Acute Pancreatitis symptoms characterized by sudden onset, intense and violent. The main allegations are:

- Severe abdominal pain with localization in the upper half of the abdomen and left shoulder back and irradiation, is characterized by pain in the classic bar and is resistant to common analgesics. Worsen the food (especially the rich products fat).

- Abdominal tenderness to palpation, abdominal wall edematous, swollen abdomen, epigastria defensive muscle and adjacent areas

- Nausea, vomiting (Food, bilious, mixed)

- diarrhea and stopping bowel

- Malaise - patient ventricular tachycardia, fever, agitation, with cold sweats to the general shock and hemodynamic instability.

Associated signs of severe acute pancreatitis multiple organ failure with impaired breathing, kidney and brain function.

Chronic pancreatitis - They very much like symptoms of acute pancreatitis that (especially in time of attack). The pain is constant, has the same location and radiation in some patients and can seriously affect quality of life.

Other symptoms: significant weight loss through impaired absorption of food (as a result of insufficient exocrine pancreas becomes unable to secrete the enzymes needed for proper digestion of food, as a result of extensive fibrosis that characterizes chronic pancreatitis). Patients show steatorrhea (Diarrhea caused by fat malabsorption, which has a rancid odor, fetid) and eating disorders, especially when eating foods rich in protein and fat. Over time, patients may develop diabetes (by catching the disease process of the endocrine component).

Most cases of acute pancreatitis are caused by gallstones and excessive and chronic alcohol consumption. Other causes are less common: use of various medications, lipid metabolism disorders (particularly triglycerides), infection, surgery or abdominal trauma. 10-15% of pancreatitis still remains without an identifiable cause and are considered idiopathic.

Chronic pancreatitis has the primary cause of chronic alcohol intake (in 70% of cases - patients affected by consuming an average of 15 grams of alcohol / day for 6-12 years) which directly affects and irreversible parenchyma, leading to necrosis and subsequent fibrosis of pancreatic tissue. There are metabolic imbalances caused by chronic pancreatitis, hereditary causes or associated with abusive consumption NSAIDs, Autoimmune pancreatitis or sphincter Odd dysfunction secondary. In children, the most common cause is Cystic Fibrosis (Cystic fibrosis - exocrine glands hereditary disease that affects the liver, pancreas, and determinations with severe lung and causing multiple organ failure).

Causes of acute pancreatitis:

- Drugs: sulfonamides, azathioprine, steroids, NSAIDs, furosemide, thiazide diuretics. Acute pancreatitis may occur in the context of autoimmune diseases such as polyarteritis nodes, systemic lupus erythematosus.

- Paramyxovirus viral infections, with cytomegalovirus, Epstein-Barr.

- Endoscope maneuvers: ERCP .

Less common causes: fatty necrosis, carcinoma of the head of the pancreas, blocking the duct with ascarizi, varicella-zoster virus infections.

Pancreatitis can occur in any individual state apparently in full health, but is more common in adults (compared with young and old) and men (in fact explained by the presence of risk factors). There are several contributing factor to associate a higher risk of developing pancreatic population-specific categories:

- Land biliary disease: gallstones, microlitiaza (sand) biliary

- Diet: chronic and excessive alcohol consumption, excessive consumption of fat

- Metabolic field: metabolic syndrome.

Acute pancreatitis can be the first event when gallstones. The two diseases are related because of excretion of the gallbladder duct joins the pancreatic excretory duct and opens into the duodenum through a common hole. Thus, a calculation of gallbladder migrated to go block to block ampoule duodenal pancreatic duct. Pancreatic juice, but some of the ball will go retrograde channel Wirsung (Main pancreatic duct) within the pancreatic parenchyma, where they activate enzymes that trigger autodigesty. Enzyme activation process is self-sustaining, and the key is to turn tripsinogen in trypsin. Will then be active and pancreatic lipases and amilaze, is producing a chain reaction. The process is not localized, and can extend locally, regionally, causing destructions per pancreatic major local bleeding and intraperitoneal fluid accumulation.

Risk factors for chronic pancreatitis are mainly: acute pancreatitis attacks and prolonged alcohol consumption. People with chronic pancreatitis are usually men, aged 30-45 years

Diagnosis Acute pancreatitis is clinically suspected when a person in full health or presenting important risk factors (chronic alcoholism, history of gallstones) develop symptoms suggestive of violence that is the disease: abdominal pain in the bar, which does not improve the analgesic, malaise.

To confirm the diagnosis, the doctor will perform a series of specialized investigations, including:

- blood count with the determination of hematocrit, hemoglobin

- Tests for kidney function, liver

- serum calcium

- Determination of blood gases

- Determining the level of serum amylase and lipase.

The latter, serum amylase and lipase are specific investigations for diagnosing acute pancreatitis (they are usually high)

- Increases in serum amylase 2-12 hours after onset of symptoms and return to normal within 72 hours

- Serum lipase begins to grow at 4 hours after onset and normalize 7-14 days.

However, in 10% of cases amylase can maintain high serum in cases of acute pancreatitis, chronic pancreatitis and hypertriglyceridemia. Report amylase / lipase is an indicator of etiology: if lipase is 2-3 times higher than amylase, pancreatitis is due to acute alcohol ingestion.

Other investigations include:

- Abdominal X-ray - to exclude a perforation: the case of acute pancreatitis on abdominal radiography is a typical aspect called sentinel loop, or radiopaque gallstones can be seen in 10% of patients

- Abdominal computed tomography - experts do not recommend them in the first 48 hours since the result can be not important enough.

Certainty of diagnosis chronic pancreatitis includes:

- Determinations amilazelor lipases and serum: elevated in chronic pancreatitis are not advanced but objectivity can be a useful marker for pancreatic inflammation

- Determining the level of triglycerides.

Imaging tests include abdominal ultrasound, radiography, nuclear imaging, and computed tomography.

Gold standard in terms of diagnosis of chronic pancreatitis is ERCP (endoscope retrograde colangiopancreatografy). This is practice in case of acute pancreases, but only 48-72 hours after onset.

For diagnosis of acute pancreatitis ultrasound is the method of choice, being noninvasive and providing data on complex free fluid in the abdomen, appearance and pancreas and peripancreatic tissue present in gallbladder stones.

Other tests are useful in determining the diagnosis of chronic pancreatitis bilirubin and alkaline phosphates (They are usually high), the determination of RF, antinuclear antibodies (if autoimmune etiologies).

In advanced stages of disease when malabsorption and diabetes are present, blood analysis, urine and the seat will confirm the disease. In these situations it is and oral glucose tolerance test to assess the state of the endocrine pancreas.

Endoscopies and ultrasound guided pancreatic biopsy are used to extract a small piece of tissue for analysis and diagnosis, type and stage morphopathological evolutionary process.

May be used in emergency and Laparoscopy to confirm diagnosis and to quickly view the damage, complications and the extension of the disease process. However, such exploration is considered by many dangerous and can lead to infection can hardly be stopped and treated.

Note!

Diagnosis of acute pancreatitis can be considered when a patient has severe abdominal pain amilazemie least 3 times higher than normal.

Treatment of acute pancreatitis

Therapeutic measures taken in patients with acute pancreatitis are supportive, medical and surgical specialty.

In supportive measures the supply and management practice analgezics suppression. Not recommended morphine or its derivatives as the sphincter odd spasm and cause not only aggravate the pain. Still manages antispasmodic and oxygen mask. The patient will be restrained in a prone position and transported to the hospital. During this time the patient will receive intravenous fluids to prevent dehydration. Approximately 20% of patients develop severe acute pancreatitis and require hospitalization in an intensive care unit. Here the patient can be closely monitored because of serious forms of pancreatitis associated with a major vital risk severe damage to liver, lungs, heart and kidneys.

Medical treatment apply in cases uncomplicated and consists of a suppression effect by administration of pancreatic enzymes, sedation, pain, preventing infection (with antibiotics and reduce inflammation - with corticosteroid therapy).

Acute pancreatitis attack lasts several days in the absence of complications and is properly treated by complete medical and supportive measures. However, patients with acute pancreatitis should be hospitalized and followed in a surgical department because his condition is unduly easy. Complications of acute pancreatitis are generally intestinal occlusions, organ perforation, peritonitis generalized (in the initial and early stages) or complications of peripancreatic necrosis (suppurations, abscesses and even septicemia).

In severe cases, extensive pancreatic necrosis, infectious complications will be treated surgically, removing devitalized tissue is very important to promote rapid healing.

Acute pancreatitis complicated (especially when the nature of obstructive, infectious and erosion) is surgery. Also, acute pancreatitis gallstones are solved by surgery (the immediate removal of calculus). Generally, after the stones are removed, the inflammatory process gradually decreases in intensity and completely turns off, the pancreas returns to previous state.

Surgical intervention can be achieved by classical or laparoscopic method - minimally invasive technique. In this process are done several small incisions (5-10 millimeters) in the abdominal wall through which it is inserted and laparoscopic instruments, a tube equipped with a video camera that transmits images of the abdominal cavity. Is connected to a monitor and so the surgeon can maneuver the instruments with great precision. The advantages of this technique are the small incisions, minor scars, less intense pain, less risk of infection and recovery.

Note!

Indications for surgery were patients with an infected pancreatic necrosis and complications.

Another therapeutic approach is represented by ERCP, but it should be done only in the first 24-72 hours after admission. ERCP reduces mortality and morbidity, and indications they are:

- The patient's clinical deterioration or lack of improvement of symptoms under medical supportive treatment in 24 hours

- Detection of common bile-duct stones and intrahepatic ducts horses / extra hepatic dilated at CT.

ERCP disadvantages are a major risk of developing bleeding after surgery and the fact that this technique itself is able to precipitate an outbreak of pancreatitis or pancreatitis triggered already infected, but sterile.

Treatment of chronic pancreatitis

Chronic pancreatitis is more difficult and more complicated to treat. The first therapeutic measures consist of pain by analgesics and improvement of metabolic and nutritional status of the patient (these problems are a direct consequence of functional failure of pancreatic exocrine and endocrine). Patients will receive enzymes to supplant the normal secretion and insulin if necessary and (if the disease process is so intense and evolved that can not synthesize and secrete insulin, glucagons - is therefore abolished and endocrine function of the gland).

The patient will receive these enzymes for life, then, to stimulate the function and absorption of essential nutrients. Replacement of pancreatic enzymes to treat malabsorption and steatorrhea. A low-fat diet may have protective effects.

Abdominal surgery can relieve pain, can restore proper drainage of pancreatic secretions (in cases of chronic pancreatitis by blocking lithiasic) and reduce the frequency of attacks. The most frequent indication for surgery is the pain and slow functional deterioration. Also, chronic pancreatitis in the event of needing surgery complications: biliary obstruction, duodenal, pancreatic cyst and pseudocysts, gastrointestinal bleeding. Operations are generally pancreatic resection or drainage procedures.