Acute pancreatitis: Acute Pancreatitis Treatment,Symptoms,Causes,Diet: Acute pancreatitis is caused by the development of powerful inflammatory reactions in pancreatic tissues, resulting from the impact of a combination of causes. The basis is the aggressive influence of the own produced enzymes, which are not activated in the duodenum, but directly in the gland. Enzymes trigger the mechanism of digestion of own tissues, during which the body increases in size, swells, necrosis occurs with the formation of pathological areas – clusters of dead cells.
Necrotic changes in pancreatic tissues proceed aseptically, without secondary accession of infection. As the inflammatory reactions progress, the number of dead cells increases, while fatty degeneration develops, which creates optimal conditions for purulent necrosis. Purulent necrosis manifests itself in the form of signs of intoxication.
Acute pancreatitis is classified by severity:
mild pancreatitis is accompanied by a weak lesion of the pancreas (interstitial edema), minimal symptoms, quickly curable, the prognosis is favorable in 100% of cases;
severe pancreatitis is caused by severe clinical signs and extensive lesions of the pancreas, often local complications such as bulky areas of necrosis, abscesses with purulent contents, cysts, and the addition of a bacterial infection often result from severe course.
General Information About Acute Pancreatitis
Acute pancreatitis (AP) is characterized by the development of pancreatic edema (edematous pancreatitis) or primary aseptic pancreatic necrosis (destructive pancreatitis), followed by an inflammatory reaction.
Acute destructive pancreatitis has a phase flow, and each phase corresponds to a specific clinical form.
- Protocol Code: HS-016 “Acute Pancreatitis”
- Profile: surgical
- Stage: hospital
- Code (s) for ICD-10:
- K85 Acute pancreatitis
- K86 Other pancreatic diseases
Acute Pancreatitis Risk Factors
The triggering mechanism of acute inflammation of the pancreas is facilitated by factors that cause excessive secretion of enzymes and their premature activation. The main causes of acute pancreatitis:
- unbalanced diet – abuse of fried, spicy food; food on the run, receiving large amounts of fatty foods on an empty stomach;
- systematic use of alcohol;
- biliary tract diseases;
- organ trauma;
- bacterial and viral diseases – mycoplasmosis, hepatitis, epidemic parotitis;
- pancreatic dysfunction on the background of surgical interventions;
- the use of drugs in high doses without taking into account the consequences for the body – antibiotics, diuretics, corticosteroids, estrogens, immunosuppressants; in this case, it is a question of drug-induced pancreatitis in adults or (very rarely) in children;
- abnormalities of the gland of congenital nature;
- severe genetic pathologies that are not curable – cystic fibrosis;
- endocrine diseases of nature – obesity, diabetes, hyperparateriosis;
- burdened heredity;
Other diseases of the digestive tract – enterocolitis, gastroduodenitis, hepatitis.
Acute Pancreatitis Symptoms
Symptoms of acute pancreatitis develop after the negative effect of the root cause (taking large doses of alcohol or aggressive food, prolonged treatment with antibacterial drugs). There is an attack, which is accompanied by the classic signs of acute pancreatitis:
- pain that is regular and intense; the site of localization is the right and left upper quadrant, the central part of the abdomen is above the navel, irradiating to the clavicle and lower ribs, with the development of an attack of acute pancreatitis in women, pain often radiates to the pelvic area; an important feature of the pain – increased in the supine position (on the back); and the cause of its occurrence is the process of the death of nerve fibers and gland tissues;
- nausea, vomiting – an essential symptom of pathology; vomiting with acute pancreatitis copious, painful, there is no relief even when the stomach is devastated; vomit consists of the contents of the stomach with the presence of bile, mucus;
- temperature in acute pancreatitis caused by poisoning of the body against the background of necrotic processes; however, an attack of pancreatitis is not always accompanied by temperature — with a mild degree of inflammation, the indicator rises to a maximum of 1 ° above normal, fever up to 39 ° is characteristic with the formation of multiple purulent abscesses in the gland;
- lack of appetite, even aversion to food, is associated with a lack of enzymes in the small intestine;
- peritoneal syndrome – excessive tension of the front abdominal muscles, sharp pain on palpation of the abdomen;
- discoloration of the skin to yellow, including yellowing of the sclera;
- specific symptom of cyanosis due to microcirculation disorder, localization of cyanotic spots on the face, neck, abdomen.
Symptoms of acute pancreatitis include dyspeptic manifestations – multiple diarrhea (sometimes there are constipation); flatulence and marked bloating, mild epigastric discomfort (feeling of heaviness and distention). Dyspepsia in acute pancreatic inflammation caused by a sharp lack of enzymes, lack of (full or partial) motility in the gastrointestinal tract.
Acute Pancreatitis Diagnosis
Diagnosis of acute pancreatitis is performed by a gastroenterologist through a set of procedures – an objective examination, discussion of complaints, laboratory tests and instrumental measures. Patients with acute pancreatitis reveal low blood pressure, signs of tachycardia, with auscultation of the outer wall of the peritoneum reveal a specific symptom of inflammation – weakness or complete absence of intestinal motility.
When organizing the diagnosis is carried out:
- complete blood count, the result of which shows typical signs of inflammatory processes – accelerated ESR, moderate leukocytosis, increased number of stab neutrophils;
- blood biochemistry with the determination of the activity of amylase and lipase – in the presence of pathology, indicators increase; increases the concentration of glucose and urea; C-reactive protein level is significantly higher than normal; reduced amount of total protein, albumin, globulins;
- ionogram, the results of which indicate dehydration – the concentration of calcium, sodium, potassium falls;
- urinalysis with the detection of diastasis, indirectly to the presence of pathology indicates an increase in protein, the appearance of fresh red blood cells and white blood cells.
It is impossible to speak precisely about the diagnosis of acute pancreatitis without instrumental examination, including invasive and visual methods.
- Sonography (ultrasound) of the pancreas can detect increased size, organ swelling, heterogeneous echogenicity, fuzzy contours and the presence of accumulation of free fluid in the retroperitoneal region.
- Radiography shows a pathological change in the glandular layer of the gland, swollen intestinal loops as a secondary sign of acute inflammation.
- CT allows with maximum certainty to establish the presence, localization and volume of areas of necrosis of the organ.
- Laparoscopy as an invasive diagnostic method is highly accurate and allows you to confirm the direct signs of illness – the accumulation of exudate in the tissues of the gland, hemorrhages on the walls of the abdominal cavity and the mesentery.
Differentiation during the examination is carried out with other acute conditions – an attack of cholecystitis, acute intestinal obstruction, perforation of the stomach and large intestine, acute bleeding from the gastrointestinal tract, abdominal syndrome.
Acute Pancreatitis Treatment
Treatment of acute pancreatitis requires placement in the surgical department of the hospital, the primary task of hospitalization is to relieve pain and provide complete rest to the patient. Strict bed rest is required. The objectives of drug therapy for acute inflammation of the pancreas – the elimination of negative causes, the maximum elimination of the organ and the process of its recovery.
Treatment of Acute Pancreatitis with Drug Therapy
With a diagnosis of acute pancreatitis, drug therapy includes:
- pain relief that helps relieve excruciating pain, but oral administration of antispasmodics and analgesics helps weakly, the best result in relieving pain is achieved by blockade (novocainic, epidural anesthesia) or by intravenous injection of Baralgin, Tramadol;
- creating hypothermic conditions (ice compresses) on the gland area in order to lower its enzymatic activity, at the same time aspirating the contents from the stomach cavity and organizing parenteral nutrition;
- intravenous infusion of drugs to accelerate microcirculation – hemodez;
- the appointment of deactivators of synthesized enzymes – Kontrikal, Gordoks;
- intravenous administration of solutions with sodium and potassium salts for the correction of water and electrolyte deficiency, prevention of dehydration;
- administration of medications from the group of neutralizers of gastric contents – Omez, Pantoprazole;
- antibiotic therapy, prescribed for prophylactic purposes and for signs of secondary bacterial complications; antibiotics are chosen with a wide spectrum of action and in high doses, Ciprofloxacin is considered the most effective;
- detoxification measures aimed at removing from the body of excess enzymes and their decomposition products; The most effective was recognized forced diuresis with the use of Lasix diuretic, capable of removing signs of intoxication in one procedure.
Surgical treatment is carried out at the transition of pathology to the severe stage with bacterial complications and the ineffectiveness of drug treatment. Other indications for surgery are calculi in the bile ducts, accumulation of free fluid in the tissues of the gland, the presence of multiple necrotic areas, cystic cavities, abscesses. The operation includes excision of dead tissue lesions (necrotomy) or complete removal of the pancreas. In the postoperative period, organize comprehensive prophylactic procedures to prevent purulent-septic complications.
Specialized Treatment Of Acute Pancreatitis
- Antisecretory therapy (the optimal period is the first three days of the disease):
- drug of choice – sandostatin (octreotide) 100 µg x 3 p. subcutaneously;
- reserve drugs – quamel (40 mg x 2 p. w / w), 5-fluorouracil (5% 5 ml w / w).
- Rheologically active therapy (heparin, reopolyglukine, refortan, etc.).
- Compensation of plasma losses (correction of water-electrolyte, protein losses, etc.: a total of at least 40 ml of appropriate infusion means per 1 kg of body weight; the ratio of colloid and crystalloid solutions is 1: 4).
- anti-enzyme therapy (kontrikal – at least 50 thousand units, pride-not less than 500 thousand units in / in. The optimal period – the first 5 days of the disease);
- antioxidant and antihypoxant therapy.
- Broad-spectrum antibiotic therapy with the use of two antibiotics (fluoroquinolones, metronidazole).
DIET FOR Acute Pancreatitis Patient
Diet for acute pancreatitis has its own characteristics. In the first 5 days from the onset of a pancreatic attack, complete rest is required – “starvation” diet No. 0 is prescribed. For the first 24 hours, the patient is provided with parenteral nutrition, on the second day it is allowed to drink water, exclusively alkaline. The volume of water consumed – at least 2 liters per day.
After 3-5 days it is allowed to use pureed porridge – rice, manna. The diet is gradually expanded, enriching the ration with vegetable soups, lean meat, white lean fish, and weak tea. Food should be thoroughly minced, served in the form of heat. After the state is normalized, it is important to follow the recommendations on nutrition:
- food in small portions, no more than 300 g per reception;
- food fractional and frequent, up to 5 times per day;
- exclusion of food containing extractives, spices, large amounts of animal fats;
- the limit in daily consumption of salt to 6 g;
The basis of the diet is vegetarian food, including fruits (non-acidic), vegetables (without coarse fiber), cereals (excluding wheat and pearl barley).
Complications Acute Pancreatitis
Acute pancreatitis is among the dangerous pathologies with a high probability of serious complications. The consequences of untreated or not fully cured inflammation can lead to the death of the patient due to sepsis, peritonitis. If time does not remove the attack of the disease, a state of shock may develop, followed by multiple organ failure.
After a postponed seizure, false cysts can form in the pancreas – limited accumulations of fluid in the paineathic layer. The danger of a pseudocyst is in the gradual destructive influence on the structure of the organ and the bile ducts. Against the background of spontaneous rupture of cysts and fluid flow, ascites may develop.
A no less formidable complication is the regeneration of pancreatic cells into cancer cells, which gives rise to a tumor process. A frequent negative consequence of surgical intervention is the formation of pancreatic fistulas – pathological messages of the gland with closely spaced organs. There is evidence of the development of attacks of mental disorders on the background of acute pancreatic inflammation.
Acute Pancreatitis Prevention & prognosis
Prevention of acute pancreatitis is based on a reasonable healthy diet, rejection of nicotine and alcohol intake. It is important to remember – an acute catarrhal process in the pancreas can occur not only in individuals who regularly drink alcohol, but also after a single consumption of a large amount of fatty foods combined with alcohol. Therefore, a healthy lifestyle should become a habit – then the risk of pathology will be minimal.
The prognosis for recovery is due to the stage of the disease, the presence of complications and the adequacy of treatment. Uncomplicated forms with early diagnosis in 100% of cases have a favorable outcome with complete restoration of the gland. Purulent and necrotic forms are difficult, mortality is high, especially in the elderly. Refusal of treatment, self-treatment and ignoring medical prescriptions leads to relapses and chronic pancreatitis.