Attack of edematous

Acute pancreatitis

AN Bakool and VV Vinogradov (1951) distinguish edematous pancreatitis, pancreatic necrosis and suppurative pancreatitis, which can be transformed into one another, presenting in severe cases, a single stage of the pathological process. H. Beger [2] introduces the classification, in addition to interstitial-edematous and necrotic pancreatitis (sterile and infected), its major complications: pancreatic abscesses and pseudocysts.

The clinical picture

The clinical course of OP is determined by the severity of the pathological process. When interstitial OP no jaundice, and significant changes in the level of glucose and calcium in the blood, creatinine, hematocrit, with limited pancreatic necrosis observed subikterichnost skin, pronounced changes in these parameters, the deterioration of the patient, in spite of intensive therapy, with diffuse necrotizing pancreatitis align respiratory failure and encephalopathy [3 ].

The severity and prognosis of patients with brand viagra treatment of the OP depends on the depth of the defeat of the pancreas, the surrounding tissues and organs. J. Ranson [4] developed a list of prognostic criteria fixed by the patient on admission to hospital and after 48 h (see table).

In identifying more than two prognostic signs probability of death does not exceed 1-2%, in the presence of 6.5 symptoms for 40%, and in patients with signs of 8.7 or more, closer to 100%.

Treatment

Conservative treatment usually can cut short an attack of edematous (interstitial) OP and prevent the development of "surgical" complications from a limited non-infected pancreatic necrosis.

Aims of conservative treatment of OP and means for their solution can be formulated as follows:

• minimize the severity of inflammation of the pancreas: inhibition of pancreatic secretion (nasogastric tube, anticholinergic agents, somatostatin), inhibition of pancreatic enzymes (antiproteases, fresh frozen plasma);

• impact on the pathogenic mechanisms of complications (antibiotics, antacids, cimetidine);

• supportive care and treatment of complications (recovery and maintenance of circulating blood volume (CBV), compensation of electrolyte balance, support of respiratory function, nutrition, analgesia, heparin).

Possibilities of conservative treatment "to create peace RV, inhibition of its secretion, deactivation inform your doctor of enzymes by holangiolitikov, protease inhibitors, cytostatics, drugs somatostatin, glucagon, H2-blockers are limited [5], and he plays the role of maintenance therapy and prevention of complications of OP. One should distinguish between the standard basic therapy with relatively mild OA and during intensive therapy for pancreatogenic shock, multiple organ failure and septic complications.

Baseline therapy includes discontinuation of food and liquid through the mouth, gastric decompression, local application of cold, infusion of saline and 5% glucose, antibiotics and analgesics. Most effectively arrest the pain syndrome and paresis of the bowel at the OP can with epidural anesthesia.

Complex of intensive therapy for pancreatic necrosis with organ failure include modern methods of detoxification, prolonged mechanical ventilation, compensation deficit of fluid, electrolytes, protein composition of blood, the elimination of anemia, parenteral and enteral tube feeding, insulin. For the prevention of complications of pancreatic necrosis designate broad-spectrum antibiotics, cimetidine to prevent gastroduodenal ulceration of the stomach and bleeding.
Indications for surgery in acute pancreatitis are: _ the clinical picture of "acute abdomen" when it is impossible to exclude other acute surgical diseases; _ destructive cholecystitis, obstructive jaundice, cholangitis, _ the progression of multiple organ failure despite intensive therapy; _ infection of necrotic areas and RV parapankreaticheskoy fiber ; _ complications of pancreatic necrosis: bleeding, gastric and intestinal fistulas, peritonitis, intestinal obstruction, pseudocyst.

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