Any damage to the pancreas, regardless of the etiologic factor, is a difficult task for diagnosis and treatment, especially in a non-specialized hospital setting.
For the development of damage to the pancreas, the effects of the causes are divided into:
- exogenous - penetrating and blunt( closed) injuries, radiation, etc.;
- endogenous - oncological processes, metabolic disorders, emboli, abscesses, poisons, infarction, etc.
The first include all kinds of effects that traumatize through whole or damaged skin( directly or indirectly), and endogenous affect pancreatic tissue from the inside, likeusually through the vascular bed.
Exogenous injuries occur due to various injuries or effects. All of them are classified into:
- open - with damage to the skin( knife, bullet, fragmentation, etc.);
- closed - strong exposure to a blunt object, penetrating radiation( β˗ and γ˗ radiation) or mediated injury( fragments and splinters of ribs, crest of the ilium, vertebrae).
Endogenous lesions are generally conditions developing over a prolonged period of time, the result of which is developing pancreatic dysfunction due to degenerative changes.
Exceptions are emboli, which for years can grow( thrombi), then come off and immediately clog the large artery in the pancreas, causing a clinical picture characteristic of acute pancreatitis.
Rarely occurs with penetrating ulcers of the duodenum and the body of the stomach.
The degree of severity is determined by the severity of morphological changes in pancreatic injury:
- I st. Bruising, subcapsular rupture and hemorrhage into the organ tissue.
- II Art. Rupture of the parenchyma and outer capsule.
- III st. Destruction of the parenchyma without trauma to the ducts.
- IV Art. Massive destruction with a rupture of the central duct.
For some damage to the pancreas( acute closed and open), a particularly vivid clinical picture including symptoms of pancreatic injuries is typical:
- acute pain in the epigastric region radiating in the back like a "wide belt" around the back;
- persistent nausea and paroxysmal vomiting, which does not alleviate the patient's condition;
- Clinic of increasing bleeding: dizziness, decreased pressure, darkening in the eyes, pancreatic collapse;
- developing peritonitis.
Due to the lack of pathognomonic symptoms, the diagnosis is made on the basis of a typical medical history, clinical picture, laboratory tests and results of instrumental studies.