Acute pancreatitis in which hospital to treat. Treatment of pancreatitis

In acute inflammation of the pancreas, the patient must be hospitalized. Treatment of pancreatitis in a hospital is necessary, because due to severe pathological changes in the affected organ, there is a high risk of disability or death.

Kinds

An attack of pancreatitis in an acute form with a severe pain syndrome can be stopped by 2 options for medical care:

1. Emergency operation.
2. Intensive drug therapy.

The decision on the advisability of a particular treatment tactic is made by a gastroenterologist. Most often, conservative therapy is prescribed. Surgical intervention is recognized as necessary if the severity of the disease threatens the life of the patient.

Surgical therapy

Many patients are hospitalized in a critical condition, which is due to either extensive edema or necrotic process in the pancreas. According to medical statistics, surgery is prescribed for every third patient with the death of organ tissues. The choice of the method of surgical treatment is determined by the cause of acute pancreatitis, the severity of the disease, the presence of the spread of the inflammatory process to neighboring abdominal organs.

Most often practiced:

1. Puncture and drainage is a minimally invasive intervention to remove effusion in the development of enzymatic peritonitis.
2. Laparoscopy is also a minimally traumatic method used for non-infectious necrosis. With its help, excision of dead areas of the gland, drainage of pseudocysts, and elimination of neoplasms are carried out.
3. Laparotomy - opening of the abdominal cavity with multiple infected cysts, phlegmon, peritonitis.

Minimally invasive techniques are often used in preparation for a laparotomy. If such interventions, together with taking medications, do not lead to the desired result, surgeons resort to radical operations. They are carried out under the control of x-ray and ultrasound machines. This is:

1. Necrosequestrectomy - puncture of cystic neoplasms, pumping out fluid from them and installing drainage.
2. Distal or subtotal resection. In the first case, the tail and body of the gland are removed, in the second, almost the entire affected organ is removed, with the exception of areas adjacent to the duodenum.

Intensive conservative therapy

If the patient is admitted in a moderate condition, the attack is stopped in the intensive care unit of the hospital. In order to eliminate the inflammatory process and prevent necrosis of the gland, temporary fasting, gastric lavage and complex drug treatment are prescribed.

The following groups of drugs are used:

• painkillers during exacerbation of the pathology simultaneously with antispasmodics: Ketorol, No-shpa;
• medicines that reduce the acidity of gastric juice: Almagel, Gaviscon, Omeprazole, Ranitidine;
• agents for the regulation of the secretory function of the gland: Gordox, Aminocaproic acid, Kontrykal (intravenous administration);
• antibiotics: Tienam (imipenem plus cilastatin sodium), doxycycline, (infusions are prescribed in severe cases);
• drugs for cardiovascular insufficiency: solutions of the hormones Dopamine, Adrenaline (drip administration);
• means that normalize the water-salt balance: solutions of glucose, sodium chloride, Glucosolan, Regidron.

Standard and scheme

Methods of providing medical care to patients with attacks of acute pancreatitis are selected depending on the cause, severity of the disease and the presence of complications.

When choosing a scheme for inpatient treatment, the doctor is guided by the protocol of the initial examination, which is carried out immediately after the patient's hospitalization, and the preliminary diagnosis.

If mild pancreatitis is detected, conservative therapy is prescribed. Her tasks:

• anesthesia with analgesics of the narcotic group;
• elimination of dehydration due to serial vomiting;
• antibiotic treatment if foci of infection are found.

In severe pancreatitis, during which is accompanied by signs of acute intoxication, severe pain, loss of consciousness, patients are placed in the intensive care unit of the hospital. Conservative therapy is actively carried out. If after 2 days the doctor's efforts are in vain and it is not possible to stop the development of the pathological process in the gland, a decision is made on the advisability of a surgical operation.

Timing

The duration of inpatient treatment depends on the condition of the person in which he was hospitalized and the exact fulfillment of medical prescriptions. Symptoms of mild pancreatitis are most often relieved within a few days with intensive drug infusions. Treatment of exacerbations in patients with chronic inflammation of the gland requires a much longer hospital stay, especially during surgery.

Acute form of the disease

With a primary attack of moderate pancreatitis, a course of therapy of about 2-3 weeks is required. During this time, in most clinical cases, it is possible to completely heal the pancreas. However, 6 months after discharge from the hospital, it is necessary to repeat the treatment so that the disease does not become chronic.

chronic stage

People suffering from a long-term form of pancreatitis need scheduled hospitalization every six months to prevent exacerbations. This is facilitated by medical rehabilitation of the pancreas and the whole organism. The duration of the course of treatment can vary from 10 to 21 days.

Further management of the patient

The complication of acute pancreatitis with concomitant diseases, especially diabetes, pathologies of the digestive system, increases the risk of recurrence of inflammation of the gland. After discharge from the hospital, such patients need dispensary registration and preventive treatment. Patients who have suffered pancreatic necrosis should examine the condition of the gland every six months. At the same time, it is important not to break the diet, lead a healthy lifestyle, and at the first signs of an exacerbation of the disease, immediately contact a gastroenterologist.

Inflammation of the pancreas, pancreatitis, is most often noticed in the acute phase of the disease. In cases where the initial stage is not fully cured, the disease passes into a sluggish, chronic form.

How is pancreatitis (acute, chronic) treated in specialized departments, with what medicines? - the main burning questions for those who have an urgent need to cure the pancreas. We will divide our discussion of current topics into two sections:

1. Urgent treatment of acute pancreatitis in a hospital.
2. Planned, inpatient treatment of chronic pancreatitis

Be careful! The description highlights information in a general, cognitive context. In no case should you make independent attempts to test on yourself (at home) the dosage, the use of medicines, the procedures that are indicated in the text material! Such actions are fraught with dangerous consequences - individual incompatibility with the composition of medications (drug intoxication), anaphylactic shock, paralysis of the pancreas.

"Urgent call!": unbearable pain in the hypochondrium

Before proceeding to the direct disclosure of the main provisions, it is necessary (extremely necessary!) To pay attention to the important preamble of the topic - calling an ambulance for acute pancreatitis. What you need to know before the arrival of doctors?

With severe pain under the left or right rib, you should call and wait for emergency medical care. Categorically you should not do before the arrival of the doctor:

• take painkillers - "Analgin", "No-shpa", "Spazmalgon", other analgesics, antispasmodics;
• apply a hot heating pad to the painful area;
• tightly pull (with a handkerchief, towel) the upper hypochondrium;
• drink alcohol-containing drinks (vodka, cognac, motherwort tincture) to calm the pain;
• drink water, especially carbonated water.

What can and is allowed with acute, cramp-like symptoms in the abdominal cavity? It is best to resort to such actions:

• put the patient on the sofa (bed) in the floor in a sitting position;
• attach a cloth folded four times moistened with cool water (several napkins, a small towel) to the painful area;
• with vomiting, nausea, heartburn, you can not take a soda solution, as well as "Mezim", "Reni", "Maalox";
• open the window for a massive flow of fresh air (having previously covered the patient).

If a person suffers from a disease of the pancreas for a long time, is registered at the place of residence in a district hospital with a diagnosis of chronic pancreatitis, then he has a complication of the disease. The doctor who came to the call will undertake the necessary therapy, based on the patient's condition.

In most cases, in order to transport the patient without pain shock, he will make an intramuscular injection in the forearm: "Papaverine", (2 ml, saline / solution 5 ml), "Platyfillin" (in the same scheme).

Important! It is impossible to refuse hospitalization, in spite of any difficulties and situation in the family, at work, etc. If the pancreas organ declared its dysfunction with such a strong, painful picture, this indicates that severe pathological changes have begun in it.

Only careful laboratory tests, intensive care (regular intravenous drips, muscle injections, control of drug treatment and prescribed diet) can prevent necrosis (death) of the glandular tissue itself.

Urgent hospitalization for acute pancreatitis: examination, treatment

In the emergency room, the incoming patient is carried out the primary examination method:

• Check blood pressure (blood pressure);
• measure temperature;
• palpate the abdominal cavity (slightly press with hands, palpate painful areas);
• take an express clinical blood test from a finger, cubital vein;
• look through the whites of the eyes (sclera) for evidence of yellowness;
• note swelling of the hands, fingers, swelling on the legs.

In a state of moderate severity, the patient is sent to the intensive care unit. In the opposite case, severe: with the threat of glycemic coma, extensive intoxication, loss of consciousness due to pain, they are immediately (on a stretcher) hospitalized in the intensive care unit.

First of all, resuscitators take measures to get out of a clinical crisis:

• A special long-term catheter (“butterfly”) is implanted into the subclavian (jugular) vein. It is connected under the drip system, a spectrum of glycocorticoids is injected alternately in a jet stream together with analgesics - Prednisolone (65-120 mg), Hydrocortisone (120-500 mg), Dexamethasone (15-25 mg), Analgin + Diphenhydramine (50% solution, 2-3 ml per 200 ml of saline / solution). In the future, when the patient is stabilized, control "instillations" are carried out with antihistamines - "Diprazin", "Suprastin" (about 5 - 1 mg / kg).

• In parallel, the method of endovisceral suction is used (a hollow probe is inserted into the esophagus, bringing it to the gastric sphere). Through it, gastric secretion is selected, which is in acute inflammation of the pancreas in aggressive acidity. Thus, enzyme intoxication of the body is removed, tension of smooth muscle layers in the parenchyma of the stomach and pancreas is prevented. For sorption (absorption of toxins, decomposition products of putrefactive bacteria), a sorbent is introduced through this catheter - "Silicon Dioxide" (12 g per day, the powder is dissolved in 200 mg of distilled water).

• As a rule, after 1-2 days of stay in intensive care and fixing the absence of a life-threatening epicrisis, the patient is transferred to the intensive care unit.

• The subsequent treatment regimen includes: fasting (2-3 days, when wetting the mouth with water and spitting). On the 4th day, liquid broth (not greasy!), pure spring (boiled) water is allowed, no more than 500 ml per day. Pancreatic diet type No. 16. In the medical aspect of treatment, intravenous infusions are continued, - "Gistak", "Losek" (from 40 to 50 mg, distributed in 3 droppers in a daily dosage). Antibiotics - "Kontrykal", dosage from 20,000 (units) to 60,000 (units) 3-4 times a day, "Gabexat mesilat" (from 800 to 1000 units, one-time infusion per day), "Gordox", as well as "Kontrykal", starting from 100,000 units. up to a volume of 200,000 units, but not more than 2 times a day.

The course of full-fledged treatment of acute pancreatitis in a medical institution is designed for 24-25 days. It is recommended to undergo a duplicate cycle for pancreatic remission after treatment in a hospital, not earlier than six months, but not later than 8 months.

Treatment of pancreatitis in a hospital: chronic course

With a chronic characteristic of pancreatitis, patients are prescribed to undergo hospitalization 2 times a year, the course is planned for 20-25 days. In the first week, desensitization of the body is carried out (cleansing from slagging with toxins). The patient is given an enema upon admission, the stomach is washed and transferred to prophylactic fasting. Within 3-4 days, they are kept with a minimum water diet. For active sorption of pathogenic microflora, sorbents (powders) are prescribed - Sorbex, Smekta, Almagel Forte. The drug "Rheosorbilact" is used intravenously 200 ml daily. Then they are transferred to diet tables (No. 14,15, 16).

The group of anti-inflammatory drugs includes - "Kontrykal", "Gordox" (50,000 units, 3 times a day intravenous infusion), "Hemodez", (300-500 mg per physical / r - re). In addition to them, do not forget about the effective solution of "Mannitol" (125-135 ml). As a diuretic that removes hydrolysis in muscle tissues, 1 tablet of Furosemide (with Asparkam, 1 tablet) is administered orally every three days.

In conclusion, summing up, the main idea should be emphasized, the value of this information is the timeliness of the treatment of acute / chronic pancreatitis in a hospital setting. Goals, thanks to which a person has a real chance to completely cure a diseased pancreas.

Naturally, the treatment of pancreatitis (the choice of a method with appropriate medications) is prescribed by a doctor. Symptoms of pathology are diverse, may be similar to other diseases. Therefore, self-treatment of pancreatitis is categorically unacceptable. You can not tolerate the resulting paroxysmal pain in the abdomen, apply heat and wash the stomach. You just need to seek medical help in a timely manner.

It is possible to quickly stop the course (or exacerbation) of the disease if it is detected only when it begins.

Diagnosis of the disease

Before treating chronic pancreatitis, the doctor prescribes urine and blood tests and a pancreatic examination using ultrasound.

A blood test for pancreatitis shows an increase in ESR, a decrease in the amount of proteins. When analyzing urine, alpha-amylase is detected in the acute period of the disease, bilirubin is observed in the presence of obstructive jaundice. An ultrasound visualizes the deformity of the gland, a change in the edge, or the development of nodules (cysts).

According to the analysis of feces, the work of the pancreas is also evaluated.

In addition to the fact that pain occurs in the left side in the hypochondrium, it can radiate to the region of the heart or peritoneum, take on a girdle character. At the same time, nausea and vomiting. In the feces, particles of undigested food and a greasy sheen are noted. The patient's weight is drastically reduced.

Treatment of chronic pancreatitis inpatient

The doctor performs an initial examination of the patient with an ambulance. Suspecting acute pancreatitis, he will perform an injection of an antispasmodic drug. If cholelithiasis led to an attack, the pain will decrease. If this is the initial degree of pancreatitis, then the effect of the injection will be small.

Treatment of chronic pancreatitis in the acute period in children and adults is carried out permanently. The patient is admitted to the Department of Surgery. But this does not mean that the patient will immediately undergo surgery. He will first be observed and will undergo mandatory examinations.

With the classical treatment regimen, "cold, hunger and rest" is indicated.

An ice pack is placed on the epigastric region. It is forbidden to eat for two to four days. Then they are allowed to eat food in liquid form.

To eliminate pain, a thin catheter is inserted through the nasal passages into the stomach for a couple of days and connected to the suction in order to create negative pressure. At the same time, painkillers are administered intravenously. In the absence of vomiting, Almagel A is given. However, only a doctor prescribes all drugs.

Taking medication for exacerbation of pancreatitis is only the first aid during an illness. Read more about what medications to take here.

Eliminate intoxication in pancreatitis and reduce the degree of swelling of the pancreas through intravenous administration of electrolytic solutions (Hemodez, Mannitol), glucose, urination agents.

The suppression of enzyme activity helps to prevent tissue breakdown. Why intravenously injected with a dropper Contrykal, Traciol, Gordox.

Each patient requires the use of significant doses of antibiotic drugs, because an inflammatory process begins near and in the pancreas itself. Assign more often 2 antibiotics (intramuscularly or intravenously).

In order to maintain blood pressure in a state of shock, cardiovascular and hormonal drugs are administered.

Treatment is carried out by monitoring it with studies of electrolyte (sodium, potassium, calcium), protein (protein fractions, total plasma protein) and carbohydrate (blood sugar) metabolism.

They jointly carry out activities aimed at maintaining the kidneys and liver, since they are under a significant load during the period of an attack and treatment. To support the liver, the patient receives large doses of glucose and vitamins. Kidney function is increased through the introduction of sacrospinal blockade and aminophylline, diuretic drugs.

It is not surprising that at an early stage of the course of the disease (or during its exacerbation), a detailed examination is not carried out. The reason is that a diverse examination of patients is impossible at an early stage due to the serious condition and the existing danger of worsening the course of the pathology.

An illiterate examination at the initial stage can lead to a new wave of exacerbation of the pathological process and even progression of the disease. This can be caused by blood tests for sugar load, duodenal sounding, etc. To avoid this, the hospital conducts an examination twice.

If signs of peritoneal irritation appear, drainage of the abdominal cavity is performed, the supply of drugs and antibiotics is carried out directly into the abdominal cavity by means of catheterization.

Surgical intervention (resection of the head of the pancreas) is used in a situation where it is impossible to obtain results by other methods of treatment.

In the adult population, the treatment of pancreatitis is often accompanied by the presence of stones in the ducts of the gallbladder, alcoholic cirrhosis of the liver, peptic ulcer. Therefore, it is not possible to get rid of such a set of diseases once and for all. After undergoing treatment in a hospital, the patient is obliged to adhere to the recommendations of a gastroenterologist and therapist for a long time in order to get rid of existing pathologies.

After the removal of acute symptoms, a difficult period of adaptation of the patient to a new way of life and a different diet will be stationary. It would be a mistake to assume that only drugs are enough for treatment.

Strict adherence to the rules of diet therapy for pancreatitis is an equally important component of treatment. At the same time, one should refrain from fried, fatty, fat, broths on fatty meats for a long time. Meals are allowed to be consumed only in boiled, baked or steam-cooked form. Drinking - only a rosehip broth or dried fruit compotes. Dry cookies replace cakes and pastries.

Each time, violating diet therapy, one should expect a return of exacerbation, but in a much more severe form.

The acute phase of pancreatitis lasts five weeks. It will take one year to restore the disturbed enzymatic balance.

The outpatient stage for the patient means that you have to take medication for a long time.

This is the take:

• antispasmodics (Platifillin, No-shpa);
• enzymes to improve the digestion process (Mezim, Panzinorm, Pancreatin, Creon, Festal);
• means for lowering acid in gastric juice (Phosphalugel, Almagel);
• vitamin-mineral complex, including vitamins A, B, E, D, which restore disorders of fat metabolism.

The fact that the enzyme composition has returned to normal is evidenced by the cessation of diarrhea in the patient and the absence of undigested food particles in the feces.

Competently behaves the patient with a chronic form of pancreatitis, who regularly visits a doctor and takes measures under his control.

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What is acute pancreatitis and how does the disease manifest itself?

The hallmark of acute pancreatitis is severe, sudden pain in the upper abdomen, just below the sternum, that comes on in waves, often, and intensely until it becomes constant. In 50% of cases, the pain is felt in the lower abdomen and spreads to the back.

Other characteristic manifestations in acute inflammation of the pancreas:

• loss of appetite caused by a lack of pancreatic enzymes released into the intestines;
• acute pains in the abdominal cavity of various localization, which increase after eating, coughing, deep breathing, touching the stomach;
• in the supine position, the pain is worse than in the sitting position;
• severe nausea and vomiting, even in the absence of vomit;
• due to a lack of digestive enzymes, bloating occurs, the patient is tormented by frequent loose stools with a pungent odor, flatulence;
• rapid pulse - from 100 to 140 beats per minute, frequent and shallow breathing;
• fever and fever over 38°C;
• the skin and whites of the eyes become yellowish;
• persistent pain, in which even potent painkillers do not help.

The fetal position slightly relieves the symptoms of acute pancreatitis. If, even while sitting still, you experience pain and cannot find a comfortable position, contact your doctor immediately.

Causes and mechanism of development

The pancreas is an organ that produces digestive enzymes and hormones that regulate the uptake of glucose by all body cells. Digestive gland enzymes normally begin to work only in the intestines. But in the acute course of pancreatitis, they are activated ahead of time, not yet leaving the gland, irritating its walls and causing inflammation. With repeated acute attacks of pancreatitis, the mucous membranes of the pancreas are damaged, scars form at the site of the damaged tissue. Because of this, it gradually loses its functions. This leads to chronic pancreatitis, digestive problems and diabetes.

In more than 10% of cases, the disease is called idiopathic, that is, its cause cannot be found.

The main causes of acute pancreatitis include:

• Gallstones. They cause about 40% of cases of the disease. Moving along the bile ducts, they block the junction of the ducts of the gallbladder and pancreas. As a result, pancreatic juice cannot leave the gland, accumulates in it, destroying tissues.
• Excessive alcohol consumption causes acute attacks of pancreatitis in about 30% of cases. The risk of developing the disease increases with an increase in the daily consumption of alcoholic beverages above 40 g of pure alcohol per day for men and 30 g for women.
• Mechanical damage to the pancreas during injuries, operations on the gallbladder, instrumental studies.
• Elevated levels of triglycerides and calcium in the blood.
• Viral infections - mumps, cytomegalovirus and their complications.
• Cystic fibrosis is a formidable disease that damages not only the pancreas, but also the lungs, liver, and other organs.
• Taking estrogens, steroids, some antibiotics.
• Smoking.
• Kidney transplant.

What diseases can resemble acute pancreatitis

There are a number of diseases that can resemble an attack of pancreatitis with their symptoms:

• Cholecystitis, or inflammation of the gallbladder. Accompanied by acute undulating bouts of pain, nausea, vomiting and yellowing of the skin.
• Perforated ulcer of the stomach or duodenum. Causes severe acute pain in the upper abdomen, nausea, vomiting.
• Attack of acute appendicitis. The pain is growing in nature, it is noted in the lower abdomen on the right. The patient is sick, the temperature rises.
• Myocardial infarction. The victim has general weakness, severe retrosternal pain, rapid shallow breathing.
• Food poisoning. Causes severe diarrhea, bloating and pain in the lower abdomen, weakness from loss of large amounts of fluid.

Possible Complications

Acute pancreatitis leads to an imbalance of all the chemical elements of our body, causing severe complications:

• Pseudocyst - formed as a result of necrosis of the pancreas. It may go away on its own, but sometimes it breaks through, causing infection and bleeding.
• Infection of the inflamed pancreas. The body becomes vulnerable to bacteria. Immediate surgery is required to remove the infected tissue to avoid purulent pancreatitis.
• Severe damage to the lungs, heart, liver, kidneys, developing as a result of a sharp damage to the pancreas. At the same time, its activated enzymes and toxins penetrate the bloodstream, lower blood pressure, cause general organ failure, and lead to serious complications, up to death.


• Diabetes occurs when the cells that produce insulin are damaged.
• Swelling of the upper abdomen - appears when fluid accumulates in the abdominal cavity due to a decrease in intestinal motility.
• Malnutrition. Systematic attacks of pancreatitis lead to a lack of digestive enzymes. This disrupts the absorption of nutrients, leads to malnutrition, diarrhea, weight loss.
• Pancreatic cancer - prolonged and systematic inflammation in the gland is a risk factor for the development of cancer.

Prompt and effective treatment of pancreatitis reduces the risk of complications. Therefore, it is important to seek the help of specialists at the first acute symptoms.

Which doctor to contact

A characteristic symptom of the acute form of pancreatitis is a tense abdominal wall and pain when probing the peritoneum.

If, as a result of a preliminary examination, the family doctor suspects pancreatitis, you should contact a specialist dealing with problems of the digestive tract - a gastroenterologist.

To make a diagnosis, a blood test is prescribed and hardware examinations of the diseased organ are performed:

• Ultrasound of the abdominal organs;
• computed tomography of the pancreas;
• magnetic resonance cholangiopancreatography - a special MRI that allows you to examine the pancreatic and bile ducts;
• endoscopic retrograde cholangiopancreatography - the procedure allows not only to view the ducts, but also to remove gallstones.

Treatment of acute pancreatitis

The treatment regimen for acute pancreatitis will depend on the severity of the symptoms. The therapy includes the following steps:

• elimination of pain syndrome;
• the introduction of a sufficient amount of fluid;
• nutrition support;
• performing endoscopy or surgery if the acute attack is caused by gallstones or pseudocysts.

Medical treatment

In the presence of mild to moderate symptoms, treatment for acute pancreatitis in the hospital includes the following procedures:

• Starvation. The patient does not take food for several days to allow the pancreas to rest. After the disappearance of pain, the cessation of nausea and vomiting, semi-liquid food can be introduced into the diet - cereals, soups, as well as drinks (kefir, weak tea).
• Taking painkillers to relieve pain. For this, Tramadol, Baralgin, various types of blockades are prescribed.
• Preventing dehydration, which worsens symptoms and increases the risk of complications.

Patients with severe symptoms of pancreatitis are treated in the intensive care unit, where their vital signs are constantly monitored - pulse, pressure, breathing rate and urine production.

The patient is prescribed:

• antibiotics to prevent infection, such as metronidazole, ciprofloxacin, and others;
• intravenous administration of solutions of sodium chloride and potassium chloride to eliminate dehydration;
• a pulmonary ventilator to help the patient breathe;
• to maintain the required volume of blood, patients with low blood pressure are injected intravenously with solutions of Polyglukin, Albumin, etc.;
• to feed seriously ill patients, thin tubes are used, which are inserted through the nose and stomach into the small intestine.

The patient remains in the intensive care unit until the risk of organ failure, hypovolemic shock and sepsis disappears.

Surgical intervention

If the cause of acute pancreatitis is blocked bile or pancreatic ducts, then an endoscopic procedure is used to open or widen these ducts.

In case of blockage of the ducts by gallstones, doctors recommend removing the gallbladder.

Folk methods

An acute attack of pancreatitis occurs suddenly and develops very quickly. For its diagnosis and therapy, complex examinations, modern medical equipment, medicines, solid professional experience and hospital conditions are required. Given the rate of development of complications in this pathology, the use of alternative methods will lead to the loss of precious time, which is fraught with death. It will be possible to use folk remedies after the relief of acute symptoms, and only in agreement with the doctor.

Diet after treatment

After leaving the walls of the hospital, it is necessary to continue the recovery of the body after an attack of pancreatitis. The main role here belongs to the diet:

• Stop drinking alcohol. If you can not do it yourself, use special programs to get rid of addiction.
• Quit smoking. If you don't smoke, then don't start.
• Choose a diet low in fat, rich in fresh fruits and vegetables, whole grains, and lean meats.
• Drink more pure water.

Forecast and prevention

An acute attack of pancreatitis causes severe short-term pain. Depending on the severity of the attack, it can be treated in a hospital within 1-2 weeks. Frequent and recurrent outbreaks of the disease lead to chronic problems and complications. Timely treatment, feasible physical activity, a healthy lifestyle will allow you to eliminate the risk of possible relapses, live comfortably and without pain.

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A set of measures to reduce the functional activity of the pancreas

1. Hunger. During the period of intense pain and vomiting, the patient does not receive any food or water through the mouth. In persons with mild and moderate disease, hunger lasts 2-4 days. From the 3-5th day, a liquid and semi-liquid diet (type No. 16 pancreatic) is prescribed for 3-6 days.
2. Through the nasal passages, a catheter is placed in the stomach, which is connected to a suction device that creates a slight negative pressure. Usually the catheter is in the stomach for 1-3 days. Often, within a few hours after the installation of the catheter, the pain clearly decreases.
3. In the absence of intense pain and vomiting, antacids are prescribed (for example, Almagel 10-15 ml 4 times a day); in a more severe course, parenteral administration of H2-blockers (for example, gistak 50 mg intravenously or intramuscularly every 6-8 hours) or proton pump blockers (for example, losec 40 mg 1 time per day intravenously).

For the same purpose, somatostatin (stylamin 250 mg IV), glucagon 1 mg s/c, IM, IV, calcitonin (myocalcic 300 IU per day IV drip) are used for the same purposes.

The fight against edema of the gland and parapancreatic tissue

1. Cold on the region of the gland.
2. The introduction of a 15-20% solution of mannitol in an amount of 150-300 ml intravenously.
3. Hemodez 300 ml intravenous drip.
4. Furosemide (1-2 ml of a 2% solution) is administered intravenously in the first 12-24 hours of illness.

Preventing Enzyme Intoxication

1. Aprotinin.
2. Kontrykal (trasilol) at a dose of 20,000-60,000 IU intravenously, in the first days of the disease, the drug is administered 2-3 times a day.
3. Gordox 100,000-200,000 IU intravenously, 2-3 times in the first days.
4. Gabeksat mesilat 800-1000 mg intravenously per day.

Allergic reactions to the administration of this group of drugs are relatively often observed, in some cases anaphylactic shock develops. Therefore, when introducing anti-enzymatic agents, prednisolone in ampoules should always be ready.

In antienzymatic therapy, aminocaproic acid, 5-fluorouracil, etc. are also used. It is also proposed to introduce 5-fluorouracil into the celiac trunk. The efficacy of these drugs is highly controversial.

Pain therapy

1. Analgin (50% solution) 2-3 ml intravenously or intramuscularly 2-3 times a day, it is advisable not to exceed the daily dose of 3.0 g.
2. Procaine (0.5-0.25% novocaine solution intravenously, total no more than 2 g per day).
3. Promedol (1% solution) 1-2 ml subcutaneously, intramuscularly, intravenously 1-3 times a day.
4. Fentanyl (0.005%) 1-3 ml intramuscularly 1-3 times a day.
5. Pentazocine (fortral) 30-60 mg intramuscularly every 3-4 hours.
6. Buprenorphine (torgesic) 300 mg intramuscularly or intravenously every 6 to 8 hours.
7. Tramadol (tramal) 150-200 mg subcutaneously, intramuscularly, intravenously 3-4 times a day, the total dose is not more than 400 mg per day.

Usually, non-narcotic and narcotic analgesics are combined with the introduction of myotropic antispasmodics, such as drotaverine (no-shpa 2% solution of 2 ml subcutaneously or intramuscularly).

Antibacterial therapy.

As already mentioned, all patients with necrotizing forms of acute pancreatitis need antibiotic therapy. At the same time, among other characteristics, great importance is attached to the intensity of accumulation of the antibiotic in the gland.

Tienam (imipenem + cilastatin) 250 or 500 mg intravenously slowly for at least 20-30 minutes, 3-4 times a day.

When prescribing other antibiotics, they are usually combined with taking two drugs orally for the purpose of selective intestinal decontamination: metronidazole 0.5 g 3 times a day and ampicillin 0.5-0.75 g per day.

The role of the "main" antibiotic in this case is played by:

• Ofloxacin (tarivid, zanosin) 200 mg intravenously slowly 2 times a day.
• Ciprofloxacin (cyprobay) 200 mg intravenously twice a day.
• Cefotaxime (Claforan) 1-2 g 2 times a day intramuscularly or intravenously. The choice of antibiotics can be expanded to include the drugs listed in Chapter 36.

Fight against vascular insufficiency

1. Solutions of hormones and catecholamines: 0.2% solution of adrenaline (epinephrine) 1-2 ml s / c, iv; 0.2% solution of norepinephrine 2-4 ml in 5% glucose solution or isotonic sodium chloride solution intravenously slowly; dopamine 50-200 mg intravenously slowly, 2-4 times a day; hydrocortisone 250 mg IM or IV; prednisolone 30-60 mg intramuscularly or intramuscularly, mezaton (solution) 1-2 ml subcutaneously or intramuscularly.
2. Reopoliglyukin 400-500 ml intravenous drip.

Correction of water and electrolyte balance

Correction of water and electrolyte balance is carried out using isotonic sodium chloride solution and 5% glucose solution (in the absence of hyperglycemia).

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How is acute pancreatitis treated in a hospital?

Hospitalization is needed with a severe attack of acute pancreatitis, which cannot be stopped with painkillers at home. After the patient is delivered, he is transferred from the admission department of the clinic to the intensive care unit. Treatment is carried out with the obligatory participation of an anesthesiologist and resuscitator.

Acute pancreatitis is treated as follows:

1. First, doctors relieve the patient of pain and various nervous, reflex disorders with the help of analgesics. For this, drugs Baralgin, Promedol, Analgin, etc. are used. Novocain blockade can be used.
2. To combat hypertension in the bile ducts, doctors use No-shpu, Nitroglycerin and other drugs.
3. The pancreas must be unloaded, so the patient is prescribed hunger. He must take alkaline drinks, such as Borjomi.
4. In combination with the above measures, prevention and treatment of blood clots in the vessels of various organs (pancreas, liver, etc.) is carried out.

In order not to worsen the condition of a patient with pancreatitis due to intoxication, the heart and lungs are checked for performance, and then drainage and gastric lavage are performed. This procedure is carried out with a solution of soda, Pyrroxane or Obzidan are used.

Intravenous injections are made with insulin solutions with glucose and potassium.

With acute pancreatitis during inpatient treatment, the patient is under constant monitoring of studies of metabolic processes occurring in his body. The exchange of electrolytes (for example, sodium or potassium) is examined, the level of sugar in the blood, the presence of proteins in it, etc. are checked.

Usually, during the inpatient treatment of acute pancreatitis, a complete examination of the patient is not carried out, since it is impossible due to the severity of the person's condition and can lead to a rapid and sharp deterioration in the course of the disease. Therefore, the survey is carried out in 2 stages. Initially, only on the basis of symptoms, the diagnosis is confirmed, and then the above measures are taken, and after the patient's condition improves, laboratory tests are carried out.

Treatment of chronic pancreatitis

Usually, before the start of the treatment process, a complete examination of the patient is carried out. There are many methods for detecting this disease, but they are practically useless in the early stages of the disease due to the presence of a large number of various symptoms and phases of the further development of the disease, interspersed with periods of remission.

Therefore, it is necessary to conduct a comprehensive examination, which includes blood, urine, feces tests. Ultrasound is performed to detect changes in the pancreas, radiography of the abdominal organs, and other studies.

Chronic pancreatitis is usually treated at home or on an outpatient basis. Hospitalization of the patient is not required. He is prescribed a special diet and conservative medication.

If the patient has an acute attack that he cannot stop with the drugs prescribed by the doctor, then you should immediately call an ambulance. After that, the patient will be treated for an attack according to the above method to eliminate the signs of acute pancreatitis.

Until a car with doctors arrives, it is necessary to transfer the patient to a horizontal position (lay on a sofa or bed). The room where it is located is recommended to be constantly ventilated, and the patient should put something cold on the stomach area, such as an ice pack. If the doctors are late, then it is not necessary to feed the patient. It is best if he fasts for 3 days.

Treatment of chronic pancreatitis in the hospital is usually carried out with medications. At the next attack, the pain is eliminated by drugs such as Papaverine, No-shpa, Atropine, etc. It is forbidden to use Aspirin and other NSAIDs, as they only thin the blood and irritate the mucous membranes.

To suppress the excessive secretion of a diseased organ, omeprazole and similar drugs are used. The gland is unloaded with the help of drugs such as Mezim, Digestal, etc. To eliminate the infectious lesion on the gland, antibacterial therapy is prescribed with medicines such as Ampicillin. Water and salt balance is restored with the help of physiological solutions.

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Diagnostic measures

It is difficult to determine the pathology of the pancreas on its own at an early stage of development, without the help of a doctor. The medical specialist conducts not only an examination, but also directs for additional tests and studies.

Diagnostic methods:

Endoscopic retrograde cholangiopancreatography (ERCP) helps to determine the disease at the stage of exacerbation. Diagnosis and treatment of acute pancreatitis is carried out by qualified medical specialists in stationary conditions.

Treatment Methods

Exacerbation of pancreatitis requires hospitalization of the patient. Against the background of the development of serious complications, he can be transferred to intensive care. The patient is advised to be in complete rest, as well as to starve. Thus, the activity of the pancreas decreases, which leads to a decrease in the area of ​​damage to the organ. Treatment is carried out comprehensively, it is necessary to eliminate not only the exacerbation of pancreatitis, but also the pathology that caused its development.

In medicine, there is a type of inflammatory process of the pancreas, which is called reactive pancreatitis. Its peculiarity is that the symptoms are very similar to the acute form of the disease. In addition, with reactive pancreatitis, the patient is prescribed similar diagnostic measures and treatment.

Medical therapy

Before prescribing drugs to the patient, doctors determine the severity of the disease, the spread of pathological processes. The presence of infection matters. If this is an edematous form of the disease, then the patient is prescribed medications. In the case of a destructive type, surgical treatment of acute pancreatitis will be required.

Drug therapy provides for a certain scheme:

• The patient is prescribed drugs that soothe the pain syndrome.
• Drugs that remove toxins from the human body.
• Means that will help stop dehydration during an exacerbation of the disease.
• Medications to restore disturbed microcirculation.
• Medicines are prescribed to prevent the development of a bacterial infection.
• Medicines that depress the pancreas are used.

Antispasmodic drugs help not only to soothe the pain. They help to relax the smooth muscles of the bile duct and sphincter to prevent bile reflux into the ducts. In addition, they reduce pressure in the stomach and duodenum with pancreatitis.

Anti-inflammatory drugs of the non-steroidal group are necessary to eliminate the pain syndrome. But they also have a decongestant effect. Sometimes, with severe attacks of pain that accompany the destructive form of pancreatitis, the doctor prescribes narcotic painkillers to his patients.

Important. Without consulting a doctor, you should not take medicines, there is a risk of causing complications and worsening the health of the body.

In the fight against dehydration, specialists use infusion solutions. They are given to patients intravenously in the hospital. Due to frequent vomiting, a person has severe dehydration. This is one of the signs that manifests itself during exacerbation of pancreatitis. Solutions contain potassium chloride, which is always lacking during dehydration.

Together with the restoration of microcirculation, doctors prescribe special medications to get rid of the intoxication of the body. Treatment in a hospital involves the use of diuretics and procedures that purify the blood.

The main stage in the fight against acute pancreatitis involves the inhibition of the pancreas. Qualified specialists for this purpose prescribe inhibitors of proteolytic enzymes to their patients. They help to reduce the activity of the gland and the production of enzymes necessary to maintain the digestive process.

In order not only to relieve an attack of pancreatitis, but also to prevent the development of a bacterial infection, doctors prescribe extensive antibiotics to their patients. They help even if the pancreas is swollen. During exacerbations, the patient is given strong antibiotics, including carbapenems, which are reserve antibacterial agents.

Surgery

Surgical methods of dealing with acute pancreatitis are used quite often. There are certain indications for the operation:

• sharply aggravated signs of the inflammatory process in the pancreas;
• doctors diagnosed the patient with a destructive form of the disease;
• with the development of focal infected pancreatic necrosis;
• treatment of acute pancreatitis with medicines did not lead to positive dynamics;
• exacerbated intoxication syndrome.

If fluid has formed in the affected area by pathological processes, specialists resort to a minimally invasive operation. During the procedure, drains are installed, for a maximum of 2 days, to wash the pancreatic cavity and remove dead tissue using antiseptic solutions.

Large-scale surgical treatment will be required if the patient does not feel better after minimally invasive manipulations. The main indications for surgery:

• heavy bleeding;
• acute inflammatory process in the abdominal cavity;
• pancreatic necrosis of an extensive type;
• abscess accompanied by perforation;
• development of destructive cholecystitis.

During surgical treatment, surgeons remove some parts of the pancreas. The problem is that it is impossible to establish where is the healthy and where is the affected area. The doctor may remove tissue that has not been affected by the disease.

Surgical procedures for acute pancreatitis:

Distal resection. During the procedure, doctors remove the tail of the pancreas. The operation is prescribed for patients whose organ damage is limited and the exacerbation develops in a small area.

subtotal resection. Not only most of the pancreas is removed, but also the tail, as well as the body of the organ. Some areas located near the duodenum remain intact. To restore the functions of the removed organ, it is necessary to transplant healthy tissues.

Necrsequestrectomy. The procedure is performed using ultrasound and fluoroscopy. When carrying out manipulations, specialists find liquid formations, mark them. Then, using drainage tubes, the contents are removed. The operation ends with washing the affected area. In order for the cavity and the wound to gradually heal, doctors leave small drains, which are also necessary for the outflow of excess fluid.

After the operation, the patient may experience serious consequences in the work of the body, which require further treatment. Therapy will need to be continued at home. During treatment, a person needs to drink digestive enzymes with meals. He will be disturbed by bouts of disorder, symptoms of diabetes.

Considering the seriousness of the situation, that is why qualified specialists insist that the treatment take place in a hospital, because doctors will be able to provide medical care to the patient in a timely manner and stop the attack.

Diet food

Patients with acute pancreatitis, doctors prescribe a strict diet. But during the first 4 days you need to completely starve. While the patient is being treated, nutrition should not burden the pancreas.

Menu of a patient with acute pancreatitis:

• Mineral water without gas, drink in small sips.
• Meals cooked with steam or water, which include a sufficient amount of protein (80 grams).
• Products with a fat content (60 grams). As for carbohydrates, they should be as small as possible.
• The daily energy value for a patient with acute inflammation should not be more than 2000 kcal.
• Refuse to use salt. It contributes to an increase in edema, increased production of hydrochloric acid and an accelerated digestion process.

With exacerbation of pancreatitis, you should eat food in small portions, 5-6 times a day. It is better if the dishes are in a liquid or semi-liquid state. A week after the relief of attacks, the patient is allowed to dilute the menu with slimy soups, jelly, cereals, crackers, lean steamed cutlets, mashed potatoes, weak tea or rosehip broth.

If the attending physician allows, you can add cheeses, protein omelet and baked apples. While the patient is being treated, he should completely abandon fried, smoked, salty, pickled foods. The same applies to fat, fatty dairy products, muffins, alcoholic beverages. The duration of the diet is one year.

The patient should follow medical advice. Otherwise, violations will lead not only to an exacerbation of the disease, but also to its transition to a chronic form.

Preventive treatment

To prevent the development of the disease, it is necessary to prevent the transition of the disease into a chronic form. All patients diagnosed with acute pancreatitis should be treated in a hospital, strictly as prescribed by a specialist.

Each patient must understand that the inflammatory process persists for a long period of time. If a person feels better, you can not refuse drug treatment, it is important to finish therapy. In such cases, the pathology is not always manifested by pronounced symptoms. Refusal of treatment will lead to the development of a chronic form. It is accompanied not only by exacerbations, but also by serious complications.

Prevention provides for certain recommendations that doctors advise to adhere to:

1. The patient should completely refrain from any kind of alcohol.
2. It is necessary to constantly follow a diet.
3. Timely treat various infectious diseases (caries, sinusitis, otitis media, cholecystitis).
4. Remove medicines from the medicine cabinet that can harm the pancreas.
5. By following all the rules and recommendations, you can avoid not only the development of pathological processes, but also the exacerbation of the disease.

If the patient refuses to treat acute pancreatitis, then there is a risk of developing a reactive type of pathology. Therefore, it is important to seek help from medical specialists in a timely manner in order to receive qualified assistance. Treatment of reactive pancreatitis is carried out medically or surgically, strictly in stationary conditions.

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An ambulance doctor conducts an initial examination of the patient. If acute pancreatitis is suspected, he will inject antispasmodic drugs. The pain will decrease if the attack is associated with gallstone disease. In primary pancreatitis, the effect is negligible.

Treatment of pancreatitis in adults and children with exacerbation should begin with a stationary stage. The patient must be admitted to the surgical department. This does not mean that there is an emergency surgical treatment. The patient is observed, urgent research is carried out.

The classical scheme calls for assigning "hunger, cold and thirst." An ice pack is placed on the epigastric region. Eating and drinking is not allowed for two to four days. Then they switch to liquid food.

To relieve pain through the nose, a thin catheter is inserted into the stomach for 2-3 days, it is attached to the suction to create a slight negative pressure. At the same time, intravenous painkillers are administered. If there is no vomiting, you can give Almagel A inside. Which drug to use is decided by the attending physician.

In order to combat intoxication in pancreatitis, to reduce pancreatic edema, Hemodez, Mannitol, and diuretics are administered intravenously.

The only way to prevent tissue breakdown is to suppress the activity of enzymes. For this, Trasilol, Kontrykal, Gordox are used intravenously.

All patients need high doses of antibiotics because inflammation develops around and inside the pancreas. Apply 2 antibiotics (intravenously and intramuscularly).

To maintain blood pressure in a state of shock, hormonal and cardiovascular agents can be administered.

Intoxication is treated with solutions of electrolytes, glucose, Reopoliglyukin.

If there are symptoms of peritoneal irritation, the abdominal cavity is drained, drugs and antibiotics are administered directly into the cavity through a catheter. There is a surgical method of treatment - resection of the head of the pancreas, but it is resorted to in the absence of results from other methods.

Treatment of pancreatitis in adults is often complicated by the presence of gallstones, alcoholic cirrhosis of the liver, and concomitant peptic ulcer disease. Therefore, it is impossible to cure such a set of diseases forever. But after inpatient treatment, the patient will have to follow the recommendations of the gastroenterologist and the therapist for a long time in order to cure at least part of the pathological changes.

When acute phenomena are removed in a hospital, a difficult period of adaptation of the patient to a different diet and regimen lies ahead. If someone thinks whether pancreatitis can be cured without a diet, with medication alone, he is very mistaken. Strict adherence to a dietary regimen for pancreatitis is as much a part of treatment as expensive medications. It is necessary to give up fatty foods, fat, rich broths for a long time. Fried foods are contraindicated. You can only eat boiled, baked or steamed foods. Instead of strong coffee and tea, dried fruit compote, rosehip broth are recommended. Cake and pastries are replaced with dry cookies.

Any violation in nutrition, alcohol intake will cause a return of exacerbation in a more severe form.

The duration of the acute period with pancreatitis lasts up to five weeks. It is believed that it takes at least a year to restore the enzymatic balance of the pancreas.

At the outpatient stage, the patient should take the following drugs for a long time:

• antispasmodics - recommended for increased pain (No-shpa, Platifillin);
• enzymes as assistants in restoring impaired digestion in the intestines (Mezim, Pancreatin, Panzinorm, Festal, Creon), only a doctor can choose the right enzyme preparation, taking into account its activity, combination with bile acids;
• drugs that reduce the acidity of gastric juice (Almagel, Phosphalugel);
• vitamin complex, including such as A, B, D, E, restoring fat metabolism.

The normalization of the enzyme composition is judged by the cessation of diarrhea in the patient and the absence of undigested food in the analysis of feces.

That patient with chronic pancreatitis, who is constantly treated under the supervision of a doctor, is doing the right thing, is fully and regularly examined.

Failures in the functioning of the pancreas cause a lot of inconvenience to a person, interfere with normal life. Pancreatitis is diagnosed in acute or chronic form. Pain in pancreatitis can reach a high intensity, they are accompanied by loss of appetite, weight loss, inability to sit and walk normally. It is important to know how to diagnose pancreatitis and be able to cope with pain at home and in a hospital setting.

Inflammatory-degenerative processes that occur in the pancreas are called pancreatitis. The mechanism of the appearance of pain is influenced by the following processes occurring in the pancreas:

Experts identify many reasons for the onset and progression of pancreatitis. According to statistics, in 30% of patients the cause of inflammation of the pancreas cannot be found out. Pancreatitis can be caused by:

• The use of alcoholic beverages in excessive doses. Alcohol is one of the main causes of pancreatitis, with regular drinking of strong drinks, iron ceases to function normally, which has an extremely negative effect on the health of the whole organism.
• Nutritional errors. Fatty, fried and spicy foods, systematic overeating leads to excessive production of gastric juice and damage to the gland.
• Anomalies in the work of the gallbladder (cholelithiasis). The pancreas and gallbladder have a common excretory duct into the duodenum. If the duct is clogged with stones, stagnation of the digestive secretion occurs, which causes inflammation or destruction of the gland.
• Stressful situations, nervous strain.
• Injuries, abdominal operations, wounds of the abdomen, abdominal cavity, in which the pancreatic gland can be damaged.
• Diabetes mellitus.
• Hormonal disorders.
• Infections (flu, mumps, colds, viral hepatitis).
• Neoplasms in the peritoneum.
• hereditary predisposition.
• High blood pressure.
• Inflammatory diseases of the gastrointestinal tract and duodenum. Gastritis, duodenitis, ulcers can adversely affect the release of intestinal juice.
• The negative impact of medical agents. Many antibiotics, hormones, non-steroidal anti-inflammatory drugs have a negative effect on the pancreas and can cause inflammation.

The nature and localization of pain in pancreatitis

Pain sensations in pancreatitis are different, have a daily frequency and depend on the anatomical location of the focus - the region of the pancreas lesion (head, body, tail), the type of inflammatory process. The nature of pain in pancreatitis is different:

• cutting;
• pricking;
• aching;
• spicy;
• blunt;
• pressing;
• burning;
• drilling;
• pulling.

In chronic pancreatitis, there is no clear localization of pain, it can be of different intensity, occur periodically (cramping type). Strengthening of the pain syndrome occurs at night. With chronic inflammation of the gland, pain is localized in:

• upper and middle abdomen;
• lumbar region, in the form of a full belt or partial - on the left side;
• back area;
• the lower part of the chest (the area of ​​the lower ribs).

In acute pancreatitis, patients feel a pulling, unbearable, sharp, squeezing, acute and girdle pain, which is localized in:

• left side of the abdomen;
• back
• left hypochondrium;
• abdominal cavity.

How to recognize acute pancreatitis

In an acute attack of pancreatitis, the pancreas begins to digest not food, but itself. If you do not seek medical help in time, do not begin to follow the rules of nutrition, there is swelling and inflammation of the tissue around the pancreas. In advanced cases, necrosis of the gland may develop. Identifying the symptoms of acute pancreatitis is simple:

• nausea;
• bloating;
• heart palpitations;
• a significant decrease in blood pressure;
• aversion to all food and drinking water;
• dizziness;
• sharp pain under the right rib;
• flatulence;
• vomiting gusts with bile impurities;
• pale, yellowish skin;
• acute girdle pain in pancreatitis, which subsides in a sitting or lying position, if you bend your knees under you.

How to relieve pain in acute pancreatitis

Acute inflammation of the pancreas occurs suddenly, often the patient has to provide first aid at work or at home. Therapy of this form of pancreatitis is carried out exclusively in a hospital under the supervision of a physician. In case of acute girdle pain, you need to call an ambulance and do the following:

• Provide the patient with peace - both physical (sudden movements cause pain), and emotional.
• Remove or unfasten clothing that interferes with normal breathing or compresses the stomach.
• To reduce pain, you need to seat the sufferer, tilting the torso forward, or recommend lying in the fetal position.
• The patient needs to drink a quarter cup of boiled water or mineral water without gas every half an hour.
• The cold relieves the pain. For 10-15 minutes, you can put an ice pack, chilled gel bags or a bottle of frozen water on your stomach (on the area of ​​pain localization).
• Let the patient take an antispasmodic - No-shpu, Papaverine or Drotaverine, if possible, make an intramuscular injection with one of these drugs.

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Only doctors can determine the type of inflammation. In order not to aggravate the situation even more before the doctors arrive, during an acute attack, the sufferer is prohibited from:

• Taking deep breaths makes the pain worse.
• Consume food.
• Take painkillers (Spazmalgon, Analgin, Baralgin) - they dull the pain and can prevent specialists from correctly diagnosing the disease.
• Take enzyme preparations (Mezim, Creon, Festal), which can worsen the patient's condition.
• When vomiting, do not use solutions or medicines to cleanse the stomach.
• Warm the abdominal area - this can lead to swelling and sepsis.

Treatment in a hospital

After hospitalization, in order to determine the symptoms of pancreatitis, the patient is prescribed a diagnosis, which includes:

• general blood analysis;
• x-ray and ultrasound of the peritoneum;
• blood chemistry;
• fibrogastroduodenoscopy (probing);
• laparoscopy;
• computed tomography.

To relieve pain, doctors may prescribe narcotic analgesics, and in severe cases, the anesthesia scheme is supplemented with the appointment of neuroleptics, antispasmodics, antibiotics, tranquilizers, antidepressants. The most common analgesics:

• Ketanov;
• Tramadol;
• Diclofenac;
• Omnopon;
• Promedol;
• fentanyl;
• Novocaine.

Therapy for acute pancreatitis is selected individually for each patient. In addition to taking medications, the patient must adhere to a strict diet. In the first days after hospitalization, doctors prescribe:

• Bed rest. It is necessary to get out of bed and move gradually, after the permission of the doctor.
• Hunger - its duration is determined by a specialist, after the end of the diet, the diet expands gradually.

First aid for exacerbation of chronic pancreatitis

In the chronic form of pancreatitis, the patient has similar symptoms - as in acute inflammation, but they are less pronounced. At first, the pain is paroxysmal and cutting, then it becomes aching and dull. Often there are hungry pains in pancreatitis, which are relieved after eating, but do not completely disappear. In most cases, the symptoms of chronic pancreatitis appear after:

1. violations of diet;
2. nervous shocks;
3. alcohol abuse;
4. heavy smoking.

If acute chronic inflammation occurs, you should not self-medicate - you should immediately call the doctors. Before the ambulance arrives, you need to provide the sufferer with first aid (similarly, as with acute inflammation) and give the following drugs:

• Painkillers (Paracetamol, Ibuprofen, Metamizole, Dicloberl, Spasmalgon, Baralgin, Ibufen). They can be taken only if the patient is sure that the pain is caused by an exacerbation of inflammation of the pancreas. The dosage and type of medication depend on the recommendations of the specialist during previous attacks.
• 2 tablets of Allochol in combination with an antispasmodic (Drotaverine, No-shpa). The drug can be taken in the absence of gallstones, it helps to normalize the outflow of bile and gastric secretions from the gland.

Pain management for chronic pancreatitis

Treatment of chronic inflammation is aimed at detoxifying the body, eliminating pain, relieving the inflammatory process, and normalizing digestion. After a comprehensive examination of the peritoneum and in the presence of test results, the gastroenterologist individually develops a treatment regimen for each patient, which includes taking medications, anti-enzyme drugs, vitamins, and dieting. Of the medicines, doctors prescribe:

1. Pancreatic secretion inhibitors - are used to temporarily suppress (turn off) the gland. The drugs in this group include Gordox, Kontrykal, Kontriven, Aprocal. These medicines:
   • slow down the functioning of the protease of cellular elements and blood plasma;
   • prevent pancreatic necrosis;
   • reduce the functioning of the kinin-kallikrein system (KKS).
2. The hormonal drug Somatostatin or its analogues (Octreotide) is used to reduce pain in chronic pancreatitis, to suppress the secretion of serotonin in the gland.
3. Enzyme drugs (Panzinorm, Mezim, Festal, Pankurmen, Creon, Enzistal Pancreatin) - have the following effect on the health of the sufferer:
   • facilitate the process of processing food;
   • reduce the intensity of pain;
   • normalize work and reduce the load on the pancreas;
   • contribute to the proper absorption of organic substances.
4. Histamine H2 receptor blockers (Famotidine, Nizatidine, Cimetidine) - designed to inhibit secretion in the pancreatic gland by suppressing the production of hydrochloric acid in the intestine.
5. Blockers (inhibitors) of the proton pump - Ezokar, Omeoprazole, Rabeprazole. The main task of these drugs is to ensure the inhibition of hydrochloric acid secretions by blocking the proton pump in the parietal cells.
6. Diuretic drugs - Diakarb, Triampur, Furosemide.
7. Antihistamines (Pipolfen, Suprastin, Peritol, Diphenhydramine) are prescribed to reduce swelling of the gland tissues.
8. Antacids (Phosphalugel, Palmagel, Maalox, Altacid) - designed to neutralize hydrochloric acid, which is secreted by the stomach.
9. Antispasmodics (Drotaverine, Papaverine, Eufillin, No-shpa, Riabal, Spasmolin) - are prescribed for the relief of pain.
10. Antibacterial drugs (Amoxilav, Azithromycin, Abaktal, Sumamed) - are used to eliminate bacterial microflora, which can be the cause of infection. Antibiotics completely destroy the entire microflora in the intestine, so they are used in combination with probiotics (Linex).
11. Cholinolytics - Chlorosine, Metacin, Platifillin, Antopit. Medicines of this group normalize the digestive function.
12. Antisecretory agents - Omeprazole, Lansoprazole, Omez. Medicines significantly reduce pain, suppress the secretion of hydrochloric acid, and reduce inflammation.

Prevention

Preventive measures for any type of pancreatitis are simple. To prevent the occurrence of inflammation, you must adhere to the following rules:

• Get rid of bad habits. Minimize or completely stop drinking alcohol and smoking.
• Lead an active lifestyle, engage in light sports (for example, breathing exercises).
• Coffee lovers are allowed to drink no more than 1 cup per day. Preference should be given to natural products.
• Observe the regime of the day, do not eat at night and before bedtime.
• It is worth limiting the consumption of fast food, fatty, smoked, spicy, fried foods.
• Eat sugary foods in moderation.
• You need to eat fractionally, in small portions, there are freshly prepared dishes.
• Before the feast, it is necessary to take enzyme medicines (Pancreatin, Mezim, Festal).

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Pancreatic pancreatitis is a very serious disease in which the gland is damaged, and in the future this leads to changes in metabolism. Today we will consider the causes of this disease, how to deal with it, what methods to use.

Causes of the disease

The diagnosis of "pancreatic pancreatitis" in our time is a fairly common occurrence. But why do people suffer from it more and more often? You will understand everything when you find out the reasons that stimulate the appearance of this disease.

1. Bust with alcoholic beverages.
2. Improper nutrition, namely the frequent use of salty, spicy and fatty foods.
3. Excess weight.
4. Concomitant diseases, such as: cholecystitis, hepatitis, cholelithiasis, ulcer, gastritis, tumor.
5. Operations on the pancreas or injuries on it.
6. Tobacco smoking.
7. food allergy.
8. Heredity.
9. Taking medications, after which the disease appears (tetracyclines, cytostatics, sulfonamides).

Symptoms of acute pancreatitis

With this form of the disease, the free outflow of pancreatic juice is disturbed, it ceases to be digested by its own enzymes. For such a diagnosis as acute pancreatitis of the pancreas, the following are characteristic:

1. Strong pain. It occurs in the left side of the abdomen, and after a while it spreads to the entire abdomen.
2. Nausea and even vomiting.
3. Arterial pressure is disorganized.
4. The understanding of reality is broken.
5. There may be a state of shock.

These symptoms are too severe to be treated at home. Therefore, in acute pancreatitis, you should urgently call an ambulance. An experienced surgeon must examine the patient and without fail determine him to the hospital for further treatment and observation. It is unlikely that it will be possible to avoid surgery on the pancreas in the acute form of the disease.

Chronic pancreatitis: symptoms and treatment in the initial period

The symptoms of this type of disease are not so terrible and do not require urgent help. Now consider what constitutes chronic pancreatitis, the symptoms and treatment of this type of disease.

To begin with, it is necessary to distinguish two periods in chronic inflammation:

1. Elementary.
2. The period of obvious damage to the pancreas.

The first period can last a long time - up to 10 years. Symptoms for this period:

1. Pain syndrome. Pain can be localized in the upper and middle parts of the abdomen, in the left lumbar region, and even in the region of the heart. Most often, such discomfort occurs 15-20 minutes after eating.
2. Nausea, possible vomiting.
3. Bloating.
4. Diarrhea.

The first point is observed in patients often, but the rest may not occur. Even if some symptom appears, then with the help of medicines you can quickly alleviate the condition.

Period of obvious damage to the pancreas

Here the signs are:

1. Pain becomes not so obvious as in the first case.
2. In this case, dyspeptic syndrome prevails: heartburn, belching, nausea, bloating.
3. There is a syndrome of maldigestion. This is when there is a violation of the digestion of food to those particles that would be absorbed.
4. There is a syndrome of malabsorption. In this case, the mechanism of absorption in the small intestine is completely disrupted.

Symptoms of maldigestion and malabsorption include:

• offensive, copious stools;
• weight loss;
• reduced vision in the evening;
• there is bleeding gums;
• conjunctivitis, stomatitis, and itching of the skin may occur;
• anemia develops;
• due to the fact that there is a violation of calcium absorption, there are cramps and pain in the bones;
• neuropsychic arousal;
• the appearance of cold sweat;
• trembling in the body;
• dry skin;
• there is a feeling of constant thirst.

Treating chronic pancreatitis is necessary to avoid pancreatic surgery. Therapy should be adequate and reasonable. Only after passing all the necessary tests, as well as consulting a doctor, therapy can be prescribed. Now let's consider what kind of diagnosis a sick person should undergo in order to clarify the picture of the disease.

Disease recognition

The following types of diagnostics will give a complete picture of the disease:

1. Ultrasound procedure. Ultrasound of the pancreas for pancreatitis is an integral analysis procedure. This type of diagnosis shows how enlarged it is, shows the heterogeneity of the structure, the possible presence of cysts and the expansion of the ducts. The accuracy of such a study is 80-85%. This is not a very high result, so additional laboratory tests should be taken.
2. Computed and magnetic resonance imaging. Such types of diagnostics, as in the first case, show how enlarged the pancreas is. In addition, with the help of such studies, malignant tumors, pseudocysts, and lesions of neighboring organs can be detected.
3. Endoscopic retrograde cholangiopancreatography. This is the most accurate procedure that shows almost 100% result. Plus, this type of diagnostics is the cheapest of the above. True, there is a minus: this method is not the most pleasant, and in some cases painful.

What tests are needed to make a diagnosis?

In addition to the above methods of recognizing the disease, the doctor gives a direction for the delivery of such studies:

1. General blood analysis. His results show signs of inflammation and possible anemia.
2. Donating blood to determine the level of sugar in the blood. Such an analysis is necessary to find out if the patient has diabetes mellitus.
3. General urine analysis. Indicates possible kidney disease.
4. Electrocardiogram and echocardiography rule out heart disease.

After passing the above tests, the picture will become clearly visible, and the diagnosis of "pancreatic pancreatitis" has been made or not.

The role of specialists in the treatment of the disease

Pancreatitis of the pancreas requires competent treatment. Therefore, the patient should be consulted not by one doctor, but by several, so that a general picture of his condition is formed, and the doctors prescribe the correct therapy for him.

The patient should come for a consultation with such specialists:

1. Gastroenterologist. He prescribes treatment.
2. surgeon. The help of this specialist is needed if the pain does not stop or any complications appear.
3. Endocrinologist. It is necessary if the patient has diabetes mellitus.
4. Cardiologist. Consultation with this specialist is necessary to exclude possible pathologies of the cardiovascular system.

The outcome of the treatment will depend on the qualifications of the doctors. Therefore, you need to choose the best of the best in their fields. You can ask about the experience of the doctors, how many surgeries they performed, if there are any statistics. Your health is in your hands. And because of how experienced the specialist is, 80% will depend on the speed and effectiveness of your treatment and a speedy recovery.

Principles of proper nutrition in pancreatitis. Diet

With this disease, it is important to follow certain rules regarding nutrition. Since the health of the patient will depend on the quality and quantity of the food taken. The following principles need to be known:

1. You need to eat food at least 5-6 times a day. You need to eat little by little, in small portions.
2. It is best to eat pureed foods. The fact is that with such a serving of the dish, the mucous membrane of the stomach will not be irritated.
3. Proteins should prevail in the diet (150 grams per day). The amount of fat should not be more than 80 grams per day. You also need to be careful with carbohydrates.
4. A taboo is placed on too hot or, conversely, cold dishes.
5. During the period of exacerbation of the condition, it is desirable to completely abandon any food for at least one day.

Now let's look at what foods have a beneficial effect on the state of the pancreas.

The main condition for such a disease as pancreatic pancreatitis is diet. This is the main principle of treatment. What is the essence of the diet? In the use of only those foods and dishes that will not irritate the mucous membrane of the pancreas. The following products can and should be used by people suffering from this type of inflammation.

1. Wheat bread is stale, yesterday's.
2. Soup in secondary chicken or beef broth.
3. Meat: chicken, veal, turkey. Method of preparation: boil, bake in the oven. Meat should not contain any seasonings.
4. Fish, steamed, boiled or baked in the oven.
5. Dairy products with a low percentage of fat.
6. Boiled vegetables. If you want raw, then only in grated form.
7. Various types of pasta.
8. Cereals (buckwheat, rice, oatmeal).
9. Fruits in a baked form (meaning apples and pears).
10. Jelly.
11. Compotes, jelly, weak tea.

List of foods that are contraindicated in pancreatitis

1. Primary meat or fish broths. That is, fatty, high-calorie.
2. From cereals you can not eat millet.
3. Fatty meats, fish, poultry.
4. From vegetables taboo on radish, radish, cabbage, sorrel and spinach.
5. Fresh bread or any sweets.
6. Various types of sausages, canned food.
7. Alcoholic drinks.
8. Ice cream.
9. Strong tea, coffee.

The use of the above products will lead to a negative outcome, which is called "inflammation of the pancreas" (pancreatitis, simply put). In order not to play roulette with your health, remember the foods that are forbidden to eat with this disease. After all, dieting is already 60% of the positive outcome of the course of the disease.

Treatment of chronic pancreatitis

Therapy of this disease is aimed at reducing the amount of bile. Pancreatitis of the pancreas, the treatment of which is reduced only to the use of special tablets, will give a temporary result. And if, in addition to this, the patient will eat right, follow a diet, then this will be almost a 100% guarantee of a successful recovery.

But now let's focus on drugs that help fight this disease.

So, drugs that help relieve muscle spasm:

1. These are pills for the pancreas. Pancreatitis is treated with the following antispasmodics: No-shpa, Spazmoverin, Spazmol.
2. Substance for the preparation of dosage forms "Papaverine".

The following drugs reduce the secretion of gastric juice:

1. Capsules "Omeprazole".
2. Tablets "Ranitidine", "Famotidine".

The following drugs normalize the process of digestion and regulate the functions of the pancreas. "Allochol", "Pancreatin", "Phenipentol" are tablets from the pancreas. Pancreatitis is not a death sentence.

Also, for the treatment of pancreatitis, drugs are prescribed that inhibit the production of pancreatic enzymes. Among these drugs, the Aprotinin solution is often used.

If severe pain is present or a person is losing weight, then hospitalization and further therapy are possible strictly under the supervision of specialists. Surgical intervention is prescribed if the pancreas is no longer subject to therapy. Treatment, diet with severe damage will not help. Only the removal of one part of it will save from further destruction.

It cannot be said that after drug treatment there is a complete recovery. It is sad to say, but pancreatitis cannot be completely cured. But in order for the pancreas not to collapse further, it is important to undergo treatment, as well as follow a strict diet, which was described above.

Treatment of acute pancreatitis

This type of disease requires hospitalization. In the hospital, the patient is prescribed the following therapy:

In addition, therapy includes:

1. Complete interruption of nutrition by mouth for up to 6 days. This is necessary so that the activity of the pancreas is temporarily suspended.
2. Nutrition intravenously.
3. Artificial activation of urination so that toxic substances leave the body with urine as soon as possible.
4. Bowel lavage.

Prevention of pancreatitis

In order to avoid a relapse, and the disease does not knock you down again, it is important to follow the following rules:

1. Healthy food. Dieting is the most important condition for maintaining the health of the pancreas.
2. A categorical ban on any kind of alcoholic beverages.
3. Give up smoking.
4. Reduce physical activity. Running, jumping, visiting baths and saunas have a bad effect on the pancreas. The ideal option is breathing exercises and massage.

From the article, you learned what a disease called "pancreatic pancreatitis" is. Determined by what methods to treat this disease, as well as how to recognize the disease. We realized that a strict diet is the key to a speedy recovery of the patient.

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Treatment of pancreatitis in a hospital is carried out in order to eliminate the symptoms of the disease, if the disease has passed into a severe phase. Treatment of acute pancreatitis in a hospital is necessary to stop the impact on the patient's body of the current attack of the disease, as well as to eliminate factors that can cause further development of the disease.

Chronic types of illness are usually treated at home, but in some cases they are treated on an outpatient basis in a polyclinic. Sometimes, if the patient has begun necrosis of the pancreatic tissue, the patient undergoes a surgical operation.

How is acute pancreatitis treated in a hospital?

Hospitalization is needed with a severe attack of acute pancreatitis, which cannot be stopped with painkillers at home. After the patient is delivered, he is transferred from the admission department of the clinic to the intensive care unit. Treatment is carried out with the obligatory participation of an anesthesiologist and resuscitator.

Acute pancreatitis is treated as follows:

1. First, doctors relieve the patient of pain and various nervous, reflex disorders with the help of analgesics. For this, drugs Baralgin, Promedol, Analgin, etc. are used. Novocain blockade can be used.
2. To combat hypertension in the bile ducts, doctors use No-shpu, Nitroglycerin and other drugs.
3. The pancreas must be unloaded, so the patient is prescribed hunger. He must take alkaline drinks, such as Borjomi.
4. In combination with the above measures, prevention and treatment of blood clots in the vessels of various organs (pancreas, liver, etc.) is carried out.