One of the most serious diseases of the human digestive system is pancreatic pancreatic necrosis, a fatal outcome in which, according to statistics, occurs in 40-60% of cases.
Causes of pancreatic necrosis
Acute pancreatitis, the complication of which is pancreatic necrosis, is in third place in frequency of occurrence, letting forward only acute appendicitis and cholecystitis. As a rule, it develops as a result of damage to the secretory cells of the pancreas, excessive production of pancreatic juice and impaired outflow. These processes can provoke:
- abdominal injuries;
- abdominal surgery;
- intoxication of the body (including alcohol);
- allergic reactions;
- gallstone disease ;
- infectious or parasitic diseases;
- excessive consumption of fried meat, extractive substances, animal fats.
The causes of pancreatic pancreatic necrosis are numerous, but most often it develops after drinking a large amount of alcohol combined with fatty protein foods. It happens that the disease proceeds almost instantly and an attack can develop against the background of complete well-being. Cases have been reported when pancreatic pancreatic necrosis, the fatal outcome of which occurred within hours after the first signs of the disease, developed a few days after an abundant feast.
What happens with pancreatic necrosis
A healthy pancreas produces enzymes that are necessary for the breakdown of food entering the stomach. It is thanks to them that food is split into elements that can enter the blood through the mucous membrane of the stomach, which delivers them to tissues and organs. This makes the pancreas one of the important organs in the body. Drinking alcohol with plenty of fatty foods dramatically stimulates the pancreas to produce juice, and since the ducts cannot completely remove it, it begins to accumulate inside the gland. This leads to the development of edema, further compression of the excretory ducts and their subsequent blockage. The active enzymes of the pancreas, whose function was originally the breakdown of proteins, sweat through the walls of the ducts and begin to dissolve them, under the action of the enzymes, “own” gland tissues are “digested”. Active enzymes and decay products formed in this process enter the bloodstream and contribute to the dissolution of other organs and tissues, causing severe intoxication. Thus, pancreatic pancreatic necrosis, the prognosis of which is rather difficult to predict, is a very dangerous disease.
Classification of pancreatic necrosis
Depending on the extent of the lesion of the gland, small-focal, medium-focal, large-focal, subtotal and total pancreatic necrosis are distinguished. Of course, the differences between the first two species are largely arbitrary. Doctors use these concepts in order to determine the degree of organ damage. With subtotal pancreatic necrosis, necrotic changes affect most of the gland. If the organ is completely affected, then total pancreatic pancreatic necrosis is diagnosed. In this case, a fatal outcome is always observed.
There is another classification option. It divides pancreatic necrosis into two types:
- Limited. This includes a process in which foci of different sizes are formed.
- Common. In this case, most of the gland or the entire organ is affected.
Types of pancreatic necrosis
Depending on the presence of infection in the affected areas, sterile or infected pancreatic necrosis is distinguished. Moreover, in the case of an infected process, the prognosis is rather unfavorable, since there is a high probability of developing an infectious toxic shock, and it can be extremely difficult to get a patient out of this condition.
Sterile pancreatic necrosis is divided into the following types:
- fatty - it is characterized by slow development for 4–5 days and a milder course;
- hemorrhagic - characterized by a rapid course and frequent bleeding;
- mixed - occurs most often, since with pancreatic necrosis, adipose tissue and pancreatic parenchyma are equally affected.
If pancreatic pancreatic necrosis is diagnosed, surgery is inevitable. But often it does not give the desired result, and perhaps the re-development of necrotic foci.
Symptoms and diagnosis of pancreatic necrosis
Clinically acute pancreatitis is manifested by severe pain in the left hypochondrium or pains that have a shingles. There is vomiting of intestinal contents, which does not bring relief, diarrhea. Against this background, dehydration quickly occurs, intoxication intensifies. When making a diagnosis, the collection of anamnesis is of great importance. If it contains information about the abuse of alcohol, fatty foods or information about diseases of the liver and gall bladder, this is very likely to make a diagnosis of pancreatic pancreatic necrosis. The prognosis in this case will largely depend on at what stage of the disease the patient sought medical help, and on the extent of the lesion.
As for laboratory diagnostics, here they pay attention to the analysis of urine and blood, where there is a significant excess of the level of amylase. Ultrasound of the abdominal cavity, CT or MRI is also performed, where you can see the appearance of necrotic areas in the tissues of the pancreas.
Treatment
In most cases, pancreatic necrosis requires surgical intervention. At the same time, despite the fact that the mortality rate is quite high, timely surgery gives a great chance of recovery. Conservative treatment includes the following steps:
- within a few days after the attack - complete starvation, and depending on the severity of the disease, the introduction of nutrients by intravenous infusion can last for weeks;
- blood purification (hemosorption) - is carried out with severe intoxication;
- somatostatin is a hormone that can reduce the consequences of impaired renal function, often accompanying pancreatic necrosis;
- with infectious forms - antibiotics.
Acute Pancreatitis - Diet
Since it is the nutritional factor that very often becomes the cause of acute pancreatitis, it is of great importance in the treatment process. As mentioned above, in the first days after the diagnosis of acute pancreatitis was established, the diet is very strict - complete starvation is observed. In severe cases, parenteral administration of nutrients can last several weeks.
In the future, nutrition in pancreatic pancreatic necrosis implies a sparing regime, which is ensured by the maximum exception of fats and carbohydrates from the diet, as well as products that cause increased gas formation. The food is steamed and chopped thoroughly. It is taken in small portions five to six times a day. The use of extractives and salt is completely ruled out. Such a diet, depending on the severity of the disease, should last from several months to a year.
Of course, with such a serious illness as pancreatic pancreatic necrosis, a fatal outcome is possible, and, of course, it is better not to bring your body to an attack, eliminating risk factors as much as possible. But if the disease still developed, then careful adherence to the diet will help to avoid relapses in the future.