Acute pancreatitis: symptoms, treatment and diet, causes of the disease and possible complications. Causes and treatment of acute pancreatitis

Sudden inflammation of the pancreas, which is one of the most severe surgical diseases, leading to necrosis of pancreatic tissue.

In acute pancreatitis, the glandular tissue is damaged by the gland's own enzymes, which are activated under the influence of one or another factor, then penetrating the glandular tissue and destroying it. Active enzymes circulating in the blood lead to dysfunction of all organs and systems of the body.

The main symptoms of acute pancreatitis are: acute pain in the upper abdomen, nausea and vomiting. Diagnosis of acute pancreatitis is based on determining the level of pancreatic enzymes (amylase and lipase) in the blood.

Treatment of acute pancreatitis is conservative and consists of following a diet, cleansing the blood of pancreatic enzymes, as well as symptomatic treatment. If the condition worsens, surgery may be performed to remove dead pancreatic tissue.

Causes of acute pancreatitis

The greatest significance in the occurrence and development of this disease belongs to alcohol abuse, abuse of juice and choleretic foods (for example, fatty fried meats).

Trauma to the pancreas, diseases of the digestive organs (liver, biliary tract, duodenum), and various vascular diseases are also important.

Besides:

Attack of acute pancreatitis

An attack of acute pancreatitis usually develops suddenly, after ingesting food or alcohol.

The main symptoms of an attack of acute pancreatitis include:

First aid for an attack of acute pancreatitis

Important: In case of an attack of pancreatitis, you should immediately call a doctor, because any delay may lead to serious complications and even to the death of the patient.

Before his arrival, you should not eat anything, and to reduce the secretion of the gland, you can put an ice pack on your stomach.

You should not take over-the-counter analgesics. They will not bring relief, but may complicate the clinical picture of pancreatitis. You can take the following medications:

• "No-shpa";
• "Baralgin";
• "Papaverine" in combination with "Platifillin".

It should be noted that the first strong dose should not exceed two tablets, and the next dose should be taken only after two hours.

Important: at unbearable pain the patient is administered potent drugs that will protect against pancreatic necrosis.

Symptoms of acute pancreatitis

The disease begins with severe girdling pain in the upper abdomen. Sometimes severe attack pain precedes initial symptoms acute pancreatitis - a state of discomfort, short-term vague abdominal pain, loose stool.

Lying on your back increases pain. With the onset of necrosis of pancreatic tissue, pain may decrease due to the fact that necrosis has also affected the nerve endings. Obligatory symptoms of acute pancreatitis are also nausea, vomiting and bloating.

Vomiting can be painful, persistent, sometimes uncontrollable and never brings relief. Increasing bloating due to the accumulation of gases disrupts the motor activity of the intestines.

When enzymes enter the blood, its circulation in small blood vessels is disrupted, stagnation leads to the appearance of small pinpoint hemorrhages on the skin in the navel and buttocks.

The skin of such patients becomes pale, with a bluish tint. General intoxication of the body with enzymes and breakdown products of the pancreas affects the activity of all organs.

Acute pain

Acute pain, girdling in nature, is localized in the right and left hypochondrium, epigastric (epigastric) region. The pain radiates (radiates) to the left side of the body: to the shoulder, shoulder blade, lower ribs from the back. Intense pain, constant, even in the background drug treatment may continue for another day. The cause of pain is necrosis (death) of the tissue and nerve endings of the pancreas.

Lack of appetite

Lack of appetite, aversion to food develops, is the result of a lack of excretion of pancreatic enzymes into the intestines.

Nausea with vomiting

Nausea and vomiting caused by eating are the result of a lack of enzymes in the intestines necessary for normal digestion. Uncontrollable, profuse vomiting of stomach contents or bile, which does not bring relief.

Symptoms of intoxication

Symptoms of intoxication develop with the development of purulent foci in the pancreas:

• body temperature rises above 38C with chills;
• pulse increases above 90 beats/min;
• the skin becomes cold and damp;
• increased breathing.

Shock

Signs of shock appear as a result of severe pain and loss of fluid from the body, due to uncontrollable vomiting: a decrease in pressure below 90 mm/Hg.

Bloating

Bloating of the upper abdomen and a feeling of fullness, as a result of digestive disorders associated with a lack of enzymes and impaired transit through the intestines.

Diarrhea

Frequent loose stools due to indigestion resulting from a lack of pancreatic enzymes in the intestines.

Skin is pale with a dark tint

Acute pancreatitis is characterized by specific symptoms of cyanosis, developing as a result of a sharp disruption of microcirculation, due to a decrease in the volume of circulating blood, as a result of profuse vomiting. Blue spots form on different areas body (in the face and neck, sides of the abdomen, navel area).

Abdominal tension

The abdominal wall of the abdomen is tense on the left below the costal arch.

Descriptions of symptoms of acute pancreatitis

Complications of acute pancreatitis

Acute pancreatitis can be complicated by the formation of abscesses (ulcers limited to a capsule), as well as the transition of inflammatory phenomena to other organs gastrointestinal tract, for example, on the biliary tract and gallbladder.

If the wall of a blood vessel is damaged, acute gastrointestinal bleeding may occur.

During the destruction of pancreatic tissue, various substances enter the bloodstream, which can cause complications in the form of a sharp decrease in blood pressure(collapse), renal dysfunction, as well as various complications from other internal organs.

In addition, blood poisoning (sepsis) may occur.

Diagnosis of acute pancreatitis

Acute pancreatitis has a very characteristic features. The diagnosis is confirmed using laboratory research. So, in the very first hours after the onset of the disease, high content pancreatic enzyme amylase.

When pancreatic tissue is destroyed, the amount of amylase, on the contrary, decreases and may be completely absent. The amount of amylase and another enzyme - lipase in the blood also increases.

Signs are found in the blood of a patient with acute pancreatitis inflammatory process: a large number of leukocytes and accelerated ESR (erythrocyte sedimentation rate).

To clarify the diagnosis, the following studies are sometimes performed:

Treatment of acute pancreatitis

Patients with acute pancreatitis primarily require hospitalization, painkillers and intravenous infusions solutions in order to restore the water-salt balance.

In approximately every fifth person, acute pancreatitis occurs in severe form, requires close monitoring in the emergency room or intensive care unit (ICU), as pancreatitis can lead to damage to the heart, lungs, or kidneys.

Some cases of pancreatitis can lead to necrosis of pancreatic tissue (pancreatic necrosis). In these cases, or if there is a secondary infection, surgery may be required to remove the damaged tissue.

Which doctors should I contact for acute pancreatitis?

Surgical treatment of acute pancreatitis

An acute attack of pancreatitis caused by blockage of the bile duct with a stone may require removal of the gallbladder or the much less traumatic restoration of the patency of the bile ducts using an endoscope.

After removal gallstones and inflammation subsides, the pancreas usually returns to normal fairly quickly. Pancreas surgery and gallbladder can be performed either with a wide section or with a laparoscopic, or “minimally invasive” method.

During laparoscopic surgery, a small (usually 5-10 mm) incision is made on the abdominal wall, through which abdominal cavity The laparoscope and the surgical instrument itself are inserted. During the operation, the surgeon is guided by the image of the internal organs transmitted from the laparoscope camera to the monitor.

The benefits of laparoscopic surgery include reduced risk of infection, more fast recovery, minimal cosmetic defect, low risk of postoperative adhesions and a much less painful postoperative period.

Diet for acute pancreatitis

An important therapeutic factor for all forms of acute pancreatitis is diet:

Questions and answers on the topic "Acute pancreatitis"

Acute pancreatitis is an inflammation of the pancreas that occurs due to the activation of its enzymes before entering the gastrointestinal tract (ICD-10 code: K86.8). According to statistics, half a billion people in the world are diagnosed with this disease every year, the majority of whom are men.

The problem occurs when a stone, cyst or tumor blocks the flow of digestive juices into the duodenum. Enzymes accumulate and begin to corrode the walls of the organ, damaging surrounding tissues and blood vessels.

Inflammation upsets the balance biologically active substances in the blood (hormones, enzymes, vitamins, nucleic acids), which leads to secondary negative effects on the liver, kidneys, lungs and heart. In advanced cases, this process can lead to the death of the patient.

Main causes of the disease:

• Pathologies of the stomach and duodenum, such as gastritis or ulcers.
• Poisoning with alcohol, food and toxic substances. Chemicals contribute to the occurrence of pathology nutritional supplements, as well as the use of pesticides in agriculture.
• Circulatory disorders caused by hypertension, diabetes, atherosclerosis and other reasons.
• Overeating, especially if the food is fatty and cooked by frying. This diet promotes the production of too many digestive enzymes.
• In women, there is an increased risk during pregnancy. Problems with blood circulation in the body contribute to the formation of inflammation.
• Use of medications that affect the functioning of the pancreas. These include some antibiotics, steroids, cholinesterase inhibitors, diuretics, immunosuppressives and anti-inflammatory drugs.
• Mechanical damage to internal organs.
• Allergic reactions.
• Infectious diseases(chickenpox, mumps, hepatitis, dysentery, intestinal sepsis).
• If a pathology is detected in a child, this is a consequence of a genetic predisposition. In adulthood, inflammation progresses.

Difference between acute form

This type of disease has obvious symptoms and poses a threat to the patient’s life, and therefore requires emergency care. When the factor that provokes inflammation is eliminated, the pathology stops developing. The attack is preceded by poisoning, injury or overeating.

Against, pancreatitis chronic type proceeds slowly, alternating periods of exacerbations and recessions, and its characteristic signs may not be expressed. However, it is accompanied structural changes pancreatic tissue and, if left untreated, leads to dangerous consequences.

These two forms of inflammation are interrelated; after an attack, chronic course pathology.

Symptoms of acute pancreatitis

Anxiety states, which indicate the disease are the following:

• Severe cutting pain, sometimes leading a person to loss of consciousness. It can prick the left or right hypochondrium, depending on which part of the gland is damaged. If inflammation has taken over the entire organ, the pain becomes girdling.
• High temperature, high or low blood pressure, general malaise.
• The skin on your face changes color and becomes duller every day.
• Blue spots appear on the lower back due to blood entering the subcutaneous area from the source of the pathology.
• Nausea, hiccups, belching, bloating, vomiting bile. Eruption of stomach contents does not bring relief.
• At the initial stage there is constipation. Subsequently it alternates with diarrhea.

Diagnosis of the disease

To obtain information about the causes, localization and course of the pathology, the following methods are used:

• Ultrasound – examination of the abdominal cavity using ultrasonic waves. Allows you to monitor changes in the condition of internal organs.
• Computed tomography is rational in complex cases, as it gives a holistic picture of the problem area.
• Gastroduodenoscopy is a method of examining internal organs using a flexible tube inserted into the patient’s mouth and passing through the esophagus.
• Radiography is effective for detecting pathological formations, foreign objects, accumulations of liquid, gases and waste.
• Palpation - feeling the abdominal area with your fingers. In the case of pancreatitis, certain points begin to hurt when pressed.
• Blood, urine and stool tests help identify the problem. Alarming signs: increased concentrations of leukocytes and glucose, increased amounts of digestive enzymes, the presence of diastase in the urine.

Treatment of acute pancreatitis

The first steps during an attack at home are as follows:

• Call ambulance for any suspicion of acute pancreatitis.
• Apply cold to the upper abdomen, preferably using a heating pad filled with water rather than ice.
• Refusal to eat for 3 days is required. The production of enzymes stops, causing inflammation to become weaker. And subsequently hunger appears important part treatment.
• Provide the patient with rest and bed rest. Less blood flows to the damaged organ, which improves the condition.

Pills and medicines

Medications, effective for pancreatitis and which can be taken independently at home are the following:

• Drotaverine, Spazmalgon, No-shpa, Maxigan. These are all antispasmodics that help cope with pain, sometimes they are administered as an injection. Any other medications are taken only as directed by your doctor.
• Ranitidine and Famotidine are agents that reduce enzyme production.
• Cefotaxime, Amoxiclav, Abactal and Vancocin are antibiotics that will help avoid complications.
• Creon 8000, Mezim, Pancreatin, Festal are enzyme medications for normalizing the functioning of the pancreas.

Sedative, hormonal, choleretic, enveloping agents and antacids that neutralize acid are also used gastric juice.

Surgery

In the acute form of the disease, the patient needs care in inpatient conditions. The operation is performed in 8–10% of cases.

Surgeon intervention is required when following states:

• Aseptic peritonitis provoked by digestive enzymes.
• Pancreatic necrosis, a form of disease in which pancreatic tissue dies.
• If conservative treatment within 3–4 days does not lead to improvement.
• When the disease is accompanied by destructive cholecystitis, destruction of the walls of the gallbladder.
• For other types of complications (abscess of the omental bursa, purulent pancreatitis, arrosive bleeding, obstructive jaundice).

If the situation is difficult, the patient is placed in the intensive care unit, since this the only way study the dynamics of blood circulation in detail, and create an environment suitable for treatment.

During the operation, laparoscopy is used, in which the abdominal cavity is pumped with carbon dioxide. This minimally invasive method is used to remove fluid accumulations and prepare for major surgery.

A type of surgery that involves making cuts in the abdominal wall is called a laparotomy. It is necessary in cases of purulent complications of pancreatic necrosis, bleeding, and lack of improvement after laparoscopy.

Classification of operations depending on the period:

• Early. They are carried out in the first week in case of complications of peritonitis, cholecystitis, or failure of drug treatment.
• Late. Their duration can be up to a month after the onset of the disease. Used for tissue necrosis.
• Postponed. They are performed to prevent relapses in situations where symptoms temporarily do not appear.

For peritonitis, laparoscopic drainage of the abdominal cavity after surgery is used. This process makes it possible to organize the outflow of pathogenic fluid and the introduction of drugs into the vascular bed, which provides suitable conditions for the restoration of the body.

Postoperative treatment includes the use of antibiotics and anti-inflammatory medications. In some cases, dehydration therapy is used to reduce the amount of fluid in the body.

Folk remedies

Among the traditional methods of treating and preventing pancreatitis, the following are popular:

• Tincture from Amur kryphea normalizes the balance of gastrointestinal acids, accelerates recovery processes, improves general health.
• Black cumin seed extract destroys malignant cells and is thus used for cancer prevention.
• Kvass from whey and celandine destroys bacteria, reduces pain, and helps tissues recover.
• Juicing Brussels sprouts, carrots, lettuce and green beans improves secretory function pancreas.
• Decoctions and jelly from flax seeds help remove toxins from the body, and also have an enveloping and cleansing effect. However, consultation with a doctor is required, since this remedy should not be used by people with urolithiasis.
• Royal jelly strengthens and supports immune system, has a general healing effect.
• Hericium mushroom powder is used against many diseases, including those of the gastrointestinal tract. Significantly increases the effectiveness of chemotherapy.

Diet for acute pancreatitis

Within 2–3 days after the onset of symptoms, it is necessary complete failure from food. Several times a day you can drink a glass of still mineral water or rosehip decoction.

In the subsequent period, you need to adhere to a diet with a minimum amount of carbohydrates, fats and coarse fiber. It is recommended to consume a lot of protein. Eat small portions 5-6 times a day. Taking vitamins of groups A, B, D, E, K gives good results.

After the peak of the disease has passed, soups, lean meat and fish, cottage cheese, vegetables, and cereals are allowed. It is allowed to consume sugar, fruit juices, honey, and jam. Dairy products include kefir and yogurt.

You cannot eat fried, salted, smoked and pickled foods, spices, baked goods, or alcohol for more than six months. Recommended separate meals. The same types of proteins, fats and carbohydrates are easier to digest and therefore do not provoke inflammation.

Possible complications

In the absence of timely treatment, secondary pathologies develop:

• Education false cyst, a cavity in the pancreatic parenchyma filled with pancreatic fluid and dead tissue.
• An abscess in which pus accumulates in the diseased organ or in the space surrounding it.
• Stomach bleeding and ulcers caused by toxins.
• With alcoholism, intoxication psychosis can occur, which manifests itself as outbursts of excitement, loss of self-control, and hallucinations.

Acute pancreatitis is an acute inflammation of the pancreas caused by the activation of its own digestive enzymes and leading to self-digestion and the development of complete or partial organ tissue.
Typically, acute pancreatitis occurs in persons who abuse alcohol or have a history of pathologies of the biliary system - chronic cholecystitis or cholelithiasis.
Factors provoking the development of the disease are:

• increased secretion of the gland,
• impaired outflow of pancreatic juice,
• change chemical properties juice, namely increasing its viscosity.

Classification by etiology

• Food and alcohol pancreatitis occurs more often in young and mature men.
• occurs simultaneously with diseases of the biliary tract and occurs in women of any age.
• Gastrogenic pancreatitis develops against the background of such chronic diseases of the stomach and duodenum, How chronic gastritis, diverticulum and peptic ulcer.
• Vascular or ischemic pancreatitis is associated with deterioration of blood supply to the pancreas and is observed in old age with atherosclerosis, aortic aneurysm or arterial hypertension.
• Infectious pancreatitis most often develops when the gland is damaged by bacteria or viruses. This pathology is characteristic of young people and children who have had hepatitis, typhus, mumps.
• Toxic-allergic pancreatitis - inflammation of the pancreas caused by certain allergens, exposure to heavy metal salts or organic matter, taking medications.
• Congenital pathologies of the pancreas, diseases of the thyroid and parathyroid glands, cystic fibrosis and some other metabolic disorders can lead to the formation of pancreatitis.
• Traumatic and postoperative pancreatitis occurs due to mechanical trauma to the gland, acute blood loss, shock, operational stress, anesthesia.

Pathogenesis

Despite the large number of causes causing acute pancreatitis, the disease develops in the same way. Self-digestion of the gland occurs under the influence of aggressive enzymes: trypsin and peptidase break down proteins, lipase and phospholipase break down fats, and amylase break down carbohydrates.
First, edematous pancreatitis develops, which goes away without consequences if treatment is started in a timely manner.
IN severe cases the edema progresses, compresses the vessels feeding the organ, which ends in the formation of foci of necrosis and the development of necrotizing pancreatitis. This form of the disease with small-focal necrosis is relatively easy, with large-focal necrosis it is difficult, and with total necrosis, pancreatitis occurs at lightning speed, all gland tissues die and the patient, as a rule, dies.
Mild forms of pathology are most common, so mortality in acute pancreatitis is low.

Periods of illness

1. The early or enzymatic period lasts from five to seven days and is characterized by swelling and necrosis of the gland due to the primary activation of enzymes. Severe forms are accompanied by inflammation of not only the tissues of the pancreas, but also surrounding organs, the peritoneum, as well as general intoxication of the body caused by the absorption of tissue breakdown products into the blood.
   Signs of acute pancreatitis during this period are combined with symptoms of diseases of the lungs, heart, brain, and kidneys. Death from fulminant pancreatitis occurs in half of the patients at this time.
2. The reactive period begins after the body copes with enzyme intoxication. It is characterized by the rejection of foci of necrosis, the formation of a pancreatic infiltrate, which is easily palpable in the pancreas area. The main symptom of this period is fever caused by the products of resorption of necrosis.

   Possible complications from the stomach - acute ulcers, from the biliary tract - jaundice.

   Duration - ten days.
3. Period purulent complications begins on the tenth day of the disease and is characterized by suppuration of foci of necrosis, separation of dead tissue with the formation of sequesters, and the appearance of symptoms of purulent intoxication. Suppuration gradually spreads to the surrounding organ adipose tissue with the formation of ulcers and phlegmons, flowing into separated parts of the abdomen. Often, pus breaks into the pleural or abdominal cavity, corrodes blood vessels, which leads to internal bleeding that is difficult to stop.
4. The period of outcomes of acute pancreatitis occurs only in case of successful treatment of the disease. After mild forms of pancreatitis, patients recover in two to three weeks; moderate forms require longer rehabilitation: about two months are needed for complete resorption of the infiltrate. The outcome of severe acute pancreatitis is a pancreatic cyst or chronic pancreatitis.

Clinical picture

Acute pancreatitis begins with severe “girdling” pain, localized in the upper abdomen and radiating to the shoulder blades, left collarbone, and lower ribs.

Severe pain lasts up to three days, and then gradually decreases and turns into a dull, aching pain.

One of the main symptoms of acute pancreatitis is painful, repeated vomiting that does not bring relief. It appears at the beginning of the disease, during the period of pancreatic colic and with the development of complications.
Acute pancreatitis is characterized by increased heart rate, tachycardia, fever and chills caused by intoxication.
Upon examination, the patient notices bloating, which is associated with retention of gases and stool. Palpation reveals pain in the left epigastric region and left hypochondrium. Severe forms are accompanied by signs of peritonitis.
From the fifth day, a slightly painful infiltrate can be felt in the epigastric region.

One more typical complication acute pancreatitis in these periods is omentobursitis, which is an accumulation of fluid around the pancreas. Usually omentobursitis resolves, but sometimes it turns into a cyst, festeres and requires surgery.

IN general analysis blood shows signs of thickening: increased hemoglobin, red blood cells, decreased ESR. Gradually, these indicators return to normal, and typical inflammatory changes appear in the blood test - leukocytosis, shift leukocyte formula to the left, increase in ESR.
In a general urine test, signs of toxic damage to the kidneys appear: the daily amount of urine decreases, protein, red blood cells, casts, renal epithelium, and sometimes sugar and urobilin are found in it. A specific sign of acute pancreatitis is an increase in urine amylase activity.
In addition, the amount of all pancreatic enzymes, sugar, bilirubin, and urea in the blood increases.

Treatment

First aid for an attack of acute pancreatitis consists of applying cold to the sore spot and taking antispasmodics. Do not use painkillers or apply heat to the painful area. If there is a sudden appearance of acute pain in the epigastrium, nausea, uncontrollable vomiting, diarrhea, flatulence, or fever, you must immediately call an ambulance. Further treatment acute pancreatitis is carried out in the intensive care unit under the supervision of doctors.

Diet therapy

Nutrition for acute pancreatitis should provide maximum rest to the gland and reduce gastric and pancreatic secretion.
Patients are shown complete fasting for the first four days. Allowed to drink mineral water without gas in small sips. Boiled or steamed foods are gradually introduced into the diet. protein dishes. The patient's menu should contain a sufficient amount of fat and few carbohydrates. Energy value daily diet - approximately two thousand kilocalories.
The diet for acute pancreatitis should consist of eighty grams of protein, sixty grams of fat and a small amount of carbohydrates. It is also necessary to limit salt to reduce swelling, reduce production of hydrochloric acid and slow digestion. Welcome fractional meals up to six times a day in small portions. Food should be taken warm, preferably liquid or semi-liquid.
From the seventh day, the diet includes slimy soups, jelly, porridge, crackers, lean steamed cutlets, mashed potatoes, weak tea, rose hip decoction. Then the diet is expanded with cheeses, protein omelettes, baked apples.
Fried, smoked, salty foods, marinades, lard, fatty dairy products, baked goods, and alcohol are completely excluded from the diet for a long time. The duration of the diet is a year. If you ignore the principles therapeutic diet, then acute pancreatitis will quickly turn into chronic.

Conservative treatment

Treatment of acute pancreatitis is carried out on an outpatient basis in surgical department. Severe and complicated forms of the disease are treated in the intensive care unit.
Basic medicinal purposes— limiting necrotic processes in the pancreas and combating intoxication.
Disease on early stage treated with gentle detoxification methods. For this use:

The first mention of acute pancreatitis was found in scientific works in the 16th century. In 1578, S. Alberti described the clinical picture of the disease. In 1870, acute pancreatitis was identified as a separate nosological entity. The beginning of the 20th century was marked by a scientific breakthrough in diagnostics, which significantly increased the detection of pathology before surgical intervention. For this purpose, in patients with an acute abdomen, the content of diastase in the urine was determined, an increase in which is characteristic of damage to pancreatic cells.

In the middle of the last century, the principles of pathogenetic therapy were developed. Treatment of acute pancreatitis has become combined. Depending on activity pathological process Various combinations of drug therapy and surgical correction were used.

About 120 years ago, scientists formulated the first theory of the pathogenesis of the disease.

Theories of the pathogenesis of acute pancreatitis:

• Metabolic theory - the development of acute pancreatitis is based on significant metabolic disorders within the organ, due to which enzymatic autoaggression occurs.
• Flow-enzymatic theory - trigger mechanism for the development of pathology is the reflux of bile into the pancreas, which provokes aseptic inflammation.
• Circulatory theory - poor circulation affects the resistance of pancreatic tissue to its own enzymes.
• The theory of toxic shocks - scientists have expressed the opinion that an increase in the permeability of the walls of blood vessels located in the pancreas stimulates the release of red blood cells from the bloodstream. In this case, they come into contact with enzymes, which provokes the formation of toxic compounds that damage pancreatic tissue. Subsequently, it was proven that contact with blood cells activates trypsin, causing necrotic processes in the organ.
• Immunological theory - primary damage to pancreatic cells is caused by circulating immune complexes against your own tissues.

WHAT CAUSES ACUTE PANCREATITIS

Numerous studies have proven that the inflammatory process in the pancreas has a polyetiological nature. The cause of acute pancreatitis is usually combined. There are three groups etiological factors:

• mechanical;
• toxic-allergic;
• neurohumoral.

Mechanical group of causes

This group includes all conditions in which mechanical damage pancreas:

• Reflux. Rejection into the ductal system is observed in cholelithiasis, oncological pathology hepatobiliary or duodenal localization, increased pressure in the ampulla of the large duodenal nipple, ulcerative processes in the intestines.
• Traumatic exposure is the cause of pancreatitis in 5% of patients, often complicating surgical interventions in the abdominal cavity.

Toxic-allergic group of causes

The most significant etiological factors from this group are:

• alcohol abuse;
• food allergies;
• allergic reactions to medications.

The above factors damage the endothelium of the pancreatic ducts, which is accompanied by damage to its own tissue by enzymes. Alcohol also increases the secretory activity of the organ and can increase intraductal pressure.

Neurohumoral group of causes

Symptoms of acute pancreatitis arise due to metabolic disorders, most often fat, with the development of hyperlipidemia in the blood. This group of factors also includes pregnancy and postpartum period, since at this time it can be observed pronounced violation neurohumoral reactions.

PATHOGENESIS OF THE DISEASE

The cascade of processes developing in the pancreas during acute pancreatitis remains not fully understood. The most logical in terms of validity pathogenetic mechanisms is the enzymatic theory.

Phases of the enzymatic theory

• Lipolysis. Under the influence various combinations etiological factors, pancreatic enzymes lipase and phospholipase enter the organ tissue, causing the death of pancreatic cells and necrotic changes in fatty tissue. This is called the autodigestive process. During this period, the first symptoms of acute pancreatitis appear.
• Demarcation inflammation. In this phase, areas of fatty tissue necrosis occur with the development of a protective inflammatory reaction. This is facilitated by a large number of mediators and biologically active substances released in the area of ​​inflammation.
• Proteolysis. In some cases, destruction of its connective tissue is observed in the pancreas. This occurs due to the activation of trypsin and other lysosomal enzymes. As a result, blood vessels are damaged, plasma is damaged, and blood cells sweat into the parenchyma of the organ. Necrosis from fatty tissue becomes hemorrhagic.

HOW IS ACUTE PANCREATITIS CLASSIFIED?

In domestic medicine, it is taken as a basis international classification, adopted at the congress of pancreatologists at the end of the last century. It allows you to clearly separate the symptoms and treatment of acute pancreatitis, develop a prognosis and preventive measures for the patient, based on common principles. Highlight:

• acute mild pancreatitis;
• acute severe pancreatitis, in which pancreatic necrosis of varying severity and nature occurs;
• acute severe pancreatitis with complications.

CLINICAL SYMPTOMATICS OF ACUTE PANCREATITIS

As a rule, the picture in the acute phase of pancreatic pathology does not have characteristic manifestations. This is due to the close location and general functional orientation of most abdominal organs. However, an experienced specialist may suspect acute pancreatitis based on the totality of complaints and an objective examination of the patient.

Complaints

The disease begins suddenly, against the background of complete well-being. When questioning the patient, it is often possible to identify a connection between the onset of pathology and excessive intake fatty foods or alcohol abuse. The patient usually complains:

• Pain in the epigastric region of significant intensity, which can be girdling in nature. In some patients it manifests itself as attacks of colic. Irradiation is characteristic pain syndrome depending on the location of the pathological process in the pancreas. Severe disease may be accompanied by the development of pancreatogenic shock.
• The second most common manifestation of acute pancreatitis is vomiting. In most patients, it is repeated and does not bring relief. First, food remains are found in the vomit, then the contents of the gallbladder, streaks of blood, and gastric juice.
• Also, in all patients with acute pancreatitis, general state, a sharp weakness appears, which prevents the performance of routine work.
• Dyspeptic symptoms occur in approximately a quarter of patients. They experience a delay in physiological functions and complain of a feeling of fullness in the intestines due to excessive gas formation.
• Increased body temperature, usually to low-grade levels.

EXAMINATION OF THE PATIENT

When examining a patient with suspected acute pancreatitis, the following is observed:

• significant pallor skin and visible mucous membranes;
• protruding parts on the face acquire a bluish tint;
• features are sharpened;
• sclera may be icteric.

Further progression of acute pancreatitis is accompanied by impaired microcirculation in the brain. This is manifested by confusion, disorientation of the patient, motor and speech excitability.

The development of multiple organ failure leads to damage to all internal organs. Upon examination, shortness of breath is revealed, wheezing is heard in the lungs, the rhythmic activity of the heart muscle is disrupted, the boundaries of the liver expand, and diuresis decreases.

When palpating the anterior wall of the abdominal cavity, the patient experiences increased pain. The abdomen may be swollen, often in the projection of the colon.

The symptoms and treatment of acute pancreatitis correlate with each other. The more severe the symptoms, the greater the volume of therapy. clinical manifestations diseases.

HOW TO DIAGNOSE ACUTE PANCREATITIS

Diagnosis of acute pancreatitis consists of two main areas:

• laboratory;
• instrumental.

Laboratory diagnostics

This diagnostic direction is intended not only to confirm the diagnosis, but also to determine the severity of damage to the pancreas and monitor the effectiveness of the prescribed treatment.

Nonspecific laboratory diagnostics:

• a general blood test reveals signs of an inflammatory process, such as leukocytosis and an increase in erythrocyte sedimentation rate;
• determination of the content of proteins, fats, carbohydrates and microelements allows us to judge the severity of metabolic disorders;
• a decrease in calcium concentration indicates severe course acute pancreatitis;
• a general urine test reveals protein, casts and red blood cells;
• the volume of daily diuresis decreases.

Specific laboratory diagnostics

This group of tests is based on the determination of pancreatic enzymes in blood plasma: M

• fat necrosis is accompanied by the appearance of amylase, lipase and proteases;
• with hemorrhagic necrosis, the concentration of trypsin in the blood increases;
• a total necrotic process in the organ leads to a decrease in the content of all enzymes.

By doing specific methods laboratory diagnostics pancreatitis, it is important to take into account concomitant pathology. However, in patients with chronic diseases of internal organs, the sensitivity of tests can be greatly distorted.

Instrumental methods

Computed tomography is considered the most reliable method for diagnosing pancreatic pathology. In addition to the exact localization of the pathological process, the study allows us to determine the spread of inflammation to nearby organs, the condition of blood vessels and ducts, the presence of cavities and cysts. Computed tomography is used to perform drainage manipulations.

Ultrasound examination of the abdominal organs is the most accessible method diagnosis of acute pancreatitis, however, does not always allow one to determine the form of the pathology. The accumulation of gases in the intestines, a thick layer of subcutaneous fat, and conditions after laparoscopy significantly reduce the information content of this technique.

From invasive methods Laparoscopy is the most widely used method for verifying acute pancreatitis. Besides diagnostic value, this technique can be used for surgical correction of the disease.

Indications for laparoscopy:

• blurred clinical picture;
• differential diagnosis with other inflammatory diseases of nearby organs;
• the need for histological examination of pancreatic tissue;
• the need for dynamic diagnostic observation.

Completing the above measures in full allows you to understand how to treat acute pancreatitis in a particular case.

Goals of therapy for acute pancreatitis:

• reduction in disease mortality by up to 30%;
• diagnosis should last no more than 2 days;
• it is necessary to establish the cause of the development of the pathology; only a quarter of patients may have idiopathic pathology;
• in severe cases, it is necessary to treat acute pancreatitis in an intensive care unit, where monitoring of vital signs is possible;
• carrying out computed tomography must be completed no later than the 10th day of hospital stay.

These criteria were developed by leading specialists of the World Health Organization and are actively being implemented in domestic medicine.

PRINCIPLES OF TREATMENT

When treating acute pancreatitis, the doctor chooses the optimal amount of therapy based on the clinical manifestations of the disease, data from laboratory and instrumental diagnostic techniques.

Medical nutrition

Diet plays a key role in the treatment of acute pancreatitis. Its goal is to minimize the functional activity of the pancreas:

• At the onset of the disease, exclude all foods. The patient is allowed to drink alkaline drinks.
• In the subsequent menu, it expands to include protein and carbohydrate products nutrition. Fats enhance the enzyme activity of the organ, so they can be used only in small quantities.
• The diet should be rich in vitamins and microelements.
• The number of meals is increased to 6 times a day, while reducing the portion size.
• Products are steamed, which helps preserve nutritional value for the patient.
• The consumption of alcoholic beverages is strictly prohibited.

Conservative therapy

In the treatment regimen for acute pancreatitis the following is used:

• analgesics to relieve attacks of pain;
• water-electrolyte solutions;
• glucose and amino acid solutions to maintain metabolic reactions;
• medications that control the secretion of gastric juice;
• antimetabolites that suppress the functional activity of pancreatic cells;
• peptide drugs that reduce the uptake of amino acids necessary for the synthesis of enzymes by pancreatic cells;
• proteinase inhibitors;
• antibiotics.

The development of complications requires a larger volume of drug therapy aimed at minimizing multiple organ failure.

Surgical correction

Surgical interventions are performed when conservative therapy is ineffective. The most widespread is laparoscopy, which allows you to install drainages, remove part of an organ, etc.

WHAT IS ACUTE PANCREATITIS DANGEROUS?

The lack of the required amount of drug or surgical correction can cause the following complications in the patient:

• accession bacterial infection with the development of purulent processes in the organ or outside it;
• release of active enzymes into the abdominal cavity, which entails necrotic damage to fatty tissue various localizations;
• inflammation of the peritoneum of various types;
• development of abscesses and pseudocysts;
• penetration of a secondary infection into the bloodstream and spread of pathogenic microorganisms throughout all organs and systems;
• damage to large vessels by thrombotic formations;
• the appearance of internal bleeding.

PROGNOSIS FOR THE PATIENT

The prognosis for acute pancreatitis is very serious, despite the development of pathogenetically based conservative and surgical treatment methods. This is due to high fatal disease, which can be up to 85% in patients with complicated forms of pancreatic necrosis. The most common cause of death is multiple organ failure.

In every fifth patient, after treatment of acute pancreatitis, the symptoms become chronic with periods of remission and exacerbation.

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Acute pancreatitis is an inflammation of the pancreas that occurs suddenly. The attack is very severe pain in the upper abdomen and lasts several days. Inflammation occurring in soft form, often does not require medical intervention and goes away on its own. In severe cases, it can cause complications that are incompatible with life. Situations like this require emergency hospitalization the victim. In case of untimely medical care mortality rates range from 5 to 30%. Regardless of the form of the disease - mild, moderate or severe, abdominal pain - serious reason to see a doctor.

What is acute pancreatitis and how does the disease manifest?

The hallmark signs of acute pancreatitis are severe, sudden pain in the upper abdomen, just below the sternum, which occurs in waves, frequently and intensely until it becomes constant. In 50% of cases, pain is felt in the lower abdomen and spreads to the back.

Other characteristic manifestations of acute inflammation pancreas:

• loss of appetite caused by a lack of pancreatic enzymes secreted into the intestines;
• acute pain in the abdominal cavity of various localizations, which intensifies after eating, coughing, deep breathing, touching the stomach;
• in a lying position the pain is stronger than in a sitting position;
• severe nausea and vomiting, even in the absence of vomit;
• due to a lack of digestive enzymes, bloating occurs, the patient suffers from frequent loose stools with a pungent odor, and flatulence;
• rapid pulse - from 100 to 140 beats per minute, frequent and shallow breathing;
• fever and temperature rise above 38°C;
• the skin and whites of the eyes acquire a yellowish tint;
• persistent pain, for which even strong painkillers do not help.

The fetal position slightly alleviates the symptoms of acute pancreatitis. If, even while sitting still, you experience pain and cannot find a comfortable position, consult a doctor immediately.

Causes of occurrence and mechanism of development

The pancreas is an organ that produces enzymes for digestion and hormones that regulate the absorption of glucose by all cells of the body. Digestive enzymes of the gland normally begin to work only in the intestines. But in acute pancreatitis, they are activated ahead of time, before leaving the gland, irritating its walls and causing inflammation. With repeated acute attacks of pancreatitis, the mucous membranes of the pancreas are damaged, and scars form in place of the damaged tissue. Because of this, it gradually loses its functions. This leads to chronic pancreatitis, digestive problems and diabetes.

The main causes of acute pancreatitis include:

• Gallstones. They cause about 40% of cases of the disease. Moving along bile ducts, they block the junction of the gallbladder and pancreatic ducts. As a result, pancreatic juice cannot leave the gland and accumulates in it, destroying the tissue.
• Excessive alcohol consumption causes acute attacks of pancreatitis in approximately 30% of cases. The risk of developing the disease increases with an increase in daily consumption of alcoholic beverages over 40 g of pure alcohol per day for men and 30 g for women.
• Mechanical damage to the pancreas during trauma, gall bladder surgery, and instrumental studies.
• Increased levels of triglycerides and calcium in the blood.
• Viral infections - mumps, cytomegalovirus and complications caused by them.
• Cystic fibrosis is a serious disease that damages not only the pancreas, but also the lungs, liver, and other organs.
• Taking estrogens, steroids, and some antibiotics.
• Smoking.
• Kidney transplantation.

What diseases may resemble acute pancreatitis?

There are a number of diseases whose symptoms may resemble an attack of pancreatitis:

• Cholecystitis, or inflammation of the gallbladder. Accompanied by acute wave-like attacks of pain, nausea, vomiting and yellowing of the skin.
• Perforated ulcer of the stomach or duodenum. Causes severe acute pain in the upper abdomen, nausea, and vomiting.
• Attack acute appendicitis. The pain is increasing in nature and is noted in the lower abdomen on the right. The patient feels sick and has a fever.
• Myocardial infarction. The victim experiences general weakness, severe chest pain, and rapid, shallow breathing.
• Food poisoning. Causes severe diarrhea, bloating and pain in the lower abdomen, weakness from loss of large amounts of fluid.

Possible complications

Acute pancreatitis leads to an imbalance of all chemical elements in our body, causing severe complications:

• Pseudocyst – formed as a result of necrosis of the pancreas. It may go away on its own, but sometimes breaks through, causing infection and bleeding.
• Infection of the inflamed pancreas. The organ becomes vulnerable to bacteria. Immediate surgery is required to remove the infected tissue to avoid suppurative pancreatitis.
• Severe damage to the lungs, heart, liver, kidneys, developing as a result of severe damage to the pancreas. At the same time, its activated enzymes and toxins penetrate into the bloodstream, reducing blood pressure, cause general organ failure and lead to severe complications, including death.
• Diabetes occurs when the cells that produce insulin are damaged.
• Swelling of the upper abdomen - appears when fluid accumulates in the abdominal cavity due to decreased intestinal motility.
• Malnutrition. Systematic attacks of pancreatitis lead to a lack of digestive enzymes. This disrupts the absorption of nutrients, leading to malnutrition, diarrhea, and weight loss.
• Pancreatic cancer - long-term and systematic inflammation in the gland is a risk factor for the development of cancer.

Fast and effective treatment pancreatitis reduces the risk of complications. Therefore, it is important to seek the help of specialists at the first acute symptoms.

Which doctor should I contact?

A characteristic symptom of acute pancreatitis is tense abdominal wall and pain when palpating the peritoneum.

To make a diagnosis, a blood test is prescribed and hardware examinations of the diseased organ are performed:

• Ultrasound of the abdominal organs;
• computed tomography of the pancreas;
• magnetic resonance cholangiopancreatography - a special MRI that allows you to examine the pancreatic and bile ducts;
• endoscopic retrograde cholangiopancreatography - the procedure allows not only to view the ducts, but also to remove gallstones.

Treatment of acute pancreatitis

The treatment regimen for acute pancreatitis will depend on the severity of the symptoms. Therapy includes the following stages:

• elimination of pain syndrome;
• administering sufficient fluids;
• nutrition support;
• endoscopy or surgery if acute attack caused by gallstones or pseudocysts.

Drug treatment

If mild to moderate symptoms are present, treatment for acute pancreatitis in hospital includes the following procedures:

• Starvation. The patient does not eat for several days to give the pancreas a rest. After the pain disappears and nausea and vomiting stops, you can introduce it into your diet. semi-liquid food– cereals, soups, as well as drinks (kefir, weak tea).
• Taking painkillers to relieve pain. For this, Tramadol, Baralgin, and various types of blockades are prescribed.
• Prevent dehydration, which worsens symptoms and increases the risk of complications.

Patients with severe symptoms of pancreatitis are treated in the intensive care unit, where their vital signs - pulse, blood pressure, breathing rate and urine production - are constantly monitored.

The patient is prescribed:

• antibiotics to prevent infection, such as Metronidazole, Ciprofloxacin, etc.;
• intravenous administration of sodium chloride solutions and potassium chloride to eliminate dehydration;
• a pulmonary ventilator to help the patient breathe;
• to maintain the required blood volume, patients with low blood pressure are given intravenous solutions of Polyglyukin, Albumin, etc.;
• To feed seriously ill patients, thin tubes are used that are inserted through the nose and stomach into the small intestine.

The patient remains in the intensive care unit until the risk of organ failure, hypovolemic shock, and sepsis subsides.

Surgical intervention

If the cause of acute pancreatitis is blocked bile or pancreatic ducts, then an endoscopic procedure is used to open or widen these ducts.

If the ducts are blocked by gallstones, doctors recommend removing the gallbladder.

Traditional methods

An acute attack of pancreatitis occurs suddenly and develops very quickly. Its diagnosis and therapy require complex examinations, modern medical equipment, medications, solid professional experience and hospital conditions. Considering the speed of development of complications in this pathology, the use of traditional methods will lead to the loss of precious time, which is fraught fatal. Use folk remedies It will be possible after relief of acute symptoms, and only in agreement with the doctor.

Diet after treatment

After leaving the hospital, it is necessary to continue to restore the body after an attack of pancreatitis. The main role here belongs to diet:

• Stop drinking alcohol. If you can't do it yourself, use special programs to get rid of addiction.
• Quit smoking. If you don't smoke, don't start.
• Choose a diet with low content fat, plenty of fresh fruits and vegetables, whole grains, eat lean meat.
• Drink more clean water.

Prognosis and prevention

An acute attack of pancreatitis causes severe short-term pain. Depending on the severity of the attack, it can be treated in a hospital within 1-2 weeks. Frequent and recurrent outbreaks of the disease lead to chronic problems and complications. Timely treatment, feasible physical exercise, healthy image life will allow you to eliminate the risk of possible relapses, live comfortably and without pain.