Pancreatitis is a dangerous inflammatory disease of the pancreas. An acute attack is accompanied by a rapid deterioration in well-being, intense pain, loss of consciousness is possible. Naturally, urgent hospitalization is required. Then, acute pancreatitis in a hospital is necessarily treated. And the principles of therapy should now be described in detail.
What to do with an attack?
This question needs to be answered first. With an exacerbation of pancreatitis, you must definitely call an ambulance. It is forbidden to take painkillers ("Spazmalgon", "Analgin", etc.) before doctors arrive.
Also, you can not apply a hot or warm heating pad to a sore spot, drink anything, pull the costal part. Vomiting and nausea are prohibited from eliminating antiemetics.
Here are the actions allowed:
- A person should take a semi-sitting position, sitting on a sofa or bed.
- A cold heating pad or chilled moist tissue should be applied to the site of pain localization.
- Be sure to provide an influx of fresh air (open windows, door).
The doctor who arrived will conduct a quick examination, make an injection of Papaverine diluted with physiological saline, and then the person will be hospitalized for treatment of acute pancreatitis in a hospital.
In which department is the therapy carried out?
If a person is diagnosed with a moderate condition, then he is determined in the intensive care unit. If extensive intoxication is detected, loss of consciousness due to severe pain, or in the presence of a coma threat, the patient is immediately sent to intensive care.
There he is under the constant supervision of doctors. As a rule, people with a necrotic or edematous form are hospitalized. According to statistics, in 70% of cases conservative treatment of acute pancreatitis in a hospital is required. The goal of therapy is to stabilize the patient's condition and prevent the destructive stage.
Doctors should also bring a person back to normal as soon as possible, since the risk of death is great. And at an early stage of exacerbation, the pathological process can be really controlled, therefore it is necessary to apply a set of all the procedures shown in order to bring the patient out of a life-threatening condition.
Diagnostics
When a patient is brought to an emergency room, the first thing they do is measure blood pressure and body temperature. Then the doctor carries out exercises of the abdominal cavity, reveals the presence of yellowness in the eye proteins, checks the limbs for swelling.
Also, to prescribe a competent treatment of acute pancreatitis, in the hospital they conduct such studies:
- Biochemical blood test, identification of enzymes.
- An ultrasound scan is necessary to determine the localization of inflammation.
- Detection of leukocytes in the blood and their assessment.
- Laparoscopy.
After this, the form of the disease is determined, as well as its localization and the volume of the focus. Be sure to calculate the likelihood of complications.
Based on the information received, a decision is made regarding what the treatment in the hospital of acute pancreatitis will be like in this case. It can be either conservative or surgical.
Principles of Therapy
Now we can talk about the standard of treatment for acute pancreatitis in a hospital. The first step is to carry out activities aimed at reducing the load exerted on the pancreas:
- While the patient has a pronounced pain syndrome, accompanied by nausea and vomiting, he does not receive food through his mouth. It is also forbidden to drink.
- With an average and mild exacerbation, hunger lasts 2-4 days.
- It is allowed to start taking liquid food for 3-5 days. This mode is observed for 3-5 days.
- A catheter is installed through the nose in the stomach, which helps to reduce pressure and maintain it at this level. He is there for 24-72 hours. This method helps to quickly eliminate the pain.
If a person does not have intense discomfort, then he is shown antacids. The best is "Almagel" - 4 times a day for 10 ml. In a serious condition, blockers are administered parenterally for its investment.
Puffiness elimination
This is mandatory for a diagnosis of acute pancreatitis. To reduce the swelling of the pancreas, the following methods are used:
- Apply a rubber heating pad filled with cold water to the pancreas.
- Intravenous administration of Mannitolum solution.
- The use of the Furosemide diuretic on the first day.
- Drip injection of the drug "Hemodez."
It is also very important to prevent enzymatic intoxication, otherwise all of the above will be meaningless. To do this, use "Contrical". The drug is administered intravenously three times a day.
In some cases, an allergic reaction is detected in people. Therefore, ampoules with Prednisolone are always at hand. You can not do without it when removing the patient from a serious condition.
Other features of therapy
Continuing to talk about the treatment of a patient who has experienced any stage of acute pancreatitis, other important nuances should be noted.
So, for example, if a necrotic form is detected in an adult, then treatment with antibacterial agents is mandatory. As a rule, "Tienam" is prescribed at 250 or 500 mg. Enter it slowly through a dropper.
If we talk about painkillers, then appoint “Analgin” (into a vein or muscle), “Promedol” and “Procain”. In most cases, analgesics are combined with the use of myotropic antispasmodics.
To adjust the electrolyte and water balance, which is greatly disturbed in a disease such as acute pancreatitis, an isotonic sodium chloride solution is administered.
An alternative is a 5 percent glucose composition. But it is used if the patient has normal sugar.
In heart failure, a hormonal solution (norepinephrine and adrenaline), as well as catecholamines, are used.
How long does the therapy last?
This question interests many. How many days can the treatment of acute pancreatitis in a hospital last? In general, the course is designed for three weeks. After this time, the person is discharged.
But after about 6-8 months, he will need to undergo preventive therapy. This is necessary to prevent relapse of the disease.
Surgical intervention
When discussing how to treat acute pancreatitis, it is necessary to make a reservation that in about 30% of cases they resort to surgical methods. The operation is shown in such cases:
- Injury or trauma to the abdominal cavity.
- Unclear diagnosis.
- Pancreatic necrosis.
- Obstructive jaundice, which is caused by an infection of the biliary tract.
- Hemorrhagic pancreatitis.
- Abscess, bleeding, perforation of the intestine.
Also indications for the intervention are:
- Stones localized in the ducts of the gland. This is called wirsungolithiasis.
- Chronic pancreatitis with diseases of the duodenum, stomach and liver.
- Duodenostasis.
- Violation of patency in pancreatic ducts.
- Cysts and fistulas.
- Suspicion of oncological processes occurring in the pancreas.
- A persistent pain syndrome that cannot be stopped by any means.
Depending on the condition of the patient and the characteristics of his illness, a specific operation is prescribed. This can be a longitudinal anastomosis of the pancreatic duct or resection (left-sided, subtotal, pancreatoduodenal).
In especially severe cases, total duodenopancreatectomy is indicated. It is carried out if an extensive lesion of the parenchyma with necrosis is diagnosed, which has also spread to the duodenum 12.
Also, surgery can not be dispensed with in cases where another disease has joined pancreatitis. Most often it is an abscess, peritonitis, cholangitis. Often there is obstruction of the small intestine and bleeding in necrotic places. There is a blockage in the calculus of the duodenal papilla.
The duration of the further recovery period and the prognosis for rehabilitation depend on what operation is prescribed to the patient. Minimally invasive interventions, as a rule, do not cause complications, patients tolerate them easily. Cavity require a long recovery.
Diet
Above was briefly described about the treatment of acute pancreatitis. Recommendations also need to be addressed. And the key one is dieting.
With an exacerbation of the condition, it is necessary to suppress gland hyperfermentation, and also contribute to a decrease in secretion and stasis in the ducts.
In the early days, as mentioned earlier, hunger is indicated. Then they introduce weak tea, alkaline waters, rosehip broth.
From the third day it is allowed to eat, very little - a maximum of 100 grams, but 8 az per day. You can eat unsalted mucous soups, cereal broths, mashed cereals and stewed fruit, stale bread, crackers, as well as jelly and jelly from fruit juice.
Two days later, add protein products - soufflé, curd paste and puddings, steam omelet, milk porridge, cream soups from boiled meat. On the 6th day add mashed vegetable soup, mashed potatoes, a little butter. On the 7th day you can eat fish and meat soufflé, dumplings and steam cutlets.
In general, the diet for pancreatitis is very specific, but physiologically complete. The doctor will prescribe all the details to the patient. Anyway, after exacerbation, the diet will have to be followed for 6-12 months.