Take Care of Your Pancreas!

Depending on the phase acute pancreatitis (AP) has a polymorphic sonographic picture. Diagnostic accuracy of non-invasive ultrasonic tomography (UST) in verification of the stage of development of AP and character of its complications usually does not exceed 80 % that makes puncture biopsy necesssary.

The basic method to choose the zone to intake the material and make fine-needle biopsy is to reveal necrosis zones with the help of estimation of the blood flow in the pancreatic area in a regimen of color doppler mapping and make comparative estimation of the amount of doppler signals in the thickness of the pancreas and its surface. A 50 % decrease in number of doppler signals serves as a precise marker of necrosis and the destructive process in the pancreas.

Diagnostic fine-needle puncture biopsy (PB) with microbiological and cytologic examination of the aspirate is necessary with patients suspected of the destructive form of AP. Results of PB allow to use LIM under utrasonic guidance differentially and to choose the proper medical treatment in case of various forms of pancreatitis.

When diagnostic fine-needle puncture is used efficiency of the traditional ultrasonic investigation of various forms acute pancreatitis is increased.

Speaking of diapeutic interventions, a series of paracentetic interventions is applied at pseudocysts with the size no more than 5 cm and volume up to 40 ml. Expediency of sanation paracentetic interventions in pseudocysts is justified in case of an uncomplicated “acute” cyst of small size and in some cases of complicated pseudocysts with the absence of safe access to the cavity of the cyst to make a drainage. Efficiency of paracentetic treatment is usually low and pseudocysts are often formed.

In other cases various percutaneous drainings from nidi of infection are usually made. With patients having pseudocyst of the pancreas drainage № 8-12 Fr is performed (according to the technique of Seldinger). Also percutaneous draining with the use of drainages № 8-12 Fr is carried out with some patients with infected pseudocysts; the installation of two drainages at the top and bottom pole of the cyst with an active aspiration of the content is made with 4 of them. Telescopic tight bougieurage of the primary paracentetic canal to the calibre of the used drainage tube (8-11 mm) is made with some patients with pancreatogenic abscess.

With some groups of patients having pseudocysts of the pancreas LIM with installation of drainages are the most effective. The complete medical effect with patients with abscesses of the abdominal cavity attained more than 90 percent. Draining of nidi is the most effective in case of omentobursitis. Efficiency of a series of punctures, combination of punctures and drainages, installations of drainages under ultrasonic guidance is the subject for further improvement.

Diagnostic efficiency of ultrasonic tomography (UST) with low-invasive manipulations (LIM) in differential diagnostics of various morphological forms of acute pancreatitis (AP) can be represented in the following table (one of the first examinations). LIM under ultrasonic guidance are specifying diagnostics, therefore, specificity is constant.

A combination of paracentetic treatments (diapeutic LIM) and drainage installation is the basis of the medical LIM in case of complicated acute pancreatitis. Manipulations are carried out in the certain sequence. There is a combination of aspirating needles and drainages of various diameter and type. As a matter of fact, frequency of a puncturation also changes. Medical programs are usually based on the results of organoleptic and analytical examination of the material.

Diagnostic multifocal puncture biopsy (PB) is the next stage of AP diagnosis. The purpose of PB is to verify microbiological and morphological nature of diffuse changes. It is carried out according to diagnostic paracentetic regimens: different needles are applied subsequently while frequency of PB is changed.

According to statistical processing of microbiological and cytologic conclusions, in case of the edematic interstitial form of acute pancreatitis a moderate number of inflammatory elements and a large number of blood elements are often revealed. A large number of blood and inflammatory elements and a moderate quantity of necrotic massess is typical of the necrotic form of AP. The infiltrative necrotic form of AP is characterized by a large number of necrotic masses and inflammatory elements. A large number of necrotic massess and inflammatory elements is also typical of the purulo-necrotic form of AP. The aspirate taken from the abscess cavity usually contains modified blood elements, necrotic masses and inflammatory elements. Exacerbation of the chronic recurrent form of pancreatitis is characterized by inflammatory elements and low-prismatic epithelium with a low degree of proliferation. The cytologic picture of pseudocysts of the pancreas contains inflammatory and blood elements and elements of the cystous cavity.

The majority of patients usually have a negative bacterial inoculation. Microbiological investigation often brings positive results. In most cases bacterial flora constitutes conditional pathogenic enterobacteria of the gram-negative spectrum. Frequency of infection caused by gram-positive agents attained is low (about 25 %).