- Acute pancreatitis is a widespread condition in Western societies at 11_40 cases per 100,000 people and an estimated fatality rate of 7-8%.
- Warning of acute pancreatitis is strongly linked to degree of tissue necrosis in the pancreas, although most cases tend to heal it automatically in about 15% of patients severe necrosis occurs and dangerous in the pancreas and other organs.
- Patients who have inflammation of the pancreas with an injury and lack of other members of the pancreatic necrosis ratio of approximately 30_50% of the gland tissue with high mortality.
- About 80% of cases of acute pancreatitis due to channel University of pebbles and excessive alcohol consumption.
- 10% of cases of unknown cause and the rest are caused by obstructions or drugs or metabolic, genetic or septic, or due to diseases of the blood.
Clinical manifestations and diagnosis
Patients complain of acute pancreatitis acute epigastric pain and sudden, sometimes spreads to the back, these symptoms may be associated with nausea, vomiting, fever and accelerate the pulse,
Clinical examination, we find reluctantly and tenderness in the epigastric region with abdominal distension and poor intestinal sounds with occasional fever.
Put the diagnosis with certainty based on laboratory tests that show high concentration of serum amylase and lipase three times the normal limit, at least, and the high degree of enzyme does not bear any indication of the degree of necrosis.
It is also the serological tests low sensitivity, because about a third of the patients happen to have a height of pancreatic enzymes, but less than three times the normal limit, and high amylase blood may be a reason beyond the pancreas being produced in the salivary glands and the horn tubes and rises if the ulcer perforated or intestinal infarction, or renal failure.
Therefore, serum lipase is considered to be more accurate but may be high in some patients asymptomatic.
Although the imaging and x-ray tests are not required but it is always useful in determining the severity of inflammation and the reasons sometimes.
CT imaging is considered the most accurate and useful in terms of the quality of discrimination between pancreatic Almtozm and interstitial inflammation and necrotizing inflammation.
More assets are seen on the CT scan is the magnitude of the pancreas and uneven edges and inflammation of tissue around the pancreas and concentration of liquids (see figure).
MRI is magnetic is very useful in patients sensitive to contrast radiography.
Also, the ultrasound in the detection of stones in the event of doubt reg inflammation of origin.
Warning criteria in acute pancreatitis:
Most episodes of acute pancreatitis are of moderate interstitial form, and nearly all mortality occurs in patients with necrotizing form of acute pancreatitis, which ranges in which the mortality rate between 30% and 10_ specifically, septic pancreatic necrosis.
And use a variety of systems, calculating the points for the definition of degree of seriousness of the patient's condition and determine the warning, and these systems standards Ranson, Glasgow system, and evaluation of Apache 2.
Ranson criteria and remains the most widely used, while the Apache system is more complex, and should not replace any test subject clinical trial minute for each patient individually.
And increase serum concentration of the reactive protein in conjunction with the severity of acute pancreatitis, but it is not a name and a sensitive and early on the severity of the disease.
As the disease is more severe in the case of obesity (body mass index above the 30).
Measure
Often heals acute pancreatitis from the mild form in the interstitial space of a few days without causing Bakabil functional. The measure consists mainly of supportive measures, including bowel rest (absolute oral diet), intravenous fluid, and pain control using appropriate analgesics.
Patients who suffer from severe acute pancreatitis should be performed, CT is supported to assess the degree of necrosis caused and the severity.
According to the preventive treatment with antibiotics only patients with pancreatitis Altnchri, has been found that both Alemippinim, cephalosporins and fluoroquinolones has led to the low rate of morbidity and mortality.
Shall be subject to pancreatitis patients Altnchri of fine needle aspiration through the skin and for the transplant and dye grams in order to assess the presence of inflammation of the pancreas Tnchri, which should be addressed Baltnder surgery.
Patients with acute pancreatitis often spend a long time in the hospital with their inability to take food or fluids orally. And recent evidence suggests that early use of the feeding tube through the nasal tract
Specific (nasal jejunoileal) may reduce the rate of morbidity, especially septic complications, compared to intravenous nutrition.
And advised to use imaging technology, and ductal pancreatic bile reflux endoscopically for patients who have signs of inflammation of the pancreas Bhsaat bitterness and suspicion biliary obstruction. Embolism is suspected in the case of biliary bile Althsa channel counts or university, and we find a widening of the bile duct in this case and a rise in liver enzymes. Alaminotransferraz concentration rises first in the inflammation of the pancreas Bhsaat bitterness, followed by a rise in alkaline phosphatase and bilirubin if the blockage.
Has shown an endoscopic technique with a few mill previous decline in the proportion of morbidity and mortality in those patients, and significantly reduced the rate of cholangitis and biliary infection.
Complications:
False pancreatic cysts: is the mixing of the most common acute pancreatitis (which is about cysts of the pancreatic juice with a fibrous lining is present on the epithelial gland).
These cysts need at least 4 weeks to form and often break down spontaneously, without symptoms, but may cause pain or blockage of pressure on other organs.
The cysts occasional false address Balenzh through the skin Oalenzh endoscopic or surgical through the stomach or duodenum.
Patient with septic Pkissat false (pancreatic abscess) is suffering from deteriorating abdominal pain, fever and a high rate of leukocytes. Balenzh treatment is surgical or through the skin and antibiotics.
Less common complications of acute pancreatitis is the holes or channels, pancreatic fistulas, which are associated with Alhabn pancreatic origin. Treatment and resting during bowel endoscopy or surgery.
Inflammation of the pancreas may lead to splenic vein thrombosis with gastric varices and subsequent hemorrhages.
Some patients with severe pancreatitis and those with significant necrosis may develop with diabetes.
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