Pancreatita acut\u0103 este o inflamare grav\u0103 a pancreasului, ce necesit\u0103 interven\u021bii medicale de urgen\u021b\u0103. Este boala care l-a r\u0103pus pe celebrul DJ suedez Avicii, la doar 28 de ani. <\/p>\n\n\n\n
Acad.prof.univ.dr. Dan Sab\u0103u, \u0219eful sec\u021biei Chirurgie II, din cadrul Spitalului Clinic Jude\u021bean de Urgen\u021b\u0103 Sibiu, a explicat pentru sibiu100.ro<\/em> cum s\u0103 recunoa\u0219tem un episod de pancreatit\u0103 acut\u0103 \u0219i cum poate fi tratat\u0103.<\/p>\n\n\n\n Ce este pancreatita acut\u0103?<\/strong><\/p>\n\n\n\n Extrem de grav\u0103 pancreatita acut\u0103 denumit\u0103 de altfel \u015fi \u201dmarea dram\u0103 abdominal\u0103\u201d este o boal\u0103 plurietiologic\u0103, cauzat\u0103 de diver\u0219i factori: litiaz\u0103 biliar\u0103, consum de alcool, dislipidemii, alergii, vasculopatii etc.<\/p>\n\n\n\n C\u00e2nd se produce un astfel de episod?<\/strong><\/p>\n\n\n\n Cel mai frecvent, pancreatita acut\u0103 se declan\u015feaz\u0103 pe fondul litiazei biliare, odat\u0103 cu consumul de gr\u0103simi asociate cu alcool (bere, vin, alcool rafinat). Ambele sexe sunt aproximativ egal afectate.<\/p>\n\n\n\n Care sunt simptomele care trebuie s\u0103 \u00eengrijoreze o persoan\u0103 care se confrunt\u0103 cu aceast\u0103 afec\u0163iune?<\/strong><\/p>\n\n\n\n Simptomele cele mai frecvente \u015fi alarmante ale acestei boli sunt de regul\u0103 asociate \u015fi dominate de durere atroce \u00een etajul abdominal superior (durere a\u0219a-zis\u0103 \u201d\u00een bar\u0103\u201d sau \u201d\u00een centur\u0103\u201d), v\u0103rs\u0103turi incoercibile (nest\u0103p\u00e2nite), stare general\u0103 afectat\u0103 semnificativ, tulbur\u0103ri de con\u015ftient\u0103, puls accelerat, tranzit intestinal dificil p\u00e2n\u0103 la absen\u0163a tranzitului, incapacitatea de alimentare, hipertensiune arterial\u0103, distensie abdominal\u0103.<\/p>\n\n\n\n La ce complica\u0163ii poate duce neprezentarea la medic?<\/strong><\/p>\n\n\n\n Neprezentarea la medic poate duce la deces. Chiar \u015fi sub tratament, formele severe pot duce la exitus la jum\u0103tate din pacien\u0163i, mai ales \u00een cazul prezent\u0103rilor tardive. Solu\u0163ia este tratamentul precoce, aplicat c\u00e2t mai repede dup\u0103 declan\u015farea simptomelor.<\/p>\n\n\n\n \u00cen c\u00e2t timp trebuie ac\u0163ionat pentru ca via\u0163a pacientului s\u0103 nu fie pus\u0103 \u00een pericol?<\/strong><\/p>\n\n\n\n Interven\u0163ia medicului trebuie s\u0103 fie imediat\u0103, eficient\u0103, complex\u0103, cu scopul de a anula enzimele digestive circulante, de a bloca secre\u0163ia acestora \u015fi de a asigura evacuarea lor \u00een tubul digestiv (acolo unde le este locul). M\u0103surile terapeutice sunt medicale \u015fi chirurgicale, aplicate rapid \u00eentr-o a\u015fa zis\u0103 \u201dfereastr\u0103 terapeutic\u0103\u201d (\u00eentre 72 de ore \u015fi 7 zile). Instituite la timp, m\u0103surile terapeutice \u201dagresive\u201d pot duce la o reducere semnificativ\u0103 a mortalit\u0103\u0163ii \u015fi morbidit\u0103\u0163ii (sechele, vitez\u0103 de vindecare, implicare a altor organe \u015fi sisteme). Ratarea startului \u015fi a utiliz\u0103rii \u201dferestrei terapeutice\u201d duce la agravarea bolii.<\/p>\n\n\n\n Prin ce modalit\u0103\u0163i se poate pune un diagnostic exact?<\/strong><\/p>\n\n\n\n Diagnosticul exact se pune pe datele clinice (simptome, semne, anamnez\u0103), al\u0103turi de date de laborator \u015fi examin\u0103ri imagistice (ecografie abdominal\u0103, tomografie computerizat\u0103, rezonan\u0163\u0103 magnetic\u0103 \u2013 RMN).<\/p>\n\n\n\n Cum se trateaz\u0103 pancreatit\u0103 acut\u0103 \u2013 \u00een toate cazurile este nevoie de interven\u0163ie chirurgical\u0103?<\/strong><\/p>\n\n\n\n Tratamentul este complex medical \u015fi chirurgical, dup\u0103 cum spuneam, \u015fi, \u00een cea mai mare parte a cazurilor, chirurgia este inevitabil\u0103, majoritatea cazurilor de pancreatit\u0103 acut\u0103 fiind determinate de existen\u0163a litiazei biliare (pietre la fiere). Dar, chirurgia aplicat\u0103 precoce, \u00een diverse variante \u015fi mai ales laparoscopic, reduce semnificativ morbiditatea (suferin\u0163e complexe asociate postoperator) \u015fi mortalitatea postterapeutic\u0103.<\/p>\n\n\n\n C\u00e2t dureaz\u0103 \u00een medie, ce \u015fanse de reu\u015fit\u0103 exist\u0103 \u015fi ce riscuri implic\u0103 opera\u0163ia de pancreatit\u0103?<\/strong><\/p>\n\n\n\n Riscurile opera\u0163iei sunt prezente, dar cu at\u00e2t mai mici cu c\u00e2t echipa este mai antrenat\u0103. Chirurgia clasic\u0103 \u00een optic\u0103 tradi\u0163ional\u0103 \u00ee\u015fi propunea tratamentul complica\u0163iilor \u015fi nu al pancreatitei, ci al efectelor ei. Optic\u0103 modern\u0103, ini\u0163iat\u0103 \u015fi aplicat\u0103 de noi pentru prima dat\u0103 \u00een Rom\u00e2nia, este aceea c\u0103 trebuie rapid tratat\u0103 cauza, blocate mecanismele pancreatitei pe toate c\u0103ile \u00eenc\u0103 de la declan\u015fare \u015fi \u00een condi\u0163iile interven\u0163iei laparoscopice. De altfel, de aproximativ 4-5 ani chirurgiile european\u0103 \u015fi american\u0103 recunosc ferm superioritatea laparoscopiei, care \u00een condi\u0163iile experien\u0163ei, devine o cale sigur\u0103 \u015fi nu o aventur\u0103. Tratat\u0103 la timp, pancreatit\u0103 acut\u0103 are mari \u015fanse de succes. Neglijat\u0103, pancreatita este o boal\u0103 mortal\u0103.<\/p>\n\n\n\n \u00cen c\u00e2t timp se recupereaz\u0103 pacientul dup\u0103 opera\u0163ie \u015fi ce m\u0103suri (din punct de vedere alimentar, al mi\u015fc\u0103rii) trebuie s\u0103 respecte?<\/strong><\/p>\n\n\n\n Recuperarea pacientului dup\u0103 o astfel de boal\u0103 \u015fi, \u00een general, dup\u0103 o lung\u0103 internare menit\u0103 s\u0103 corecteze mecanisme \u015fi deficien\u0163e metabolice presupune \u00eentre 40 \u015fi 60 de zile \u00een absen\u0163a complica\u0163iilor. Formele u\u015foare de pancreatit\u0103 se pot recupera mai repede. Pacientul recuperat dup\u0103 pancreatit\u0103 acut\u0103 necesit\u0103 un regim prudent igienodietetic \u015fi evitarea cu fermitate a condi\u0163iilor de declan\u015fare a bolii (gr\u0103simi, alcool, m\u00e2nc\u0103ruri greu digerabile, oboseal\u0103 extrem\u0103). De regul\u0103, urmarea este pancreatita cronic\u0103 rezidual\u0103 \u015fi\/sau eventualitatea rec\u0103derilor de pancreatit\u0103 (relapsing pancreatitis). Cum pot fi prevenite crizele de pancreatit\u0103 acut\u0103?<\/strong><\/p>\n\n\n\n Crizele de pancreatit\u0103 acut\u0103 pot fi prevenite prin respectarea unui regim alimentar s\u0103n\u0103tos, prin evitarea abuzurilor de gr\u0103simi \u015fi alcool, prin extirparea la timp a colecistului cu litiaz\u0103 \u0219i tratarea dislipidemiilor.<\/p>\n","protected":false},"excerpt":{"rendered":" Pancreatita acut\u0103 este o inflamare grav\u0103 a pancreasului, ce necesit\u0103 interven\u021bii medicale de urgen\u021b\u0103. Este boala care l-a r\u0103pus pe<\/p>\n","protected":false},"author":1,"featured_media":49398,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"spay_email":"","footnotes":"","jetpack_publicize_message":""},"categories":[80],"tags":[],"class_list":["post-49397","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sanatate"],"jetpack_featured_media_url":"https:\/\/i2.wp.com\/realitatearutiera.ro\/wp-content\/uploads\/2019\/05\/pancreatita-e1495188198908.jpg?fit=603%2C379&ssl=1","jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p61naM-cQJ","jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=\/wp\/v2\/posts\/49397","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=49397"}],"version-history":[{"count":1,"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=\/wp\/v2\/posts\/49397\/revisions"}],"predecessor-version":[{"id":49399,"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=\/wp\/v2\/posts\/49397\/revisions\/49399"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=\/wp\/v2\/media\/49398"}],"wp:attachment":[{"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=49397"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=49397"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/realitatearutiera.ro\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=49397"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Din punct de vedere al recuper\u0103rii fizice, al integrit\u0103\u0163ii peretelui abdominal, al capacit\u0103\u0163ii pacientului de reintegrare socioprofesional\u0103, varianta chirurgical\u0103 laparoscopic\u0103 este net superioar\u0103 agresivit\u0103\u0163ii chirurgiei clasice frecvent invalidant\u0103, cu excludere profesional\u0103 \u015fi limitare social\u0103.<\/p>\n\n\n\n