Purulent pancreatitis

Purulent pancreatitis is a serious disease accompanied by acute inflammation of the pancreas. Most often the inflammatory process leads to the formation of purulent abscesses on the affected organ.

Acute pancreatitis today is the third most important acute abdominal disease, requiring immediate treatment in a surgical hospital. The first place in this ranking is acute appendicitis, and the second - acute cholecystitis. According to world statistics, acute pancreatitis is detected annually in 200-800 people out of 1 million. Most often, this disease is detected in males.

Purulent pancreatitis occurs in 10-15% of cases of acute pancreatitis and is characterized by an extremely difficult condition of the patient with a high risk of death. In general, the disease occurs as an immediate reaction in response to various etiological factors, in particular, food intoxication, neurovascular disorders, etc.

In most cases, a combination of several factors is observed in the clinic of purulent pancreatitis. By itself, an infection that penetrated the ducts of the pancreas can not cause such a serious pathology. Usually the inflammatory process develops against the background of a violation of the integrity of the pancreas - its glandular tissue, ducts and vessels.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Causes of purulent pancreatitis

Purulent pancreatitis can develop for a number of reasons. It can be both congenital anomalies of the pancreas, and various inflammatory diseases of the digestive organs.

The most common causes of purulent pancreatitis:

• alcohol abuse (chronic and acute alcoholism);
• various intoxications;
• infection with the virus (mumps, hepatitis B and C);
• bacterial infection;
• cholelithiasis;
• diseases of the stomach and duodenum (ulcer, gastroduodenitis);
• appendicitis;
• taking drugs that affect pathologically the pancreas: antibiotics, immunosuppressants, estrogens, azathioprine, as well as corticosteroids and thiazide diuretics;
• surgical interventions and various pancreatic injuries;
• genetic predisposition.

Acute inflammation of the pancreas, as a result of which purulent pancreatitis develops, according to the main medical theory, develops as a result of damage to the cells of this organ by enzymes that prematurely become active. In normal operation of the pancreas, digestive enzymes are produced in their inactive form. They are activated by being in the digestive tract. However, under the influence of various pathological factors, enzymes can be activated directly in the pancreas, which leads to self-digestion of its tissues. The result of this process is swelling of the tissue, acute inflammation, damage to the vessels of the pancreatic parenchyma, development of abscesses, i.e. Purulent pancreatitis.

The pathological process often extends to the peritoneum and retroperitoneal tissue, intestinal loops, omentum other nearby tissues. Observed pronounced impairments in the form of the appearance of secondary inflammation in other organs and the occurrence of dystrophic disorders.

[13], [14], [15], [16], [17], [18], [19], [20], [21], [22]

Symptoms of purulent pancreatitis

Purulent pancreatitis manifests itself by a decrease in appetite, which is accompanied by frequent eructations, dry mouth, hiccups, bloating and nausea. Since the development of purulent pancreatitis disrupts the functioning of the digestive system, the patient becomes very thin. Vomiting is a constant process accompanying this disease.

Other symptoms of purulent pancreatitis:

• paroxysmal pains in the abdomen - most often in the epigastric region (cutting, blunt, convulsive, surrounding, growing);
• increased heart rate;
• chills;
• increased temperature due to intoxication;
• the appearance of dyspnea;
• lowering blood pressure;
• bloating;
• diarrhea or stool retention;
• a sharp deterioration in the state of health of the patient;
• pronounced leukocytosis.

The progressive course of the disease provokes a worsening of the person's condition, exhausting pain exhausts him. Any movement, coughing, deep sigh causes an attack of unbearable pain, sometimes leading to a shock state.

Skin covers can be covered with spots of cyanosis (Cullen's symptom), most often in the peripodal region and on the lateral areas of the abdomen. Due to the breakthrough of pus in the abdominal cavity, peritonitis may develop, which, in turn, increases the risk of death.

Acute purulent pancreatitis

Purulent pancreatitis can occur in an acute form, this is the most severe form of the disease, which is very rare, in only 10-15% of patients. A distinctive feature of acute purulent pancreatitis is an extremely high level of death.

Acute purulent pancreatitis in most cases develops as a result of neurovascular disorders or food poisoning. In isolated cases, the primary causes of the disease were syphilis, typhoid or parotitis. The disease occurs against a background of strong, debilitating pain in the upper abdomen, often leading to shock and collapse. With a painful shock, the person's face becomes ashy-gray, and the pulse is practically not palpable. In addition, the attack is accompanied by bloating, nausea and vomiting. At the same time, the tension of the abdominal muscles is felt.

Many medical experts agree that the development of acute purulent pancreatitis provokes several pathogenic factors. Penetration of infection is not the only reason, it is important to have an appropriate environment: damaged vessels, glandular tissue, ducts. Activation of lipase and trypsin leads to a violation of blood circulation. From other factors, you can identify stomach diseases, malnutrition, pancreatic injury.

[23], [24], [25], [26], [27], [28], [29], [30], [31], [32]

Diagnosis of purulent pancreatitis

Purulent pancreatitis is diagnosed by studying in the laboratory conditions a blood test (general, detailed, biochemical) and urine, abdominal radiography, and, if necessary, other medical research. High level of leukocytes (leukocytosis), release of pancreatic enzymes, in particular, an increase in the amylase index, acceleration of ESR, increase or decrease in blood sugar level is a typical picture of purulent pancreatitis. Radiography of the abdominal cavity can show the presence of signs of intestinal paresis (obstruction), flatulence of the colon, as well as the high position of the diaphragm.

Diagnosis of purulent pancreatitis is also performed with the help of ultrasound examination of the pancreas, as a result of which there is an increase in the size of the body due to severe inflammation. In addition, cysts and foci of abscesses are observed. Sometimes for more accurate diagnosis, an examination of the diseased organ is required through a special instrument - a laparoscope, i.e. Laparoscopy of the pancreas is performed.

In general, the diagnosis of "purulent pancreatitis" is based on clinical data. With the development of purulent pancreatitis, the predominance of the phenomena of abscess "melting" of the pancreas is noted. Detection of the disease requires immediate hospitalization of a sick person. Patients with this diagnosis are placed in the intensive care unit.

[33], [34], [35], [36], [37], [38]

Treatment of purulent pancreatitis

Purulent pancreatitis is a disease that requires urgent care and constant medical supervision of the patient exclusively in a hospital hospital.

Treatment of purulent pancreatitis when observing the catarrhal (edematic) phases of the disease consists in keeping the patients in strict bed rest, probing the stomach with cold water. The patient is prescribed an alkaline drink, a hot-water bottle with ice on his stomach and hunger. By means of droppers and injections, analgesics, spasmolytics (no-shpu, baralgin, papaverine, etc.) are injected into the body, as well as diuretics for swelling. Assign a heparin, novocaine and novocaine blockades, reopolyglucin; for the reduction of pancreatic secretion, most often used are diamond, rannisan, trasilol, cimetidine, etc.

The severe form of purulent pancreatitis (the transition of the inflammatory process to a destructive form) with hemorrhages and the formation of a number of abscesses in the tissues of the pancreas requires urgent surgical intervention. The main task of the surgical operation is to purify the body of toxins, prevent dehydration of the body and stop the destruction of the gland by delimiting the inflammatory process. Contraindication to the operation may be extremely difficult condition of the patient, which can not be deduced from shock.

The optimal solution for surgical treatment is laparotomy - surgery by cutting the abdominal wall, which allows you to get to the abscesses and gently remove them. Against the backdrop of the operation, a permanent scan is performed, as well as monitoring the patient's condition by visualization methods - CT, fluoroscopy, ultrasound. If the patient is simultaneously observed purulent inflammation of the gallbladder, he can be made cholecystectomy (removal of the gallbladder), or cholecystostomy (external drainage of the gallbladder).

Prevention of purulent pancreatitis

Purulent pancreatitis can be prevented if follow preventive measures. First of all, a person must constantly monitor their health, including the timely detection and effective treatment of various gastrointestinal diseases, cholecystitis, cholelithiasis. When diagnosing any disease of the internal organs, including the pancreas, it is necessary to undergo a full course of treatment, following all the prescriptions of the attending physician. At the first symptoms of the development of gastrointestinal disease (nausea, vomiting, diarrhea, heartburn, pain in the hypochondrium, stomach and other places) you should consult a doctor for advice.

Prevention of purulent pancreatitis is also in the fight against overeating, obesity, alcohol abuse. It is important to adhere to a diet if there are pathological changes in the work of the digestive system, pancreas, gall bladder. For this purpose, a diet rich in carbohydrates is best. Containing rice, low-fat milk, white breadcrumbs, cottage cheese, fruit juices.

It is very important to adhere to the rules of rational nutrition, to give up harmful habits, including smoking, alcohol, and drug use. It helps to avoid complications and exacerbations of diseases of the gastrointestinal tract and sanatorium treatment.

Prognosis of purulent pancreatitis

Purulent pancreatitis is very important in time to identify in order to minimize the risks of death. Because severe forms of the disease can cost a person's life.

The prognosis of purulent pancreatitis is always very serious. Complications arising from acute pancreatitis are mainly associated with the release into the blood of a large number of pancreatic enzymes and poisonous products of its decay (pancreatic necrosis). Intoxication of the body and the strongest pain syndrome during an attack cause a shock in the patient - a life-threatening condition. A terrible complication of this disease is also the fermented diffuse peritonitis, which has an aseptic character and develops against the background of an overabundance of pancreatic enzymes, which have an aggressive effect on the peritoneum.

Severe intoxication of the body, which is observed during the course of acute pancreatitis, is dangerous because it can lead to acute renal and hepatic insufficiency, jaundice development, ulceration of the gastric mucosa, pulmonary edema as a result of toxic pneumonia, and psychoses of toxic origin. It should be emphasized that the course and further prognosis of purulent pancreatitis is significantly affected by alcohol intake. If a patient, despite diagnosing a severe form of the disease, continues to consume alcohol, the risks of a lethal outcome are doubled.

It should be remembered that the main cause of death of patients with purulent pancreatitis is a strong intoxication of the body in combination with purulent-septic complications. Especially neglected cases develop sepsis. The prognosis of purulent pancreatitis is significantly worsened due to late complications of this disease. Most often - an abscess of the abdominal cavity, sepsis, phlegmon retroperitoneal tissue and pylephlebitis.

Lethal outcome in purulent pancreatitis

Purulent pancreatitis, first of all, is dangerous because it can lead to death. The severe degree of intoxication of the body of a sick person causes damage not only to the pancreas itself, but also to other vital organs - the brain, kidneys, heart, lungs. Blood decay products and enzymes are absorbed into the blood, provoking a rapid poisoning of the whole organism. It is for this reason that there is a high risk of death.

The fatal outcome for purulent pancreatitis is observed in 10-15% of the total number of cases of the disease. If at first the lesions of the internal organs due to acute pancreatitis are of a focal character, then with the development of the disease, inflammation rapidly "attacks" practically the whole organism, leading to its strongest intoxication. The patient's state of health deteriorates with every minute, bringing unbearable suffering. In most cases, the patient's death occurs because of untimely diagnosis. As a result, pathogenetic therapy does not give the desired results, because it is applied too late.

Purulent pancreatitis is a dangerous disease requiring urgent medical intervention. Therefore, it is so important to identify the disease in time to be able to save a person's life.