VARIABILITY OF PAIN SYNDROME AND ULTRASONOGRAPHIC SIGNS OF PANCREATIC FIBROSIS IN PATIENTS WITH CHRONIC PANCREATITIS COMORBID WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The purpose of the study – to determine the intensity of pain and pancreatic fi brosisin patients with chronic pancreatitis (CP) with comorbidity in chronic obstructivepulmonary disease (COPD).Material and methods. An analysis of medical records of 106 inpatients was conducted.The fi rst group consisted of 48 patients with isolated CP, the second group consisted of 58patients with CP with comorbid COPD. The comparison group consisted of 30 practicallyhealthy individuals (PHI). Results. Analysis of subjective symptoms of pancreatic infl ammation that occurred in the examined patients indicates that manifestations of abdominal pain syndrome were observed in patients of the 2nd group 1.2 times more often than in patients of group 1. The leading symptom of this syndrome in patients of group 1 was paroxysmal pain in the projection of the pancreas, which occurred 3.6 times more often in patients of group 1. Constant pain syndrome in the projection of the pancreas prevailed in patients of group 2 and exceeded the frequency in group 1 by 4.5 times. The maximum intensity of pain was registered in patients of group 1, and in patients of group 2 the frequency of occurrence of pain of signifi cant intensity was lower, respectively, by 2.0 times. In patients of group 2, aching pain in the projection of the pancreas of weak intensity prevailed (respectively, 2.4 times more often than in group 1). Analysis of the parameters of ultrasonography (USG) of the pancreas in patients revealed characteristic ultrasonographic signs of CP, namely: changes in the size of the pancreas, uneven contour, heterogeneous echostructure, increased echogenicity, dilation of the main pancreatic duct, calcifi cation of the pancreas, soreness when pressed with the USG sensor in the projection of the pancreas. In patients of group 1, the size of the head of the pancreas was 1.4 times higher than in PHI. The size of the head of the pancreas in patients of group 2 was signifi cantly increased – 1.6 times compared to the 1st observation group. In patients of both groups, the vertical size of the body of the pancreas exceeded the fi gure in practically healthy individuals by 1.4 and 2.1 times, respectively. Heterogeneity of the structure, mosaic increase and decrease in echogenicity of the pancreas were observed in patients of all groups under observation. When studying changes in the echogenicity of the pancreatic tissue, it was found that in patients of group 2, heterogeneous increase in echogenicity of the pancreas was most often detected as a result of the presence of hypoechoic (areas of infl ammation and infi ltration) and hyperechoic (foci of fi brosis and calcifi cation) areas against the background of normal pancreatic parenchyma of medium echogenicity.Conclusions. Chronic pancreatitis with comorbidity with COPD is characterized by a signifi cantly lower frequency of paroxysmal abdominal pain syndrome and its lower intensity compared to the isolated course of CP, but with a higher frequency of constant aching pain in the projection of the pancreas, the most pronounced changes in the sonographic structure of the pancreas, which indicates the maximum degree of fi brosis among the comparison groups.