Acute pancreatitis is an inflammatory response to the pancreatic tissue's own digestion, edema, bleeding, and even necrosis after the pancreatic enzyme is activated in the pancreas due to a variety of causes. Clinical features acute epigastric pain, nausea, vomiting, fever, and increased hemacreatic enzymes. The degree of lesions varies from mild to severe, and the mild ones are mainly pancreatic edema, which is more common clinically, and the condition is often self-limiting, and the prognosis is good, also known as mild acute pancreatitis. A small number of severe patients have hemorrhagic necrosis of the pancreas, often secondary to infection, peritonitis and shock, etc., and the case fatality rate is high, called severe acute pancreatitis. Clinicopathology often divides acute pancreatitis into two types: edema and hemorrhagic necrosis.
Causes of acute pancreatitis
1. Obstructive factors
Bile reflux due to biliary roundworms, incarceration of calculus in the abdomen, and narrowing of the duodenal papillae. If the lower end of the bile duct is obviously obstructed, the pressure in the biliary tract is very high, and the high-pressure bile refluxes the pancreatic duct, causing the pancreatic acinar to rupture, and the pancreatic enzyme enters the pancreatic interstitium and pancreatitis occurs.
2. Alcohol factor
Long-term drinkers are prone to pancreatitis, on this basis, when a large amount of alcohol and binge eating, promote a large number of secretion of pancreatic enzymes, resulting in a sudden rise in pressure in the pancreatic duct, causing the rupture of pancreatic vesicles, pancreatic enzymes into the interstitial between the acinar follicles and promote acute pancreatitis. Alcohol is ingested at the same time as high-protein and high-fat foods, which not only increases pancreatic enzyme secretion, but also can cause hyperlipoproteinemia. At this time, pancreatic lipase breaks down triglycerides to release free fatty acids that damage the pancreas.
3. Vascular factors
Small movements of the pancreas, acute embolism of veins, obstruction, the occurrence of acute blood circulation disorders of the pancreas and lead to acute pancreatitis; another factor is based on the obstruction of the pancreatic duct, when the pancreatic duct obstruction, the high pressure in the pancreatic duct, the pancreatic enzyme passively "penetrates" into the interstitial. Due to the stimulation of pancreatic enzymes, lymphatic vessels, veins, and arteries in the interstitium is embolism, followed by ischemic necrosis of the pancreas.
4. Trauma
Acute severe pancreatitis occurs due to pancreatic trauma that ruptures the pancreatic duct, spills pancreatic fluid, and inadequate blood supply after trauma.
5. Infectious factors
Acute pancreatitis can occur with various bacterial infections and viral infections, viruses or bacteria that enter the pancreatic tissue through the blood or lymph, causing pancreatitis. In general, this infection is simple edematous pancreatitis, and hemorrhagic necrotizing pancreatitis is less common.
6. Metabolic diseases
It may be associated with hypercalcemia, hyperlipidemia and other conditions.
7. Other factors
Such as drug allergies, hemochromatosis, genetics, etc.
Edematous pancreatitis: the pancreas is slightly larger, the margins are regular, the echo of the pancreatic head and body is reduced, and the predisposing is homogeneous
Edematous pancreatitis: diffuse enlargement of the pancreas, regular margins, decreased internal echo, and compression of blood vessels posterior to the pancreas are not clear
Diagnostic criteria for acute pancreatitis
1. Typical abdominal pain symptoms (pain in the upper quadrant and left upper quadrant, which can radiate to the back chest or both sides)
2. Amylase or lipase is three times higher than the upper limit of normal values
3.B imaging tests such as ultrasound, CT, or MRI suggest pancreatitis
Acute pancreatitis is divided into edematous and necrotic types
The main pathology of edema-type acute pancreatitis is hyperemia and edema of the pancreatic interstitium, and the lesions are mild and common. Necrotizing acute pancreatitis is characterized by a large number of pancreatic acinar vesicles, fat, and vascular necrosis, accompanied by a large amount of peripheral bloody exudate, and high mortality, which is rare. Chronic pancreatitis is mainly pathologically altered by fibrotic hyperplasia.
Sonogram of acute pancreatitis
(1) The pancreas is diffuse or localized, and it can lose its normal form and be unclear.
(2) The internal echo is reduced, showing a diffuse distribution of weaknesses, and there are flaky echoes with uneven strength, uneven morphology, and unclear boundaries in the middle. Severe edema presents a dark area of translucency, resembling a sonogram of a cyst.
(3) There is more gastrointestinal gas in the pancreatic region, which is worse in the pancreatic head area, making the detection more difficult.
Treatment of acute pancreatitis
1. Non-surgical treatment
Prevent shock, improve microcirculation, antispasmodic, analgesic, inhibit pancreatic enzyme secretion, anti-infection, nutritional support, prevent the occurrence of complications, strengthen intensive care and some measures.
(1) Prevention and control of shock to improve microcirculation Liquid, electrolyte and heat should be actively replenished to maintain the stability of circulation and water-electrolyte balance.
(2) inhibition of pancreatic secretion (1) H2 receptor blocker; (2) aprotinin; (3) 5-fluorouracil; (4) fasting and gastrointestinal decompression.
(3) Antispasmodic analgesia should be given regularly, the traditional method is intravenous infusion of 0.1% procaine for intravenous closure. And can be used regularly with atropine, both pain relief and relief of Oddi sphincter spasm, morphine is disabled, so as not to cause Oddi sphincter spasm. In addition, isoamyl nitrite, nitrite glycerin, etc. are used in severe pain, especially in elderly patients, which can relieve the spasm of the Oddi sphincter to a certain extent, and at the same time greatly benefit the coronary blood supply.
(4) Nutritional support When acute severe pancreatitis, the body's catabolism is high, inflammatory exudation, long-term fasting, high fever, etc., the patient is in negative nitrogen balance and hypoproteinosis, so nutritional support is needed, and while giving nutritional support, it is necessary to make the pancreas secrete or less secreted.
(5) Application of antibiotics The application of antibiotics to acute pancreatitis is one of the indispensable contents of comprehensive treatment. The use of antibiotics in acute hemorrhagic necrotizing pancreatitis is beyond reproach. Acute edematous pancreatitis, as a prevention of secondary infection, should be rationally used with a certain amount of antibiotics.
(6) Peritoneal lavage For those who have a large amount of exudate in the abdominal cavity, intraperitoneal lavage can be done to dilute and exclude the liquid containing a large amount of pancreatic enzymes and toxins in the abdominal cavity.
(7) Strengthen guardianship.
(8) Indirect cooling therapy.
2. Surgical treatment
Although there is localized regional pancreatic necrosis and exudation, patients who do not have infection and whose symptoms of systemic poisoning are not very severe do not require rush to surgery. If there is an infection, it should be treated surgically accordingly.