Pancreatic necrosis of the pancreas - a lethal outcome? Pancreonecrosis prognosis

One of the most serious diseases of the human digestive system is pancreatic necrosis of the pancreas, a lethal outcome in which, according to statistics, occurs in 40-60% of cases.

Causes of pancreatic necrosis

Acute pancreatitis, of which pancreatic necrosis is a complication, ranks third in the frequency of onset, leaving only acute appendicitis and cholecystitis ahead. As a rule, it develops as a result of damage to the secretory cells of the pancreas, excessive production of pancreatic juice and disturbance of its outflow. These processes can provoke:

• Abdominal trauma;
• Operations on the organs of the abdominal cavity;
• Intoxication of the body (including alcohol);
• Allergic reactions;
• Cholelithiasis ;
• Infectious or parasitic diseases;
• Excessive consumption of fried meat, extractives, fats of animal origin.

The causes of pancreatic necrosis of the pancreas are numerous, but most often it develops after consuming a large amount of alcohol combined with fatty protein foods. It happens that the disease is almost instantaneous and the attack can develop against a background of complete well-being. There are cases when the pancreatic necrosis of the pancreas, the lethal outcome of which occurred within a few hours after the appearance of the first signs of the disease, developed several days after a plentiful feast.

What happens with pancreaticecrosis

A healthy pancreas produces enzymes that are necessary to break down the food that enters the stomach. It is thanks to them that the food is split into elements capable of flowing through the gastric mucosa into the blood, which delivers them to tissues and organs. This makes the pancreas one of the important organs in the body. The use of alcohol with abundant fatty foods sharply stimulates the pancreatic juice production of the juice, and since the ducts can not completely remove it, it begins to accumulate inside the gland. This leads to the development of edema, further compression of the outflow ducts and their subsequent blockage. The active enzymes of the pancreas, whose function was originally the cleavage of proteins, sweat through the walls of the ducts and begin to dissolve them, enzymes "digest" their own gland tissues. Active enzymes and decay products, formed in this case, enter the bloodstream and promote the dissolution of other organs and tissues, causing severe intoxication. Thus, the pancreatic necrosis of the pancreas, whose prediction is 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-focus, large-focal, subtotal and total pancreonecrosis are distinguished. Of course, the differences between the first two species are largely conditional. These terms doctors use to determine the degree of organ damage. With subtotal pancreatic necrosis, necrotic changes affect most of the gland. If the body is completely affected, then the total pancreatic necrosis of the pancreas is diagnosed. In this case, a lethal outcome is always observed.

There is one more classification option. It divides pancreatic necrosis into two types:

• Limited. This includes the process in 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. In this case, the prognosis is rather unfavorable in the case of the infected process, since the probability of developing an infectious-toxic shock is high, and it is extremely difficult to withdraw the patient from this condition.

Sterile pancreonecrosis is divided into the following types:

• Fatty - it is characterized by a slow development within 4-5 days and an easier flow;
• Hemorrhagic - is characterized by rapid flow and frequent bleeding;
• Mixed - occurs most often, as in pancreatic necrosis, both adipose tissue and parenchyma of the pancreas are affected equally.

If a destructive pancreatic necrosis is diagnosed, the operation is inevitable. But often it does not give the desired result, and it is possible to re-develop necrotic foci.

Symptoms and Diagnosis of Pancreaticecrosis

Clinically acute pancreatitis is manifested by severe pain in the left hypochondrium or pains that have a girdling character. There is vomiting of intestinal contents, not bringing relief, diarrhea. Against this background, dehydration of the body quickly begins, intoxication intensifies. When making a diagnosis, it is very important to have an anamnesis. If it contains information about the abuse of alcohol, fatty foods or information about diseases of the liver and gallbladder, this is likely to allow a diagnosis such as pancreatic necrosis of the pancreas. The prognosis in this case will largely depend on the stage of the disease the patient asked for medical help, and the extent of the lesion.

As for laboratory diagnostics, here we pay attention to the analysis of urine and blood, where there is a significant excess of the level of amylase. Also, ultrasound of the abdominal cavity, CT or MRI, where you can see the appearance of necrotic areas in the tissues of the pancreas.

Treatment

In most cases, pancreatic necrosis requires surgical intervention. At the same time, despite the fact that the percentage of mortality is high enough, a timely operation gives a greater chance of recovery. Conservative treatment includes the following stages:

• A few days after the attack - complete starvation, and depending on the severity of the disease, the introduction of nutrients through intravenous infusions can last for weeks;
• Purification of blood (hemosorption) - carried out with severe intoxication;
• Somatostatin is a hormone that reduces the effects of impaired kidney function, often accompanying pancreatic necrosis;
• At infectious forms - antibiotics.

Acute pancreatitis - diet

Since it is the food factor that very often becomes the cause of acute pancreatitis, it is it that is of great importance in the treatment process. As mentioned above, in the first days after the diagnosis of acute pancreatitis, the diet is very strict - complete starvation is observed. In severe cases, the introduction of nutrients parenterally can last several weeks.

Further nutrition with pancreatic necrosis of the pancreas implies a sparing regimen, which is ensured by the maximum elimination of fat and carbohydrates from the diet, as well as products that cause increased gas production. The food is steamed and crushed thoroughly. It is taken in small portions five to six times a day. The use of extractives and salt 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 illness as a pancreatic necrosis, a fatal outcome is possible, and, of course, it is better not to bring your body to an attack, excluding risk factors as much as possible. But if the disease still developed, then careful compliance with the diet will help in the future to avoid relapse.