Acute pancreatitis

Description:

Acute pancreatitis (Latin pancreatitis, from other - Greek  — a pancreas + - itis — an inflammation) — sharply proceeding aseptic inflammation of a pancreas of demarcation type which cornerstone the necrobiosis of pankreatotsit and a fermental autoaggression with the subsequent necrosis and dystrophy of gland and accession of a consecutive purulent infection are.

Lethality, despite use of modern techniques of conservative and operational treatment, high: the general 7 — 15%, at destructive forms — 40 — 70%.

Symptoms of Acute pancreatitis:

There is no clear clinical picture. In this regard a number of additional researches is necessary for exact diagnosis of acute pancreatitis.

Complaints to an acute pain in a stomach, the nausea, vomiting duodenal contents which is not giving relief, abdominal distention. As a rule, because of intoxication and vomiting there comes disturbance of water and electrolytic balance, dehydration which plays an important role in a disease pathogeny. There can be hemorrhagic cyanotic spots on the left sidewall of a stomach, sometimes with a yellowish shade (Gray's symptom of Turner). Emergence of spots at a navel (Kullen's symptom) is possible.

Developing of acute pancreatitis is possible against the background of chronic pancreatitis. Acute pancreatitis differs from the concept "exacerbation of chronic pancreatitis".

Often after the postponed acute pancreatitis pancreas pseudocysts are formed. Increasing in sizes and accumulating pathological liquid, the pseudocyst at the expense of a prelum of surrounding bodies can cause pains, disturbance of the movement of food in a stomach and a duodenum. Pseudocyst suppuration is possible.

Sometimes swelled or the sclerosis in the field of a head of a pancreas is led to the clinical picture reminding a prelum of channels of bilious ways and a pancreat duct (Virsungov Canal). The similar picture is observed at pancreas head tumors therefore such form of pancreatitis call pseudo-tumorous. Disturbance of outflow of bile in such cases can cause mechanical jaundice.

The endogenous intoxication which is followed by development of circulator hypovolemic shock, brain hypostasis, an acute renal failure is the most frequent cause of death of patients with acute pancreatitis in the first days of a disease.

Reasons of Acute pancreatitis:

Also poisonings, injuries, viral diseases, operations and endoscopic manipulations can be the reasons of pancreatitis. More often at the age of 30-60 years, and at women twice more often than at men.

Treatment of Acute pancreatitis:

Conservative treatment:

Starvation is shown.

Therapy has to be selected strictly individually, depending on pathogenetic factors, this or that stage and a form of destructive pancreatitis.

At an initial stage treatment consists in desintoxication (including haemo - lympho-or a plazmosorbtion).

It is necessary to eliminate a spasm of smooth muscles.

The stomach decompression by installation of the nazogastralny probe is carried out.

The anti-fermental therapy which was earlier considered as the main method of treatment of acute pancreatitis is not applied in connection with unconfirmed efficiency now. Thus, inhibitors of proteinases (Contrykal, Gordoxum, etc.) are excluded from the list of the drugs recommended for use at the specified pathology today.

(5-ftoruratsit) the cytostatic drugs oppressing synthesis of protein and, in particular, intracellular formation of enzymes. Pancreatic ribonuclease which, destroying m-RNK, causes reversible disturbance of biosynthesis of protein in a pancreas possesses the similar mechanism of action.

Use of somatostatin and its analogs render good effect both on process of the disease, and on its outcome. These drugs reduce pancreatic secretion, eliminate need of analgesic therapy, reduce the frequency of complications and a lethality.

Infusion of somatostatin improves an index of glomerular filtering and raises a renal blood stream that is important for prevention of complications from kidneys at destructive forms of acute pancreatitis.
Surgical treatment:

Tactics of surgical intervention is defined first of all by depth of anatomic changes in the pancreas.

The laparoscopy should be considered as the main method of surgical treatment. Use of a laparoscopy allows to avoid unreasonable laparotomies, to provide adequate drainage and effective treatment and to prove indications to a laparotomy.

Main types of surgical intervention:

    * Installation of drainages and carrying out peritoneal lavage dialysis. It allows to delete toxic and vasoactive substances. After operation there occurs improvement of a condition of the patient during the first 10 days, but emergence of complications is not excluded further. Besides, it is possible to carry out dialysis only in the first 48 hours after installation of drainages as then they cease to function.
    * Resection (usually distal departments) of a pancreas. It eliminates a possibility of an arrosion of vessels and bleeding, and also prevents formation of abscesses. A lack of this method is that at considerable number of patients in the postoperative period also endocrine insufficiency develops ekzo-. It is connected or with the considerable volume of intervention at extensive defeat of gland, or with impossibility to find defeat volume before operation or on the operation course (even when using intraoperative ultrasonography of a pancreas) therefore also not changed gland fabric is removed.
    * Lawson's operation (operation of "a multiple ostomy"). It consists in an establishment of gastric fistula and holetsistostoma, drainage of an epiploic foramen and area of a pancreas. At the same time it is necessary to control outflow of fermentonasyshchenny separated, to carry out a decompression of extrahepatic bilious channels. The patient is transferred to an enteroalimentation. Operation should not be performed in the conditions of pankreatogenny peritonitis.

Operative measure not always eliminates a possibility of development of purulent complications. In this regard there is sometimes a need for repeated operations that increases a postoperative lethality. Death, as a rule, is caused by heavy septic complications and respiratory insufficiency.

The most frequent problem at all types of operations is need of relaparotomies of the proceeding pancreatonecrosis or in connection with development of secondary complications (abscesses, bleedings, etc.).

For performance of numerous planned relaparotomies and temporary closure of a laparotomny wound fasteners - "lightnings" are used. However they have shortcomings as can cause a necrosis of fabrics of a wall of a stomach, besides, they do not allow to regulate change of intra belly pressure adequately.