Coma in pancreatitis is observed in adult patients, as well as in children who have reached the age of 3 years. In the tissues of the pancreas, autolysis develops under the action of proteolytic enzymes. When they get into the bloodstream, systems and organs are affected. The disease manifests itself with a pain syndrome, usually in the epigastric region and spreads to the waist. Pain is the result of an acute attack of pancreatitis. The patient begins vomiting, the temperature rises, there is a disturbance of movement and nervous excitability. Also, there are all signs of intoxication, and its symptoms are leading:
- dry and pale skin with an earthy tinge;
- pupils are narrowed and do not respond to changes in illumination;
- sharpening of facial features;
- pathologically rare breathing;
- intestinal paresis;
- threadlike pulse;
- deaf heart sounds;
- a tachycardia of the expressed character.
Diagnosis and treatment of pancreatic coma
For the diagnosis of pancreatic coma, anamnesis is made, examination with palpation and paraclinical examinations:
- in the abdomen, pain of paroxysmal nature is observed;
- tongue is covered in gray;
- is a positive Mayo-Robson symptom;
- loose stools, vomiting, belching;
- in the pancreas zone, palpation shows severe pain;
- peritoneum muscles are locally strained;
- in feces is neutral fat.
It is mandatory to conduct laboratory studies of the activity of amylase and lipase. For this, the patient gives blood and urine tests. In addition, if the patient has increased psychoneurological changes, it should be assumed that coma develops in pancreatitis. If glucosuria and hyperglycemia develop against the background of the pain syndrome, it is important not to make a mistake in diagnosis, that is, not to ascertain the diabetic coma. Also, hemodynamic disorders can show changes in the cardiogram( typical of patients with IHD), which can also lead to erroneous diagnosis of alcoholic delirium.
Emergency care for coma with pancreatitis should be aimed at arresting spasms and pain syndrome. Further, the enzyme release activity should be reduced and the edema of the pancreas removed. Then, desintaxation therapy is carried out and the equilibrium of the acid-base medium is restored. Further treatment is carried out strictly in accordance with the data of the surveys and analyzes.