Pancreatic infarction and apoplexy: causes, symptoms, diagnosis, treatment

Causes, pathogenesis. In a number of cases, especially with pronounced widespread atherosclerotic vascular lesions in elderly and senile patients, thromboses and pancreatic infarctions sometimes occur. They can be caused by small thrombi and embolism from the left atrium with heart defects (stenosis of the left atrioventricular orifice), infectious endocarditis, embolism from atheromatous plaque, etc. It is believed (and this, as a rule, and occurs in real life), that in these cases emboli also fall into various other organs: the kidneys, spleen, liver, etc. It is believed that the provoking factors in embolism atheromatous plaques can be treated with anticoagulants, carrying out aortography, since these factors are a method tvuyut detachment of atheromatous content of atherosclerotic plaques. This kind of embolism can be suspected in patients with advanced severe atherosclerosis (atheromatosis,) of the aorta in combination with hypertension.

Pathomorphology. Apoplexy and infarction of the pancreas, at least at the beginning of the development of the process, differ from acute hemorrhagic pancreatitis according to morphological criteria by the limitation, strict focality of the hemorrhagic process. The tissue of the pancreas with an infarct and apoplexy outside the foci of the hemorrhage remains intact, as well as the retroperitoneal tissue surrounding the gland. With hemorrhagic pancreatitis, the entire tissue of the pancreas is in a state of marked inflammation and necrosis, impregnated with blood (hemorrhagic pancreatitis); hemorrhagic impregnation captures and surrounding the pancreas retroperitoneal tissue.

Symptoms, diagnosis. The clinical picture of acute circulatory disorders of the pancreas such as hemorrhage or thromboembolism is bright: the main symptom is the sharpest pain in the area of the pancreas, accompanied by a collapoid state and a sharp pain in the area of the gland. The activity of pancreatic enzymes in serum and urine in the first hours usually does not change.

Immediate, non-contrast radiography of the abdominal cavity can reveal deposits of calcium salts in the aorta, sometimes calcifications of the pancreas itself (traces of past hemorrhages or embolisms), calcium deposits as a result of long-term chronic pancreatitis. At US in some cases it is possible to reveal, in addition to an edema and quite often a sclerosis (at persons of advanced age), unevenness of a tissue of a pancreas. However, one should remember the strongest pains that occur when a pancreas is affected, which in itself makes it difficult to perform at least some minimal long-term study, requiring at least a brief immovable position of the patient (without a sufficiently strong analgesia).

In the future, without treatment, the prognosis is bad in many cases.

Treatment. Carried out in the conditions of the surgical department of the hospital according to the general principles of treatment of acute hemorrhagic pancreatitis. In cases of suppuration and sequestration of hemorrhagic lesions of the pancreas, highly active antimicrobial agents with a wide spectrum of action and surgical treatment are shown. In all cases of vascular lesions of the pancreas, one should not lose sight of the state of its second extremely important function - an endocrine function, especially in severe cases of the disease. It is necessary to monitor the state of carbohydrate metabolism (the heavier the patient's condition, the more often - every 3-4 hours, then every day: blood tests, urine tests); if any deviations are found, correct them immediately. With the improvement of the patient's condition, the main disease and pancreatic lesions are treated (according to the principles of treatment of subacute and chronic pancreatitis).

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