What is acute pancreatitis.
Acute pancreatitis is a reaction caused by multiple etiologies in which pancreatic enzymes secreted by the exocrine glands of the pancreas cause self-digestion within the pancreas, resulting in pancreatic edema, peripheral oozing, and even hemorrhagic necrosis.
Overview of the pancreas.
The pancreas is an organ located outside the peritoneum and separated from other organs in the abdominal cavity, such as the stomach and intestines, by a thin layer of peritoneum; it is the second largest digestive organ in the body and has internal and external secretory functions; exocrine mainly refers to the secretion of digestive enzymes into the intestine so as to digest food, and endocrine function, mainly refers to the secretion of hormones directly into the bloodstream to play a role, the most familiar is the secretion of insulin, which if secreted The most familiar is the secretion of insulin, if the secretion is reduced, it will easily lead to diabetes.
Causes of acute pancreatitis.
Under normal circumstances the pancreatic fluid secreted by the pancreas is in the form of enzymogen, which is not active and cannot function within the pancreas itself, but can only function when it enters the intestine and goes down to the protective device under the action of activating factors.
The causes of this activation are the following.
1. Bile reflux and return of duodenal fluid into the pancreas.
Gallstone disease blocks the common opening of the pancreatic duct and bile duct, bile enters the pancreas to activate pancreatic enzymes or cause pancreatic necrosis, the pressure in the duodenum or distal small intestine increases, and intestinal fluid also enters the pancreatic duct through the above pathway causing the above pathological changes.
2.Alcoholism.
Alcoholism, leading to increased secretion of pancreatic juice, increased pressure in the pancreatic duct, drinking alcohol can cause pancreatic duct obstruction and other factors, leading to rupture of the small pancreatic duct, pancreatic enzymes into the pancreatic tissue, activation of pancreatic enzymes, self-digestion, pancreatic exudate edema, necrosis, etc.
3, hyperlipidemia.
Triglyceride generation directly damages the active substances of the pancreatic glands.
4, overeating, trauma, infection, surgery, pregnancy, electrolyte disorders, etc.
Under the action of the above factors, pancreatitis attacks, and as the disease progresses, blood damage can become impaired, the inflammatory response in the body forms a waterfall amplification effect, as well as infection and other factors can lead to further aggravation of the disease.
Pathological changes of acute pancreatitis: According to the pathological changes, it is divided into light pancreatitis and heavy pancreatitis, which were also previously called acute edematous pancreatitis and acute necrotizing pancreatitis; acute light pancreatitis mainly manifests as pancreatic edema, swelling, inflammatory cell infiltration, sometimes with a small amount of very slight intra-tissue hemorrhage or small punctate necrosis.
Acute severe pancreatitis: necrotic foci are flaky or scattered in the pancreas, the necrotic foci are black, there is more bleeding in the pancreas, saponification spots can be formed, there is a large amount of bloody exudate in the abdominal cavity, the structure of the pancreas is unclear, there is thrombosis in the blood vessels, etc.
Clinical manifestations of acute pancreatitis.
Symptoms.
1, sudden abdominal pain: mainly located in the upper abdomen slightly to the left, appear very quickly, suddenly, pain intensity is very intense, persistent, general painkillers can not be relieved, the left low back and left shoulder can also feel pain.
2, abdominal distension: abdominal distension often occurs along with abdominal pain, feeling serious, bringing pain to patients even more than abdominal pain, not easy to relieve.
3, nausea and vomiting.
4, fever: usually only moderate fever in the early morning without combined necrotizing infection, or partial relief after high fever.
5, other organ dysfunction or shock manifestations.
Physical examination.
There may be rapid heart rate and low blood pressure; painful abdominal pressure, diminished bowel sounds, and patchy cyanotic-purple petechiae around the waist and belly button.
Laboratory tests: mainly blood and urine amylase is increased, lipase is increased, but other diseases amylase may also be increased, if the pancreatic necrosis is severe amylase may also be increased.
Imaging tests.
Ultrasound, CT, MRI: can find enlargement of the pancreas, exudation, uneven density, necrosis, etc.
Diagnosis of acute pancreatitis.
It is not difficult to diagnose acute pancreatitis by combining abdominal pain, abdominal distension, changes in blood and urine amylase, especially with the current popularity of enhanced CT.
In the process of diagnosing acute pancreatitis, several conditions should be distinguished.
1, what causes pancreatitis: gallstone disease, overeating, alcoholism, hyperlipidemia, etc.
2. To distinguish whether there is a combination of large necrotic infection.
3, to distinguish between mild: heavy, or fulminant pancreatitis.
4.If it is biliary in origin. Pancreatitis is the main conflict, or biliary symptoms is the current problem that must be solved.
Treatment of acute pancreatitis.
Most pancreatitis currently does not advocate emergency surgery, combined with severe infection or biliary obstruction this requires surgical management.
Non-surgical treatment.
1, fasting, lower gastric tube gastrointestinal decompression.
2, suppress pancreatic secretion.
3, inhibit pancreatic enzyme activity and the cascade of inflammatory response.
4.Apply antibiotics to prevent infection.
5.Fluid resuscitation, nutritional support.
6, symptomatic treatment, pain relief, etc.
7.Can Chinese herbal medicine, or mannitol topical application.
Surgical treatment.
Necrotic tissue removal, lavage and drainage of the abdominal cavity, dialysis if combined with renal failure, ventilator support if combined with respiratory dysfunction, and surgery to relieve biliary obstruction is feasible if biliary inflammation is severe.
Management of complications of acute pancreatitis: early massive abdominal fluid exudation can generally be self-absorbed; pancreatic pseudocysts, if not absorbed and symptomatic, laparoscopic internal drainage of cysts is feasible; pancreatic abscess: surgical drainage.