The pancreas is located behind the peritoneum at the level of I-II vertebral segments of the lumbar. This organ is involved in the most important processes in the body. Next, we will understand what his functions are, what violations may be in his activities. In particular, we will consider how acute pancreatic necrosis is manifested.
General information
The pancreas (the norm in size: 15-10 cm - length, 2-3 cm - width) is considered a fairly large organ. Its weight in an adult is about 100 g. At birth, its weight is not more than three grams. In the human body, the organ performs two important functions. Consider them in more detail below.
Body functions
External pancreatic secretion is important for the duodenum - pancreatic juice is secreted into it . It contains enzymes: amylase, lactase, maltase, lipase, trypsin and others. Due to pancreatic juice, the acidic gastric contents are neutralized and food is digested. Initially, enzymes are produced in an inactive form, subsequently being activated in the duodenum 12. Their action is aimed at the breakdown of carbohydrates, fats, proteins into the main components.
Enzyme activation occurs under the influence of enterokinase, bile. Internal secretion is the production of essential compounds. These include, in particular, lipocaine, glucagon and insulin. The last two are antagonists among themselves. They are involved in the regulation of blood sugar concentration, carbohydrate metabolism. Due to lipocaine, phospholipids are formed in the liver. This, in turn, has a beneficial effect on the
oxidation of fatty acids. With a deficiency of lipocaine, fatty degeneration of the liver is likely.
Ducts
Inside the gland passes a channel that opens into the duodenum. The common bile and pancreatic ducts in most cases form an ampoule. As a result, they open in the large nipple of the duodenum. In the pancreatic ducts, normal pressure should be higher than in the common bile duct. This is due to the need to prevent the release of the contents of the intestines and gall bladder.
Disorders of the body
With changes in the pressure difference in the pancreas, hypertension appears. It is associated with obstructed outflow of pancreatic juice, the release of the contents of the gallbladder or intestines. Against the background of increased pressure, the pancreas’s own cells begin to become damaged. Enzyme compounds are released and activated from them. They penetrate the parenchyma, adipose and connective tissue of the gland. As a result, a chain reaction occurs. Through one enzyme, another is released. This provokes an inflammatory process, leading to increased blood circulation, and subsequently - to stagnation of blood. This contributes to thrombosis in the gland. As a result of circulatory disorders, pancreatitis occurs, often provoking pancreatic necrosis.
Causes of disruption
The pathological condition, as a rule, appears as a result of a single or repeated bouts of pancreatitis. The acute form is directly related to gallstone disease. Ulcer (stomach or duodenal ulcer), cirrhosis, hepatitis, and alcoholism act as provoking factors.
Important information
As mentioned above, one of the functions of the gland is the secretion of hormone production. The islets of Langerhans participate in this task. In case of their defeat against the background of pathologies, including pancreatitis in the chronic course, fatty degeneration in the liver and diabetes (sugar) develop. The pancreas is able to independently adapt to the type of food. It all depends on the food you eat. When taking a large amount of carbohydrates, more enzymes that break them down are activated. If fatty food predominates, then more lipase is produced, and if protein - trypsin. However, these features should not be abused. The fact is that the pancreas very rarely gives signals of a likely overload. As a rule, a rather violent reaction manifests itself, which does not indicate the initial stage of the pathology, but its full flowering.
The consequences of neglected diseases
A neglect of the state of the pancreas can provoke various complications. The danger consists mainly in the fact that next to it are other organs that are no less important for the body. This, in particular, the spleen, liver, stomach. The heart does not stand aside. With violations in the pancreas, this organ is also subjected to stress. Changes in the operation of systems occur very quickly. For the pancreas, sometimes several hours are enough.
Acute pancreatic necrosis
This process is the death of organ tissues. Various traumatic factors influence its development. They are based on organ inflammation. Acute pancreatic necrosis develops in the case of prolonged examination and treatment. In the process, the body's own enzymes take an active part. Under their action, the pancreas is digested. With the activation of interstitial enzymes, pathological processes progress. As a result, foci of fatty necrosis are formed.
Process description
As a result of the breakdown of fatty acids, a pH shift occurs. In this case, intracellular trypsogen is activated. Subsequently, it transforms into trypsin. This compound, in turn, activates proteinases that form certain proteolytic foci. Enzymes begin to corrode the vascular walls and connective tissue. The destructive process goes beyond the pancreas. Restoration of the organ in this case becomes impossible. With the manifestation of obvious signs, a fatal outcome can be instant.
Provocative factors
Pancreatic necrosis, the symptoms of which will be discussed below, is most often the result of excessive alcohol consumption, overeating, dyskinesia in the biliary tract, disturbances in the outflow of enzymes against the background of cholangitis, calculous cholecystitis. Incorrect medication, dose violation and dosage regimen can cause pathology. Acute pancreatic necrosis can be caused by frequent infectious diseases, stress.
Pathology
Depending on the area of distribution, acute pancreatic necrosis can be extensive and focal. The process can progress quickly or proceed sluggishly enough. In accordance with the type of pathological course, pancreatic necrosis is divided into destructive, functional, hemostatic, hemorrhagic and edematous. The latter is considered the mildest form. Due to puffiness, the pancreas is enlarged, which provokes an increase in pressure on pancreatocytes and a disorder of microcirculation. Treatment of the edematous stage is usually successful. With an untimely appeal to a specialist, the pathology takes a more neglected form. In particular, the necrotic process disrupts the outflow of digestive enzymes from the pancreas. As a result, digestion of the organ from the inside begins. With the course of the process, pus penetrates into the abdominal cavity. As a result, acute peritonitis develops. In this case, surgery is inevitable. Otherwise, sepsis will begin, which will lead to death.
Clinical picture
How is pancreatic necrosis manifested? Symptoms of the pathology are quite intense. In the left hypochondrium develops soreness of herpes zoster. It spreads throughout the body below the ribs. Pain radiates to the shoulder and shoulder blade, as in a heart attack. The processes are accompanied by profuse vomiting, bloating, flatulence. The patient's temperature rises, the skin turns pale or red. The main symptom of a pathological condition is the symptom of Gray-Turner. It manifests itself in the form of bluish spots from the sides of the abdominal cavity. On palpation of the wall, pain and tension are noted. Diagnosis is based on visual inspection, patient complaints, as well as the results of instrumental and laboratory studies. An ultrasound is prescribed to assess the echogenicity of the parenchyma. CT and MRI, angiography and laparoscopy can establish the exact onset of the disease.
Therapeutic measures
Treatment of acute necrosis can be both surgical and conservative. The choice will depend on pathological changes in the organ. Drug exposure is prescribed individually. Among the drugs recommended for use are antispasmodics (No-Shpa, for example), antienzyme and cytotoxic drugs that affect enzyme synthesis. Of the surgical methods, laparotomy and laparoscopy are used. However, during the operation it is not always possible to eliminate the pathology completely. In general, patients are treated in a hospital setting.