Acute pancreatitis is an inflammatory-degenerative lesion of the pancreas, caused by various causes and manifested by acute abdominal pain. In relation to acute processes in the abdominal cavity, it ranges from 2.0 to 4% and 0.4-0.6% among surgical pathology. Data on the true prevalence of acute pancreatitis is incomplete, since they are based on the frequency of hospitalization in surgical hospitals for patients with predominantly severe illness. There is every reason to believe that the mild form is not registered and proceeds under a different diagnosis.
Acute pancreatitis in life began to recognize and operate at the beginning of the XX century. However, it was a destructive option. The mild form of pathology began to be correctly diagnosed only in the 1970s. In the last 10 years, the number of cases of acute pancreatitis increased by 3-4 times. It is most common among women (2-3 times more often). About 60% of cases are people who drink alcohol daily for a year or more. More than 50% of patients are 30-45 years old. The acute process subsequently becomes chronic.
The results of treatment of acute pancreatitis remain unsatisfactory. Overall mortality is 3-4%, postoperative - 15-20%, and in the case of destructive damage to the pancreas - 40-50%.
The pancreas is a mixed secretion organ. The bulk of its cells belongs to the excretory. These cells form small segments - acini, from which pancreatic juice enters the main duct (Wirsung) through the small excretory ducts and through it into the duodenum. During the day, the pancreas secretes up to 1.5 liters of juice containing amylase, lipase, trypsin, maltose, lactose, etc.
Mostly in the caudal gland are clusters of endocrine glands - the islets of Langerhans. They have no excretory ducts, and the hormone they produce insulin is absorbed directly into the blood and is involved in carbohydrate metabolism.
All enzymes that affect the splitting of food and metabolism, with the defeat of the pancreas, take part in the "self-digestion" of the body with the development of acute pancreatitis. This is facilitated by diseases of the gallbladder, gastrointestinal duct, obesity, poor circulation of the pancreas, allergic reactions, injuries, infections, poisoning, pregnancy, etc.
Often, acute pancreatitis occurs against the background of biliary tract pathology (gallstones, cicatricial stricture of the common bile duct, spasm of the sphincter of Oddi, etc.). This complicates the flow of bile into the duodenum and leads to an increase in pressure in the common bile duct - biliary hypertension syndrome. When the common bile and pancreatic ducts merge into the common canal before flowing into the duodenum, hypertension leads to the throwing of bile into the pancreatic ducts and causes the activation of trypsinogen with the development of acute pancreatitis. The disease can also provoke stagnant and inflammatory processes in the upper parts of the digestive tract (duodenostasis, gastritis, ulcer). It was also found that the emergence of acute pancreatitis predisposes an imbalance in the system of proteolytic enzymes and their inhibitors.
During the pathology, it is advisable to distinguish the following options: edematous, hemorrhagic pancreatitis, pancreatic necrosis and purulent pancreatitis.
Symptoms characteristic of acute pancreatitis are pain, dyspeptic, inflammatory, peritoneal and dynamic intestinal obstruction. Severe pain in the upper abdomen, radiating to the back, is the main symptom of acute pancreatitis. The relationship between the area of irradiation and the localization of the lesion of the pancreas. Thus, pains in the pancreas and right hypochondrium indicate the pathology of the head and body of the gland, in the epigastrium and left hypochondrium - of the body and tail, under the spoon (as if by a “belt, hoop”) - of the whole organ.
In an edematous form of acute pancreatitis, pain is noted mainly in the upper half, with destruction spreading throughout the abdomen.
Increased irritability of the stomach and duodenum caused by irritation of the solar plexus, followed by paresis of the gastrointestinal tract, leads to indomitable vomiting.
For acute pancreatitis is characterized by intense pain with a relatively soft stomach. As the effusion spreads, tension and a symptom of peritoneal irritation are detected. Pulsation of the abdominal aorta is not detected due to pronounced swelling of the pancreas. In most cases, there is an irradiation of pain in the left shoulder and chest.
In acute pancreatitis, severe tachycardia occurs. Blood pressure in the initial stage of the disease is slightly increased, and as it develops it decreases. Pallor of the skin, weakness, cold sweat. Cyanosis of the face and local cyanosis of the side areas of the abdomen or around the navel are characteristic of advanced forms of acute pancreatitis.
The number of leukocytes and the activity of enzymes in the blood and urine, especially amylases and aminotransferases (ACT, ALT), increase early. The activity of blood trypsin increases, while its inhibitor, on the contrary, decreases. Blood sugar levels are rising.
The clinical picture in acute pancreatitis can be “erased” in normal laboratory conditions. In such cases, it is necessary to monitor the patient dynamically with repeated blood and urine tests and body temperature measurements.
There are many atypical forms of acute pancreatitis that mimic the clinic of various processes in the abdominal cavity. Often, acute pancreatitis is “simulated” by acute cholecystitis. However, the pains in cholecystitis are more pronounced in the right hypochondrium, radiating to the right half of the chest, right shoulder and shoulder blade and not shingles. Increased activity of pancreatic enzymes in the blood or urine is a crucial diagnostic test.
In case of perforated gastric or duodenal ulcer, there is a “dagger” pain, a retracted and tense abdominal wall, which is not involved in the act of movement, as well as the disappearance of hepatic “dullness”. Bradycardia and normal temperature are observed at the onset of the disease. Intoxication does not develop so quickly.
In acute appendicitis, the patient is relatively calm. Often the process begins gradually with pain in the pancreas, less intense than with pancreatitis. In the future, it is more pronounced in the right iliac region. Muscle tension and a positive symptom of Shchetkin - Blumberg appear here.
Acute pancreatitis and food poisoning have a similar clinical picture. However, with the latter, against the background of minor abdominal pain and dyspeptic phenomena, common symptoms prevail: weakness, headache, intoxication. The decisive moment of diagnosis is the high activity of pancreatic enzymes and the epidemiological history.
Acute gastritis occurs with less intense pain, with a relatively satisfactory condition of the patient vomiting is not so painful and brings relief.
Acute intestinal obstruction can "simulate" acute pancreatitis, manifesting itself with vomiting and severe pain. However, they are cramping in nature, increased peristalsis, there is a delay of gases and lack of stool. Radiographically determined horizontal levels in the intestine. Sometimes acute pancreatitis is difficult to differentiate with pulmonary diseases and myocardial infarction. In these cases, ECG and X-ray examination are required.
Patients with suspected acute pancreatitis should be urgently hospitalized to the surgical department. In case of pronounced pain syndrome at the pre-hospital stage, antispasmodic drugs are indicated. In the hospital, a complex drug treatment is carried out, including a bilateral lumbar novocaine blockade, the introduction of polyglucin-novocaine-anti-enzyme mixture, glucose solutions, calcium chloride with vitamins B and C, diuretics, insulin, cardiac antispasmodics and antihistamines, and hunger 2-4 days and anti-infective measures.
With the development of diffuse peritonitis or unsuccessful intensive therapy for 1-2 days shown laparoscopic drainage of the abdominal cavity and, if necessary, advanced surgical intervention. In the first 5-6 days antienzyme preparations should be used (sandostatin, contrycal, etc.). After surgery, it is necessary to conduct intensive treatment in full.
In the absence of intervention after discharge from the hospital, patients should receive medical therapy on an outpatient basis for 10–12 days with a diet.
After destructive pancreatitis, patients are disabled for 2-3 months, during this period the necessary supporting conservative treatment should be carried out, including delagil, pancreatic enzymes.
All patients who have had acute pancreatitis need regular follow-up and annual spa treatment.
(Leonovich S.I., Revtovich M.Yu. BSMU.
Published: "Medical panorama" (number 4, June 2002)
Pancreas and Pancreatitis
One of the largest and most important glands in the human body is the pancreas, which is actively involved in the digestion of food and performs endocrine and exocrine functions. It is this body that produces insulin, which determines the level of sugar in human blood.
A pancreatic juice consists of numerous enzymes necessary for the breakdown of food, involved in the absorption of proteins, fats and carbohydrates:
Any violation of the functionality of the gland leads to serious diseases. In recent years, the number of diseases of the pancreas has increased. And pancreatitis, which is the most common disease, is “younger”.
Inflammatory processes in the pancreas, manifesting themselves to some changes, causing pain and functional dysfunction called pancreatitis.
The pancreas is an extremely vulnerable organ that often suffers from its own enzymes. This occurs on the basis of their premature activation and the flow of bile into the body. The result is inflammatory syndrome and self-destruction.
Inflammation of the pancreas is fraught with irreversible processes and intoxication of the body. Lack of necessary treatment is life threatening in general.
Learn about the causes of the disease in more detail from the proposed video.
Types of pancreatitis
Regardless of the causes of the inflammatory process in the body of the pancreas, pancreatitis is distinguished by the type of its course:
The characteristic signs of acute pancreatitis are the rapid course of pathological processes, both in separate parts of the organ and in the whole gland. The disease in a chronic form develops slowly, without sudden changes in the patient's condition, but in the absence of the necessary treatment, the condition may worsen. Reactive pancreatitis develops on the background of diseases of the gastrointestinal tract and other internal organs during an attack of acute pancreatitis.
Depending on the causes of the disease, acute pancreatitis has several subtypes:
- Alimentary, when the inflammatory process develops due to eating disorders, eating spicy and fatty foods, large doses of alcohol,
- Gastrogenic, provoked by diseases of the digestive tract,
- Ischemic arising on the background of blood clots and atherosclerosis,
- Biliary, which appeared due to diseases of the biliary tract,
- Infectious, the occurrence of which is associated with various infections: mumps, hepatitis,
- Traumatic after injury
- Postoperative, when the disease is the result of major blood loss or operational stress,
- Toxic-allergic, appearing under the influence of toxic fumes of the human body, liquids, gases.
Pancreatitis can develop against the background of any disease, poisoning, medication, mechanical and psychological effects. Any action that can gradually replace the tissue of an organ with adipose or scar tissue, causing necrosis or other complications, is the root cause of pancreatitis.
Causes of acute pancreatitis
Acute pancreatitis is the death of pancreatic cells due to self-digestion. The disease is serious and dangerous. In 15% of cases, patients die despite treatment.
The main causes of the disease are the following factors:
- In 70% of all cases - alcohol intake,
Surgery on the stomach.
- Single cases based on:
- Viral and infectious diseases,
- Obesity and overeating,
- Allergic reactions
- Heavy metal poisoning, medical preparations, paint fumes, agricultural chemicals,
- Congenital genetic abnormalities,
- Ulcer diseases.
Extremely rare causes in cases of acute pancreatitis can be oncology and scorpion bites. The catalyst of the disease is often hyperlipidermia - an abnormal high level of lipids in human blood.
There are risk factors that, under certain conditions, can adversely affect the state of the pancreas, causing disease:
- Helminthic invasion,
- Metabolic disease,
- Vascular pathologies,
- Eating substandard products.
Any of these reasons in the aggregate or alone can cause disease.
Clinical picture and symptoms
Acute pancreatitis is characterized by acute severe pain, accompanied by vomiting. The pain is localized initially in the supracarpular region of the abdomen, girdles, radiates to the heart and left scapula, is accompanied by tachycardia, hypotension, spasms. Vomiting repetitive, indomitable. First, vomit is food, and then bile. Such is the clinic of acute pancreatitis. If the exacerbation is severe, then collapse and shock may occur.
Based on numerous studies, some features of the condition of patients with acute pancreatitis were noted:
- Paleness of the skin,
- Purple spots on the face and body.
Abdominal distention may occur. Often the patient's body temperature rises. Reaching sometimes up to 39 degrees. Often diagnosed as paresis of the colon. There is a delay in stool and difficulty with gas separation. With the formation of hemorrhagic exudate, pleurisy, pericarditis, and kidney damage may occur.
There is a certain classification of clinical forms of acute pancreatitis:
- Edematous, without necrotic changes, peculiar to young patients,
- Hemorrhagic, with a predominance of necrotic processes and hemorrhages, has a high level of lethal outcomes,
- Purulent, with the addition of a secondary infection, is characteristic of elderly patients.
Confirm the diagnosis is possible only on the basis of a full examination, comparing the data analysis and symptoms.
All the main symptoms of acute pancreatitis can be grouped by denoting the following:
- Weakness and malaise
- Decreased appetite
- Nausea turning into vomiting
- Dry skin
- Acute pain, girdling and penetrating,
- Undigested food particles in gag,
- Impaired stool
- Severe tachycardia
- Taste of bile in the mouth,
The main symptom is pain, which persists after vomiting, bowel movements and eating. If against the background of all these signs there is an overstrain of the abdominal muscles, minor hemorrhages in the lumbar region, bloody vomiting and blue limbs, then emergency medical care is needed, as it can be a case of destruction resulting in an unfavorable prognosis for the patient.
How to diagnose inflammation of the pancreas?
Properly collected history - the key to correct diagnosis. It is this one that makes it possible to diagnose the disease in some patients, especially when there are no other instruments for examination.
For a full diagnosis using laboratory and instrumental methods:
- Blood and urine tests,
- Analysis of duodenal contents,
- Stool analysis
- Ultrasound of the digestive tract and abdominal cavity,
- CT and MRI of the pancreas,
All laboratory tests are biochemical testing to determine the state of the secretory function of the pancreas. It clarifies the level of enzymes in the allocation of their gland.
All tests carried out on an empty stomach. A high level of diastase in the blood and urine will confirm the presence of the disease. A degree of severity determines the content of enzymes in the duodenal juice. Ultrasound or echography helps determine the dynamics of the disease, the direction of the process.
Visual examinations help differentiate pancreatitis with other diseases that have similar symptoms. And only an accurate diagnosis allows the doctor to prescribe the correct treatment.
In acute pancreatitis, hospital treatment is indicated. Monitoring the patient’s condition will prevent complications and unexpected negative processes.
The goals of therapy are to relieve pain, restore the gland and its functions.
To do this, reduce the load on the body. If an attack of acute pancreatitis occurs spontaneously, “emergency care” should be called. And before the arrival of the physicians, the patient must be put in, leaving him to take a comfortable position himself and relax. Do not give drugs and food.
It is recommended to moisten the lips, and apply a hot water bottle with cold water to the place of the pain. There are medical and surgical treatment of acute pancreatitis.
Conservative therapy and medications
Drug therapy is indicated for patients with a disease not burdened by other chronic diseases and pathologies.
These measures include:
- Pain relief with spasmolytics and painkillers,
- Creating hypothermia conditions to reduce gland activity using hunger and ice,
- The use of drugs antacids and proton pump inhibitors,
- Deactivating gland enzymes with proteolysis inhibitors,
- The effect of antibiotics for the prevention of infectious diseases,
- Detoxification by cleansing the body,
- Correction of homeostasis.
Conservative treatment, started on time and correctly - this is the first step to the patient's recovery. Often, in 70% of cases, patients manage to avoid surgery, following all the recommendations of the doctor.
In the early days, severe fasting and cleansing of the stomach was recommended. the duration of this “execution” is up to 3 days. With pancreatic necrosis, fasting is prescribed for up to 10 days. This helps to relieve pain and prevent purulent complications. An unlimited amount of clean drinking water and complete rest will help improve your condition.
It is undesirable to use morphine and its analogues, as this will create a spasm of the sphincter of Oddi, which will only increase the growth of pancreatitis. Narcotic analgesics are indicated only for oncological diseases and severe pain.
Most often in the treatment of acute pancreatitis using spasmolytics:
It is possible to use Omnopon and Promedol. Treatment with medications is always complex, so in parallel they use antihistamines, such as Suprastin, Dimedrol, Tavegil, Claritin.
The doctor during drug therapy in severe cases, appoint Insulin, Trassilol, Dissol, vitamin complexes, protein drugs. If the disease has a fatty form, then apply anti-enzymes.
Trental, Reopoliglukin and Reomacrodex are often used to restore blood loss. Depending on the severity of the condition, Heparin, Lasix and Mannitol may be involved.
On the background of fasting, patients receive parenteral nutrition - this is intravenous administration of nutrients.
Conservative treatment involves infusion therapy. These are special solutions that dilute the patient's blood, reducing the level of pancreatic enzymes in the plasma.
To stop vomiting, calcium levels in the blood are increased and antiemetics, such as Rehydron, are used.
If there is no improvement, if the drugs do not give the expected effect, then surgical intervention is prescribed.
When drugs and traditional medicine is powerless, apply a laparotomy. This is penetration into the abdominal cavity in order to remove diseased dead parts of the pancreas.
Operations are prescribed for the detection of the following conditions on the background of pancreatitis:
- Stones in the biliary tract,
- Fluid accumulation around the pancreas,
- The presence of necrosis, abscess and tumors.
In addition to laparoscopy, other methods are used:
- Endoscopic drainage - fluid catheterization, possible with the localization of pathology in the body of the gland,
- Marsupialization of the cyst - partial excision of the formation walls with their subsequent stitching to the peritoneum, recommended for false cysts, suppurations, tumors,
- Cystogastrostomy - is applicable in rare cases when the removal of the damaged part of the gland and cyst cannot be used.
In the postoperative period restorative methods are used, prevention of purulent diseases, sepsis and other complications. The duration of treatment depends on the individual characteristics of the patient, the severity of the disease and the method of treatment.
After treatment, regardless of its type, requires careful attention to health, anchoring therapy, proper nutrition.
Diet, nutrition and lifestyle
Food in acute pancreatitis is based on food restriction, fasting. Food should be light, low-fat, fast-absorbing.
First, in the diet of the patient injected wiped semi-liquid food. These can be cereals, cottage cheese, boiled vegetables, lean meat, mashed soups. In the future, the menu introduces fruits, ordinary soups, weak tea. You can eat eggs, fruit puree and salads.
Spices, chocolate, mushrooms, alcohol and soda are banned. Do not eat fatty foods. Prohibited:
- Smoked meat
- Sour berries and fruits
- Salted and pickled products.
All foods must be steamed or boiled. A good addition would be herbal based teas. With the help of them you can not cure the disease, but you can support the sick organ. The use of marigold, plantain, chamomile, mint, golden whisker will help reduce inflammation.
Mineral treatment-table water without gas will fill up the volume of liquid, normalizes the acid-base balance and improves the condition of the diseased gland. The best choice would be Nabenglavvi, Arkhyz, Borjomi, Borovaya, Kvasova Polyana, Essentuki.
Diet for acute pancreatitis is strict adherence to all recommendations of a nutritionist and a doctor, eating only approved foods and dishes, otherwise the occurrence of complications is fraught.
Complications of acute pancreatitis
The whole danger of acute pancreatitis lies in the possible development of severe complications.
Early complications include:
- Hepatic and renal failure,
- Blood clots
- Mental disorders,
- Internal bleeding
Lack of proper, timely treatment can be fatal. If the inflamed pancreatic tissue is infected by bacteria that live in the human intestine, the result will be necrosis of the gland and abscess.
Against the background of the disease, shock can occur, and in the presence of cardiovascular diseases such a condition of the patient is very dangerous. Shock often results in multiple organ failure.
Necrosis of the gland forms cysts, destroys the structure of the ducts. The outflow from the arisen cysts provokes the occurrence of ascites. There is a possibility of fistula, phlebitis, cancer, blood infection, phlegmon, sepsis.
To avoid serious complications, you need to carefully consider your health, be monitored by a doctor, undergo medical examinations. Only immediate treatment will help to avoid serious consequences.