Despite the achieved success in treatment of acute pancreatitis, mortality at this pathology continues to remain high. Treatment of patients with acute pancreatitis is carried out as in offices of a surgical profile (easy forms of edematous pancreatitis), and in intensive care units and resuscitation (medium-weight and severe forms of destructive pancreatitis). Timely hospitalization of the patient with a severe form of pancreatitis in intensive care unit is extremely important as it allows to provide all complex diagnostic and treatment at once. Treatment of such forms of pancreatitis demands big material inputs, work and time.
The pancreatitis pathogeny even is up to the end not studied now and the set of the reasons leading to its development is known. The bulk of the reasons is made by cholelithiasis and a chronic alcohol abuse (to 75% of all reasons). There are also certain geographical differences in frequency and development of a disease. Reaction to various etiological factors can have genetic predisposition that conducts to various forecast of a disease in different ethnic groups. The lethal outcome at the beginning of a disease is usually caused by development of a syndrome of the system inflammatory answer and also multiorgan insufficiency. In more remote terms sepsis and pyoinflammatory complications are the leading reasons of lethality.
The clinic of acute pancreatitis in many cases is rather typical. The acute pain in upper parts of a stomach which often begins in two-three days after intake of strong alcohol or considerable errors in food towards greasy food which causes considerable load of a pancreas is noted. The debut of a disease can quickly develop, and can drag on for several days.
Often patients complain of a dorsodynia of the surrounding character, they note nausea, vomiting and also excitement and concern. Regarding cases acute pancreatitis can begin with development of shock or even coma.
At physical inspection clinical manifestations of pancreatitis often depend on severity of a disease. The pain syndrome, morbidity at a palpation of epigastric area is noted, signs of obstruction of the general bilious channel in some cases, the exudate in a pleural cavity can be noted. If the patient asks for medical care late, in process of development of a disease in epigastric area volume education owing to development of a pseudocyst of a pancreas can be noted.
The diagnosis of acute pancreatitis is confirmed at a biochemical blood analysis and also at ultrasonography and a radiological research. At a biochemical research the level of amylase of blood serum increases in 6–12 hours after the beginning of a disease, this enzyme quickly is removed from a blood-groove and at pancreatitis is raised within 3–5 days. This test cannot be used alone for diagnosis as the level of amylase can increase at various pathology. Besides, measurement of level of enzymes has the low predictive importance for assessment of a course of a disease and an outcome. In certain hard cases, owing to a pancreas necrosis, the level of amylase can be within norm.
The great value in diagnostics of pancreatitis belongs to radiodiagnosis, namely — a computer tomography. The research with oral or intravenous contrasting has to be executed in 48 hours, carrying out a research in earlier terms can not give complete idea of character and prevalence of a disease.
Treatment of the patient with pancreatitis in intensive care unit includes the comprehensive program directed to various links of an etiology and a pathogeny of a disease. Treatment is carried out together with the surgeon who has to define need of an operative measure and its volume and also resolve an issue with elimination of the reason of pancreatitis (if it is removable in this clinical situation). If necessary invasive monitoring is used. Adequate infusional therapy at pancreatitis has huge value as in the damaged tissues of a pancreas and parapancreatic cellulose large volumes of liquid can accumulate. Inadequate infusional therapy can lead to further distribution of a necrosis. Also carry out elimination of a pain syndrome for what regional methods of anesthesia can be used. For prevention of an infection appoint antibacterial drugs of a broad spectrum of activity. Adequate nutritive support shall be provided to the patient.