Acute pancreatitis often has a dramatic, severe course. Immediately there is severe pain in the abdomen caused by the penetration of pancreatic enzymes into the bloodstream. There may be extensive damage to the parenchyma resulting from the stroke of enzymes and enzymatic self-healing of the organ. The disease may cause severe but initially reversible damage to the pancreas and peripancreatic tissues in the form of edema and necrosis. In addition, in some patients multi-organ complications. When the disease often recurs and the episodes of acute inflammation are repeated - then permanent pancreatic pancreatic damage may occur.
Symptoms of acute pancreatitis
- severe pains located in the middle and upper abdomen
- abdominal pressure soreness
- nausea and vomiting - not relieving
Abdominal distension, often gas and stools
- fever, sometimes chills, muscle pain
The onset of symptoms is usually sudden. Note: Each case of symptoms of acute or chronic pancreatitis requires contact with a doctor and usually admission to the hospital.
When do we call an ambulance? In case of severe symptoms, when they occur:
- severe abdominal pain, vomiting, chills and progressive weakness
- pulse acceleration, lowering of blood pressure, disturbance of consciousness, fainting
- urinary retention and acute renal failure
Warning! In these extreme cases, acute pancreatitis can even end in death.
Diagnosis of acute pancreatitis
In addition to the above symptoms, confirmation of the diagnosis of acute pancreatitis requires a significant increase in the activity of pancreatic enzymes in the blood and / or urine. It is also helpful to carry out imaging studies.
Imaging diagnosis of acute pancreatitis:
a / ultrasound examination (ultrasound) is helpful in monitoring the progress of treatment and early detection of some complications of the disease.
b / computed tomography (CT) - the best allows to assess changes in the pancreas and its physiological environment
c / it is sometimes advisable to perform endoscopic retrograde cholangiopancreatography (ERCP)
d / radiological examination of the chest (X-ray) helps to reveal the presence of fluid in the pleural cavities, which is found in every eighth patient suffering from acute pancreatitis.
TREATMENT OF ACUTE INFLAMMATION
The expected course of the disease
Acute pancreatitis usually requires intensive treatment in a hospital setting. The rule is total hunger and inclusion of intravenous nutrition, administration of painkillers, accurate control of all vital functions, including renal function and respiratory function. Some forms of acute pancreatitis may require surgical treatment. In about 5% of cases, and in severe forms in about 10-40%, despite proper treatment, it is impossible to control the disease and it ends in death.
Conservative treatment of acute pancreatitis
Patients who have been diagnosed with acute pancreatitis and exclusion of intestinal perforation, gastric or duodenal ulcer, acute cholecystitis, intestinal obstruction - can be treated conservatively. Treatment consists of anti-shaking treatment, intravenous irrigation and electrolyte replenishment, sometimes insertion of the probe into the stomach to alleviate emesis. In some cases, parenteral nutrition (through venipuncture) or enteral (administered by the probe directly to the small intestine) are used to better nourish patients. ). In more severe cases, attempts are made to prevent infection by using antibiotics.
Surgical and endoscopic treatment of acute pancreatitis
The surgical treatment depends on the organ changes mentioned above. The indication for surgery can be:
a / excision of necrotic tissue of infected tissues or abscesses
b / excision of the gallbladder (most often this procedure is performed after a few weeks, after controlling the disease.
c / endoscopic incision of the duodenal wart, to which the bile and pancreatic ducts pass, which allows the removal of deposits in the bile ducts, which are often the cause of the disease. In many cases, this contributes to faster recovery.
d / resection of necrotic intestinal loops.
Nutritional treatment
During the first few days the patient only receives intravenous fluids and stays on the fast track. With the decrease of symptoms and the improvement of the results of additional tests, oral nutrition can be started. They are usually started with the use of only water and gruel, and in the event of good nutrition tolerance, the range of consumed food is gradually expanded. Meals should be taken frequently, in small amounts. The diet should be easily digestible and contain a limited amount of fats. It is assumed that in most cases you can return to a fully normal diet after about 3 months.
Prevention is mainly about:
a / avoiding excess in drinking alcohol
b / healing of cholelithiasis
c) diet rationalization and body weight normalization
ed. Edward Ozga Michalski, MA
consultation by dr n. med. Janusz Ciok
gastroenterologist
