Classification of acute pancreatitis: types and forms, description

In the classification of acute pancreatitis, all degrees of inflammation should be taken into account. It is important to evaluate not only the degree of damage to the pancreas, but also all organs located in close proximity to it. This should be done by a qualified specialist based on analysis and research.

What is acute pancreatitis?

Pancreatitis is an inflammation of the pancreas. The acute form of pathology is the most dangerous, since in the absence of timely treatment, the patient may die. This is due to the fact that with this form bleeding, suppuration, as well as decay and necrosis of pancreatic tissues develop.

What is the essence of the classification of pancreatitis

In order to establish an accurate diagnosis, a classification and types have been developed in medicine. The most popular in Russia is the classification of acute pancreatitis according to Savelyev in collaboration with doctors (V. A. Gagushin and V. I. Filin). She has established herself as very informative. In accordance with this classification, pathology is diagnosed by three signs: by the severity of the pathology, by the reasons for its development and by the forms of the disease.

No less popular is the international classification, which was adopted in Atlanta in 1992 and subsequently called the Atlanta Classification of Acute Pancreatitis. Diagnosis of the disease by this gradation also reflects its essence well. It also coincides with the classification by Savelyev and the modern classification of pancreatitis.

Simplified classification

A simplified classification of acute pancreatitis suggests several variations in the development of the pathological process:

1. Acute pancreatitis.
2. Acute pancreatitis with the development of exacerbations.
3. Chronic pancreatitis.
4. Exacerbations of pancreatitis, proceeding in a chronic form.

Classification by form of disease

This type of classification of acute pancreatitis includes: symptoms of pathology, degree of organ damage, decoding of laboratory tests and the effectiveness of the therapy used. At the same time, several main forms of the disease are distinguished.

1. Edematous form of pancreatitis. The mildest form of acute pancreatitis, in which any significant changes in the pancreas does not occur. With proper and timely treatment, the prognosis is charitable. When diagnosing a patient, an elevated level of fibrin in the blood is detected, which indicates the development of the inflammatory process. This form of acute pancreatitis is characterized by: an increase in body temperature, yellowness of the skin, pain in the hypochondrium on the left side, nausea.
2. Limited pancreatic necrosis. The inflammatory process with this form of pancreatitis occurs in only one part of the pancreas - it can be the body, tail or head. Characteristic signs are: nausea, bloating, vomiting, bowel obstruction. When diagnosing, an elevated blood sugar level, the appearance of pancreatic enzymes, and a deficiency in the blood cells that are responsible for oxygen delivery are detected. With the right treatment, the prognosis is favorable, but this form can be treated much more difficult than the previous one.
3. Diffuse pancreatic necrosis. This form develops in the case of extensive damage to the cells of the pancreas. In addition to the described symptoms, there is a fever, signs of poisoning, oliguria, sometimes stomach bleeding. In the analyzes - hyperglycemia and hypocalcemia. Therapy requires immediate intervention with a wide range of medications. Often, one of the therapeutic measures aimed at treating diffuse pancreatic necrosis is surgery.
4. Total pancreatic necrosis. This form of acute pancreatitis affects the entire pancreas. The patient develops pulmonary, renal and heart failure, if all the care measures are not taken in time, the patient is at risk of death.

Causal Classification of Pancreatitis

This Atlanta classification of acute pancreatitis implies the presence of reasons for the development of pathology:

1. Alimentary. It develops when eating fried, fatty and spicy dishes with a large number of seasonings, as well as when drinking alcohol.
2. Biliary. Development occurs against a background of various diseases of the liver, biliary tract and gall bladder.
3. Gastrogenic. The cause of the development of the pathology are diseases of the gastrointestinal tract, in particular, gastritis and gastric ulcer.
4. Ischemic. Factors that contribute to the development of ischemic pancreatitis are disorders in the pancreas.
5. Toxic-allergic pancreatitis develops as a result of excessive use of drugs or against the background of an allergic reaction to some medications.
6. Infectious. It develops when various bacteria and viruses are exposed to the body.
7. Traumatic. This type of pancreatitis is diagnosed in most cases after injuries of the anterior wall of the abdominal cavity.
8. Congenital. Such pancreatitis often combines other congenital diseases or genetic abnormalities of the body.

By severity

The classification of acute pancreatitis approved in Atlanta implies a mild, moderate, severe and critical degree of development of pathology. In this case, mild and moderate degree of acute pancreatitis undergo conservative treatment, while in severe cases of the disease in most cases it is necessary to resort to surgical intervention.

Atlanta Pancreatitis Classification was proposed in 1992. Later, in 2012, it was improved. With the critical development of pathology, emergency measures are required to provide first aid to the patient in order to avoid death.

The scale and nature of the lesion

According to the classification, acute pancreatitis according to these criteria can be divided into five main types:

1. Hydropic. The disease proceeds without any changes in the pancreas. With the edematous form of pancreatitis, no surgical intervention is required, since this type of disease is characterized by a reversible process, for this it is enough to undergo a course of drug therapy and follow a strict diet for some time.
2. Pancreatic necrosis is sterile. This variety is characterized by the destruction of some parts of the pancreas by its own enzymes, but there are no infectious complications.
3. Infectious pancreatic necrosis. At this stage, an infection that infects both the pancreas and the organs adjacent to it joins the disease.
4. Pancreatogenic abscess. As a result of the development of infection in the pancreas, a cavity appears that is filled with pus.
5. Pseudocyst. A cavity filled with liquid appears in the pancreas, it can be exudate, pancreatic juice or blood.

Clinical forms

There are two clinical forms of acute pancreatitis:

1. Interstitial. This form of acute pancreatitis is characterized by swelling of the pancreas and surrounding tissues, while the integrity of the organ is fully preserved and there are no complications or consequences.
2. Necrotic. With the necrotic form, the pancreas is highly inflamed, which can be fraught with some complications.

In addition, necrotic pancreatitis can be divided into several forms:

1. Local The disease develops only in the pancreas and does not go beyond it.
2. Focal. With focal pancreatic necrosis, the size of the lesion of the organ by pathology can vary from a small to a large specific site of the pancreas.
3. Common. The following complications are common for a common form of necrotic pancreatitis: shock, bleeding that develops in the stomach or pancreas, DIC, and electrolyte and metabolic disorders. In addition, this form of acute pancreatitis can be either subtotal or total - in both cases, this most often results in the death of the patient.

Diagnostics

One of the main tests that you need to take when you suspect pancreatitis is a biochemical blood test.

The clinical and morphological classification of acute pancreatitis is complex. In order to attribute the disease to one or another group, one needs to undergo a number of studies: an ultrasound examination of the abdominal organs, a coprogram, an aspiration biopsy, and computed tomography.

Possible complications of pancreatitis

With pathology occurring in acute severe form, the risk of the following complications is possible.

1. Fistulas that can appear both on the inside and on the outside of the pancreas.
2. Sterile or infected pseudocyst formation.
3. Bacterial inflammation of the abdominal cavity, which can subsequently lead to enzymatic peritonitis.
4. Squeezing and swelling of the Vater papilla, responsible for the normalization of the outflow of bile. As a result of such compression, the development of mechanical or obstructive jaundice is possible.
5. Damage to the vessels of the abdominal organs, which can trigger the development of bleeding. In particular, we are talking about gastric bleeding, often bleeding develops in the pancreas itself.
6. Pancreatogenic abdominal abscess.

You can minimize the risk of exacerbations and complications of acute pancreatitis, and the classification has nothing to do with it. In order to achieve this, it is necessary to limit or stop taking alcoholic beverages, stop eating improper and poor-quality food, use all medicines only as directed by a doctor, treat all pathologies of internal organs in a timely manner and lead an active lifestyle - move more and spend time as often as possible in the fresh air.

Acute pancreatitis is a very serious disease, some forms of which are developing almost rapidly, which can lead to unforeseen circumstances if the patient is not provided with emergency assistance.