Acute pancreatitis, symptoms and treatment regimen

Acute pancreatitis - an inflammation of the pancreas that develops against the backdrop of various trigger factors, and requires immediate medical intervention.

According to various data, mortality from acute pancreatitis can reach up to 40%. Risk of disease is the rapid development of serious complications, up to complete necrosis of the pancreas. However, timeliness and correctness of the treatment makes it possible to avoid them, and the patient recovers completely.

What it is?

Acute pancreatitis - acute flowing aseptic inflammation of the pancreas such as demarcation, which is based on necrobiosis pankreatotsitov autoaggression enzyme and followed by necrosis and dystrophic gland and attaching secondary purulent infection.

Lethality, despite the use of modern methods of conservative and surgical treatment, high: a total of 7-15%, with destructive forms - 40-70%.

Causes

Acute pancreatitis is fixed in adults 30-40 years old. Are at greater risk for male population than female. Incidence form higher in people who abuse alcohol and suffering biliary tract disorders, such as:

• dyskinesia zhelchetoka on hypertonic type;
• cholecystitis, chronic or acute;
• cholelithiasis.

The remaining causes of pancreatitis:

• hypertriglyceridemia;
• failures in the system of circulation of glandular tissue;
• cystic fibrosis;
• hemolytic-uremic syndrome;
• hyperparathyroidism;
• abdominal trauma;
• heredity;
• autoimmune diseases;
• ductal obstruction of the pancreas or common zheltetoka;
• damage channels and prostate in operation;
• uncontrolled use of drugs;
• the effects of severe acute respiratory viral infection, mumps, mycoplasma pneumonia, hepatitis;
• various gastrointestinal diseases.

Acute pancreatitis can occur in two forms:

• light - organs and systems are poorly struck. The disease responds well to treatment, recovery occurs rapidly;
• heavy - in tissues and organs are marked clearly expressed disorders are not excluded tissue necrosis, abscesses and cysts.

The clinical picture of the disease in a severe form can also be accompanied by:

• inside the prostate observed accumulation of fluid;
• infection and tissue necrosis;
• false cyst;
• in iron or in nearby tissues it is accumulated pus.

development mechanism

When the pancreas is functioning properly, the enzymes which it generates, are allocated in the duodenum and under the influence of certain factors permitting activated. Thus flows the physiological process of digestion - digestion of proteins, fats and carbohydrates into simpler components.

However, for a number of reasons described above, enzyme activation can begin even within the gland. Lysis of its tissues, followed by their withering, edema and compression of the prostate tissue interstitial fluid, spasms of the vasculature and circulatory problems in the body. Large pancreatic duct becomes blocked. Pancreatic juice is not the usual way out is its stagnation and increasing aggression against the digestive enzymes of glandular tissue.

Pancreas increased in size, it first develops aseptic (noninfectious) inflammation. Occurs effusion liquid, saturated active enzymes in peritoneal cavity, irritable visceral (abdominal organs coating) and parietal peritoneum. Compressed nerves and chafe nociceptors, which is rich in the peritoneum. First pain occurs directly in the projection of the pancreas itself - from the navel to the left to return back. Then he has the entire abdomen hurts, developing peritonitis.

Occurs absorption of enzymes and excess necrotic products in the bloodstream, develops intoxication, the temperature rises, becomes more frequent pulse, blood pressure decreases. The patient is observed toxic and painful shock. Lymphatic pathways from the intestine into the fall zone of inflammation microorganisms (Escherichia coli, Clostridium, Staphylococcus, Proteus and others.). Peritonitis becomes purulent and amenable to treatment extremely difficult and the mortality rate at this stage is 70%.

Symptoms of acute pancreatitis

Clear clinical signs are not present in acute pancreatitis. In this connection, for accurate diagnosis it requires a number of additional studies.

Complaints of severe pain in the abdomen, nausea, vomiting, duodenal contents, not bringing relief, bloating. As a rule, due to intoxication and vomiting occurs violation of water-electrolyte balance, dehydration, which plays an important role in the pathogenesis of the disease. May appear hemorrhagic bluish spots on the left side wall of the abdomen, sometimes with a yellowish tinge (Gray Turner's sign). Perhaps the emergence of spots in the umbilicus (Cullen's sign).

Often after suffering acute pancreatitis, pancreatic pseudocyst formed. Increasing in size and accumulating abnormal fluid pseudocyst due to compression of the surrounding organs can cause pain, impaired food movement in the stomach and duodenum. Perhaps pseudocyst abscess.

Sometimes sclerosis or edema in the head of the pancreas leading to the clinical picture resembling compression biliary duct and pancreatic duct (Wirsung duct). A similar pattern is observed in tumors of the pancreatic head, so this form of pancreatitis called pseudotumor. Violation bile outflow in such cases may cause mechanical jaundice.

The most common cause of death in patients with acute pancreatitis in the early days of the disease is endogenous intoxication, accompanied by the development of circulatory hypovolemic shock, brain edema, acute renal insufficiency.

complications

Are possible consequences:

1. Pancreatic necrosis.
2. Pancreas cancer.
3. Jaundice.
4. Pancreatic coma.
5. Cysts and pancreatic pseudocysts.
6. Pancreatic abscess.
7. Reactive hepatitis.
8. Reactive pleurisy.

When complications changes the habitual nature of the disease: changing the nature, location and intensity of pain, it can become permanent. The development of complications in chronic pancreatitis can occur at any stage of the disease and requires immediate inspection medical and hospitalization in a surgical hospital, as many complications pose an immediate threat to life patient.

Diagnostics

Diagnosis consists of the following procedures:

• history taking, visual examination of the patient by palpation of the abdomen, to identify the causes sharp pain;
• Endoscopic ultrasonography (in addition to assessing the size and structure of the pancreas, the study examines the state of its ducts); Angiography (may confirm the disorder of blood supply to an inflamed pancreas);
• Ultrasound to detect the degree of increase in the size of pancreas, Fitting etiology of the disease in the presence of concentrations of gases or liquids in the intestinal loops; More details on how the ultrasound scan of the pancreas →
• physical examination to determine the exact visualization of false cysts or abscess, necrosis track outside pancreatic closer to the intestines;
• laparoscopy (has direct visual inspection of the organs in the abdominal cavity, showing evidence of acute pancreatitis: the area of ​​fat necrosis in the peritoneum and omentum, excess fluid in the abdomen, various bleeding, redness of the peritoneum, swelling balling).
• CT as a more accurate method of diagnosis, in contrast to US without interference by introducing a contrast agent into the peritoneum for weed detect total or local imaging magnification in prostate size and edema, presence of necrosis and localization.

In addition, differential diagnosis is carried out in the department of acute pancreatitis from cholecystitis, acute appendicitis, intestinal obstruction, gastrointestinal perforation bleeding stomach ulcers, abdominal ischemic syndrome.

Treatment of acute pancreatitis

In acute pancreatitis, the treatment is possible only in a hospital under the supervision of qualified professionals, it is considered a very dangerous condition. Suspected acute pancreatitis should immediately call an ambulance and a person should be urgently hospitalized.

Sometimes delayed medical care can cost a person their life. First aid that can be given to man with a bout of pancreatitis, symptoms of which are obvious, it is on the application of cold in stomach reception spasmolytic - On-spa, papaverine, and rejection of the reception of any food and bed rest before the ambulance help.

In the first 3-5 days, the patient is assigned to a diet 0, which means - hunger. Starting from the second day is necessary to drink water alkaline (Borjomi Essetuki №4) in large amounts, up to about 2 liters per day. 3-5 day resolved light, liquid porridge (excluding wheat). For 5-6 days can be added to the diet of light low-fat soups, yogurt, teas, and other lean fish. Food must be warm (not hot or cold) melkoizmelchonnoy, semi-liquid consistency.

Drug treatment of acute pancreatitis

1. To improve microcirculation: used intravenous solutions (Reopoligljukin, Hemodez and others).
2. Pain relief: Due to the introduction of severe pain is only pain medication does not allow her to remove, so to carry out various kinds of blockades (sacrospinal novocaine blockade, perirenal, epidural anesthesia with administration of anesthetic through the catheter) intravenous anesthetic drugs (Tramadol, and Baralgin others).
3. Eliminating shock characteristics (low pressure) is performed by means of intravenous solutions (polyglukin, albumin, and others).
4. Correction of water scarcity and electrolytes conducted using intravenous solutions containing salt (NaCl, KCl, and others).
5. Prevention of suppurative complications and peritonitis: carried out by means of the application of broad-spectrum antibiotics (ciprofloxacin, imipenem, metronidazole, and others).
6. Excretion of excess enzymes excreted: performed by means of forced diuresis, diuretic (Lasix) administered after intravenous solutions; plasmapheresis.
7. Reduced production of enzymes by the pancreas: statins (Somatostatin), protease inhibitors (Contrycal, Gordoks). Antisecretory agents (Kvamatel, omeprazole) used for neutralization of gastric contents, since hydrochloric acid is a powerful stimulator of the secretion of pancreas.

Approximately 10-15% of patients with acute pancreatitis moved to the step of purulent complications require surgical treatment. Performed under general anesthesia with intubation of the lungs, pancreas removed from areas of necrosis (dead tissue).

Rehabilitation at home

Patients in remission is recommended to follow the work and rest. Prohibited smoking and drinking. Sanatorium treatment - only when stable remission and absence of symptoms. Showing spa resorts hydrocarbonate waters with low and medium salinity. It Essentuki, Truskavets, Morshyn, Zheleznovodsk, Borjomi. Extreme caution should be treated and physiotherapy, to hold them only when stable remission.

In acute pancreatitis temporary disablement often delayed. It depends not only on the patient's state of health, but on the complete disappearance of pathological local (palpation, sonographic, and others.) And laboratory symptoms. In some cases, a subsequent temporary or permanent employment of WCC line. Contraindicated work associated with significant physical stress, the body shaking, traumatization of the abdomen, the contact with poisons, and work, are such that the dietary regimen.

In severe, chronic, acute pancreatitis form without surgical treatment of long-term disability arises, leading to disability group II or III.

prevention

The primary prevention of acute pancreatitis is a diet, eating small meals several times a day, giving up sharp, fatty and smoked foods. It is crucial to not less than 1 time per year undergo routine diagnostics. Do not give up on the timely treatment of gastritis, cholecystitis, hepatitis, congenital malformation of the pancreas.

Attending gastroenterologist at least 2 times a year, and not to postpone the hike to a specialist for suspected development of acute pancreatitis. It is always important to remember that only a complete and timely rendered medical assistance to enable fast eliminate all the unpleasant symptoms of acute pancreatitis, lead indicators of blood and urine norm.

If you did not manage to avoid the disease, the analysis should be a periodic submission of, and supervision by a gastroenterologist - a constant.