What is pancreatitis: description and definition of the disease. Most common complications in patients with acute appendicitis
The inflammatory process that occurs in the pancreas is called pancreatitis. The disease is divided into different forms and types:
- acute pancreatitis;
- acute recurrent pancreatitis;
- acute chronic pancreatitis.
Symptoms of an attack of acute pancreatitis
Acute pancreatitis dangerous in that it affects not only the pancreas directly, but also the organs located next to it. Decay products and enzymes are absorbed into the blood, which leads to intoxication (poisoning) of the body. And this is not the only moment why pancreatitis is dangerous.
Such severe poisoning leads to the fact that the heart, brain, kidneys, lungs are affected. Mortality of patients from acute, fulminant pancreatitis is very high.
The main manifestation of acute pancreatitis is dull or cutting pains in a stomach. As the disease progresses, these pains can increase to very severe, sometimes leading the patient into a state of shock.
Pain may be constant, incessant, or characterized by sharp attacks resembling convulsions. Strong and prolonged pain bring a person to exhaustion and are often accompanied by a fear of approaching death, he begins to panic and become depressed.
Usually, pains are localized in the area of the convergence of the ribs (pituitary region), and can be given to left shoulder, under the left costal arch, in the region of the left kidney. But more often than not, they are intrusive. The patient quickly understands.
Sometimes the pain radiates to right shoulder or right side chest. This fact confuses the patient himself and his relatives, because in such a situation one can suspect myocardial infarction, angina pectoris, renal or biliary colic. Other symptoms also appear:
- dry mouth;
- persistent and unrelieved vomiting;
- bloating, gas;
- nausea, belching, hiccups.
Consequences of acute pancreatitis
A common complication of an attack of pancreatitis is:
- the occurrence of an abscess of the stuffing bag;
- sepsis;
- bleeding;
- development of jaundice with compression of the common bile duct;
- peritonitis.
Acute pancreatitis can be fatal, to prevent this, the patient must be immediately hospitalized in a hospital. Acute pancreatitis in severe form, with the presence of complications, is treated only in the Department of Surgery. First, the patient is placed in intensive care.
The blood test shows:
- acceleration of ESR;
- leukocytosis;
- hypo- or hyperglycemia;
- increase in amylase.
The level of amylase also rises in the urine - this is hallmark acute pancreatitis, it is always detected in this analysis.
Plain radiography and ultrasound abdominal region come to light:
- flatulence of the large intestine;
- signs of intestinal paresis;
- fluid in the pleural cavities;
- high standing of the diaphragm;
- enlargement of the inflamed pancreas;
- the presence of abscesses and cysts.
Laparoscopy (examination of the gland through a laparoscope) is prescribed in more severe situations.
An attack of pancreatitis in a mild form - symptoms
With mild pancreatitis, the pains are constant aching in nature, but they are not so sharp and can be tolerated. If the pains are sharp, paroxysmal in nature and resemble convulsions, then this signals a severe form of a pancreatic attack.
This condition is necessarily accompanied by vomiting, which does not bring relief, and vomiting occurs again. There is an increase in body temperature, chills with fever, which are caused by mild intoxication.
The patient has pronounced bloating, which may be accompanied by stool retention or, conversely, diarrhea with gases, he experiences constant discomfort.
Consequences of an attack of mild pancreatitis
After proper treatment, all external signs an attack of mild pancreatitis disappear completely. But a slight swelling of the pancreas develops. IN certain parts it increases in volume, it can be the area of the body, head or tail.
The outcome of such pancreatitis is quite optimistic, since the gland can fully recover both anatomically and functionally, but only if the treatment is correct and timely.
Even if an attack of pancreatitis proceeded in mild form, it is necessary to call a doctor who will stop the swelling in time. You can never predict the outcome of an attack in advance. There are cases when he went from a mild form to a severe one.
Only an immediate stop of its inflammation can lead to a complete restoration of the pancreas.
Chronic pancreatitis
Chronic pancreatitis is a dysfunction of the pancreas, accompanied by a deficiency of secreted pancreatic juice. Over time, chronic pancreatitis can lead to significant deformation of the organ. It can end with calcification or fibrosis of the gland tissue.
What is fibrosis? This is coarsening connective tissue and the appearance of cicatricial changes in various bodies. This pathology usually occurs as a result of chronic inflammation.
Calcification (calcification) - deposition in the tissues of calcium salts dissolved in tissue fluids and blood. Calcification of the walls of the arteries is dangerous by a violation of the function of the vessels supplying the organ with blood.
Chronic pancreatitis develops in 50-70% after an attack of acute pancreatitis, or it is primary (in 30-40%) and develops slowly and gradually, but rather blurred.
Slowly ongoing inflammation of the pancreas is accompanied by gradual violations of its function, which, in the end, leads to digestive disorders in the body.
Exacerbations of chronic pancreatitis
The first and main sign of acute chronic pancreatitis in 80-90% is pain syndrome. Localization of pain occurs in a conditional triangle, which has a vertex on the arch of the ribs (subcutaneous region) and in the left hypochondrium, rarely in the right.
Usually It's a dull pain, increases after eating and often occurs as a result of a violation of the diet, or rather, after eating fried, spicy, fatty and forbidden raw fruits and vegetables.
The pain may also appear at night. With exacerbation of chronic pancreatitis occurs:
- bloating,
- flatulence,
- increased gas production
- rumbling,
- nausea,
- belching.
What is the danger of chronic pancreatitis
Pancreatic necrosis is the main complication of chronic pancreatitis, or rather, the end of the disease. In other words, this is the "death" of the pancreas. How does pancreatic necrosis develop?
A healthy pancreas produces enzymes that are necessary for the processing of carbohydrates, proteins and fats that enter the intestines through the ducts. Due to the formation of stones in the bile ducts, there is no outflow of enzymes, and they return to the pancreas.
As a result, the pressure in the gland increases, and the walls of the organ begin to be digested by enzymes. This is how the development of pancreatic necrosis occurs, and rarely gives a favorable one.
An equally dangerous complication is the development of pancreatic cancer, the risk of this disease increases with an increase in the "experience" of chronic pancreatitis.
Damage to the pancreas increases the likelihood of developing diabetes mellitus, up to its type 1, when insulin production is completely absent and the patient needs replacement therapy.
Acute pancreatitis is an inflammation of the pancreas. The symptoms of pathology primarily include unbearable acute pain in the abdomen. The localization of pain will depend on which part of the gland is inflamed. So, pain can be localized in the epigastric region, in the left or right hypochondrium.
There are options when the pain is girdle in nature. pancreatitis in chronic form accompanied by symptoms such as loss of appetite, indigestion, acute pain that occurs after drinking alcohol, spicy or fatty foods.
In this article, we consider the complications of acute pancreatitis.
Description of the disease
Pancreatitis is a disease that is characterized by the occurrence and development of inflammatory processes affecting the tissues of the pancreas. Pancreatitis can be classified according to the nature of its course into chronic and acute. However, pancreatitis acute form is the third in the ranking of the most common requiring treatment in a hospital setting. Acute appendicitis and acute cholecystitis. Complications of acute pancreatitis can be very serious.
Statistical data
World statistics show that every year up to 800 people out of a million fall ill with such an ailment as acute pancreatitis. Men suffer from this type of pancreatitis much more often than women. The age of the patients is sufficient wide range, and this is directly related to the reasons for which acute pancreatitis arose. If acute pancreatitis arose and developed against the background of excessive alcohol consumption, then average age patients is 39 years old. If the cause of this disease was cholelithiasis, then the average age of patients is at around 69 years.
Pathogenesis and etiology of acute pancreatitis
A variety of factors can contribute to the occurrence of a disease such as acute pancreatitis. Among them:
- Cholelithiasis.
- Bad eating habits.
- Abuse of alcoholic beverages.
- Viral infections, such as the Coxsackievirus.
- Bacterial infection, for example, campylobacter or mycoplasma.
- Injury to the pancreas.
- Taking drugs that contain estrogens, corticosteroids, thiazide diuretics, azathioprine. That is, those medicines that have a pathological effect on the pancreas. Such pancreatitis is drug-induced.
- Surgical interventions that were aimed at treating other diseases of the pancreas and biliary tract.
- Cystic fibrosis.
- genetic predisposition.
- A congenital anomaly that affected the development of the pancreas.
- Diseases of the digestive tract inflammatory nature, including cholecystitis, gastroduodenitis, hepatitis.
Complications of acute pancreatitis can be prevented if pathology is detected in a timely manner.
Provoking factor
In accordance with the most common theory about the causes of pancreatitis, the main factor provoking the development of this disease is cell damage, which is caused by prematurely activated enzymes. If the conditions are normal, then the pancreas produces the enzymes involved in digestion in a reactive state. They are activated directly in digestive tract. If there are internal pathological factors or are influenced by external factors, then the activation of enzymes occurs out of time, in the tissues of the pancreas. The consequence of this is the digestion of the tissues of the pancreas itself. As a result, swelling of the tissues develops, and the vessels of the parenchyma of the gland are damaged. The medical history (acute pancreatitis) is known to all specialists.
If pancreatitis has an acute form, then such a pathological process can affect tissues located in the immediate vicinity of the gland itself, for example, retroperitoneal tissue, omental sac, peritoneum, omentum, intestinal mesentery, liver ligaments may be affected. If acute pancreatitis proceeds in a severe form, then the level of various biologically active substances in the blood increases sharply. active substances. This leads to severe disturbances in the functioning of the body. Secondary inflammatory processes, dystrophic disorders may occur various organs and tissues, eg heart, kidney, lung, liver.
These manifestations are complications of acute pancreatitis.
Disease classification
Acute pancreatitis can be classified according to the severity of its course:
- Mild pancreatitis causes minimal damage to tissues and organs. It is expressed mainly by interstitial edema of the pancreas itself. Therapy lends itself quite easily, the prognosis is very favorable, implying a quick and complete recovery.
- Acute pancreatitis, which occurs in severe form, causes significant and severe disorders of tissues and organs. It is also characteristic local complications, which include tissue necrosis, infection, abscesses, cysts.
Acute liver failure in severe form may be accompanied by:
- Acute accumulation of fluid in the tissues of the gland or in the peripancreatic space that does not have granulation or fibrous walls.
- Acute pseudocyst, which is an accumulation of pancreatic juice, which is surrounded by a fibrous wall or granulations and resulting from an attack of the disease. The development of such a cyst occurs over four to six weeks.
- Pancreatic abscess, which is a collection of pus in the tissues of the pancreas and tissues that are in close proximity to it.
- Pancreatic necrosis leading to tissue infection. There is a diffuse or limited area of the parenchyma, which begins to die. If infection attaches and purulent pancreatitis begins to develop, the likelihood of death increases significantly.
Below we will talk about the history of acute pancreatitis in more detail.
Symptoms
TO characteristic symptoms acute pancreatitis can include:
- Pain syndrome. Pain may have epigastric localization, may be observed in the left hypochondrium, be shingles in nature, it is possible to radiate under the left shoulder blade. Pain in acute pancreatitis is pronounced and permanent. If the patient is in the supine position, the pain increases significantly. The pain also increases after taking spicy, fatty or fried foods, after drinking alcohol.
- Feeling of nausea, vomiting. At the same time, vomiting is most often indomitable, contains a large amount of bile, and does not bring relief.
- Jaundice of the sclera. It is expressed most often moderately. In rare cases, jaundice may appear on the skin.
In addition, acute pancreatitis may be accompanied by dyspeptic symptoms. These include flatulence, bloating, heartburn. Manifestations on the skin are not excluded, for example, hemorrhages located in the navel, spots on the body that have a bluish color.
How is acute liver failure diagnosed in a person?
Diagnosis of the disease
Gastroenterologists carry out the procedure for diagnosing pancreatitis, based on the patient's complaints and physical examination. The latter allows you to identify specific symptoms.
What tests are done for pancreatitis?
During the procedure for measuring pulse and blood pressure, tachycardia and hypotension are detected. To confirm the diagnosis, various laboratory tests of urine and blood, ultrasound of the organs located in the abdominal cavity, MSCT, MRI of the pancreas are carried out.
In case of acute edematous pancreatitis during a blood test general analysis shows signs inflammatory process(there is an acceleration of ESR, the level of leukocytes increases). Biochemical analysis detects increased activity of pancreatic-type enzymes (lipase and amylase). Hypocalcemia and hyperglycemia are not excluded. In addition, the level of concentration of enzyme compounds in the patient's urine should be determined. Possible manifestations of bilirubinemia, increased activity of liver enzymes.
Allows you to determine the activity of amylase in the urine.
It is necessary to conduct a visual examination of the pancreas, as well as organs in the immediate vicinity. A similar study is carried out through CT, ultrasound, MRI. It allows you to detect a pathological change in the parenchyma, cysts, abscesses, stones in the ducts, an increase in the gland.
Treatment
If acute pancreatitis is detected, the patient is hospitalized, followed by bed rest. The main goal of the treatment is to eliminate the pain syndrome, stimulate the processes of self-healing, reduce the load that falls on the pancreas.
Therapeutic treatments include:
- novocaine and antispasmodic blockade, the main purpose of which is to relieve too pronounced pain syndrome;
- the use of deactivators of pancreatic enzymes (inhibitors of proteolysis);
- conducting detoxification therapy;
- the use of antibiotic therapy to prevent complications of an infectious type; most often used drugs that have a wide spectrum of action, but in large dosages;
- fasting, applying ice to the area where the gland is located in order to create local hyperthermia.
Surgical treatment is prescribed in the following cases:
- in the presence of ;
- accumulation of fluid around the gland or in it;
- the occurrence of cysts, necrosis, abscesses.
In acute pancreatitis, endoscopic drainage, cystogastrostomy, and marsupialization of the cyst may be indicated. If necrosis has formed, then, depending on its size, the doctor may prescribe a necrectomy or an operation to resect the pancreas. Stones can cause duct surgery.
Possible Complications
Acute pancreatitis is dangerous for its possible consequences and complications. If there is an infection of the tissue that is inflamed, then the occurrence of necrosis and abscesses is not excluded. If you do not carry out timely treatment, then a fatal outcome is possible.
If the disease is severe, it is possible to develop state of shock with pancreatitis and multiple organ failure.
The result of the development of acute pancreatitis may be the formation of pseudocysts, the rupture of which is fraught with the occurrence of ascites.
Diet for pancreatitis: menu for the week
With exacerbation of pancreatitis in the first day or two, you must observe starvation diet, two glasses of rosehip broth are allowed, up to 1 liter of alkaline mineral water. In severe cases, nutrition is only drip intravenously.
With pancreatitis, diet No. 5p is shown, which consists of several options.
Below we give sample menu for a week with pancreatitis of the pancreas.
- For breakfast, you can eat meat (chicken or beef), steamed. Drink rosehip broth or weak tea.
- For a second breakfast, oatmeal with milk is served, washed down with a decoction or infusion of wild rose.
- For lunch - soup-puree of carrots and potatoes. You can eat steamed fish. Dried fruits compote.
- For an afternoon snack - fruit puree (apple or pear).
- Dinner should include a piece of boiled chicken, vegetable stew and weak tea.
- Before going to bed, drink a glass of kefir.
- Early. They can develop in parallel with the onset of the first symptoms of acute pancreatitis. They are caused by the release of pancreatic enzymes into the bloodstream, their systemic action and dysregulation of vascular function.
- Late. Usually occur after 7-14 days and are associated with the addition of an infection.
Early Complications acute pancreatitis:- hypovolemic shock. It develops as a result of a sharp decrease in blood volume due to inflammation and toxic effect pancreatic enzymes. As a result, all organs cease to receive required amount oxygen, develops multiple organ failure.
- Complications of the lungs and pleura: « shock lung », respiratory failure, exudative pleurisy(inflammation of the pleura, in which fluid accumulates between its sheets), atelectasis(collapse) of the lung.
- Liver failure. In mild cases, it manifests as slight jaundice. In more severe develops acute toxic hepatitis. Liver damage develops as a result of shock and toxic effects enzymes. Patients who already suffer from chronic diseases of the liver, gallbladder, and biliary tract are most at risk.
- kidney failure. It has the same causes as liver failure.
- Impaired function of cardio-vascular system (cardiovascular failure).
- . Causes: stress ulcer, erosive gastritis (a form of gastritis, in which defects form on the gastric mucosa - erosion), ruptures of the mucous membrane at the junction of the esophagus into the stomach, a violation of blood clotting.
- Peritonitis- Inflammation in the abdominal cavity. In acute pancreatitis, peritonitis may be aseptic(inflammation without infection) or purulent.
- Mental disorders . They occur when the brain is damaged against the background of intoxication of the body. Typically, psychosis begins on the third day and continues for several days.
- Formation of blood clots in blood vessels.
Late complications of acute pancreatitis:- Sepsis (blood poisoning). The most severe complication, which often leads to the death of the patient.
- Abscesses (pustules) in the abdominal cavity.
- Purulent pancreatitis. Is separate form disease, but may be considered as a complication.
- Pancreatic fistulas - pathological communications with neighboring organs. Most often, they form at the site of the operation, where the drains were installed. As a rule, fistulas open into nearby organs: stomach, duodenum, small and large intestine.
- Parapancreatitis- purulent inflammation of the tissues around the pancreas.
- Necrosis (death) of the pancreas.
- Bleeding in internal organs.
- Pseudocysts of the pancreas. If the dead tissue is not completely absorbed, a connective tissue capsule is formed around it. Inside may be sterile contents or pus. If the cyst communicates with the pancreatic ducts, it may resolve on its own.
- Tumors of the pancreas. The inflammatory process in acute pancreatitis can provoke the degeneration of cells, as a result of which they will give rise to tumor growth.
Does acute pancreatitis happen in children? How is it manifested?
Acute pancreatitis occurs not only in adults, but also in children. Causes that can lead to a disease in a child:- Anomalies in the development of the ducts of the pancreas, gallbladder and bile ducts, duodenum.
- Blunt abdominal trauma.
- Worms (for example, ascariasis).
- Binge eating.
- Non-compliance with the diet.
- Eating spicy, fatty, chips, crackers with spices, soda, fast food products.
- Violation of the development of connective tissue.
- Hypothyroidism (decreased thyroid function).
- Cystic fibrosis is a hereditary disease characterized by impaired function of the pancreas and other external secretion glands, lungs.
- various infections.
What is the prevention of acute pancreatitis?
| What do we have to do? | What should be avoided? |
 |
|
Is it possible to provide first aid for acute pancreatitis before the doctor arrives?
| What do we have to do? | What can not be done? |
 |
|
Are there effective folk remedies for acute pancreatitis?
Acute pancreatitis - acute surgical pathology. It can lead to severe complications, up to the death of the patient. A successful outcome depends on timely correct treatment.No folk remedy can replace full treatment in the hospital. Moreover, with the inept use of medicinal plants and other means, it is possible to harm the patient, aggravate the severity of his condition. By self-medicating and putting off calling the ambulance, you can lose time.
What diseases can resemble acute pancreatitis?
Symptoms of acute pancreatitis may resemble other diseases. Only a doctor can establish a diagnosis after examining the patient, conducting additional studies and tests.
Diseases that may resemble acute pancreatitis:
- Acute cholecystitis- inflammation of the gallbladder. It starts gradually. It manifests itself in the form of cramping pains under the right rib, which are given to the right shoulder, under the shoulder blade, yellowness of the skin, nausea, vomiting.
- Perforation of a gastric or duodenal ulcer- a condition in which a through hole appears in the wall of an organ. There is a strong acute pain in the upper abdomen (sometimes it is compared with a "dagger strike"), nausea, and a single vomiting. The abdominal muscles become very tense. As a rule, before this, the patient has already been diagnosed with an ulcer.
- Intestinal obstruction. This condition may be due to different reasons. Manifested by a gradual increase in colic, cramping abdominal pain, lack of stool, vomiting with bad smell.
- Intestinal infarction. Occurs when blood flow is interrupted mesenteric vessels that feed the gut. There is an acute cramping pain in the abdomen, nausea, vomiting, there is no stool. Typically, these patients have previously suffered from cardiovascular disease.
- Acute appendicitis- inflammation of the appendix ( appendix). Gradually, pain in the abdomen increases, which then shifts to its lower right part, nausea and tension in the abdominal muscles occur. The body temperature may rise slightly.
- myocardial infarction. Usually characterized by chest pain, but may present atypically, such as severe pain in a stomach. The patient becomes pale, shortness of breath appears, cold sticky sweat. Final Diagnosis established after an ECG.
- Pinched diaphragmatic hernia. A diaphragmatic hernia is a condition in which part of the stomach and/or intestines is pushed up through the diaphragm and into the chest. Usually, pinching occurs during physical exertion, there is a sharp pain in the chest and abdomen, which spreads to the arm, under the shoulder blade. The patient lies on his side and pulls his knees to his chest, his blood pressure drops, he becomes pale, protrudes cold sweat. When the stomach is pinched, vomiting occurs.
- food poisoning. A disease in which bacteria become contaminated with toxins, usually through food. There is pain in the abdomen, diarrhea, general deterioration.
- Lower lobe pneumonia- inflammation in lower sections lungs. The body temperature rises, there is pain in the chest sometimes in the stomach. A dry cough appears, which after 2 days becomes wet. Shortness of breath occurs, the general condition of the patient worsens.
What is the Atlanta classification for acute pancreatitis?
The most common classification of acute pancreatitis, adopted in the American city of Atlanta (Georgia) in 1992. Today, doctors from many countries are guided by it. It helps to determine the severity of the disease, the stage of the course of the process, the nature of the pathological changes occurring in the pancreas, to correctly build a prognosis and take the right decision about the treatment.International classification of acute pancreatitis, adopted in Atlanta:
| Pathological processes occurring in the pancreas | 1. Acute pancreatitis:
3. Pancreatic necrosis(death of pancreatic tissue):
5. Pancreatic abscess (abscess). |
| Condition of the pancreas |
|
| Spread of necrosis into pancreatic tissue |
|
| The course of the disease |
|
| Disease periods | 1. Violation of blood circulation, shock. 2. Dysfunction of internal organs. 3. Complications. |
What is acute postoperative pancreatitis?
Postoperative pancreatitis occurs after surgery on the pancreas and other organs. Depending on the causes, there are two types of postoperative pancreatitis: - Traumatic. It is caused by damage to the pancreas or its vessels during surgery. Most often, injury occurs when surgical interventions on the gland itself, on the stomach, duodenum, liver and gallbladder, less often - during operations on the intestines.
- non-traumatic. It is due to other reasons, when the functions of the pancreas and neighboring organs are disturbed after the operation.
Symptoms, diagnosis and treatment of postoperative pancreatitis are the same as for other varieties. It is often difficult for a doctor to immediately establish a diagnosis due to the following factors.:
- it is not clear whether the pain is caused by the operation itself, or by damage to the pancreas;
- due to the use of painkillers and sedatives, the symptoms are not so pronounced;
- after surgery, many complications can occur, and it is far from always possible to immediately understand that the symptoms are associated specifically with the pancreas.
What are the prognosis for acute pancreatitis?
The outcome of the disease depends on the form of acute pancreatitis.The best prognosis is observed with edematous form. Usually such acute pancreatitis resolves on its own, or under the influence of drug therapy. Less than 1% of patients die.
The prognosis for pancreatic necrosis is more serious. They lead to the death of 20%-40% of patients. Purulent complications further increase the risks.
With the advent modern technologies prognosis for patients with acute pancreatitis has improved. Thus, when using minimally invasive technologies, mortality is 10% or less.
What is the difference between chronic pancreatitis and acute pancreatitis?
Unlike acute pancreatitis, chronic pancreatitis lasts for a long time. Its main reason is alcohol consumption. Sometimes the disease develops against the background of gallstone disease. The mechanism of development of chronic pancreatitis, as well as acute, is not yet fully understood. If, in the acute form, the gland tissue is mainly damaged by its own enzymes, then in the chronic form, the glandular tissue is replaced by scar tissue.
Chronic pancreatitis most often proceeds in waves: during an exacerbation, the symptoms are most pronounced, and then remission, improvement.
Chronic pancreatitis is usually treated medications. If there are certain indications, you have to resort to surgery.
Is blood purification used in acute pancreatitis?
Plasmapheresis, or blood cleansing, is a procedure during which a certain amount of blood is taken from the patient, purified, and then returned back to vascular bed. Typically, plasmapheresis is used to remove toxic substances from the bloodstream. Indications for plasmapheresis in acute pancreatitis:
- Immediately upon admission to the hospital. In this case, you can "catch" acute pancreatitis at the edematous stage and prevent more severe disorders.
- With the development of pancreatic necrosis.
- With severe inflammatory response, peritonitis, dysfunction of internal organs.
- Before surgery - in order to relieve intoxication and prevent possible complications.
Contraindications to plasmapheresis in acute pancreatitis:
- Severe damage to vital organs.
- Bleeding that cannot be stopped.
Is minimally invasive treatment possible for acute pancreatitis?
In acute pancreatitis and its complications, minimally invasive operations can be used ( laparoscopy – surgical operations in which the surgeon makes a small incision and inserts into abdominal cavity special endoscopic instruments). Minimally invasive interventions have advantages over conventional operations through an incision. They are just as effective, but at the same time, tissue injury is minimized. With the introduction of minimally invasive surgical technician the results of treatment of acute pancreatitis have improved significantly, patients have become less likely to die.
What is rehabilitation after acute pancreatitis?
The duration of hospital treatment for acute pancreatitis may be different, depending on the severity of the course, complications.If there are no complications, then the patient is in the hospital for 1-2 weeks. After discharge, it is necessary to limit physical exercise within 2-3 months.
If the patient has complications after the operation, hospital treatment will be longer. Sometimes acute pancreatitis can lead to disability, the patient can be assigned group I, II or III.
Sanatoriums and resorts that are best suited for such patients:
| Resort name | Description |
| Morshyn | Resort town in the Lviv region of Ukraine. Basic healing factor- mineral water. Patients are treated here chronic diseases intestines, stomach, pancreas, kidneys. Basic Treatments:
 |
| Truskavets | Another resort in the Lviv region. On its territory there are a large number of healing springs and rehabilitation centers. People come here to treat diseases of the liver, stomach, pancreas, cardiovascular and genitourinary systems. Healing factors:
|
| Caucasian mineral waters | They represent the Caucasian-Mineral Water agglomeration, which unites resort cities:
Healing factors:
 |
What are the severity levels of acute pancreatitis? How to define them?
Doctors rate the severity of acute pancreatitis using the Ranson Scale, developed in 1974. Immediately after hospitalization and 48 hours later, a number of indicators are evaluated. The presence of each of them adds to general assessment 1 point:| Immediately upon admission | ||
| Age | Over 55 years old | |
| Blood glucose level | More than 11.1 mmol / l | |
| The level of leukocytes in the blood | More than 16,000 in mm 3 | |
| The level of lactate dehydrogenase (LDH) in the blood | More than 350 IU/l | |
| The level of aspartate aminotransferase (AST) in the blood | More than 250 IU/l | |
| After 48 hours | ||
| Hematocrit (ratio of red blood cells to total blood volume) | Less than 10% | |
| Plasma calcium level | Less than 2 mmol/l | |
| Metabolic acidosis (acidification of the blood) | ||
| The level of urea nitrogen in the blood | An increase of 1.8 mmol / l compared with the level that was at admission | |
| Partial pressure of oxygen in the blood | Less than 60 mm. rt. Art. | |
| Excess fluid retention in the body | More than 6 l | |
Interpretation of results:
- Less than 3 points – easy current. The prognosis is favorable. The probability of death is no more than 1%.
- 3 - 5 points– severe course. The probability of death is 10-20%.
- 6 points or more- severe course. 60% chance of death.
The clinical course of AC and the prognosis with the development of its complications are significantly worse.
One of the most common complications of AC is the formation perivesical infiltrate, as a rule, on the 3-4th day of the disease due to the transition of the inflammatory process beyond serous membrane walls of the HP. Its characteristic features are Blunt pain, the presence of a dense tumor-like formation with fuzzy contours in the right hypochondrium. With the progression of the disease, a perivesical abscess develops, which is clinically manifested by a deterioration in the general condition of the patient, an increase in body temperature, fever, and progressive intoxication.
Biliary peritonitis
Biliary peritonitis is one of the most severe complications OH. Of his many classifications, the most accepted and recognized is the one based on two criteria: clinical and anatomical.
In accordance with this classification, two forms of biliary peritonitis are distinguished:
■ perforated, developing as a result of inflammatory destruction and perforation of the wall of the gallbladder, mainly in the region of its bottom, where the blood supply is the least intense, or due to the development of a decubitus of the wall of the gallbladder or bile ducts, caused by bile calculi.
■ Biliary peritonitis as a result of diffusion (filtration) of bile into the abdominal cavity through the wall of the gallbladder due to its inflammatory or destructive changes.
Perforated biliary peritonitis
This complication develops in 3-5% of cases, manifesting itself as clinical signs of a catastrophe in the abdominal cavity. Perforation of the gallbladder occurs in the presence of gangrenous changes in its wall in patients hospitalized with a significant delay, with an unreasonably long observation period or conservative treatment in a hospital, due to a decrease in the protective and plastic properties of the peritoneum, etc. With late hospitalization, especially in patients with advanced and old age, the moment of perforation may be skipped.
As a rule, perforation is manifested by a sudden increase in pain, an increase in its intensity, the appearance of symptoms of peritoneal irritation in the right hypochondrium, followed by its spread along the right flank. At the time of perforation, especially with empyema of the gallbladder, the development of collapse is possible. Perforation can occur in adjacent organs (stomach, duodenum, small intestine, and others) with regression of clinical symptoms or in the greater omentum, followed by the development of a subhepatic or paravesical infiltrate and/or abscess. U 70-75 % patients, complications appear on the 3-4th day of the disease.
In the genesis of further clinical course pathological process, the following factors are essential:
- 1. The nature of the contents of the gallbladder (infected bile, pus, mucus, fibrin), its quantity, the rate of expiration.
- 2. Place of bile outflow (free abdominal cavity, into the area of paravesical infiltrate with subsequent development of paravesical abscess, into the retroperitoneal space).
- 3. The patient's condition (age, nature of the underlying disease, concomitant diseases).
Clinical manifestations bile peritonitis are characterized by two groups of symptoms - general and local.
local signs with perforated bile peritonitis are clearly expressed in most patients. Among them are tension in the muscles of the anterior abdominal wall, a positive Shchetkin-Blumberg symptom in the right hypochondrium, bloating, the presence of an enlarged painful gallbladder or infiltrate in the right hypochondrium during palpation, weakening or absence of intestinal motility. IN early diagnosis bile peritonitis, an important criterion is the predominance of general symptoms over local ones. With severe biliary peritonitis, changes in peripheral blood.
Common signs of biliary peritonitis include: short-term hyperthermia followed by a critical decrease in body temperature after 8-12 hours. or, conversely, sudden hyperthermia with fever and jaundice, which is alarm signal, indicating the development of purulent cholangitis, abscess formation in the area of bile accumulation; signs of cardiovascular (hemodynamic disturbances, cardiac arrhythmias, which is especially dangerous for patients with hypertensive, coronary heart disease), respiratory (shortness of breath, increased respiratory rate, cyanosis of the skin of the face, limbs, visible mucous membranes), hepatic-renal (usually develops on the 3rd-5th day of the disease and is manifested by encephalopathy, increasing weakness, lethargy, adynamia, etc.) insufficiency. Often there is progressive jaundice with relative bradycardia, a decrease in diuresis. According to laboratory research elevated levels of bilirubin, residual nitrogen, urea, transaminase activity, etc.
With bile effusion peritonitis in most patients, the course of the disease is more favorable, with a predominance of early local symptoms. Only in late stage diseases join more severe clinical manifestations bile peritonitis, hepatic and renal insufficiency of varying severity (in 60% of patients).
Acute inflammation of the pancreas is a serious and dangerous pathology which often leads to irreversible consequences. The basis of the disease is the aggressive effect of its own enzymes on the tissue of the organ.
Depending on the type and prevalence, there are various complications acute pancreatitis, the occurrence of which increases the risk lethal outcome up to 32%.
The disease usually proceeds with bright clinical picture and typical changes in laboratory tests and functional methods research. Classic Symptoms acute inflammation- this is severe pain in the abdomen, repeated vomiting, general intoxication of the body and loose frequent stools.
Depending on the timing of the onset of complications of acute pancreatitis:
- Early - appear in the first days of the disease, have an extremely severe course and an unfavorable prognosis. Their cause of occurrence is the entry of a huge amount of enzymes into the peripheral blood, the development of severe intoxication of the body. These include:
- early bleeding from vessels, organs of the digestive tract;
- acute renal and hepatic insufficiency;
- pain, hemorrhagic or toxic shock;
- acute thrombosis of large vessels;
- intoxication psychosis - delirium;
- diffuse enzymatic peritonitis, pleurisy, pneumonia;
- jaundice.
- Late - occur after 10-14 days from the onset of the disease. To a greater extent associated with the addition of bacteria. There are the following complications of an inflammatory and purulent nature:
- abscesses of the liver, pancreas, abdominal cavity;
- fistulas;
- purulent or parapancreatitis (involvement in the process of fatty tissue surrounding the organ);
- phlegmon;
- pylephlebitis;
- gastrointestinal bleeding;
- cystic lesions of the gland.
Any complication requires careful diagnosis and the appointment of timely rational therapy with conservative or operational way otherwise there is a high risk of death.
Characteristics of the most frequent complications
As a result of inflammation of the pancreas, not only its destruction occurs, but also the involvement of nearby organs and structures in the process, the destruction of blood vessels and the massive release of enzymes into the systemic circulation.
ARROSIVE BLEEDING
Arrosion of the vessel
This complication usually occurs after surgical interventions removal of large necrotic foci. Bleeding occurs from large feeding vessels located near the pancreas (splenic, mesenteric arteries, small arteries of ligaments).
The clinical picture depends on the degree and duration of blood loss. The patient has weakness constant dizziness, a sharp darkening of the eyes, tinnitus and conspicuous pallor of the skin. In the peripheral blood, anemia and thickening are detected. Treatment consists of ligation and tamponade of the bleeding vessel.
For cupping this complication use endovascular techniques to stop bleeding. Thus, a small operating field and more short time recovery period.
RENAL AND LIVER INSUFFICIENCY
The mechanism of development is that severe intoxication inhibits the functional activity of the liver, therefore, it becomes unable to perform its detoxification function. The kidneys react to this, which intensively filter the blood, which contains a high concentration of toxins and enzymes.
Multiple organ failure in pancreatitis is manifested by an increase in liver size, dryness, yellowing of the skin, lethargy, increased systemic pressure, polyuria, or vice versa - urinary retention. Corresponding changes are found in clinical analyzes(high numbers of urea, creatinine, liver enzymes, bilirubin, decrease in total protein).
The main therapy consists in stopping the inflammation of the gland, conducting detoxification therapy (glucose 10%, saline solutions, albumin, rheosorbilact), intravenous administration proteolysis inhibitors, hepatoprotectors. Rarely, patients require hemodialysis.
STATE OF SHOCK
Often occurs in acute pancreatitis complication in the form of shock. It can be the result of unbearable pain, severe intoxication or volumetric blood loss, especially in the hemorrhagic form.
The condition is deteriorating significantly. The pain syndrome increases, the skin becomes gray-earthy, there is a pronounced tachycardia and a decrease in systemic pressure to critical numbers. Breathing becomes shallow and rapid, urine output slows down, the patient becomes nervously excitable.
Used in treatment infusion therapy aimed at restoring the volume of circulating blood and blood pressure, glucocorticoid hormones, if necessary - Mezaton, Dopamine, Epinephrine (these drugs quickly increase systemic pressure). Everything is done in the intensive care unit.
PERITONITIS
In some cases, against the background of severe inflammation of the pancreas, enzymatic peritonitis develops. The released enzymes damage not only the gland, but also adjacent organs, the wall of the abdominal cavity.
With the development of peritonitis in acute pancreatitis, the patient's condition deteriorates sharply and a clinic of "acute abdomen" appears:
- sharp diffuse pain in the abdomen;
- nausea and vomiting;
- forced position in bed;
- blanching and dry skin;
- drop in blood pressure;
- positive tests of irritation of the peritoneum.
If the patient is not provided with timely assistance, then with highly likely death will occur within 1-2 days.
Treatment of peritonitis consists in the sanitation of the abdominal cavity, the introduction of drainage and antibacterial agents.
ABSCESSES AND FISTULAS
Fistulography procedure
Postnecrotic complications of acute pancreatitis are abscesses and fistulas that form when bacterial infection. An abscess is an encysted collection of pus, while a fistula is the formation of an abnormal channel between two organs or an organ and the abdominal wall. Therefore, there are external and internal fistulas.
Such patients begin to have a high fever and complain of abdominal pain. Over time, the manifestations of intoxication increase even more: the skin becomes pale and dry, tachycardia develops, facial features become sharper. Peripheral blood shows high leukocytosis, neutrophilia, accelerated ESR, an increase in the level of C-reactive protein (acute phase indicator) and procalcitonin.
Abscesses or fistulas can be detected using ultrasound scanning and fistulography (contrast injection into an external fistula followed by an X-ray).
Treatment is only surgical - excision of the abscess and suturing the canal. Then the peritoneal cavity is sanitized and drains are installed for a while. Systemic antibiotic therapy is also prescribed.
PHEGMON AND PURULENT TYPE
Phlegmon is a typical complication of infected pancreatic necrosis. Purulent fusion of fiber develops near the pancreas, and the process can spread up to the small pelvis. Purulent pancreatitis of the pancreas - common late complication a disease that carries a strong threat to life due to bacterial inflammation of the organ.
In both cases, symptoms of intoxication (hectic fever with chills, pallor or acrocyanosis, palpitations) and dysfunction of vital organs (kidneys, liver) progress rapidly. Retroperitoneal phlegmon is the leading cause of death from pancreatitis.
Treatment consists in the revision of the abdominal organs, the maximum removal of necrotic foci and masses, and drainage. Glucose-salt solutions, inhibitors of proteolytic enzymes and a wide range of antibiotics are administered intravenously.
PANCREAS CYSTS
What do cystic formations look like?
In the place where there was a heart attack, or necrosis, of the pancreas, one or more cysts may form. This is a round cavity formation, often with fluid of various origins (transudate, pus, blood).
The danger lies in the fact that suppuration of the cyst is possible, followed by its rupture and the release of the contents into the abdominal cavity. Consequently, peritonitis will develop, with an unfavorable course - a septic state (hit a large number toxins into the bloodstream).
Uncomplicated cysts may long time do not manifest itself, only occasionally causing discomfort in the abdomen. If they become inflamed, then an intoxication syndrome joins, intense pain in epigastric region, lower back.
Diagnosis consists of ultrasound, computed tomography. In some cases, conservative management of pathology (antibiotics, anti-inflammatory drugs, physiotherapy) is possible. For large cysts, percutaneous drainage is performed, complicated formations are removed laparoscopically.
