Acute pancreatitis not only delivers physical torment, sometimes intolerable, to patients, but also can threaten their lives. Some patients can be saved only with timely surgical intervention.
Acute pancreatitis is an inflammation of the pancreas. Symptoms of pancreatitis: acute and intolerable pain in the abdomen. Depending on what part of the gland is inflamed, pain localization is possible in the right or left hypochondrium in the epigastric region, the pain may be shingling. Chronic pancreatitis is accompanied by a loss of appetite, a violation of digestion, acute pain that occur after consuming fatty, spicy food or alcohol.
Pancreatitis is a disease characterized by the development of inflammation in the tissue of the pancreas. By the nature of the course, pancreatitis is divided into acute and chronic. Acute pancreatitis ranks third among diseases of the abdominal cavity of the acute course requiring treatment in a surgical hospital. The first and second place is occupied by acute appendicitis and cholecystitis.
According to world statistics, 200 to 800 people out of a million fall ill with pancreatitis. This disease is more common in men. The age of patients varies widely and depends on the causes of pancreatitis.
Etiology and pathogenesis
In the development of inflammation of the pancreas according to the most common theory, the main factor is cell damage by prematurely activated enzymes. Under normal conditions, digestive enzymes are produced by the pancreas in an inactive form and are activated already in the digestive tract. Under the influence of external and internal pathological factors, the mechanism of production is disrupted, enzymes are activated in the pancreas and digestion of its tissue begins. The result is inflammation, swelling of the tissue develops, parenchyma vessels of the gland are affected.
Pathological process can spread to nearby tissues. The severe form of acute pancreatitis promotes a sharp increase in the level of various biologically active substances in the blood, which leads to pronounced common impairments in vital activity: secondary inflammation and dystrophic disorders in tissues and organs – lungs, liver, kidneys and heart.
Acute pancreatitis is classified by severity:
- Mild pancreatitis occurs with minimal damage to organs and systems, is expressed mainly by interstitial swelling of the gland, is easily amenable to therapy and has a favorable prognosis for rapid recovery;
- Severe form of acute pancreatitis is characterized by the development of severe disorders in organs and tissues, or local complications (tissue necrosis, infection, cysts, abscesses).
- Pain syndrome. The pain can be localized in the epigastrium, the left hypochondrium and irradiate under the left scapula. Pain has a pronounced permanent character, it becomes worse in the supine position. Pain is also intensified after eating, especially – fatty, spicy, fried, alcohol.
- Nausea, vomiting. Vomiting can be indomitable, contains bile, does not bring relief.
- Increased body temperature.
- Moderate icteric sclera. Rarely, mild jaundice of the skin.
In addition, acute pancreatitis can be accompanied by dyspeptic symptoms (bloating, flatulence, heartburn), skin manifestations (bluish spots on the body, hemorrhages in the navel area).
Gastroenterologists diagnose pancreatitis on the basis of complaints, physical examination and identification of characteristic symptoms. When measuring blood pressure and pulse, hypotonia and tachycardia are often noted. The diagnosis is conformed with laboratory tests of blood and urine, MSCT and ultrasound of the abdominal cavity organs, MRI of the pancreas.
When examining the blood in a general analysis signs of inflammation (accelerated ESR, increased white blood cell count) are noted, an increase in the activity of pancreatic enzymes (amylase, lipase), possible hyperglycemia and hypocalcaemia – in the biochemical analysis of the blood. Also, it is important to determine the concentration of enzymes in the urine. Bilirubinemia and increased activity of hepatic enzymes can be noted.
When diagnosing this disease, a biochemical analysis of urine is taken and the activity of urine amylase is determined. Visual examination (ultrasound, CT, MRI) allows the specialist to reveal pathological changes of the parenchyma, increase the organ in the volume, detect abscesses, cysts, presence of stones in the bile ducts.
First of all, hospitalization is indicated. Bed rest is prescribed to all patients. The main goals of therapy are to relieve the pain syndrome, reduce the load on the pancreas and stimulate the mechanisms of its self-healing.
- novocain blockade and antispasmodics to relieve severe pain syndrome;
- hunger, ice on the projection area of the gland (creating local hypothermia to reduce its functional activity);
- pancreatic enzyme deactivators (proteolysis inhibitors);
- necessary correction of homeostasis (water-electrolyte, acid-base, protein balance) by infusion of salt and protein solutions;
- detoxification therapy;
- antibiotic therapy (broad-spectrum drugs in large dosages) as prevention of infectious complications.
Surgical treatment is indicated in case of detection:
- stones in the bile ducts;
- accumulation of fluid in or around the gland;
- areas of pancreatic necrosis, cysts, abscesses.
Prophylaxis and prognosis
Primary prophylaxis is a rational healthy diet, the exclusion of alcohol, acute, oily, abundant food, and non-smoking. Acute pancreatitis can develop not only in individuals who regularly abuse alcohol, but also as a consequence of a single intake of alcohol-containing drinks for fatty, fried and hot snacks in large quantities.
The prognosis depends on its form, the adequacy of therapy and complications. The mild form of pancreatitis usually gives a favorable prognosis and a high probability of a lethal outcome with necrotic and hemorrhagic pancreatitis. Insufficient treatment and failure to follow medical recommendations on diet and regimen can lead to recurrence of the disease.