One of the most serious diseases of the human digestive system is pancreatic necrosis, which, according to statistics, is fatal in 40-60% of cases.
Causes of pancreatic necrosis
Acute pancreatitis, a complication of which is pancreatic necrosis, is in third place in terms of frequency of occurrence, skipping ahead only acute appendicitis and cholecystitis. As a rule, it develops due to damage to the secretory cells of the pancreas, excessive production of pancreatic juice and impaired outflow. These processes can provoke:
- abdominal injury;
- abdominal surgery;
- body intoxication (including alcohol);
- allergic reactions;
- gallstone disease;
- infectious or parasitic diseases;
- excessive consumption of fried meat, extractives, animal fats.
Causes of pancreatic necrosis of the pancreasare numerous, but most often it develops after drinking a large amount of alcohol combined with fatty protein foods. It happens that the disease occurs almost instantly and an attack can develop against the background of complete well-being. Cases have been registered when pancreatic necrosis, in which a fatal outcome occurred within hours after the first signs of the disease appeared, developed several days after a plentiful feast.
What happens with pancreatic necrosis
A he althy pancreas produces enzymes that are needed to break down the food that enters the stomach. It is thanks to them that food is broken down into elements that can enter the bloodstream through the gastric mucosa, which delivers them to tissues and organs. This makes the pancreas one of the important organs in the body. Drinking alcohol with rich fatty foods dramatically stimulates the production of juice by the pancreas, and since the ducts cannot remove it completely, it begins to accumulate inside the gland. This leads to the development of edema, further compression of the excretory ducts and their subsequent blockage. Active pancreatic enzymes, whose function was originally the breakdown of proteins, sweat through the walls of the ducts and begin to dissolve them, under the action of enzymes, the "digestion" of the gland's own tissues occurs. Active enzymes and decay products resulting from this enter the bloodstream and contribute to the dissolution of other organs and tissues, causingsevere intoxication. Thus, pancreatic necrosis, the prognosis of which is rather difficult to predict, is a very dangerous disease.
Classification of pancreatic necrosis
Depending on the extent of the lesion of the gland, small-focal, medium-focal, large-focal, subtotal and total pancreatic necrosis are distinguished. Of course, the differences between the first two types are largely arbitrary. Doctors use these concepts in order to determine the degree of organ damage. In subtotal pancreatic necrosis, necrotic changes affect most of the gland. If the organ is completely affected, then total pancreatic necrosis of the pancreas is diagnosed. Lethal outcome in this case is always observed.
There is another classification option. She divides pancreatic necrosis into two types:
- Limited. This includes the process by which foci of different sizes are formed.
- Common. In this case, most of the gland or the entire organ is affected.
Types of pancreatic necrosis
Depending on the presence of infection in the affected areas, sterile or infected pancreatic necrosis is distinguished. At the same time, in the case of an infected process, the prognosis is rather unfavorable, since there is a high probability of developing an infectious-toxic shock, and it can be extremely difficult to get the patient out of this state.
Sterile pancreatic necrosis is divided into the following types:
- fat - it is characterized by a slowdevelopment within 4–5 days or milder;
- hemorrhagic - characterized by rapid flow and frequent bleeding;
- mixed - occurs most often, since pancreatic necrosis equally affects both adipose tissue and the pancreatic parenchyma.
If destructive pancreatic necrosis of the pancreas is diagnosed, surgery is inevitable. But often it does not give the desired result, and re-development of necrotic foci is possible.
Symptoms and diagnosis of pancreatic necrosis
Clinically acute pancreatitis is manifested by severe pain in the left hypochondrium or pain that has girdle character. There is vomiting of intestinal contents, which does not bring relief, diarrhea. Against this background, dehydration of the body quickly sets in, intoxication intensifies. When making a diagnosis, the collection of anamnesis is of great importance. If it contains information about the abuse of alcohol, fatty foods, or information about diseases of the liver and gallbladder, this most likely makes it possible to make such a diagnosis as pancreatic necrosis of the pancreas. The prognosis in this case will largely depend on at what stage of the disease the patient sought medical help, and on the extent of the lesion.
As for laboratory diagnostics, here they pay attention to the analysis of urine and blood, where there is a significant excess of amylase levels. Abdominal ultrasound, CT or MRI is also performed, where you can see the appearance of necrotic areas inpancreatic tissues.
Treatment
In most cases, pancreatic necrosis requires surgery. At the same time, despite the fact that the mortality rate is quite high, timely surgery gives a great chance of recovery. Conservative treatment includes the following steps:
- within a few days after the attack - complete fasting, and depending on the severity of the disease, the introduction of nutrients through intravenous infusions can continue for weeks;
- blood purification (hemosorption) - carried out with severe intoxication;
- somatostatin is a hormone that can reduce the effects of kidney damage that often accompanies pancreatic necrosis;
- in infectious forms - antibiotics.
Acute Pancreatitis Diet
Since it is the food factor that very often becomes the cause of acute pancreatitis, it is he who is of great importance in the treatment process. As mentioned above, in the first days after the diagnosis of acute pancreatitis was established, the diet is very strict - complete fasting is observed. In severe cases, parenteral nutrition may continue for several weeks.
In the future, nutrition for pancreatic necrosis of the pancreas implies a sparing regimen, which is ensured by the maximum exclusion from the diet of fats and carbohydrates, as well as products that cause increased gas formation. The food is steamed and finely chopped. Accepted by smallportions five to six times a day. The use of extractives and s alt is completely excluded. Such a diet, depending on the severity of the disease, should last from several months to a year.
Of course, with such a serious disease as pancreatic necrosis, a fatal outcome is possible, and, of course, it is better not to bring your body to an attack, eliminating risk factors as much as possible. But if the disease nevertheless developed, then careful adherence to the diet will help to avoid relapses in the future.
