Acute hemorrhagic necrotic pancreatitis

　　The etiology of acute hemorrhagic necrotic pancreatitis is still not fully understood to date, mainly due to the large differences between animal models and clinical cases. From the data, the etiology of the disease is related to the following factors.
　　1. Obstructive factors
　　Due to bile duct ascaris, impacted Whipple's ampulla stones, narrowing of the duodenal papilla, etc., leading to bile reflux.
　　2. Alcohol factors
　　Long-term alcohol consumption is prone to pancreatitis, which is a common phenomenon in the Western world, accounting for 70%.
　　3. Vascular factors
　　Acute occlusion of the small and medium arteries and veins of the pancreas can lead to acute circulatory disorders in the pancreas and acute hemorrhagic necrotic pancreatitis.
　　4. Trauma and iatrogenic factors
　　Pancreatic trauma causes rupture of the pancreatic duct, extravasation of pancreatic juice, and insufficient blood supply after trauma, leading to acute severe pancreatitis.
　　5. Infection factors
　　Acute hemorrhagic necrotic pancreatitis can occur in various bacterial and viral infections, such as mumps virus, adenovirus, hepatitis A virus, and bacterial pneumonia, etc. Viruses or bacteria enter the pancreatic tissue through the blood or lymph, causing pancreatitis.
　　6. Other factors
　　Such as drug allergy, drug poisoning, hemochromatosis, adrenal cortical hormones, etc.

　　Acute hemorrhagic necrotic pancreatitis is characterized by sudden onset of severe upper abdominal pain. Severe cases with a long course can die due to shock; they can also form localized abscesses or pseudopancreatic cysts.

　　Acute hemorrhagic necrotic pancreatitis is characterized by sudden onset of severe upper abdominal pain. Physical examination shows abdominal distension, abdominal tenderness, shifting dullness, and disappearance of bowel sounds. A few patients may develop subcutaneous fat necrosis, ecchymosis on both abdominal walls, and discoloration around the umbilicus due to blood-containing pancreatic enzymes渗液 through the retroperitoneal space.

　　Acute hemorrhagic necrotic pancreatitis is particularly dangerous, with a rapid onset and high mortality rate. It is known that the onset is mainly due to retrograde pancreatic juice and pancreatic enzyme damage to the pancreas, and prevention can be targeted at these factors.
　　1. Bile duct diseases:Avoid or eliminate bile duct diseases. For example, prevent intestinal ascaris infection, timely treat bile duct stones, and avoid acute exacerbation of bile duct diseases.
　　2. Alcoholism:Chronic alcoholism can damage the liver, pancreas, and other organs due to chronic alcohol intoxication and malnutrition, leading to a decrease in the body's ability to resist infection. On this basis, acute pancreatitis can occur due to a single episode of heavy drinking.
　　3. Overeating and overdrinking:Can lead to gastrointestinal dysfunction, causing normal intestinal activity and emptying to be impaired, obstructing the normal drainage of bile and pancreatic juice, and leading to pancreatitis.

　　In addition to clinical manifestations and signs, auxiliary examinations are also essential for the diagnosis of acute hemorrhagic necrotizing pancreatitis. Commonly used clinical examinations include:
　　1. Laboratory examination Blood and urine amylase levels may remain elevated or not elevated due to widespread necrosis of the pancreas; blood calcium levels decrease, and their values　　2. Other auxiliary examinations B-ultrasound examination shows enlargement of the pancreas with few internal light point reflections; CT shows diffuse enlargement of the pancreas with irregular shape, blurred edges, and widened peripancreatic spaces.

　　Acute hemorrhagic necrotizing pancreatitis patients should be forbidden from drinking and eating in the early stage to avoid promoting pancreatic juice secretion. As the condition improves, fluid diet should be started. Even if food can be consumed, the digestive ability is very low. Therefore, appropriate food should be prepared.
　　In summary, the basic dietary principles for acute pancreatitis are to provide a small amount of easily swallowed and digested, low-protein and low-fat carbohydrate diet. Some symptoms require strict control of fat and protein, and symptoms can gradually increase when there are no abnormalities. Salt intake should be limited when there is edema.

　　The treatment of acute hemorrhagic necrotizing pancreatitis includes non-surgical treatment and surgical treatment. If the clinical manifestations are not severe, and there is no infection in the necrotic pancreas and surrounding tissues, conservative treatment can be adopted first.

　　1. Non-surgical Treatment
　　1. Refrain from eating and continue with continuous gastrointestinal decompression.
　　2. Supplement blood volume, and pay attention to correct water and electrolyte imbalances and maintain acid-base balance.
　　3. Use atropine, 5-fluorouracil, and trypsin inhibitor. If conditions permit, growth hormone-releasing hormone and its analogs can be used. Insulin should be used for those with hyperglycemia.
　　4. Use total parenteral nutrition and appropriately supplement calcium.
　　5. Use effective antibiotics to prevent the occurrence or progression of infection.
　　6. Abdominal lavage is used in the early stage of severe pancreatitis.

　　2. Surgical Treatment
　　Indications: The diagnosis of necrotizing pancreatitis is not yet clear, and it cannot be excluded that other acute abdominal conditions requiring surgical treatment may exist; after non-surgical treatment for hemorrhagic necrotizing pancreatitis, there is no significant improvement in clinical symptoms or secondary infection of the pancreas and peripancreatic tissue; biliary pancreatitis, such as pancreatitis caused by ascaris entering the pancreatic duct or gallstones in the common bile duct.