Pancreatitis

Pancreatitis

This term includes two diseases that differ in symptoms, course, pathogenesis, treatment and prognosis.
Acute pancreatitis - a serious disease of pancreatic parenchyma, where it comes to uncontrolled activation of pancreatic enzymes and consequently to damages of the gland and the surrounding tissues. Untreated can lead to death. The most common causes of disease are biliary obstruction, alcohol abuse or trauma. For less common reasons for sickness can include regurgitation of duodenal contents into the digestive tract, mumps, diagnostic tests, metabolic disorders and the lack of obvious cause (idiopathic pancreatitis). Damaged cells release proteolytic enzymes that cause inflammation (pancreatitis slight edema) - in some cases: abscess and tissue necrosis (extending along the lumbar muscles). There is a whole range of systemic complications, including shock and death.

Symptoms

The lumbar pain, sometimes radiating to the abdomen and chest disorders of the gastrointestinal tract (vomiting, nausea), fever, yellowing of the eyes, painful abdominal palpation, symptoms of shock (low blood pressure, increased pulse rate, tachypnea, dyspnea, anuria, disseminated intravascular coagulation, impaired consciousness, Cullen sign (ecchymosis around the umbilicus).

Diagnosis involves blood tests (leukocytosis, hyperbilirubinemia, elevation of liver transaminases, amylase threefold increase in blood - mostly pancreatic isoenzyme, high lipase activity - the best diagnostic test, increased CRP - high values indicate pancreatic necrosis), ultrasound (inflammatory infiltration, seizure borders, enlarged prostate, fluid), CT with contrast (visibility of the inflammatory foci and necrotic), ERCP (diagnostic and treatment - allows for removal of gallstones from the bile ducts), X-ray of the abdomen (a symptom of the loop on guard - distension of one loop of the small intestine) .

The procedure involves conservative treatment - pethidine (analgesic, relaxant), absolute fasting (with the possible feeding by naso-intestinal tube, especially PV), control of water and electrolyte (potassium, sodium, calcium), proton pump inhibitors, aprotinin, prophylactic antibiotic therapy, oxygen therapy. In case of complications, surgery should be performed (infection of necrotic pancreatic parenchyma can cause multiple organ failure and collapse, the abscess may be punctured to the intestines or peritoneal cavity).

Chronic pancreatitis - chronic inflammation of pancreatic parenchyma, which leads to fibrosis and glandular atrophy. As a result, it comes to impaired excretory function of the pancreas. The most common cause is alcoholism, others are less frequent (e.g. hypercalcemia, chronic renal failure, poisoning phenacetin). It is divided into calcifying inflammation (deposits in the parenchyma and bile ducts) and obstructive (problems within the pancreatic duct).

Symptoms

Recurrent abdominal pain, vomiting, weight loss, fatty diarrhea, episodic jaundice. The disease can lead to a lot of complications (abscesses, peritonitis, renal, and endocrine organ outside).
The examination of choice is computed tomography (calcifications, deposits, cysts, enlargement of the pancreatic head), it is helpful to use ultrasound, ERCP, EUS, MRCP.

Treatment includes diet (calorie, protein, many small meals throughout the day), a ban on drinking alcohol (absolute), use of pancreatic enzymes, supplementation of fat soluble vitamins, analgesic treatment. When the cause is narrowing of the pancreatic duct or the presence of deposits, it should be performed endoscopic procedures to remove the changes. In some cases, surgery is indicated (unsuccessful endoscopic treatment, fistula, symptomatic cysts, severe pain, suspicion of neoplastic processes, the need for foundation drainage or resection).