Patient, male, 65 years old, with pain in the middle and upper abdomen for 1 day. After the banquet the day before, there was persistent dull pain in the mid-upper abdomen, which became worse after eating, and the anterior bow curvature could be slightly relieved, with nausea, vomiting, and reduced eating. Self-administration of gastric mucosal protective agent had a certain effect and affected eating; After the fish soup, the upper abdominal pain was significantly worsened, and the antispasmodic medication was ineffective, and nausea and vomiting were once. The clinical diagnosis was acute pancreatitis.
Acute pancreatitis is a very serious disease. According to the clinical prognosis, acute hemorrhagic necrotizing pancreatitis is acute, severe, prognostic, and has a high mortality rate. Early diagnosis and treatment of pancreatitis is the key to improving the prognosis. We understand the definition, etiology, classification, symptoms, treatment and precautions of acute pancreatitis.
What is acute pancreatitis?
Acute pancreatitis is a pathological change of pancreatic edema, hemorrhage, and necrosis caused by the self-digestion of pancreatic tissue caused by various causes. Clinically, it is characterized by acute upper abdominal pain, elevated blood amylase or lipase. Most patients are mild and have a good prognosis. A few patients are severely ill, and may be accompanied by multiple organ dysfunction and local complications of the pancreas. The mortality is high.
Causes of Acute Pancreatitis
The causes of acute pancreatitis are diverse. The more common causes are the following eight, of which the former four are relatively common–
(1) Biliary tract diseases: Cholelithiasis and biliary tract infections are the most common causes of acute pancreatitis. Once the stones are incarcerated or small stones, inflammation in the bile ducts leads to poor pancreatic fluid outflow, and the pressure in the pancreatic ducts can cause pancreatitis.
(2) Alcohol: Alcohol promotes secretion of pancreatic juice. When drinking alcohol, the secretion of pancreatic juice increases. When the pancreatic duct outflow tract cannot drain a large amount of pancreatic juice in time, the pressure in the pancreatic duct rises, causing pancreatic cell damage. In addition, when alcohol is metabolized in the pancreas, it produces a large number of reactive oxygen species, which activates the inflammatory response. Therefore, acute pancreatitis is prone to occur when drinking a lot of alcohol, especially in the presence of biliary diseases, which together cause acute pancreatitis.
(3) Pancreatic duct obstructive disease: When pancreatic duct stones, maggots, and tumors inside and outside the pancreas cause pancreatic duct obstruction, the pressure in the pancreatic duct rises, which triggers acute pancreatitis. Therefore, we must also be highly vigilant about the presence of tumors during the onset of acute pancreatitis.
(IV) Metabolic disorders: When blood triglyceride exceeds 11.3mmol / L, it is associated with the etiology of acute pancreatitis. Lipid microcapsules affect the microcirculation of the pancreas, and fatty acids that are metabolites of triglycerides damage pancreatic cells.
(5) Diseases of the lower part of the duodenum: Because the opening of the pancreatic duct is in the lower part of the duodenum, some diseases near the opening such as penetrating ulcers after the duodenum, diverticulitis of the lower part of the duodenum Tumors around the openings of the bile ducts of the pancreatic duct can cause pancreatitis.
(6) Infection and systemic inflammatory response: Some viral infections such as acute mumps, influenza A, infectious single cell polypsy, coxsackie virus infection, chlamydia pneumonia, and systemic inflammatory response, the pancreas can be damaged One of the target organs appears as an acute inflammatory injury.
(VII) Drugs: thiazide diuretics, azathioprine, and sulfa drugs can trigger acute pancreatitis.
(8) Others: Autoimmune vasculitis affects the blood supply of the pancreas and triggers acute pancreatitis; eating too much food often induces acute pancreatitis based on some underlying causes.
Classification of acute pancreatitis
(A) acute pancreatitis
1. Acute edema type: The pancreas is mainly congested, edema, and swollen, with slight local necrosis.
2. Acute hemorrhagic and necrotic type: pancreatic hemorrhage and necrosis. Acute hemorrhagic necrosis can develop from acute edema, but bleeding and necrosis occur at the beginning of the onset.
(Two) severe acute pancreatitis
As inflammation spreads throughout the body, other organs such as the small intestine, lungs, liver, kidneys and other organs appear to have inflammatory pathological changes, often accompanied by pleural effusion, ascites, and even multiple organ failure.
Fourth, the main symptoms of acute pancreatitis
(A) abdominal pain: abdominal pain is a common symptom of acute pancreatitis. Generally, the pain will occur in the left upper quadrant or middle upper quadrant, and some patients radiate pain to the left scapula and back. Pancreatitis pain is similar to stomach pain when it is located in the middle and upper abdomen, but it is essentially different from stomach pain. Gastric pain is generally intermittent and repetitive, while pancreatitis pain is persistent. Pancreatitis abdominal pain can last for several days.
(2) Abdominal distension: When pancreatitis is more severe, abdominal pain is often accompanied by abdominal distension. Abdominal pain continues unabated, and abdominal distension gradually worsens. In severe cases, abdominal distension, tenderness, rebound pain, and stop defecation.
(3) Symptoms of severe acute pancreatitis: If it is severe acute pancreatitis, the above symptoms continue to be relieved, and hypotension, shock, dyspnea, oliguria and urination, jaundice, gastrointestinal bleeding, mental disorders, and disturbance of consciousness , Sudden death and other symptoms.
Five, secondary symptoms of acute pancreatitis
(1) Nausea and vomiting: Due to abdominal pain and bloating, nausea and vomiting may be associated with the onset of the disease.
(B) loss of appetite: loss of appetite is one of the common symptoms of pancreatitis. Aggravating pain after eating can limit eating. In addition, the lack of or insufficient secretion of digestive enzymes synthesized by the pancreas results in loss of appetite and indigestion.
(Three) weight loss: restricted eating, loss of appetite leading to insufficient intake and weight loss.
What are the treatments for acute pancreatitis?
(A) medical treatment
In the early stages of acute pancreatitis, patients with mild pancreatitis and those without infection should be treated non-surgically.
1. Surveillance: monitor vital signs and closely observe changes in the condition.
2. Replenish body fluids to prevent shock: All patients should be fully replenished with fluids, electrolytes and heat through the veins to maintain circulation stability and water-electrolyte balance. Improve microcirculation and prevent hypotension.
3. Reduce pancreatic juice secretion:
(1) Fasting and decompression of nasogastric tube: fasting water to reduce pancreatic juice secretion; continuous gastrointestinal decompression, reducing abdominal distension, preventing vomiting and aspiration.
(2) Inhibit gastric acid: reduce the secretion of pancreatic juice caused by gastric acid.
(3) Inhibition of pancreatic exocrine secretion and pancreatic enzyme secretion: The application of somatostatin drugs can inhibit basal secretion of pancreatic juice stimulated by gastrin and cholecystokinin. Trypsin inhibitors such as aprotinin and gabexate inhibit pancreatin activity and reduce self-digestion.
(4) Analgesia: After the above treatment, if the abdominal pain is not satisfied or the abdominal pain is relieved, a small amount of pethidine can be used to relieve the pain, but morphine is prohibited, so as not to cause Oddi sphincter spasm and increase pancreatic inflammation.