Differential diagnosis of acute pancreatitis is a very complex task, which usually takes place in several stages and represents a series of laboratory and radiation studies. It is especially difficult to recognize such a disease at the initial stage of development, when the symptoms are not too vivid and often resemble the symptoms of other similar diseases of the abdominal cavity.
Usually the initial stage of this disease is characterized by a strong pain syndrome and signs of general intoxication( vomiting, nausea and many others).Therefore, the initial stage of manifestation of the symptoms of the disease is intended to determine the symptoms of acute pancreatitis from manifestations of other diseases, such as cholecystitis, ulcer, appendicitis and even myocardial infarction.
Basically, primarily as a differential diagnosis of such a disease, a laboratory examination of the patient's blood is carried out, which then, in the presence of all signs of inflammation of the pancreas, is supported by radiation studies and allows accurate diagnosis in time. As such diagnosis of the disease mainly used ultrasound( ultrasound) or computed tomography( CT) of the focus of the inflammatory process. Radiation examination of this disease in the form of ultrasound is performed both by portable and stationary devices, using special sensors that allow to reliably estimate the density changes in the parenchyma of the inflamed pancreas in the acute form of pancreatitis, the sharpness of the contours of this organ and the relationship of the inflammatory focus to other body systems. Another common form of this study is computed tomography, this radiation examination allows to accurately identify the edematous form of acute pancreatitis due to a diffuse increase in the size of the pancreas. Application of all the above types of research allows you to accurately differentiate the disease from others and in a timely manner to assign effective treatment to the patient.
A differentiated laboratory examination of a patient's blood with suspected acute pancreatitis allows preliminary diagnosis to be made for some features of the blood composition, but due to the similarity of the disease with some others, it is not decisive and other types of examinations are required for the final diagnosis. Especially important is the conclusion of studies to differentiate acute pancreatitis in severe disease, when the count goes to the clock.
Another type of research that is widely used in this disease in the early stages is laparoscopic intervention. Laprascopy is a kind of surgical intervention that allows you to reliably diagnose a patient and differentiate acute pancreatitis with insufficient effectiveness of other types of laboratory and radiation diagnostics. After all, even the life of a patient depends on the correct setting of the initial diagnosis.
Differential diagnosis, both laboratory and radial, is also important for determining the size of necrotic pancreatic lesions. After all, if the laboratory or radiation methods of research have shown that necrosis is not too extensive, a patient with acute pancreatitis can still be saved by surgery.
Thus, the use of all types of laboratory and radiation methods of research allows to reliably diagnose in the shortest possible time and to appoint the most effective treatment.
Diagnostic criteria for acute pancreatitis.
The patient is diagnosed in several stages. In addition to visual examination, the doctor should also be guided by certain criteria that characterize the patient's condition. On the Ranson scale, you can assess the severity of the disease.
This diagnostic type consists of 11 criteria. At the appearance of the first symptoms of the disease, for the presence of each of them the patient receives one ball. Consequently, the total number of balls indicates the severity of the disease.
Let's consider in more detail the criteria for acute pancreatitis:
- age is more than 55 years;
- LDG & gt;350 IU / l;
- ACAT & gt;250 IU / l;
- PaO2 & lt;gt;p.
- Ca in blood more than 2 mmol / l;
- hematocrit is increased 1/10;
- analysis of the state of metabolic acidosis with a deficiency of bases & gt;4 meq / l;
- increase in the level of nitrogenous bases in urea more than 1.8 mmol / l;
- from the body does not excrete water, more than 6 liters;
- blood sugar exceeded 11.1 mmol / l;The
- leukocytes exceed 16,000 / mm³.
Analyzing the number of scores received, all patients who are sick with this disease can be conditionally divided into several subgroups with:
- mild course of the disease( with a total number of criteria from 1 to 3. Moreover, they have a low probability of transition of the disease into a complex form that may endlethal outcome of the
- with a severe course of the disease. This subgroup includes people who have identified at least one of the following characteristics: more than 3 points on the Ranson scale, with one, several opsif there are local complications that may occur in necrosis, abscess, pseudocyst
If the number of criteria increases, the likelihood of lethality increases
Methods for diagnosing acute pancreatitis
All methods for diagnosing acute pancreatitis are to identify characteristics that indicate the presence of symptomsThey can be divided into several areas:
- Physical examination - a set of activities that the doctor conducts to determinediagnosis. It is based on the sense organs of the medical professional. This: examination, palpation, percussion, auscultation.
- Laboratory examination is performed by analyzing the content of pancreatic enzymes in urine and blood.
- Instrumental examination includes: ultrasound, X-ray analysis, tomography, magnetic resonance imaging, laparoscopy, angiography, endoscopy of the upper gastrointestinal tract.
Instrumental examination includes: ultrasound, X-ray analysis, tomography, magnetic resonance imaging, laparoscopy, angiography, endoscopy of the upper gastrointestinal tract.
ECG in Acute Pancreatitis
Medical science claims that with acute pancreatitis, the ECG pattern often changes. This is due not only to the characteristics of the disease, but also to the age of the patients. In general, people over 50 years old suffer from this disease.
The disease leads to changes that are nonspecific and manifest as:
- the displacement of the ST fragment;
- change in the shape of the T wave, which leads to a change in the repolarization.
Therefore, in order to avoid the appearance of pathological changes in the Q wave, it is necessary to perform an ECG in acute pancreatitis. This examination also helps prevent the development of myocardial infarction, namely, it often becomes a clear complication of the disease. After treatment of the disease, often the changes found on the ECG, come back to normal.
Justification and formulation of the diagnosis of "acute pancreatitis"
Summing up all of the above, it can be said that the rationale and formulation of the diagnosis of "acute pancreatitis" is the following - a disease that is accompanied by the onset of an inflammatory process in the pancreas. Its basis is the autonomous destruction of the tissues of the organ, which leads to an increase in size, the development of edema, necrosis, or diffuse peripancreatitis.