Surgery to pancreatitis. Gostry pancreatitis

Ethiology

1. Poisonous disease of the late gallbladder (gallbladder ailment, choledocholithiasis, spasm or stenosis of the Vater's nipple, discoloration of the gallbladder, etc.).
2. Exogenous intoxication (alcohol that yogo surrogates, deyakі lіki toscho).
3. Infection of the 12th intestine (duodenostasis, duodenal diverticulum).
4. Traumatic ears of the nipple nipple.

Clinical-morphological classification

1. I... Gostry pancreatitis.
2. Nabryakla form.
3. Nabryakova form for purchased rіdini klitkoviny, oily sumts).

1. II... Gostria severe pancreatitis.
2. Pancreatic necrosis of noninfections

(fatty, proteolytic,hemorrhagic, change):

- pulmonary focal

- mid-range

- velikovnishchevy

- total

1. Pancreatic necrosis of infections

- pulmonary focal

- mid-range

- velikovnishchevy

- total

III... Gostry important pancreatitis,

Folding:

1. Parapancreatic Infiltrate
2. Necrotizing parapancreatitis (muscle,

Let's expand)

- non-info

- information

1. Gostra pancreatic city

- non-information

- info

1. Peritonitis (muscle, raslitim, diffuse)

- enzymatic

- Gnіynim

1. Gnіynyi abscesses of destructive localization
2. Sepsis
3. Digestive and pancreatic norits
4. Bleeding (shlunkovo-intestinal,

internal)

1. Functional lack of organs

I systems:

- Heart-Sudin

- dizzy

- nirkovy

pechinkovo

- polyorgannoy

Klinika

A lingering symptom of a severe pancreatitis, an intense bile, as a rule, in the course of a severe pancreatitis, in the course of a pancreatic gullet, as well as a raptus winy, should often be found to overhead. In some cases there is a build-up step-by-step, it has a somewhat similar character and is not even more intense.

Others, due to the frequency (80-92% of ailments), a symptom of severe pancreatitis є repeat, but do not bring lulling blues, as you should start to appear immediately if you are in pain (or maybe overwhelm), I get sick, as a rule, for a long time. The body temperature is normal and subfebrile. Characteristic є "knives" - temperature rise from frequency and pulse.

Diagnosis of gastrointestinal pancreatitis

In diagnostics of the gross pancreatitis of many clinicians, it is of great importance to make changes in the level of curvatures. Zhovtyanitsa on the cob get sick of tramping ridko. Most often, the blink of curvatures is characteristic. Acro- і zagalny cyanosis, which appears to be worse, accumulation of destructive behavior, toxic odor capillaries and characteristic for important forms of pancreatitis. Tom should serve as a rotten predictive sign. Dryness of mov when state of pancreatitis Yak і in the case of the other state of the art surgical ailments of the abdomen, imaging the steps of dehydration to the body.

It lives only in the epigastric dilation, along the transverse colon (Bond's symptom), and in all cases.

The tension of the mucous membranes of the cranial stem is localized in the projection of the cranial cavity (Kert's symptom).

The fate of the reaction of the mucus in the entire abdomen is indicative of an accelerated pancreatitis with enzymatic, and, perhaps, with ginny peritonitis, when one immediately detects a positive symptom of Shchetkina-Blumberg.

The Grekov-Ortner symptom confirms the fate of the cheeky michur in the pathological process and is positive in approximately 32% of the ailments.

When peripheral blood is advanced, 61-80% of ailments have an increase in the number of leukocytes and a white blood cell formula, and in 54-82% - lymphopenia.

Significantly, there are more serpents on the side of red blood. The anemia of the connection with the entry of the blood cells into the interstitial space due to the increased penetration of the vertebral column, which is ruined by the infusion of proteolytic enzymes. We will establish є the value of additional duresis (if necessary, valid), the indicators of which can be introduced at the stage of intoxication. Proteinuria, microhematuria, cylindruria and other pathological houses appear in this group.

Osoblive diagnostic value may be biochemical advances, and in advance of the activity of enzymes in the undergrowth. If not all ailments reach the hospital in the first year of illness, then the activity of these enzymes appears in 82.5-97.2% of patients. Tom normal indicators enzymes in the blood that do not show signs of severe pancreatitis. In the early hours of the disease, the frequency of hyperenzyme changes decreases. Significant value of the most significant and significant indicators of bilirubin in blood.

An important role in the diagnosis of gastrointestinal pancreatitis is to monitor the x-ray and fluoroscopy of the breast cell and black emptying; Often there is a swelling of the transverse-rimal intestine - a symptom of Bond - that is the largest intestine, the increase in the appearance of the great curvature of the slunk and cross-rim intestine... Radiologic dosage of the cervical tube allows the detection of indirect signs of pancreatitis: laryngeal enlargement and depression of the lower loop of the 12-palate intestine, pressure and reduction of the slurry and 12-palate intestine, that is the value of the damage.

Selective angiography

(mesentericotography) yes, there is a possibility of finding direct signs of a severe pancreatitis in case of suitable ailments in the case of a disease, if the indicators of the activity of enzymes in the blood and are normal. In addition, behind the additional angiography, such acceleration appears, such as thrombosis of the great arterial and venous trunks and in.

Scrubbing of the slurry

allows for the reduction of the level of improvement in the function of acinar cells and the effect of deformation and improvement of the organ itself. The practitioner of surgery of endoscopic and non-invasive methods has continued to use two remaining methods, but it has also been reduced.

Fibrogastroduodenoscopy

vikonuє additional role of diagnostics of gastrointestinal pancreatitis. Naybilsha characteristic endoscopic signs є vibuchs of the back wall of the shlunk і a picture of a hospitable gastroduodenitis. With severe pancreatitis, erosive and hemorrhagic gastroduodenitis, papilitis and signs of reflux pyloritis often occur. Great diagnostic capabilities for laparoscopic clinics. Direct signs of gastrointestinal pancreatitis є plaques of fatty necrosis on the omentum, omentum, hemorrhagic vipitis, omentum swelling, intestinal brisket, blood clotting, hyperemia and embryonic omentum. Among the indirect signs are: paresis of the shlunk and transverse-free intestine, stagnant zhovchny mikhur. The high activity of enzymes in the pancreatic cavity in the peritoneal period during an hour of laparoscopy increases the diagnosis of gastrointestinal pancreatitis.

Likuvannya

The current conservative therapy for gastrointestinal pancreatitis is as follows:

1. Elimination of pain and spasm, reduction of microcirculation in the hall;
2. Fight against shock and renewal of homeostasis;
3. Implication of exocrine secretion and activity of enzymes in zalozi;
4. the fight against toxemia;
5. Normalization of performance of legends, hearts, nirok, pechinki;
6. Prevention and treatment accelerated.

In the development of the state of the art pancreatitis, the development of the disease prompt engagement, which may be two main purposes:

Kupiruvati gostry attack of ailments and prevent lethal result;

Avoid the relapse of the severe pancreatitis by drinking whiskey from the patient from the hospital.

For the most beautiful basic nutrition surgical treatment that surgery for ailments with pancreatitis (fallen as a phase of development and the period when ailments break) are divided into 3 groups:

Early, to visit in the first year that day, get sick at the stately period, the development of the embryo or necrosis of the ground. Shown before early operations:

Difficult to diagnose;

Razlitiy enzymatic peritonitis due to the manifestations of viral intoxication;

Ponannya to pancreatitis with destructive cholecystitis;

Obturatsіyna zhovtyanytsya.

The practice of urgent surgery of laparoscopy, which allows the form of pancreatitis and the size of the standard of the bilar system, has changed, has changed a number of early operations. In addition, laparoscopic lavage can be used as a preoperative preparation for a sick person. During singing demonstrations of early operations, the resection of the pidshlung zone and sanitation of the bilious system will end.

Operations at the phase of melting and sequestration of necrotic cavities of the creeping ground and in the uterine cell, which are carried out on the 2nd or 3rd from the ear of the ear. In case of ailment in the phase, one can instantly see the dead tissue of the udder, that of the umbilical cordine, so that it is time to see necromancy (after the 10th day of the disease) or sequestrectomy (for 3-4 years in the ear).

Pizni (vidstrocheni) operations, which are carried out according to the planned order, every hour of the rest of the order pathological changes pidshlunkovoy zalozi. These operations are indicated for quiet abdominal organ problems, which can cause pancreatitis or cause this development (gum disease, cholecystitis, gastroduodenal laxity, duodenal ulcer, intestinal diverticulum) The stench is straightforward to prevent recurrence of severe pancreatitis by the way of operative sanitation of female nobles and other organs of poisoning, as well as of fledgling burrows.

Mainly, the operation is carried out on the podshlunkovy zalozi polyagaє in the case of the minds, which includes the development of hypertension in the pancreatic ducts.

• Early... Can develop in parallel from the first symptoms of gastrointestinal pancreatitis. Noise in the flow of enzymes in the bloodstream, and systemic damage to the regulation of robotics.
• Pizni... Call to be diagnosed in 7-14 days and will be tied to the infection.

• Hypovolemic shock... To develop into a dramatic change in blood volume through a toxic infusion of enzymes into the soil. The results of all organizations cease to be trimmed and there is a need for an amount of sourness to develop polyorganic lack.
• Folding from the side leg and pleurisy: « shock is easy», insane lack, exudative pleurisy(burning pleurisy, with each leaflet accumulate ridin), atelectasis(Falling down) legends.
• Pechinkova lack... In mild cases, it is manifested in a small zhovtyanitsa viglyad. Important to develop Gostry toxic hepatitis... The destruction of the liver develops in the form of shock and toxic enzymes injected. Naybіlshe risikuyut paciєnti, as they are already suffering on chronic ailments of the stove, zhovchny mihur, zhovchividnyh nobles.
• Nirkova lack... There are some reasons, as well as pechinka lack.
• Damaged function heart-vascular system (Sertsevo-sudinna lack).
• ... Reasons: stress traverse, erosive gastritis(a form of gastritis, when there is a defect on the mucous membrane of the slunk - eroses), cut the mucous membrane at the point of the passage to the drainage pipe, the destruction of the throat of the blood.
• Peritonitis- Fired in a black empty. With gross pancreatitis, peritonitis can be aseptic(fired without infection)
• Psychic problems ... It is diagnosed when the brain is affected by aphids of intoxication to the body. Call psychosis to fix it on the third day and continue for a long period of time.
• Osvita at sudina thrombi.

• Sepsis (blood infection). Naivazhche accelerated, which often leads to the bend of the patient.
• Abscesses (gn_yniki) at the black empty.
• Gn_inny pancreatitis.Є by shape getting sick, but you can look at yak slower.
• Pancreatic norits - pathological appearance of susceptible organs... Most of the time it is set up at the stage of the operation, there, de-bulo, drainage has been installed. As a rule, norits appear in adjoining organisms: a slunker, two to twenty digits, a small intestine.
• Parapancreatitis– fiercely hot fabrics near the bottom hole.
• Necrosis (necrosis).
• Bleeding from internal organs.
• Pseudo-slurry... If the fabric is folded, I will not get wet, the capsule will form next to it. with good fabrics... All the middle can be sterile instead of any other. As soon as you can see through the ducts of the slurry zone, you can see it on your own.
• Pukhlini pidshlunkovoy zalozi. Ignition process in case of severe pancreatitis, it is possible to provoke degeneration of the clitin, for the sake of which the stench will give a cob to the chubby growth.

Chi buvaє gostry pancreatitis in children? Yak to appear?

• Anomalies in the development of the duct of the pidshlunkovaya zalozi, the chewing michura and the chewing ducts, the twelve-fingered intestine.
• Dull abdominal trauma.
• Worms (for example, ascariasis).
• Transfer.
• Nedotrimannya regime live.
• Vzhivannya in the gourmet, fatty food, chips, crackers with spices, gazuvannya, products of shvidky grub.
• Damaged development of the resulting fabric.
• Hypothyroidism (decreased function thyroid gland).
• Mucoviscidosis is a decline in disease, as it is characterized by impaired functions of the flesh-throat zone and of the other diseases of the secondary secretion, leg.
• Rise of infections.

Yaka prophylactics of gastric pancreatitis?

What kind of robots are needed?

Why is it necessary to be unique?

Correctly eating. Dotrimannya regime gruzhuvannya. Pidtrimka okay wagi. Prosperity physical activity. Chastely lіkuvannya ailment of the herbal system (a slurry that two-fingered intestine, liver and a zhovchny mіkhur), cautioned by a gastroenterologist, taking into account all the recommendations of the doctor. Prevention of recurrence of gastric pancreatitis: Early detection and treatment of primary gastrointestinal pancreatitis. As a result of the treatment in the hospital of primary gastric pancreatitis, the docks do not go through all the symptoms and all the indicators do not normalize. Alert at the gastroenterologist for the transferred primary gastrointestinal pancreatitis.

Fat, greased, gostra їzha, a great number of specials. Fast food. Systematic transfer. Irregular, wrong food. Overwhelming oil. Low physical activity, little-destructive way of life. Alcohol. Piznya turnout before the lykar, not chasing illnesses of the herbal system.

How can I give a persha to help with a pancreatitis before the arrival of a lykar?

What kind of robots are needed?

Can't you robiti?

Place the sick nabik. If you are lying on your back, if you think of a blues, then you can drink in dickheads. Apply cold to the upper part of the abdomen: ice, obhorny with a towel, grilka z cold water cold water rushnyk. Negligently viclicati I will help you". Forecast to lie strongly due to the fact that there will be a lot of ailments to be delivered to the hospital and will receive the help of the doctor.

Come on, drink. Hunger is needed when there is a state of pancreatitis. Promivati ​​shlunnok. Tse will not bring corista, but deprive me of my blues. Give me antibiotic drugs. The stench can make a picture, and it will be more important to put the correct diagnosis.

How to find effective people in case of severe pancreatitis?

Zhoden Narodniy cannot substitute for the permanent treatment at the stationary. Moreover, with insignificant stasis Lykarsky Roslin That іnshikh zasobіv can nashkoditi a sick person, to cope with the severity of his camp. If you are engaged in self-care and connection of links to "Shvidkoy Dopomoga", you can spend an hour.

How much can you get sick with pancreatitis?

Zahvoryuvannya, who can nagaduvati gostry pancreatitis:

• Hostry cholecystitis- Zapalennya zhovchny mikhura. Obey in steps. Come to see more similar pains before we rule the edge, as we see right shoulder, on the scapula, zhovtyanichnostі shkіri, tediousness, blues.
• Perforation of the groove of the slunk or two-fingered intestine- Stan, when there is a vine in the station, a nasal opening. Winikak strong gostry bіl at the upper part of the abdomen (one of the thighs іz "blow of the dagger"), nudota, one-time blues. M'yazi of the black press become very stressed. As a rule, before the sick person is already diagnosed with a twist.
• Kishkova imperfection... Tsei stan can be made for different reasons. We appear to act on the growths of rings, overcoming similar pains in the abdomen, on the day out, bloating unacceptable smell.
• Intestinal infarction... Vinikє with impaired blood flow in brijovy court to liven up the gut. Winikak gostry perejmopodіbniy bіl in the stomach, nudota, blues, style wіddsutnіy. Zvvychay such ailments previously suffered at heart-sudinni ailments.
• Gostry appendicitis- Filling the worm-like outgrowth ( appendix). There is a step-by-step growth in the stomach, which is able to make up for it in the right direction. bottom part, vinikє nudota, tension in the abdominal mucosa.
• Myocardial infarction... It is characterized by pain behind the sternum, or it can manifest itself atypically, for example, yak severe pain in the belly. Sickness sta blіdim, zadishka, cold sticky pіt appears. The residual diagnosis will be established after the EHC is carried out.
• Pinching of the diaphragmatic joint... The diaphragmatic hernia is a camp, when a part of the slunk and / or the intestine flows through the diaphragm uphill, at the breast cancer. Zvychay zatiskannya vinnikє for an hour of physical navantazhen, there is a hospitality in the breasts and belly, which widen into the hand, before the shoulder blade. Khvoriy lyagak on bik і pidtyagu colin to the breasts, at the new drop an arterial vise, win sta blidim, in the form of cold pit. If the shlunka is pinched, the bloom is found.
• Kharchova toxicoinfection... If you get sick, if you get infected with toxins from bacteria, you will be lured through it. Winikak b_l in the belly, diarrhea, I’m going to die in the back.
• Lower lobe pneumonia- Legends in the lower frames. The temperature rises, the temperature rises breast cancer, inodі - in the belly. There is a dry cough, which after 2 days grows up. Winikak zadishka, zagalny camp of the ailing one will burn.

What is the classification of Atlanta in case of pancreatitis?

International Classification of Gentle Pancreatitis, adopted in Atlanta:

What kind of pancreatitis is there?

• Traumatic... Zooms to the ears of the pidshlunkovoy zalozi abo її Sudin before the hour of the operation. The most frequent trauma occurs during surgical interventions on the very ground, on the slunk. twelve-fingered intestines, pechinki that zhovchny mikhury, Ridche - every hour of bowel surgery.
• Non-traumatic... Zooms by other reasons, if the operation breaks down the functions of the podshlunkovaya zalozi and suspicious organs.

Symptoms, diagnostics and treatment of pancreatitis during surgery for the first time. Often, it is easy to quickly establish a diagnosis immediately through the onset of the factor:

• unreasonable, why amazed the pain by the very transferred operation, and the lesions of the underworld;
• through zasosuvannya zannebolyuvalnyh and zaspookіlivіh drugs in the symptoms of swelling is not so strong;
• During the operation, there may be a lot of acceleration, and it is far from expecting to be seen at once, but the symptoms are linked with the mud.

What are the prognosis for gastric pancreatitis?

The best forecast is indicated when the form is full. Call this kind of pancreatitis to pass on its own, or on its own drug therapy... Guineas less than 1% of the ailments.

Predictions for pancreatic necrosis are more serious. The stench is produced to bend 20-40% of patients. Gnіynі accelerated more and more increase of risiks.

I will appear modern technologies the prognosis for the ailments on the gostrian pancreatitis has diminished. So, with vicious minimally invasive technologies, the mortality rate becomes 10% or less.

How to recover from chronic pancreatitis?

Mechanism of development of chronic pancreatitis, as well as severe, as long as there is no residual implantation. Yaksho at state form In the main, it is a waste of tissue covered with moisture enzymes, then in chronic cases - replacement of scarred scar tissue.

Chronic pancreatitis is most often the opposite of chronic pancreatitis: when the symptoms become more acute, the symptoms are stronger, and then remission, Polіpshennya will become.

As a rule, chronic pancreatitis is elusive with medication... For the obviousness of the singers, it is necessary to go into the operation.

How do you get rid of the cleansing of blood in case of pancreatitis?

Shown before plasmapheresis for gastric pancreatitis.:

• Immediately upon entry to the stationary. At the same time, it is possible to "malign" the pancreatitis at the swelling stage and prevent serious damage.
• With the development of pancreatic necrosis.
• With severe ignition reaction, peritonitis, impaired functions of internal organs.
• Before the operation - with the help of anti-toxicity and prevention of young people.

Prototype indication before plasmapheresis in case of pancreatitis:

• Stronger the ear for life of important organs.
• Bleeding, yaku does not go into zupiniti.

What is more minimally invasive treatment for gastrointestinal pancreatitis?

Minimally invasive involvement in the process of transferring changes before special operations through retail outlets. The stench is also effective, even if it is made to the minimum of tissue trauma. With the help of minimally invasive surgical techniques, the results of the treatment of state of the art pancreatitis were reduced, and the ailments became older than ginut.

Yaka reabilitation for a hostile pancreatitis?

As soon as the days are slowed down, the ailments will be overtaken at the stationary 1-2 days. Whiskey need to be wrapped physical options stretching 2-3 months.

As soon as the operation is carried out, the sick person will be diagnosed with acceleration, the stationary treatment will be trivial. Inodi gastric pancreatitis can lead to disability, a person who is sick can nadati I, II or III group.

Sanatoriums and resorts, which are most suitable for such patients:

Name of the resort	Description
Morshin	Misto-resort near Lviv region of Ukraine. The main licensed official is mineral water. There are patients with chronic diseases of the intestines, shlunk, pidshlunkovaya zalozi, nirok. Basic methods of treatment: Perlinny, coniferous, mineral and in. microcrystals. Gryazelіkuvannya. Ozokeritotherapy. іngalyatsії. Likuvalna physical culture.
Truskavets	Another resort near the Lviv region. On this territory there are a great number of seeking dzherel and rehabilitation centers. They come for the treatment of sickness of the stove, shlunka, sludge zone, heart-vessel and sechostatic system. Likuvalny factories: Mineral water (from the winter dzherel there is a warehouse and a step of the mineralization). Klimat (girskie povitrya). Lіkuvalnі baths, fіtovanі. Likuvalny souls. Massage. Likuvalna physical culture.
Caucasian Mineral Water	Є Kavkazko-Mineralovodskiy agglomeration, like one of the only places-resort.: Zheleznovodsk. Єsentuki. Lermontov. Kislovodsk. Pyatigorsk. Mineral water. Whether it is from these resorts to go for people who have suffered from pancreatitis, and also suffer from chronic pancreatitis. Likuvalny factories: Lіkuvalnі mineral water (ponad 130 dzherel). Girskiy klimat. Mineral mud. Sanatoriums of the Caucasian Mineral Waters a wide range of get sick.

What are the degrees of severity overcoming severe pancreatitis? What a yak?

• Less than 3 points- Easier by a stretch. Prognosis Immobility of the bend - trochas more than 1%.
• 3 - 5 points- Heavy relocation. The bend can be 10-20%.
• 6 points and more- Heavy relocation. Bend Іmovіrnіstі 60%.

GOSTRIY PANCREATITIS

ICD-10 code

K85. Gostry pancreatitis.

Gostry pancreatitis gostre zvoryuvannya pidshlunkovaya zalozi, which is supervised by necrosis and hemorrhages in the body, amalgamated by enzymatic autolysis.

Children are suffering from pancreatitis, which grows rather wide, and their widening ranges from 0.4 to 1.0% of all surgical problems.

Ethiology and pathogenesis

The reasons for the ailment are the intake of fatty izhi, as well as the hyperstimulation of the sickness, the implantation of alcohol, zhovchnokam'yana hvoroba(ZhKL), scho to create obstruction of the pancreatic duct. Metabolic, likarsky urazhennya, nirkova lack, іnfektsії (epіdemic parotitis, virus Koksaki type B, cytomegalovirus, vitryana vispa, hepatitis B), surgical engagement yak looking ethiological factors rіdshe.

Acquisition of vines in the period of early activation of winter granules, in which lympolytic enzymes are injected into phospholipase A that lipase, which overtravels cells from the lactose of fat, in the form of fatty acids. As long as the accumulation of fatty acid pH in lipase-rich pancreatocytes is increased to 3.5-4.5, then the internal trypsinogen is transformed into trypsin. Trypsin activates lysosomal enzymes and proteases, leading to proteolytic necrobiosis of pancreatocytes. Elastaza lizu stinks of sudin, middles of semi-fabric headers. Cepriy a widening of enzymatic autolysis (self-digestion) in podshlunkovy zalozi and її between, tobto. Hostry pancreatitis is a toxic enzyme disease (Fig. 5-1). By means of a triggering mechanism, the activation of active pancreatic enzymes from the acinar cells of the pancreatic enzymes, which is due to the presence of inactive enzymes in the eyes. The severity of the disease is due to the balance between proteolytic enzymes, which can be caused by antiproteolytic factors. Remaining include internal cell block, pancreatic trypsin, circulating p2-macroglobulin, α-1-antitrypsin and ingibitorium C1-esterasi.

Table. 5-1 presents the clinical and morphological classification of gastric pancreatitis.

Table 5-1. Clinical and morphological classification of gastrointestinal pancreatitis

Small. 5-1. Pathogenesis of gastric pancreatitis

key picture

Independently from nature, pancreatitis is reduced to a low level. key manifestations, how to get along with the onset of syndromes:

Bolovy;

Dyspeptic;

Exocrine deficiencies;

Endocrine deficiency.

Pain syndrome characterized by pain in upper half belly, lіvoruch і right handers from the middle line of thіl, as well as іrradіyuyut across, liv leg be operative in nature. It’s more painful to do it when you accept it, be lodged by hunger, cold and calm. The intensity of the pain can be rather slow, but the smell is more intense, it’s more than a few years old, it’s nasty to stop.

Dyspeptic syndrome manifest itself as tediousness, blues, do not bring lulling, flatulence.

Exocrine (external) deficiency syndrome dressings with a deficiency of herbal enzymes: amylazi (amilorrhea - the appearance of starch with feces), trypsin (creatorrhea - non-etched fiber), lipase (type I steatorrhea - more than 9% of neutral fat) coprograms. Polyfecalis is characteristic (up to 400 g / day). Type II steatorrhea is seen as a large quantity of fatty acids (pathology of the small intestine).

Endocrine (internal secretory) deficiency syndrome manifest itself as hyperglycemic and ketosis.

Due to changes in the balance in the "protease-antiprotease" system, a systemic ignition type (SIRS - System Inflammatory Response Syndrom), I will summarize the lack of polyorganism (like in case of great traumas, illnesses, sepsis), the main manifestations of which include:

A dizzy lack;

arterial hypertension;

Prerenal azotemia;

tubular necrosis;

Dissemination of the internal vessel sore throat

(DVZ);

Pancreatic shock.

Diagnostics

Have out-of-the-box analysis blood is susceptible to nonspecific changes: leukocytosis, neutrophilosis, adduction SHOE.

Biochemical dosages include indicators (amylase, transaminase) and pathogenetic (lipase, trypsin) tests. The activity of amylase in the blood during gastric pancreatitis increases rapidly. Amilase, which is seen from the cross, is called a diastasis, and even more, and most amilasemia and diastasis develop in case of parotitis.

At the stage of the activity of phospholipase A2 in syrovatz blood, assess the deterioration in the legends; after rіvnem syrovatkovo ribonuclease (RNase) - the phase of severe destructive pancreatitis. Alkaline phosphate, transaminase and bilirubin determination by diagnostic criteria for the failure of the bilirubic tract.

The other signs of biochemistry are hypercoagulation, hypoproteinemia, improvement of the sechovina. In 15% of children with pancreatitis, hypocalcitis develops and up to 25% may be hyperglycemic before an hour of hostile attack.

Unfriendly prognostic signs of severe pancreatitis:

. leukocytosis more than 15000x109 / l;

Hypercoagulation (fibrinogen> 6 g / l);

Amilasemia> 6 norms;

Amilozurya> 4 norms;

Hyperbylirubinemia> 4 norms;

Hyperglikemia> 2 norms;

Addition of sechovin> 2 norms;

Hypoproteinemia<60 г/л.

An important diagnostic criterion is a test for monoclonal antibodies in the presence of monoclonal antibodies, when there is a decrease in the activity of elastase-1 in feces. Indicators: in normі - 200 μg / g feces and more; pomirny, easy steps of exocrine deficiency - 100-200; important step - less than 100 mcg / g feces.

Instrumental diagnostics includes ultrasound scan of the slurry zone (decrease in echogenicity - build up, increase in echogenicity - growth in the resulting tissue), MRI and CT. I will stay in front of the ultrasound scan, and I will save the impression of a specific visualization of the fabric of the flesh and the retroperitoneal devices. It allows the assessment of levels of tissue metabolism, the presence of ischemia, necrosis of pancreatocytes, age in navkolishnyh tissues of the pancreatic cavity in patients with severe pancreatitis (Fig. 5-2, a), similarly in cases of pancreatitis. -2, b).

Small. 5-2. CT: a - gostry pancreatitis (arrows indicate the purchase of ridini in navkolishnykh fabrics); b) chronic pancreatitis

Endoscopic advancement of upper clinical tests is carried out to additional instrumental methods of advanced diagnostic testing in case of severe pancreatitis, and is used for differential diagnostics of diseases of blood vessels.

Laparoscopy allows you to specify the form and type of illness, diagnostics of pancreatogenic peritonitis, parapancreatic infiltration, suppurative destructive cholecystitis.

Pathomorphology

In case of pancreatic necrosis, the visibility of the tissue in the middle layer is more likely to occur - "minus tissue": internal tissue swelling, hemorrhages, fatty and clitinous necrosis (Fig. 5-3, a). Hostria serous-ginny pancreatitis presents with massive leukocyte infiltrating stromia, purchased ginny masses from the lumen of the great vivid duct (Fig. 5-3, b).

Small. 5-3. Pathomorphology of pancreatic necrosis and pancreatitis: a - macropreparation of the pancreatic necrosis: pancreatic necrosis; b - microdrug: gostry serous-gn_inny pancreatitis (boiled with hematoxylin-eosin; 100)

Differential diagnosis

Radiological features of gastric and chronic pancreatitis are shown in Fig. 5-2. The main diseases, of which the differentiation of the gostry pancreatitis is:

gostry cholecystitis, gastritis, kharchova іntoksikatsіya, perforated vyrazka shlunka and duodenum, gastric appendicitis, intestinal laxity, nirkova kolka, myocardial infarction. It is necessary to ensure the possibility of mesenteric imperfections, post-vaginal vaginosity (in children of children), lower lobular pneumonia and paranephritis.

Likuvannya

Extra hospitalization. The therapy is complex and conservative. I mean Suvoriy is a post-regime, cold to live.

Parenteral administration of Ridin (salt solutions, 5-10% of glucose with insulin) up to 1-3 L, preparations of kaliyu, calcium, low-molecular-weight plasma-metabolizers, bilkovy preparations is shown.

In case of fermentation and fermentation, the internal introduction of anti-enzyme drugs (antikinin), such as aprotinin (trasilol *, contrikal *, gordox *), is shown, the dose of which is due to the severity of the process. Antibacterial therapy should be carried out at times of contamination accelerated.

Effective є regulatory peptides, somatostatin. Octreotide (sandostatin) should be consumed at RD 50-100 mcg 2-3 times a day, internally, internally, internally for 3-5 days. If necessary, prescribe antihepatic, antihistamines and sechogins.

I mean also holinolitic, spasmolytic and ganglionic drugs, to bathe the pain syndrome and spasm of the sphinkter Oddi: drotaverine (no-shpa *), papaverin, mebeverin (duspatalin *), platyphlerin *, platyphlerin * Platifilin is recognized in 0.2% of the range for ін'єкцій № 10, in tablets - 5 mg each.

The functional activity of podshlunkovoy zolozi m-cholinolytic pirenzepin (gastrocepin *), which is used in tablets of 25 and 50 mg, is attributed. Children 4-7 years old should receive 12.5 mg (1/2 tablet), 8-15 years old - 25 mg 3 times a day for 2-3 days.

Prevention

Secondary prophylaxis includes the usunenia of the ethological official of the zhvoryuvannya. The dispensary is cautious about the development of pancreatitis for 5 years. After 3 years, the child will be transferred to a group of rhiziks for chronic pancreatitis from a choric look. Great importance is the marginalization of food, the basis of which is the principle of balance according to the main food components of the physiological characteristics of a child's life. It is absolutely necessary to eliminate alcohol and alcoholic beverages, to mix the implantation of tonic, to add preservatives and barvniks to ridin. Especially respect for the merits of children who are often ill, as well as children who suffer from allergic illnesses.

Forecast

The prognosis is serious in development. Patients with non-flattening pancreatitis in children may have a favorable prognosis. With this form, the mortality rate becomes close to 10%, and in some cases, with necrotic abnormal hemorrhagic pancreatitis - up to 90%. Periodic epizodi of gastric pancreatitis can lead to chronic pancreatitis.

CHRONIC PANCREATITIS

Cody z MKH-10

K86.1. pancreatitis.

K87. Chronic pancreatitis.

K86. Recurrent pancreatitis.

Chronic pancreatitis is a progressively destructive disease of the dermal zone, which is characterized by the growth of necrotic necrotic and fiery-destructive snakes of parenchyma, which can lead to severe degradation of the endocrine function.

Letters of literature on the widening of pancreatitis in children in the structures of organ disease etching in the edge of the supernumerary (from 5 to 25% of cases of gastroenterological ailments).

Ethiology and pathogenesis

With the detection of patients in early stages, with low pancreatitis, carry out a retinal analysis of the family tree. Pancreatitis rarely develops with cystic fibrosis, Crohn's ailments, NUC, VC. Often the cause of chronic pancreatitis in children is not home.

Obstructions of the pancreatobiliac tract in cases of congenital (stenosis of the papilla of the Vater, anomalies of the duodenum, arteriovenous compression) and nabutykh (ZhKL, opisthorchiasis, ecchinococosis) causes of pancreatic disease. A child's child may have a blunt abdominal injury when hitting, falling from the air (for example, a goydalka - a blow from a goydalka when he is alive), going to a crossroads when riding a bicycle (an injury about kermo). It is especially significant that the reason for the development of pancreatitis is due to alcohol, the spice in children. In the midst of severe infections, there may be significant mumps, herpes, mononucleosis, and in the middle of bacterial infections - іrsiniosis, salmonellosis and others.

Adding a vice in the duct system, to produce a cascade of reactions, to activate a cascade of reactions, to activate a cascade of enzymes in a zalose. Let me remember the role of playing the changes in the microcirculation system, how to create the hypoxia of the cells and increase the level of cAMP in them, which, in their own house, spriyu activating the transport of Ca 2+ in the cells. As a result of the

Small. 5-4. Pathogenesis of chronic pancreatitis

go over the top of the surface of the clitin calcine, above the surface of the accumulation of it in the mitochondria, until the rise of oxidation and phosphorylation. A phase of deenergization of the disease and an increase in the processes of dystrophy is coming.

Classification

Great test for diagnostics of pancreatitis on the other gastroduodenal pathology. For the duration of organ changes and pancreatic abdominal pains and minor changes in amylasis, it is recommended to diagnose sphinkter Oddi's dysfunction, pancreatic variant. Dysfunctional disorders of the bilious tract (K82.8) are subdivided into 2 types: dysfunction of the chewing moth and dysfunction of the sphinkter Oddi. It is not easy to pick up the term "reactive pancreatitis" and "dispancreatism", if the ICD-10 has no problems. Stagnate the onset of the classification of pancreatitis in children (Table 5-2).

Table 5-2. Classification of chronic pancreatitis in children

key picture

The clever picture of chronic pancreatitis is analogous to that of chronic pancreatitis, right from the etiology. Significantly, there are symptoms of intoxication, asthenovegetative manifestations: increased stomachability, part of the headache, emotional labiality, drasticness. In some ailments, the pain syndrome is superseded by changes in temperature for a few days, changes in the clinical analysis of blood.

Diagnostics

Diagnosis of chronic pancreatitis vistavlyayut from the onset of signs.

The occurrence of abdominal pain episodes of more than 1 rate from localization in the upper left quadrant, epigastria, from a man from the edge to the edge (to operate).

The manifestation is a sign of the destruction of the secret secretary function of the pidshlunkovaya zalozi.

Change the structure of the body for data of ultrasound, CT and MRI, magnetic resonance cholangiopancreatography, retrograde cholangiopancreatography.

Pathomorphology

Chronic firing process in slurry salmon is characterized by non-fledged morphological changes. To prevent atrophy of hairy elements (pancreocytes) with enlarged ducts and substitutions with full tissue, calcification, cysts. In fig. 5-5 a is a microscopic picture of the intermittent microcrystalline infiltration in the stroma and the growth of tissue along the septa (fibrosis of the stroma).

Differential diagnosis

Some symptomatology can be spared in case of malaise, the first for all with the most frequent pathology of children.

s'kogo vіku - chronic gastritis and / abo CGD. Significance in the development of chronic pancreatitis is the pathology of post-bulbar duodenal ulcer and great duodenal papilla (Fig. 5-5 b), which should be used for additional endoscopy, as well as to reduce the pressure in the duodenum. With HGD, the snake stays deprived of the mucous membrane of the slurry and the duodenum.

Small. 5-5. Pathomorphology of ailments in pidshlunkovoi zolozi: a - microdrug for chronic pancreatitis (hematoxylin-eosin boiling; 250); b - anatomical elements of the sphinkter Oddi; c - normal acinus of the creeper; d - cystic fibrosis; e - chronic pancreatitis (enlargement of small spaces is indicated by arrows)

Chronic pancreatitis is differentiated from cystic fibrosis, when there is an increase in the viscosity of the mucus, which accumulates in the ducts, and the enlarged ducts and those of cystic fibrosis can be reduced to atrophy and fibrosis. In case of pancreatitis, the expansion of small spaces is accelerated, in which case some enzymes are called, impaired penetration of acini up to fatty degeneration of cells (normal 5-5, in the norm).

Likuvannya

Necessary individual therapeutic pidhid, albeit accepted the following principles of therapy:

Pain relief;

Funktsionalny spokіy pіdshlunkovoy zalozi;

Decrease in secretory activity of pidshlunkovaya zalozi;

Correction of exocrine and endocrine deficiencies.

In the period of zagostrennya, the child's transfer to the stationary is shown, the stem of the physiological calm and the sparing of the ailing organ, which takes care of the signs of the post-regime, hunger. It is recommended to carry out aspiration instead of the shlunk after a nasogastric tube.

For the elimination of pain syndrome from medications using vicorist drugs, antispasmodics, analgesics,

blockers of the secretion of pidshlunkovaya zalozi, antacids, which will allow the spasm of the sphinkter Oddi to be put down, to reduce the internal duct vise that will prevent the passage of pancreatic juice and gum from the duodenum.

Traditionally, it is successful in case of aggravated pancreatitis for galvanizing slunk and pancreatic secretion of anticholinergic secretions: 0.1% atropin, 0.2% atropin, 0.1% in metacin and in.

Remaining rocky with the help of smothering of the slunk secretion vikoristovuyut such antisecretory drugs: IPN omeprazole, selective H2-receptor blockers (for example, famotidine). Omeprazole internally (losek *) should be administered at 20-40 mg for 3-5 days, then switch to omeprazole vseredin (omez *, ultratop *) for 4-6 days.

A decrease in the stimulatory action of hydrochloric acid can be reached by the sign of antacid preparations for 3-4 times (almagel *, maalox *, phosphalugel *, rutacid * and in.).

Destruction of the rucous function of the DPK, zhovchovidnyh nobles due to duodenostasis and hypomotor dysinesia are absorbed by the signs of prokinetics (domperidone, cisapride *).

One of the main directions of therapy for chronic pancreatitis is the reduction of regulatory peptides - analogs of endogenous somatostatin, to which octreotide and somatostatin are used - humoral ingibitories of the exocrine and endocrine secretions of the intestine. Octreotide viclikal is responsible for galvanizing the secretion of the pancreatic cavity, the slunker, the liver of the small intestine, driving motility, lowering the internal duct hypertension, driving the secretory biologic. Protisapalny for octreotide is also tied due to stabilization of cell membranes, blockade of cytokinogenesis, production of prostaglandins.

Octreotide (sandostatin) 0.01% solution is dispensed in ampoules of 50 or 100 μg, the course of treatment does not last 5-10 days. RD for preschool children should be 25-50 mcg, for schoolchildren - 75-100 mcg 2-3 times per dose. The drug should be administered internally and podshkirno. The triviality of the drug is up to 10-12 years. Varying side effects are not seen.

The antikinovy ​​drug aprotinin (kontrikal *, gordox *) is not used for somatostatin drugs.

Of particular importance in the period of acute aggravated pancreatitis is infusion therapy, the reduction of metabolic disorders and the nature of endogenous intoxication. At the same time, dextran (reopolyglyukin *), 5% glucose roschin, 10% albumin roschin, fresh frozen plasma, glucosonovokainova sumish are administered to the sick.

At the period of time, there is an important nutritional response - a sign of parenteral and enteral nutrition. Amino acids for parenteral feeding (aminosteril KE *, aminosol-neo * and in), polyamin, and electrolytes should be administered internally in droplets from the indicators of acid-base balance. The order of them is vicious fatty emulsion for immobilization of active lipase and reduction of fatty acid deficiency in the blood: 10-20% of the range for intralipid * or lipofundin * with heparin internally, drop-sided for 1–2-30 gallbladder. vagi tila.

Enteral eating can be done with dietary sums - gidrolizates of a baby, like a child's first life, but in case of pancreatitis it is possible to be vicious in any child. Silence to enter intraduodenally through a probe in a warm viglyad.

Antibacterial therapy is indicated for the improvement of secondary infection, in case of a threat of cyst and fistula formation, the development of peritonitis and early delay. Vikoristovuyu seized penicillin (amoxiclav *, augmentin * 100 mg / kg internally) or cephalosporin III generation (cefotaxime *, ceftriaxone * 50-100 mg / kg internally or internally).

Stagnate pentoxyl sodium, which can be antiproteolytic and antiapalny, 50-100 mg 3 times a day for 3-4 days for blood analysis.

Foldable nutrition for the treatment of pancreatic insufficiency є vibrating of different enzyme therapy (Table 5-3), which is corrected to eliminate the deterioration of the absorption of fats, proteins and carbohydrates. When a hungry child is fed up, they give a test to non-combinated preparations of pancreatin, then, after 3-4 days, with a stiff aggravation, vicorist enzymes with added gum acids and / or hemiceluliasis.

Table 5-3. Classification of enzyme preparations

The activity of enzymes is due to lipase. I mean fermentation 3-4 times per hour for an hour, in courses of 2-3 times with a 3-4-hour break, all in all 4-5 courses for a week. Pancreatin at a dose of 250 mg is used for children younger than 3 times 1/2 tablet, 3-7 times - 1 tablet each, 8-9 times - 1.5 tablets each, 10-14 times - 2 tablets 3 times a day. It is also possible to prescribe pancreatin with a lipolytic activity of 3500 OD (mezim forte) in tablets, as well as doses for pancreatin. For mezim forti 10,000 * (10,000 OD) a dose of lipase is 3 times transformed into mezim forti.

In the midst of depleted enzyme preparations, we reduce the effect of micro-granular enzymes with acidic membrane: lycrease *, pancytrate *, creon * and in. The drug is priznachayut at a dose of 1000 OD / kg per dose for pancreatitis. Creon * 25,000 and 40,000 OD for cystic fibrosis. Creon 10,000 children younger than 2 years will receive 1/3 capsules, 2-5 years - 1/2 capsule each, older than 5 years - 1 capsule 3 times a day. For breastfeeding babies, 1 / 3-1 / 4 capsules (manually delayed on zoshitovy leaves from the clytin, hanging from the capsules) should be given 120 ml of milk sum, an additional dose is not more than 10,000 OD (1 capsule). Pancitrate in capsules is recognized for 6 years. Wobenzim * at a dose of 1 tablet per 6 kg of oil for doba, divided into 3 doses.

In the case of an intravenous period, it is recommended to conserve natural phospholipids and other hepatoprotectors, vitamins, gum disease (immortelle, gum tea, sorbitol, xylthene preparation) It is widely used in physiotherapy, physiotherapy, physical culture, reception of mineral water and weak and medium mineralization. On the smallest swollen pain syndrome, local hypothermia is indicated, and in the world of a decrease in pain syndrome and enzyme activity - ultrasound, diathermy, inductotherm, sinusoidal modulation of struma, paraffin, ozokeritis.

In the majority of children, complex therapy allows them to reach full health and compensate for impaired functions.

In case of a serious interruption and development, acceleration is shown promptly, the tactics of which should be started at once from the surgeries.

Prevention

Prevention of chronic pancreatitis, including low stages. The stench is presented below.

Forecast

The prognosis є friendly, protective pancreatitis є a known factor in the development of adenocarcinoma of the pancreatic disease.

Gostry pancreatitis is a disease of the dermal zone, as a result of the autolysis of the tissue of the dermal zone by polypolytic and active proteolytic enzymes, which manifests itself in a wide range of snakes - in the form of an enlargement to the midline hememorrhoid.

Ethiology and pathogenesis. Pathogenesis of malignant pancreatitis. The main ethological factor is autolysis of parenchymal papillae, which is associated with hyperstimulation of exocrine function, partial obturation of the ampulla of the great duodenal papilla, development of a large duodenal papilla. Internal duct hypertension, how to develop, increase the rate and increase the penetration of the walls of the thermal ducts. Create mind for activization of enzymes, going out of the boreal ducts, infiltrating parenchyma and autolysis of the tissue of the flesh.

Often the cause of severe pancreatitis is overwhelming the implantation of alcohol and fatty food.

The most common cause of internal ductal hypertension is the development of bilious and alcoholic pancreatitis. Tsіvodydi pancreatitis becomes 90% of all pancreatitis. The skin from them has a great specialness in the most important overcoming and the result of ailments. Until more serious reasons for the development of gastrointestinal pancreatitis, it is seen as a result of cardiac abdominal trauma, intraoperative tissue closure, atherosclerotic occlusion of abdominal aorticoid hypertension, ectopoietic

Necrosis of pancreatic cells and cells, which drains off parts of the slurry, on the very cob of the process will be absorbed by the infusion of lipase. Lipase penetrates into the middle of the blood cell, hydrolysis of the inner layer of triglyceride from the fatty acids. In young cells, internal cell acidosis develops with a pH of up to 35-45. In the acidosis drainage, inactive trypsinogen is transformed into active trypsin, which activates phospholipase A, vivilnya and activates lysosomal enzymes (elastase, collagenase, chymotrypsin and in.). Instead of phospholipase A and lisolecithin in the tissue of the pancreatic cavity in case of severe pancreatitis, the sutta grows. Tse to inform about the role in the autolysis of tissue. With the infusion of polypolytic active proteolytic enzymes, there are microscopic or macroscopic changes in the growth of fatty necrosis of parenchymal fenestrations. On the whole background, elastase is caused by the lysis of the walls of the venules and the middles of the semi-tissue partitions. As a result, there are great hemorrhages, the transformation of fatty pancreatic necrosis into hemorrhagic one is observed. Before the severity of the primary necrosis, leukocytes are rectified. Accumulation of leukocytes near the end of necrosis means the development of a burned-out reaction, which is superfluous. For the prevention of necrosis and elimination of necrotic tissue, macrophages, leukocytes, lymphocytes, endothelial cells see pro-burning and anti-firing interleukin, active acid radicals. There are small periods of necrosis in the course of the course of reactions to interchange, to lysis with the onset of elimination of products in the fall. The processes wicked into the organism will match the mice reaction ignited.

With great necrosis, macrophages, neutrophilic leukocytes, lymphocytes are aware of overworldly stimulation, the production of interleukin and acidic radicals of growth, go to the control of the immune system. Change against anti-firing interleukin. The stench of your ears is yak, weave, and yak organi. Tissue necrosis does not affect interleukin, such as active acid radicals, nitrogen oxide (NO) and most aggressive peroxynitrile (ONOO). Interleukin is not necessary to prepare a soil for the whole: to reduce the tone of venous capillaries, to increase penetration, to wick thrombosis of capillaries.

The changes in the microcirculatory channel are affected by nitrogen oxide. The ignition reaction is progressing, the zone of necrosis is expanding. Misce's reaction to fiery reaction to a systemic reaction, the syndrome of a systemic reaction to firing develops.

Classification. Behind the nature of the change in pidshlunkovy zalozi see:

Nabryakovy, or interstitial, pancreatitis;

Fatty pancreatic necrosis,

Hemorrhagic pancreatic necrosis.

Nabryakla abortive form of pancreatitis develops on aphids of an insignificant, microscopic ear clitin pidshlunkovoy zalozi. The filling phase can, over a period of 1–2 days, re-develop into the necrosis phase. With progressive pancreatitis, fatty pancreatic necrosis develops, which, in the world, the development of hemorrhages is transformed into hemorrhagic diseases due to the statements of the great, the appearance of hemorrhagic pancreatitis in the midst In a number of patients, there is a decrease in the form of pancreatitis: hemorrhagic pancreatitis due to intermediate fatty necrosis and fatty pancreatic necrosis due to hemorrhages.

Falling from the broader process to the development of an average, subotal and total pancreatic necrosis.

Behind the cliché interruption, there are abortive and progressive overburden of ailments.

Behind the phases of the passage of important forms of gastrointestinal pancreatitis, there is a period of hemodynamic damage - pancreatogenic shock, functional deficiency (dysfunction) of internal organs and period of severe delay, which is infused in 10-15 days.

Klinichna picture and diagnostics. In the cob period, ailment (1-3-a doba), both in case of abdominal (abortive) forms of pancreatitis, and in case of progressive pancreatitis ailment, to skip on acute, persistent pain in a stomach-lung disease, ...

In the early term, there is an ear for the ear, especially in the case of embryonic forms: a slight malformation of the sclera (with bilious pancreatitis), mild cyanosis. The pulse can be normal and the temperature is normal. The process of necrosis starts to move as if it were some kind of gnarly process.

Lives meek, all seen take part in the act of dichotomy, and in some cases it means that the belly is healthy. Symptom Schotkіna-Blumberg negative. Approximately 1-2% of severely ill people in the abdomen have cyanosis, some of them are covered with cyanosis (Gray Turner's symptom) and as a result of dehydration of blood in the area of ​​the infertile hemorrhage Likewise, the beaches can be promoted in the dialect of the navel (symptom Purchased). Percussion causes a viscous tympanitis over the upper abdomen - intestinal paresis of the vein as a result of teasing or phlegmon of the urinary cellulitis or peritonitis. With the accumulated significant amount of exudate in the black empty, it means the dullness of the percussion sound in the shallow parts of the abdomen, so it is easier to appear in the position of the sick person on the boat.

With palpation of the abdomen, there is a soreness in the epigastric disease. Frictions of the abdominal muscles in the cob period do not develop pancreatitis. If there is only some resistance and soreness in the epigastric disease in the zone of growth of the lactic acidosis (Kerti symptom). Palpation in the left costal-spinal cod (projection of the tail of the feline burrow) is often swollen (Mayo-Robson's symptom).

Most of the ailments contribute to the disorder of the psyche: anxiety, misinterpretation of witness, steps of destruction, which are completely determined by the points of the Glasgow scale.

Functional stoppage of the stove will start appearing to the barbers of the stove. In case of stiff obturation of the backbone duct, the mechanic zhovtyanitsa with the help of the rivnya bilirubin, transaminases, and the enlargement of the liver. Gastrointestinal pancreatitis is characterized by an increase in amilase and lipasis in syrovatz blood. Significantly increase the concentration of amylazi (diastasis) in the slaughter, in the exudate of the crank and pleural empty. With total pancreatic necrosis, the level of amilazi decreases. Greater specific dosages for early diagnostics of pancreatitis include trypsin in the bloodstream, achimotipsin, elastase, carboxypeptidase and especially phospholipase A, which plays a key role in development. In addition to the foldability of the streaming value, the expansion of the meaningful methods.

Ultrasound dosage. I will help you in the diagnosis of ultrasonic diagnostics, allowing you to establish etiological factors (cholecysto-and choledocholithiasis), to find the growth and increase the size of the intestines, to purchase petroleum products from the rose. Signs of an increase in the size of a creeper, a reduction in the efficiency of a fabric, a reduction in the degree of display of a signal. In case of necrosis of the bottom hole, there is an intermixture of reduced echogenicity or more of the daytime signal.

Computer tomography is an accurate method of diagnostics of gastrointestinal pancreatitis against ultrasound. For її there is no transition. The reliability of diagnostics is improved with intravenous and oral oral administration with contrast material. .Computer tomography with the strength allows you to quickly develop the diffuse, but locally increase the growth of the growth, the growth of the necrosis, the purchase of the birth, the changes in the parapancreatic path of the cells of the interstices, "

Magnetic resonance tomography is a thorough diagnostic method. Vona gives information similar to the acquired computer tomography.

Radiologic allowance for pathological changes in horse-drawn ones in large patients: isolation of the dilatation of the transverse colon intestine, segments of the poor and two-fingered intestines, until there is

Esophagogastroduodenoscopy is observed in case of shlunkov-intestinal bleeding from gostrich eroziy and virazok, as well as accelerated severe (most often destructive) pancreatitis. Retrograde pancreato-cholangiography in case of gross pancreatitis is not shown, there is some evidence of a grip in the head prototypes of the pancreatic cavity during the whole procedure.

Laparoscopy is indicated in case of an unclear diagnosis, if a laparoscopic installation of drains is required for the treatment of gastric pancreatitis. Laparoscopy allows you to poke the midsection of steatonecrosis (stearinovy ​​beaches), igniting the serpentine, zhivny mikhur, penetrate into the empty area of ​​the small omentum and glance at the bottom of the omentum, establish drainage for the small industrial plant.

Likuvannya. Perchochergovim zavdannyam є zyattya pain and spasm of sphinkter Oddi. Using this method, I recognize non-narcotic analgesics, antispasmodics, and holinolitics. If the diagnosis is firm, the introduction of narcotic analgesics is permissible. Zastosuvannya drugs in the morphine row, wiklikayut spasm of sphinkter Oddi, є is unacceptable. For zeniebolyuvannya, inject also internally dribbled glucose-novocaine sumish (10 ml of 1% novokain and 400 ml of 5% glucose). I will paint a painless diyu maє epidural anesthesia.

For the hormonal stimulation of the exocrine function of the body, it is necessary to increase the rate of release through the mouth. It is also shown to post-process aspiration instead of the shlunk through a nasogastric tube. An important role in lycuvanne pancreatitis is to induce the secretory function of the slurry for additional blockers of H2-histamine receptors, antacids, anticholinergic drugs (gastrocepin, atropin).

Naybіlsh effective means of stifling the exocrine function of the pancreatic cavity є cytostatics (5-fluorouracil, cyclophosphamide), synthetic neuropeptides (dalargin), synthetic analogs of somatostatin (sandostatin, oxytethridamine).

For the fight against enzymatic toxemia in the first phase of gastric pancreatitis, vicoristovyt ingibitori proteases (trasilol, counterkal, gordox et al.). The drugs are capable of producing proteolytic enzymes and calories and thus reducing the toxicity. In the last few years, the effectiveness and efficiency of the collection is put on the basis of the sum.

For the correction of the BCC, it is necessary to inject internally the differences of coloidal and crystalline differences under the control of the level of the central venous vise and weather-related diuresis. Spividnoshennya coloide and crystal-like solutions can be approximately 1: 1.

Parenteral grubbing is a general viscous component of the liquefaction, splinters of grubbing through the mouth take 3-5 days. Energy consumption by the organism of a sick person (30 calories per day per 1 kg of fatty acids with increased amounts of up to 60 calories per 1 kg.of fatty substances per day) without the introduction of concentrated solutions of glucose with insulin, dietary supplementation

For deintoxication, forcing duresis is often stagnant. For normalization of the circulating blood volume for additional infusion therapy, inject sechogenic drugs (lasix, furosemid). At the same time, toxins, products of a drop of blood, ferments are emitted.

Peritoneal lavage stasis is not only for diagnostics, but for the treatment of pancreatic necrosis (most often hemorrhagic). With a lot of emptying, they see exudate, abundance of proteolytic and lipolytic enzymes, cytokines, kinins and other toxic substances, products of melted necrotic tissue. Peritoneal lavage in order to reduce the moisture of toxic products and reduce the amount of toxins on the parenchymal organisms.

To carry out peritoneal lavage under the control of the laparoscope, drainage is installed at the upper side of the transverse emptying, the emptying of the small pelvis and the right lateral canal. Along the upper drainage lines, enter the empty space at the top, through the lower - the line, see the name. At the same time, it is necessary to follow the balance of the line, to be introduced and to be introduced, to control the CVP, and to transfer the potential for acceleration.

For the reduction of microcirculation, among other things, in the middle zone, inject rheopolyglyukin, small doses of heparin, stagnate kerovan hemodilution.

Antibacterial therapy for pancreatic necrosis should be carried out for the prevention of infection in the presence of necrosis, as well as for the treatment of infection, even to develop. They provide antibiotics of a wide range of diy (cephalosporins of the 3-4th generation, carbopenemi, aminoglikosidi), which can be used to adapt the development of gram-positive and gram-negative microfloria. An obligatory component of antibacterial therapy is the introduction of metronidazole (prapor), which is a vibrating infusion on the non-clostridial microbial flora.

Indicated before the operative treatment є: 1) inability to diagnose; 2) lіkuvannya vtorinnoї іnfektsії (poєdnannya GOSTR pancreatitis of destructive cholecystitis, іnfіkuvannya nekrotichnoї tkanini zalozi, gnіyniki in zaocherevinnіy klіtkovinі, poshireny gnіyny peritonіt, abscess in cherevnіy porozhninі, Yakscho nemozhlive lіkuvannya cherezshkіrnim drenuvannyam pid 3) progresuyuche pogіrshennya will ailing, nezvazhayuchi to adequate іntensivne lykuvannya (including with the failure of laparoscopic lavage of black emptying), massive arrosive bleeding.

By the method of surgical treatment є seeing the information of necrotic tissue doughs until the development of purulence, optimal drainage of black emptying for the treatment of peritoneal disease, or the visualization of birthplace, which is the reason for the great ferment

With abnormal multiple semicircular pancreatic necrosis, in the presence of peritonitis, it is thrown up to a gradual necrosis, so that a programmed revision and production of black emptying is possible. Do not close the wound tightly with any method, just put it in a bandage for the release of the peritoneal exudate. Afterwards, I’ll see a sick person and given instrumental methods to diagnose (ultrasound or CT) after 1-2 days, open the wound, carry out a revision with the visible signs of necrosis and repeat the procedures of the wounds.

In case of semiconducting pancreatic necrosis in the tail of the subshlunkovaya zolozi and unsuccessful complex intensive treatment, it is possible to carry out distal resection of the zalosi. In single cases, with total pancreatonecrosis, a total or subtotal pancreatctomy was performed earlier. However, the operation is traumatic, it leads to high lethality, which, by the way, was introduced.

In the last few years, in clinical practice, there are minimally invasive methods of "closed" treatment of pancreatic necrosis and its acceleration. Diagnostic operatives who have previously been diagnosed for additional wide laparotomy (cholecystostomy, drainage of the omentum bursa, black empty, black blood cells, drainage of abscesses and ultrasound diagnostics through ultrasound), can Through the installation of drainage in this way, it is possible to aspirate instead of empty empty cysts, to drain the empty ones and inject antibacterial drugs. The given technique is less traumatic, it is easier to be tolerated by ailments, it is easier to endure with a lesser number of accelerated and lower lethality.

Lecture for masters

Lecture topic: Gostry pancreatitis

Entry

Gostry pancreatitis is one of the folding problems in non-operable surgery of organs of a black empty. Remaining rocky is characterized by unhealthy growths of illness for pancreatitis, the patients are close to 8% of the contingent of surgical hospitals, and for the frequency of their visit the third month is sent for a severe appendicitis and a hostile cholecystitis.

Until the end of the hour, there is a low level of non-virulent nutrition, which includes the pathogenesis of impairment, the pattern of development of the process, the appearance of a single classification for clinicians and morphologies. The first problems of diagnostics, conservative and operational tactics in case of gostrich pancreatitis (OP).

According to the data of recent authors, the mortality rate in case of OP does not exceed 2 to 8%. With bulky forms of CAP, the result is the prognosis is often agreeable. Mortality in pancreatic necrosis is 10 to 15%, mainly in the case of septic-septic diseases.

By means of the given є to make the deyak clear in nutrition diagnostics, conservative and operational tactics in OP.

Anatomy

Pidshlunkova zloza was roasted in the space around the ravine on the level L1-L2. They have a headline, just that head. The head of the slurry sticks up to the twelve-fingered intestine, the tail reaches the spleen. The anterior and lower surfaces of the body are interspersed with a gut. The zaliza is a thin semi-tissue capsule and rotates badly with semi-tissue partitions. Dovzhina pidshlunkovoi 15-25 cm, width of the head - 3-7.5 cm, body - 2-5 cm, tail - 2 - 3.4 cm.Mata organ - 60-115g.

Topography of the slurry zone (Fig. 1 and 3).

The head of the subcutaneous nodule with a lump-like protuberance lies at the subdial-like vigina of the twelve-fingered intestine. On the cordon with the til, there is a virizka, in which the upper artery and Vienna pass through, how to brigade. Behind the head of the opening of the lower emptying and gate veins, right of the artery and vein, the posterior opening of the duct.

Until the posterior surface lies the aorta and splenic vein, and behind the tail there is a liva nirka with an artery that vein, livy nirnik.

Shyka pidshlunkovoy zalozi roztashovana on the level of zlittya selesinkovoi ta

Small. 1 Ductal system of the lower brijovian veins.

Before the front surface of the slurry hole, lay the back wall of the slurry. From the front edge of the trunk of the lobes, take the ear of the duplikatura of the root of the breech of the transverse colon.

The duct of the subshlunkovaya zalozi (Virsunga duct) gets angry with the zhaglunovy duct, filling the ampoule of the Vater's papilla of the twelve-fingered intestine. In 20% of the ducts vipadk_v in the duodenum, the intestine flows okremo.

Dodatkova duct of the pidshlunkovaya zalozi (Santorini duct) grows on the small papilla by 2 cm in the view of the great duodenal papilla.

Blood circulation (Fig. 2):

1. Blood posture of the head of the dermal zone - the upper and lower pancreatoduodenal arteries and veins. The upper pancreatoduodenal artery is the shlunkovo-duodenal artery, the lower is the upper bridgework artery.

2. Til and tail to find shelter from the spleen artery.

Lіmfovіdtіkannya.

Lymphatic universities are growing along the course of the course and will end in pancreatic-splenic lymphatic universities. A part of lymphatic tissue can also reach the pancreatoduodenal and periaortal lymphatic universities of the upper bryzhovo artery.

Innervation is sympathetic and parasympathetic through the gossip through the gossip and the small world, through the pechinka and gossip from the top. Eferent parasympathetic fibers of the bloating nerve pass through the gossip without setting up synapses and end with parasympathetic ganglia in the middle fibrous septa, so they break out the small parts of the flesh. Post-ganglionic fibers supply acini, ducts, islands of Langerhans. Efficient sympathetic fibers take their cob from the lateral systems of the speech of the thoracic and lumbar spinal cord, then establish synapses with the neurons of the ganglion of the cranial and upper breech plexus. Post-ganglionic sympathetic fibers innervate the blood-bearing judgment. Affective part of the nerve is not vivified until the end, but it is more possible that the fibers pass at once from the bloating nerve through the gossip and then to a pretty lance through the great splanchnic nerves. In general, you must be nerves to go to the bottom of the hole and go through the gossip.

Ethiology of hospitable pancreatitis

Hostry pancreatitis is a polyetiological one, with a phase transition to the dehydration of the dehydrated zone, connected with the activation of enzymes and the flow of the remains onto the tissue, even to the point of self-etching and necrosis.

Theory of VP

1... Flow enzymatic theory for the theory of the “out-of-the-box channel” that is forced into a pancreatic prototype. Reflux of the duodenal gland into the head pancreatic duct of the vein in the zone of developmental pancreatitis. On the thought of the authors in the basis of the flow-enzymatic theory, there is an internal organ (internal duct) activation of the lipase duodenal in the place of the mouth, yak, at its own devil, wicked into the great changes of the parasite, in the same place

2. "Sudista" the theory is based on factors due to provincial factors, spasm of arteries, venous thrombosis, inflammation of the brain, as well as impairment of intraorgan blood flow in the microcirculatory channel, to reduce the enzyme tolerance from autism to moisture

3. “Trypsin” theory, which is why the active pancreatitis is based on activation of moisture pancreas enzymes with increased losses of tissue (active trypsin, infused on the intermediate tissue of the pancreas to penetrate the blood vessels until the vessels, , the advancement of penetration, the infusion of blood stasis, the establishment of blood clots, so that you can bring your blood clots to the brink, bloody that necrosis.

Development of fatty and hemorrhagic pancreatic necrosis. Ї суд Most often it is offensive to see necrosis to admire the majestic heroes of one of them.

Pathomorphological stages:

1. Nabrya phase Axis: zaliza blida, sclopodibna, nagryakla, firm, nabryak expand to the neck, to the neck of the cell. Because of the other chances to recharge with blood, there is stasis, the growth of capillaries, the tissue has blood thinning. Zaliza old chervona, nabryakloy - hemorrhagic nabryak.

2. Hemorrhagic necrosis phase: zaliza v'yala, kissed with bloodshed, dark beaches of necrosis.

3. Fat necrosis phase: inheritance of a series of proteolytic enzymes - zaliza v'yala, patched by siruvaya beaches, which may look like greasy candies.

4. Phase of education of the cyst. In addition to the theory of pancreatitis, it is necessary to say a few words about the anatomical and physiological peculiarities of the undergrowth, like about the additional factor, which should lead to the development of state fire and destructive processes in the process.

5. Zmen in case of OP are found in the zalose itself, and in the other organs: in the liver, pleura, ocherevin.

Classification of VP

1. Gostriy nabryak chi interstitial pancreatitis;

2. Hostry hemorrhagic pancreatitis;

3. Hostry pancreatic necrosis;

Decreased pancreatitis

1. Parapancreatitis

2. Peritonitis

3.Infiltration of the omentum bursa (pancreatogenic omentobursitis)

4. Brushes for the slurry

5. Gn_inny pancreatitis - suppuration of pancreatonecrosis, gn_yny peripancreatitis, abscess of the omental bursa, gn_yny peritonitis;

6. Pancreatic norits

7. Bleeding (also arrosive);

Klinichny options overbig OP:

1. Pancreato-cardiovascular syndrome;

2. Pancreato-suprarenal syndrome;

3. Pancreato-renal syndrome;

4. Pancreatic-cerebral syndrome;

special forms VP:

1. Hostry cholecystopancreatitis

2. Pislyaoperatsіyny

3. Traumatic

atypical form of pancreatitis:

1. Pancreatitis of thyroidectomy;

2. Pancreatitis on aphids;

3. Pancreatitis and mumps natomy;

5. Vagitnyh pancreatitis;

6. Spadkovі pankkatiti;

EP diagnostics

Diagnostics of gastrointestinal pancreatitis є an urgent problem of urgent surgery. In case of acute help, the diagnosis of pancreatitis does not arise in 38-80.4% of patients. It is worth explaining the polysymptoms, and often the atypical clinical picture of ailment, heavy haemodynamics, alcoholic intoxication, the manifestation of grave companions, a reactive sick person / 10

Povnotsinna diagnostics of the state of pancreatitis transmission: 1) the appearance of the disease and the confirmation of the form; 2) an assessment of the camp of zhovchnyh nobles; 3) development of early acceleration; 4) predicting the overrun of the disease / 10 /.

It is the most effective way to diagnose pancreatitis to diagnose patients with ailments in the hospital. To navigate in the minds of a surgical stationary by reaching out with the first, finish off the ear of a disease that does not occur in 10-43% of the sick (Biliy I.S., Desyaterik V.I. 1989). It is not a matter of foldable workers є a quick establishment of the form of pancreatitis, a form of destructive changes, which have developed, in the flesh zone. The number of diagnostic pardons for destructive forms of incapacitation reaches 52-62% (Buyanov V.M., Balalikin A.S. 1986) / 10 /.

Clinical and morphological signs of malignant forms of destructive pancreatitis.

Naybіlsh vazhky klіnіchny perebіg destructive pancreatitis sposterіgaєtsya zazvichay at razі formuvannya mnozhinnih drіbnih vognisch scho іnfіltruyut entire tovschu pіdshlunkovoї zalozi (difuzno drіbnoochagovy pancreatonecrosis) Especially when great utvorennі dekіlkoh vognisch abo zlittі drіbnih vognisch at velikі nekrotichnі field (vognischevo). The most important factor, which is the beginning of the severity of clinical manifestations, є the wideness of the affected territory, affected by destructive changes / 14 /.

The peculiarity of the destructive forms of pancreatitis is in the fact that snakes develop for them in the middens, and in the middle.

In the presence of steatonecrosis, hemorrhage, hemorrhagic and serous infiltration, it is established in the cell structures of the uterine space, near the ligamentous apparatus of the black empty space, and it is not easy to navigate in the middle of the bed, 14

Parapancreatitis- one of the most important components in pancreatic necrosis. Yogo Evolution is rich in what is the result of the disease. Until then, show that pancreatic necrosis with a lethal end, as a rule, dressings for infections of children in the womb of the womb. In the most important cases in the fire, the reduction of cells appears on the surface of the shlunk-rim connection of that great omentum, on the surface of the visceral and partial queens, domes of the diaphragms, at the cells of the stem cells.

Klіtkoviny in the cob stages of destructive pancreatitis is the power of the severity of the fight. The nature of the destructiveness of the knotting with a wide leverage and one more factor, which is infused into the critical interruption, and the result of the disease.

The reasons pіznoї dіagnostiki GOSTR pancreatitis Minds statsіonaru Je nedostatnya іnformativnіst laboratory metodіv scho zastosovuyutsya, nevіdpovіdnіst fermentemії tyazhkostі destructive for Change in pіdshlunkovіy zalozі, viklyuchennya laparoskopіchnogo doslіdzhennya, osoblivostі topographic anatomіchnogo roztashuvannya, suttєvі vіdmіnnostі in virazhenostі okremih simptomіv. Problems of diagnostics of destructive pancreatitis should be caused before the sick people are not adequately treated with pathogenetic therapy, even to a lethal result. Unsatisfactory results of the treatment of gastrointestinal pancreatitis due to the lack of understanding of the existing methods of early diagnostics and confirmation of diagnosis, differentiation and clarification of the formation of the prognosis, assessment of the diagnosis Only an early diagnosis and a quick release of an intensive pathogenetic treatment give a reduction in the inheritance of an illness in the sutta, and a decrease in an accelerated mortality / 10 /.

In most patients, diagnostics of gastrointestinal pancreatitis is carried out on the basis of ailments, observational and laboratory data.

Skargi, who are diagnosed with ailments with gastrointestinal pancreatitis, are characterized by pains, operative character, in the epicranial dylyantsi that over the navel, in the right abnormal pidreber, with irradiation across, nudity.

Objectively: most often the ducts live near the projection of the transverse colon, locally painful, tender, more stressful, with peritoneal symptoms, with weakened intestinal peristalsis, and with the appearance of the bowel / 4 /.

Syndromic diagnosis in destructive forms of gastrointestinal pancreatitis is not widespread. Protecting the analysis of clinical syndromes that occur in those who are cautious about the morphological verification of the diagnosis of pancreatic necrosis, which is scientifically practical / 2 /.

At the cob stages of destructive pancreatitis, the following clinical syndromes are most demonstrative:

1) bolovy

2) peritoneal

3) dynamic intestinal obstruction

4) hemodynamic breakdowns

The retardation of clinical manifestations with manifestations during verification of morphological features showed that the intensity and dynamics of cych syndromes are rather high, due to the widening of destructive fatty worms in the middle of late autumn It is not only for the early diagnosis of pancreatic necrosis, but for the diagnostic assessment of the development of the disease / 2 /.

I. Pain syndrome (PS) with destructive pancreatitis develops a special intensity. It is more likely to be localized in the upper abdomen and may have an operative character. The main feature of BS in pancreatic necrosis is that it is not spasmodic and antispasmodic drugs, as well as the transverse novocaine blockade, the internal introduction of glucose-novocaine confusion gives a time-consuming and ample knowledge. Introduced morphine that analogue is unacceptable, fragments of the progress of necrotic changes in pidshlunkovy zalozi / 2 /.

Extras in hand (laparoscopy, laparotomy), after 6-12 years from the ear of severe operative pains, showed, also in the whole term, macroscopic signs of destructive pancreatitis: peritoneal adiposexudate in high /.

Intensive BS in case of clinical picture of gastrointestinal pancreatitis followed by one of the early clinical signs of the formation of a destructive form of seizure, and widening of the zone of large symptoms in the lower and more vital signs

II. Peritoneal syndrome is diagnosed in 20-40% of patients with pancreatitis.

Bulo was established, at the cob stage of pancreatic necrosis in 97.4% of cases, and Shchetkina-Blumberg symptom - in 57.7% of them. With hemorrhagic pancreatic necrosis, clinical manifestation of peritoneal syndrome occurs practically in 100% of ailments, and with fatty - in 96.9% / 2 /.

The inconsistency of the intensity of the peritoneal syndrome and the swelling of the painful symptoms in the clinical picture of gastric pancreatitis followed by the development of one sign of pancreatic necrosis, which is forming / 2 /.

Primary pancreatogenic peritonitis is pathogenetic of dressings from the cob stage of congestion, from the form of pancreatic necrosis and parapancreatitis.

The reaction of the leaves of the queue to the process of destruction in the pancreatic cavity and the nascent cells, as well as the development of the state portal hypertension during the period of the attack of pancreatic necrosis is carried out during the period of unsuccessful / successful implementation.

Prot_vayuyu through the nutlet, which curls the pidshlunkovy zalozu and zajrevinnuy klіtkovinu, vipit accumulate in the oily bag and in the black empty slots not very often from the great number / 14 /.

Proof of the pancreatogenic nature of peritoneal exudate є the manifestation of new enzymatic activity. With a retrospective analysis, it was established that the activity of amylase in exudate (512-1024 units of Volgemut and viscera) was found in 80.8% of patients with extended forms of pancreatogenic pancreatitis. Verification of the precautions behind the data of the operations and the pathologists' studies showed that the adjustment of the amilolytic activity could be achieved exactly as a result of the general battle.

Most of the temporal activity is indicated in total and subtotal pancreatic necrosis. In sparing the activity of amylase in peritoneal exudate 1024 odes. Volgemut's lethality becomes 59.1%, and for less activity - 19.0%. Tse uzgodzhutsya s data about those, that the steps of the enzymatic activity of exudate are tied to the broadening and glybin of necrotic snakes in the parenchyma of the fledgling zone and with the diameter of the protozoa in the case of the whole pancreatic.

Secondary pancreatogenic peritonitis in the course of an inflammation-gnarly evolution of pancreatic necrosis and parapancreatitis, for example, accelerated from the side of their organs. To secondary peritonitis, sweaty or perforated gum peritonitis, peritonitis due to perforation of the pseudocyst of the omentum bursa, perforated perforation of the intestinal tract / 14 / can be carried out.

Exudate in case of secondary peritonitis to take revenge on the house of zhovchy, intestinal vmist, fibrin and gniy / 14 /.

Intensiveness of gummy exudate in case of fatty pancreatic necrosis lies at the stage of bilious hypertension and propelling the gum through the stink of girders. Prevention of bloody exudate in hemorrhagic pancreatic necrosis lies at the level of penetration of the vertebral column. With coarse structural changes, sprouting with pancreatic necrosis, it is not just splinters of erythrocytes, but unimaginable clitins that enter the perivascular space / 2 /.

ІІІ. Syndrome of dynamic intestinal obstruction (DNA) in case of gastrointestinal pancreatitis is attributed to 40-60%, and, according to the facts, in 90% of patients.

Clinical and morphological images showed that the bagatorazovy bluing was followed by a prognostic sign. In case of vipadkah, because of the unpleasant result, one has to recover from the earliest years of a painful attack / 2 /.

Bloating masses in ailments with destructive pancreatitis will start to take revenge on the little house, and if there is a depletion of veins, the stench may look like "cavalry thick", and if there is a lot of cystic disease, there may be a small amount of varicose veins.

The change in morphological changes resulted in a parallelism between the intensity of DNA and the severity of the clinical transition from destructive pancreatitis / 2 /.

Pancreatic necrosis due to the unpleasant result of supervising trivial DNA, conservative entry is not effective. On the x-ray signs of such ailments, stretched intestinal loops can be seen, not rarely from the same age. Differential diagnostics for mechanical impairment in times of additional assistance to prolong the passage of barriers through the intestines. In those who operated, or died with such a clichéd picture, the ailments manifested a total or subtotal pancreatic necrosis due to the great lesions on the colopancreatic cotcini, the great omentum. In a large number of such preventions, there is a large number of steatonecrosis in the cells of the small intestine, in one or a few cases of the intestinal cells / 2 /.

To assess the severity of pancreatic necrosis, it’s stagnant to take the volume of the stagnant shlunny vystu, won for a nasogastric tube for dobu / 2 /.

For a group of ailments with a friendly result (div. Table), a long-term period is reached for 2-3 days, and I do not change 600-800 ml for doba. On the 4th-5th day, the wine changes to 300-400 ml or less.

In a group of ailments with an unpleasant result, pancreatic necrosis is replaced by a slunker, but on the 2nd or 3rd day I change 1000 ml. At the beginning of the day, the stagnant shlunkovy vysyag instead of 2-3 times / 2 /.

The whole simple reception allows even in the first days ailment I want to see a group of ailments with a prognostic disagreeable interruption of ailment and apparently a problem.

IV. Hemodinamіchnі rosladi with gosstromy pancreatitis report vivchenі for the additional help of special instrumental techniques. In the minds of non-advanced diagnostics of destructive pancreatitis, an on-line assessment of hemodynamics can be carried out behind the camp of the pulse, peripheral microcirculation, arterial and central venous vise / 2 /.

Tachycardia in the form of pancreatic necrosis in the first years of a painful attack. Pershu dobu vona has 67% of ailments (120-130 blows per quill), (with hemorrhagic pancreatitis - in 49.3%, with fatty pancreatic necrosis - in 71.4%). For 2-3, the number of such ailments will increase to 81.5% / 2 /.

Systolic arterial vise(SBP) in the first days of the formation of destructive forms of pancreatitis are characterized by three options: hypertonic, normotonic and hypotonic. In the middle of the verified warnings, the early term passed over the hypertonic and normo-tonic options / 2 /.

An analysis of the verified steps has shown that the level of hemodynamic changes is likely to lead to the development of destructive pancreatitis / 2 /.

In 19.1% of patients with a verified diagnosis of pancreatic necrosis after the CAT reached 250/100 mm Hg. Art. and settling for 7-8 days. The development of a similar "hypertensive crisis" is one of the key signs of the formation of pancreatic necrosis with the progress of destructive changes. In the section, in such vipadas, there is a great level of growth of the seedling and the worms. Pathologists have shown that even in the first 4-5 days of destructive changes (mid-fat necrosis, hemorrhage, mid-necrosis) є in the paraadrenal cells and in the parenchyma of the supra-nirkoval cavities. The process of allowing the formation of a hypertensive crisis in the first days of the formation of pancreatic necrosis is not only with reflex reactions to a large amount of heat, but also with expanded zones of destructive changes on the paraadrenal cells of the veins, above Arterial hypertension and "pancreatogenic hypertensive crisis" often occur with fatty pancreatic necrosis (52.1%), but with hemorrhagic (23.3%) / 2 /.

Arterial hypertension is more frequent in cases of hemorrhagic pancreatic necrosis (60.7%), less in fatty pancreatic necrosis (11.1%) / 2 /.

The normo-tonic variant of hemodynamics in the 1st addition to the formation of pancreatic necrosis was diagnosed in 37.4% of patients with a verified diagnosis / 2 /.

The changes in the central venous vise (CVP) in verified pancreatic necrosis conditions were also small because of the critical interruption of the disease. Negative or close to zero showing CVP in the first 24 years of illness was found on the aphids of great necrotic lesions of the midwash and the womb cell / 2 /.

Disruption of peripheral microcirculation of the abdomen (NPMK) in children / children in color / in 39.6% of the ailments (violets on the abdomen, children, cyanosis and acrocyanosis, blushing of 1

In the last few years in the diagnosis of gastrointestinal pancreatitis, it is more and more common to know the ultrasound and angiographic dosage, endoscopic retrograde pancreatocholangiography (ERPGG) and computer tomography.

However, in the diagnosis of gastric pancreatitis ERPGG and angiography are not widespread due to the increased invasiveness and folding of these techniques. The most promising instrumental method for diagnosing gastrointestinal pancreatitis is the method of ultrasound diagnosis (UZD), which is gradually being understood. It is simple for the victorian method, but it cannot be proved, ultrasonic scanning is especially valuable in connection with the possibility of repeated stagnation for dynamic control over the mill of the undergrowth and in the case of parapancreatic development of the pancreas, which helps to improve

However, the rejection of clear ultrasonic data about the disease of the midsection in the state of health / disease is often hampered by significant purchases of gas from the intestines, in those with disabilities, in those who operated on the organs of the upper village in the past.

Neo-evaluated ultrasound scan service is necessary for diagnostics of pancreatonecrosis - frequent and even more dangerous acceleration of severe pancreatitis. Osnovnі ultrazvukovі danі (stupіn zbіlshennya pіdshlunkovoї zalozi, chіtkіst її konturіv, poshirennya log The exo-structure ehogennіst parenhіmi, zmіni in zhovchnomu mіhurі) is Mali dostovіrnogo vzaєmozv'yazku of perebіgom that result zahvoryuvannya against viyavleno zakonomіrnіst in perebіgu pancreatic necrosis with troh types poєdnan Tsikh the moon-structures of the pidshlunkovoy zalozi. The diffuse moon-heterogeneity of the parenchyma from the cherguvannya of the dylyanoks, the reduction and development (type 1) in 14.8% of the populations resulted in a further development of local postnecrotic patients. Such a slowdown developed in a third of the ailments with outliers of zones with a high intensity of the display of the exo signal (type 2), the frequency of them reached 80% in quiet cases, since they outnumbered the great differences in the reduction of the 3 types 10/.

Among the instrumental methods of diagnosing pancreatitis, it is important to panaroscopically advance, as an additional aid to the prevention of changes from the side of the other organs in the black empty space, to clarify the development of a destructive process, to clarify

The laparoscopic method can be used as an alternative to laparotomy, the optimal way to provide a low-traumatic and sufficiently adequate surgical procedure for patients with severe pancreatitis. However, the diagnostic and therapeutic potential of the method can be limited due to the lack of accessibility of the gallbladder due to the lack of accessibility of the gallbladder for the eyes, it is difficult to detect the gallbladder enlargement, when the intestinal discomfort occurs due to the adhesions 4/.

There is a great number of angiographic signs of severe pancreatitis and the variability of these for close options for the treatment of a dermal condition, accelerate the diagnostic interpretation of the data for a specific skin condition.

To that, they do a good job of understanding on singing after cich. It is a sign that they are able to see the blood and the expanded necrosis of the parenchymal flesh.

You can see three types of options for the following:

1. Dribnooseredkovaya destruction. Angiosemiotics is poor and weakly pronounced, characterized by overwhelmingly diffuse stenoses, occlusions and deformities of other pancreatic arteries.

2. Velikovognischeva destruction. Characterized by the appearance of great hypo-and avascular zones, as well as anatomical formation.

Often the trivial occlusion of contrasting speech in the arteries of the splenic vein, and in the venous phase - stenosis and thrombosis of the splenic vein.

3. Totally subtotal necrosis. Typically, the appearance of the avascular zones, triviality of the contrasting speech in the arteries of 2-3 anatomical forms of the zone, often thrombosis or stenosis of the splenic vein, reducing the blood flow in the cervical stovburi.

It also means that the methods of instrumental diagnostics of the response to this world of virality are due to the appearance of gross morphological manifestations of the destructive process of fledgling lobes. With the development of folding pathophysiological and biochemical processes, how to overcome and supervise the development of clinical and morphological manifestations of destructive pancreatitis, the fixation of these methods does not solve the problem of overcoming the problem of early diagnosis. To navigate the intraoperative condition of the underdog zone can not be diagnosed and predicted, especially at the cob stages of congestion / 4 /.

With progressive clinical picture of pancreatitis, ineffectiveness of conservative visits, failure of a sick person, showing peritoneal symptoms, diagnosis of destructive pancreatitis for additional instrumental and operational methods I show you how to do it, intensively go in, get used to the whole stage, often appear to be ineffective. Vyhodyach from vyschevikladenogo, a viral role in the early diagnosis and prognosis of the overcoming of severe pancreatitis can be introduced by special laboratory methods of prediction of infantile disease. Prior to them, there is a pre-development activity of enzymes in the slurry zone, versatile functional tests, indicators of protein, carbohydrate, electrolyte metabolism. In connection with this, the secretion of the secretion of all groups of herbal enzymes, on the paths of organ-specific diagnostics of pancreatitis, the central microscope of borrowing the pre-development of enzymes in children in the biological medium / 4 organs.

Historically, amilase became the first enzyme, which became vivchatsya for diagnostics of severe pancreatitis. On the current day, the appointment of the enzyme in the blood and the slaughter according to the method, proponated

Volgemut is more than 80 years old, and we will broaden the most advanced diagnostic test for patients with severe pancreatitis. Already at the early stages of becoming ill, it is more likely that a woman is becoming ill and one of the most significant indicators of amylase in the blood and blood. The same power has given the enzyme a great deal of value in the diagnosis of severe pancreatitis for the minds of a surgical hospital. However, it is a great clinical and experimental information about the onset of shortcomings in this economic indicator: shortness and inconsistency of the diagnosis, low specificity, and the absence of a pathological prognostic value of a typical

The low specificity of amylase for podshlunkovaya zolozi is zoomed in thymus, so that the enzyme grows and is present in the organs and tissues of the organisms - silky and vapors, lungs, pies, intestines, intestines Volodiyuchi identical to the enzyme activity, as well as the enzyme's form, the indices of the amylase may be increased at least in 30 cases, such as appendicitis, cholecystitis, intestinal congestion, congestion Even in the 70s, the rocky rivnya amylazi, and at the sech otsinuvsya 265, 512, 1024 od. and more. Protect pathognomonic for pancreatitis amylazi nemaє. Along with significant reserves in acinar cells, be it the deterioration of the integrity of the histological bar'єru, the difficulty of the normal output of pancreatic secretion to produce a significant wicid of an enzymatically active enzyme in the bloodstream. Especially it is often the case that sposterigati occurs in milder forms of pancreatitis. With a severe, progressive interruption, the activity of amylase can quickly go down to normal and subnormal values. Great influx of indicators into the blood and into the bloodstream is a great flow of filtration into the building of a robot of nirkovy tubules, a functional standard of amylase readsorption into the bloodstream and part of the penetration into the bloodstream. At the same time, the relative importance of the digital value of amylase activity from the severity of the disease, its forms, the low role of predicted interruption of pancreatitis. In such a rank, the value of the digital values ​​of the activity of amylase, the dynamism of the guilt is estimated only in the complex with the clinical, instrumental and laboratory data / 4 /.

Let's step on the values ​​of laboratory diagnostics of gastric pancreatitis є the value of the step of advancing the total proteolytic activity of plasmas. It seems that indicators of protease activity in case of gastrointestinal pancreatitis are increased by pathological activation of secretory zymogens in the serine row, and in the first place, trypsin is the main representative. However, the data about the change of "trypsinase" activity in the blood in case of severe pancreatitis should be completed superbly. The prevalence of unambiguous results can be explained by the apparent evidence in the blood and tissues of the strained proteases. Plasma infections are produced by parenchymal lesions, liver, and lingering vines, tying in blood proteases and seen by cells of the reticuloendothelial system. In the case of early forms of that at the early stages of gastric pancreatitis, inflammatory proteases in the blood ((1-antitrypsin, (2- maroglobulin, antithrombin III, (1- antichymotripsin, inter- (- antitrypsin, (2-antiplasmin).) blood may cause negative results in the activity of trypsin and / or navpaki, in case of decreased reactivity of trypsynemia.

The value of trypsin in the blood plasma does not reflect the nature of the pathological changes in the pediatric saline, but it reduces the diagnostic value. The foldability of the value of the true activity of trypsin polyanga in the presence of specific substrates / 4 /.

Let's step after the diagnostic test of gastrointestinal pancreatitis є the value of the activity of pancreatic lipasis in syrovatz blood.

For the enzyme to be used in the Danish hour, it takes about 10 different substrates, so that it’s quick to diagnose. In addition to the methodical difficulties, shortcomings given to the test, there is an increase in the activity of lipase in the blood, a lack of specificity and sensitivity, an inadequacy of the digital values ​​of the severity of the process in the middle of the hall. Lack of specificity of lipasis is zoomed in to the increase in activity in case of gross cholecystitis, feverish ailments and other health problems. There are great hopes for the nature of the destructive processes that develop, in the slurry hall, for the associated activity in the blood of the lipolytic enzyme-phospholipase A2. Also at the stage of vivchennya - the correlation of the activity of elastasia

1 at the syrovatz blood and severe destructive processes at the underdogs. For the differential diagnosis of forms of pancreatitis, a vicoristovuvati type of methemalbum is used, as well as special enzymological tests - pancreatitis, transaminases, benzidine test.

In case of fiery middlings near the slurry zone, the lipid peroxide oxidation processes are even more active. To this end, it is possible to begin with markers of peroxide oxidation of lipids in the blood.

Such markers є dianova conjugati are LPO products. The method of evaluating peroxidation products in the test with tobarbituric acid has been promoted, as well as the determination of the level for weak light plasmas. Acid phosphatase is also a marker of lipid peroxidation (acid phosphatase), the activity of which is widely stagnated in cells / 13 /.

As a criterion for the reduction of cell membranes, it is possible to determine the value of the activity of endogenous enzymes (LDH, ALaT, ASaT, transaminidase), concentration in the blood of B-lipoproteins / 13 /.

The very versatility of the proponated indicators to talk about their lack of information, to indicate the need for a little more sensitive and specific diagnostic tests with a state of pancreatitis.

Likuvannya VP

I. Conservative methods of treatment:

Recovering from the 80s, the greater number of surgeries has been transformed into the conservative treatment of severe pancreatitis with surgeries being shown after suvorim. The basis of the complex treatment for gastrointestinal pancreatitis is the following basic principle:

1. Usunennya pain;

2. Preservation of the functional calmness of the bush;

3. Stabilization of biosynthetic processes in pancreatitis;

4. Detoxification;

5. Correction of volatile problems and disturbances of microcirculation;

6. Korekts_ya porushen kisnevy exchange;

7. Prevention of gn_innyh acceleration;

8. Population of energetic vitrates;

To fight against the main key symptom of becoming ill - pain - stagnation of new blockade - perinephric, cranial gossip of that pretty stovbur, vagosympathetic, sacrospinal, epidural, subxyphoid, fractional, transcranial. The analgesic effect of bending can be reached when a trimeka is inserted into the epidural space. A good analgesic effect is indicated when procaine is consumed with hydrochloride, pirazolone, pethidine, pentazocine, derivatives of pirazolone, and infusion calcitonin / 12 /.

Recently carried out recently showed the need for suppression of advanced slunk secretion in complex treatment of gastrointestinal pancreatitis.

It has been established that it is possible to reduce the reduction of the slurry to a reduction in the reduction of the secretion of the slurry. For cich tsіley vikorystovuvsya gastrocepіn, zasosuvannya cimetidine wide expansion did not know through a great number of side effects. At the same time, somatostatin, glucagon and calcitonin at therapeutic concentrations galvanize the acid-replenishing function of the slurry and the eccobolic secretion of the subshlung after additional blockade of the acinar clitins. Admitting that somatostatin and glucagon stimulate the activation of calcitonin, which induces the resorption of calcium in the cysts, and this calcium plays an important role in the process of activation of the secretory 6

Dose a lot of ideas about the mechanism of antienzyme drugs. Some adversaries vvazayut, how the stench blocks the blood plasma, and they themselves take advantage of the preparation of the vigor of the blood It is also meant that the ingibitories of proteases are injected into the internal synthesis of proteins, which are reduced during the hour of decreasing their viroblension / 6 /.

Among the positive indications about the effectiveness of anti-inflammatory proteases in case of gastric pancreatitis, data on the overall efficiency of the disease, or more on the basis of the effectiveness of the reaction in case of pancreatitis. On the thought of a number of authors, the stagnation of ingibitoriv proteases does not lead to the development of morphological changes in fledglings and does not infuse the lethality and accelerated frequency / 6 /.

In the literature, there are indications for the great effectiveness of antienzyme drugs with selective intraarterial injected drugs, injected with a round liver ligament, parapancreatic cellkovine, and an empty one with laparoscopic dosing. Stagnate also the internal tissue and transduodenal electrophoresis of the ingibitorіv proteases. It is also the most promising the preparation of anti-inflammatory proteases of prolonged action, the growth of preparations based on gordox and carboxymethyldextran with a molecular weight of 60,000 / 12 /.

O. M. Shcherbyuk vvazhaє, so the Ingibitories of proteases will give a significant polyphenia to the ailments of the Persh, I will add the illnesses of the protesters of the Protishokiy Diy. The preparations are guilty of vicorisation only for the first time to get ill at once from the means, which will bring the function of the fodder. Mechanism of the development of intellectuals, in the mind of the author, polyagus at the glimpse of stylish complexes, reduced catalytic activity / 6 /.

Achieve a wide spread in patients with severe pancreatitis nabuli cytostatics. Bagato authors describe the success of 5-fluorouracil in patients with severe pancreatitis. Mechanism of developing cytostatics to achieve folding and to build up from such factors, such as driving DNA synthesis into the nucleus of a cell of the peptide, galvanizing transcription, disruption of translation in the process of biosynthesis of the volume /

One of the most incomplete drugs and toxicity, before showing any changes in the blood spectrum of blood and calories in the erythrocytes, the diagnosis of intestinal hypertrophytic neutrophilic neutrophilic For the weakening of side effects, the drug should be administered at the retropancreatic cell, intracranially, at the cranial stove, intraarterally, at the round liver ligament, at the duct of the subshlunk zone, endolus / lymphoma.

Bagato authors for the treatment of severe pancreatitis and the rapid development of pancreatic RNase. Vvazayut, how RNase is included in the secretory cycle, reducing the number and quality of synthesized pancreatic enzymes, not with a lot of ears, pouring into cells. However, allergic reactions often occur when the drug is repeated. To that end, a one-time injection of RNKazi / 12 /.

Hunger - the idea of ​​a pathogenetic draining in pancreatitis, when it comes to a child and a child, it stimulates the exocrine activity of the flesh. However, with a trivial hunger, the body's opacity decreases, the acid-base stance collapses in the development of acidosis, the weight decreases and the risk of infection increases. The triviality of hunger is due to the obviousness of functional damage to the intestinal tract and the immobility of the sharpening process to renew the harvest by a natural way, tobto. hour, necessary for the provision of sufficient functional calmness of the creeper. However, in case of trivial hunger, it is necessary to do something to the organism of living words. Parenteral feeding, which is carried out at the same time, will increase the functional sleep of the child, still not in the whole world to compensate for the energy and energy in the organism of the patient.

The interconnection of the possibilities of parenteral feeding and the need for trivial catheterization of the magistral vessels for infusion therapy dictate the need for additional introduction of energy and energy. All the great popularity will remain for an hour, filling up the supply with the help of an enteral probe harchuvannya (EZP). It has been established that the carbohydrate components are soaked in the small intestine without the stress of the exocrine secretion of the small intestine. A lot of pancreatic secretion is deposited as a form of introduction of living money into the intestine, as of a point of introduction and as a point of introduction, as a result of an injection, as it turns out / is

Continuously aspirating the slurry instead of rocking to reach the stimulation of the slurry with hydrochloric acid, changing the parallel expansion of the slurry, reducing the energy and gas exchange / 6 /.

In connection with the need for usunification of the manifestations of enzyme toxemia, it should be at the basis of the systemic manifestations of illness, an inadvertent component of therapy and disintoxication. For the whole of the survivors of practice, it is widely used forcing of duresis and peritoneal dialysis. It is also possible to drain the thoracic duct for visual enzymes and biologically active speech. The shortcomings of the method are the elimination of lymphocytes, electrolytes, bіlka / 6 /.

Infusion therapy has become unnecessary for a part of the complex of medical visits in case of severe pancreatitis. At the same time, it is widespread to vikoristovuyat blood cells of both coloidal and crystalline types. The most positive effect of the frozen preparations is albumin and the plasma is frozen. With the help of microcirculation correction of high molecular weight dextran / 6 /.

More importantly, the normalization of metabolic processes in patients with severe pancreatitis is poor in sour balance. I try to get rid of kisnedotherapy, and for the ailments with heavy interruption, get sick - a piece of ventilation. Hyperbaric oxygenation is widely used. Perevaga HBO before oxygen therapy with an atmospheric clutch of polyaga in that HBO, in addition to the correction of the acidic balance, in the organism is brought into the exocrine function of fodder deposits, lowering the secretion of hydrochloric acid / and pepsin.

The results have allowed the development of information about the importance of failure of lipid exchange in the process of development of severe pancreatitis. A number of authors have indicated that the processes of peroxidation of lipids can be quickly adapted to the state of pancreatitis. With the help of the correction of lipid exchange and stabilization of membranes, dibunol and delagil are stored. At the same time, catalase and peroxidase - enzymes, which reduce active radicals in case of peroxidized lipid peroxidation in mussel water, is justified.

Victory of fatty emulsions in patients with ailments on the OP with a statistically significant decrease in the activity of internal enzymes in the blood on the basis of normalization of indicators of reversal of reactions.

SEX and increased concentration of substances in the blood, so that the transport of phosphoglycerides in the system of biomembranes - B-lipoprotein. The slid of gadgets, which results in the effect of being tied in injected onto the membrane systems / cells of fatty tissue / tissue deposits, and the organisms by means of a path to reduce the reaction of highly radical oxidation of phosphorus, and the introduction of fatty tissue into the membranes of the organisms

In connection with the need for an increase in the diagnosis of antibacterial drugs, it is recommended to use antibacterial drugs. Likewise, in the literature, it is about the greater efficiency of non-traditional methods of introducing antibacterial drugs - intra-arterially, in the middle stovbur, endolymphatic, in the round ligament of the liver / 6 /.

1992 to rock in Moscow, in the Institute of Im. The Sklifosov group of them introduced the method of endoscopic drug denervation of the shlunks in patients with gastric pancreatitis. Here is the onset of the pathophysiological mechanism, which will explain the superiority of this method. There is a strong physiological connection between the shlunkovy secretion, the tone of the bloating nerve and the secretion of the shlunkovaya zalozi. There is data on the improvement of the functional activity of the slurry in case of flare-ups of the slurry, especially in ailments with severe disruption to the pancreatitis, the hyperacidity of the intestine is reduced to the deterioration of the meadow. For a long time, the regulation of gastrointestinal hormones / 15 / will get tired.

There are a number of ways I can use them - hypothermia, hunger, aspiration of the slurry instead of the slurry, the consumption of lykarsky preparations. However, the first two ways can not increase the blockage of the shlunkovy secretion, so as without the intake of moisture in the shlunkovy hydrochloric acid (basal secretion). Aspiration instead of the slunk needs to be carried through the skin for 2 years, which is not handy in case of viciousness in a wide clinical practice. There is a short supply of medications, which reduces the production of hydrochloric acid, є the possibility of allergic reactions and the amount of drugs / 15 /.

The method of breaking up the process of securing a high degree of reduction of acid production at the slunk. The method of carrying out the offensive: the breakdown of ethyl alcohol, the injection into the area of ​​the blistering nerve, a combination of functional damage to the nerve conductivity, and at the same time the disturbance of the damage to the nerve elements / 15

According to the special methodology, the FGS is tested, before an hour is passed through the opening of the tube, carried out through the working channel of the fibroscope, the information is infiltrated from the meat-cut ball into the cut of the slurry to the cardiac 0.5 cm below the cardial pulp). Vikoristovuyt 30% alcohol at the price of 2% novokainu.

The glybin is up to 0.6 - 0.7 cm, the amount of sum is not more than 16 - 18 ml.

Such a bit of alcohol, as shown by the histological preliminaries, aseptically fired nerve elements, does not lead to destructive changes in the tissue from the side of the other tissues. Before the hour of the introduction of the sum, as a rule, there is ailment to see the oven at the shlunk. It is not a good idea to go through the process of manipulation. It is necessary to admit it, so that you are guilty of being in the serous-mallet ball of the slunker, some of the sprinkles are consumed in the slime-ball when you approve the hospitality and the microscope. After the manipulation was carried out, a blockade would develop, and then the panning of the nerve elements of the Auerbach and Meissner's gossip, to get over the vaginal movement and the pleasant, impulse of the guest

II. Surgical methods of treatment:

Winning the development of localization options, the broadening of the nature of pathomorphological changes in pedunculated areas, on the colonic organs and tissues in the presence of a state of pancreatitis in the introduction of such a number of methods According to the tradition, which has been inclined, the development of methods of operative treatment of gastrointestinal pancreatitis is mentally capable of radical (partial or total pancreatectomy) and palatial (necrsequestrectomy of tissue from the middle of the disease)

As well as ten years ago, in wide surgical practice in the operative treatment of autologous pancreatitis, the priority is given to other people who are focused on the prevention of acute diseases, the evacuation of toxic diseases It is a pity that the number of severe pancreatic necrosis, which are diagnosed, is too big for this day. In case of great necrosis of the pancreatic pancreatitis, the development of the glandular pancreatitis, the firing process even rapidly expands to the parapancreatic cellulitis, which can lead to the diagnosis of the obesity phlegmon, which is one of the reasons for the death of the ailment. When analyzing the causes of lethal inheritance, it is necessary to establish inadequate drainage of the area of ​​the cranial cavity with necrosis of the cell, phlegmon or multiple abscesses in the vaginal space. At the connection with the cym, the development of methods for the urea drainage is more important and practical / 5, 9 /.

Operativnі access Square od FORMS GOSTR pancreatitis termіnіv od cob zahvoryuvannya, that yakostі dooperatsіynoї topіchnoї dіagnostiki uskladnen perevazhna tіlki upper midrange laparotomіya, yak pіslya revіzії cherevnoї porozhnini, pozapechіnkovih zhovchnih shlyahіv, salnikovoї bags pіdshlunkovoї zalozi that zaocherevinnih klіtkovih fields fallow od konkretnoї situatsії / 9 /.

In a large number of cases in the past, there is a large number of cases in which there are widespread access to the wider areas of growth of gnaries, some of them are more evident about the localization of cells in the necrosis of the process of enlargement of gnarial retardation. To a small, "merciful" oozing of the operation, it often clogs up inadequate visuals of necrotic tissues and ineffective drains of necrotic vognisches / 9 /.

V. A. Gagushin, the co-authors of his article "Retroperitoneostomy in the surgery of pancreatic necrosis", propose anteroposterior antero-malignant approach to the subcutaneous cavity. Growths of the shkiri vibrate at the left edge of the straight edge of the abdomen, at the bottom 4 cm from the costal arch, to the rear groin line. It’s an hour to grow fibers. It is necessary that the width of the wound hole of the ball is not less than 12-16 cm and the operator's groove passed through the new one. Retinue the transverse fascia over the entire length of time. The peritoneum is extended medially to the ridge of the widest protrusion. Access is yes, you can open up all the gnaries and purchase exudates on the front and back surfaces of the front and back surfaces of the tail and tail. Dobre is available for draining liva navkoloobodova, para-aortic and perinephric cells, possibly a necro-necro-sequestrectomy / 3 /.

Revizia of black emptying. The vibration of the operative engagement and adequate drainage operation in the larger world is due to the revision of the worms, the gallbladders, the omentum bag and the gallbladder. Bagato in the field of coagulation and to induce colic necrosis in infants, as well as in parapancreatic cells are often unavailable for preoperative diagnostics when testing any available ultrasound methods, including

Last revision:

1. Inspection of the lower view of the black emptying, the value of the character of the vipot in them, the important localization of the fat necrosis. If necessary, it is necessary to carry out an additional birth on the place of enzymes in the slurry and the presence of microbial flora / 9 /. It is essential that the presence of microbial flora in the peritoneal exudate is not yet a factor in the absolute prognosis of the development of early growth / 7 /. Due to the presence of fatty necrosis plaques and hemorrhagic tissue infections in cych zones, there is a large amount of fatty necrosis plaques and hemorrhagic tissue infections, it is necessary to grow the necrosis and maximize fat necrosis, especially necrotic tissue / 9 /.

2. The revision of the slurry ring and the omentum bag is carried out for a wide distribution of the slurry-rim connection. The visual picture of nabryonic pancreatitis is characterized by a squalid nodule of the nodule over the undergrowth, the parenchyma itself and the clitkovini itself.

The lobular structure is easily quilted, the fabric is practically not prejudiced. Ridko є with fat necrosis, points of hemorrhage.

Pancreatic necrosis can often be seen as signs of early signs of illness. As a rule, the seedling zloza grows rapidly in size and differentiates nonviolently from navkolishnyh tissues, is sharp on a dot, and is replaced by a characteristic part. Navi at the early term from the ear of the ear is a lot of fatty necrosis, and there are great periods of hemorrhage, but one of them is a sign of the possibility of overwhelming / 9 /.

In case of massive hematologic haemorrhage, yak often put on a queue of a black raincoat, diagnostics of the correct localization of the skin is difficult and may be inadequate. Diagnostics can be removed from the diagnosis when revising the slurry layer by sending the rosette of the parietal line along the upper and lower ribs, as well as the mobilization of the head of the slurry line in one go. Vikoristovuchi method of blunt preparation, more part of the body and the tail of the seed is easy to see from the peer-to-pea cell (after taking special care, there is little chance of getting rid of the seed). This allows you to healthily revise the pancreatic cavity, to reduce the growth of the lungs / to prevent the decompression of the organ, to assess the growth of the intestinal cellulitis, to overcome the enlargement of the prostate enzymatic hemorrhage

3. The revision of the post-pectoral female nobles for the prevention of cholelitis, firing changes at the stage of the female moth, bilious hypertension. There is a slid of nagolosity, which visually changes in the stage of a zhovchnyi michur in case of gross pancreatitis, which, as a rule, fills with catarrhal and earlier phlegmonous fumes. However, in the basis of such changes, it is often the enzymatic infusion on the glass of the ruminant, and when the decompression of the bilious stench is healthy, it will quickly regress.

It is practically important to become too much of a diet, if there is a viral cholecystectomy. There is evidence of large pre-existing problems of gastrointestinal pancreatitis in the case of such a need for cholecystectomy, as it is often possible to promote and help destructive changes in the woman's confusion. To that, due to the appearance of obvious phlegmonous-gangrenous changes in the stage of a zhivny mikhur in case of severe pancreatitis, cholecystectomy is shrinking. To navigate for the manifestation of cholecystolithiasis only in case of embryonic pancreatitis, it is possible to find a cholecystectomy with a secondary biliary decompression through the mucus duct, and in patients with pancreatic necrosis, cholecystitis is healthy. Borderly unsafe in case of gross pancreatitis and guilt, it is added to the calmness of the sign of being involved in the backward zhovchniy prototypes of the great duodenal papilla. That is, when concrement is diagnosed in the great duodenal papilla, it will become possible to pass the endoscopic papilotomy.

Draining of the black wastes. Pidshlunkovy zloza that from the pectoralis from the two to twenty-fingered intestines are laid down at the box with the fascias of the pectoral walking. The rear wall of the warehouse is filled with Toldt's fascias, and the front wall is filled with a breech (or even old) of the intestine.

Spinal tissue of Klitkovina in the whole bed is fluffy from the bottom of the fascial leaflets, which gives a wide spread of exudate in case of destructive pancreatitis in the boundaries of the bed itself, as well as in the right abnormal paracolon, which will come with it. The shape of the closures is based on the significant features of the growth of fascial leaves. With the localization of destruction in the head of the pancreatic zone, the eksudat, clinging to the interface between the pancreaticoduodenal complex, can then, without special transition, descend into the right paracolon, so that it goes into the muscle, and it grows With the localization of destruction in the middle part of the breech of the small intestine, it can accumulate in the boundaries of the middle part of the root of the breech of the transverse colon and the cob of the breech of the small intestine.

Rozpovsyujennyu in the right paracolon at the tsyom vypadku pereshkojaє the lower urethral ligament of the twelve-fingered intestine / 16 /.

With the localization of destruction in the livia part of the piedslunk zone, the exudate can expand to the livi paracolon. If you have a lot of space, you can occupy all the space.

Slide two balls to the paracolon: front and back. The stench of Toldt's fascias. The back of Stromberg's descriptions of wearing it and taking revenge on fat cells. Front paracolon of descriptions by the author of the Central Statistical Office - O. Bondarchuk І. I am surrounded by the fascial Toldt, and in front of the vischid or lower intestine with the fixed “breeches”. The wine is filled with fluffy, semi-tissue cells and on the back side of the bed, in which the gut is twelve and twenty, the intestine and the bottom of the bed. To that, the anterior paracolon є without pereskodnaya possibility to extend the eksudat. What is the need for zooming in case of severe pancreatitis.

If you look at the fascial sheets of the pancreatoduodenal zone, if you go back in advance, you can see the offensive order of the lagoon:

1. Prerenal fascia;

2. Fascia Toldt (primary parietal gut);

3. The posterior leaf of the vascular fascia of the twelve-fingered intestine and the subshlunkovaya zalozi (the primary visceral orevina);

4. Anterior leaflet of the vascular fascia of the pancreatoduodenal complex (also the primary visceral neoplasm);

In addition to the descriptions of the fascial appositions, there is the appearance of the lower urethral ligament of the two-fingered intestine, stretched across the lower surface of the lower horizontal part of the intestine and the root of the small intestine. Qia trikutna form zyzuvannya z vilnim right edge zapovnyu kut between the lower part of the two-fingered intestine and the upper part of the small intestine / 16 /.

The length of the lower part of the gut, the width of the described ligament can reach 7-8 cm. The lower edge of the ligament is thinner than the upper one;

Shown: the appearance of a large empty vipot or an eksudat from a great number.

Technics. In case of enzymatic (non-inflammatory) vipoti up to 200 ml, silikonovy drainage is established with an internal space of 5 mm at the zone of the opening and is introduced through the puncture of the anterior cervical wall of the lower costal arch along the anterior groin. In case of a large amount of vipot, thoroughly install drainage into the empty pelvis through the puncture of the anterior cranial wall in the right hypochondrium. Only in cases of advanced peritonitis, it is also necessary to drain 2 - 4 micro-agents for the infusion of antibacterial diseases.

Drenuvannya of the omentum bag that of the urea space. In case of obricular pancreatitis, the main method of drainage is evacuation of the vipot from the omentum bursa and the prevention of gallbladder retardation. Oskіlki obsyag serous vipotus don’t change 50-100 ml, one silikon drainage with an internal diameter of 5-6 mm is enough, inserted into the omentum bag through the opening of the openings. In addition, in the omentum bag there is one microrigator for the infusion of antibiotics, which is called through a hole in the shlunkovo-rim junction and an edge puncture of the anterior “black” picture 1 of the village (divine.

In case of pancreatic necrosis, drainage may be overlapped with wider cells - the prevention of regional lavage for the visually toxic, with active enzymes of dehydration, vipot, how to put the products of the growth of tissue and other important tissue In addition, a microrigator for infusion of lykarskih outlets, as well as no less than two silikonovy drains with an internal diameter of up to 12-15 mm, and multiple branch openings, should be placed in the omentum bag. One of the drainages is located on the lower edge of the lower edge of the bottom hole, and the other one - on the upper edge. As for both drainages, the aspirations are in progress without interruption in the operating period. In a number of cases, it is possible to carry out a simple drainage, if a pipe of a great diameter with no small openings lies along the rear-lower surface of the bottom hole, and the luckiest ones are right for the village.

The challenge of this type of drainage is the ability to systematically replace the tubes, as it will educate you about necrotic detritus and drainage of power. The drainage system is used for carrying out the flow-through cleaning of the omentum bag with antiseptic lines with the obligatory active aspiration through large tubes of diameter.

With post-necrotic ginny accelerated vibrating, the drainage method should be based on the nature of the ginning process. Only when there are isolated gauze tampons with a drainage pipe, as well as a small amount of rice in front of a village, it is true that a gum-gauze tampon with a drain pidshlunkovoy zalozi ").

A.V. Pugaev from the co-authors propose a number of methods for draining the fallow bed and the fallow bed due to the localization of necrotic empty slopes. When the central tipі urazhennya dvoprosvіtnі drenazhі vstanovlyuyut the lower edge pіdshlunkovoї zalozi i behind neї, ukladayuchi ostannіy parallel to the upper edge pіdshlunkovoї zalozi to golіvki i vivodyachi їh through rozrіzi in poperekovіy dіlyantsі pid (II rib. When lіvomu tipі zatіk behind nizhіdnogo vіddіlu., Vivodyachi Yogo through In the case of a low type of reduction, the methodology was used to supplement the drainage of the right uterine space through the same transverse area. /eight/.

Construction її taka. A fragment of the foam tube is modeled with the shape of the surface of the necrotic zone. In the middle of the sponge, form a canal, which is similar to the diameter of the drainage tube, so that it can be inserted into it, with 2-3 bit holes. Lay the Qiu drainage-foam rubber system on the necrotic surface. The other tube is named and connected to the aspirating system. Foam drainage, modeling, until the formation of the wound, will not adequately see the juice of the slurry, which accumulates and comes up, fuses exudate, accumulates on the surface of other tissue sequesters.

The stagnation of such an aspirational system is due to the fact that we can achieve a low level of performance: 1) the drainage of all the surface of the pathological industry is prevented; 2) there is a large porous surface of the cyclones, with detritus and fragments of sequesters; 3) to assimilate the problem of decubitus ulcers and arrosive bleeding / 3 /.

I especially respect the merit of the tactics in case of urea phlegmon.

It is more likely that if the lumbotomy is healthy, it can be less efficient and less efficient. Right-handed lumbotomy is vicious, so that in a straight line in the uterine space there can be drains for the mobilization of the liver's gut, and go until the beginning of the lower lunar space. (Div. Babies

"Drenuvannya of the bed of the bottom hole through the lumbotomy for active aspiration") / 9 /.

Necrsequestrectomy from underslung burrowing and navkolishnykh fabrics.

Draining operations for pancreatic necrosis and post-necrotic slow-downs appear to be ineffective and do not neglect sick people if they are spared in the zone of adolescent formation of massive necrosis and widespread tissue secretions.

Control over the process of sequestration is necessary for the hour of dressings, as it is violated during anesthesia. Particularly retreats should be noticed when necrosis is seen in the zone of illness of the brijovaya and splenic veins - the main dzherel of arrosive bleeding and compression of the blood flow.

By the visual criteria of the unpollutedness of the dilenka of the pied-slunk zone, the visibility of the fabric of a gray or black color is visible in the view of the structureless mass, from which one can see the gnarl. As a rule, it is quite possible for a dilenka to fiddle with pincers at a soft sequestration / 11 /.

Visnovok

In such a rank, the diagnosis and treatment of ailments on the pancreatitis prodovzhuyut prodovzhuyutsya foldable and until the end is not a problem.

Іsnuyuchі trudnoschі klіnіchnoї, іnstrumentalnoї that laboratornoї dіagnostiki GOSTR pancreatitis zumovlyuyut one of the main napryamkіv in problemі pancreatitis - Poshuk novih scho bazuyutsya on mehanіzmі pathogenesis, ob'єktivnih bіohіmіchnih pokaznikіv, zdatnih pіdvischiti tochnіst i svoєchasnіst dіagnostiki, vіdobraziti dinamіku GOSTR patologіchnogo Process. The development of such methods is also of great theoretical significance, except for the practical vicariousness in the clinic, you can know the stasis in the experimental pancreatology, in addition to the widespread recent reports about the pancreatitis hospitality.

List of Victorian literature

1. Albitsky VB / / Hirurgic ailments (clinical lectures for subordinators) in two volumes. 1993 p.

2. Atanov YP // Clinical assessment of pancreatic necrosis syndromes.

Khirurgiya No. 10.-1993r - z 64-70.

3. Gagushin V.A., Solovyov V.A.// Retroperitoneostomy in pancreatic necrosis surgery. Hirurgiya number 6 - 1996 - z 66-68.

4. Penin VA, Pisarevskiy GM // Problems of diagnostics of gastric pancreatitis. Khirurgiya No. 12 - 1993 - z 62-66.

5. Sirbu I.F., Kapshitar A.V., Mogilny V.A.// Diagnostics and treatment of gastric pancreatitis. Khirurgiya No. 3 - 1993 - z 47-51.

6. Prayer books AB, Kadoshchuk Yu.T., Gasse M.V. Khirurgiya number 6 - 1996 - z 38-

7. Pugaev AV, Bogomolova NS, Bagdasarov VV, Sirozhetdinov KB. Bulletin of surgery number 1 volume 154.II - 1995 - z 32-34.

8. Puga A.V., Bagdasarov V.V. // Hirurgic treatment of acute pancreatitis. Khirurgiya No. 2 - 1997 - z 79-81.

9. Kubishkin V.A. Khirurgiya No. 1-1997 - z 29-32.

10. Kubishkin V.A., Savel'ev V.S. // Pancreatonecrosis. This is the perspective. Khirurgiya No. 6 - 1993 - z 22-27.

11. Sazhin V.P., Avdovenko O.L., Glushko V.A., Musatova L.D. Khirurgiya № 3 - 1994.

12. Lawrence D.R., Bennit P.N.// Clinical pharmacology. Have two volumes. M.

"Medicine" 1993r.

13. Kirilov Yu.B., Potapov A.A., Smirnov D.A., Aristarkhov V.G., Korvyakov A.P. Khirurgiya № 11 - 1991r. З 53-56

14. Atanov YP // Clinical and morphological signs of destructive forms of destructive pancreatitis. Khirurgiya № 11 - 1991r. w 62-68

15. Sinov Yu. V., Bodukhin MV, Shcherbyuk AN, Golubov A.S. Khirurgiya No. 1-1992. P. 58-61.

16. Bondarchuk O. I., Kadoshchuk T. A., Terent'ev G. V., Seredin V. G. // How to drain the urethral space in case of destructive pancreatitis. Khirurgiya No. 1 - 1992. p. 89-92.