Purulent pancreatitis: diagnosis and treatment

2024 Author: Curtis Blomfield | [email protected]. Last modified: 2023-12-16 20:44

Purulent pancreatitis is one of the most dangerous forms of acute inflammation of the pancreas. Without treatment, this pathology often leads to death. This is a fairly common disease, in terms of prevalence it is in third place after appendicitis and cholecystitis. How to recognize this dangerous disease? And is it possible to recover without surgery? We will answer these questions in the article.

Description of pathology

Purulent pancreatitis is an inflammatory process in the tissues of the pancreas, which is accompanied by diffuse suppuration, swelling and cell death. Multiple abscesses and areas of necrosis are formed in the organ. The structure and enzymatic function of the gland is disturbed.

Purulent-necrotic pancreatitis develops and progresses rapidly. Cell death is accompanied by irritation of the receptors of the organ, which leads to a pronounced pain syndrome. Due to dysfunction of the gland, dyspeptic phenomena occur. Intoxication of the body with decay products occursnecrotic tissue and excess enzymes. This can lead to coma and death.

Reasons

Doctors found that purulent pancreatitis occurs under the influence of the following factors:

1. Infections. Bacteria very rarely penetrate the pancreas from the external environment. Most often, pathogens are brought into the body with a blood or lymph flow from other foci of inflammation. But the penetration of bacteria alone is not enough for the development of purulent inflammation. The disease occurs when favorable conditions are created in the gland for the reproduction of pathogens.
2. Violations of the integrity of the tissues of the gland. A purulent process occurs if the patient already has pathological changes in the organ.

This pathology develops as one of the purulent complications of acute pancreatitis. First, the tissues of the organ become inflamed in the patient. When they become infected, abscesses form in the gland.

The following pathologies and bad habits of the patient can become the cause of inflammation of the pancreas tissues:

• chronic cholecystitis;
• gallstones;
• hormonal disorders;
• abdominal injury;
• alcohol abuse;
• excess of spicy and fatty foods in the diet;
• uncontrolled medication.

The above factors contribute to the disruption of the enzymatic function of the gland, which further leads to its inflammation and necrosis. If left untreated, the affected tissues become infected and a purulent process begins.

Pathogenesis

Let's consider the mechanism of development of pancreatitis with a purulent complication. Under the influence of various adverse factors, pancreatic dysfunction first occurs. Normally, this organ produces digestive enzymes, which become active only when they enter the intestines. If these substances are activated ahead of time, then they aggressively affect the gland and destroy its tissues. An inflammatory process occurs with the formation of areas of necrosis.

Most often, excessive enzyme activity is observed in patients who abuse alcohol. Gallbladder disease, abdominal trauma, and drug abuse can also cause gland dysfunction.

If inflamed and necrotic tissues become infected, abscesses form in the gland. Purulent complications of acute pancreatitis most often occur 10 to 12 days after the onset of the disease.

Symptomatics

At the onset of the disease, the patient has the following signs of an inflammatory process in the pancreas:

1. Pain syndrome. There are strong unbearable pains on the left and right under the ribs. They are girdle in nature and give to the shoulders, shoulder blades and lower back. The pain syndrome can be so intense that the patient loses consciousness.
2. Lack of appetite. Due to a violation of the enzymatic function, the patient experiences an aversion to food.
3. Vomiting. The patient develops a deficiency of enzymes in the intestine and theirexcess in the pancreas. As a result, vomiting occurs after eating, which does not bring relief. Vomit often contains bile.
4. Diarrhea. Due to indigestion in the intestines, the stool becomes frequent and liquid.

Subsequently, symptoms of general intoxication of the body appear. This indicates the addition of a bacterial infection and the formation of abscesses in the pancreas. Purulent pancreatitis is characterized by the following manifestations:

• fever (up to +39 degrees);
• rapid breathing;
• ache all over the body;
• chill;
• fall in blood pressure;
• tachycardia.

The skin becomes pale and moist. In some cases, large purple spots appear on the abdomen.

If the patient is not treated in time, his he alth is rapidly deteriorating. Toxins affect the central nervous system. The patient has confusion, lethargy or overexcitation. This condition is extremely dangerous, it can end in coma and death of the patient.

Consequences

With purulent pancreatitis, the infectious-inflammatory process can spread from the pancreas to other organs. This leads to the following dangerous pathologies:

• peritonitis;
• abscesses of the liver and peritoneum;
• purulent paranephritis;
• retroperitoneal phlegmon;
• severe pneumonia withabscess formation in the lungs;
• purulent pleurisy.

If in acute pancreatitis the patient's condition does not improve within 4 weeks, then sepsis occurs in half of the cases. This is a life-threatening condition in which bacteria and their toxins are constantly circulating in the blood.

First Aid

With purulent pancreatitis, the patient needs emergency hospitalization in a hospital. Therefore, during a painful attack, it is necessary to call an ambulance team as soon as possible. Prior to the arrival of doctors, the following measures must be taken:

1. The patient should be in a sitting position with the torso slightly tilted forward. In this position, the pain subsides a little.
2. The patient needs to stop eating. You can only drink still water in small portions.
3. When an attack of pancreatitis is recommended to breathe shallowly. Deep breaths make the pain worse.
4. In no case should you wash the stomach and apply cold to the stomach. This can only worsen the patient's condition.
5. The patient is forbidden to give analgesics and enzyme preparations. To relieve pain, you can only take antispasmodics ("Nosh-pu" or "Papaverine").

Further assistance to the patient is provided by doctors. The patient is urgently admitted to the hospital for examination and therapy.

Next, we will consider in detail the diagnosis and treatment of purulent complications of acute pancreatitis.

Examination

It is necessary to differentiate the purulent form of pancreatitis from other gastroenterological pathologies. FROMFor this purpose, the following examinations are carried out in the hospital:

1. Biochemical blood test. A sign of purulent inflammation in the pancreas is a sharp increase in the concentration of amylase and lipase. Glucose levels also increase and total protein levels decrease.
2. Urine analysis for biochemical parameters. With pancreatitis, the diastase indicator is significantly higher than normal.
3. Ultrasound. With purulent pancreatitis, the pancreas is enlarged, and its structure is heterogeneous. There is fluid accumulation in the retroperitoneal region.
4. MRI. Tomography shows the presence of purulent-necrotic areas in the gland.
5. Laparoscopy. This is the most reliable way to diagnose pathology. The procedure is invasive and is performed under anesthesia. Several small incisions are made in the abdomen. Through them, probes are inserted and the gland is examined using a special device. Laparoscopic examination shows the presence of necrotic spots and abscesses in the gland, as well as the accumulation of exudate.

Conservative Therapy

Drug treatment of purulent pancreatitis is effective only at the initial stage, when serious destructive changes have not yet occurred in the organ. Upon admission to the hospital, the patient is given droppers with antispasmodics and painkillers:

• "Nosh-sing".
• "Baralgin".
• "Papaverine".

In case of severe pain syndrome, novocaine blockades are carried out, and in case of dehydration and intoxication, the drug is dripped"Reopoliglyukin".

After stopping the pain and improving the patient's condition, antibiotic therapy is carried out. This is necessary to fight infection and purulent inflammation. The following groups of antibiotics are prescribed:

• penicillins: Amoxiclav, Sulbactam, Flemoxin Solutab;
• macrolides: "Clarithromycin", "Azithromycin";
• cephalosporins: "Ceftriaxone", "Cefaperazone";
• fluoroquinolones: Gatifloxacin, Moxifloxacin;
• carbapenems: "Ertapenem", "Meropenem".

The following drugs are used to reduce the secretion of pancreatic enzymes:

• "Almagel".
• "Cimetidine".
• "Ranisan".

Doctors also recommend drinking alkaline mineral water without gas. This helps to reduce the aggressive effect of enzymes on gland tissues.

Diet

Medical treatment alone is not enough to get rid of purulent pancreatitis. The patient must strictly adhere to a special diet. With such a serious illness, any deviation from the rules of nutrition is extremely dangerous. The use of prohibited foods can lead to a sharp deterioration in well-being and the development of complications.

In the first 3-5 days of illness, the patient needs a complete hunger. Until the relief of acute manifestations of purulentinflammation should completely refrain from eating. In the future, the patient's diet is gradually expanded:

1. On the second day. Acceptance of alkaline water without gas is allowed. Mineral water must be drunk in large quantities (at least 2 liters per day).
2. 3-5 days. Liquid cereals are introduced into the menu.
3. 5-6 days. The patient is allowed to consume light soups with vegetable broth, low-fat steamed fish, kefir and weak tea. Food should be at room temperature. Food is served ground or pureed.

A week after the onset of the disease, the patient is transferred to table number 5. This is a diet for patients with chronic pancreatitis. It involves the rejection of fatty, fried and spicy foods, as well as vegetables rich in fiber and carbohydrates. Patients are strictly forbidden to take alcoholic beverages, even in small quantities.

Surgical methods

If acute purulent pancreatitis occurs in a severe and neglected form, then the patient needs an urgent operation. Indications for surgical treatment are the following pathological changes:

• irreversible and extensive destruction of the organ structure;
• multiple abscesses;
• severe intoxication of the body;
• hemorrhages in the tissue of the gland.

Surgery is contraindicated if the patient is in shock.

During surgery, the doctor removes abscesses and necrotic areas of the gland. Currently, they are trying to do such an operationendoscopically, through a small incision.

Often, patients are simultaneously diagnosed with purulent cholecystitis. In this case, during the operation, the gallbladder is removed or drained.

Forecast

How life-threatening is purulent pancreatitis? Lethal outcome in this pathology is observed in 20-25% of cases. The cause of death is most often intoxication of the body with enzymes and decay products of necrotic tissues. Poisoning with toxic elements leads to a state of shock.

Septic complications can also be the cause of the patient's death. The prognosis worsens significantly if the patient has secondary purulent foci in other organs. The spread of infection throughout the body very quickly leads to blood poisoning.

The risk of death doubles if the patient does not follow the doctor's recommendations. High mortality from complications of pancreatitis is observed among patients with chronic alcoholism.

At an early stage, purulent inflammation of the pancreas is treatable. After discharge from the hospital, the patient must be under dispensary observation for 1 year. The diet should be followed for at least 6 months.

Prevention

To avoid purulent inflammation of the pancreas, the following rules must be observed:

1. Stop drinking alcohol.
2. Do not abuse spicy and fatty foods.
3. Cure gallbladder disease in time.
4. Alltake medicines only as prescribed by a doctor.
5. Protect the abdominal cavity from injury.
6. If there are girdle pains in the abdomen, urgently visit a gastroenterologist.

These measures will help prevent the occurrence of a dangerous and serious illness.