If the phrase “acute pancreatitis” doesn’t tell you anything, it means that you had no problems with the pancreas. This diagnosis is given to patients who have a pronounced degenerative-inflammatory process. The disease is characterized by painful symptoms. The clinic of acute pancreatitis does not allow confusing it with other pathologies of the digestive system.
Briefly about the disease
A patient with a clinic of acute pancreatitis feels acute, unbearable pain in the upper abdomen. The exact localization of painful sensations depends on which of the pancreatic lobes is affected. Pain can occur both on the right and on the left side in the hypochondrium, radiating to the epigastrium or encircling it. Unlike acute, chronic inflammation is less aggressive. The patient's appetite worsens, digestive disorders are noted, paroxysmal, but less severe pain occurs after consuming prohibited foods (fatty, spicy foods, alcohol).
What happens to the gland
During the disease, powerful inflammatory reactions occur in the tissues of the gland. The cause of acute pancreatitis, the clinic and the symptoms of which lead to temporary disability, is the influence of various factors. However, the underlying mechanism of the pathology is the adverse effect of enzymes - amylase and lipase, without which the process of digesting food is impossible, which the pancreas itself produces. Normally, these enzymes should be activated in the duodenum, but for a number of reasons, this process starts when the enzymes have not yet left the gland tissue. Consequently, the pancreas begins to digest itself.
The result of this violation is an increase in body size, the appearance of swelling, necrotic changes, which provoke a clinic of acute pancreatitis. When diagnosing, any experienced specialist will find pathological areas that are clusters of dead cells.
The process of death of pancreatic cells does not threaten the accession of a secondary infection. As the disease progresses, the area of organ damage increases. In addition, in parallel with necrosis, fatty degeneration can progress, creating suitable conditions for the transition of the disease into a purulent form.
Severity of inflammation
Depending on the severity of the clinic of acute pancreatitis, there are mild and severe inflammation of the pancreas. In the first case, the so-called interstitial edema is observed, in which a weak lesion of the gland occurs. Mild pancreatitis can be treated more quickly, because the disease, as a rule, is not accompanied by complications. In the vast majority of cases, patients are given a favorable prognosis.
The clinic of acute pancreatitis with a severe degree of the disease is caused by a large-scale damage to the organ tissues, which serves as a background for the development of local complications. In addition to necrotic foci, abscesses with purulent contents, cysts, and the addition of a bacterial infection may appear in the pancreas.
What can cause the disease?
The cause of the development of acute pancreatitis are factors that provoke the excessive production of digestive enzymes and their premature activation. The risk of increased secretion of amylase and lipase increases in people who:
- poorly eat and abuse harmful products (fried, fatty dishes, sweets, spices and seasonings);
- do not comply with the meal schedule, often eat in the dryer and on the run;
- systematically abuse alcohol;
- have a history of biliary tract disease, organ damage;
- infected with severe bacterial and viral infections - mycoplasmosis, viral hepatitis, mumps.
Gland dysfunction resulting from surgery can lead to pancreatitis. The disease can also occur against the background of prolonged use of potent drugs. Antibiotics, hormones, immunosuppressants can lead to adverse effects. Such pancreatitis is called medication.
In children, inflammation of the pancreas is rare. Pancreatitis in newborns is usually an anomaly of a congenital nature. Genetic diseases, endocrine diseases, including diabetes, can also provoke inflammation. Some experts believe that the likelihood of pancreatitis is higher with burdened heredity and concomitant diseases of the gastrointestinal tract, liver, gall bladder.
Typical symptoms
The clinic of acute pancreatitis is difficult to confuse with any other disease. Often, symptoms of this pathology occur after exposure to a risk factor. Most often, they find nutrition errors and prolonged treatment with antibiotics, corticosteroids. The manifestation of the disease usually begins with an attack, which indicates that the patient urgently needs help. The clinic of acute pancreatitis is growing very quickly, so with the first symptoms it is necessary to call an ambulance.
The first characteristic sign is pain localized in the right or left hypochondrium or immediately on both sides. Sometimes the pain syndrome surrounds the entire part of the abdomen above the navel. Patients feel how discomfort is given to the collarbone and lower ribs. In women, another clinic of acute pancreatitis can also be observed: the manifestation of the inflammatory process in women is sometimes accompanied by the irradiation of pain in the pelvic area. It should be noted that in the supine position, pain in patients, as a rule, increases.
The second symptom by which one can make an assumption of acute pancreatitis is vomiting and nausea. With inflammation of the pancreas, strong urge to torment. With vomiting, plentiful masses with impurities of bile and mucus are secreted, but at the same time relief does not occur even with complete emptying of the stomach. This symptom is a direct indication for calling a team of doctors or self-transportation of the patient to the clinic. Emergency first aid for acute pancreatitis begins with the introduction of parenteral drugs, including antiemetics.
Fever is not always observed in patients with this disease. So, for example, with a mild form of pancreatitis, this indicator can increase by only one degree, that is, rise to subfebrile values. With a complicated course of inflammation, a prolonged fever is possible, which cannot be stopped with antipyretic drugs.
In addition to pain in acute pancreatitis and other described symptoms, patients lose their appetite. Aversion to food occurs due to a lack of enzymes in the small intestine. Perhaps the appearance of peritoneal syndrome, which is characterized by excessive tension of the muscles of the abdominal wall and pain during palpation of the abdomen. With pancreatitis, a change in the color of the skin is not excluded - they become yellowish or bluish, which is caused by a violation of the microcirculation of blood on the face, neck, stomach.
Symptoms of pancreatic inflammation may include dyspeptic disorders - diarrhea, severe flatulence, heaviness and bursting in the epigastric region. Dyspepsia in acute pancreatitis causes a sharp deficiency of enzymes and the lack of full intestinal motility.
First aid at home
At a clinic of acute pancreatitis, treatment must be started before the ambulance arrives. A patient who has symptoms of pancreatic inflammation needs first aid, which includes a whole range of measures:
- Provide the patient with complete physical rest and immobility.
- To unfasten the constraining and squeezing clothes.
- To reduce the intensity of the pain syndrome, seat the patient so that the torso is tilted forward.
- Do not give any food to the patient, although with an acute form, patients do not have such a desire due to a lack of appetite.
- Limit fluid intake. You need to drink in small sips every half hour, use only non-carbonated, purified or ordinary boiled water.
In order to stop at least a little pain it is undesirable to take deep breaths and exhalations. Breathing should be shallow, with a periodic delay. First aid in the clinic of acute pancreatitis does not involve gastric lavage with drugs, even if the patient has intense vomiting. In order to facilitate the passage of vomit when the next urge appears, you just need to put pressure on the root of the tongue.
Examination: how to make a correct diagnosis
When choosing the tactics of differential diagnosis, the causes and the clinic of acute pancreatitis are of paramount importance. First of all, it is necessary to exclude conditions such as exacerbation of chronic cholecystitis, acute intestinal obstruction, perforation of the wall of the stomach or colon, bleeding.
Examination of the patient with suspected inflammation is prescribed by a gastroenterologist or therapist. As a rule, complex diagnostics is required in the clinic of acute pancreatitis. First, the patient is examined, a conversation is held with him, during which he voices all the complaints, describes the symptoms in detail. Then the patient is measured blood pressure. If it is lowered and there are signs of tachycardia, doubts about the diagnosis are completely dispelled, but laboratory tests and instrumental procedures must be performed to accurately confirm acute pancreatitis.
Based on the results of a general blood test, one can judge the presence of an inflammatory process in the body. In particular, increased ESR and stab neutrophils are important for the recognition of pancreatitis. A biochemical blood test to determine the activity of enzymes in the presence of pathology will show overestimated amylase and lipase, an increased concentration of glucose and urea, an overestimated level of C-reactive protein against a background of a decrease in the total amount of protein, albumin, and globulins.
Indirectly, acute pancreatitis can be indicated by the result of an ionogram - if, in conclusion, calcium, sodium and potassium are less than expected, then dehydration develops in the body, which is one of the signs of inflammation. But even this is not enough to make a final diagnosis. To avoid complications of acute pancreatitis, diagnosis and treatment in the clinic is carried out as soon as possible. The examination also involves the use of instrumental invasive and non-invasive methods:
- ultrasound examination of the abdominal cavity, including the pancreas, which will allow you to determine the size of the organ, detect swelling, heterogeneous echogenicity, smeared contours or fluid accumulation in the retroperitoneal space;
- X-ray is done in order to assess the condition of the parinhematous layer of the gland;
- computed tomography is the most informative method of examination, which will help to clarify the localization and area of necrotic lesions;
- laparoscopy is an invasive research method that confirms all the signs of the disease (the presence of exudative fluid in the tissues of the organ, hemorrhage on the walls of the abdominal cavity and mesentery).
Emergency medical activities
Treatment at the clinic of acute pancreatitis occurs in the intensive care unit. When the patient is hospitalized, the goal is to eliminate the pain syndrome and provide the patient with complete rest. Patients with pancreatic inflammation are shown strict bed rest.
After establishing a diagnosis, doctors have the opportunity to proceed to a medical course. The correct selection of drugs will eliminate symptoms, restore the normal production and activation of digestive enzymes, as well as stimulate the processes of tissue repair of the gland. Patients with acute pancreatitis are urgently given painkillers. To relieve acute excruciating pain, the use of potent analgesic and antispasmodic drugs is required. In tablet form, the drugs practically do not help, so the medicine is administered intravenously. In severe acute pancreatitis, the use of opioid analgesics, novocaine blockade, epidural anesthesia are allowed.
The patient also needs to administer drugs to accelerate blood microcirculation (Hemodez), deactivators of synthesized enzymes (Kontrikal, Gordoks) and solutions with sodium and potassium salts to restore water-electrolyte balance and prevent dehydration. In parallel with the parenteral administration of drugs, it is important to reduce the enzymatic activity of the inflamed gland. This can be done by applying ice compresses to the upper abdomen. In addition, aspiration of contents from the gastric cavity should be performed. Since in the coming days any food is contraindicated for the patient, he is prescribed parenteral nutrition by infusion of glucose-containing solutions.
Drug treatment course
As soon as the patient's condition stabilizes, injections and droppers are replaced by tablet forms of drugs. The attending physician determines the dosage and duration of use of the following drugs:
- proton pump inhibitors - Omez, Pantoprazole, Nolpaza;
- antibiotics - Ceftriaxone, Ciproflaxacin, Amocicillin, Clorithromycin (antibacterial drugs are taken to prevent bacterial complications);
- detoxification agents and adsorbents aimed at removing excess enzymes from the body;
- diuretics that relieve manifestations of intoxication on the background of tissue necrosis ("Furosemide", "Lasix").
If the disease becomes severe, the doctor may decide on the need for surgical intervention. Indications for pancreatic surgery are bacterial complications and the ineffectiveness of drug exposure. Also, an indication for surgical treatment may be the presence of stones in the bile ducts, fluid accumulation in certain parts of the gland, numerous necrotic foci, cystic cavities, abscesses. During the operation, the surgeon excises the foci of the affected and dead organ tissues or completely removes it.
What can I eat with acute pancreatitis
The diet for inflammation of the pancreas has a number of features. During the first 3-5 days, depending on the condition of the patient, he is prescribed a "hungry" diet. In accordance with the clinical guidelines for acute pancreatitis, complete nutritional rest is of particular importance. During the first day, the patient may be forbidden to even drink water. As soon as relief comes, with pancreatitis it is recommended to drink alkaline water in the usual daily volume.
The first meal is allowed after 3-5 days. You can only use mashed cereals boiled in water (rice, semolina, buckwheat). The diet is expanded in stages, introducing into the diet vegetable soups, lean meats, white low-fat fish, weak tea.
Food must be thoroughly chopped and served to the patient in a warm form. As soon as the patient's condition normalizes, the diet is changed, adhering to the following principles:
- take food in small portions (200-300 g) at least five times a day;
- completely eliminate fats of animal origin, products containing extractive substances, spices;
- minimize consumption of table salt;
- give preference to steamed and boiled vegetables and fruits without coarse fiber.
What can be the complications
With a severe form of purulent necrosis, complications often develop. The clinic of acute pancreatitis becomes more pronounced, as the development of sepsis or peritonitis may indicate. A negative consequence of untreated pancreatic inflammation can be a shock condition with the development of multiple organ failure. Other dangerous complications of acute pancreatitis include:
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