ABSTRACT
Protocols of diagnosis and treatment of acute pancreatitis are presented. Definition based on pathogenesis of the disease is given. Phases of acute pancreatitis, features of diagnosis and treatment in each phase are analyzed. Terms of surgical treatment, main principles of postoperative treatment are discussed.
Subject(s)
Clinical Protocols , Pancreatectomy/methods , Pancreatitis, Acute Necrotizing , Humans , Laparoscopy , Pancreatitis, Acute Necrotizing/diagnosis , Pancreatitis, Acute Necrotizing/surgery , Practice Guidelines as Topic , Severity of Illness IndexABSTRACT
Antisecretory therapy is an important and integral component of complex therapy of acute pancreatitis. The clinical estimation of efficiency of various antisecterory preparations, sandostatin and famotidin (quamatel) was made in treatment of acute pancreatitis at an early stage of the disease. The results of the research have shown that the efficiency of sandostatin and famotidin (quamatel) in treatment of not severe (mild and medium) forms of acute pancreatitis is approximately identical. But the application of famotidin (quamatel) is economically more favorable (8.3 times cheaper than sandostatin). In treatment of severe acute pancreatitis of paramount importance are the terms of the beginning of antisecretory therapy, the optimum term being the first day of the disease. The preparation of choice is sandostatin, the preparation of reserve--famotidin (quamotel). The duration of a medical course of treatment is the first three days from the beginning of the disease. The application of antisecretory preparations in question is less effective when used in later terms.
Subject(s)
Famotidine/therapeutic use , Gastrointestinal Agents/therapeutic use , Histamine H2 Antagonists/therapeutic use , Octreotide/therapeutic use , Pancreatitis/drug therapy , Acute Disease , Famotidine/administration & dosage , Gastrointestinal Agents/administration & dosage , Histamine H2 Antagonists/administration & dosage , Humans , Octreotide/administration & dosage , Time FactorsABSTRACT
We evaluated the efficiency of perfusion with olifen in preventing oxidative stress at the early stage of acute pancreatitis. Transaortic perfusion with olifen prevented clinical and biochemical symptoms of acute pancreatitis, attenuated oxidative stress, reduced peritoneal exudation, and restricts the area of pancreatic necrosis to 6% tissue.
Subject(s)
Antioxidants/pharmacology , Pancreatitis, Acute Necrotizing/prevention & control , Phenyl Ethers/pharmacology , Amylases/blood , Animals , Cats , Disease Models, Animal , Lactic Acid/blood , Oxidative Stress , Pancreatitis, Acute Necrotizing/blood , Pancreatitis, Acute Necrotizing/pathologyABSTRACT
The main criterion of severity of acute destructive pancreatitis (ADP) is the volume of pancreatonecrosis formed during the first 24 hours of the disease. A prognostic system is developed allowing to urgently detect the "risk group"--patients with the developing massive pancreatonecrosis by means of the assessment of clinical criteria. In the process of intensive therapy of the "risk group" patients there occurs arresting, "abruption" of the destructive process which greatly improves the results of treatment (the frequency of purulent complications decreases from 32% to 14%, lethality from 45% to 19%). Different methods of "abrupting" therapy are described, the best of them is a combination of curative plasmapheresis with the intraaortal perfusion of the splanchnic area with antienzymes, antihypoxants and antithrombotics. In the group of 17 patients with severe ADP treated by the method described suppuration was noted in 1 (6%) patient, and no lethal outcomes. The pressing problem is to increase the number of patients with severe ODP treated by the method of "abrupting" therapy as early as possible which can be achieved with the help of early hospitalization, with using prognostic systems and creation of a network of specialized pancreatological clinics with the corresponding equipment.
