is paid to the small intestine, liver, spleen, stomach, which are located nearby.
The most common inflammation of the pancreas (acute and chronic), cancer and diabetes.
To diagnose pancreatic pathologies, laboratory methods of research and instrumental methods are used. In particular, a general blood test is performed, biochemical diagnosis, electrocardiography, chest and abdominal chest X-ray, etc.
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Description of the pancreas
The pancreas is an oblong organ located in the abdominal cavity, with functions of digestion (exocrine) and hormonal (endocrine). It is located in the transpiloric plane. With the exception of the tail, the prostate is mainly located in the retroperitoneal space, located deep in the upper abdomen in the epigastrium and its left areas.
In the abdominal cavity, the prostate has direct anatomical connections with several structures: organs and vascular plexuses.
- Stomach - is located separately from the prostate, but is at a close distance, as the stomach and pylorus lie in front of the pancreas.
- Duodenum - duodenum is bent in the form of the letter "C" around the head of the pancreas. Part of the duodenum is located in front, while the second part of the organ is located on the side and to the right of the head of the pancreas.
- The transverse colon is attached to the front surface of the prostate.
- Common bile duct - descends behind the head of the pancreas before opening into the second part of the duodenum next to the main duct of the prostate through the main duodenal papilla.
- Spleen - located at the back and side of the pancreas. Linorenal ligament is formed from the peritoneum and connects the spleen with the tail of the prostate.
The pancreas is located close to several large vessels, which are essential reference points in vascular anatomy:
- The aorta and inferior vena cava pass posterior to the head of the prostate.
- The superior mesenteric artery is located behind the pancreas.
- The posterior part of the prostate, splenic and superior mesenteric veins combine to form a hepatic portal vein.
- Splenic artery crosses the upper border of the pancreas.
The pancreas is anatomically divided into five parts;
- The head is the widest part of the organ. It lies in the C-shaped arch, created by the duodenum, and is connected with it by a connective tissue.
- The hook-shaped process is the formation that occurs from the lower part of the head and passes medially, therefore it lies, as it were, under the body of the prostate and behind the superior mesenteric vessels.
- Pancreatic notch (neck) - located between the head and the body of the pancreas. It overlaps the upper mesenteric vessels, which form a groove in its posterior part.
- The body is located in the center, thus crossing the median line, which allows this part of the organ to lie behind the stomach and to the left of the superior mesenteric vessels.
- The tail is the end of the pancreas, which is on the left in the immediate vicinity of the spleen. It enters the splenorenal ligament with the vessels of the spleen. This is the only part of the pancreas that belongs to the intraperitoneal space.
- The pancreas, which performs exocrine function, produces the precursors of the digestive enzyme in the duodenum.The digestive fluid of the cell, called acini, is connected by short intercalated ducts.
- Intercalated ducts pass into a space that joins adjacent segments and through them enzymes enter the network of intracavitary canals, which, in turn, are combined into the main canal of the pancreas.
- The pancreas passes through the entire length of the pancreas and combines with the common bile duct, forming a hepatopancreatic ampoule of Vater. Then this structure opens into the duodenum through a large duodenal papilla.
- The process of isolation into the duodenum is controlled by a muscular valve - the sphincter of Oddi. It surrounds the Vater's ampoule, performing the function of the valve.
The prostate is supplied with blood through the pancreatic branches of the splenic artery. The head is additionally supplied with the upper and lower pancreatoduodenal arteries, which are branches of the gastroduodenal and superior mesenteric arteries, respectively.
The venous network of the head of the prostate is included in the upper mesenteric branches of the hepatic portal vein.Pancreatic veins that depart from the rest of the pancreas divert blood from the organ through the splenic vein.
The pancreas is equipped with lymphatic vessels, located similar to the arterial message. Lymph nodes of the pancreas and pyloric intestine are connected with the superior mesenteric and abdominal parts of the lymphatic system.
Influence of the pancreas on the heart
The main organ in the cardiovascular system is the heart. This muscle in the form of a cone organ can work automatically and at the same time performs an important function - pumps blood throughout the body. The proximity of the heart to the pancreas and stomach contributes to the fact that the various inflammatory processes of these organs contribute to a change in cardiac activity.
The main violations of the heart with pancreatic pain:
- Tachycardia - heart palpitations
- Extrasystoles - extraordinary myocardial contractions.
Above, the features of the structure and equipment of the pancreas were indicated. All this confirms the complexity of the organization of the body and the importance of its influence on the whole organism and the heart in particular.Because with pancreatitis, the first thing that bothers the patient is pain, it is her presence and severity that significantly affects the functioning of the heart.
Pain causes an increase in blood pressure and heart rate by two basic mechanisms that can act simultaneously.
- The sympathetic (vegetative) nervous system is stimulated by electrical pain signals that reach the central nervous system. This often occurs with acute pain, exacerbation, but it can also occur with chronic pain. Aberrant neuroanatomical changes in the brain, which can occur with severe permanent pain, can produce continuous sympathicotonia. As a result, the excitation of the sympathetic part leads to a change in the heart rate and the magnitude of the pressure.
- In pain, signals are sent to the hypothalamus and pituitary gland, which promotes the release of the hormone adrenocorticotropin (ACTH) , which stimulates the adrenal glands, which release adrenaline with a subsequent increase in heart rate and blood pressure.
The stronger the pain, the more pronounced can be the changes from the cardiovascular system. Such disorders are especially susceptible to people who have previously been diagnosed with heart or vascular disease.
In such cases, the risk of myocardial infarction is especially high, since with severe pain the blood supply to the heart muscle is impaired, which can lead to its ischemia and necrosis.
If the pain does not go away for a long time, it is necessary to apply suitable medications that could previously be prescribed by a doctor. If this is not the case, then you should immediately contact the gastroenterologist, who will prescribe medications to eliminate pain in pancreatitis, which will help normalize cardiac activity.
Symptoms of violations
First of all, in patients with prostate disease, patients are concerned about abdominal pain. The presence of this sign allows you to immediately diagnose. Additionally, violations from the heart and vessels of the following nature can be determined:
1. Tachycardia - the patient feels heart palpitations, that is, heart rate above 90 beats per minute (in adults).Tachycardia can be supplemented by a feeling of weakness, lack of air, dizziness, loss of appetite, a sense of anxiety or fear.
The cause of the appearance of palpitations in diseases of the prostate can be an increased body temperature, indicating an intoxication of the body. In addition, the patient may have excessive excitability, which also affects the state of the cardiovascular system. If the pain is severe, then the blood pressure decreases, which also contributes to the appearance of tachycardia.
2. Extrasystoles - the patient has a feeling of disruption in the heart, and there may also be an uncomfortable feeling in the cardiac region. If during an attack it is possible to make an electrocardiography, then, as a rule, extraordinary cuts that violate the usual rhythm of the heart are recorded. The more often such extrasystoles appear, the more pronounced the clinic and the worse the patient feels.
The emergence of extrasystoles in diseases of the prostate, especially accompanied by pain syndrome, has a reflex character. The situation worsens if the patient has increased nervousness or other negative emotions. Also sometimes pancreatitis is accompanied by increased diarrhea and vomiting, which promotes the excretion of potassium from the body. This, in turn, can also contribute to a disorder of the heart rhythm and the occurrence of extrasystole.
Medical treatment of pain in pancreatitis
In 1986, WHO proposed an analgesia regimen for the treatment of severe pain. This treatment tactic was originally developed to eliminate severe pain in cancer. Later, the proposed method of anesthesia presupposed the elimination of pain due to causes other than cancer.
According to the WHO scheme, the treatment of pain begins with low-potential non-steroidal anti-inflammatory drugs, the effects of which can be sufficient for mild or moderate pain due to pancreatitis. Further, more and more potent NSAIDs are gradually used, which eventually can be combined with opioids.
Previously, the analgesic regimen for WHO treatment was only partially useful for the treatment of patients with acute pancreatitis (OP), because opioid analgesics, especially morphine, have long been considered causative in the violation of Oddi's sphincter dysfunction. Nevertheless, several studies have shown that morphine does not have a significant adverse effect on the course of pancreatitis in acute form. In a comparative study between metamizole and morphine, it was found that the first drug led to more frequent and faster relief of pain than the same morphine.
Additional studies have suggested pethidine as an analgesic during the choice of treatment of pain in pancreatitis.However, buprenorphine, as an analgesic of a longer duration, has a similar analgesic ability, like pethidine, but a lower potential causing physical opioid dependence.
Change in nutrition to eliminate pain in pancreatitis
One of the interesting features associated with pain in pancreatitis is its potential exacerbation after ingestion of food or liquids. This food-dependent progression of abdominal pain raises the question of how adequate nutritional therapy contributes to pain management. For this reason, a common parenteral nutrition was used earlier in acute pancreatitis, but then it was found that complete parenteral nutrition of patients with OP does not provide any benefit with regard to the number of days of ingestion, general hospital stay or the number of complications associated with OP.
It is believed that the correctness of nutrition during a painful attack depends heavily on the severity of OP.
Current evidence suggests that oral feeding should be supported only in patients with severe pancreatitis, whereas support for food is usually not needed for patients with mild or moderate disease. In such cases, oral feeding should be started as soon as possible. If it is necessary for these patients to support nutrition, it is recommended to use enteral nutrition in front of the parenteral.
Of the new methods of treating pain in OP at the study stage are the following:
- Epidural analgesia
- Anecdotal agents
- Magnesium sulfate.
Thus, abdominal pain is the earliest and leading symptom in patients with OP. There is compelling evidence that the severity of pain can be a clue in determining the clinical course of the disease. The treatment of pain during OP remains a challenge in clinical practice and includes a combination of medications in accordance with the WHO analgesic regimen, adequate nutritional support and, in some cases, interventional therapy.
Nevertheless, to eliminate pain in pancreatitis is an extremely important task, since then the work of not only the pancreas, but also other organs and, first of all, the heart, can improve.
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The frequency and regularity of the heartbeat is an important sign of the state of human health. The rhythm should be constant, without interruptions and pauses. Heart rate (heart rate) is determined during a minute at rest after a 10 - 15-minute rest. It changes with physical activity, fear, emotional reactions.
Many cardiac arrhythmias, despite the illness, continue to think about various trips, trips and rest in other countries. Getting to the far-disposed destination today is real by air. In such cases, the question arises immediately, can a person with arrhythmia of the heart be able to fly on an airplane.
The most critical conditions are considered shock, because with their development a person can die very quickly. If emergency care is not provided, including cardiogenic shock, death occurs within a few minutes. The occurrence of a violation is primarily associated with cardiovascular diseases.