Symptoms and treatment of acute hemorrhagic pancreatitis. Pancreatic necrosis of the pancreas - a lethal outcome? Prognosis for pancreatic necrosis

Pancreatic necrosis of the pancreas involves the death of cells this body due to the development of pancreatitis. The diagnosis is made by a pathologist, since a sharp exacerbation this process almost always leads to death.

Pancreatic necrosis occurs as a result of pancreatitis if it long time was not treated, or the patient was engaged in ineffective self-treatment without the supervision of a specialist.

Pancreatitis is formed as a result of:

persistent alcohol abuse;
malnutrition, in which dishes with a high fat content predominate;
diseases of bile-forming and excretory organs;
pathology of any organs abdominal cavity.

The most popular reason for getting people on the table to surgeons is the simultaneous abuse of large doses of alcohol and overeating of fatty foods. As a rule, after the festive gatherings with eating to failure, the departments of surgery and gastroenterology are overcrowded with patients.

Necrosis of the head of the pancreas means an urgent call for an ambulance or delivery of the patient to surgery department. Unfortunately, most of The victims are immediately diagnosed with pancreatic necrosis, since before entering the hospital there were prerequisites for pancreatitis.

It is also worth noting the more rare causes of this diagnosis:

If any of the above is present, the person should be regularly observed by a gastroenterologist to prevent complications.

Kinds

In the presence of complications of the pancreas pancreatic necrosis is sufficient common cause lethal outcome. The probability of death depends on the type of disease. Classification occurs according to several parameters, each of which should be considered separately.

General classification

To begin with, the doctor determines the type of focal development of necrosis:

small focal;
mid-focal;
macrofocal;
subtotal;
total.

The variety is determined by the size of the lesion of the gland by pancreatic necrosis. The first and second stages do not have a clear boundary, the third is quite serious. At the fourth stage, experts observe the death of more than half of the organ.

Hemorrhagic total necrosis - what is it? This is the rapid and complete death of an organ, which leads to death.

The above stages previously had only two groups - limited (the first three stages) and common (the last two, leading to death). This simpler classification is considered an alternative.

Classification by the presence of an infectious process

There are also two more types of pancreatic necrosis - sterile and infected. This classification significantly affects treatment options, as it indicates the presence or absence of an infectious complication in the organ. Let's consider them in more detail.

Hemorrhagic form

Hemorrhagic pancreatic necrosis (pancreatitis) or pancreatic necrosis is a sudden onset disease that leads to death within a day. The disease is also called "gangrene" - necrosis of body tissues by decay.

The reasons

Hemorrhagic pancreatic necrosis develops as a result of such factors:

severe poisoning;
malnutrition with the abuse of dishes that disrupt the digestive tract (spicy, fatty, sour and salty);
allergy;
with diabetes mellitus in combination with diseases digestive organs;
transferring lupus;
reception of numerous medicines in dosages not controlled by a doctor;
certain types of infectious diseases (mumps, acute intestinal infections);
hypothyroidism and the like.

The main reason for the appearance of necrosis is the joint abuse of alcoholic beverages and fatty foods. The cause of death in hemorrhagic pancreatic necrosis is that the flesh rapidly rots, acting toxic from the inside on all organs and systems.

Symptoms

A clear sign of developing necrosis is clouding of the patient's consciousness. Since during the internal decomposition of living tissues, toxic substances, this causes a shock in the body:

the skin of the victim turns pale;
lost pulse;
intestinal obstruction develops.

Other diseases during an exacerbation, such as cholecystitis, also have such signs. Pancreatic necrosis is different in that all these manifestations are expressed immediately after eating.

Acute hemorrhagic pancreatic necrosis develops from one to two weeks, ending in death. In isolated cases, everything happens in a day.

Pathogenesis

The process is to break normal operation enzymes secreted by the pancreas. At normal process they are released from the organ and flow into the intestinal cavity. This is where the bile produced by the liver comes in. Upon contact, these two substances are activated and begin to digest food.

When the sequence is broken, the enzymes are activated in the ducts, not reaching their destination. Because of this, they no longer process food, but the very gland that produces them.

Pancreatitis becomes acute due to the strong alcohol intoxication. In this case, the following changes are observed in the body:

at the sphincter, which controls the flow of bile and pancreatic fluid into the cavity of the duodenum, the tone increases;
the production of digestive substances is enhanced;
significantly increases the pressure on the bile and pancreatic passages.

All these changes lead to the movement of bile into the pancreatic ducts, since it has nowhere else to flow. The sphincter does not allow it to pass into the intestine, it mixes with pancreatic juice and flows into the passages for enzymes in the pancreas. This is how these elements are activated. First of all, the membranes of healthy cells are destroyed, and if the process continues, the protein is cleaved under the action of enzymes, which is called pancreatic autolysis.

This is how the gland self-digestion occurs. In fact, it destroys itself.

Note! A serious complication is pancreatic necrosis with peritonitis - the ingestion of the contents of the digestive organs into the abdominal cavity.

Diagnostics

It is impossible to make a diagnosis by analyzing the symptoms. Pancreatic necrosis is no different from many other diseases gastrointestinal tract: bloating, pain in the abdomen, periodic nausea, up to vomiting, diarrhea, as a result - dehydration of the body. AT exceptional cases there is blueness of the abdomen.

Taking into account the problems of symptom analysis, the diagnosis is made according to the results of instrumental and laboratory examination. Results indicating pancreatic necrosis:

Clear signs of alcohol abuse.
The manifestation of pronounced symptoms occurs at a time when the patient is in the stage of intoxication.
Edematous process around the pancreas.
The patient suffers from hepatic and biliary diseases.

Laboratory diagnostics includes the study of blood and urine for amylase levels. As an instrumental examination, ultrasound, CT, MRI are performed. It is these three studies that make it possible to identify the extent of pancreatic necrosis and the nature of changes in the parenchyma of the gland.

Treatment

The best treatment would be to perform an operation with the removal of purulent parts of the organ that has decomposed, and cleaning the ducts from pus. As the patient is tormented severe pain in the abdomen, he is injected intravenously with morphine or novocaine. After the operation, a course of antibiotics is selected. With severe intoxication of the body, a transfusion of pure donor blood is possible.

If the operation is carried out at the wrong time or unsuccessfully, and the death of cells begins to spread beyond the pancreas, the only possible help from doctors is an anesthetic to relieve the agony of the dying. Repeated surgery will not help.

With successful timely removal of decomposition and cleaning of the ducts, the patient with great difficulty, but survives, continuing treatment with a course of drugs.

In the presence of diseases of the biliary organs, it is necessary to be observed by a gastroenterologist. Also, as a warning of exacerbation, it is important to eat as fully and correctly as possible, excluding heavy food, support healthy lifestyle life and quit smoking and alcohol. It is recommended to undergo a general check-up every six months.

The development of the disease is based on the loss protective function from exposure to pancreatic enzymes. As a result, the cells of the organ are partially or completely destroyed, areas of necrosis are formed. And this leads to inflammation and enlargement of the organ.

The reasons for the development of such a pathology:

violation of the outflow of pancreatic juice, resulting in inflammation of the pancreas;
infections of the biliary tract and bile ducts;
abuse of ethyl alcohol;
ingress of pancreatic juice into the ducts;
increased blood clotting as a result malignant neoplasms or vascular thrombosis;
consequence surgical intervention;
organ injury;
transferred severe infectious or viral diseases;
autoimmune disorders;
taking medications;
constant stress.

Predisposing factors are malnutrition, namely the use of fatty foods and alcohol, in acute or chronic form.

Symptoms and stages

Symptoms depend on the course of the disease and the size of the lesion. According to the last sign, it is limited (areas of necrosis are concentrated in one area) and widespread (the disease affects the entire department or the entire organ).

Classification of hemorrhagic necrosis by form:

Spicy. The disease develops as a result of acute or. Acute hemorrhagic pancreatic necrosis is manifested by pronounced symptoms and leads to serious consequences.
Chronic. The severe form is characteristic only for the stage of exacerbation.

By the severity of the injury:

Local. It is characterized by partial cell death.
Total hemorrhagic pancreatic necrosis. It is manifested by the death of all cells.

By the presence of infection:

Infectious.
Sterile.

By the nature of the flow:

Abortive.
Progressive.

Regardless of the type, the disease must be treated.

The main symptom of hemorrhagic pancreatic necrosis is pain in the left side. Painful sensations are strong, sometimes they radiate to the lumbar region, shoulders or chest.

Other signs:

severe vomiting with an admixture of blood and bile;
yellow coating on the tongue;
dry mouth;
bloating, flatulence;
diarrhea;
decreased urine output, symptoms of dehydration;
purple-blue spots on the abdomen, which indicate bleeding;
swings blood pressure;
fever, fever;
respiratory failure;
increased heart rate and heart rate;
paleness, yellowness, or redness skin on the face;
jumps in glucose levels;
incoordination, agitation or lethargy.

As complications develop, symptoms become more severe. Possibility of multiple organ failure internal bleeding, abscesses and peritonitis.

In 20% of patients, the acute form of the disease leads to a crisis, in 35% it causes a mental disorder.

Hemorrhagic pancreatic necrosis develops gradually. There are 3 stages:

At the first stage, active reproduction of pathogenic microorganisms occurs, which weaken the organ, provoke intoxication with waste products. The duration of the first stage is a week.
The second is characterized by purulent decomposition of the cells of the organ with the further formation of holes in its walls.
In the third stage, most of the pancreas is affected, inflammation spreads to neighboring organs.

Which doctor should I contact for hemorrhagic pancreatic necrosis?

The treatment of hemorrhagic pancreatic necrosis is carried out by a gastroenterologist.

Diagnostics

More often, patients go to the hospital for final stages with acute pain. Signs of pancreatic necrosis are similar to other diseases digestive system Therefore, the doctor prescribes the following diagnostic methods:

blood analysis;
analysis of feces and urine;
determination of acidity gastric juice;
Ultrasound of the abdominal organs;
radiography of the pancreas;
probing to determine the presence of enzymes in pancreatic juice;
puncture for the collection of necrotic tissue for examination;
endoscopic cholangiopancreatography.

Additionally, CT or may be needed.

Treatment

Treatment takes place only within the walls of the hospital. At severe course the patient is placed in intensive care unit where he is constantly under the supervision of medical personnel.

Folk remedies or at home hemorrhagic pancreatic necrosis is not treated.

Treatment of the disease can be conservative or surgical.

In the first 3-4 days after admission of the patient to medical institution starvation is shown. Nutrients are given intravenously. Be sure to wash the stomach through a tube.

Medical treatment:

taking painkillers and antispasmodics - No-Shpy, Ketanov or Novocain;
the use of drugs to reduce the activity of the pancreas - Gordoksa, Atropine sulfate;
taking funds to normalize acidity - Kvamatela;
the use of antibiotics - Ceporin or Cefalexin;
use of means for removing toxins - Ringer's solution.

Medical therapy is aimed at relieving symptoms.

With extensive damage, treatment is surgical. Spend laparoscopic drainage of the abdominal cavity and intra-abdominal dialysis.

At infectious lesion choose another type of surgical intervention - resection of the organ with the removal of areas of necrosis or sequestrectomy with resection of dead zones.

Recovery takes up to 6 months.

Mortality and prognosis

Mortality from hemorrhagic pancreatic necrosis is 7-15%, in severe cases - 40-70%. The disease leads not only to disruption of the functioning of the pancreas, but also to the whole organism. The patient's immunity decreases, the process of digestion is disturbed.

Hemorrhagic pancreatic necrosis can cause necrosis of cells of other organs that are located near the pancreas.

The most common cause of death from this disease is intoxication of the body due to purulent peritonitis.

The prognosis for recovery is favorable only with early admission to the hospital and correct therapy. After treatment, you need to follow a diet and give up bad habits.

Prevention

Preventive measures are proper nutrition quitting smoking and drinking alcohol. It is necessary to treat in time, dyskinesia of the bile duct, as well as 12 duodenal ulcer.

You need to be attentive to your health, if you feel worse, go to the hospital. This is the only way to avoid serious consequences.

Useful video about pancreatic necrosis

Leads to necrosis of the pancreas. On the early dates the symptoms are very poor, and some pallor of the skin, yellowness of the sclera, and slight cyanosis can be noted.

The pulse is normal, perhaps slightly accelerated, the temperature is also within normal limits, but it increases with infection of necrotic foci.

Symptoms of total pancreatic necrosis

There may be swelling and pain in a stomach. Then the paresis and bloating of the intestine increase, there is a weakening of peristaltic noises.

The body gives a systemic response to inflammation with developing gland necrosis, as a result, vital organs are disrupted and cardiovascular, respiratory, gastrointestinal, liver and kidney failure develops.

Organs respiratory system respond with interstitial pulmonary edema, accumulation of transudate in pleural cavity. Cardiovascular system - cyanosis of visible mucous membranes and skin, hypotension, decreased cardiac output, filiform frequent pulse, myocardial ischemia, a mental disorder begins, excessive arousal and confusion appear. Manifestations of "mechanical" jaundice are noticeable.

Complications of total pancreatic necrosis

Complications of pancreatic necrosis are multiple organ failure, hypovolemic shock, liver damage, pleuropulmonary complications, abscesses of the retroperitoneal tissue and pancreas, internal and external pancreatic fistulas, peritonitis and bleeding, since a breakthrough into the free abdominal cavity of a parapancreatic abscess is possible.

How to treat total pancreatic necrosis?

During surgery, it is necessary to remove infected necrotic tissue areas, and in case of peritonitis, drainage of the abdominal cavity should also be performed. With total necrosis, complete removal pancreas, this is a very traumatic operation, in which there is a high fatal outcome and are trying to get rid of it.

Recently, "closed" options for the treatment of necrosis have been more often used, in which purulent cavity drains are installed, while the contents of the brush of the cavities are aspirated, they are washed and inserted antibacterial agents. This is a low-impact method.

However, total hemorrhagic pancreatic necrosis is a very severe degree of the disease, here 90-100% of the retroperitoneal tissue is affected along the lateral canals to the iliac fossae. In this case, the patient's condition worsens over the course of a day or three, even with massive infusion therapy, and to the whole set of features total defeat symptoms of multiple organ failure and pancreatogenic shock are added.

A blood test shows a noticeable increase in leukocytes, which occurs due to a significant number of neutrophils, and leukocytosis is also possible. Does not occur in leukocytosis normal discharge pancreatic enzymes into the intestine, accumulate due to outflow in the intercellular space of the pancreas, then they penetrate into the blood and exit with urine. Therefore, an excessive amount of pancreatic enzymes is determined in the blood, on which the diagnosis of this pathology is based. It takes place, and the blood sugar content exceeds 10 mmol / l, severe dehydration occurs in the serous cavities.

In addition, multiple organ failure is observed, which develops very quickly, noticeably and terminal state. Due to the fact that with total pancreatic necrosis of a very severe degree, most of the cells of the pancreas die off, enzymes do not enter the bloodstream and the presence of diastase in the urine may not exceed normal values and even decrease, and the lack of insulin production and cell damage leads to hyperglycemia and glucosuria.

by the most real method treatment for total necrosis is the implementation of early radical operation, which may be resection of the gland, pancreatectomy, sequestrectomy. First two surgical procedures recommended for patients for whom active complex treatment, and the progression of the necrotic process takes place.

Hemorrhagic pancreatic necrosis (ICD code 10 K86.8.1) is a complete or partial tissue death.

The disease is one of the pathologies that can short time lead to the death of the patient.

The difficulty in treatment is associated both with the rate of development of pancreatic necrosis (1 day), and with the fact that the affected organ, even after treatment, does not recover and does not produce some enzymes and hormones.

That is why one of the complications of the disease is diabetes 2 and 3 types.

Development mechanism

What is this disease and what are the reasons for its development? With pancreatic necrosis, a fistula is formed, through which the contents of the pancreas penetrate into the abdominal cavity almost unhindered.

Dead tissues, together with hemorrhagic exudate, become the impetus for the development of purulent peritonitis, which in 50% of cases leads to the death of the patient.

Tissue necrosis appears due to the inability of the pancreas to withstand the aggressive gastric juice. Enzymes are not excreted from the affected organ and alkalis begin to break down protein compounds.

That is, the pancreas begins to digest itself. This destruction is not limited. Necrosis extends to penetrating organ blood vessels, injuring them and causing bleeding.

Causes of pathology

Hemorrhagic pancreatic necrosis does not develop from scratch.

The following factors can provoke a serious violation:

alcohol or food poisoning;
abuse of dishes that disrupt the gastrointestinal tract (spicy, salty, fatty);
allergic reactions;
autoimmune diseases;
malignant formations, accompanied by a violation of blood clotting;
blockage of the bile ducts;
infectious diseases, which include acute intestinal infections, lupus and mumps;
taking drugs and medications without a doctor's prescription;
endocrine disorders (hypothyroidism, diabetes mellitus, complicated by diseases of the digestive tract).

Among the people at risk, the following categories can be distinguished:

alcoholics and drug addicts;
elderly people with a bouquet of concomitant diseases;
patients with pathologies of the pancreas, liver, gastrointestinal tract;
people who regularly abuse spicy, salty, smoked and fatty foods;
people with abdominal injuries.

Symptoms of the disease

Symptoms of hemorrhagic pancreatic necrosis are always acute. It is impossible not to notice them. On the initial stage the patient begins to experience nausea, sharp pain, more often localized in the left hypochondrium.

Sometimes the pain is girdle, sometimes it resembles symptoms heart attack. Decrease pain a person succeeds only in a sitting position, always with the knees pulled up to the stomach as much as possible.

Also, the pathology is characterized by such signs:

plentiful and frequent vomiting bringing no relief;
a strong increase in body temperature to maximum values;
changes in the skin (redness, pallor, the appearance of hematomas, increased pain sensitivity with a light touch);
against the background of pancreatic necrosis, ascites, phlegmon of the abdominal cavity develops;
blood sugar levels rise sharply, which is especially dangerous in diabetes and can lead to;
there is a feeling of imposition of the language;
the volume of urine released during urination decreases sharply;
shortness of breath appears, the pulse quickens, blood pressure becomes unstable;
there are violations on the part of nervous system(lethargy or agitation);
every fifth patient experiences a state of collapse, every third falls into a coma.

Stages of progression

There are several mandatory stages of development.

At the first - in the affected gland, they begin to actively multiply pathogenic microorganisms. It is at this stage that the patient begins to suffer from vomiting, the stool becomes unstable, and the body temperature rises significantly.

At the second stage, purulent decomposition of cells begins, a failure forms in the organ. The most dangerous stage- third. Inflammation quickly spreads to areas of healthy tissue, the destruction of the pancreas is accelerated.

Given the speed with which one stage replaces the previous one, it is impossible to hesitate to call an ambulance in any case.

After the patient is delivered to a medical facility, he is carefully examined, the type and stage of pancreatic necrosis are determined, and treatment is started. emergency treatment pathology.

A disease that can develop as a result of any predisposing factor requires mandatory hospitalization and emergency treatment.

Classification and types

Necrosis resulting from pathology is divided into several types. This allows you to prescribe the optimal treatment regimen and operate on the patient delivered to the hospital in time.

Defeat can be:

small focal;
mid-focal;
macrofocal;
subtotal;
total.

The diagnosis is made based on the size of the area of the pancreas affected by pancreatic necrosis.

At the first or second stage, the boundaries are fuzzy. On the third - they are clearly visible and outlined. The subtotal stage involves the death of most of the organ, the total - the complete death of pancreatic tissues.

In the final stages, surgical intervention is indispensable. Affected tissue must be completely removed.

Pancreatic necrosis is also distinguished by the presence or absence of infectious process infected or sterile.

Establishing diagnosis

On examination and subsequent examination, hemorrhagic pancreatic necrosis is differentiated from other pathologies. To do this, the doctor interrogates the patient, finding out if he abuses alcohol or fatty foods, what chronic diseases are in his anamnesis.

a blood test showing the doctor data on the content of pancreatic enzymes (an increase in these indicators by 6-9 times indicates hemorrhagic pancreatic necrosis);
analysis of gastric juice, which allows you to quickly and accurately determine the level of acidity;
urinalysis for research on ureaplasma and trypsinogen;
probing for the determination of bicarbonates and enzymes;
analysis of exhaled air for the presence of amylase and triglycerides;
coproscopy necessary to study residual fats in stool Oh.

Percutaneously, a puncture of the necrosis area is taken, endoscopic cholangiopancreatography and, if necessary, laparoscopy of the abdominal cavity is performed, which makes it possible to see the whole picture of the lesion of the pancreas and other vital organs. important organs.

Only after complex diagnostic manipulations begin to treat the patient.

Treatment of the disease

At the first symptoms of pancreatic necrosis, the patient is hospitalized. After the diagnosis is made, the patient is sent either to the intensive care unit or immediately to the operating room. It is important to act as quickly as possible to save the pancreas and the life of the patient.

Treatment consists of:

withdrawal pain syndrome and spasm from the bile ducts;
stopping enzymatic activity;
decreased production of gastric juice;
prevention of secondary infection.

The patient is given drugs that relieve pain, for example, novocaine blockade. Pain relief relaxes the ducts, allowing the pancreatic juice to exit.

Increased production of enzymes is managed with anti-enzymatic drugs, and antibiotic therapy prevents infection of other organs and tissues. This allows you to stop the process of violation of the enzymatic and humoral functions pancreas.

Conservative therapy is carried out against the background of mandatory fasting. Required nutrients are administered exclusively intravenously to exclude the release of pancreatic secretions.

Previously, all the contents of the stomach are removed by washing. It is important to provide the patient with peace and comfortable conditions. The room should be ventilated with a comfortable air temperature. This will help prevent the further spread of toxins released by the patient throughout the body.

If there is no improvement, there is a need for emergency surgery. The type of operation depends on the course of hemorrhagic pancreatic necrosis. Laparoscopy or percutaneous drainage is relevant for cases where there is no infection.

Abdominal surgery is performed with accumulation a large number exudate. Peritoneal dialysis is widely used, which cleanses the blood of toxins and enzymes and thereby prevents the death of the patient from intoxication with decay products.

Life after

The postoperative period is long and difficult. The most important condition recovery is the observance of a rest regimen with minimal physical activity for the duration of everything recovery period(at least 4 months).

It is necessary to take insulin-containing drugs, drugs that promote the digestion of food (enzymes).

The patient who has undergone acute pancreatic necrosis, physiotherapeutic procedures and physiotherapy exercises necessary for the speedy rehabilitation are prescribed.

Food restrictions are lifelong. Diet involves reducing the load on the pancreas. It is important to eat regularly and often (5-6 times a day). Food should be of neutral temperature and soft texture.

boiled or steamed vegetables;
porridge on the water;
bread (dried);
light broths;
dairy products with a minimum fat content;
poultry meat.

There are a number of products that people who have had this terrible disease should be forgotten forever.

Taboo is imposed on:

canned foods (fish, meat, vegetables);
alcoholic beverages, even in a minimal amount;
soda;
smoked meats;
fatty meats;
any fresh baked goods;
fast food;
whole milk;
seasonings;
pickles;
vegetables, fruits and berries (fresh).

It is important to adhere to such a diet in order to prevent the development of complications associated with the inability of the pancreas to produce essential hormones and enzymes.

Since diabetes mellitus often becomes a complication of pancreatic necrosis, it is important to monitor, be examined regularly and follow all the medical recommendations of an endocrinologist.

Video from a patient who had the disease:

Prevention of hemorrhagic pancreatic necrosis

A person who is at risk of developing this pathology should take preventive measures. To do this, you should completely abandon the use of alcoholic beverages, adhere to the principles of proper nutrition.

It is imperative to timely diagnose and treat diseases that can lead to the development of hemorrhagic pancreatic necrosis - biliary dyskinesia, ulcer duodenum and stomach, cholecystitis.

It is worth remembering that even a single abuse of fatty foods or alcohol can lead to pancreatic necrosis and, as a result, to complex operation and even to death.

Particularly careful for festive table should be people with a history of diabetes mellitus of any type. Simple preventive measures do not guarantee that pancreatic necrosis will not develop, but they reduce the likelihood of experiencing the pathology on yourself to a minimum.

Hemorrhagic pancreatic necrosis is a disease of the pancreas, in which there is a fairly rapid death of the cells of the organ without the possibility of their renewal. Most often, the disease manifests itself when a person has pancreatitis in an acute form or during an exacerbation of the chronic form of this disease. Acute hemorrhagic pancreatic necrosis is diagnosed in patients from the middle and older age categories. There are no restrictions regarding gender. Pathology can develop under the influence of many adverse factors.

Reasons for development

Hemorrhagic pancreatic necrosis develops under the influence of the following reasons:

penetration infectious agents in bile ducts and bile ducts;
predilection for alcoholic beverages. This pathological condition quite often begins to develop in people who abuse alcohol and use it without any measure;
reflux of pancreatic juice back into the pancreatic ducts. Most often, such a pathological condition is observed during the formation of calculi in gallbladder person;
DIC or thrombohemorrhagic syndrome. These two pathological conditions progress in people after chemotherapy, with the development of diseases of a bacterial and viral nature;
progression of pathologies of an autoimmune nature. This group primarily includes hemorrhagic vasculitis;
organ trauma. May occur as a result of strong external influence(for example, a blow) or during an operable intervention on organs located in the abdominal cavity.

If the patient progresses local or total hemorrhagic pancreatic necrosis, then in this case it is necessary to pathological process the acinus will be involved. This is a special section of the gland, which is responsible for the production of enzymes that are a component of pancreatic juice. If their number becomes very large, then they begin to negatively affect the tissues of the pancreas and blood vessels. An enzyme such as elastase corrodes the vessel wall, thereby provoking the occurrence of hemorrhages (hemorrhages). Hence the name of the pathology - hemorrhagic pancreatic necrosis.

Symptoms

Such a disease usually proceeds with a pronounced clinical picture. acute form pancreatic necrosis can lead a person to collapse, and in a third of patients with such a diagnosis, psychological disorders. The progression of the disease is accompanied by the formation of specific pancreatic-retroperitoneal fistulas - this leads to the fact that the contents of the pancreas, including dead cells, penetrate the peritoneum. It is for this reason that patients develop abdominal tissue abscesses and peritonitis. Even with treatment, the prognosis can be disappointing - in half of the cases a person dies. The cause of death is a severe intoxication syndrome.

The main symptoms indicating the development of pathology include the following:

redness of the skin on the face;
occurrence of pain syndrome acute nature in the area of the left hypochondrium. Pain may radiate to chest, lower back and shoulder;
on the abdomen, the formation of several spots with a blue-purple hue can be noted;
dry mouth. If you examine the oral cavity, it can be noted that the tongue of a sick person is lined;
an increase in body temperature to critical levels;
nausea and vomiting. A person vomits many times, but his condition does not improve;
abdominal distension and flatulence;
violation of the excretion of feces - a person has severe diarrhea;
Heart rate increases;
dyspnea;
blood pressure indicators are constantly changing - a sick person may have both hypertension and hypotension;
the amount of excreted urine decreases;
mental disorders.

If the patient has at least one of these signs, he should be immediately taken to a medical facility for diagnosis and full treatment.

Diagnostic measures

The first stage of diagnosis is a survey and examination of the patient. It is important for the doctor to clarify the first time the expression of symptoms, their intensity, the location of the pain. In addition, it is clarified whether the patient has any chronic diseases in particular the pancreas. Next is the palpation of the abdominal cavity, examination of the skin and mucous membranes.

The second stage is the laboratory and instrumental diagnostics. To the most informative methods include:

blood and urine tests;
general clinical;
a blood test to detect the level of pancreatic enzymes;
analysis of excrement;
analysis of urine to determine the level of uroamylase and trypsinogen;
assessment of the acidity of gastric juice;
retrograde pancreatocholangiography performed using endoscopic equipment;
percutaneous puncture of a site with necrosis.

In some situations, doctors may resort to abdominal laparoscopy.

Therapeutic measures

Hemorrhagic pancreatic necrosis is treated with conservative techniques and surgical intervention. Conservative therapy includes:

taking painkillers;
the use of novocaine blockade;
intravenous infusions of Trasilol and Kontrykal to inhibit enzyme activity;
the appointment of funds to reduce the level of acidity of gastric juice;
taking antibacterial drugs.

If the above measures did not bring the effect, then in this case, surgical intervention is performed.