The modern classification of pancreatitis is acute, moderate, severe. Biliary-dependent biliary pancreatitis. Cystic variant of chronic

The classification of chronic pancreatitis is an excellent help for medical specialists in making the correct diagnosis and determining further treatment methods. In total, more than 40 types of classifications of pancreatic pathology of the pancreas have been developed, which are based on clinical signs of the disease, functional manifestations, pathomorphological forms of changes, types of complications and much more. In this review, we will consider in more detail only those types of classifications that have the highest level of popularity and are used not only in theory, but also in practice.

Classification by clinical manifestation

For the first time, the classification of CP according to clinical manifestations was developed by A. A. Shalimov in 1964, taking as a basis all previously existing types of classifications, expanding them and giving them a clinical focus.

He carried out extensive work on the study of this pathology and identified the following varieties:

• , or interstitial pancreatitis;
• acute form of hemorrhagic pathology;
• pancreatic necrosis and purulent form of pancreatitis;
• acute form;
• almost all types of chronic pancreatitis, including cholecystopancreatitis, asymptomatic pancreatitis, its recurrent form and non-relapse pathology, and pseudotumor, fibrous pancreatitis with disorders of the pancreatic ducts, as well as the fibrous-degenerative form of the disease.

In practice, this type of classification is mostly used by surgical specialists.

Among surgical specialists, the most common classification is based on the nature of the development of the pathology, which was developed in 1970 by A. A. Shelagurov, who identified the following features:

1. The peculiarity of the pathology is that no matter what therapeutic treatment is carried out, the symptoms of the disease will still appear again and again.
2. Painful pancreatitis is characterized by severe pain.
3. , or painless, develops without much aggravation of the patient’s general well-being, there are no complaints, and diagnostic procedures indicate a progressive stage of the chronic form of classic pancreatic lesions of the pancreas.
4. Pancreatitis is characterized by the fact that during ultrasound diagnostics, the expanding head of the parenchymal gland is visualized on the monitor screen, similar to the development of a tumor, on the basis of which it is also called capitate pancreatitis. This pathology is accompanied by severe pain and intense weight loss.
5. The developing cholecystocholangiopancreatic disease is characterized by the fact that against the background of the release of bile from the gallbladder into the cavity of the pancreatic ducts, the clinic of both pancreatic lesions of the gland and cholangiocholecystitis begins to develop.
6. Indurative pathology is characterized by the fact that the cavity of the pancreas, under the influence of pathogenic factors, begins to calcify, which leads to the appearance of stones, and fibrosis of tissue structures develops, followed by blockage of the gland ducts.

It is also worth noting that in practice, medical specialists often refer to a classification based on the severity of chronic pancreatitis, distinguishing the following stages of this pathology:

1. Mild degree, or stage 1, characterized by the absence of signs of a functional disorder of the gland and exacerbations every 12 months; this type of pathology is sluggish with a protracted development.
2. Average, or 2nd degree, which is characterized by dysfunction of the parenchymal gland, the development of type 2 diabetes mellitus and the occurrence of exacerbations at least 4 times a year.
3. Severe, or 3rd stage, characterized by frequent and prolonged exacerbations, the formation of debilitating diarrhea, severe exhaustion of the patient’s body, the development of toxic infections and vitamin deficiency.

Marseille-Roman International Classification

The Marseille-Roman classification of chronic pancreatitis was developed in 1988 and systematized the clinical picture, etiology and morphology, as well as various variations in the course of the acute and chronic forms of this disease.

Three forms of chronic pancreatic lesions of the parenchymal gland have been identified:

1. pathology characterized by irregular fibrosis, as well as a heterogeneous distribution of affected areas within the lobules of the pancreas or small areas with different levels of density between the lobules of the affected organ.
2. An obstructive form, during the development of which dilatation of the pancreatic ducts occurs against the background of scars or a tumor. A uniform diffuse fibrous lesion of the gland parenchyma develops, as well as atrophic processes in the cavity of the acinar cells. Disturbances in the pancreas that are structural and functional in nature can become reversible if the provoking factor is eliminated.
3. The inflammatory form of CP is characterized by dense development of fibrosis, as well as loss of exocrine parenchyma against the background of the progressive development of inflammation in the gland. Histological examination shows the development of mononuclear cell infiltration.

Among the most popular complications according to this classification, CP can lead to:

• retention type of cystic lesion;
• the formation of ordinary and necrotic pseudocysts;
• in severe cases, an abscess may develop.

Zurich classification

This type of classification characterizes to a greater extent the progression of CP against the background of patients’ dependence on alcohol-containing products, but can also be used to characterize other forms of pancreatic damage to a parenchymal organ.

This type of classification is not widely popular due to the complexity of its structure.

And besides, its peculiarity that it does not provide an explanation of the etiological factors contributing to the occurrence of CP significantly reduces the interest in its use in practice.

Pancreatic lesions of the parenchymal gland are identified by the presence of the following factors:

• the formation of stones, or calcifications, in the cavity of the gland;
• damage to the integrity of the pancreatic ducts;
• development of exocrine insufficiency;
• typical histological background.

The likelihood of a diagnosis of CP reaches its maximum level in the presence of the following signs:

• the pancreatic ducts undergo pathological changes;
• pseudocysts form;
• the secretin-pancreazimin test shows the presence of a pathological disorder in the gland;
• the presence of exocrine insufficiency.

Etiological factors are primarily the development of pancreatitis of alcoholic and non-alcoholic nature. Diseases of the pancreas of non-alcoholic etiology include:

• idiopathic pancreatitis;
• as well as metabolic and tropical;
• and hereditary.

Exacerbations leading to a decrease in the functionality of the gland are diagnosed at various stages of the clinical development of CP.

At the initial stages of development, they manifest themselves in the form of an attack of acute pancreatic damage, and in later periods, pronounced symptoms of a certain type of disease appear.

Clinical and morphological classification of Ivashkin

Dr. Ivashkin V.T. developed a complete classification of parenchymal gland disease, which includes various pathological factors, which more fully describes the pathology and allows the attending physician to make the most accurate diagnosis. Let's consider the main sections of its classification.

A type of pancreatic pathology, according to its structure:

• interstitial-edematous pathology;
• parenchymal disease;
• indurative pancreatitis;
• hyperplastic form of the disease;
• cystic disease.

According to the manifested signs of pathology, the following are distinguished:

• sickly type;
• hyposecretory form;
• hypochondriacal variety;
• latent form;
• combined type of disease.

By intensity of development:

• rarely recurring exacerbations;
• frequently repeated;
• persistent attacks.

According to provoking factors:

• biliary or biliary-dependent pancreatitis;
• alcoholic type of illness;
• dysmetabolic pancreatitis;
• dosage form of pathology;
• acute idiopathic pancreatitis;
• infectious type of disease.

Type of complications:

• blockage of the bile ducts;
• development of portal hypertension;
• infectious diseases;
• inflammation;
• endocrine pathologies.

Zimmermann classification

According to the etiology, Y. S. Zimmerman put forward a version of the existence of two types of pathologies: these are primary and secondary pancreatitis, in which more precise provoking factors are determined.

Primary provoking factors include:

• alcoholic drinks;
• hereditary factor;
• medicines;
• ischemic pathologies;
• idiopathic type of CP.

Secondary causes include:

• development of cholepancreatitis;
• the presence of chronic hepatitis and cirrhosis of the liver;
• helminth infestation;
• formation of cystic fibrosis;
• presence of hemochromatosis;
• progressive stage of mumps;
• ulcerative colitis and allergic reactions.

Based on clinical manifestations, Dr. Zimmerman identified the following types of pathology.

A painful option that can occur with temporary or permanent pain.

According to the morphology of CP it can be:

• calcifying;
• obstructive;
• inductive;
• infiltrative-fibrous.

According to the functionality of the organ, the following are distinguished:

• hypo- and hypersecretory form;
• obstructive type;
• ductular form;
• reduced or excessively increased functionality of the insular apparatus.

The disease can have a mild, moderate or severe course. Among the complications that both adults and children can be exposed to, in case of untimely treatment and lack of prevention, the following types of pathologies are distinguished:

• at an early stage: jaundice, hemorrhages in the intestinal cavity, retention cyst, hypertension and pseudocyst;
• in the later stages, the development of duodenal stenosis, steatorrhea, anemia, encephalopathy, osteomalacia and local pathological infections occurs.

Characteristics of the main forms of chronic pancreatitis Khazanova

A.I. Khazanov developed a classification in 1987, identifying the following types of pathology:

1. Subacute pancreatitis, characterized by symptomatic signs close to the acute form, but the intensity of the pain syndrome is less reactive, and the duration of the pathology is more than 6 months.
2. Recurrent form, expressed in the regularity of exacerbations.
3. Pseudotumorous pathology, characterized by changes and compaction of one of the organ sections.
4. Cystic variety, occurring with the formation of small cysts

Cambridge classification

The most popular in Western countries is this type of classification, which is based on a gradation of pathological disorders in the affected organ at various stages of the disease. The following stages of pathology are identified:

1. The normal state of an organ with normal structure and proper functioning.
2. Pathogenic disorders of a chronic nature, in which changes in functionality occur at a minor level.
3. Pathologies of a mild nature cause disruption in the lateral ducts.
4. Moderate pathologies contribute to disruption of the functionality of the main and lateral pancreatic ducts of the gland, the formation of cysts and necrotic tissue.
5. Against the background of intense pathologies, extensive cystic lesions and calcifications can form in the cavity of the gland.

There is also a classification of HP according to ICD 10 code, which is updated once a decade. The ICD 10 code defines a specific code for each type of pancreatic pathology, according to which every specialist immediately understands what is at stake.

Treatment of any type of CP consists of following a special diet, drug therapy and, when the pathology goes into remission, the use of folk remedies. A common modern method of treating toxic pancreatic lesions of the gland is the use of stem cells.

The prognosis of the medical history, subject to proper dietary nutrition and all the recommendations of the attending physician, in most cases, can be quite favorable.

Bibliography

1. Tarasenko S.V. and others. Analysis of classifications of chronic pancreatitis and criteria that determine the tactics of surgical treatment. Bulletin of Surgery named after. I. I. Grekova 2008 T. 167, No. 3. pp. 15–18.
2. Ivashkin V.T., Khazanov A.I., Piskunov G.G. et al. On the classification of chronic pancreatitis. Clinical Medicine 1990 No. 10 pp. 96–99.
3. Kalinin A.V. Chronic pancreatitis: etiology, classification, clinical picture, diagnosis, treatment and prevention: Method. recom. M.: 1999, p. 45.
4. Khazanov A.I. Chronic pancreatitis. New in etiology, pathogenesis, diagnosis. Modern classification. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 1997 No. 1, pp. 56–62.
5. Tarasenko S. V., Rakhmaev T. S., Peskov O. D., Kopeikin A. A., Zaitsev O. V., Sokolova S. N., Bakonina I. V., Natalsky A. A., Bogomolov A. Yu., Kadykova O. A. Classification criteria for chronic pancreatitis. Russian Medical and Biological Bulletin named after. acad. I. P. Pavlova. 2016. No. 1 pp. 91–97.

Biliary pancreatitis is one of the forms of acute pancreatitis that develops against the background of cholelithiasis or against the background of diseases of the duodenum and major duodenal papilla, accompanied by stagnation of bile in the ducts.

This pancreatitis has relatively recently been identified as a separate nosological form. This is due to the fact that the disease has a special clinical course, clear etiology and pathogenesis. This means that the approach to treatment, diagnosis and prevention of this disease has its own characteristics.

The disease can occur in acute and chronic form. If there is an acute process in the patient’s body, then it is customary to talk about biliary pancreatitis, if the disease has taken a chronic form, then they talk about biliary-dependent pancreatitis.

Etiology

Biliary pancreatitis is widespread throughout the world. The anatomical and functional similarity of the pancreatobiliary system determines the occurrence of the disease against the background of pathology of the biliary system in 50% of cases.

The disease has a polyetiological nature. At its core, inflammation of an organ occurs secondary, that is, infectious agents are brought in from other organs and systems, and pancreatitis itself occurs against the background of another pathology. It could be:

• Gallstone disease (chronic calculous cholecystitis, choledocholithiasis).
• Biliary dyskinesia.
• Congenital strictures and other anomalies of the biliary tract and gallbladder.
• Functional or organic disorders of the duodenum and large duodenal sphincter (between the main bile duct and the intestinal cavity).
• Liver diseases (hepatitis, cirrhosis).

Pathogenesis

The mechanisms of inflammation development in biliary-dependent pancreatitis are diverse. There are three ways of infection:

1. Lymphogenic. In this case, infectious agents are introduced into the pancreas from the liver, gallbladder or bile ducts through the lymphatic vessels. After purulent melting of the organ tissue occurs, the disease takes an acute form and, if not intervened in time, can quickly lead to death.
2. Hypertensive. Bile is an aggressive agent. It contains special compounds that are capable of breaking down any organic substances. If the functioning of the biliary tract is impaired (or the function of the sphincter of Oddi is impaired), bile stagnation occurs. The constant accumulation of bile leads to the fact that it is thrown back into the pancreatic ducts, after which it begins to aggressively affect the gland itself. Aseptic chronic inflammation occurs, which is called biliary-dependent pancreatitis.
3. Duadenopancreatic reflux. In diseases of the duodenum, intestinal motility is impaired and intraintestinal pressure increases. All this contributes to the disruption of the outflow of bile from the common bile duct into the intestinal cavity, and biliary-dependent pancreatitis occurs.

Clinical forms of biliary pancreatitis

The disease occurs in several stages:

• Mild form (edematous).
• Sterile pancreatic necrosis.
• Infected pancreatic necrosis.

Inflammation can affect both part of the gland (head, body, tail) and the entire organ.

Clinical picture of the disease

The clinical picture of biliary-dependent pancreatitis consists of several symptoms.

• Pain is the first symptom that forces patients to see a doctor. It can be encircling in nature or radiate to the back or hypochondrium. With biliary pancreatitis, pain occurs after eating fried, fatty foods, since such dishes are choleretic. The pain occurs a couple of hours after the last meal, but can also occur at night on an empty stomach. Due to the prolonged digestion of fats, pain can be observed for several hours.
• Dyspeptic disorders (vomiting, nausea, flatulence, bitterness in the mouth, feeling of heaviness in the stomach, bitter belching, retention or absence of feces). More often, patients notice repeated vomiting of food, which occurs at a height of pain. Vomiting does not bring relief, and new urges arise within a few minutes.
• Symptoms of intoxication: increased body temperature, weakness, decreased appetite.
• Jaundice: icteric staining of the sclera, oral mucosa, nail plates, skin.

Important! If these symptoms become protracted and bother the patient for a month or more, then this is a sign of chronicity of the inflammatory process. From this moment on, they talk about chronic biliary-dependent pancreatitis.

Read also: Chronic pancreatitis - a modern view of the problem

Diagnostics and laboratory research methods

The diagnosis of biliary-dependent pancreatitis is made after collecting the patient’s complaints and anamnesis, and an objective examination of the patient. The presence of predisposing diseases in the patient (cholelithiasis, liver or duodenal diseases) will help to suspect a malfunction of the pancreas.

During the examination, you should pay attention to the staining of the sclera and mucous membranes, and palpate the abdomen. As a rule, with biliary pancreatitis, the abdomen is not accessible for deep palpation in the epigastric and subcostal regions. In addition, there is pain in the projection points of the gallbladder.

To confirm the presence of the disease, additional laboratory and instrumental research methods are prescribed:

• General clinical blood test (outside an exacerbation of biliary pancreatitis, a moderate increase in the number of leukocytes is observed; during an exacerbation, pronounced leukocytosis with a shift in the leukocyte formula to the left).
• Blood chemistry. Here they look at the amount of liver enzymes: amylase (with exacerbation of biliary pancreatitis, the value can be 10 times or higher), transferases (AST, ALT), alkaline phosphatase, lipase.
• Analysis of stool for the presence of fat in it.
• Ultrasound examination is the gold standard for diagnosis. In this case, voluminous dense formations are detected in the gallbladder or in its ducts, stagnation of bile, a thickened wall of the gallbladder, diffuse changes in the pancreas (heterogeneous structure, uneven contours, edema, calcifications and petrification in the organ tissue).
• Dynamic cholecystography and ERCP (endoscopic retrograde cholangiopancreatography) will help determine whether there are changes in the major duodenal papilla and in the terminal sections of the pancreatic ducts. During ERCP, a papillosphincterotomy is often performed to remove the stone and relieve hypertension in the bile ducts.
• EGDS (esophagogastroduodenoscopy) is performed in all patients with suspected biliary pancreatitis. During the examination, the digestive tract is completely examined. Particular attention is paid to the area of ​​the large duodenal papilla, examining it for the presence of fibrous changes, strictures and other pathological processes.

Read also: Pancreatic steatosis: features of the course and diagnosis

Treatment of biliary-dependent pancreatitis

In mild forms, preference is given to conservative therapy. The main thing here is to strictly follow a diet and take antisecretory drugs.

If there are stones in the gallbladder or its ducts, they resort to surgical intervention, during which they are removed. The operation is also performed for advanced forms of biliary-dependent pancreatitis, when necrosis of the gland tissue is already observed. This operation is an emergency and is performed for life-saving reasons.

Diet

With exacerbation of biliary pancreatitis, patients are prescribed fasting for the first 4-5 days. This reduces the enzymatic load on the pancreas and creates functional rest for it. Then the patient is prescribed a gentle diet (table No. 5) with a limit on fatty, salty, fried, and canned foods.

Important! Carbonated and alcoholic drinks, dishes that increase the load on the pancreas, and hard-to-digest foods are completely excluded from the diet.

With biliary pancreatitis, the emphasis is on protein foods, which come from lean meats and fish, cereals and dairy products. Drinks allowed are teas, decoctions, dried fruit compotes, and jelly. You can consume up to 50 grams of sugar and a piece of dried (not fresh) bread per day.

Conservative treatment

In parallel with the diet, drug therapy is prescribed:

• Fighting pain. If there is pain, antispasmodics are prescribed (no-spa, papaverine, platyphylline, etc.). It may be that the pain is caused by atony of the gallbladder. In this case, on the contrary, substances that spasm smooth muscles (domperidone, cerucal, etc.) are used. The latter improve intestinal motility, thereby improving digestion.
• Antisecretory therapy. During exacerbation of biliary-dependent pancreatitis, it is important to suppress the enzyme-forming function of the pancreas. For this purpose, Famotidine, Ranitidine or the latest generation drug – Octreotide – are prescribed. At the same time, gastric secretion is blocked by Omeprazole, which helps restore the pancreas.
• Anticoagulant therapy. It is carried out with low molecular weight heparins, which prevent the formation of blood clots in the vessels of the gland, improve microcirculation, and increase blood flow to the organ.

If there is a spasm of the sphincter of the major papilla, then a myotropic antispasmodic is prescribed - Mebeverine. This improves bile circulation, relieves hypertension and congestion in the ducts.

In the presence of stones of small diameter, deoxycholic acid preparations are added to the treatment of biliary-dependent pancreatitis, which help dissolve the stones and remove them into the intestinal cavity (for example, Ursosan).

The lack of pancreatic secretion is compensated by replacement therapy. In this case, enzyme preparations (for example, Creon) are prescribed, which improve cavity digestion and relieve hypertension. This accelerates the flow of bile and normalizes the functioning of the digestive tract.

Classification of pancreatitis

Pancreatitis is a severe form of pancreatic disease that can take different forms depending on the type of lesion and its duration. The main cause of the disease is bad habits and abuse of spicy and fried foods.

Classification and types of disease - subforms of the disease used to make a diagnosis. Classification is necessary for prescribing medications and diet. Clinicians distinguish two forms of development of pancreatitis, which are used in practice:

• spicy
• chronic

Each type of pancreatitis can have its own forms of progression and severity. Forms, in turn, are divided into four types. Pancreatitis is also classified according to 7 reasons. We will consider the features of the classification in more detail below.

The classification of pancreatitis is the identification of separate varieties of this disease, which have different causes and clinical picture. The treatment tactics for each of them will also be individual. Pancreatitis is an inflammatory disease of the pancreas, which is one of the most common in the clinic of internal diseases.

The most common causes of its development are poor diet and alcohol abuse. The number of patients with pancreatitis around the world is growing rapidly. Until recently, pancreatitis was classified as age-related, that is, it affected mainly older people. However, due to the popularity of unhealthy food, every year more and more children and adolescents are turning to the doctor with its symptoms.

Two main types of pancreatitis

The main classification of pancreatitis involves dividing it into 2 main groups: acute and chronic pancreatitis. These are not stages of the same disease. These are completely different types of inflammation of the pancreas; treatment tactics will be different in each case.

• Due to development:
  1. (reason - disruption of the gallbladder),

  2. with alcohol abuse,

  3. due to metabolic disorders,

  4. while taking medications, idiopathic (the exact cause is unknown).

• According to clinical manifestations:
  1. painful form,

  2. disruption of the digestive process (decreased enzyme production),

  3. hypochondriacal (the patient has many complaints that do not correspond to the real picture),

  4. hidden treatment,

  5. mixed type (which combines the previous options).

There are also separate classifications of the disease based on morphological changes and presence. Each of them has its own treatment approaches. Therapy should be chosen by a general practitioner or

Source: https://medaboutme.ru/zdorove/publikacii/stati/sovety_vracha/klassifikatsiya_pankreatita/

Modern ideas about the classification of chronic pancreatitis

Chronic pancreatitis (CP) is a group of chronic diseases of the pancreas (PG) of various etiologies, predominantly inflammatory in nature, characterized by:

1. phase-progressive segmental or diffuse degenerative, destructive changes in its exocrine part;
2. atrophy of glandular elements (pancreocytes) and their replacement with connective (fibrous) tissue;
3. changes in the ductal system of the pancreas with the formation of cysts and stones;
4. varying degrees of disturbances in the exocrine and endocrine functions of the pancreas.

The important medical and social significance of the problem of CP is due to its wide distribution among the working population (CP usually develops at the age of 35-50 years). The incidence of CP throughout the world is clearly increasing: over the past 30 years, a more than twofold increase in incidence has been noted.

According to many authors, the prevalence of CP among the population of different countries varies from 0.2 to 0.68%, and among gastroenterological patients it reaches 6-9%. Every year, CP is registered in 8.2-10 people per 100 thousand population.

The prevalence of the disease in Europe is 25-26.4 cases per 100 thousand adults. A significant increase in the prevalence of CP has been registered in Russia; The incidence rate of CP among young people and adolescents has increased 4 times over the past 10 years.

The incidence of CP in Russia is 27.4-50 cases per 100 thousand adults and 9-25 cases per 100 thousand children. In the practice of an outpatient gastroenterologist, patients with CP account for approximately 35-45%, in the gastroenterology department of a hospital - up to 20-45%.

Apparently, this trend is due, firstly, to an increase in alcohol consumption and, accordingly, an increase in the number of patients with alcoholic CP; secondly, irrational unbalanced nutrition and, as a result, a high incidence of cholelithiasis (GSD).

Important clinically and socially are such features of CP as a progressive course with a gradual increase in exocrine insufficiency; pain and dyspepsia that persist for a long time and quickly recur with any error in nutrition, necessitating, on the one hand, the need for frequent expensive therapeutic measures and clinical observation, and on the other hand, requiring the patient to constantly follow a diet and take enzyme preparations.

Attention!

Exocrine pancreatic insufficiency is difficult to correct, often persists and progresses (despite enzyme replacement therapy) and inevitably leads to disturbances in the nutritional status of patients and degenerative changes in internal organs.

The disease is characterized by a long-term, chronic, progressive course, which has an extremely negative impact on the quality of life of patients and leads to partial or complete loss of ability to work. Disability in CP reaches 15%.

The prognosis of the disease is determined by the nature of the course: frequent exacerbations of the painful form of CP are accompanied by a high risk of complications, the mortality rate of which reaches 5.5%. At the same time, there is also overdiagnosis of CP. A wide variety of digestive disorders, often not associated with the pancreas, in particular the “echoic heterogeneity” of the pancreas, identified with, are often considered as unfounded criteria for diagnosing CP.

In this regard, the issues of classification of CP are very important, since they reflect modern views on the etiology and pathogenesis of this pathology, determine the clinical variants of the disease, modern diagnostic and therapeutic approaches.

Classification of chronic pancreatitis

For a long time, pancreatology was dominated by the recommendations of experts from the I International Symposium on Pancreatitis (Marseille, 1962). In the classification adopted there, acute pancreatitis (AP) and CP were distinguished, which was divided into forms - recurrent painless with exo- and endocrine insufficiency and painful.

This classification was close to the classification proposed by N.I. Leporsky in 1951 and adopted at the plenum of the All-Union Scientific Society of Gastroenterologists (Chernivtsi, 1971). It was also recommended to additionally isolate the pseudotumor form of CP.

Further developers of the classification of CP, mainly surgeons, proposed to distinguish parenchymal CP without damage to the ducts and ductal CP, which occurs with expansion and deformation of the main pancreatic duct.

At the II International Symposium on Pancreatitis (Marseille, 1983), the issues of classification of CP were re-examined. It was decided to abandon the formulations “acute recurrent pancreatitis” and “chronic recurrent pancreatitis”, since in clinical practice they cannot be clearly differentiated. Then it was decided to distinguish the following forms of CP:

CP with focal necrosis, segmental or diffuse fibrosis with (or without):

• calcifications;
• expansion and deformation of the ductal system of the gland;
• inflammatory infiltration, cyst formation.

CP is obstructive, characterized by expansion and/or deformation of the ductal system, parenchymal atrophy and diffuse fibrosis proximal to the site of ductal occlusion.

Depending on the clinical symptoms, the following were distinguished:

• latent, or subclinical, CP, in which morphological changes and organ dysfunction are detected in the pancreas in the absence of clear clinical symptoms of the disease;
• painful CP, characterized by the presence of recurrent or constant abdominal pain;
• painless CP occurring with exo- and (or) endocrine insufficiency of the pancreas with or without complications.

With undoubted progress and merits

II Marseille classification, it is not relevant for widespread clinical practice, since its use requires endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic biopsy with subsequent histological examination, which is fraught with great difficulties.

In this regard, there was a need to create a classification close to the Marseilles one, but based mainly on clinical and laboratory parameters and data obtained using ultrasound and computed tomography (CT).

In this regard, the Roman classification of HP (Rome, 1989) was of intermediate importance, which proposed to distinguish:

1. chronic calcific pancreatitis. The most common cause is alcohol consumption. As a result of inflammation and changes in the structure of the smallest ducts of the pancreas, the secretion thickens with the formation of plugs rich in protein and calcium. In this process, an important role is played by a decrease in the concentration of lithostatin (a protein that prevents stone formation);
2. chronic obstructive pancreatitis. It is observed with pronounced narrowing of the main pancreatic duct or its large branches, or the nipple of Vater. Causes of development: alcohol, cholelithiasis, trauma, tumor, birth defects. Occurs infrequently;
3. chronic parenchymal-fibrous (inflammatory) pancreatitis. It is a relatively rare form of the disease.

The presented classification is quite widely used in developed countries. However, the weak point in this classification was the identification of “calcifying pancreatitis”. It can include cases with both the presence of gland calcifications and their absence, allowing for the possibility of their development in the future.

The International Classification of Diseases (ICD-10, 1999) distinguishes:

• CP of alcoholic etiology (K 86.0);
• other CP (CP of unknown etiology, infectious, recurrent) (K86.1).

It should be emphasized that this international classification is statistical and presents CP extremely succinctly, without covering important features of the disease. ICD-10 cannot replace the clinical classification of CP. In recent years, the clinical classification of CP proposed by V.T. has become widespread in our country. Ivashkin et al. The main options are presented in table. 1.

Among the new modern classifications that most fully take into account the causes of pancreatitis, it is necessary to highlight the etiological classification TIGAR-O: Toxic-metabolic (toxic-metabolic), Idiopathic (idiopathic), Genetic (hereditary), Autoimmune (autoimmune), Recurrent and severe acute pancreatitis (recurrent and severe acute pancreatitis), or Obstructive (Table 2),

as well as the multifactorial classification M-ANNHEIM: Multiple Alcohol, Nicotine, Nutrition, Hereditary, Efferent, Immunological, Metabolic.

The TIGAR-O classification is focused on understanding the causes of CP and choosing the appropriate diagnostic and treatment tactics. This is its main advantage and convenience for practitioners.

The literature describes such rare forms of CP as tropical and hereditary CP, the etiology and pathogenesis of which are not fully understood. Hereditary pancreatitis is an autosomal dominant type of inheritance with incomplete penetrance.

The TIGAR-O etiologic classification represents the four best-studied genes whose mutations predispose to the development of hereditary pancreatitis: the cationic trypsinogen gene (PRSS1), the cystic fibrosis gene (CFTR), the pancreatic secretory trypsin inhibitor gene (SPINK), and the α1-antitrypsin polymorphism gene.

Until recent years, tropical pancreatitis was associated with the dietary habits of patients. Due to the unclear etiology of tropical CP, the TIGAR-O classification considers tropical CP as a variant of idiopathic CP.

To date, ideas about the etiological factors of tropical CP have changed. Researchers are increasingly inclined to the idea of ​​the hereditary nature of the disease. In addition, the development of CP is facilitated by the influence of unidentified external factors, the search for which continues.

The M-ANNHEIM classification provides for the determination of clinical stages of CP.

The course of CP is divided into two phases: asymptomatic and with clinical manifestations. The latter includes four stages (I, II, III, IV), and each of them has substages, including the development of severe complications.

Asymptomatic phase of CP:

0 – subclinical CP:

• period without symptoms (determined by chance, for example, during autopsy);
• acute pancreatitis (AP) – the first episode (possibly the beginning of CP);
• AP with severe complications.

CP with clinical manifestation:

Stage I – without pancreatic failure:

• Relapse of AP (no pain between episodes of AP).
• Recurrent or persistent abdominal pain (including pain between episodes of AP).
• I a/b with severe complications.

Stage II – exo- or endocrine insufficiency of the pancreas:

• isolated exocrine (or endocrine) insufficiency without pain;
• isolated exocrine (or endocrine) insufficiency with pain;
• II a/b with severe complications;

Stage III – exo- and endocrine insufficiency of the pancreas in combination with pain:

• exocrine and endocrine insufficiency of the pancreas (with pain, including those requiring treatment with analgesics);
• III a with severe complications.

stage – decrease in pain intensity (stage of “burnout” of the pancreas):

• exocrine and endocrine insufficiency of the pancreas in the absence of pain, without severe complications;
• exocrine and endocrine insufficiency of the pancreas in the absence of pain, with severe complications.

The advantages of this classification are that it covers almost all aspects of the course of the disease, does not require invasive, in particular, morphological research methods, uses accessible and understandable terminology, and is based on practical criteria.

Based on the intensity of pain and duration of the disease, patients with CP can be divided into three groups. When comparing these two parameters, an inverse relationship was revealed between them: the longer the disease, the less severe the pain.

Currently, to assess the presence, degree and localization of pain in the clinic, psychological, psychophysiological and neurophysiological methods are used, most of which are based on the subjective assessment of their sensations by the patients themselves.

The simplest way to quantify pain is to use a ranking scale. The numerical ranking scale consists of a sequential series of numbers from 0 to 10. Patients are asked to rate their pain sensations with numbers from 0 (no pain) to 10 (maximum possible pain).

When comparing the identified clinical, laboratory and morphological data, three variants of the course of CP were identified:

1. option A – duration of the disease is less than 5 years, severe pain, the level of fecal pancreatic elastase (E-1) is reduced slightly, but significantly (pv0.05), there is an increase in the content of acetylcholine (Ax) in the blood (p<0,05) и серотонина (5-НТ) (р<0,05), высокий уровень провоспалительных цитокинов, умеренное повышение холецистокинина (ХЦК) и снижение секретина. В ткани ПЖ выявляются воспаление и отек;
2. option B – the duration of the disease is from 5 to 10 years, the E-1 level decreases significantly (below 100 mcg/g), the pain syndrome is moderate, 5-HT begins to predominate (p<0,05), как стимулятор секреторной активности ПЖ. Остаются высоким ХЦК и низким секретин. Прогрессируют фиброзные изменения, выявляется кальциноз в ткани ПЖ;
3. option C – disease duration of 10 years or more, mild pain syndrome, a further increase in 5-HT concentration is observed, which leads to decompensation of the regulatory mechanisms of pancreatic secretory activity. The increase in CCK and the decrease in secretin levels persist. The protective properties of duodenal mucus are reduced. Against the background of a decrease in the level of endogenous insulin, the clinical picture of diabetes mellitus develops in 30% of cases.

This classification has no practical significance due to the difficulty of determining Ax, 5-HT and CCK in the daily practice of doctors. In 2009, M. Buchler et al. proposed a stage (A, B, C) classification system for CP, taking into account both the clinical manifestations of the disease and the results of imaging methods.

To classify CP, in addition to taking into account the etiological factor, the authors propose to use one clinical criterion or the presence of clearly defined complications of the disease in combination with pathological changes detected by imaging methods or using direct functional pancreatic tests.

Stage A. CP is determined at the initial manifestations of the disease, when there are still no complications and no clinical manifestations of disturbances in exocrine and endocrine functions (no steatorrhea, diabetes mellitus). However, subclinical signs of the disease may already appear (for example, impaired glucose tolerance or decreased exocrine function without steatorrhea).

Stage B(intermediate). Determined in patients with identified complications of the disease, but without signs of steatorrhea or diabetes mellitus. The diagnosis must indicate the type of complication.

Stage C. It is the final stage of CP, when the presence of fibrosis leads to clinical manifestations of exocrine and endocrine insufficiency, while complications may not be diagnosed. This stage is divided into subtypes:

• C1 (presence of endocrine disorders);
• C2 (presence of exocrine disorders);
• C3 (presence of exo- or endocrine disorders and/or complications).

Recently, such a rare form of CP as autoimmune pancreatitis (AIP) has been described, in which the diagnosis and choice of treatment tactics present certain difficulties. AIP is a variant of CP that occurs in the absence of gallstones, pancreas divisum (split pancreas), alcohol abuse or other factors causing CP.

Ultrasound may reveal diffuse or local enlargement of the pancreas with diffuse hypoechogenicity of the affected areas. The classic CT sign of AIP is a “sausage-shaped” pancreatic thickening with homogeneous attenuation, moderate contrast enhancement, and a peripheral hypodense rim. In this form, there is loss of lobular structure, minimal reaction of peripancreatic fat, and enlargement of regional lymph nodes.

With long-term AIP, atrophy of the tail of the pancreas is almost always observed. Typical changes in serological tests include an increase in plasma levels of 0xE3;-globulins or immunoglobulins, in particular IgG4, the presence of antinuclear antibodies, as well as antibodies to lactoferrin, carbonic anhydrase II, and smooth muscle.

Histological criteria for AIP are periductal lymphoplasmacytic infiltration or fibrosis, obliterating phlebitis, and an increased content of IgG4-positive plasma cells in pancreatic tissues. In the domestic literature there are only isolated reports on proven cases of AIP and the effectiveness of its treatment.

This is due to the relative rarity of this disease, diagnostic difficulties, but mainly due to the lack of information about the existence and possibility of identifying and treating this form of CP.

Source: https://www.mediasphera.ru/issues/dokazatelnaya-gastroenterologiya/2013/1/032305-2260201317

Acute pancreatitis: modern classification system

Acute pancreatitis (AP) is one of the most common emergency pathologies of the gastrointestinal tract. Recent studies under the auspices of WHO have noted a constant increase in the annual incidence of AP, which ranges from 4.9 to 73.4 cases per 100,000 population.

Attention!

In Russia, the incidence of AP is 20–80 people per 100,000 population; in Russian hospitals, AP ranks 3rd among acute surgical diseases of the abdomen and accounts for 12.5% ​​of all acute surgical abdominal pathologies.

Of all forms of acute pancreatitis, the most significant level is accompanied by acute severe pancreatitis (ASP), developing in 20–30%. The number of patients who develop infected pancreatic necrosis, late multiple organ failure and other severe purulent-destructive complications of acute pancreatitis - arrosive bleeding, duodenal fistula, small and large intestinal fistulas, pancreatic fistula - is increasing.

At the same time, in the Russian Federation, at least 2 million rubles are spent on the treatment of patients with infected pancreatic necrosis in intensive care units for one month. For the successful treatment of this severe pathology, it is important to develop unified approaches to treatment based on a single classification.

However, in Russia the attitude towards the classification of OP is still ambiguous. In 2000, at the IX All-Russian Congress of Surgeons in Volgograd, V.S. Savelyev conducted a survey of surgeons from 18 regions of the Russian Federation regarding the classification of AP they used.

The survey result was unexpected. 12% of surgeons did not use the classification in their work at all, 53% preferred the international Atlanta classification - 1992, the rest worked according to outdated classifications by V.S. Savelyev (1983) and S.A. Shalimova (1990).

The international community of pancreatological surgeons is constantly working on issues of a unified strategy in the diagnosis and treatment of AP. An international group of 40 experts from 15 international and national associations of pancreatic surgeons in 1992 prepared and reported at the International Congress on September 11–13, 1992 in Atlanta (USA) the first substantiated classification system for OP.

Over the past more than 20 years, some important points of the classification have been revised by international groups of leading pancreatologists in the world in accordance with the deepening of knowledge about the pathophysiology, morphology, course of AP, as well as taking into account the emergence of new diagnostic capabilities. In 2007, on the initiative of M.G. Sarr (USA) once again created an international working group for the 3rd revision of the Atlanta 1992 OP classification.

For 5 years, experts studied international experience in the diagnosis and treatment of AP in large-scale studies, and in 2013, the text of the third revision of the classification of AP - 2012 was published and recommended for use.

Below we present the most significant, in our opinion, criteria for a practicing physician, classification points and prognostic scales recommended by an international working group for use in widespread practice.

Diagnostic criteria

The diagnosis of “acute pancreatitis” is made when at least two of the three signs listed below are detected:

1. abdominal pain characteristic of acute pancreatitis;
2. an increase in the level of serum lipase or serum amylase by 3 times the upper limit of normal;
3. detection of characteristic signs by ultrasound and contrast-enhanced CT, MRI.

The time of onset of the disease is considered to be the moment when typical abdominal pain appears. Pancreatic necrosis is diagnosed in the presence of a diffuse or focal area of ​​non-viable pancreatic parenchyma (PG) more than 3 cm in diameter or occupying more than 30% of the pancreas (according to radiological diagnostic methods).

Items of the international classification Atlanta-92 third revision (2012).

Section A. By type of acute pancreatitis

1. Interstitial edematous acute pancreatitis
2. Necrotizing acute pancreatitis

Section B. According to the clinical picture and severity

Modified Marshall Scale for Acute Pancreatitis

Acute mild pancreatitis is characterized by rapid benefit from fluid therapy, usually within 3–7 days. Does not require a stay in the ICU, there is no need for surgical treatment. Frequency - 80–85% of patients with AP. Morphologically it corresponds to interstitial edematous pancreatitis; microscopic necrosis of the pancreatic parenchyma is rare.

Moderate acute pancreatitis is characterized by transient organ dysfunction, which can be relieved with appropriate fluid therapy within 48 hours.

Morphologically, there are local or diffuse areas of non-viable pancreatic parenchyma of varying extent and localization, necrosis of peripancreatic tissues of varying extent and location. Moderate AP can occur with or without complications of acute pancreatitis.

Severe acute pancreatitis is accompanied by permanent or progressive organ dysfunction, which is not relieved by infusion therapy for more than 48 hours. Morphologically, there is necrosis of the pancreatic parenchyma and/or peripancreatic tissues of varying prevalence and localization, sterile or infected; the formation of acute fluid accumulations and other local complications of acute pancreatitis. Severe pancreatitis occurs in 15–20% of patients.

Section B. Phases of acute pancreatitis

1. The early phase is 1–2 weeks from the onset of the disease. It is characterized by activation of the cytokine cascade due to severe inflammation in the pancreas. Clinically, SIRS manifests itself with a high risk of developing organ failure and pancreatogenic shock.
2. Late phase - after the first or second weeks of the disease. It develops only in patients with moderate acute pancreatitis and severe AP, and is characterized by the development of local complications, often purulent, leading to transient or permanent organ failure.

Section D. Complications of acute pancreatitis

Morphological criteria for the severity of AP according to the Balthazar scale

Scores for the severity of pancreatitis and the extent of necrosis are summed up. The maximum severity is 10 points, the minimum is 0 points.

Clinical criteria for severity of AP for non-biliary pancreatitis

Ranson scale

The presence of each characteristic is scored 1 point, the absence – 0 points, all points are summed up. The prognostic value of the scale is as follows: if there are 2 or less points, mortality is less than 1% (mild severity of pancreatitis), from 3 to 5 points - mortality up to 15% (moderate severity of pancreatitis), from 6 to 8 points - mortality up to 40% and 9 or more points - mortality up to 100% (6 or more points - severe pancreatitis).

To correctly select the access and extent of the operation, a standardized assessment of the location of the lesion in the retroperitoneal tissue is necessary. For these purposes, we think the most convenient is the following scheme, highlighting zones of pancreatogenic aggression.

Peripancreatic fiber. Fiber located around the pancreas and directly adjacent to its surface. Its main part can be adequately drained through a bursoomentostomy.

S1 - left upper quadrant of the retroperitoneum. Fiber located to the left of the spine and above the mesentery of the colon. It is often involved in the process together with the parapancreatic, and its drainage requires extraperitoneal contraperture in the left lumbar region.

S2 - left lower quadrant of the retroperitoneum. Fiber located to the left of the spine and below the mesentery of the colon. As a rule, it is a consequence of the progression of pancreatogenic aggression from S1, and for its adequate drainage, in addition to bursoomentostomy and making an incision in the left lumbar region, extraperitoneal division of all retroperitoneal tissue to the left of the spine and extraperitoneal contraperture in the left iliac region are necessary.

D1 - right upper quadrant of the retroperitoneum. Fiber located to the right of the spine and above the mesentery of the colon.

A significant part of it is difficult to reach from the lumen of the omental bursa; for its drainage, an upper transrectal subhepatic approach through the abdominal cavity is used with elements of mobilization of the duodenum according to Kocher and an extraperitoneal contraperture in the right lumbar region.

D2 - right lower quadrant of the retroperitoneum. Fiber located to the right of the spine and below the mesentery of the colon. As a rule, it is a consequence of the progression of pancreatogenic aggression from D1, and for its adequate drainage, extraperitoneal separation of all retroperitoneal tissue to the right of the spine and extraperitoneal counter-opening in the right iliac region are additionally required.

Thus, the lack of standardized approaches to diagnostic and treatment algorithms plays a role in the continued high overall and postoperative mortality in severe AP. To overcome this situation, it is critically necessary to introduce scientifically based modern classification schemes into widespread surgical practice.

Classifications and types of pancreatitis are generally accepted types and subforms of the disease, which are used in medical practice to make a diagnosis. Pancreatitis is an inflammatory disease that affects the pancreas. In medical practice, it is most often discovered that the disease is formed under the influence of abuse of bad habits and poor nutrition.

General classification

Clinicians identify forms of development of pancreatitis that are used in practice:

• spicy;
• chronic.

Each type has its own symptoms, indicators and treatment principles.

At the first International Conference in Marseille, participants identified 5 main types of pathology. When compiling the classification, scientists relied on the degree of organ damage. As a result, the following varieties were developed:

• spicy;
• recurrent acute;
• chronic;
• obstructive;
• calcific.

• calcifying - often diagnosed, formed due to excessive alcohol consumption;
• obstructive - characterized by complete or partial damage to the main duct;
• inflamed - diagnosed quite rarely, can lead to serious complications, for example, splenic infarction, thrombophlebitis, phlebothrombosis;
• pancreatic fibrosis - pathology threatens with abnormal thickening of pancreatic secretions.

The classification of acute pancreatitis has several varieties. Clinicians divide the disease according to certain characteristics.

According to the severity of the pathology, they are distinguished:

• light form;
• heavy.

Based on the scale and nature of damage to the gland, 5 types of pancreatitis have been identified:

• hydropic;
• sterile pancreatic necrosis;
• infected;
• pancreatogenic abscess;

Also, to determine the exact disease, doctors developed a causal classification. Acute pancreatitis is divided into food, biliary, gastrogenic, ischemic, infectious, toxic-allergic, congenital and traumatic.

To quickly determine the severity of an acute type of pathology, doctors distinguish clinical forms of the disease:

• interstitial - swelling of the pancreas and tissue;
• necrotic - serious inflammation with complications.

Classification of chronic pancreatitis

The chronic type of the disease is much more common. It is characterized by specific symptoms that may fade and reappear. Clinicians distinguish several types of the disease according to different criteria. Classification of chronic pancreatitis according to morphological characteristics:

• interstitial;
• indurative;
• parenchymal;
• cystic;

Chronic disease is divided into 2 stages - and remission. Based on the frequency of repeated inflammation, clinicians have identified the following types of chronic pancreatitis:

• rare relapses;
• frequent relapses;
• persistent (constant symptoms).

Chronic pancreatitis is characterized in practice by various symptoms, under the influence of which another systematization of types has been created. Depending on the dominant symptom, the following diseases are distinguished:

• painful;
• hyposecretory;
• hypochondriacal;
• latent;
• combined.

Acute and chronic pancreatitis have certain causes that form the disease. Therefore, according to the etiological factor, the classification of these two types of disease is slightly similar:

• biliary dependent;
• alcoholic;
• dismetabolic;
• infectious;
• drug;
• idiopathic.

The classification of chronic pancreatitis is also based on the form of complications. According to this principle, doctors distinguish 5 forms of the disease:

• infectious - abscess, cholangitis develops;
• inflammatory - progressive renal failure, cyst, bleeding from the gastrointestinal tract;
• portal hypertension - compression of the portal vein;
• endocrine - diabetes mellitus and hypoglycemia develop;
• failure in the outflow of bile.

Classification according to the editorship of V.T. Ivashkina

As a result of the development of the disease and the manifestation of new causes of the disease, the types of pancreatitis that were identified by scientist Ivashkin are considered obsolete based on etiology. The doctor proposed a complete classification of the disease, which was divided according to many factors and allowed doctors to make an accurate diagnosis.

The form of development of the disease varies. In this regard, the doctor identified a separate section of the classification for the types of pancreatitis by structure:

• interstitial-edematous;
• parenchymal;
• indurative;
• hyperplastic;
• cystic.

Based on the signs of the disease, the following were identified:

• pain option;
• hyposecretory;
• astheno-neurotic or hypochondriacal;
• latent;
• combined.

According to the severity of the disease:

• rare recurrences of inflammation;
• frequent repetitions;
• persistent.

Due to the manifestation of pathology:

• biliary dependent;
• alcoholic;
• dismetabolic;
• infectious;
• drug;
• idiopathic.

Types of pathology associated with complications:

• disturbances in the outflow of bile;
• portal hypertension;
• infectious diseases;
• inflammatory disorders;
• endocrine diseases.

Classification of pancreatitis as edited by Ya.S. Zimmerman

Based on the etiology, Dr. Zimmerman identified two types of the disease - primary and secondary, in which more precise reasons for the formation of the pathology were identified:

Primary reasons:

• alcohol;
• heredity;
• medicines;
• ischemic;
• idiopathic;

Secondary causes:

Chronic and acute pancreatitis has special clinical manifestations, so the doctor identified the following types:

Painful option:

• with temporary pain;
• with constant pain;

According to morphological indicator:

• calcifying;
• obstructive;
• infiltrative fibrous;
• indurative.

The functionality of the organ also influenced classification. Therefore, the following types are distinguished:

• hypersecretory type;
• hyposecretory type;
• obstructive type;
• ductular type;
• hyperinsulinism;
• hypofunction of the insular apparatus.

The disease can occur in three different stages:

• light;
• moderate severity;
• heavy.

The disease is characterized by certain complications, which also served as the reason for the formation of the classification:

• early: jaundice, hypertension, intestinal bleeding, retention cysts and pseudocysts;
• late: steatorrhea, duodenal stenosis, encephalopathy, anemia, local infections, arteriopathy of the lower extremities, osteomalacia.

In their work, clinicians use only a few of the most common classifications of the disease.

Similar materials

Pancreatitis is an inflammatory process localized in the pancreas. It can occur both acutely and chronically. It is precisely because of the presence of inflammation that the question arises: can the temperature rise? In this case, clinicians do not give a definite answer, since everything depends on the clinical picture and anamnesis.

Pancreatitis is a serious inflammation of the pancreas that can take several forms depending on the type of lesion, how long it lasts, and how quickly it progresses.

The classification of acute pancreatitis is important, since the type and plan of future treatment, and therefore the patient’s possibility of recovery, will depend on the correct diagnosis.

Pancreatitis as a disease of inflammatory nature can be divided into the following types:

• spicy;
• acute with possible relapses;
• chronic.

In turn, each type can have its own forms of progression. So, acute and recurrent can occur with restoration of organ function. Chronic may be accompanied by associated problems, such as calcification, the appearance of tumors, and the inability to fully restore the functioning of the organ.

Acute pancreatitis and its classification

There are several classification options for acute pancreatitis. They are important for their correct identification and further prescription of therapy.

By stage of progression and severity

Currently there are characteristics for three degrees:

• mild (does not involve major changes; following a diet and recommendations can make many negative processes reversible);
• moderate (complications and rapid transition to a severe stage of progression are possible in the absence of treatment);
• severe (involves serious complications, some of which can lead to necrosis and death).

In any degree, acute pancreatitis is dangerous and requires immediate hospitalization, since it can develop quickly and lead to complications.

By form

The prescribed treatment and recommendations may depend not only on the identified stage of disease progression, but also on its forms. Often their symptoms differ, and the indications of ultrasound and other studies may be somewhat different.

Currently, the following forms of pathology are distinguished:

1. Edema. It is considered the easiest and does not involve serious changes in the tissues of the pancreas. The fibrin level in this case is increased, the patient feels persistent pain in the left hypochondrium. With the right treatment, the prognosis is usually positive.
2. Organic pancreatic necrosis. Serious negative changes are observed in the tissues of one of the areas of the organ. The pain that arose in the left side gradually intensified, nausea and stool disturbances, and flatulence developed. Often the level of glucose in the blood increases and the volume of blood cells decreases, causing jaundice.
3. Diffuse pancreatic necrosis. A dangerous form of inflammation, in which the lesion rapidly expands, the general symptoms of necrotic changes intensify, intoxication appears, urination problems, fever, and gastric bleeding is possible. If left untreated, the pathology can be fatal.
4. Total pancreatic necrosis can be considered the most dangerous form, since it covers almost the entire area of ​​the pancreas. Against this background, renal, pulmonary and heart failure, intoxication, and shock may develop. All this without emergency help can also lead to death.

The form can be determined by signs and symptoms, as well as a comprehensive medical examination.

Because of

The causes of acute inflammatory processes in the pancreas can be diseases of internal systems and organs, poor quality nutrition and many other problems. They also classify acute and chronic pancreatitis:

1. Alimentary (food). Occurs as a result of eating the most harmful foods and spicy seasonings, as well as alcohol. It can develop both after a one-time practice of such nutrition, and after some time.
2. Biliary. Accompanied by the development of pathologies of the gallbladder and liver.
3. Gastrogenic. Occurs with stomach diseases.
4. Ischemic. The cause of the pathology is poor blood supply to the organ.
5. Allergic. It can develop due to exposure to toxic substances and medications that cause allergies.
6. Infectious. Occurs as a consequence of the development of infections.
7. Traumatic. The cause is mechanical damage, trauma to the pancreas.

There is also a congenital type of acute pancreatitis, when the pancreas is affected due to any hereditary diseases or disorders in the body.

Diagnostic methods

There are several methods for diagnosing the disease. But most often the best results are obtained from a combination of them.

Inspection

The initial examination of the patient is the most important method of making a diagnosis. With its help, possible pallor and cyanosis of the skin and limbs, as well as jaundice in severe cases, are determined. Bloody spots can also be detected in the navel, on the face and on the sides of the abdomen. They usually talk about disturbances in the blood supply to tissues.

Palpation in such cases may reveal the following symptoms:

• abdominal tension (symptom of pancreatic necrosis);
• pain in the left hypochondrium.

An important factor is also the interview and study of the patient’s medical history.

Laboratory procedures

The following tests will help determine acute pancreatitis and the form of the disease:

• general blood test (detects signs of inflammation and dehydration);
• biochemical urine analysis (determines the level of electrolytes and increased levels of amylases and C-active protein as a sign of inflammation);
• blood test for glucose (with pancreatitis, its level is often elevated).

Application of devices and tools

Questioning, examination and tests are often not enough to accurately diagnose the cause of the disease. Also in diagnosis it is important to use the following methods:

• ultrasonography;
• radiography;
• cholecystopancreaography;
• tomography (computer and magnetic resonance imaging);
• laparoscopy.

Echogenicity of the pancreas

These techniques allow you to visualize the pancreas, ducts and gallbladder, determine their size and deviations from the norm, as well as identify the density and presence of tumors. Based on these studies, the diagnosis can be determined quite accurately, therefore, before starting a medical examination, the patient must follow some recommendations on the daily routine and diet.

Conclusion

There are several different classifications of acute pancreatitis, based on different criteria. Using them, you can correlate the patient’s clinical picture with signs of disease development, as well as identify and eliminate the causes of the pathology, as well as draw up a treatment plan and basic therapeutic recommendations.