Prevention and treatment of acute pancreatitis

Prevention of acute pancreatitis is based on the views of the etiology of the disease and provide timely treatment of diseases of biliary tracts and other diseases of the gastrointestinal tract, balanced diet with restriction or exclusion of alcoholic beverages.
Patients with suspected acute pancreatitis or with a diagnosis should be directed to the Department of surgery, which is conservative and, if necessary, and surgical treatment.
Conservative treatment provides the struggle against shock and elimination of pain, creation of physiological rest sick organ and the prevention of secondary infections. A strict bed rest.
To soothe the pain used analgesic and antispasmodic, for example promedol 1-2% 1 ml subcutaneously every 12 hours or more.
The purpose of morphine or other drugs of the opium is contraindicated, as they cause spasm of the sphincter of Oddi and strengthen nausea and vomiting. Appropriate designation of papaverine, atropine, holding paravertebral and perirenal procaine blockade, intravenous 20-30 ml of 0.5% solution novokaina. Spasm of the sphincter of Oddi relaxes inhalation amilnitrita, sublingual application nitroglycerine, the introduction ganglioblokatorov, such as geksony, benzogeksony, gangleronum, dificil, kvataron, standard dosage.
In shock intravenous drip of 5% glucose solution (2.5 to 3 liters), whole blood, plasma, subcutaneously caffeine, ephedrine, camphor, kordiamin.
Attempts to use extracts from seeds of a soya, inactivate in the body trypsin, were not successful because of the side effects of these drugs. In this regard, effective was the kallikrein inhibitor and trypsin allocated from the liver and other Organon cattle. He is known under the name of trasilol.
Trasilol slowly injected by syringe or, better, the drip method on 10 000-40 000 and more kallickreina units a day. First, the introduction of trasilol to create in the blood necessary concentration recommend using a syringe. Further treatment trasilol held for several days (up to two weeks) in the drop way to the disappearance of symptoms of intoxication.
In addition trasilol in clinical practice are applied Talal, inprol and other antifermentny drugs. M. F. Kamaev was a positive effect from the use of pentoksila, administering it in the dose of 0.2 g 3-4 times a day. Inhibiting the activity of trypsin, pentauxil along with this has provided anti-edematous and anti-inflammatory effect.
There is conflicting evidence about the positive effects of drugs steroid hormones; they are usually appointed in severe disease for a short time (prednisolone on 20-40 mg / day and others).
When saline infusion is necessary to control blood levels of electrolytes.
To combat vomiting patients not allow to drink, introducing into the stomach thin probe with constant suction content. The first days are limited parenteral nutrition. To maintain normal levels of blood calcium is administered intravenously 20 ml of 10% solution of calcium gluconate. Secondary infection is warned parenteral introduction of broad-spectrum antibiotics. The improvement in the patient through a feeding tube enter the water with egg white, milk, diluted fruit juices; tube feeding keep to stop the vomiting and complete removal of the patient from a state of shock. The following days the patient receives a strict diet, rich in easily absorbed carbohydrates, moderate protein restriction and sharp restriction of fat. With the improvement of the patient's state food regime is gradually expanding.
Although mortality in surgical treatment of acute pancreatitis higher than in conservative, surgical intervention may be required in the following cases: 1) when the deterioration of the General condition of the patient; 2) increase of intoxication and peritoneal phenomena; 3) with a sharp increase of the number of diastase in the blood and in the urine or by reducing its level on the background of the deterioration of the General condition of the patient; 4) in the case of signs of suppuration of the pancreas.