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What is acute pancreatitis?
Pancreatitis is a condition associated with development of acute and sudden inflammation of the pancreas. Experimental data show that during an attack of pancreatitis, pancreatic enzymes are released in the abdomen and cause inflammation by the damage from digestion of normal body structures, especially fat in the abdomen. In about 85% of patients, acute pancreatitis is a mild disease and is usually associated with a rapid recovery within a few days of onset of the illness.
There are a number of symptoms of acute pancreatitis, including:
- Severe pain around the upper part of your abdomen (tummy) and/or back which is worse when you lie down
- Feeling sick
- A high temperature
- Jaundice - which is when the whites of your eyes and your skin look yellowed
- Your abdomen (tummy) is larger than usual
- The skin on your lower bak or your abdomen may be blue-grey
In eight out of 10 people with acute pancreatitis the causes are:
Other causes include:
- Gallstones in the bile duct - this is the most common cause
- Excess alcohol
- Certain medicines (eg azathioprine, corticosteroids)
- Abdominal injuries
- A tumour
- After an ERCP (see Diagnosis)
- Increased calcium or lipid (fat) levels in the blood
- Pancreas divisum - this is when you are born with ducts in the pancreas which don't function properly
- Genetics - you may inherit a faulty gene from your parents, this is called hereditary pancreatitis
- Inflammation of the blood vessels in the pancreas or reduced blood flow to the pancreas
- Renal failure
Your health care provider will ask about your medical history, particularly about how much alcohol you drink and whether you have had gallstones. Your provider will ask about your symptoms and examine you.
You may have the following tests:
- Blood tests
- Urine tests
- X-rays of your abdomen and chest
- Ultrasound exam of the pancreas and gallbladder
- CT scan of the pancreas
- ERCP, which is a way of looking at your pancreas through a slim flexible tube called an endoscope, which is passed through your mouth and stomach to where your pancreas and intestines are connected.
Treatment of acute pancreatitis
In treatment of an acute pancreatitis the operative method offered by German surgeon Korbe in 1894 However a high lethality (90 10 0 %) even from the very beginning prevailed has at that time forced to concern this method frostily. Now mainly conservative method of treatment of an acute pancreatitis is conventional. However medical tactics is dictated mainly by the disease form. If at an intersticial and necrotic pancreatitis crucial importance has timely carrying out of conservative therapy and, to a lesser degree, operation, and at infiltrative-necrotical - only conservative treatment purulent-nekroticheskaja the form demands an obligatory operative measure.
Modern conservative therapy of an acute pancreatitis solves following problems:
In different phases and the seasons of development of an acute pancreatitis the various operative measures, pursuing two main objectives are justified:
- Pain and spastic stricture liquidation, microcirculation enriching in iron
- Struggle against a shock and homeostasis restoration
- Depressing of an exocrine secretion and activity of enzymes of a gland
- Struggle against a toxemia
- Normalisation of activity of lungs, hearts, nephroses, a liver
- Preventive maintenance and treatment of complications
For the best decision of the basic questions of surgical treatment and operation at patients with an acute pancreatitis (depending on a phase of development and the disease season) divide into 3 bunches:
- To Stop an acute attack of disease and not to admit a lethal outcome
- To Warn relapse of an acute pancreatitis after an extract of the patient from a hospital
- Early, carried out during the first hours and days of disease in the acute season of an edematization or a gland necrosis. Indications to early operations:
- Difficulty at diagnosis statement
- The Diffuse enzymatic peritonitis with the phenomena of the expressed intoxication
- The Combination of a pancreatitis to a destructive cholecystitis
- The Obstructive jaundice
After introduction in practice of urgent surgery of the laparoscopy, allowing to define the form of a pancreatitis and to define a condition of biliary system, the number of early operations has decreased. Besides, laparoscopic lavage can be used as preoperative preparation of the patient.
At certain indications early operations come to an end with a pancreatectomy and sanation of biliary system.
- Operations in a phase of fusion and a sequestration of the necrotic locuses of pancreas and a retroperitoneal fat which are effected usually on 2-3rd week from the disease beginning. At treatment of patients in this phase probably in time to remove dead tissues of a gland and a retroperitoneal fat, that is will in due time execute a necretomy (after 10th day of disease) or a sequestectomy (on 3 4th week from the disease beginning). 3. The serotinal (delayed) operations spent in a planned order in a subsiding or full liquidation of pathological changes of pancreas. These operations are shown at those diseases of organs of a gaste which can cause a pancreatitis or promote its development (cholically-stone disease, a cholecystitis, gastroduodenal impassability, duodenostasis, a diverticulum 12-tiperstnoj intestines, impassability of a pancreatic duct, etc.) . They are referred on the prevention of relapse of an acute pancreatitis by operative sanation of cholic pathes and other organs of digestion, and also the pancreas.
Most cases go away in a week. However, some cases develop into a life-threatening illness.
The death rate is high with:
- Hemorrhagic pancreatitis
- Liver, heart, or kidney impairment
- Necrotizing pancreatitis
- It is common for the condition to return.
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