Scripta Medica (Jan 2018)
Complications of treatment of acute pancreatitis
Abstract
Introduction: Acute pancreatitis is non-specific inflammation of the pancreas due to the intrapancreatic activation of its proteolytic and lipolytic enzymes - enzyme lesions. The enzymes normally excreted by the pancreas are activated in the pancreas and destroy its tissue, leading to an autolysis process that causes bleeding and damage to the blood vessels. Enzyme auto digestion begins with local inflammation, edema, bleeding and necrosis. Aim of the Study: The aim of this paper is to determine the incidence and complications in patients with acute pancreatitis and on the basis of the results obtained define specific health care measures for prevention and suppression of complications. Patients and Methods: This study included patients, suffering from acute pancreatitis, treated at the Clinic for General and Abdominal Surgery of UCCof the Republic of Srpska in Banja Luka, in the period from January 1st, 2015 until April 30th, 2017. The total number of patients treated in this period is 147. Diagnosis of the disease is based on a detailed anamnesis at the entrance (acute abdominal pain in all patients), laboratory examinations (complete blood images, C-reactive protein, amylase, and lipase) and diagnostic procedures (abdominal ultrasound examination, chest RTG, CT, ERCP, NMR and ECG). Based on the data obtained from the history of the disease, protocols and release lists, the following statistical analyses were performed: frequency of complications was established as well as mortality in biliary, alcoholic and idiopathic types of acute pancreatitis. Results: The examinations performed determined the minimum number of laboratory and diagnostic procedures that confirm the acute pancreatitis diagnosis within a short period of time. The leading symptom of admission was a strong abdominal pain, present in all patients. Laboratory trials are dominated in elevated values of the total number leukocytes, C-reactive protein (CRP), and serum levels of amylase, lipase and bilirubin. Early diagnostic procedures, within the first 48 hours, significantly contribute to the reduction of acute pancreatitis complications. Out of a total of 147 patients with this diagnosis, 110 patients were treated conservatively and 27 operatively. Eight patients had a mortal outcome. By type of acute pancreatitis, biliary form is in the first, idiopathic second and alcoholic form in the third place. The mild clinical form of acute pancreatitis was present in 124 patients and severe in 23. Mortality rate was 5.44% in all three clinical forms. Conclusion: Early confirmation of acute pancreatitis diagnosis is the basic prerequisite of disease progression, reduction of possible complications, and death as an outcome of the disease. Patients who were treated conservatively had a lower rate of complications, shorter hospital stay, faster recovery and better quality of life in the later period. Multidisciplinary approach to diagnosis and treatment patients suffering from acute pancreatitis significantly reduces morbidity and mortality. Quality and comprehensive health care, as part of multidisciplinary team work, contributes to reducing disease complications and faster recovery of the patient. The results of treatment of acute pancreatitis patients at UCC RS do not differ significantly from the results of treatment in similar institutions in the region and the world.
