Necrotic pancreatitis

Description:

Necrotic pankreatitpredstavlyat himself a widespread necrosis of a parenchyma with sites of hemorrhages and widespread necroses of fatty tissue in gland and around it. About 15% of patients with acute pancreatitis suffer from this severe form of an inflammation of a pancreas.

Symptoms of Necrotic pancreatitis:

It is purulent - necrotic pancreatitis is the form characteristic of a phase is purulent - putrefactive sequestration of necrotic bodies. After a pancreas injury it develops much more often (24% of cases), than at not traumatic pancreatitis (no more than 3 — 5%).
Fusion and sequestration of necroses at OTP begin on 5 — the 7th days, and various symptoms is purulent - necrotic pancreatitis appear in different terms.
The majority of clinical signs is purulent - necrotic pancreatitis are symptoms in strict sense of the word is purulent - necrotic parapancreatitis — the main component of local pathological changes at OTP. In most cases prevalence of parapancreatitis is defined as expressiveness it is purulent - necrotic process in retroperitoneal space, and a clinical picture of a disease.
Early and main symptom it is purulent - necrotic pancreatitis fever is. In the beginning the alternating type, with evening rises in temperature to 38 — 38,5as, it becomes a constant, and at> OTP in a phase of sequestration is especially characteristic morning - fervescence. Further there are oznoba with pouring sweats.

Reasons of Necrotic pancreatitis:

— Cholelithiasis;
— tumor of an ampoule or pancreas;
— helminths or foreign bodys;
— periampulyarny diverticulums of a duodenum;
— hernia of a bilious channel;
— hyper tone of a sphincter of Oddi.

Treatment of Necrotic pancreatitis:

To reduce pancreatic secretion, reduce acidity of a gastric juice. Cimetidinum and atropine are for this purpose used, for example.

It is necessary to recover the broken outflow of a secret of a pancreas. A special operative measure - an endoscopic papillosfinkterotomiya (a nipple sphincter section) after which the level of enzymes in blood and urine decreases is for this purpose carried out, and the health of the patient improves.

At a pancreatonecrosis carry out also a detoxication, or removal from an organism of excess of enzymes and cytotoxins. It is reached by means of an artificial diuresis - intravenous or intra arterial administration of special drugs which cause plentiful and frequent release of urine. Duration of an artificial diuresis can reach weeks.

If in an abdominal cavity find liquid with blood impurity in the patient with a pancreatonecrosis, laparoscopic dialysis is appointed. It is carried out by means of drainages through which liquid is pumped out and the solution consisting of novocaine, sodium chloride and antibiotics is entered. As soon as the liquid flowing from an abdominal cavity becomes transparent, and amylase level in it decreases, the procedure is stopped.

In cases of the accruing intoxication and at made jokes, the pancreatitis complicated by jaundice carry out hemosorption, or blood clarification.

To avoid purulent complications, a sick pancreatonecrosis appoint antibacterial drugs and antiseptic agents, and also the means improving work of immune system.

At correctly carried out treatment the phase of a toxaemia of a pancreatonecrosis comes to an end with recovery of the patient. However happens and so that the stage of infiltrate and purulent complications develops.

As it is difficult to define what site of a pancreas underwent a necrosis, surgeons consider operation in a phase of a toxaemia contraindicated.

Quite often in a pancreas after the carried-out treatment there is an infiltrate. At the same time the patient can not feel deteriorations in health, number of leukocytes in blood and a blood sedimentation rate decrease, but temperature remains high, and in an upper half of a stomach painful consolidation is defined. Availability of infiltrate decides on the help of ultrasonography or a computer tomography.

In such situation to the patient appoint antibiotics of a broad spectrum of activity which enter through femoral arteries. Usually after that infiltrate resolves.

The pancreatonecrosis is treated only in the conditions of a hospital first of all it demands intervention of many doctors: the endocrinologist, the therapist, and if necessary - resuscitation crew. The correct diagnosis and more successful treatment requires participation of specialists in an ekhotomografiya and endoscopy.