Sharp pancreatitis – a pancreas inflammation. Symptoms of sharp pancreatitis: acute, intolerable pain in a stomach. Depending on what part of gland is inflamed, localization of pain is possible in right or in the left podreberye, in subspoon area, pain can be surrounding. Chronic pancreatitis is followed by appetite loss, the digestion violation, sharp pains (as at a sharp form) arising after the use of greasy, spicy food or alcohol.
Pancreatitis – the disease which is characterized by development of an inflammation in pancreas tissue. On character of a current pancreatitis is divided on sharp and chronic. Sharp pancreatitis takes the third place among the diseases of an abdominal cavity of a sharp current demanding treatment in a surgical hospital. The first and second place is taken by sharp appendicitis and cholecystitis.
According to data of world statistics, in a year with sharp pancreatitis from 200 to 800 people from one million get sick. This disease meets at men more often. The age of patients fluctuates over a wide range and depends on the reasons of development of pancreatitis. Sharp pancreatitis against the background of abuse of alcohol arises on average at the age of about 39 years, and at the pancreatitis associated with a zhelchekamenny disease, average age of patients – 69 years.
Etiology and pathogenesis
The factors promoting developing of sharp pancreatitis:
- abuse of alcohol, harmful eating habits (greasy, spicy food);
- zhelchekamenny disease;
- infection with a virus (mumps, Koksaki's virus) or bacterial infection (mycoplasma, campylobacters);
- pancreas injuries;
- surgical interventions concerning other pathologies of a pancreas and biliary tract;
- reception of estrogen, corticosteroids, tiazidny diuretics, an azatioprina, other medicines with the expressed pathological action on a pancreas (medicamentous pancreatitis);
- congenital anomalies of development of gland, genetic predisposition, ;
- inflammatory a disease of the digestive system (cholecystitis, hepatitis, gastroduodenit).
In development of an acute inflammation of a pancreas according to the most widespread theory damage of cages by prematurely activated enzymes acts as a major factor. In normal conditions digestive enzymes are produced by a pancreas in an inactive form and become more active already in a digestive tract. Under the influence of external and internal pathological factors the mechanism of development is broken, enzymes become more active in a pancreas and begin digestion of its fabric. The inflammation becomes result, fabric hypostasis develops, gland parenchyma vessels are surprised.
Pathological process at sharp pancreatitis can extend to nearby fabrics: zabryushinny cellulose, omental bag, peritoneum, epiploon, bryzheyka of intestines and sheaf baking of DPK. The severe form of sharp pancreatitis promotes sharp increase in level of various biologically active agents in blood that leads to the expressed general violations of activity: secondary inflammations and dystrophic frustration in fabrics and bodies – lungs, a liver, kidneys, heart.
Sharp pancreatitis is classified by severity:
- slight pancreatitis proceeds with the minimum defeat of bodies and systems, is expressed by generally interstitsialny hypostasis of gland, easily gives in to therapy and has the favorable forecast to bystry recovery;
- the severe form of sharp pancreatitis is characterized by development of the expressed violations in bodies and fabrics, or local complications (a necrosis of fabrics, infection, cysts, abscesses).
The severe form of sharp pancreatitis can be followed:
- sharp congestion of liquid in gland or in okolopankreatichesky space which can not have granulyatsionny or fibrous walls;
- pancreatic necrosis with possible infection of fabrics (there is a limited or poured zone of the dying-off parenchyma and peripankreatichesky fabrics, at accession of an infection and development of purulent pancreatitis the probability of a lethal outcome increases);
- sharp false cyst (the congestion of pancreatic juice surrounded with fibrous walls, or granulations which arises after an attack of sharp pancreatitis it is formed within 4 and more weeks);
- pancreatic abscess (a pus congestion in a pancreas or nearby fabrics).
Symptoms of sharp pancreatitis
Characteristic symptoms of sharp pancreatitis.
- Pain syndrome. Pain can be localized in an epigastriya, the left podreberye, have the surrounding character, irradiate under a left shoulder-blade. Pain has the expressed constant character, in a prone position on a back amplifies. Strengthening of pain happens also after meal, especially – fat, sharp, fried, alcohol.
- Nausea, vomiting. Vomiting can be unrestrained, contains bile, does not give relief.
- Temperature increase of a body.
- Moderately expressed yellowness a skler. Seldom – slight jaundice of integuments.
Besides, sharp pancreatitis can be followed by dispepsichesky symptoms (an abdominal distension, a meteorizm, heartburn), skin manifestations (cyanotic spots on a body, hemorrhages in a navel).
Gastroenterologists perform diagnosis of pancreatitis on the basis of complaints, fizikalny survey, identification of characteristic symptoms. At measurement of arterial pressure and pulse often note hypotonia and tachycardia. For confirmation of the diagnosis laboratory blood tests and urine, MSKT and ultrasonography of abdominal organs, pancreas MRT serve.
At blood test in the general analysis inflammation signs (SOE is accelerated, the maintenance of leukocytes is increased) are noted, in biochemical blood test find increase in activity of pancreatic enzymes (amylase, a lipase), the hyperglycemia and a gipokaltsiyemiya is possible. Also carry out definition of concentration of enzymes in urine. The bilirubinemiya and increases in activity of hepatic enzymes can be noted.
When diagnosing sharp pancreatitis take the biochemical analysis of urine and define activity of amylase of urine.
The visual research of a pancreas and nearby bodies (ultrasonography, KT, MPT) allows to reveal pathological changes of a parenchyma, increase in body in volume, to find abscesses, cysts, existence of stones in bilious channels.
Differential diagnosis of sharp pancreatitis is carried out with:
- acute appendicitis and sharp cholecystitis;
- perforation of hollow bodies (probodny stomach ulcers and intestines);
- sharp intestinal impassability;
- sharp gastrointestinal bleeding (the bleeding stomach ulcer and 12 items of a gut, bleeding from varicose veins of a gullet, intestinal bleeding);
- sharp ischemic abdominal syndrome.
Treatment of sharp pancreatitis
At sharp pancreatitis hospitalization is shown. The bed rest is ordered to all patients. Main objectives of therapy is removal of a pain syndrome, decrease in load of a pancreas, stimulation of mechanisms of its self-restoration.
- novokainovy blockade and spazmolitik for removal of the expressed pain syndrome;
- hunger, ice on area of a projection of gland (creation of a local hypothermia for decrease in its functional activity), food carry out parenteral, gastric contents aspirirut, appoint antatsida and inhibitors of a proton pomp;
- deactivators of pancreatic enzymes (inhibitors of a proteoliz);
- necessary correction of a homeostasis (water and electrolytic, acid and main, proteinaceous balance) by means of infusion of salt and proteinaceous solutions;
- dezintoksikatsionny therapy;
- antibiotic treatment (medicines of a broad spectrum of activity in big dosages) as prevention of infectious complications.
Surgical treatment is shown in case of identification:
- stones in bilious channels;
- liquid congestions in iron or around it;
- sites of a pancreatic necrosis, cysts, abscesses.
Treat the operations performed at sharp pancreatitis with formation of cysts or abscesses: endoscopic drainage, cyst marsupialization, tsistogastrostomiya, etc. At formation of sites of a necrosis, depending on their size, carry out a nekrektomiya or a resection of a pancreas. Existence of stones is the indication to operations on a channel of a pancreas.
Can resort to surgical intervention also in case of doubts in diagnostics and probabilities to pass other surgical disease demanding surgical treatment. The postoperative period means intensive measures of prevention is purulent - septic complications and recovery therapy.
Treatment of an easy form of pancreatitis, as a rule, comes easy, and positive dynamics is noted within a week. Treatment from a severe form of pancreatitis requires much more time.
Danger of sharp pancreatitis consists in high probability of development of heavy complications. At infection of the inflamed gland fabric with the bacteria living in a small intestine the necrosis of sites of gland and developing of abscesses is possible. This state without timely treatment (up to surgical intervention) can will end with a lethal outcome.
At the heavy course of pancreatitis a state of shock and, as a result, polyorgan insufficiency can develop. After development of sharp pancreatitis in fabric of gland pseudo-cysts (liquid congestions in a parenchyma) which destroy structure of gland and bilious channels can begin to be formed. At destruction of a pseudo-cyst and the expiration of its contents there is ascites.
Prevention and forecast
Primary prevention of pancreatitis is balanced healthy diet, an exception of alcohol, spicy, greasy plentiful food, refusal of smoking. Sharp pancreatitis can develop not only at the persons who are regularly abusing alcohol but also as a result of single reception of alcohol-containing drinks under fat, fried and spicy snack in large numbers.
The forecast at sharp pancreatitis depends on its form, adequacy of therapy and existence of complications. The easy form of pancreatitis usually gives the favorable forecast, and at necrotic and hemorrhagic pancreatitis the probability of a lethal outcome is high. Insufficient treatment and non-compliance with medical recommendations about a diet and the mode can lead to a recurrence of a disease and development of chronic pancreatitis.