Diseases

Pancreatonecrosis: causes, types, treatment and prognosis

Pancreatonecrosis is a dangerous complication resulting from the inflammatory process of the pancreas. Pathology is accompanied by partial or complete death of the tissues of the body, due to the aggressive effects of proteolytic enzymes. The condition is characterized by severe course and the possibility of death in the absence of medical care.

Pathogenesis and classification of pancreatic necrosis

Necrotizing pancreatic tissue occurs as a result of being digested by its own enzymes. The precursor of this disease is the acute stage of pancreatitis, complicated by infections, peritonitis, other pathological processes, which leads to cell necrosis.

Such a disease, depending on the size, can be small, medium-focal and large-focal, as well as subtotal, which is characterized by the dying of a significant part of the organ.

The most dangerous total pancreatic necrosis, as a result of which the death of the patient almost always occurs.

Pancreatonecrosis may be sterile or infectious. According to the nature of tissue damage, the first is divided into:

  • fat, the duration of development of which is 4-5 days,
  • hemorrhagic - rapidly progressive, accompanied by bleeding,
  • mixed.

Basically there is a mixed necrotic pancreatitis, when there is a simultaneous destruction of all types of tissue. There are several stages of the disease. The beginning of the process is the formation of stones in the large ducts of the pancreas or their branches. For this reason, pancreatic juice accumulates, which stretches the walls of the organ. Hypersecretion due to alcohol abuse or an excess of fatty, spicy foods in the menu can also be a catalyst.

Next, pancreatic necrosis develops in stages:

  1. There is a formation of toxins that are not detected in blood tests,
  2. A focus of inflammation appears in the gland, which can spread to adjacent organs,
  3. The launch of necrotic processes in tissues.

It is necessary to treat the disease at the first manifestations; otherwise, death becomes inevitable.

The peculiarity of pancreatic necrosis consists in its exclusively acquired character. The most common cause of the onset of pathology is the presence of pancreatitis, which can go into an acute stage if the patient abuses alcohol and fatty foods.

According to statistics, alcohol provokes glandular tissue death in 50% of cases.

Other reasons include:

  • the presence of viruses, parasites, infections,
  • toxic poisoning by food, drugs,
  • pancreatic pathology,
  • binge eating,
  • abdominal surgery.

The main causes of pancreatic necrosis are the patient's commitment to alcohol and the consumption of fatty foods. Concomitant pathologies of the liver or biliary tract increase the risk of developing the disease.

Pancreatonecrosis has no pronounced signs that distinguish it from other pathologies of the abdominal cavity organs, which complicates the diagnosis. But the symptoms of pancreatic necrosis exist, and the task of the doctor is to isolate them.

One of the most important symptoms is acute pain with a center of localization in the left hypochondrium, which radiates to the shoulder, heart area and lower back.

The pain of a chronic nature, then subsiding, then intensifying, overtakes a person in periods.

Other symptoms of pancreatic necrosis are as follows:

  • nausea, bloating, disturbed stool,
  • prolonged vomiting, not bringing relief, and as a result - dehydration,
  • bleeding from the vessels of the stomach and upper intestines, causing the appearance of black fecal matter,
  • high temperature
  • facial redness

  • the occurrence of renal dysfunction, sometimes leading to acute renal failure,
  • respiratory failure, manifested by shortness of breath, forced position of the patient,
  • blue-purple spots appearing on the anterior abdominal wall, buttocks, sides, near the navel.

Diagnosis and treatment of pathology

The final diagnosis of pancreatic necrosis can only be made based on the results of an instrumental examination and a series of tests, since, due to the lack of specific symptoms, its diagnosis is somewhat complicated. From instrumental methods used ultrasound, computed and magnetic resonance imaging. They provide accurate information on the size of the foci of necrosis.

After the diagnosis, treatment of pancreatic necrosis begins. Drug therapy is possible only in the early stages.

Therapy at this stage is carried out by a gastroenterologist who prescribes:

  • drugs that block the production of pancreatic enzymes,
  • antibacterial agents (antibiotics, antiseptics) in the case of an infectious nature of the pathology and to stop the development of suppuration processes,
  • immunostimulants.

The patient has to be transferred for several days to full starvation, during which parenteral nutrition is prescribed - by intravenous drip. Practiced therapy hormonal means - Somatostatin, reducing the likelihood of death. In addition to taking medication, blood is often cleared if there is a strong intoxication of the body.

The vast majority of patients diagnosed with pancreatic necrosis of the pancreas, require surgical intervention.

Only its timely implementation gives a chance for recovery. In the advanced stage of the disease, the surgeon deals with the patient.

The treatment is carried out in a hospital - intensive care, intensive care unit - where the patient goes with the characteristic yellowness of the disease, dry skin, tachycardia, shortness of breath.

The patient conducts the necessary research, assesses the severity of the condition. During the operation, necrotic tissue is removed, and the patency of the organ ducts is restored. In the postoperative period, laparoscopic dialysis can be prescribed.

Recovery

The survival prognosis of patients with this disease depends on what type of pancreatic necrosis they are diagnosed with - infected or sterile, the prevalence of the process, the timeliness and quality of the treatment.

The operation improves the chances of the patient. However, there are cases when it gives a small effect, necrosis develops further, often complicated by bleeding, abscess, which requires repeated surgical intervention, which does not always lead to the desired result. But despite the high mortality from this disease, many patients manage to survive. For them, it becomes necessary to have a permanent medical treatment prescribed by a doctor, a diet and a categorical rejection of alcohol and smoking.

Patients for whom conservative treatment was sufficient should follow the same rules as the operated patients. It is important for them to give preference to boiled, low-fat food, in which the protein content exceeds the amount of carbohydrates. The use of alcoholic and carbonated drinks, pickles, smoked meats, spicy foods is strictly prohibited.

With timely access to specialists, when necrotic changes of the gland have not yet begun to progress, recovery is possible. Subsequent dieting and taking necessary medications allow patients to significantly improve their quality of life and prolong it.

About what pathological processes can cause alcohol in the pancreas, see the video:

Summary What is pancreatic necrosis?

This disease is characterized by rapid development. During the course of the inflammatory process, pancreatic cells die. When this occurs, swelling or destruction of the body, and also develops multiple organ failure.

Unfortunately, even with timely initiated therapy there is a risk of death. In the case of an abscess formation, there is no chance of the patient surviving.

There are the following stages of pancreatonecrosis:

  1. Toxemia. The duration of the stage is from 5 to 9 days. As a result of increased secretion of the gland, a violation of the outflow of pancreatic juice occurs. This process proceeds with extensive organ damage. Toxins accumulate in the blood. The latter penetrate into the internal organs.
  2. If untreated, an abscess is formed. The latter applies to nearby organs.
  3. The occurrence of purulent processes in the gland and retroperitoneal tissue.

The last third stage is considered the most dangerous and quite often ends with the death of the patient.

Disease classification

Medicine classifies the disease according to various factors.

Depending on the reasons for the formation of isolated subsequent forms of the disease:

  1. Fatty pancreatic necrosis. It occurs when an organ synthesizes an excess amount of lipase. As a result, the destruction of adipose tissue of the gland. Progressing slowly, the first signs of the disease are observed after 12 hours.
  2. Hemorrhagic. Develops with microcirculation disorders in the functioning of the body. There is a contraction of the vascular gland and swelling. This form is characterized by rapid development and manifestations of the disease are noticeable through the day. The main symptom of the disease is the accumulation of fluid with blood in the peritoneum.
  3. Mixed. It develops if the activity of enzymes that destroy fat cells and break down elastin are on the same level.

The prevalence of the disease is as follows:

  • local (limited),
  • subtotal (common),
  • total pancreatic necrosis.

Depending on the presence of infection, the ailment is classified into:

  1. Sterile.
  2. Infected pancreatic necrosis.

Downstream allocate subsequent forms of the disease:

According to statistics of therapy, it is easier to sterile form of pancreatic necrosis.

Causal factors in the development of the disease

Necrotizing pancreatitis is formed as a result of an increase in the inflammatory process in the pancreas. Because of this, the body begins to process its own cells. The latter die and form necrosis. This process takes place with weak painful sensations that a person does not pay special attention to. A day later, an attack of pancreatic necrosis occurs.

The main causes of pancreatic necrosis are divided into groups:

  1. Alimentary. These include regular intake of alcohol, the abuse of fatty and unhealthy foods.
  2. Obstructive: gallstone disease and pathology of the bile ducts. The blockage of the ducts activates the synthesis of enzymes and contributes to the formation of the disease.
  3. Reflux: obesity, abdominal injuries, pancreatic developmental pathologies, food poisoning, postoperative complications. As a result of bile reflux from the intestine into the pancreas, the enzymatic process starts and the enzymes are activated.

In some cases, to determine the cause of the disease is not possible.

Signs of disease

Pancreatonecrosis occurs with characteristic signs and is easy to differentiate from other diseases:

  1. Girdle pain in left side. The latter can irradiate into the sternum and forearm. The pain subsides with the development of the destructive process. To alleviate the condition of the patient, it is necessary to lie on one side and tighten the legs to the stomach.
  2. Unstoppable vomiting with admixtures of bile and blood. This condition can lead to dehydration.
  3. Dryness, and also pallor of integuments. The appearance of a raid on the tongue. The patient is tormented by thirst. There is practically no urination.
  4. Flatulence.
  5. Symptoms of intoxication: general weakness, fever, low blood pressure, shortness of breath. Toxins in the brain can cause the development of encephalopathy.
  6. The change in color of the skin caused by the expansion of blood vessels. The appearance of purple and blue spots in the abdomen, back as a result of internal hematomas and hemorrhages.

In addition, the pancreas increases markedly in size.

Diagnosis of the disease

To make an accurate diagnosis, the doctor interviews and examines the patient, and also designates the examination. To confirm the diagnosis using the following laboratory and instrumental diagnostic methods:

  • General analysis of urine and blood to determine the activity of alpha-amylase,
  • Ultrasound of the pancreas. This study allows to detect organ swelling and unevenness of its structure,
  • radiography
  • diagnostic laparoscopy,
  • CT scan,
  • puncture of the peritoneum.

The diagnostic method is selected based on the stage of the disease and the patient's condition.

Early treatment increases the chances of cure.

Differential diagnostics

Pancreatic necrosis occurs with symptoms similar to many pathologies of the organs of the gastrointestinal tract. Therefore, a differential diagnosis is necessarily carried out with the following diseases:

  • exacerbation of cholecystitis and gastritis,
  • appendicitis
  • cholecystopancreatitis,
  • perforated ulcer,
  • acute intestinal obstruction,
  • intestinal infarction,
  • food toxicoinfection.

Initially, the pancreatic necrosis of pain is very strong, and as a result of further development, the intensity of pain decreases.

Pancreatic Necrosis Treatment Methods

The effectiveness of therapy depends on the stage of the disease, the condition and age of the patient. When the diagnosis is confirmed, treatment begins immediately. The patient is hospitalized, provide him with absolute peace and prescribe medical fasting.

Particular attention is removed compliance with the drinking regime: the patient must drink at least 1.5 liters of fluid per day. You can drink non-carbonated mineral water.

For relief of pain on the stomach put cold. After, the patient is transferred to a fractional diet, including products that do not irritate the stomach:

  • Steamed dishes
  • boiled and stewed food.

Food should be warm and shredded to a state of mashed potatoes.

The goal of pancreatic necrosis therapy is to stop the cell necrosis of the organ, to eliminate intoxication, to prevent the formation of ulcers and the development of an abscess.

For the treatment of necrotic pancreatitis, medical and surgical methods are used.

Conservative treatment

Drug therapy includes:

  1. To relieve pain prescribed non-narcotic analgesics, antispasmodics, procaine blockade.
  2. To reduce the secretory activity of the pancreas, antienzyme preparations, anticholinergics, and gastric lavage are prescribed.
  3. To restore the water balance prescribed intravenous colloids.
  4. To reduce the gagging urge intramuscularly injected Zeercal.
  5. To clean the blood of toxins using Ringer's solution.
  6. Reduce the flow of bile with the help of infusion therapy with diuretics.
  7. To prevent the formation of ulcers used immunostimulants and antiseptics.
  8. To restore the endocrine function of the gland, to reduce internal bleeding, administration of the hormone hypothalamus is prescribed.

In addition, the doctor prescribes antibiotic therapy to destroy pathogenic microflora.

Surgical treatment method

If conservative treatment has not brought results, the operation is prescribed, during which the drainage of cavities filled with fluid is performed, as well as the elimination of necrotic foci. In the early stages of pancreatic necrosis, surgical treatment methods are not prescribed, because the doctor does not know which part of the organ is affected.

In the formation of ulcers apply the following minimally invasive surgical methods:

  • laparoscopic,
  • laparotomic
  • necrotomy.

The prognosis of the operation performed to cure pancreatic pancreatic necrosis depends on the patient’s condition, his allergies and associated diseases. The main problem of surgical intervention is not the complexity of the operation itself, but complications after it.

Pancreatonecrosis is dangerous for its complications, which include fistulas, bleeding, pathology of the digestive organs, diabetes.

Prognosis and prevention

Projections for pancreatic necrosis are not always favorable. The percentage of the probability of death of the patient is very high.

For prevention, it is recommended to give up bad habits, eat a balanced diet and undergo periodic physical examinations. After all, timely treatment will reduce the risk of death and increase the chances of recovery.

Pancreatonecrosis is a dangerous condition, cured of which a person remains disabled. He is contraindicated in hard physical labor, violation of the diet and work with toxic substances. Proper nutrition and a healthy lifestyle will help to avoid this disease.

What it is

Pancreatic necrosis is difficult, because it develops as a result of the fact that digestive enzymes are activated too early, do not go beyond the pancreas. This causes acute inflammatory tissue damage. In addition, this process provokes the digestion of the body’s own tissues. The tail of the pancreas suffers most. However, other areas may be affected.

Pancreatonecrosis is characterized by the fact that later, due to the death of tissues, abscesses are formed.

They can affect surrounding organs and tissues. Often, the symptoms increase so rapidly that a person admitted in a state of moderate severity dies within a few hours.

Pathology development mechanism

Activation of digestive enzymes in normal conditions occurs only in contact with the bile. It enters the intestine from the biliary tract of the liver. Against the background of the influence of the provoking factor, there is an increase in the tone of the sphincter of Oddi, that is, a muscle that is located in the duodenum, and access to pancreatic juice and bile is restricted.

An important condition for the development of such a state as pancreatic necrosis is an increase in pressure or blockage of biliary tract stones. These processes lead to the fact that bile is thrown into the pancreatic ducts.

This causes inflammation and splitting of fat and membranes of healthy pancreatic tissues. After this, enzymatic reactions are complicated. A protease that cleaves and proteins is released. This leads to rapid digestion of the tissues of the gland itself, the blood vessels and the surrounding fatty tissue.

Classification

The survival prognosis depends on the extent of the necrotic process. Based on this parameter, the following types of pancreatic necrosis are distinguished:

  • large-focal,
  • small focal,
  • middle focal,
  • total,
  • subtotal.

In addition, pancreatic necrosis may be common or limited. Depending on the presence of a bacterial infection, pancreatonecrosis is subdivided into sterile or infected. The first option is divided into hemorrhagic, fatty and abortive subspecies.

There are many factors that can cause the appearance of pathology. Often this disorder is the result of excessive drinking. In addition, pancreatic necrosis can be caused by acute poisoning of the body with toxic substances.

Predisposing factors for the onset of a pathological condition include:

  • injuries
  • frequent overeating,
  • obesity,
  • chronic infections
  • the formation of stones in the ducts and gall bladder,
  • bleeding disorder,
  • parasitic invasions,
  • dysfunction of the sphincter of Oddi.

Pancreatic necrosis of the pancreas can develop against the background of congenital anomalies of the structure of the organ. The development of pathology is associated with the intake of certain drugs.

Endoscopic manipulations cause a disorder such as pancreatonecrosis to develop, extremely rarely. A special risk group includes people suffering from chronic liver diseases and pathologies of the pancreas. Often, total pancreatic necrosis is diagnosed in drug addicts who use homemade injectables.

Pancreatonecrosis is always acute. Clinical signs of pathology are growing rapidly. The first symptom is acute pain in the upper abdomen. Unpleasant sensations can give in the chest, back or left shoulder. The patient develops a shock.

Other symptoms of pathology such as pancreatic necrosis include:

  • general weakness
  • facial flushing,
  • bloating
  • pallor of the skin,
  • confusion,
  • dyspnea,
  • tachycardia,
  • fever,
  • dry tongue.

Because of the violation of the sensitivity of the nerve endings responsible for the innervation of the rectum, often there are long-term constipation. Gastrointestinal bleeding may be present. If pancreatonecrosis occurs, the patient enters the medical institution with repeated vomiting. Blood clots are often present in the waste mass. This symptom indicates vascular damage by enzymes.

Diagnostics

When signs of a disorder such as pancreatonecrosis appear, urgent hospitalization is required.

The survey includes the following studies:

  • Ultrasound,
  • hemogram,
  • determination of the concentration of amylase in the urine and blood,
  • detecting calcitonin levels
  • angiography,
  • MRI,
  • laparoscopy.

Necrotic fluid may be punctured from damaged areas of the pancreas. The resulting material is used to detect bacterial tissue damage. This study allows to determine the sensitivity of an infection to antibiotics.

First aid in this condition must be provided in a medical institution. Therapy of a disease such as pancreatic necrosis can be performed using conservative and surgical methods.

With a favorable course of the pathology, complete physical rest, starvation, the use of light meals after the end of the acute period and a complex of drugs allow to stop the existing manifestations.

If conservative therapy fails, the doctor prescribes a surgical revision and removal of areas affected by necrosis.

If pancreatic necrosis develops, then in the first 2-4 days after the onset of acute symptoms, the patient is required to completely give up food.

After reducing the intensity of the signs of pathology, you should follow the diet number 5b. The diet can include:

  • crackers,
  • cereals boiled on water
  • lean meats and fish,
  • potatoes,
  • pumpkin
  • beets,
  • boiled macaroni,
  • dogrose decoction,
  • boiled vegetables,
  • protein omelets.

After stabilization of the state allowed the use of dairy products. Dieting is necessary for a long time after the elimination of the characteristic manifestations of the pathology. If pancreatonecrosis was diagnosed, it is required to exclude smoked foods, alcohol, fresh bread, spices, soda, egg yolks, grapes, oily fish and meat, coffee, etc., from the diet.

Medicamentous

In the treatment of pancreatic necrosis, most drugs are injected intramuscularly and intravenously. Drug treatment involves the use of:

  • analgesics,
  • anti-inflammatory drugs
  • vasotonic,
  • anticholinergics,
  • antibiotics
  • enzyme production blockers.

During treatment, Novocainic blockade may be required. Often, to stabilize the condition of patients who have been diagnosed with pancreatic necrosis, they resort to infusion therapy.

How to use the drug Dalargin with pancreatitis?

Rehabilitation

After the acute period of the disease has subsided, the person loses working capacity for a period of 3 to 4 months. During 1.5-2 months the patient should be in the hospital where the medical staff provides the necessary care. In the first days after discharge, relatives should provide the patient with bed rest.

Approximately 10-14 days short walks in the fresh air can be allowed.

A prerequisite for recovery is diet.

A person who has experienced a condition such as pancreatonecrosis should have time for an afternoon nap. Depending on the degree of damage to the pancreas during the rehabilitation period, the use of multienzyme and insulin-containing drugs may be indicated. After the stabilization of the state, rehabilitation can be supplemented with physiotherapeutic drugs and exercise therapy.

Meals should be steamed or boiled. Food should be given to the patient in the form of heat. All products must be frayed. Eat 5-6 times a day. It is necessary that the portions were small. Meals should be regular. Do not skip meal times.

Effects

Necrotic decomposition of the pancreas rarely passes without a trace. This body is responsible for the production of insulin, so the death of a large number of its cells leads to the development of diabetes. Damage to pancreatic tissue predisposes to their malignant degeneration. Oncology of this body worsens the prognosis.

Complications

Complications of pancreatic necrosis are no less dangerous than the condition itself. The progression of the necrotic process in the pancreas causes the disruption of the work of other organs and systems. The appearance of any complications aggravates pancreatic necrosis and leads to a deterioration in the prognosis of survival.

Often, against the background of violations of the release of pancreatic enzymes in the intestine, the destruction of blood vessels. In this case, a large amount of toxic substances enters the bloodstream. This can cause disruption of the cardiovascular system, as well as the development of severe renal failure.

The blockage of the bile duct can cause necrotic damage to the liver.

Often, people who have experienced an attack of such a pathology as pancreatic necrosis develop further cirrhosis. A frequent complication of acute lesions of the pancreas is parapancane necrotic infiltration, i.e., accumulation in the tissues of the surrounding organs of elements with blood and lymph impurities that have been released during inflammation. Pancreatic necrosis, complicated by this condition, leads to the defeat of the duodenum, stomach, spleen and other organs. This condition is the result of aseptic tissue damage.

The most formidable purulent complication of pathology is peritonitis. This condition is characterized by inflammation of the serous membranes of the peritoneum and the accumulation of purulent contents in it with a high concentration of enzymes.

In addition, pancreatonecrosis is often complicated by the appearance of a hemorrhagic effusion. This violation is accompanied by damage to the blood vessels and the development of bleeding. Further the septic component joins also. The death of patients occurs due to purulent intoxication.

Aseptic retroperitoneal phlegmon occurs a little less often against the background of such a state as pancreatic necrosis.

This pathology is an inflammation of adipose tissue, due to which impregnation and melting of tissues with pus is observed. An extensive pocket is formed, filled with serous contents.

How much live after pancreatic necrosis

The chances of survival in such pathologies as pancreatic necrosis in the first week reach no more than 40%. Mortality due to this disease is high.

Residual damage affects the overall lifespan of people who have experienced this condition. Due to organ damage, it rarely exceeds more than 10-15 years. The probability of complete recovery is extremely low.

Life Forecast Reviews

Ekaterina, 24 years old, St. Petersburg

My uncle suffered from alcoholism, so he had a seizure. Pancreatonecrosis was detected. They were taken to the hospital in a state of intoxication, which provoked the development of a violation. An urgent operation was performed, but it was all fatal within 24 hours.

Egor, 34 years old, Astrakhan

I have had problems with the pancreas before. One not quite beautiful day, felt a burning pain in his stomach. He was urgently taken to the hospital, where he was diagnosed with pancreatonecrosis. I lay in the hospital for a month. There was no surgery, but I still feel the effects of the disease.

Watch the video: Acute Pancreatitis - Overview signs and symptoms, pathophysiology, investigations, treatment (January 2020).