Pancreonecrosis survival rate. Stages of development of necrotizing pancreatitis

Hemorrhagic pancreatic necrosis is a disease that occurs against the background of the pathology of the pancreas, which is characterized by a rapid course and a large volume of destruction. Often this condition leads to the death of the patient. In this article, we will talk about what causes this disease.

Why does the disease appear?

As a rule, hemorrhagic pancreatic necrosis is a total process. It captures all parts of the gland and proceeds at lightning speed. Therefore, it must be provoked by powerful factors.

1. Hemorrhagic pancreatitis can occur when food poisoning(most often it is alcohol intoxication).
2. The disease appears in the background chronic pancreatitis when the tissue has already been changed, and the patient does not follow a diet and consumes a large amount of fatty, spicy, acidic foods.
3. Acute hemorrhagic pancreatic necrosis often occurs after trauma to the gland. Enzymes go outside and start a cascade of destructive reactions.
4. Sometimes this condition is provoked by doctors. The cause of the disease is manipulation of the pancreatic ducts (ERCP).
5. Hemorrhagic pancreatitis occurs with viral and autoimmune pathologies. For example, a severe course of parotitis or influenza can give complications to the gland. Systemic lupus erythematosus sometimes destroys the vessels of the pancreas.
6. In children, acute hemorrhagic pancreatitis may occur due to genetic disorders. Cystic fibrosis and anomalies in the structure of the gland are the causes leading to illness and sudden death.
7. Diseases of the liver and gallbladder play the second most important role in the development of reactive inflammation of the pancreas (bladder stones, duct strictures, cholangitis).

Symptoms

The causes of the disease are numerous, but as practice shows, most often gland necrosis develops against the background of alcohol consumption. Patients are admitted to the hospital with an attack within 6 hours of onset. Pancreatic necrosis is characterized by the following symptoms:

• severe condition of the patient;
• pale skin and earthy complexion;
• low blood pressure and thready pulse;
• bloating;
• muscle tension of the anterior abdominal wall;
• vomiting that does not bring relief;
• cyanotic spots, hemorrhages appear on the abdomen, back and sides.

As a rule, such patients immediately enter the intensive care unit or ward. intensive care. It is important to rule out other sources of acute peritonitis requiring emergency surgery ( calculous cholecystitis, ulcer with perforation).

Pancreatic shock can cause death. After all, several destructive factors act during the illness: pain syndrome, intoxication of the body, development of disorders in the coagulation system. Death occurs from multiple organ failure or purulent complications. In practice, there are cases when 1 day passed from the onset of an attack to death. Therefore, this fulminant form of pancreatitis requires immediate treatment.

Therapy

The first thing the patient needs is adequate pain relief and shock control. To do this, the patient is injected with electrolyte solutions and protein blood products (Polyglukin, Reopoliglyukin, Gemodez, plasma and albumin). Used for pain relief narcotic analgesics(Promedol, Diazepam). In some cases, they are supplemented antihistamines 1st generation, which have not only anti-allergic, but also a sedative effect.

Mandatory point of therapy is the removal of spasm of the sphincter. For this, antispasmodic drugs are used (Platifillin, Papaverine, Eufillin). Severe vomiting can cause electrolyte imbalances. Therefore, the patient in intensive care is often injected with solutions of potassium, calcium, magnesium. They contribute to the normalization of the work of the heart muscle.

To reduce the damaging effect of enzymes, drugs that reduce the action of proteases (Trasilol, Kontrykal) are administered. The activity of the gland is also inhibited hormonal preparations(Octreocid, Sandostatin). They reduce the area of ​​necrosis. With their prophylactic administration during manipulations on the gland, the aggression of enzymes is reduced.

With pancreatic necrosis, the process extends beyond the organ, forming lesions in the surrounding tissues. Therefore, surgical treatment for this type of pancreatitis is a vital necessity. Extensive abdominal operations have a poor prognosis. Doctors prefer laparoscopic interventions. At the same time, foci of necrosis are removed, drainage tubes are inserted into the infiltrates.

In the event that all methods do not give the desired effect, it comes fatal outcome. With this form of the disease, it can occur on the first day of the disease. At adequate treatment, but weak defenses of the body, patients die 1-2 weeks after the attack. The main causes of mortality are purulent-septic complications, pneumonia, multiple organ failure, and infectious toxic shock. In surviving patients, pancreatic necrosis leads to disability.

Disease prevention

Total necrosis of the gland is fatal. Therefore, if you have problems with the pancreas, you must be extremely careful.

1. Follow the diet recommended by your doctor (do not eat spicy, fatty, sour, smoked, pickled).
2. Give up alcohol and smoking ( narcotic substances also banned).
3. Treat diseases of the liver and gallbladder in time.
4. Lead healthy lifestyle life.

Many people often ask the question, what are the chances of surviving pancreatic necrosis? Unfortunately, no doctor can give accurate predictions, since the outcome of pancreatic necrosis largely depends on both the volume of necrotic changes in the gland and the presence of aggravating factors. For example, with biliary pancreatic necrosis in non-drinking patients of young and middle age, in the absence of chronic diseases heart, kidney, liver, pancreatic necrosis and the chances of survival with it are the greatest. I will not invent statistics, but it's obvious. By the way, read the first part of the material on adult pancreatitis.

Survival is also due to the development of complications from other organs. Complications can range in severity from mild to extremely severe, and thus pancreatic necrosis and death are very closely related.

Organ complications of pancreatic necrosis

The so-called psychoses in patients with complicated pancreatitis may themselves reduce the chances of survival in patients with pancreatic necrosis, since similar situation requires application sedatives and often immersing a person into a deep drug-induced sleep, which is impossible without artificial ventilation lungs.

Mechanical ventilation violates the natural barriers of the lungs against infection, and with prolonged mechanical breathing, severe pneumonia may develop, since immunity in patients with pancreatic necrosis is sharply reduced.

In such cases, the method of choice, nevertheless, is the transfer of a patient with pancreatitis to a ventilator, since he can injure himself, bite his tongue, fall and even choke on his own blood.

But it should be noted that psychosis is most often the lot of patients who abuse alcohol. In patients without bad habits fear of death, tearfulness, delirium may appear, but a violent state develops extremely rarely.

One of the frequent complications of necrotic processes in the pancreas is kidney failure- formidable, and in combination with other problematic organs, acute renal failure sharply reduces the patient's chances of survival in pancreatic necrosis. Since in a patient with acute renal failure, urine excretion is disturbed, the body is poisoned by its own metabolic products. healthy kidneys usually deal with this situation. But in the presence of complications not only from the renal system, but also from other vital organs, the lethal outcome in pancreatic necrosis of the pancreas increases by 50%.

kidneys- this is the organ that suffers from pancreatitis one of the first, since the main metabolic products of our body are excreted through them. Intoxication causes damage kidney which further worsens the condition of patients.

With necrosis of the gland, it may be necessary to cleanse the blood of nitrogenous toxins using special equipment. This procedure is quite complicated and may not be carried out by all patients, since the use of heparin during blood cleansing can cause severe bleeding if there are hidden sources, such as stomach ulcers, hemorrhoids, liver dysfunction, etc.

Sometimes kidney failure is accompanied by impaired liver function, which is also initially compromised in people with bad habits. In this case, yellowness of the skin, darkening of urine, increased levels of bilirubin and liver enzymes appear.

Pancreas is endocrine organ, which secretes insulin, which is responsible for the use of glucose in the human body. At severe inflammation iron reduces the production of insulin and the patient develops hyperglycemia - high blood sugar or diabetes.

For the treatment of diabetes, continuous round-the-clock intravenous insulin administration through a special dosing device may be required. Hyperglycemia is extremely resistant to treatment.

Among complications of pancreatitis patients sometimes develop a syndrome intestinal obstruction, manifested by bloating and tension of the abdomen, high standing of the diaphragm, pain on palpation and percussion, weakening or disappearance bowel sounds. The intestine stops contracting and stool accumulate in its lumen. Patients with impaired bowel function are the contingent of patients in whom the chances of survival are sharply reduced with pancreatic necrosis.

Absence of stool and gases, bloating of the intestine leads to an increase in intra-abdominal pressure and a “compartment syndrome” occurs. This is a state in which high intra-abdominal pressure contributes to the contraction of the lungs and, along with intoxication, causes a violation respiratory function and respiratory failure develops.

In severe cases, patients begin to suffer from the cardiovascular system. It should be noted that there are reliable facts that alcohol abusers almost without exception acquire alcoholic cardiomyopathy (the heart muscle becomes a flaccid part of muscle tissue replaced by fat or connective fibers), which aggravates the course of any disease.

Hemodynamic disorders are expressed in a decrease in coronary blood flow, deterioration in myocardial contractility, tachycardia, primary arrhythmias, atrial fibrillation, a decrease or increase in total peripheral resistance, and a decrease in cardiac output.

Against this background, in the initial stages, patients are recorded high blood pressure and palpitations with BP readings going off scale for 200/140 mm Hg. and heart rate up to 160-200 per minute.

In the future, compensatory ability of cardio-vascular system depleted, resulting in a decrease blood pressure and the need for medication to maintain normal level pressure.

Hypotension is dangerous for the development of acid-base balance disorders, spasm of the vessels of the kidneys and internal organs, violation of oxygen transport, its consumption and utilization with the development of tissue hypoxia and organ damage.

The most powerful intoxication in pancreatic necrosis primarily affects the main organs that perform the function of cleansing our body of toxins, causing fatal complications of pancreatitis from distant organs, such as the lungs, which, after the depletion of compensation mechanisms, begin to suffer significantly. The characteristic respiratory distress syndrome is accompanied by the collapse of the alveoli, compaction of the lung tissue, bronchospasm, multiple foci pneumonia accumulation of fluid in the pleural cavities, and finally As a result, it can lead to pulmonary edema and death. In this case, pneumonia can be bilateral pneumonia, focal pneumonia and small focal pneumonia. Pleurisy, in turn, is an unfavorable prognostic sign.

Most patients have impairments normal exchange substances - acidosis, respiratory acidosis, hyperlactatemia, electrolyte disorders, water metabolism disorders, hypocalcemia, hypomagnesemia. With the improvement of the condition, their severity decreases.

encephalopathy in pancreatitis is due to intoxication and, as a result, hypoxia, cerebral edema and / or fat embolism. The main signs of encephalopathy are disorientation, drowsiness or agitation, aggressiveness, confusion, lethargy, up to coma, convulsions, paralysis.

A formidable and extremely life-threatening complication is disseminated intravascular coagulation . At the initial stage, hypercoagulation or increased blood clotting occurs, an increase in the concentration of antihemophilic globulin and fibrinogen, and then there is a depletion of blood clotting factors and the stage of hypocoagulation. Patients develop spontaneous bleeding from the nose, oral mucosa, hemorrhages on skin, in the sclera, stomach bleeding from stress erosions and ulcers. Operations can be complicated by profuse bleeding from postoperative wound and drainage abdominal cavity . Treatment DIC is extremely difficult and often not effective enough.

Symptoms endogenous intoxication and generalized systemic inflammatory response in destructive pancreatitis, they are caused by the accumulation in the body of bacterial endo- and exotoxins, microorganisms and their metabolic products, products of pathological metabolism.

All of the above complications pancreatitis often occur in the first phase of toxemia, but can also join at the final stage of the purulent-septic stage of destructive pancreatitis.

Purulent-septic processes are common complications of inflammation of the pancreas. In some cases, destruction can end in complete resorption, which happens mainly with a focal form of destructive pancreatitis. In severe cases of total and subtotal forms of pancreatic necrosis, abscesses of the gland, retroperitoneal phlegmon, infected pancreatic cysts, etc. develop.

Unfortunately, this is the insidiousness of acute pancreatitis, that the exit from the toxic phase does not mean the beginning of recovery. The process can take several months and the prognosis is often unclear.

The most severe of all complications of the purulent-septic stage is the development of sepsis, which occurs due to the penetration of infection into the bloodstream. different ways: exogenous (through open drainage systems and tampons, catheterized peripheral vessels and urinary tract) and endogenous (translocation of microorganisms, endotoxins and aggressive factors from the intestinal lumen to the mesenteric lymphatic vessels and circulation system) by ways. In the clinical picture in patients sepsis dominated by the highest or low temperature body, weakness, a sharp decrease in appetite, weakness, palpitations, shortness of breath, hypotension. The final stage of sepsis may result in complications characteristic of the first phase of pancreatic necrosis. There is also a sharp increase in the possibility bleeding from acute stress gastroduodenal ulcers and intestinal ulcers on the background of DIC.

Other complications of this stage, erosive bleeding, gastrointestinal and pancreatic fistulas, thrombophlebitis portal vein(pylephlebitis), pancreatogenic purulent peritonitis, microangiopathy, thrombosis of the main arteries, develop as a result of the breakdown of necrotic tissue in various parts of the pancreas and retroperitoneal tissue.

gland abscesses can be localized in the parenchyma, omental bag, root of the mesentery transverse colon and subphrenic space. Phlegmon retroperitoneal space proceeds with phenomena acute inflammation, while in patients there is swelling and hyperemia in the lumbar regions with a transition to the lateral sections of the abdominal wall.

Gastric and intestinal fistulas appear as a result of necrosis of the wall of the stomach or intestines. Through fistulas, patients lose huge amount electrolytes, water, intestinal juice and nutrients. Compensation for such losses in full is often a very difficult task, patients lose weight dramatically and sometimes turn into dystrophics with impaired liver and kidney function. Fistula healing is extremely slow, because. aggressive pancreatic juice is released through the fistulous passage, which destroys the surrounding tissues and skin.

Erosive bleeding accompany the melting of tissues in the area abscesses and phlegmon when various vessels of the abdominal cavity are involved in this process. Intensive bleeding from a large arterial vessel can lead to a fatal outcome.

Modern studies clearly show that the hemostasis system plays a significant role both in the progression of pancreatic necrosis and in the development of its complications. Microthromboses cause circulatory disorders in the pancreas itself, as well as in organs remote from it, primarily the organs responsible for cleansing the body of metabolic products, “slags”. Coagulation disorders are triggered by the release of aggressive pancreatic enzymes. The whole process is very complex and not yet well understood.

As I already wrote, it is not excluded genetic factor, although this phenomenon has so far been little studied and there is no clear evidence of the presence of a genetic defect in patients with pancreatic necrosis. Do not forget that pancreatic necrosis and death can, unfortunately, be due to nature.

I think that from what you read you understand the reasons for such a long course of the disease. It will take a lot of effort on the part of the patient, medical staff and relatives, and the implementation strict diet to get out of the clutches of the insidious inflammation of the pancreas. I should also note that with pancreatic necrosis, everyone has a chance to survive and there is no need to despair in advance! We must fight the disease and survive!

If pancreatic necrosis develops, there are chances of survival, but the outcome depends on many factors: age, severity of the condition, area of ​​the lesion, concomitant diseases, and the timing of the start of treatment.

Given the high mortality rates from pancreatic necrosis, efforts modern medicine directed to search effective methods that can increase the likelihood of recovery and enable the patient to live after a serious illness.

– disability for the rest of your life?

If tissue death of a significant part of the gland occurs (total or subtotal process), the patient rarely manages to survive, despite the timely provision of adequate assistance. Cell necrosis occurs at lightning speed: sometimes the organ dies in a few hours. Even if a timely operation is performed, it is not always possible to achieve a positive result, and the chance to save a life is reduced to zero.

Often, pancreatic necrosis is so severe that complete recovery does not occur. The head, body and tail of the organ are involved in the destruction process. The most optimistic prognosis after surgery is survival, which leads to disability. In this case, the person is significantly limited in working capacity.

Contraindications after suffering pancreatic necrosis include:

• psycho-emotional stress;
• heavy physical labor;
• classes that require a violation of the diet;
• activity in contact with hepato- or pancreatic poisons.

All of the above conditions are strictly prohibited after suffering pancreatic necrosis, since they can lead to the development relapse with a fatal outcome.

Organ complications of pancreatic necrosis

Necrosis of pancreatic tissue without immediate emergency care leads to the exit a large number enzymes into blood vessels, causing them to dilate. Due to the increase in the permeability of the walls, enzymes enter the intercellular spaces. The gland swells, hemorrhages appear in its tissues and retroperitoneal tissue, which leads to irreversible processes, among which are the earliest and most common:

• infiltrate;
• hemorrhagic effusion;
• retroperitoneal abscess or phlegmon.

Infiltrate

The development of parapancreatic infiltrate occurs not only in the gland, but also in neighboring organs. Are affected:

• duodenum;
• stomach;
• spleen.

The process can go to the gallbladder, liver, cause changes in lower sections intestines. They are soldered together with the participation of exudate, which fills upper part abdominal cavity or all of its space. The formation of an infiltrate is a reaction of the body's immune system to the necrotic tissues of the gland. The process itself is aseptic at this stage, there is no infection. Therefore it is possible:

• reverse development - resorption;
• formation of cysts;
• purulent variant.

If within 3 months the infiltrate has not disappeared, cysts appear. This is a warning about a possible severe complication.

Accession of infection leads to:

• to purulent lesion pancreas;
• peritonitis;
• abscess
• phlegmon.

This significantly worsens the condition and prognosis of the disease.

Differentiate parapancreatic infiltrate and make a diagnosis without additional methods research is difficult. This is due to poor clinical manifestations due to the aseptic process:

• the general condition is not disturbed, the patient has no complaints;
• the temperature is normal, only sometimes subfebrile condition is observed - an increase to 37–37.9 degrees Celsius;
• in general analysis blood, except for a neutrophilic shift to the left (not always), there are no changes.

A complication can be suspected when performing ultrasound of the retroperitoneal space, blood and urine tests for the content of pancreatic enzymes: in biochemical analyzes, an increased level of amylase is determined, with ultrasound examination- characteristic changes.

Peritonitis

Peritonitis - inflammation of the serous layer of the abdominal cavity, leading to the accumulation of fluid with great content enzymes. The frequency of this complication is 60–70%. appears bright clinical picture acute abdomen. Appear:

• paroxysmal pain of high intensity, without a clearly defined localization, sometimes determined in the left hypochondrium and epigastrium;
• signs of an acute abdomen: tension in the anterior abdominal wall and all positive symptoms inflammation;
• severe intoxication: fever up to 40 and above, tachycardia, drop in blood pressure, nausea, vomiting, flatulence;
• psychosis;
• collapse - a sharp decrease in blood pressure and a drop in cardiac activity.

In the analyses:

• - leukocytosis and high ESR;
• biochemical - diastasis of urine and blood exceeds the norm.

Hemorrhagic effusion

Peritoneal hemorrhagic effusion is one of the causes of death from pancreatic necrosis. It is the most severe complication. Highly active enzymes lead to the progression of necrosis and mass death cells. Massive bleeding occurs, the tissues of the organ are saturated with blood. Neighboring organs are involved in the process, an infection joins, purulent intoxication develops. The disease is rapidly progressing, urgent resuscitation is needed.

Clinically, it looks like acute abdomen, but all its signs are expressed to the maximum. Suddenly develops:

• hyperthermia - the temperature reaches 41–42 degrees Celsius;
• severe chills and impaired consciousness;
• lethargy or agitation;
• heart palpitations, blood pressure instability;
• dyspnea;
• dagger pain - intense intolerable attacks acute pain in the abdomen, mainly in the left hypochondrium;
• nausea, repeated vomiting;
• diarrhea and flatulence.

Phlegmon

Retroperitoneal phlegmon - inflammation of fatty tissue without clear boundaries, which occurs acutely. Pathogenic microflora with a blood or lymph flow penetrates into the tissue from a purulent focus of infection or during an operation. Clinical symptoms suggest the development of complications:

• febrile (38–38.5 degrees Celsius and above);
• pain in lumbar region- pulsating or pulling character with irradiation into the abdominal cavity when involved in pathological process other organs;
• increased pain when moving or changing body position.

In addition to the listed organ lesions of pancreatic necrosis, often develop:

• fistulas;
• deep vein thrombosis with dysfunction of the pelvic organs;
• strictures of the hepatobiliary zone;
• gastrointestinal bleeding;
• ulcers of the stomach and intestines;
• enzyme deficiency.

Is there any chance of surviving the disease?

To survive with pancreatic necrosis, emergency hospitalization in the surgical department is necessary. The painful process of cell death proceeds rapidly, it can be lightning fast and be completed within one to two hours. If necrosis has become total, death occurs in 100% of cases. To break the vicious pathological circle, you need urgent resuscitation and operations. In this case, life can be saved.

Initially, the patient enters the intensive care unit, where all emergency measures are taken to bring the patient out of shock. Detoxification, anesthesia is carried out, complete functional rest of the pancreas is created. Approximately on the 5th day, when the boundaries and extent of the damage to the organ become clear, a necrectomy is performed.

But it doesn't always happen at that time. If the lesion is total, and the clock counts, the operation is performed immediately, sometimes the pancreas is completely removed - pancreatotomy. The patient must be fixed for further manipulations to flush the installed drainage systems, and in this position he can be for a long time.

After the operation is long, takes more than six months or a year. AT without fail the prescribed diet is observed - table number 5 according to Pevzner. In the future, under the supervision of a gastroenterologist, it can change to table number 1 and its modifications. Only a specialist can determine how long you need to be on a strict diet.

In addition, an appointment is scheduled enzyme preparations having good review about the treatment of pancreatitis, and a number of other medicines that are necessary for wellness. All prescriptions must be strictly followed - this is the only way to improve the quality of life after surgery.

Death statistics for pancreatic necrosis

Statistics show that a lethal outcome in the onset of necrosis occurs in 40–70% of cases. The reasons:

• late visit to the doctor;
• extensive area of ​​organ damage;
• joining the infection;
• the number of developed complications (more than three).

The final diagnosis in such cases is already made by a pathologist, and not by a gastroenterologist or surgeon.

With (PN), the mortality rate is high (with a total process - up to 100%), and there is no downward trend. In 97% of severe PI, mortality in patients is due to complications, including postoperative ones. The necrotic process itself can often regress, but complications develop rapidly and lead to devastating consequences.

The statistics on mortality in PN are depressing: out of 10 patients, from 2 to 9 die in a hospital or from severe complications or new illnesses after discharge. The numbers are even more frightening given the fact that people of working age fall ill with PN - from 30 to 50 years.

After suffering pancreatic necrosis, the patient's ability to work is limited or completely lost. In the future, surgical intervention may be required again due to the development of complications in PN or arising during the main operation.

Causes of death in pathology

Mortality in PN reaches 70%, the prognosis is rarely favorable. According to statistics, more than half of patients die on the operating table during urgent surgical treatment. The risk of death depends on the timing of the request for a specialized medical assistance. Playing a role:

• old age (after 50 years);
• hypotension;
• diabetes;
• blood urea, exceeding the norm;
• metabolic acidosis;
• leukocytosis.

According to numerous studies, the main causes of death include:

• early manifestations of toxemia;
• distant septic variant of the complication.

Because of their development, every fourth patient has multiple organ failure. Cause of death in late dates– infectious-toxic shock.

Important factors are also:

• excessive duration of admission - typical of male patients;
• violation of the diet and excessive consumption of fatty, spicy and fried foods;
• cholelithiasis - more often develops in women if the patient does not adhere to the recommendations for therapeutic nutrition;
• constant stressful situations.

Recovery period after surgery

After surgical treatment, patients face problems associated with emerging postoperative complications, and not with ongoing symptoms of pancreatic necrosis. During this period, the supervision of a surgeon, endocrinologist, rehabilitator is necessary.

After severe pancreatic necrosis in 70% of cases, patients remain in rehabilitation center or intensive care unit under the supervision of doctors long time- up to one year. Since a sparing regimen and complete rest are prescribed, the patient is on bed rest. Over time, this leads to muscle atrophy and the development of flexion contracture of the legs. Moreover weak muscles cannot support the body weight of the person himself. To avoid this, it is recommended to do massage, perform complexes special exercises that help strengthen muscles.

Due to autolysis (self-digestion of the gland in acute period) digestion is grossly disturbed. The patient loses up to 50% of body weight. In the postoperative rehabilitation period it is important to follow a therapeutic diet so as not to aggravate the process again and restore weight. It is recommended to eat pureed food in small portions 6-8 times a day.

Strict adherence to the diet prescribes the exclusion from the diet of spicy, fatty, fried, pickled foods, alcohol, carbonated drinks, strong tea and coffee and chocolate. The list of prohibitions is long, but every patient should know it so as not to break the diet.

Subject to diet food the patient returns to his former life and does not experience or discomfort. Violation of the diet leads to death.

How to prevent the fatal consequences of pancreatitis?

Pancreatic necrosis after surgical and conservative treatment, if the person survived, refers to diseases that can be controlled. If there is a desire to live, then a person lives with such a diagnosis, following the recommendations, and there is no danger of death. It is also necessary to follow emotional state, avoid stress, follow the rules of a healthy diet, attend dispensary examinations and consult a doctor without self-medication. Prevention of complications includes giving up bad habits: stop drinking strong and low-alcohol drinks. Subject to these rules, health can remain satisfactory.

Bibliography

1. Bondarchuk O.I., Kadoshchuk T.A. Laparoscopic drainage of the abdominal cavity in pancreatic necrosis. In the materials of the IX Conference of Surgeons-Hepatologists of Russia and CIS countries, St. Petersburg. Annals of surgical hepatology. 2002 No. 1 pp. 187–188.
2. Brekhov E.I., Mironov A.S. Modern technologies in the diagnosis and treatment of pancreatic necrosis. In the materials of the anniversary conference dedicated to the 10th anniversary of the Society of Endoscopic Surgeons of Russia "Ensuring the safety of endosurgical operations". Endoscopic surgery 2006 No. 1 p. 24.

One of the most serious illnesses digestive system human is pancreatic necrosis of the pancreas, in which, according to statistics, death occurs in 40-60% of cases.

Reasons for the development of pancreatic necrosis

The causes of pancreatic necrosis of the pancreas are numerous, but most often it develops after drinking a large amount of alcohol combined with fatty protein foods. It happens that the disease occurs almost instantly and an attack can develop against the background of complete well-being. Cases have been registered when pancreatic necrosis, in which a fatal outcome occurred within a few hours after the first signs of the disease appeared, developed several days after a plentiful feast.

What happens with pancreatic necrosis

Healthy produces enzymes that are necessary for the breakdown of food entering the stomach. It is thanks to them that food is broken down into elements that can enter the bloodstream through the gastric mucosa, which delivers them to tissues and organs. This makes the pancreas one of the important organs in the body. Drinking alcohol with rich fatty foods dramatically stimulates the production of juice by the pancreas, and since the ducts cannot remove it completely, it begins to accumulate inside the gland. This leads to the development of edema, further compression of the excretory ducts and their subsequent blockage. Active pancreatic enzymes, whose function was originally the breakdown of proteins, sweat through the walls of the ducts and begin to dissolve them, under the action of enzymes, the "digestion" of the gland's own tissues occurs. Active enzymes and decay products formed in this case enter the bloodstream and contribute to the dissolution of other organs and tissues, causing severe intoxication. Thus, pancreatic necrosis of the pancreas, the prognosis of which is quite difficult to predict, is a very dangerous disease.

Classification of pancreatic necrosis

Depending on the extent of the lesion of the gland, small-focal, medium-focal, large-focal, subtotal and total pancreatic necrosis are distinguished. Of course, the differences between the first two types are largely arbitrary. Doctors use these concepts in order to determine the degree of organ damage. In subtotal pancreatic necrosis, necrotic changes affect most of the gland. If the organ is completely affected, then total pancreatic necrosis of the pancreas is diagnosed. Lethal outcome in this case is always observed.

There is another classification option. She divides pancreatic necrosis into two types:

• Limited. This includes the process by which foci of different sizes are formed.
• Common. In this case, most of the gland or the entire organ is affected.

Types of pancreatic necrosis

Depending on the presence of infection in the affected areas, sterile or infected pancreatic necrosis is distinguished. At the same time, in the case of an infected process, the prognosis is rather unfavorable, since there is a high probability of developing an infectious-toxic shock, and it can be extremely difficult to get the patient out of this state.

Sterile pancreatic necrosis is divided into the following types:

• fatty - it is characterized by slow development within 4-5 days and a milder course;
• hemorrhagic - characterized by a rapid course and frequent bleeding;
• mixed - occurs most often, since with pancreatic necrosis it is equally affected and adipose tissue and pancreatic parenchyma.

If destructive pancreatic necrosis of the pancreas is diagnosed, surgery is inevitable. But often it does not give the desired result, and perhaps re-development necrotic foci.

Symptoms and diagnosis of pancreatic necrosis

Clinically acute pancreatitis manifested by severe pain in the left hypochondrium or pain that has a girdle character. There is vomiting of intestinal contents, which does not bring relief, diarrhea. Against this background, dehydration of the body quickly sets in, intoxication intensifies. When making a diagnosis great importance has a history. If it contains information about the abuse of alcohol, fatty foods, or information about diseases of the liver and gallbladder, this is big share probability allows you to make such a diagnosis as pancreatic necrosis of the pancreas. The prognosis in this case will largely depend on at what stage of the disease the patient sought medical help, and on the extent of the lesion.

Concerning laboratory diagnostics, here they pay attention to the analysis of urine and blood, where there is a significant excess of the level of amylase. An abdominal ultrasound, CT or MRI is also performed, where you can see the appearance of necrotic areas in the tissues of the pancreas.

Treatment

In most cases, pancreatic necrosis requires surgical intervention. At the same time, despite the fact that the mortality rate is quite high, timely surgery gives a great chance of recovery. Conservative treatment includes the following steps:

• within a few days after the attack - complete starvation, and depending on the severity of the disease, the introduction of nutrients through intravenous infusions can last for weeks;
• blood purification (hemosorption) - carried out with severe intoxication;
• somatostatin is a hormone that can reduce the effects of impaired kidney function, often accompanying pancreatic necrosis;
• at infectious forms- antibiotics.

Acute pancreatitis - diet

Since it is the food factor that very often becomes the cause of acute pancreatitis, it is he who is of great importance in the treatment process. As mentioned above, in the first days after the diagnosis of acute pancreatitis was established, the diet is very strict - complete fasting is observed. AT severe cases administration of nutrients parenterally can continue for several weeks.

In the future, the pancreas implies a sparing regimen, which is ensured by the maximum exclusion from the diet of fats and carbohydrates, as well as products that cause increased gas formation. The food is steamed and finely chopped. It is taken in small portions five to six times a day. The use of extractives and salt is completely excluded. Such a diet, depending on the severity of the disease, should last from several months to a year.

Of course, with such serious illness, as pancreatic necrosis of the pancreas, a fatal outcome is possible, and, of course, it is better not to bring your body to an attack, eliminating risk factors as much as possible. But if the disease still developed, then careful adherence to the diet will help to avoid relapses in the future.

– acute illness pancreas, which occurs against the background of damage to the cells of the organ, excess secretion juice and violation of its outflow. Pathology is caused by a number of factors and is characterized by tissue necrosis.

In case of untimely access to a doctor, the outcome of the disease is fatal; in order to survive, emergency hospitalization and the help of specialists are necessary.

Pancreatic necrosis is a complication that threatens the patient's death and requires emergency care

The main causes of the disease and risk factors

The death of pancreatic cells is a consequence of the inflammatory process in combination with infection, peritonitis and exposure to the produced enzymes on the organ. The main risk factors include:

• viral diseases (rubella, hepatitis);
• chronic cholecystitis;
• abuse alcoholic drinks and fatty foods;
• smoking;
• ulcer of the stomach and duodenum;
• food poisoning;
• abdominal trauma and the consequences of unsuccessful surgical interventions;
• action of drugs.

Excessive medication can lead to pancreatic necrosis

The disease develops rapidly, accompanied by organ edema, followed by tissue necrosis (death) and infection. When untimely appeal per medical care the chances of surviving with pancreatic necrosis tend to zero, so it is important to know the main symptoms of the disease and not delay the visit to a specialist!

Classification of pancreatic necrosis and characteristic symptoms

Depending on the localization of the inflammatory process and the extent of prevalence, there are three types of pancreatic necrosis: focal, subtotal and total.

With focal and subtotal lesions, small and medium-sized areas of pancreatic tissue necrosis are formed, with total changes, the iron dies completely and in 100% of cases an unfavorable outcome occurs.

Based on the characteristics of the course of the inflammatory process, sterile and infected pancreatic necrosis is isolated.

Hemorrhagic - one of the most dangerous types of pancreatic necrosis

It is classified into three subspecies:

1. , progressing due to the activity of proteolytic enzymes that act on protein structures. It is characterized by rapid development and total damage to the tissues of the organ with the formation of purulent exudate, which threatens with peritonitis. To prevent infectious-toxic shock, the situation requires immediate surgical intervention. Otherwise, hemorrhagic pancreatic necrosis of the pancreas is fatal.
2. Adipose, with the activation of enzymes of the lipolytic group, is characterized by slow progression. With the right treatment, the outcome of the disease is favorable.
3. Abortive, in which there is swelling of the pancreatic parenchyma, impaired microcirculation and damage to adipose tissue. This form of the disease is successfully treated with medication.

With hemorrhagic pancreatic necrosis, urgent surgery is indispensable

Infected pancreatic necrosis

It is a destructive pathology, the outcome in 40% of cases is fatal. The attached infection leads to complications: abscess, purulent peritonitis, phlegmon of the retroperitoneal space.

The process is classified according to the speed of development and is fulminant, acute and sluggish. To prevent formidable complications, do not ignore the characteristic symptoms:

• a sharp decrease in blood pressure and tachycardia;
• bloating, flatulence;
• nausea and profuse vomiting;
• diarrhea or constipation;
• dry mouth and thirst;
• intense pain girdle character in the left side of the epigastric region.

A sharp drop in blood pressure, weakness and increased heart rate may be symptoms of pancreatic necrosis.

The mechanism of the development of the disease

According to statistics, the main cause of pancreatic necrosis is overeating and uncontrolled alcohol consumption, which causes increased secretion digestive enzymes. Overload pancreatic ducts contributes to the stagnation of fluid and the formation of edema, which leads to blockage of the excretory ducts.

Against this background, spasm of the sphincter of Oddi occurs, it becomes impossible for bile and pancreatic secretions to enter the duodenum. Fermented juice begins to digest pancreatic tissue, causing intoxication of the body.

Patients who seek help in a timely manner have a chance to survive - the disease has a rapidly progressive course, the outcome of which is most often unfavorable!

Pancreatic necrosis may develop due to the use fatty foods and alcohol

Diagnosis of pathology

The decisive factor in avoiding death from pancreatic necrosis is timely appeal to the doctor, correct diagnosis and systemic treatment. Full examination allows you to determine the severity, form of the disease and includes the following activities:

• examination by a specialist and collection of anamnesis;
• biochemical blood tests;
• examination of urine and feces;
• Ultrasound, MRI or CT;
• fluoroscopy;
• endoscopic examination.

Modern hardware diagnostics allows you to accurately determine the state of pancreatic tissues and identify the causes of the development of the disease, which prevents formidable complications and allows the majority of patients to survive.

As additional diagnostics the doctor may prescribe fibrogastroduodenoscopy

Treatment of pancreatic necrosis

A systematic approach to treatment determines the successful outcome of the disease and increases the chances of recovery. Thanks to the introduction of innovative medical technologies and medicines, death from acute pancreatic necrosis is a fairly rare occurrence. Therapeutic measures are aimed at pain relief, exclusion of repeated attacks, normalization of pancreatic functions.

It is important to remember that the treatment of pancreatic necrosis and chronic pancreatitis is a long process, the successful outcome of which depends not only on the doctors, but also on the patient. It's about about proper nutrition, quitting smoking and alcohol, increasing physical activity.

With acute pain syndrome painkillers and antispasmodic drugs are administered. After establishing the cause of the pathology, the patient is prescribed complete fasting and conservative treatment:

• the introduction of drugs that reduce the secretion of gastric juice;
• parenteral nutrition with solutions of amino acids, glucose and fat emulsions;

In case of severe intoxication, high-tech detoxification methods are used, for example, hemosorption - complete purification of blood from toxins

• infusion of dehydration solutions to compensate for fluid deficiency;
• intravenous therapy;
• with severe intoxication, hemosorption is indicated;
• treatment with antibiotics and the hormone somatostatin.

If stones are found in gallbladder or extensive necrosis of pancreatic tissue, surgical methods are used.

About one of latest methods surgical intervention for pancreatic necrosis can be found in the video: