Clinical signs
There is soreness, swelling, and sometimes muscle tension of the upper abdomen. Most patients are concerned about nausea and vomiting; some - only the urge to vomit. There may be a slight blueing of the area around the navel (Cullen's symptom) or cyanosis (blueing) of the skin on the lateral surfaces of the abdomen (a symptom of Gray-Turner). This may indicate an internal hemorrhage into the abdominal cavity. The symptom of Cullen testifies to the presence of internal bleeding, in which the tissues around the navel are soaked with blood. Subcutaneous hemorrhage is a consequence of the violation of blood clotting mechanisms as a result of absorption of pancreatic enzymes. The pancreas is located in the back of the abdomen behind the lower part of the stomach. Its head lies on the bend of the duodenum.
The pancreas produces:
- insulin and glucagon - hormones that are released directly into the bloodstream and control blood sugar levels;
- pancreatic juice - consists of four enzymes that break down proteins (trypsin, chymotrypsin), as well as fats (lipase) and starch (amylase). The inferior pancreatic duct empties into the common bile duct immediately before it leaves the duodenum.
Pancreatic juice, along with bile, is mixed with partially digested food in the stomach, activated and completes the processes of nutrient breakdown.
The most common causes of acute pancreatitis are:
- bile duct disease (45%); for example, a stiffening of gallstones in the bile ducts before it enters the duodenum;
- chronic alcoholism (35%).
Other reasons are:
- blunt or penetrating abdominal trauma, for example, as a result of surgery;
- perforated ulcer of the duodenum;
- metabolic disorders, such as hypercalcemia (due to the pathology of the parathyroid glands and the intake of calcium-containing drugs); hypertriglyceridemia (elevated level of triglycerides in the blood); kidney failure;
- reaction to medicinal substances, for example, included in some oral contraceptives;
- Infectious diseases, such as parotitis, hepatitis, HIV;
- organic diseases, such as pancreatic cancer;
- idiopathic cases (of unknown origin). The mechanism of action of these factors has not been finally clarified, however, according to one of the theories, it consists in the "self-digestion" of the gland, when the activation of enzymes occurs in its tissues. By destroying the gland, they, in turn, activate other enzymes, such as elastase (dissolving elastic fibers of blood vessels) and phospholipase.
Course of the disease
Activated pancreatic enzymes can destroy cells and damage tissues, causing bleeding, edema and necrosis of the pancreas. With extensive hemorrhage, adjacent organs can also be damaged, which increases the risk of shock and other complications. With less severe acute pancreatitis, inflammation is limited only to the gland itself. Similar symptoms can be observed in other abdominal diseases (perforation or obstruction of the intestine, acute inflammation of the gallbladder), as well as the chest (heart attack 'pneumonia).
Blood test
Blood counts specific for pancreatitis do not exist, but a blood test helps supplement the clinical picture. In most cases, an increased level of pancreatic enzymes (amylase and lipase) in the blood. These indicators are of diagnostic importance at an early stage of the disease, since within a week they come back to normal. The high level of free fatty acids formed by the action of lipase causes enzymatic saponification and a decrease in the concentration of calcium in the blood. The level of leukocytes in the blood in patients with pancreatitis is usually elevated (leukocytosis), and as a result of fluid loss, hematocrit (the ratio of the volume of erythrocytes to the plasma volume) increases.
Methods of visualization
The final diagnosis of acute pancreatitis is based only on the results obtained with the help of visualizing methods: ultrasound and computed tomography. Computed tomography is necessarily performed in severe pancreatitis and in the case of complications. With the help of these methods it is sometimes possible to identify the cause of pancreatitis. Revealing the cause of the disease allows to conduct therapeutic measures aimed at its elimination, which in the future will help to avoid repeated attacks of pancreatitis.
• Yellow rounded structures on a pseudocolor scan made with an electron microscope are lymphocytes (a kind of leukocytes). The level of leukocytes in the blood in acute pancreatitis is usually elevated. The prognosis is assessed on an eleven-point scale based on prognostic criteria, which include:
- age over 55 at the time of enrollment;
- laboratory tests (four on admission and six after 48 hours). If there are three or more points at the time of entry, the probability of a lethal outcome is 1: 5; If there are seven or more points, it rises.
In the first few days, death occurs due to multiple organ failure. In most cases (80%) patients die after a week, usually due to the development of infection (abscessing) or the formation of a false cyst. The development of infection on the background of necrosis of the pancreas should be suspected in the absence of the effect of treatment or sudden deterioration. Aspiration of the contents of the abdominal cavity under the control of computed tomography can help in diagnosis. If the aspiration of infected contents does not occur in time, the mortality rate reaches 100%. A slight edematous form of pancreatitis can pass spontaneously. The patient is given intravenous infusions, the intake of food and liquids is completely excluded. To eliminate nausea and vomiting with the nasogastric tube, the stomach is emptied. This helps prevent shock, limiting fluid loss. The probe is also used to administer an anesthetic, sometimes using a patient-controlled device. This gives the patient the opportunity to control the intake of the drug, depending on the intensity of the pain. To avoid overdose, there is a special device designed to apply a limited number of doses for a certain length of time.
Thorough examination
In severe necrotizing pancreatitis, hospitalization is necessary in a specialized intensive care unit where the patient is carefully examined and the dangerous symptoms that indicate a high risk of death are revealed. Treatment is aimed at preventing complications of the disease.