RU2302003C1 - Differential diagnosis method for distinguishing chronic pancreatitis cases of alcoholic and biliary etiology - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining levels of interleukines IL-1β, IL-4, TNFα, interferon γ (IFγ), IL-8 and ferritine. IL-1β content being equal to 720-990 pg/ml, IL-4 141-197 pg/ml, TNFα 143-203 pg/ml, Ifγ 512-655 pg/ml, IL-8 408-524 pg/ml and ferritine 862-1115 ng/ml, chronic alcoholic pancreatitis is to be diagnosed. IL-1β content being equal to 285-397 pg/ml, IL-4 81-135 pg/ml, TNFα 45-124 pg/ml, Ifγ 398-508 pg/ml, IL-8 263-380 pg/ml and ferritine 674-912 ng/ml, chronic biliary pancreatitis is to be diagnosed.

EFFECT: high accuracy of diagnosis method.

Description

The invention relates to medicine and can be used in the differential diagnosis of chronic pancreatitis of alcoholic and biliary etiology.

A known method for the diagnosis of chronic pancreatitis of alcoholic etiology. including ultrasound examination (1).

A known method for the differential diagnosis of edematous form of pancreatitis and pancreatic necrosis by determining the level of immunoglobulins of classes A, M, G (2).

However, the known method does not provide the accuracy of the differential diagnosis of chronic pancreatitis of alcoholic and biliary etiology.

The aim of the invention is to improve the accuracy of the differential diagnosis of chronic pancreatitis of alcoholic and biliary etiology.

The technical result is achieved by the fact that during immunological studies determine the level of interleukins IL-1β, IL-4, TNFα, INFγ, IL-8 and ferritin and with the content of IL-1β from 720 to 990 pg / ml, IL-4 from 141 to 197 pg / ml, TNFα from 143 to 203 pg / ml, IFNγ from 512 to 655 pg / ml, IL-8 from 408 to 524 pg / ml and ferritin from 862 to 1115 ng / ml, chronic alcohol pancreatitis is diagnosed, and at the level of IL -1β from 285 to 397 pg / ml, IL-4 from 81 to 135 pg / ml, TNFα from 45 to 124 pg / ml, IFNγ from 398 to 508 pg / ml, IL-8 from 263 to 380 pg / ml and ferritin from 674 to 912 ng / ml diagnosed with chronic biliary pancreatitis

The method is as follows.

Upon admission, patients complain of pain in the upper abdomen, intense or moderate, persistent or periodic, vomiting, sleep disturbances. There is a lack of body weight.

From the history of known multiple hospitalization for pancreatic disease, provoked by the intake of alcohol. In patients with chronic biliary aetiology of pancreatitis, a history of gallstone disease is noted.

The skin and visible mucous membranes of normal color, moderate humidity. Peripheral lymph nodes are not palpable. Peripheral edema is not detected. Respiratory and circulatory organs: without pathology. HELL 110/70 mm RT. Art. Heart rate PS 75 beats / min. Digestive organs: the tongue is moist, coated with white plaque, the abdomen during examination of the usual form, palpation is soft, painful in the epigastrium, in the left hypochondrium. Liver, spleen not palpable. The chair is designed, regular, without pathological impurities; urination free, painless

In laboratory studies, an increase in the content of leukocytes, ESR, an increase in the level of amylase and lipase is noted in the acute period, with a chronic course, the main indicators can be within normal limits.

Ultrasound examination reveals uneven and fuzzy contours of the pancreas, echogenicity of the parenchyma is homogeneously or inhomogeneously increased. In addition, the presence of calcifications, cysts, pseudocysts, expansion and enlargement of the size of the main pancreatic duct is revealed.

EGDS: chronic gastroduodenitis in the acute phase, chronic esophagitis as a manifestation of GERD.

X-ray examination of the upper gastrointestinal tract: pancreatic calcification, indirect signs of chronic pancreatitis.

Ultrasound: The liver tissue is homogeneous, echogenicity is moderately diffusely elevated. The bile ducts are not dilated, the gall bladder is dilated, the walls are thin, there are no stones or single. Wirsung duct deformed, expanded. Spleen, kidneys - without features.

An immunological study determines the level of interleukins IL-1β, IL-4, TNFα, INFγ, IL-8 and ferritin and with the content of IL-1β from 720 to 990 pg / ml, IL-4 from 141 to 197 pg / ml, TNFα from 143 to 203 pg / ml, IFNγ from 512 to 655 pg / ml, IL-8 from 408 to 524 pg / ml and ferritin from 862 to 1115 ng / ml are diagnosed with chronic alcohol pancreatitis, and from the level of IL-1β from 285 to 397 pg / ml, IL-4 from 81 to 135 pg / ml, TNFα from 45 to 124 pg / ml, IFNγ from 398 to 508 pg / ml, IL-8 from 263 to 380 pg / ml and ferritin from 674 to 912 ng / ml chronic biliary pancreatitis is diagnosed.

In accordance with the results of a diagnostic study, therapeutic measures are carried out.

Against the background of the therapy, the patient's condition improved: the pain syndrome decreased, residual dull pains are sometimes observed, in particular in the right hypochondrium. Positive treatment results are evaluated as confirmation of the correctness of the diagnosis according to the claimed method.

The method is confirmed by specific examples.

Example 1

Patient V., born in 1967, admitted to the department of pancreatic pathology.

Diagnosis: chronic pancreatitis, pseudotumor form, alcohol etiology; pancreatic pseudocyst, pancreatic calcification; diabetes mellitus of moderate severity.

The patient complained of aching pain in the right hypochondrium, radiating to the lower back, right shoulder blade, arising 15-20 minutes after eating, as well as at night (at 5-6 a.m.). As well as losing weight for 1 year at 20 kg.

From the anamnesis of this disease, it is known that 9 years ago for the first time there was an acute sharp pain in the upper abdomen, repeated vomiting. An ambulance was delivered to the surgical department with a diagnosis of acute pancreatitis. This attack was preceded by alcohol abuse. Conservative therapy was performed. After discharge from the hospital, pain was not disturbed for a year. A year later, the attack repeated - he was hospitalized for SMP with a diagnosis of exacerbation of chronic pancreatitis. The frequency of repeated hospitalizations in hospitals is on average 1 time in 2 years. Last hospitalization in March 2002 with a diagnosis of diabetes mellitus insulin-dependent, moderate, first detected. Chronic pancreatitis in the acute stage. Constantly receiving insulin basal subcutaneously 12 units. in the morning, 10 units. in the evening + insulin actropide 6 units. in the morning, 6 units. at lunch, 6 units. in the evening. This deterioration over the past 2 months, when constant aching pains, sometimes intense, in the right hypochondrium, radiating to the lower back, right scapula, 20 minutes after eating and at 5-6 hours in the morning, completely stopped by analgesics, began to bother.

Anamnesis of life: born in Moscow. Work history: works as a programmer. Heredity: not burdened. Past diseases: acute respiratory viral infections in childhood, dysentery, pneumonia. Operation: was not. Diet history: dieting. Allergic reactions: no. Bad habits: smokes 1 pack of cigarettes a day; in his student years he abused alcohol: vodka, wine for 5-6 years. The exact amount of alcohol cannot be indicated. Currently does not abuse alcohol. Examination data: satisfactory condition, physique correct. Low power. Weight - 65 kg, height - 175 cm. Skin and visible mucous membranes of normal color, moderate humidity. Peripheral lymph nodes are not palpable. Peripheral edema is not detected. Respiratory and circulatory organs: without pathology. HELL 110/70 mm RT. Art. Heart rate PS 75 bpm Digestive organs: the tongue is moist, coated with white plaque, the abdomen during examination of the usual form, palpation is soft, painful in the epigastrium, in the left hypochondrium. Liver, spleen not palpable. The chair is designed, regular, without pathological impurities; urination is free, painless.

Survey results

General blood test: hemoglobin - 151 g / l; erythrocytes - 4.88-10 6 / mm ³ ; platelets - 214-10 3 / mm ³ ; white blood cells - 8.1-10 3 / mm ³ ; eosinophils: 1%, stab - 1%, segmented - 70%, lymphocytes - 22%, monocytes - 6%; ESR - 5 mm / hour.

Biochemical blood test: total protein - 71.4 g / l; total bilirubin - 8.8 μmol / l; glucose - 8.6 mmol / l; cholesterol - 5.3 mmol / l; ALT - 31.1 IU / l; ACT - 41.1 IU / l; ЩФ-313.8 IU / l; GGTP - 28 g / l; amylase - 81.2 IU / l; lipase - 154 IU / l. Glycemic profile: 9 h 30 min - 7.1 mmol / l; 14 h 00 min - 8.8 mmol / l; 16 h 00 min - 12.0 mmol / l; 20 h 00 min - 12.4 mmol / L.

Viral markers: HBsAg-negative; AT to HCV is negative.

General analysis of urine, feces - without pathology.

Daily urine sugar: daily amount - 1.5 l; specific gravity - 1023; sugar - 23 mmol / l.

ECG: semi-vertical position of the EOS, heart rate - 90 beats per minute, incomplete blockade of the right leg of the bundle of His.

Endoscopy: chronic gastroduodenitis in the acute phase.

X-ray examination of the upper gastrointestinal tract: pancreatic calcification, indirect signs of chronic pancreatitis, apparently diffuse-segmental form. X-ray of the examined chest organs: no pathology was detected.

Ultrasound: The liver tissue is homogeneous, echogenicity is moderately diffusely elevated. The bile ducts are not dilated, the gall bladder is dilated 10.1 × 3.5 cm, the walls are thin, there are no stones. Choledoch - 6 mm. The pancreas is enlarged (4.3-2.1-2.4 cm), has clear uneven contours, its tissue is heterogeneous, contains many calcifications. Dimensions 3.6 × 3.1 cm. Wirsung duct deformed, expanded: 5.2 mm. Spleen, kidneys - without features.

An immunological study determines the level of interleukins IL-1β, IL-4, TNFα, INFγ, IL-8 and ferritin: the level of IL-1β 720 pg / ml, IL-4 141 pg / ml, TNFα 143 pg / ml, IFNγ 512 pg / ml, IL-8 408 pg / ml and ferritin 862 ng / ml. Diagnosed with chronic alcoholic pancreatitis.

Treatment

Diet: table number 9

Mezim-forte 3 t.-3 p. per day

Famotidine 20 mg 1t. mornings

Gordoks 100 000 PIECES on physiological saline 0.9% -200.0 in / drip No. 5

papaverine, baralgin, riboxin, vitamins B6, C iv in a drip on saline 0.9% - 200.0 No. 10

Ketorol 1 ml / m in the evening

Baralgin 5.0 / m for severe pain

Insulin therapy (actropide 7-8 units before each meal; basal 10 units in the morning and 12 units in the evening.

Against the background of the therapy, the patient's condition improved: the pain syndrome decreased, but the aching, dull pain in the right hypochondrium, arising 15-20 minutes after eating, and also at night (at 5-6 hours in the morning) continued to disturb. The treatment results confirmed the correctness of the diagnosis according to the claimed method.

Example 2

Patient S., born in 1953, was treated in the department of pancreatic pathology.

Diagnosis: Chronic pancreatitis, exacerbation.

Complaints upon receipt of compressive-pulling pain in the upper abdomen. Nausea. Weakness. Heartburn. Burping. A rumbling in the stomach. Stool - a tendency to diarrhea, 4-6 p. per day. Appetite is reduced. Weight - lost 5 kg in the last 2.5 months.

From the anamnesis of this disease it is known that in May 2001 he suffered an acute hemorrhagic pancreatic necrosis - laparotomy. In June 2003, he was hospitalized with a diagnosis of acute pancreatitis. Diagnostic laparoscopy with drainage of the right lateral canal was performed. After discharge notes periodically the presence of pain in the epigastrium. He took almagel, ranitidnn. The state of health was satisfactory. This exacerbation since February 23, after drinking alcohol, there were sharp pains in the epigastrium, the left hypochondrium.

Anamnesis of life: born in Moscow. Work history: works as a locksmith. Heredity: not burdened. Past diseases: acute respiratory viral infections in childhood, pneumonia. Operations: 2001: laparotomy for pancreatic necrosis, 2003: laparoscopy: drainage of the right lateral canal. Diet history: does not follow a diet. Allergic reactions: no. Bad habits: smokes 1 pack of cigarettes a day; abuses alcohol: vodka, wine for a long time. The exact amount of alcohol cannot be indicated.

The condition is satisfactory. The physique is correct. Low power. Weight - 69 kg, height - 171 cm. Skin and visible mucous membranes of normal color, moderate humidity. Peripheral lymph nodes are not palpable. Peripheral edema is not detected. Respiratory and circulatory organs: without pathology. HELL 140/80 mm RT. Art. Heart rate 72 beats / min. Digestive organs: the tongue is moist, coated with white plaque, the abdomen during examination of the usual form, palpation is soft, painful in the epigastrium, in the left hypochondrium. Liver, spleen not palpable. The chair is designed, regular, without pathological impurities; urination is free, painless.

Survey Results.

General blood test: hemoglobin - 134 g / l; erythrocytes - 4.2-10 6 / mm ³ ; platelets - 214-10 3 / mm ³ ; white blood cells - 3.6-10 3 / mm ³ ; eosinophils: 1%; stabs - 2%, segmented - 55%, lymphocytes - 34%, monocytes - 8%; ESR - 4 mm / hour.

Biochemical blood test: total protein - 77 g / l; total bilirubin - 6.1 μmol / l; glucose - 6.8 mmol / l; cholesterol - 6 mmol / l; ALT - 42 IU / l; ACT - 31.0 IU / L; Alkaline phosphatase - 123 IU / l; GTPP - 162 g / l; lipase - 69 IU / l.

Viral markers: HBsAg - negative; AT to HCV is negative. Ig M 70 mg%, Ig G 700 mg%, Ig A 350 mg%,

General analysis of urine, feces - without pathology.

ECG: normal position of the electrical axis of the heart. Sinus rhythm, correct. Heart rate 92 beats / min.

Ultrasound: the liver is enlarged due to the right lobe (oblique vertical size of the right lobe is 17.5 cm). The contours are even. Signs of focal pathology were not detected. Echogenicity of the parenchyma is within normal limits. The vascular pattern is clearly detected. Intrahepatic bile ducts are not dilated. The pancreas is of normal shape and size. The contours of the pancreas are uneven, sometimes fuzzy, the echogenicity of the tissue is significantly increased, its heterogeneity is determined. Focal pathology was not detected. The main pancreatic duct is not expanded. Sonographic signs of calcification in the gland tissue and the main pancreatic duct were not detected. The gall bladder is 7 × 2 cm, deformed due to the presence of constriction, its walls are not thickened. Signs of calculi, hyperechoic suspension in the lumen were not detected. The right kidney without features, in the left is defined a cyst with a diameter of 3.2 cm. The spleen is of normal size and shape, the parenchyma echostructure is homogeneous. The portal and splenic veins are not dilated. Conclusion: hepatomegaly; signs of chronic pancreatitis; constriction in the gallbladder; cyst of the left kidney.

Endoscopy: in connection with the restless behavior of the patient could not be carried out.

X-ray examination of the gastrointestinal tract: the act of swallowing is not changed. The esophagus and cardia are freely passable. The stomach is of normal shape and size. Signs of cardia failure. The contours are clear, the relief of the mucosa is not changed. Active peristalsis. Evacuation is not broken. The duodenal bulb is not changed. Conclusion: signs of cardia failure.

An immunological study determined the level of interleukins IL-1β, IL-4, TNFα, INFγ, IL-8 and ferritin: the content of IL-1β 990 pg / ml, IL-4 197 pg / ml, TNFα 203 pg / ml, IFNu 655 pg / ml, IL-8 524 pg / ml and ferritin 1115 ng / ml. Diagnosed with chronic alcoholic pancreatitis.

Treatment

Diet: table number 9

Mezim-forte 3 t.-3 p. per day

Famotidine 20 mg 1t. mornings

Gordoks 100 000 PIECES on physiological saline 0.9% -200.0 in / drip No. 5

papaverine, riboxin, vitamins B6, I / V drip on physiological saline 0.9% -200.0 No. 10

Ketorol 1 ml / m in the evening

Baralgin 5.0 v / m

Against the background of the therapy, the patient's condition improved: the pain syndrome, nausea, heartburn, belching decreased, the stool returned to normal: it became formed, 1-2 p. per day

The treatment results confirmed the correctness of the diagnosis according to the claimed method.

Example 3

Patient M-va, 57 years old, was treated in the department of pancreatic pathology with a diagnosis of acute pancreatitis in the acute stage.

Upon admission, the patient complained of aching pain in the epigastric region, clearly not related to food intake; nausea, bitterness in the mouth in the morning.

From the anamnesis it is known that in 1998 there were repeated attacks of pain in the upper abdomen, in 1998 gallstones were revealed, cholecystectomy was performed for cholelithiasis, and pains in the upper abdomen were disturbed in the postoperative period. In April 2004, she noted an increase in body temperature to 39.5 ° C, intense pain in the upper abdomen. The current deterioration in the past month.

The patient follows a diet, there are no allergic reactions, no bad habits.

Upon examination, the condition is satisfactory, the physique is correct, the patient is of high nutrition, weight - 81 kg, height - 168 cm. Skin and visible mucous membranes of normal color, moderate humidity. Peripheral lymph nodes are not palpable. Peripheral edema is not detected. Respiratory and circulatory organs: without pathology. HELL = 140/80 mm RT. Art. Heart rate = 76 beats. in minutes Digestive organs: the tongue is moist, coated with white plaque, the abdomen upon examination of the usual form, palpation is soft, painful in the epigastrium. Liver, spleen not palpable. The chair is designed, regular, without pathological impurities; urination is free, painless.

Survey Results:

Ultrasound of the abdominal cavity: the liver is slightly enlarged. The contours are even. Echogenicity of the parenchyma: homogenously increased, the passage of the acoustic signal through it is noticeably weakened. Vascular structures are not clearly detected. Intrahepatic bile ducts are not dilated. Pancreas: normal shape, size. Contours are fuzzy. Echogenicity of the tissue of all departments is moderately increased, diffusely heterogeneous. The main pancreatic duct is not expanded. The common bile duct is not dilated (0.5 cm), the spleen is of normal size and shape. Conclusion: signs of diffuse liver disease (probably fatty degeneration), mild signs of chronic pancreatitis.

Ultrasound of the kidneys: no echographic signs of pathology were detected.

Endoscopic endoscopy: lumen of the esophagus is not changed, the mucous membrane in the lower third is hyperemic, the cardia is well closed, the folds of the stomach are of normal size, the gastric mucosa is hyperemic, the duodenal bulb is not changed, the mucous membrane is hyperemic. Conclusion: Reflux esophagitis. Chronic gastroduodenitis. ECG: normal position of the electrical axis of the heart. Sinus rhythm, correct, heart rate 87 beats / min. Weakly expressed diffuse changes in the myocardium.

Laboratory data:

General blood test: hemoglobin - 141 g / l; erythrocytes - 4.8-10 6 / mm ³ ; platelets - 268-10 3 / mm ³ ; white blood cells - 8.8-10 3 / mm ³ ; eosinophils: 4%. stab - 3%, segmented - 52%, lymphocytes - 36%, monocytes - 5%; ESR - 5 mm / hour.

Biochemical analysis of blood: total protein - 78.5 g / l; total bilirubin - 9 μmol / l; glucose - 4.5 mmol / l; cholesterol - 4.9 mmol / l; ALT - 26.4 IU / l; ACT - 27.6 IU / L; Alkaline phosphatase - 120.1 IU / l; GGTP - 35.3 g / l; amylase - 157.2 IU / l.

Viral markers: HBsAg - negative; AT to HCV is negative. Ig M 70 mg%, Ig G 700 mg%, Ig A 350 mg%.

An immunological study determines the level of interleukins IL-1β, IL-4, TNFα, INFγ, IL-8 and ferritin: IL-1β 285 pg / ml, IL-4 81 pg / ml, TNFα 45 pg / ml, IFNγ 398 pg / ml, IL-8 263 pg / ml and ferritin 674 ng / ml. Diagnosed with chronic biliary pancreatitis.

Treatment

Diet: table number 5 p

No-spa 1 t. - 3 p. per day 3 weeks

Mezim-forte 1 t. - 3 p. per day 3 weeks

Ranitidine 150 mg 1 t. - 2 p. per day

Gelusil ^® varnish 1 t. - 3 r. per day

Against the background of the therapy, the pain decreased, they began to disturb less often, their intensity decreased, bitterness in the mouth decreased, and nausea disappeared.

The results of the treatment confirmed the correctness of the differential diagnosis according to the claimed method.

Example 4

Patient S., 57 years old, was under treatment in the Department of pancreatic pathology since 9/12/04. until 12/27. 2004 year.

Diagnosis: Chronic pancreatitis, stage of exacerbation. Cholecystectomy in 2002 about cholelithiasis. Chronic gastroduodenitis.

Complaints at admission: bloating, aching pain in the right hypochondrium, arising 15 minutes after eating.

From the anamnesis of this disease it is known that for a long time suffers from chronic gastritis. In 2001, intense epigastric pain occurred, and was treated on an outpatient basis. In 2002, a gallstone was revealed, cholecystectomy was performed, and pain continued to be disturbed in the postoperative period. Last hospitalization in September 2004. Deterioration in the last 2 weeks, when there was an increase in body temperature to 38.5 ° C, there was pain in the epigastrium. Complies with the diet, there are no allergic reactions, bad habits are absent.

The condition is satisfactory, physique is correct, satisfactory nutrition. Weight - 60 kg, height - 163 cm. Skin and visible mucous membranes of normal color, moderate humidity. Peripheral lymph nodes are not palpable. Peripheral edema is not detected. Respiratory and circulatory organs: without pathology. HELL 120/70 mm RT. Art. Heart rate 77 beats / min. Digestive organs: the tongue is moist, coated with a white coating, the abdomen during examination of the usual form, on palpation is soft, sensitive in the epigastrium. Liver, spleen not palpable. The chair is designed, regular, without pathological impurities; urination is free, painless.

Survey Results:

Endoscopy: The esophagus is freely passable, the mucous membrane is pink, smooth, a small amount of fluid in the stomach, the mucous membrane of the body and antrum with areas of atrophy, the folds are thickened, elastic, active motility, the pylorus is round, it gapes widely. The cavity of the duodenal bulb is smooth, its mucosa is also with a site of atrophy, the descending part is not changed, the papilla of the nipple is flat, pale pink. Conclusion: Chronic gastroduodenitis with patches of atrophy.

Ultrasound: normal sized liver. Signs of focal pathology were not detected. Echogenicity of the parenchyma is slightly increased, vascular structures in the parenchyma are clearly identified. Intrahepatic bile ducts are not dilated. The common bile duct is not expanded. The contours of the pancreas are clear, even. The shape and size are within the normal range. Pancreatic tissue echogenicity is increased. The structure of the parenchyma is heterogeneous, fine-grained. Pancreatic cyst. The main pancreatic duct is expanded. Kidneys: the pyelocaliceal system is not expanded, the dimensions are not changed. Spleen: normal size, parenchyma echostructure homogeneous. Conclusion: echographic signs of chronic diffuse liver disease. Diffuse changes in the pancreatic parenchyma, chronic pancreatitis.

ECG: deflection of the electrical axis to the left. Sinus rhythm, correct. Heart rate 63 bpm Moderately pronounced diffuse changes in the myocardium.

Laboratory data

General blood test: hemoglobin - 133 g / l; erythrocytes - 4.39-10 6 / mm ³ ; platelets - 219-10 3 / mm ³ ; white blood cells - 4.2-10 3 / mm ³ ; eosinophils - 2, stab - 1%, segmented - 54%, lymphocytes - 38%, monocytes - 5%; ESR - 15 mm / hour. Biochemical blood test: total protein - 82 g / l; total bilirubin - 11 μmol / l; glucose - 5.6 mmol / l; cholesterol - 5.7 mmol / l; ALT - 16.2 IU / l; ACT - 29.8 IU / L; Alkaline phosphatase - 292.3 IU / l; GGTP - 42.7 g / l; lipase - 141.2 IU / l.

Viral markers: HBsAg - negative; AT to HCV is negative. Ig M 70 mg%, Ig G 700 mg%, Ig A 350 mg%,

An immunological study determines the level of interleukins IL-1β, IL-4, TNFα, INFγ, IL-8 and ferritin: IL-1β 397 pg / ml, IL-4 135 pg / ml, TNFα 124 pg / ml, IFNγ 508 pg / ml, IL-8 380 pg / ml and ferritin - 912 ng / ml diagnose chronic biliary pancreatitis.

Treatment performed:

Diet: table number 5 p

No-spa 1 t. - 3 r per day for 3 weeks.

Mezim-forte 1 t. - 3 p. per day 3 weeks.

Ranitidine 150 mg 1 t. - 2 p. per day

Gelusil ^® varnish 1 t. -3 p. per day

Against the background of the therapy, the patient's condition improved: the pain syndrome was stopped, bloating significantly decreased.

The results of the treatment confirmed the correctness of the differential diagnosis according to the claimed method.

According to the proposed method, a differential diagnosis of chronic pancreatitis of alcoholic and biliary etiology in 25 patients was carried out. Subsequent computed tomography and successful treatment results confirmed an increase in the accuracy of differential diagnosis.

Claims (1)

A method for the differential diagnosis of chronic pancreatitis of alcoholic and biliary etiology, including clinical, ultrasound and laboratory immunological studies, characterized in that the immunological study determines the level of interleukins IL-1β, IL-4, TNFα, INFγ, IL-8 and ferritin, and when IL-1β from 720 to 990 pg / ml, IL-4 from 141 to 197 pg / ml, TNFα from 143 to 203 pg / ml, IFNγ from 512 to 655 pg / ml, IL-8 from 408 to 524 pg / ml and ferritin from 862 to 1115 ng / ml are diagnosed with chronic alcoholic pancreatitis, and at the level of IL-1β from 285 to 397 pg / ml, AND -4 from 81 to 135 pg / ml, TNFα from 45 to 124 pg / ml, IFNγ from 398 to 508 pg / ml, IL-8 from 263 to 380 pg / ml and ferritin from 674 to 912 ng / ml diagnose chronic biliary pancreatitis