Pancreatitis is an inflammation of the pancreas. The clinical course pancreatitis divided into acute and chronic.
Acute pancreatitis. Etiology not yet known. Established a clear link between acute pancreatitis and diseases of the biliary tract (cholelithiasis and others), alcoholism, nutritional disorders (obesity, poor nutrition). The cause of the disease may be vascular lesions of the pancreas (thrombosis, embolism), suppurative processes in the abdominal cavity (appendicitis), injury, allergic condition of the body and infectious diseases (pneumonia, mumps, scarlet fever), causes of acute pancreatitis hematogenous route.
Postmortem in the initial period of the disease is observed focal or diffuse swelling of the pancreas. Then depending on the severity of the lesion may appear foci of necrosis, small or large abscesses.
The clinical picture. A severe form of acute pancreatitis is characterized by a rough beginning with a sharp pain in the upper abdomen, often shock (see). Pain give in the back, the left half of the body, often surrounding. Pains are continuous or paroxysmal, reminding angina, renal or hepatic colic, accompanied by nausea, vomiting, flatulence. During the examination of the abdomen muscle tension is missing or slightly expressed, which is an important diagnostic feature. Body temperature may be normal or elevated. In urine and blood greatly increases the amount of amylase (cm). The level of calcium in the blood decreases dramatically.
The differential diagnosis is carried out with acute cholecystitis (see), the attack of biliary colic (see Cholelithiasis), perforated gastric ulcer or duodenal ulcer (see peptic Ulcer disease), myocardial infarction (see), infringement of diaphragmatic hernia (see Aperture).
Treatment. At the slightest suspicion of acute pancreatitis patient should be immediately referred to a hospital. Prior to admission, the patient must stay in bed, on the upper part of the abdomen put an ice pack. The evidence used heart funds. The use of morphine or of pantopon prohibited. The treatment should be aimed at combating shock (see), the elimination of the pain and the prevention of secondary infections. To soothe the pain, use atropine (1 ml of 0.1% solution under the skin), papaverine (2 ml of 2% solution under the skin), perinephral procaine blockade (see Blockade procaine). Trasilol injected drip method to 25 000-40 000 IU or more a day to the disappearance of symptoms of intoxication (up to two weeks). Pentauxil assign inside of 0.2 g 3-4 times a day. Enter antibiotic - penicillin 250 000 IU 4 times and streptomycin 500 000 UNITS, 2 times a day intramuscularly. In the first days appoint hunger and subcutaneous administration of isotonic solution of sodium chloride (up to 3 l per day). In the future, the patient gradually they are on a diet with moderate protein restriction and sharp restriction of fat and carbohydrates.
Surgical treatment is necessary in case of deterioration of the General condition with the growing intoxication and phenomena of peritonitis, and when signs of suppuration of the pancreas.
The forecast is always serious. The cause of death, besides the shock in the initial period of the disease may be different complications (e.g., GI bleeding, peritonitis). In milder forms - full recovery.