In the article, we consider the etiology and pathogenesis of acute pancreatitis. This is an inflammation of the pancreas.
According to various sources, mortality from acute pancreatitis can reach 40%. The danger of the disease lies in the rapid development of severe complications, up to complete pancreatic necrosis. However, timely and correct treatment allows them to be avoided, and the patient fully recovers.
What are the etiology, pathogenesis and clinical picture of acute pancreatitis?
The symptomatology of the disease manifests itself in the form of severe, sometimes unbearable pain in the abdomen. Depending on which part of the gland is inflamed, localization of discomfort is possible in the right or in the left hypochondrium, in the epigastric region. Such sensations can be girdle. The disease is accompanied by loss of appetite, and in addition, a violation of the digestive system, pain occurs after consumption of fatty foods or alcohol. What is the pathogenesis of acute pancreatitis?
Description of the disease
Pancreatitis is a disease characterized by the development of inflammation in the pancreatic tissues. By the nature of the course, this ailment is divided into acute and chronic. In this article, we consider the etiology and pathogenesis of acute pancreatitis, which occupies the third place among abdominal pathologies. Such an ailment requires therapy in a surgical hospital.
According to world statistics, in a year from two hundred to eight hundred people out of one million get acute pancreatitis. This pathology is more common in men. The age of patients varies widely, and directly depends on the cause of pancreatitis.
The acute form of the disease due to alcohol abuse is formed on average at the age of about thirty-nine years. And with the appearance of pancreatitis associated with gallstone disease, the average age of patients is sixty-nine years.
The pathogenesis of acute pancreatitis is of interest to many patients. Why does the disease arise? We will examine in more detail in this matter.
Etiology and pathogenesis of acute pancreatitis
Here are the factors that contribute to the onset of the acute form of the disease:
- Alcohol abuse along with bad eating habits (fatty, spicy).
- The development of gallstone disease.
- The presence of a virus infection (for example, mumps or Coxsackie virus) or bacterial infection (this may be mycoplasma along with campylobacteria).
- Getting pancreatic injuries - this is the pathogenesis of pancreatitis in surgery.
- Surgery for various pathologies of this gland and bile ducts.
- The use of estrogens along with corticosteroids, thiazide diuretics, "Azathioprine", and other medicines with a pathological pronounced effect on the pancreas (we are talking about drug pancreatitis). What is the pathogenesis of symptoms of acute pancreatitis?
- The appearance of congenital malformations of the gland in combination with a genetic predisposition and cystic fibrosis.
- The development of inflammatory diseases of the digestive system (with cholecystitis, hepatitis, gastroduodenitis).
The pathogenesis of acute pancreatitis in surgery should be known in advance. In the development of inflammation of the gland, according to the most common theory, the main factor is cell damage by a prematurely activated enzyme. Under normal conditions, the digestive enzyme is produced in the pancreas in an inactive form and is activated directly in the digestive system.
What else is the pathogenesis of acute pancreatitis talking about?
Under the influence of various pathological factors, the mechanisms of production are disrupted, the enzymes in the gland become activated and begin to digest its tissues. The result is inflammation, edema of the walls of the organ is formed, blood vessels are affected.
Pathological processes in acute pancreatitis can spread to nearby tissue, for example, retroperitoneal tissue, peritoneum, omental bursa and omentum, and in addition to liver ligaments and mesentery of the intestine. Severe forms of acute pancreatitis contribute to a sharp increase in the level of various biologically active substances in the bloodstream, which leads to general pronounced disabilities in the form of secondary inflammation and dystrophic disorders in organs, whether they are lungs, liver, heart, and so on. Now let's talk about the clinical manifestation of this pathology and find out what symptoms most often accompany patients in the event of an acute form.
Clinic of the disease
Consider the clinic, diagnosis, treatment of acute pancreatitis. Characteristic manifestations include:
- The appearance of pain. Discomfort can be localized directly in the epigastrium, in the region of the left hypochondrium. He is able to wear herpes zoster, giving under the left shoulder blade. The pains are also constant and pronounced, and in the supine position, they intensify. Symptoms intensify after eating food, especially fatty and spicy foods, as well as alcohol.
- Onset of nausea and vomiting. The last symptom is indomitable, contains bile, without bringing any relief.
- Temperature increase.
- The presence of moderate pronounced jaundice sclera. Slight jaundice of the skin is rarely observed.
In addition, acute pancreatitis can be accompanied by dyspeptic symptoms (bloating, flatulence, heartburn), skin manifestation (bluish spots on the body, hemorrhages in the navel). As part of the treatment of the disease in question, it is extremely important to conduct a competent diagnosis. We will find out further what studies are conducted to confirm the diagnosis.
Diagnostics
Diagnosis of pancreatitis by gastroenterologists is based on complaints, physical examination and identification of characteristic signs. In the case of measuring pressure and heart rate, tachycardia is often noted. To confirm the diagnosis, laboratory tests of blood and urine, ultrasound of the abdominal organs, and magnetic resonance imaging of the pancreas are performed.
As part of a blood test, signs of inflammation are noted in the general analysis (it may be accelerated ESR, the number of leukocytes increases). As for the biochemical study, an increase in the activity of the pancreatic enzyme (amylase) is detected in it, the development of hyperglycemia and hypocalcemia is possible. The determination of the concentration of enzymes in the urine is also carried out. Bilirubinemia can be fixed along with an increase in the activity of the liver enzyme.
In the process of diagnosing an acute form of pancreatitis, a biochemical urinary analysis is taken and amylase activity is determined. Visual studies of the organ in the form of ultrasound analysis and computed tomography can detect a pathological change in the parenchyma along with an increase in the volume of the body, abscesses, cysts, the presence of stones in the ducts and the like.
Differential diagnosis
Differential diagnosis of this disease is carried out with the following ailments:
- Acute appendicitis or cholecystitis.
- The patient has perforation of hollow organs (for example, perforated stomach and intestinal ulcers).
- Acute bowel obstruction.
- Bleeding in the digestive system (stomach ulcer, pathology of varicose veins of the esophagus).
- The development of acute ischemic abdominal syndrome.
Treatment of acute pancreatitis
In the presence of acute pancreatitis, patients are shown hospitalization. All patients are prescribed bed rest. The main purpose of therapy is to relieve pain, reduce the load on the gland, stimulate the mechanism of its self-healing. The following therapeutic measures are taken:
- Carrying out novocaine blockade and the use of antispasmodics to relieve severe pain.
- Exposure to hunger, the use of ice in the area of the projection of the gland (in this case, local hypothermia is created to reduce functional activity). As a rule, parenteral nutrition is carried out, the contents of the stomach are aspirated, antacids with proton pump inhibitors are prescribed.
- The use of pancreatic enzyme deactivators (i.e. proteolysis inhibitors) is prescribed.
- Correction of homeostasis (aqueous electrolyte, acidic base and protein balance) is carried out by infusion of saline and protein solution.
- Performing detoxification therapy.
- Conducting antibiotic therapy with broad-spectrum drugs in large doses as part of the prevention of infectious complications.
Surgery
Surgical treatment of patients is prescribed if:
- Stones in the bile ducts.
- Plots with pancreatic necrosis, cysts, abscess.
- Against the background of accumulation of fluid directly in the gland or near it.
Operations that are performed in the acute form of this ailment with the formation of cysts or abscesses include the implementation of endoscopic drainage, marsupialization of the cyst, cystogastrostomy, etc. As part of the formation of sites of necrosis, depending on the size, a necrectomy or resection of the pancreas is performed. The presence of stones serves as an indication for surgery on the duct of the organ in question.
When resorting to such treatment
Surgical intervention, as a rule, is resorted to if there is doubt in the diagnosis and risks of skipping another disease that requires surgical treatment. The postoperative period involves intensive prevention of purulent and septic complications in combination with rehabilitation therapy. Treatment of mild pancreatitis usually does not present any difficulties, and a positive trend has been noted for a week. In order to cure severe forms, significantly more time is required.
The etiology and pathogenesis of acute pancreatitis we examined. Next, we find out what complications this disease can provoke.
Complications
The danger of such pancreatitis is the high likelihood of developing a serious complication. When infectious tissues of the gland are infected with bacteria that live in the intestines, serious organ necrosis and abscesses are possible. Such a condition without timely therapy (up to surgery) can be fatal.
With a severe course of pancreatitis, a shock state can occur and, as a result, multiple organ failure will occur. Following the development of acute pancreatitis in the tissues of the gland, pseudocysts (accumulation of fluid in the parenchyma) can begin to form, which destroy the structure of the gland and its ducts. Against the background of the destruction of pseudocysts and the expiration of its contents, ascites, as a rule, occurs.
Prevention
The main prevention of pancreatitis is a healthy balanced diet, along with the exception of alcohol, fatty, spicy and plentiful foods and smoking cessation. Acute pancreatitis can develop not only in individuals who regularly abuse alcohol, but also as a result of a single use of alcohol-containing drinks in large quantities for fried and savory foods.
Forecast
The prognosis in the presence of acute pancreatitis directly depends on its form, on the adequacy of treatment and the presence of any complications. A mild form of the disease usually gives a favorable prognosis, and with the development of the necrotic and hemorrhagic stage of pancreatitis, a high probability of a fatal outcome is high. Inadequate therapy and non-compliance with doctor's recommendations on diet can lead to relapse of the disease and the development of a chronic form of this ailment.
The etiology, pathogenesis, clinic and treatment of acute pancreatitis were presented in the article.