Purulent pancreatitis is one of the most dangerous forms of acute inflammation of the pancreas. Without treatment, such a pathology often leads to death. This is a fairly common disease, in terms of prevalence it is in third place after appendicitis and cholecystitis. How to recognize this dangerous disease? And is it possible to recover without surgery? We will answer these questions in the article.
Pathology Description
Purulent pancreatitis is an inflammatory process in the tissues of the pancreas, which is accompanied by diffuse suppuration, swelling and death of the cells. In the body, multiple abscesses and areas of necrosis are formed. The structure and enzymatic function of the gland is disturbed.
Purulent necrotic pancreatitis rapidly develops and progresses. Cell death is accompanied by irritation of the organ receptors, which leads to severe pain. Due to impaired gland function, dyspeptic symptoms occur. An intoxication of the body occurs with the breakdown products of necrotic tissues and an excess of enzymes. This can lead to coma and death.
Causes
Doctors have established that purulent pancreatitis occurs under the influence of the following factors:
- Infections Bacteria very rarely penetrate the pancreas from the external environment. Most often, pathogens are introduced into the body with the flow of blood or lymph from other foci of inflammation. But just the penetration of bacteria is not enough for the development of purulent inflammation. The disease occurs if favorable conditions are created in the gland for the reproduction of pathogens.
- Violations of the integrity of the gland tissue. A purulent process occurs if the patient already has pathological changes in the organ.
This pathology develops as one of the purulent complications of acute pancreatitis. First, the patient's tissues become inflamed. When they become infected, abscesses form in the gland.
The following pathologies and bad habits of the patient may be the cause of inflammation of the pancreatic tissues:
- chronic cholecystitis;
- gallstones
- hormonal disorders;
- abdominal injuries;
- alcohol abuse
- excess of spicy and fatty foods in the diet;
- uncontrolled medication.
The above factors contribute to the violation of the enzymatic function of the gland, which further leads to its inflammation and necrotization. If untreated, the affected tissues become infected and the purulent process begins.
Pathogenesis
Consider the mechanism of development of pancreatitis with purulent complication. Under the influence of various adverse factors, pancreatic dysfunction first occurs. Normally, this organ produces digestive enzymes that become active only when they enter the intestines. If these substances are activated ahead of time, then they aggressively affect the gland and destroy its tissues. An inflammatory process occurs with the formation of areas of necrosis.
Most often, excessive enzyme activity is noted in patients who abuse alcohol. Also, the cause of gland dysfunction can be gallbladder disease, abdominal trauma and drug abuse.
If inflamed and necrotic tissues become infected, abscesses form in the gland. Purulent complications of acute pancreatitis most often occur 10 to 12 days after the onset of the disease.
Symptomatology
At the beginning of the disease, the patient has the following signs of an inflammatory process in the pancreas:
- Pain syndrome. Strong unbearable pains appear on the left and right under the ribs. They are girdle-like and give to the shoulders, shoulder blades and lower back. The pain syndrome can be so intense that the patient begins to lose consciousness.
- Lack of appetite. Due to impaired enzymatic function, the patient is disgusted with food.
- Vomiting The patient has a deficiency of enzymes in the intestine and their excess in the pancreas. As a result, vomiting occurs after eating, which does not bring relief. Vomit often contains an admixture of bile.
- Diarrhea. Due to digestive disorders in the intestines, stools become frequent and loose.
Subsequently, symptoms of general intoxication of the body appear. This indicates the attachment of a bacterial infection and the formation of abscesses in the pancreas. Purulent pancreatitis is characterized by the following manifestations:
- fever (up to +39 degrees);
- rapid breathing;
- aching in the whole body;
- chills;
- drop in blood pressure;
- tachycardia.
The skin becomes pale and moist. In some cases, large purple spots appear on the abdomen.
If you do not provide the patient with help in time, then his health will rapidly worsen. Toxins affect the central nervous system. The patient develops confusion, lethargy or overexcitation. This condition is extremely dangerous, it can end in a coma and death of the patient.
Effects
With purulent pancreatitis, the infectious and inflammatory process can spread from the pancreas to other organs. This leads to the following dangerous pathologies:
- peritonitis;
- abscesses of the liver and peritoneum;
- purulent paranephritis;
- retroperitoneal phlegmon;
- severe pneumonia with the formation of abscesses in the lungs;
- purulent pleurisy.
If with acute pancreatitis the patient's condition does not improve within 4 weeks, then in half the cases sepsis occurs. This is a life-threatening condition in which bacteria and their toxins constantly circulate in the blood.
First aid
With purulent pancreatitis, the patient needs emergency hospitalization in a hospital. Therefore, during a pain attack it is necessary to call an ambulance team as soon as possible. Before doctors arrive, the following measures must be taken:
- The patient should be in a sitting position with the body slightly tilted forward. In this position, the pain subsides a little.
- The patient must refuse to eat. You can only drink still water in small portions.
- With an attack of pancreatitis, it is recommended to breathe superficially. Deep breaths intensify the pain.
- In no case should you wash your stomach and apply cold to your stomach. This can only worsen the condition of the patient.
- The patient is forbidden to give analgesics and enzyme preparations. To relieve pain, you can take only antispasmodics ("Nosh-pu" or "Papaverine").
Further help to the patient is provided by doctors. The patient is urgently hospitalized in the hospital, where they are examined and therapy.
Next, we will consider in detail the diagnosis and treatment of purulent complications of acute pancreatitis.
Survey
It is necessary to differentiate the purulent form of pancreatitis from other gastroenterological pathologies. For this purpose, the following examinations are carried out in the hospital:
- Biochemical blood test. A sign of purulent inflammation in the pancreas is a sharp increase in the concentration of amylase and lipase. Also, glucose indicators increase and the level of total protein decreases.
- Urinalysis for biochemical parameters. With pancreatitis, the diastase indicator significantly exceeds the norm.
- Ultrasound With purulent pancreatitis, the pancreas is enlarged, and its structure is heterogeneous. In the retroperitoneal region, fluid accumulation is noted.
- MRI Tomography shows the presence of purulent-necrotic areas in the gland.
- Laparoscopy This is the most reliable way to diagnose pathology. The procedure is invasive and is performed under anesthesia. In the abdomen, several small incisions are made. Probes are introduced through them and the gland is examined using a special device. Laparoscopic examination shows the presence of necrotic spots and abscesses in the gland, as well as the accumulation of exudate.
Conservative therapy
Drug treatment of purulent pancreatitis is effective only at the initial stage, when serious destructive changes have not yet occurred in the organ. Upon admission to the hospital, the patient is given droppers with antispasmodics and painkillers:
- "Nosh-sing."
- "Baralgin".
- "Papaverine."
In severe pain, novocaine blockades are performed, and in case of dehydration and intoxication, Reopoliglyukin is administered dropwise.
After stopping the pain and improving the patient's condition, antibiotic therapy is performed. This is necessary to fight infection and purulent inflammation. The following groups of antibiotics are prescribed:
- penicillins: Amoxiclav, Sulbactam, Flemoxin Solutab;
- macrolides: Clarithromycin, Azithromycin;
- cephalosporins: "Ceftriaxone", "Cefaperazone";
- fluoroquinolones: Gatifloxacin, Moxifloxacin;
- carbapenems: Ertapenem, Meropenem.
The following drugs are used to reduce the secretion of pancreatic enzymes:
- Almagel.
- Cimetidine.
- Ranisan.
Doctors also recommend consuming alkaline mineral water without gas. This helps to reduce the aggressive effects of enzymes on the gland tissue.
Diet
A medication alone is not enough to get rid of purulent pancreatitis. The patient must strictly adhere to a special diet. With such a serious illness, any deviation from the rules of nutrition is extremely dangerous. The use of prohibited foods can lead to a sharp deterioration in well-being and the development of complications.
In the first 3-5 days of illness, the patient needs complete hunger. Before stopping acute manifestations of purulent inflammation, you should completely refrain from eating. In the future, the patient’s diet is gradually expanded:
- On the second day. Accepted alkaline water without gas. Mineral water must be drunk in large quantities (at least 2 liters per day).
- 3-5 day. Liquid porridge is introduced into the menu.
- 5-6 day. The patient is allowed to consume light soups on vegetable broth, low-fat steamed fish, kefir and weak tea. Food should be at room temperature. Food is served in crushed or mashed form.
A week after the onset of the disease, the patient is transferred to table No. 5. This is a diet for patients with chronic pancreatitis. It involves the rejection of fatty, fried and spicy foods, as well as vegetables rich in fiber and carbohydrates. Patients are strictly forbidden to take alcoholic beverages, even in small quantities.
Surgical methods
If acute purulent pancreatitis proceeds in a severe and neglected form, then the patient needs urgent surgery. Indications for surgical treatment are the following pathological changes:
- irreversible and extensive destruction of the structure of the organ;
- multiple abscesses;
- severe intoxication of the body;
- hemorrhage in the gland tissue.
The operation is contraindicated if the patient is in a state of shock.
During surgery, the doctor removes abscesses and necrotic areas of the gland. Currently, they try to do such an operation in an endoscopic manner, through a small incision.
Often, patients are diagnosed with purulent cholecystitis at the same time. In this case, the gall bladder is removed or drained during the operation.
Forecast
How dangerous is purulent pancreatitis? A fatal outcome with this pathology is noted in 20-25% of cases. The cause of death most often becomes intoxication of the body with enzymes and decay products of necrotic tissues. Poisoning with toxic elements leads to a shock state.
The cause of death of the patient may be septic complications. The prognosis is significantly worsened if the patient develops secondary purulent foci in other organs. The spread of infection throughout the body very quickly leads to blood poisoning.
The risk of death is doubled if the patient does not follow the doctor's recommendations. High mortality from complications of pancreatitis is observed among patients with chronic alcoholism.
At an early stage, purulent inflammation of the pancreas is treatable. After discharge from the hospital, the patient must be under clinical supervision for 1 year. The diet should be followed for at least 6 months.
Prevention
To avoid purulent inflammation of the pancreas, the following rules must be observed:
- Refuse to drink alcohol.
- Do not abuse spicy and fatty foods.
- Time to cure gallbladder disease.
- All medications should be taken only as directed by a doctor.
- Protect the abdominal cavity from injury.
- With the appearance of girdle pain in the abdomen, an urgent visit to a gastroenterologist.
These measures will help prevent the occurrence of a dangerous and serious illness.