Fatty pancreonecrosis

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

In case of provocation and development of this disease, metabolic processes and normal functioning of gland cells fail. This leads to the cell beginning to digest itself, provoking its death.

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Causes of fatty pancreatic necrosis

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

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

• Gallstone disease. It comes out on top in terms of the frequency of disease provocations. Stones block the bile ducts, blocking the outflow of bile secretion, which leads to swelling, spasms, and increased pressure in the bile ducts. And if emergency measures are not taken, the death (necrosis) of cellular tissues begins.
• Throwing of products produced by the gland into the pancreatic ducts. This can occur when there is a malfunction of the sphincter of Oddi, which is responsible for throwing pancreatic secretion into the duodenum.
• An infectious disease in one of the abdominal organs.
• A state of shock in which the microcirculation of metabolism and blood in the body is disrupted.
• Bad habits: abuse of nicotine, drugs and/or alcohol. This mainly concerns alcoholic beverages, which sharply activate the work of pancreatic secretions. This gland is especially heavily loaded if, together with alcohol, very fatty foods enter the digestive tract. In chronic alcoholism, the product produced by the pancreas increases its density, which leads to major problems in its passage through the ducts.
• Fatty pancreatic necrosis can be provoked by diseases that also affect other abdominal organs, such as gastritis or duodenitis.
• Excess weight caused by excessive passion for food.
• A secondary acquired disorder of the hemostasis system that occurs under the influence of various pathological agents on the organic system.
• Less often, fatty pancreatic necrosis is a consequence of the “careless” performance of such a diagnostic procedure as pancreatography, as a result of which the ducts of the pancreatic acinus were injured.
• Postoperative complication in one of the abdominal organs.
• Pancreatic hypoxia is oxygen starvation of cells.
• In approximately 10–15% of disease diagnoses, it is not possible to determine the etiology.

If timely measures are not taken, this pathology is fraught with significant complications. Fatty pancreatic necrosis can be provoked by:

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

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Symptoms of fatty pancreatic necrosis

When acute abdomen syndrome occurs, the probability that the cause is fatty pancreatic necrosis is about one percent. The symptoms are quite intense and cause the patient a lot of suffering. Symptoms of fatty pancreatic necrosis can often be confused with other diseases of the gastrointestinal tract, but there are also some signs by which a qualified gastroenterologist can narrow his assumptions and direct the diagnosis in the right direction.

• Pain symptoms appear as a sharp, severe attack, localized in the upper area of the anterior abdominal wall. Depending on the area of the gland affected, pain can be felt in several different places: if the head has undergone pathological changes, the patient will feel pain on the right side in the hypochondrium area, as well as in the epigastrium; if the body of the pancreas or its tail has been affected, the pain will be most intense on the left side in the hypochondrium area and in the central upper abdomen (epigastrium). If the pathological changes have affected the entire pancreas, the patient will feel severe, constant, all-enveloping pain.
• The patient constantly feels sick. This symptom can intensify after eating, which can lead to a vomiting reflex. Vomiting can be profuse, with the outgoing liquid containing remnants of undigested food in the stomach and bile. However, the contents of the vomit in this case never contain intestinal products. Even a sip of clean water can provoke a gag reflex.
• A feeling of internal distension appears, symptoms of flatulence are observed. During palpation, the patient is struck by increasing pain that goes along the pancreas.

Gradually, the general condition of the person becomes worse, signs of intoxication of the body appear:

• The skin takes on a pale, earthy color.
• The sclera takes on a yellowish tint.
• Increased moisture of the skin is observed.
• The extremities become cold and it can be difficult to warm them up.
• Tachycardia is observed.

In case of diagnosis of severe 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, which leaves through the skin and with vomit, is that the fluid remaining in the body begins to accumulate in the peritoneal cavity, which inhibits blood flow. As a result: the amount of circulating blood decreases, the density of plasma increases, and the microcirculation of substances and oxygen decreases.
• Blue cyanotic spots can be seen all over the body, resulting from microbleeds (Mondor's syndrome).
• When listening with a statoscope, intestinal sounds are absent or weakly audible.

Diagnosis of fatty pancreatic necrosis

Only every twentieth patient diagnosed with pancreatic necrosis receives the prefix fatty. The fatty factor is predominantly stated as an accompanying characteristic in such a diagnosis as hemorrhagic necrosis or fatty pancreatic necrosis with hemorrhages. This disease develops quite slowly, the first symptoms of the appearance of infiltrates appear only on the fourth or fifth day from the moment the mechanism of pathology progression is launched. In the recurrent category of the disease, the symptoms may appear much later.

The pathology in question develops with the direct participation of lipase, a pancreatic enzyme, in the inflammation process, which is essential for digesting fats from food. Therefore, the primary diagnosis of fatty pancreatic necrosis consists of a blood test to determine the level of this enzyme. The quantitative component of elastase, another pancreatic product, is also determined. This enzyme can provoke a violation of the integrity of the walls of blood vessels, which leads to voluminous bleeding. Confirmation of the presence of this pathology in the patient's body is also a change in the mass indicators of alpha-amylase, although this enzyme does not significantly affect the pathological changes in the patient's body, but can serve as a litmus test for these changes.

Diagnosis of fatty pancreatic necrosis is:

• Examination of the lesser and greater omentum, as well as the peritoneum, which will make it possible to determine the sites of cellular necrosis of a fatty nature.
• Biochemical study of plasma to determine the level of trypsin, amylase. Low calcium content indicates necrotic processes in the body. The lower its level, the more severe the pathology.
• A comprehensive blood test for leukocytes (leukocytosis). The plasma density is determined.
• Urine analysis for protein.
• Determination of the level of blood clotting.
• An ultrasound examination that allows one to assess the condition of the organ being examined, its uneven structure and the presence of necrosis.
• Laparoscopy is an information method that allows for differential diagnosis.
• Computed tomography is the production of a series of images of sections of the pancreas, which allows one to assess its condition.
• Celiacography is an X-ray examination of the celiac trunk and branches that supply the abdominal organs.
• Fibrogastroduodenoscopy, which allows assessing the condition of the stomach.
• Angiography – makes it possible to visualize damage to the mucous membrane of blood vessels in the area of the affected organ.
• Radiography allows us to assess the condition of the pleural cavities, which can, by affecting the peritoneum, provoke an increase in intra-abdominal pressure.

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Treatment of fatty pancreatic necrosis

If the disease is not advanced 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 goal of treatment is to prevent further development of the disease, to prevent serious complications, including the emergence and development of a purulent process.

1. First of all, it is necessary to relieve the patient's pain symptoms, therefore the attending physician prescribes an antispasmodic, analgesic drugs: no-shpa, zologan, baralgin, revalgin, platifillin, kvarelin, promedol, spazmalgin, papaverine, maxigan, omnopon, spazmalgon, trigan.

Platyphylline is prescribed in the form of injections, which are administered subcutaneously at 2-4 mg, three times during the day. The maximum permissible daily dosage is 30 mg, while a single dose is equal 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 to the components of platifillin.

Spazmalgon in solution is administered by a handling nurse two to three times a day, 2 to 5 ml. Before opening, the ampoule must be warmed in the palms, only then is it broken. The duration of the treatment course is five days. The maximum amount of the drug allowed for use is 10 ml.

If there is no therapeutic effect within five days, the drug is discontinued and a stronger painkiller is re-prescribed. If the patient feels better after taking Spazmalgon, the attending physician transfers the patient to the oral form of 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 non-steroidal anti-inflammatory drugs group. It should not be prescribed in case of a failure in the hematopoietic system, with kidney and/or liver dysfunction, leukopenia, closed-angle glaucoma, in case of deficiency of glucose-6-phosphate dehydrogenase in the patient's body, with intestinal obstruction, megacolony, in case of decreased muscle tone of the gallbladder and/or urinary bladder, in collapse states.

2. Antihistamine medications are also prescribed: suprastin, erius, telfast, levocetirizine, tsuprastinex, cesera and others.

Levocetirizine is prescribed for oral administration, without chewing, with a small amount of liquid. It is advisable to administer the drug on an empty stomach or together with food.

Adults and children over six years of age are prescribed the drug at a dosage of 5 ml per day. When kidney dysfunction is diagnosed, the drug dosage is adjusted depending on the level of creatine clearance. Elderly patients should not change the recommended amount of the drug.

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

Levocetirizine is contraindicated in case of hypersensitivity to the component composition of the drug, as well as in case of renal dysfunction with creatinine clearance below 10 ml/min. Contraindications include children under 6 years of age (tablet form) and 2 years of age (drops).

3. Treatment of fatty pancreatic necrosis also includes drugs used to normalize water-electrolyte metabolism, reduce the secretory function of the pancreas. It is also necessary to "cleanse" the body, detoxifying it. For this, a glucose or rheopolyglucin solution, protease inhibitors, a lytic mixture, sodium bicarbonate, cytostatics, Ringer-Locke, hemodez, which binds toxic compounds and removes them from the body along with urine, are administered drop by drop. The recommendations for the treatment of this disease include a special diet developed by nutritionists together with doctors, and a two-day to three-day fast is also welcomed.

Rheopolyglucin, by reducing blood viscosity and preventing the unification of formed elements into one system, allows activating plasma circulation. The drug is administered intravenously, drip, 0.4 - 1.0 liters per day. The procedure is usually performed once a day, less often this volume is divided into two droppers. This amount of the drug is administered over half an hour - an hour.

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

4. After a drip of rheopolyglucin, a patient diagnosed with fatty pancreatic necrosis is also prescribed anti-inflammatory drugs. For example, endoxan, cyclophosphamide, cel.

Cyclophosphamide is administered to the patient intramuscularly into a vein or directly into the cavity. The form of administration is determined by the attending physician.

The drug is prescribed to the patient at 0.2 g (at the rate of 3 mg per kilogram of weight) once a day or 0.4 g every other day.

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

Contraindications to taking the drug include low hemoglobin levels 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 of the patient's body to one or more components of the drug.

5. A protease inhibitor is administered intravenously to a patient with fatty pancreatic necrosis after three to four hours. It activates the synthesis of enzymes (plasmin, kallikrein, trypsin) necessary for the recovery process. Such drugs include gordox, contriven, trasylol, contrikal.

Contrycal is prescribed to the patient in shock doses. The daily amount of the drug is determined by figures of 80,000 - 160,000 - 320,000 U. The dose of the administered drug is determined by the attending gastroenterologist depending on the severity of pathological changes and the general condition of the patient at the time of the procedure. Contrycal therapy is practiced until the clinical picture has normalized, the results of laboratory tests reflect the norm.

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

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

The doctor selects the method of administration and dosage of Lasix individually, based on the indications of the level of imbalance of water and electrolyte balance, as well as the quantitative indicator of glomerular filtration. Subsequently, after leveling these indicators, the quantitative component of the administered drug is adjusted.

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

Contraindications to the drug include severe electrolyte imbalance, anuria, hypersensitivity to the components of the drug, including furosemide, as well as in the case of a diagnosis of hepatic coma, dehydration, and if the woman is pregnant or breastfeeding her newborn child.

7. Treatment of fatty pancreatic necrosis cannot be done without broad-spectrum antibiotics.

This may be cefixime, cefaclor, cefroxitine, spiramycin, moxifloxacin, cefamandole, lincomycin, rovamycin, ciprofloxacin, unidox solutab, cefoperazone, clarithromycin, avelox, cefuroxime, ceftazidime, roxithromycin, rulid, cefotaxime, klacid, amoxiclav, sumamed, latamoxef, fusidin, kefzol, cefpodoxime. These are new generation drugs.

Moxifloxacin is administered orally once a day at a dose of 0.4 g with a small volume of liquid. Taking the drug does not depend on meal time. 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.

For patients with a history of renal and/or hepatic dysfunction, cardiac or pulmonary insufficiency, those on continuous hemodialysis or long-term outpatient peritoneal dialysis, as well as for persons of retirement age, there is no need to adjust the recommended dosage.

Contraindications to moxifloxacin include increased intolerance to the components of the drug by the patient's body and the patient's age under 18 years.

8. To reduce the production of external secretion by the gland, the gastroenterologist prescribes cold compresses to the patient, which are applied to the epigastric zone of the anterior abdominal wall.
9. For medical reasons, the patient may be prescribed aspiration - a minor surgical intervention in which the contents of the stomach are sucked out and washed with special alkaline solutions.
10. Intragastric hypothermia is performed, local temperature reduction to slightly below 35°C.
11. To improve the condition, the patient's blood is "cleaned". To do this, the plasma is irradiated with laser ultraviolet rays. The session lasts from 15 to 30 minutes. The minimum number of procedures is two, the maximum is up to ten. This procedure shows high efficiency. After its completion, pain symptoms are significantly reduced, inflammation foci are stopped. Plasma treatment with rays stimulates its microcirculation, improves the quality of rheological parameters. This procedure can be carried out both inpatient and outpatient.
12. During the course of treatment, the patient undergoes artificial removal of toxins from his body using an extracorporeal (outside the body) structure, i.e. extracorporeal detoxification is performed. This procedure makes it possible to cleanse the patient's body of the waste products of the pancreas, the results of necrotic cellular decay, and toxins. The following treatment methods are usually used: lymphosorption (removal of toxins from the lymph) and plasmapheresis (cleansing the body at the cellular level by filtering the blood using special devices).
13. In particularly 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, such a patient has to be surgically provided with an outflow of the contents of the cavities of the lesser omentum and peritoneum by a gastroenterologist. Drainage is performed both by classical dissection of the peritoneal tissues and through laparoscopy.

Clinical statistics of this pathology show that the risk of getting fatty pancreatic necrosis is higher in people who have previously been diagnosed with pancreatitis, gallstone disease or other diseases affecting the liver. These are people with congenital and acquired pathological changes in the liver, but half of all diagnosed cases are in people who abuse alcohol and suffer from obesity.

Prevention of fatty pancreatic necrosis

In most cases, the disease can be prevented or at least the risk of this pathology and complications during its course can be reduced. 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 stop the pathology much easier and faster:

• Every person should lead a healthy lifestyle, eliminating bad habits from it. Alcohol is especially harmful.
• Nutrition should be rational, balanced and rich in vitamins, minerals and microelements.
• You should not abuse food by overeating. Excess weight is another brick to launch the mechanism of disease development.
• If a person has gallstones, they must be removed without delay using various available modern techniques, such as laparoscopic cholecystectomy.
• Avoid hypodynamia. Movement is life! This is also relevant in this situation.
• With any therapeutic treatment, strictly monitor the dosage of drugs, do not exceed them and do not take expired medications.
• The rules of personal hygiene, which every person must follow, also play an important role.

Prognosis of fatty pancreatic necrosis

This disease is quite dangerous for human life. Its progression significantly affects other organs and systems of the body. If the pathology is not treated, it goes into a neglected state, which results in the self-destruction of liver cells. The prognosis of fatty pancreatic necrosis of such a clinical picture is very deplorable and a fatal outcome is very likely.

If this pathology is recognized at an early stage of development and the appropriate treatment therapy for this clinic is prescribed and completed in a timely manner, then we can say with confidence that the prognosis for fatty pancreatic necrosis will be favorable. A person will have to control their diet in the future, sticking to the consumption of "healthy food" and leading a healthy lifestyle. But the quality of life will remain high, without creating any problems for the former patient.

Fatty pancreatic necrosis is a very unpleasant and quite dangerous disease for human health and life. Therefore, ignoring its symptoms can lead the patient to the death bed, when no methods of modern medicine will be able to help him. In order to prevent such a development of events, you should be more attentive to the signals of your body, promptly seek advice from a specialist. It is better if the alarm was false and, having undergone an examination, you received a negative result than if time was lost and the disease was diagnosed late.

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