Fat pancreatic necrosis

Pancreatitis is a rather severe pathology affecting the organs of the abdominal cavity. One of the varieties of this disease is fatty pancreatic necrosis - an irreversible cessation of vital activity of pancreatic cells.

In case of provocation and development of this disease, there is a failure of metabolic processes and normal functioning of the gland cells. This leads to the fact that the cell begins to digest itself, provoking its withering away.

[1], [2], [3], [4], [5]

Causes of fatty pancreatic necrosis

Nature has created the human body strong enough, reliable and there must be a push, a confluence of certain factors, so that the body fails and runs a self-destruct mechanism. After all, any disease weakens a person, makes him unprotected before a more severe pathology. But in order to make the right diagnosis and conduct effective treatment, it is necessary to know the causes of fatty pancreatic necrosis. Only by eliminating the root cause - you can get rid of the pathological symptoms, as well as from the disease itself.

As statistics show, the causes of fatty pancreatic necrosis, mainly, are:

• Cholelithiasis. It comes out on top in the frequency of provocation of the disease. The stones block the bile ducts, blocking the outflow of the biliary secret, which leads to swelling, spasms, and increased pressure in the bile ducts. And if you do not take emergency measures, dying (necrosis) of cellular tissues begins.
• The casting of the products produced by the gland into the pancreatic ducts. This can occur if there is a disturbance in the operation of the sphincter ODDI, which is responsible for throwing the secretion of the pancreas into the duodenum.
• Infectious disease on one of the organs of the peritoneum.
• Shock state of the body, which disturbs the microcirculation of metabolism and blood in the body.
• Harmful habits: abuse of nicotine, drugs and / or alcohol. Mostly it concerns alcoholic beverages, which sharply activates the work of pancreatic secrets. Especially the greater loading on the given gland goes, if together with alcohol, in a digestive tract get also very fat food stuffs. In chronic alcoholism, the product produced by the pancreas increases its density, which leads to great problems in its passage through the ducts.
• Provoke fatty pancreonecrosis can be a disease that affects other abdominal organs, such as gastritis or duodenitis.
• Excess weight, which led to an excessive passion for food.
• Secondarily acquired disturbance of the hemostasis system, which occurs under the influence of various pathological agents on the organic system.
• Less fatty pancreatic necrosis is the result of "inaccurate" carrying out such a diagnostic procedure as pancreotography, which caused trauma to the ducts of the pancreatic acinus.
• Postoperative complication in one of the peritoneal organs.
• Hypoxia of the pancreas is oxygen starvation of cells.
• Approximately in 10 - 15% of the diagnosis of the disease determine the etiology is not obtained.

If timely measures are not taken, this pathology is fraught with significant complications. Fat pancreonecrosis can provoke:

• Limited purulent-inflammatory disease of the pancreatic soft tissue.
• Expansion of the inflammatory process, which begins to seize and neighboring tissues (parapancreatitis).
• Internal and external fistulas.
• Mechanical jaundice is a dangerous condition that develops as a result of an obstruction to the flow of bile from the bile ducts to the duodenum.
• Internal bleeding.
• Inflammation in the peritoneum, provoking the development of peritonitis or a purulent process.
• False cyst, located in the fibrous tissues of the pancreas.

[6], [7], [8], [9], [10]

Symptoms of fatty pancreatic necrosis

When there is a syndrome of "acute abdomen" the probability that the cause is fatty pancreatic necrosis is about one percent. The symptomatology is quite intense and delivers a lot of suffering to the patient. Symptoms of fatty pancreatic necrosis can often be confused with other diseases of the gastrointestinal tract, but there are also some signs that a qualified gastroenterologist can narrow down their assumptions and direct diagnostics in the right direction.

• Pain symptomatology appears a sharp strong attack, localized in the upper region of the anterior wall of the abdomen. Depending on the area of the lesion of the gland, pain can be felt in several different places: if the head has suffered a pathological change, the patient will feel pain on the right side in the hypochondrium, and also in epigastrium; if the lesion seizes the body of the pancreas or its tail, the pain most intense will be on the left side in the hypochondrium region and in the central upper abdominal region (epigastrium). If pathological changes affect the entire pancreas, the patient will feel a strong permanent all-binding pain.
• The patient is constantly sick. This symptom is able to intensify after eating, which can lead to vomiting refliktorike. Vomiting can be abundant, with the left in the outgoing liquid remnants of undigested food and bile in the stomach. However, the contents of vomit in this case, never contains intestinal products. Provoke a gag reflex can even swallow clean water.
• There is a feeling of internal bursting, symptoms of flatulence are observed. When palpating the patient is struck by the increasing pain that goes along the pancreas.

Gradually, the general condition of a person becomes worse, there are signs of intoxication of the body:

• The skin acquires a pale - earthy color.
• Sclera is painted in a yellowish hue.
• There is increased moisture in the skin.
• The extremities become cold, and it is problematic to warm them.
• There is a tachycardia.

In the case of diagnosing a severe degree of fatty pancreatic necrosis, a sharp drop in blood pressure can be observed, which leads the patient to a hypotonic shock state.

• The result of pain symptoms and large volumes of fluid loss that leaves through the skin and with vomit is that the liquid remaining in the body begins to accumulate in the cavity of the peritoneum, which depresses the blood flow. As a result: the amount of circulating blood decreases, the plasma density rises, the microcirculation of substances and oxygen decreases.
• Throughout the body can be observed cyanotic cyanotic spots, resulting from microblood blood (Mondor syndrome).
• In the case of listening to a stethoscope, intestinal noises are missing or poorly tapped.

Diagnosis of fatty pancreatic necrosis

Only every twentieth patient, who is diagnosed with pancreatic necrosis, receives a prefix fat. The predominantly fat factor is established as a concomitant characteristic with such a diagnosis as hemorrhagic necrosis or fatty pancreatic necrosis with hemorrhages. This disease develops slowly enough, the first symptom of the appearance of infiltrates appears only on the fourth and fifth days after the start of the mechanism of progression of pathology. With a recurring disease category, the symptomatology may appear much later.

The pathology under consideration develops with the direct participation in the process of inflammation of lipase, the enzyme of the pancreas, which is the most important for the digestion of fat coming from food. Therefore, the primary diagnosis of fat pancreatic necrosis consists of a blood test that allows you to determine the level of a given enzyme. A quantitative component of elastase, another pancreatic product, is also established. This enzyme is able to provoke a violation of the integrity of the walls of blood vessels, which leads to volumetric bleeding. Confirmation of the presence of this pathology in the patient's body is also a change in the mass indices of alpha-amylase, although this enzyme does not significantly affect pathological changes in the patient's body, but can serve as a litmus test of these changes.

Diagnosis of fatty pancreatic necrosis is:

• Examination of small and large omentum, as well as peritoneum, which will make it possible to determine the places of cellular necrosis of fatty character.
• Biochemical study of plasma to determine the level of trypsin, amylase. A low calcium content indicates necrotic processes in the body. The lower his level, the heavier the pathology.
• An extensive blood test for leukocytes (leukocytosis). The plasma density is determined.
• Analysis of urine on protein.
• Determination of the level of blood coagulability.
• Ultrasound examination, which allows to assess the condition of the organ under investigation, its uneven structure and the presence of necrosis.
• Laparoscopy is an information method that allows you to differentiate a diagnosis.
• Computer tomography - obtaining a series of snapshots of pancreas sections, which allows you to evaluate its condition.
• Celiacography is an x-ray examination of the celiac trunk and branches that feed the abdominal organs.
• Fibrogastroduodenoscopy, which allows to assess the state of the stomach.
• Angiography - makes it possible to visualize violations of the mucosa of blood vessels in the area of the affected organ.
• Radiography allows to assess the state of the pleural cavities, which can, by acting on the peritoneum, provoke the growth of intraperitoneal pressure.

[11], [12], [13], [14], [15]

Treatment of fatty pancreatic necrosis

If the disease is not started and is at an early stage, the main goal of therapy is to stop the pathological processes that progress in the affected organ. The second task of treatment is to prevent further development of the disease, not to allow serious complications, including the emergence and development of a purulent process.

1. Primarily it is necessary to remove the pain symptomatology from the patient, therefore the attending physician prescribes an antispasmodic, disabling medications: no-shpa, zolong, baralgin, revalgin, platyfilin, quarelin, promedol, spasmalgin, papaverine, maxigan, omnopon, spasmalgon, trigan.

Platyfilin is administered in the form of injections, which are administered subcutaneously at 2-4 mg, three times throughout the day. The maximum allowable daily dosage is 30 mg, while a one-time dosage is equivalent to 10 mg.

The drug is not recommended for use if the patient has a history of liver and / or kidney dysfunction, as well as glaucoma and individual intolerance of the components of platyfilin.

Spazmalgon in solution is administered by the manipulative sister two to three times a day for 2-5 ml. Before opening, the ampoule needs to be warmed in the palms, only after that it is broken. The duration of the treatment course is five days. The maximum amount allowed for use is 10 ml.

If the therapeutic effect is not observed for five days, the drug is canceled and reassigned by a stronger analgesic drug. If after receiving spasmalgone the patient becomes lighter, the attending doctor transfers the patient to the oral form of taking the drug in the form of tablets.

The drug is contraindicated for use if the patient suffers from increased individual intolerance to the components of the drug and other drugs of the group of non-steroidal anti-inflammatory drugs. It is not necessary to appoint it in case of failure in the hematopoiesis system, kidney and / or liver dysfunction, leukopenia, closed-angle glaucoma, in case of deficiency in the body of a patient with glucose-6-phosphate dehydrogenase, with intestinal obstruction, megacolony, in case of a decrease in muscle tone of bile and / or the bladder, with the collapoid states.

2. Appointed and antihistamines: suprastin, erius, telfast, levocetirizine, tsupristineks, tsezera and others.

Levocetirizine is attributed to oral intake, without chewing, with a small amount of liquid. The drug is preferably administered on an empty stomach or in conjunction with food.

Adult patients and children who are already six years old, the drug is prescribed at a dosage of 5 ml per day. When diagnosing renal dysfunction, the dose of the drug is adjusted depending on the level of creatine clearance. Elderly patients should not change the recommended amount of medication.

The duration of the treatment course depends on the diagnosis and severity of the disease, it can vary from one week to one and a half years.

Contraindicated levotsetirizin with increased sensitivity to the component composition of the drug, as well as with kidney dysfunction in the clearance of creatinine below 10 ml / min. Contraindication is the age of children under 6 years (tablets form) and 2 years (drops).

3. Treatment of fatty pancreatic necrosis includes drugs used to normalize water-electrolyte metabolism, reduce the secret function of the pancreas. And it is also necessary to "clean" the body by carrying out its detoxification. To do this, a droplet solution of glucose or rheopolyglucin, protease inhibitors, lytic mixture, sodium bicarbonate, cytostatics, Ringer-Locka, hemodez, which knits toxic compounds and removes them from the body together with urine, is injected. In the recommendation of therapeutic therapy of the disease in question is a special diet developed by dietitians together with doctors, and a two-day - three-day fasting is also welcomed.

Reopoliglyukin, due to the decrease in the viscosity of the blood and the obstacle of combining the shaped elements into one system, allows to activate the plasma circulation. The drug is administered intravenously, drip, 0.4-0.0 liters per day. The procedure is usually carried out once a day, less often this volume is divided into two droppers. Such quantity of medicinal product is introduced during half an hour - hour.

It is not recommended to prescribe the drug in case the patient suffers from thrombocytopenia, severe cardiac and / or renal insufficiency, as well as in case of hypersensitivity to the components of the drug.

4. After a dropper of rheopolyglucin, a patient with a diagnosis of fat pancreatic necrosis is prescribed and anti-inflammatory drugs. For example, endoxane, cyclophosphamide, intact.

Cyclophosphane is supplied into the patient's intramuscular system by a vein or directly into the cavity. The form of the appointment is determined by the attending physician.

The drug is prescribed to the patient for 0.2 g (based on 3 mg per kilogram of weight) once a day or 0.4 g a day.

The quantitative dose of the entire treatment course is usually from 6 to 14 g. The drugs in this group effectively inhibit the synthesis of proteolytic enzymes.

Contraindications for taking the drug include low hemoglobin in the patient's blood, cachexia (severe exhaustion of the patient's body), severe pathology of the kidneys, liver and heart, as well as individual intolerance to the patient's organisms to one or several components of the drug.

5. Intravenously after three to four hours, a protease inhibitor is introduced to a patient with fatty pancreatic necrosis, which activates the synthesis of enzymes necessary for the reduction process (plasmin, kallikrein, trypsin). To such drugs include gordoks, kontriven, trasilol, kontrikal.

Contrikal is prescribed to the patient in shock dosages. The daily amount of the medicinal product is determined by the numbers of 80 000 -160 000 - 320 000 units. The dose of the drug administered is determined by the treating gastroenterologist, depending on the severity of the pathological changes and the general condition of the patient at the time of the procedure. Kontrikal therapy is practiced until the moment when the clinical picture is normalized, the results of laboratory studies reflect the rates of the norm.

It is not recommended for this drug in case of individual intolerance of the drug components.

6. To improve the withdrawal of excess fluid from the patient's body, diuretics are prescribed: lasix, diusemide, frusemide, tasimide, mannitol.

The doctor uses the method of application and dosage of lasics individually, based on indications of the level of imbalance of water-electrolyte equilibrium, as well as the quantitative index of glomerular filtration. Subsequently, after the alignment of these indicators, the quantitative component of the drug administered is adjusted.

The starting dose of the drug is 40 mg. With a weak therapeutic effect, a dose of lazix can be increased only six to eight hours after the first injection. The drug can be taken as one or twice a day.

Contraindications of the drug include heavy failure of electrolyte balance, with anuria, increased sensitivity to the components of the drug, including furosemide, as well as in the diagnosis of hepatic coma, dehydration and in the case of a woman who is pregnant or nursing her newborn baby .

7. Do not do with the treatment of fatty pancreatic necrosis and without broad-spectrum antibiotics.

This may be cefixime, cefaclor, cefrocitin, spiramycin, moxifloxacin, cefamandol, lincomycin, rovamycin, ciprofloxacin, junidox soluteba, cefoperazone, clarithromycin, avelox, cefuroxime, ceftazidime, roxithromycin, trigger, cefotaxime, clacid, amoxiclav, sumamed, latamoxef, fusidine, kefzol, cefpodoxime. These are preparations of new generation.

Moxifloxacin is administered orally once a day at a rate of 0.4 g with a small volume of fluid. The intake of the drug does not depend on the time of the meal. The duration of the drug course depends on the patient's condition, the severity of the pathology and the speed of the onset of the therapeutic effect.

Patients who have a history of kidney and / or liver dysfunction, cardiac or pulmonary insufficiency permanently on hemodialysis or long-term out-patient peritoneal dialysis, as well as persons of retirement age, it is not necessary to make an adjustment to the recommended dosage.

Moxifloxacin contraindications include an increased intolerance to the patient's constituents and the patient's age to 18 years.

8. To reduce the production of gland by external secretion, the gastroenterologist appoints the patient cold compresses that are superimposed on the epigastric zone of the anterior wall of the abdominal cavity.
9. At medical indications, the patient can be assigned aspiration - a minor surgical intervention, in which the contents of the stomach are sucked off and it is washed with special alkaline solutions.
10. Intragastric hypothermia is carried out, the local decrease in temperature is somewhat lower than 35 ° C.
11. To improve the condition, the "cleaning" of the patient's blood is practiced. For this, a laser is irradiated with plasma by ultraviolet laser light. The session lasts from 15 to 30 minutes. The minimum number of procedures is two, the maximum - up to ten. This procedure shows high efficiency. After its passage, the pain symptoms are significantly reduced, the foci of inflammation are suppressed. Processing of plasma by rays stimulates its microcirculation, raises the quality of rheological parameters. This procedure can be performed in both inpatient and outpatient settings.
12. In the course of passing therapeutic therapy, the patient is subjected to artificial removal of toxins from his body using extracorporeal (extraorganismic) structure, that is, extracorporeal detoxification is performed. This procedure makes it possible to purify the patient's body of the products of pancreatic life, the results of necrotic cell decay, toxins. Usually, such treatment methods as lymphosorption (removal of toxins from lymph) and plasmapheresis (cleansing the body at the cellular level by filtering blood with the help of special apparatus) are usually used.
13. In especially severe cases, the treating gastroenterologist has to introduce close-focus radiation therapy into the treatment protocol. Depending on the severity of the case. The patient undergoes three to five procedures.
14. If peritonitis is not completely stopped and continues to progress, a gastroenterologist must provide an outflow of contents of the cavities of the small omentum and peritoneum to such a surgically ill gastroenterologist. Drainage is carried out both with the help of classical dissection of peritoneal tissues, and through laparoscopy.

Clinical statistics of this pathology show that the risk of getting fat pancreonecrosis is greater in people who have previously been diagnosed with pancreatitis, cholelithiasis or other diseases affecting the liver. These are people with congenital and acquired pathological changes in the liver, but half of all diagnosed cases occur in people who abuse alcohol, as well as those suffering from obesity.

Prevention of fatty pancreatic necrosis

In most cases, the disease can be prevented or at least reduced the risk of this pathology and complications during its course. Prevention of fatty pancreatic necrosis includes some rules, adhering to which, a person can protect himself from the disease, and in the case when the disease is diagnosed, improve his condition and significantly easier and faster to stop the pathology:

• Everyone should lead a correct way of life, excluding from it bad habits. Especially harmful alcohol.
• Food should be rational, balanced and rich in vitamins, minerals and trace elements.
• Do not abuse food by eating. Overweight - this is another brick to launch the mechanism of the disease.
• If a person is identified with gallstones, they should be removed without delay, using various available modern techniques, for example, laparoscopic cholecystectomy.
• Avoid hypodynamia. Movement is life! Actually this is in this situation.
• With any therapeutic treatment, clearly monitor the dosages of drugs, not exceeding them and not taking medications with expired shelf life.
• Not the last place is occupied by the rules of personal hygiene, which must be fulfilled by every person.

Forecast of fatty pancreatic necrosis

This disease is quite dangerous for human life. His progression is very significantly affects other organs and systems of the body. If the pathology is not treated, then it goes into a neglected state, resulting in the self-destruction of liver cells. The prognosis of fatty pancreatic necrosis of such a clinical picture is very pitiable and a lethal outcome is highly probable.

If this pathology is recognized at an early stage of development and was timely prescribed and passed, appropriate treatment for this clinic, then it is safe to say that the prognosis of fatty pancreatonecrosis will be favorable. The person in the future will have to control food, adhering to the consumption of "healthy food" and lead a healthy lifestyle. But the quality of life will remain at a high level, without creating any problems for the former patient.

Fatty pancreonecrosis is a very unpleasant and quite dangerous disease for a person's health and life. Therefore, ignoring his symptoms can lead a patient to a death bed, when no methods of modern medicine will be able to help him. To prevent such a development of the event, you should pay more attention to the signals of your body, consult a specialist in time. It is better - if the alarm was false and, having passed the examination, you received a negative result than if time was missed and the disease is diagnosed late.

[16], [17], [18]