With irreversible damage occurring in the pancreatic tissues, there is a high risk of disability due to pancreatitis.
With irreversible damage occurring in the pancreatic tissues, there is a high risk of disability due to pancreatitis.
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.
Features of obtaining disability due to pancreatitis
The establishment of one or another disability group depends on the severity of pancreatitis, its type, the general condition of the patient and the level of his ability to work (taking into account permissible physical and work load).
To understand under what conditions and types of pancreatitis disability is officially established, it is necessary to consider all the options in more detail.
In the chronic stage
Severe symptoms of chronic pancreatitis, combined with short time intervals of patient activity, serve as the reason for establishing the third group.
The second group of disability is established in the chronic stage of pancreatitis after distal or pancreaticoduodenectomy of the pancreas, in the event of fistulas.
Against the background of physical exhaustion, it lasts for 3-4 months and the first disability group is established.
If the patient has no appetite, food is not digested properly (frequent, painful diarrhea or vomiting occurs), and disability due to physical exhaustion lasts for 3-4 months, the first group is established.
In acute form
The third group for acute pancreatitis is for patients after a surgical operation performed without harmful consequences for the body. The patient has moderate or mild dysfunction of the digestive system without radical contraindications within the framework of work activity.
In the acute form of the disease, the second group of disability is received if a surgical intervention was performed that provoked the accumulation of pus in the pancreatic tissues, deep vein thrombosis, the appearance of external non-healing fistulas or dysfunction of the pelvic organs.
In case of small intestinal obstruction, cachexia, accompanied by mental disorders, the patient is assigned the first disability group.
In case of small intestinal obstruction, cachexia accompanied by mental disorders, severe dysfunction of the digestive system and physical exhaustion against the background of irreversible changes in the tissues of the pancreas, the patient is assigned to the first group.
During exacerbation of the disease
The third group for exacerbation of pancreatitis (exacerbation of pancreatitis should not be confused with the acute form of this disease) is assigned to patients if the pain syndrome is stable, a purulent-inflammatory process is detected in the pancreas, and regular elevated body temperature is observed.
In a situation where pancreatitis, accompanied by a sharp decrease in the endocrine function of the pancreas, worsens several times during the year, debilitating the patient, a second group is established.
The third group for exacerbation of pancreatitis is for patients with persistent pain syndrome and a purulent-inflammatory process in the pancreas.
The first group, with frequent exacerbations of pancreatitis, includes patients whose clinical picture includes harmful consequences after a radical intervention (for example, pancreatic resection), incompatible with the normal level of human capacity (against the background of exhaustion).
For pancreatitis and gastritis
In case of pancreatitis complicated by gastritis, combined with a reduction in the time interval of working ability due to frequent pain attacks, taking into account the consequences of the operations performed, the patient is assigned a third (or second) disability group.
The first group is received by patients who have lost normal capacity due to physical exhaustion, which arose as the body’s response to irreversible postoperative changes in the tissues of the diseased organ and in the functioning of the digestive system.
Cholecystopancreatitis
The group for cholecystopancreatitis is established depending on the level of severity of pancreatitis and the specificity of inflammation of the gallbladder (taking into account the presence of stones, their size, quantity and type), on the general condition of the patient and his level of ability to work.
In children
The disability group for pancreatitis in children is not established.
You can obtain the special status of a disabled child if the child has impaired legal capacity.
The severity of violations is determined by the ITU commission.
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).
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.
Disability criteria for chronic pancreatitis in adults in 2021
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).
Stages of pancreatitis
The inflammatory process of the pancreas, which is medically called pancreatitis, can have three degrees of severity. The stage of the disease is determined depending on the number of exacerbations and the explicitness (severity) of accompanying manifestations. In this case, the frequency and duration of acute symptoms, the gland dysfunction present and the complications that arise must be taken into account.
Stage I
It is established if attacks occur 1-2 times a year, and their average duration does not exceed two weeks. The results of laboratory and instrumental diagnostics do not have obvious deviations from the generally accepted norm.
Stage II
It is stated in case of complications, the frequency of which does not exceed five times a year, and the duration of each of them takes up to six weeks. At the same time, laboratory tests indicate certain deviations in exocrine function, expressed in a decline in enzyme activity and the production of bicarbonates.
Against this background, as a rule, there is a clear deterioration in the absorption of necessary substances. At the second stage, the quality of endocrine function often decreases: pancreatic cells (islets of Langerhans) produce less insulin, which as a result leads to latent diabetes mellitus.
When performing ultrasound diagnostics, structural changes in the gland tissue are clearly visible. This condition prevents the patient from performing most activities associated with physical exertion.
Stage III
The third or most severe stage is set when exacerbations are observed more than five times a year, and they last up to three months. In this situation, significant changes are determined in the samples of urine and feces taken for analysis.
How to behave at the disability commission
All functions of the pancreas are impaired, which, of course, greatly affects the general well-being of the patient.
There is a pronounced clinical picture - sharp weight loss (due to poor digestion of food), polyuria (increased volume of urine), thirst and dry mouth - obvious symptoms of diabetes.
In parallel, during the examination, signs of an inflammatory process in the gallbladder are visible; stones, cystic formations and venous thrombosis can often be detected in the pancreas and its ducts, which aggravates the general condition of the patient.
Important! If, during acute pancreatitis or a severe exacerbation of the chronic form, the pancreas begins to digest its own cells and, against this background, necrotic changes occur, then this course is equated to acute. The only possible solution in this situation is pancrectomy - partial or complete resection (removal).
Disability criteria for chronic pancreatitis in children in 2021
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.
Criteria for establishing groups
The group for a patient with pancreatitis is established in accordance with the criteria prescribed in the current state legislative framework (Order 664/n of the Ministry of Labor and Social Protection of the Russian Federation, adopted in 2014).
First
The criterion for establishing a patient in the first group is the lack of normal legal capacity, disruption of the patient’s vital functions both due to intrasecretory pancreatic dysfunction and exocrine dysfunction of the affected organ.
In this case, the patient experiences such persistent (irreversible) types of disorders as:
- protein-energy malnutrition (PEM) in severe form;
- dysfunction of the normal process of food absorption.
The criterion for establishing a patient in the first group is the lack of normal legal capacity.
Officially established disability for pancreatitis characterizes the patient as seriously ill, deprived of the ability to independently perform simple actions and operations for personal care, including going to the toilet, free movement and eating.
Second
The second group of pancreatitis is caused by a pronounced impairment of the patient’s ability to work due to protein-energy deficiency.
This condition is observed in patients whose pancreas is chronically inflamed. Cases of exacerbation of the disease occur 5-7 times in 12 months and are characterized by a long-term pain syndrome, which cannot be eliminated independently in the absence of emergency medical care, since this often causes internal bleeding, and medications do not have the desired therapeutic effect.
The patient's disability in such situations varies from 1 to 1.5 months.
The patient's disability in such situations varies from 1 to 1.5 months.
The second disability group for pancreatitis is established if the patient has external, non-healing fistulas, as well as similar wounds that appeared after surgery, and there are false pancreatic cysts.
Third
The third group is established based on the results of an examination if the patient has digestive dysfunction, including problems with the functioning of the pancreas, which do not have a radical impact on his ability to work.
The medical history of the patient with the third group contains surgical interventions that did not entail any complications, as well as the presence of dysfunction of the diseased organ with clinical manifestations expressed in moderate or mild form.
The medical history of the patient with the third group includes surgical interventions that did not lead to any complications.
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.
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.
Life after treatment of pancreatic necrosis
After the operation, the patient is registered at the dispensary. Every six months a person undertakes to examine the gastrointestinal tract. He is shown undergoing an ultrasound. Sometimes an MRI of the abdominal area is prescribed.
The life of a patient after pancreatic necrosis of the pancreas changes greatly. He is prescribed a strict diet. It is important to provide fractional meals. Food must be heated. The consumption of alcohol and non-alcoholic fizzy drinks is excluded. Avoiding sweets brings great benefits to the body.
If a person breaks his diet, his life expectancy is reduced. When a latent regime sets in, the list of permitted products can be expanded.
In some patients, blood pressure decreases by 20% after surgery. 30% of people have serious problems with their vision. Many are going blind. Sometimes arterial hypoxia develops in the pulmonary system. Vivid distress syndromes of the respiratory tract appear. Some patients develop a benign cyst.
