A long-term atrophic process in the parenchyma of the pancreas due to the chronic form of pancreatitis becomes the cause of disruption of all its vital functions.
Over time, the organ loses its ability to fully digest food, and a decrease in insulin production leads to diabetes. Due to the seriousness of the disease and the accompanying complications, patients and their loved ones often wonder whether pancreatitis is a disability?
Disability due to pancreatitis
To find out whether pancreatitis is classified as a disability group, the patient will need to undergo a medical and social examination (MSE). Only a commission consisting of appropriate specialists has the authority to decide whether to assign a person a disability status and all related benefits.
The responsibilities of the attending physician include issuing a patient referral for examination if the following aspects are present:
- second or third degree chronic form of the disease; the occurrence of frequent bleeding; the presence of deep vein thrombosis with a disorder of the functional activity of the pelvic organs and legs; conditions after surgery accompanied by moderate or severe digestive dysfunction; postoperative status, complicated by the appearance of a long-term non-healing external fistula.
For MSA, the patient will need to obtain from the attending physician a list of necessary documents, based on the results of which the commission will draw conclusions regarding the establishment of the disability group. At the same time, the patient must have in his hands: a medical card, an extract from the hospital, the results of all examinations, etc.
Reviews
Svetlana, 46 years old, Ryazan: “Five years ago I was assigned the third disability group. It was removed a year ago, although the diagnoses remained. During the re-examination, she underwent all the diagnostics, but the commission said that there was no deterioration in health, and the group was removed. It's a shame, the disease is debilitating. We must take into account that a person is trying to prevent aggravations.”
Peter, 39 years old, Moscow: “Mom was seriously ill with pancreatitis. But we always had to record every attack and hospital periods. The second group was given only after the operation. I believe that confirmation of status is a necessary procedure. When the disease is severe and health does not improve, then ITU experts have no doubts about confirming disability.”
Indications for referral to ITU
Patients with chronic pancreatitis are referred to MSE:
- at stages II and III of the disease; - with frequent bleeding; — with deep vein thrombosis and dysfunction of the pelvic organs and static-dynamic function of the lower extremities; — after surgical treatment with moderate and severe degrees of digestive dysfunction; - after surgical treatment and the presence of non-closing external fistulas.
Examinations and analyzes when referred to ITU
— routine tests; — determination of enzyme activity in the blood; — determination of amylase activity in urine; — determination of enzyme activity in the contents of the duodenum (on an empty stomach and with a load); - coprogram; - Staub-Traugott test with double sugar load; — fluoroscopy of the stomach and duodenum (in conditions of hypotension); — Ultrasound of the liver, extrahepatic biliary tract, gallbladder, pancreas; - computed tomography of the gland (for stones of the main pancreatic duct).
Main symptoms of pathology
The main symptom of the disease is pain. It occurs on the left side of the abdominal cavity. Its intensity is conventionally divided into 4 types:
Sometimes the pain syndrome radiates to the left upper limb or lumbar area. The body temperature rises, attacks of nausea appear, vomiting occurs, and bowel movements are disrupted.
Against the background of purulent complications of pancreatic necrosis of the pancreas, the patient sweats profusely. He is shivering and feverish. Some people develop symptoms of acute kidney failure. Sometimes disorders of the nervous system are diagnosed. With a more severe clinical picture, the patient falls into a coma.
Surgery
If ulcers appear against the background of progressive pancreatic necrosis of the pancreas, death is possible. Therefore, the patient is prescribed urgent surgery.
The surgeon removes dead tissue. The next step is to restore the conductivity of the ducts. If the treatment does not bring the desired result, a repeat operation is prescribed. For 48% of patients it ends successfully.
Disability criteria for chronic pancreatitis in adults in 2022
Disability is not established if the patient has:
- absence or minor dysfunction of the digestive system, characterized by mild pancreatitis, exacerbations up to 3 times a year.
Group 3 disability is established if the patient has:
- moderate disturbances of the exo- and endocrine function of the pancreas, moderate pancreatitis with exacerbations up to 4 - 5 times a year.
Disability of the 2nd group is established if the patient has:
- severe disturbances of the exo- and endocrine functions of the pancreas, severe pancreatitis with frequent exacerbations (6 - 7 times a year).
Criteria
Providing a disability group for chronic pancreatitis depends entirely on the stage of the disease and the severity of pancreatic dysfunction. For this purpose, several criteria are provided, which is what ITU members are guided by when considering each specific case.
The third group is established for a patient who has been diagnosed with the second stage of pancreatitis, that is, when there are slight deviations in the performance of the gland, which slightly affects its function as a whole. Also, this group is issued to a patient who has undergone successful surgery on the gland without any complications.
The second category of disability is assigned when pronounced limitations in the patient’s life activity are identified against the background of the third stage of the disease. This condition is characterized by frequent bleeding, the presence of large pseudocysts, or in the postoperative period the formation of external fistulas (pancreatic and biliary).
The first group is provided to persons suffering from a significant decrease in the quality of life due to the development of exocrine and endocrine insufficiency, as well as cachexia caused by disorders of the digestive processes. The first group is established without fail after a complete pancrectomy (surgery to remove the entire pancreas).
Important! The possibility of disability due to pancreatitis depends entirely on the general condition of the patient and the severity of pancreatic dysfunction.
Disability criteria for chronic pancreatitis in children in 2022
Disability is not established if the child has:
- a mild course of the disease, fecal elastase level > 200 mcg/g; no signs of malnutrition during replacement therapy; minor violations of the exocrine function of the pancreas - 100 - 200 mcg/g, minor violations - level of compensation (glycated hemoglobin HbA1c Minor violations SDS from -2.0 to -3.0.
The category “disabled child” is established if the patient has:
- moderate course of the disease, the presence of exacerbations with inpatient treatment (up to 3 times a year inclusive); the presence of exocrine insufficiency of fecal elastase (from 100 to 200 mcg/g) during replacement therapy, moderate disturbances of the exocrine function of the pancreas 60 - 100 mcg/g; moderate disturbances of endocrine insufficiency (HbAlc Moderate disturbances SDS from -3.1 to -3.9.
- severe course of the disease, frequent exacerbations (more than 4 times a year); the presence of exocrine insufficiency in fecal elastase (less than 100 mcg/g) during replacement therapy; severe disturbances of the exocrine function of the pancreas - less than 50 mcg/g; severe disturbances of HbA1c more than 9%; glycemia more than 9 mmol/l) taking into account nutritional status Severe disturbances SDS deviation of more than - 4 deviations.
A patient can receive an official conclusion on the presence (or absence) of grounds for establishing disability only based on the results of his examination at the ITU bureau of the corresponding region.
The main causes of pancreatic necrosis
The main reason for the development of pancreatic necrosis is considered to be the abuse of alcoholic beverages over a long period of time. Approximately 25% of patients have a history of gallstone disease. About 50% of patients with this diagnosis regularly overeat. Their diet contains fried, smoked, fatty foods.
Other reasons for the development of pancreatic necrosis include:
- abdominal trauma;
- progression of duodenal ulcer;
- penetration of viruses;
- development of infectious pathologies;
- stomach ulcer.
Another provoking factor is considered to be prolonged exposure to a stressful situation. Sometimes pancreatic necrosis develops due to improper use of certain medications.
Disability due to pancreatic necrosis
Death of pancreatic tissue or pancreatic necrosis is a very dangerous complication of acute pancreatitis, and in some cases chronic, and often requires urgent medical attention.
If the patient, after the necessary conservative treatment, does not develop new lesions, but, on the contrary, shows positive dynamics, then, most likely, he will be assigned a third group of disability.
If after surgery a condition of moderate severity is observed and deviations of the digestive processes persist, then the patient is assigned the second category. The first group is prescribed in case of a high risk of sudden death.
At the same time, all present variants of dysfunction of the cardiovascular and respiratory systems are assessed separately. Disability established after pancrectomy (complete or partial) can be of both the first and second groups.
The commission's decision will depend on the severity and extent of necrotic tissue damage, the size of the area of excised fragments and the occurrence of complications. Therefore, it is definitely not possible to find out which group is appropriate for a particular patient without conducting an MSE.
Contraindicated types and working conditions
If a patient is given disability group 3, he is allowed to get a job with easy working conditions that suit him.
Places of work with certain characteristics of working conditions are contraindicated for disabled people:
Pancreas restoration
After surgery, the patient is indicated for the following therapeutic measures:
- Physiotherapy.
- Gentle gymnastics.
- Automassage of the intestines.
It is strictly contraindicated for a person to overwork. It is recommended to rest after eating. Walking activity is adjusted by the attending physician.
The answer to the question of whether the pancreas recovers after pancreatic necrosis can be obtained from your gastroenterologist or endocrinologist. Reanimation of the functions of this organ is possible with the help of cleansing procedures. Lava infusion works best.
To prepare the product, you need to brew 10 leaves of the plant (200 ml) in a thermos. just boiled water, leave for 24 hours. Take 50 grams. half an hour before meals.
In order to restore the enzymes of the organ, the patient is prescribed Creon, Pancreatin, Mezim-Forte. They contain protease, lipase, and amylase. These substances are similar to enzymes that are produced by the pancreas.
