Pancreatogenic encephalopathy syndrome

　　Toxic substances and enzymes released by the diseased pancreas tissue and the direct effect on the brain, as well as cerebral ischemia caused by shock, azotemia, and other factors cause brain damage. The pathogenesis of pancreatic encephalopathy has not been definitely established yet. There are many theories, such as the action of enzymes, hemodynamic disorders, metabolic disorders, inflammatory mediators, infectious factors, malnutrition, alcoholism, and others. Among them, the mechanism recognized by most scholars is the abnormal metabolism of enzymes on the basis of severe pancreatitis, leading to brain tissue damage.

　　Pancreatic encephalopathy syndrome can complicate cranial nerve palsy, increased muscle tone, hyperreflexia, pathological reflexes, and ataxia. Secondly, due to the fact that this disease usually involves brain cell damage, causing a decrease in the efficiency of the sodium pump, which can lead to cell edema and increased intracranial pressure, causing cerebral herniation and threatening life. The necrotic hemorrhagic type of acute pancreatitis is serious, leading to shock and peritonitis quickly, and some patients may die suddenly.

　　It is not difficult to diagnose patients with central nervous system symptoms in pancreatitis, and the clinical manifestations of pancreatic encephalopathy syndrome mainly include the following aspects:

　　Symptoms of acute pancreatitis

　　The clinical manifestations are sudden onset of acute upper abdominal pain, radiating to the back, accompanied by nausea, vomiting, fever, hypotension, and elevated blood and urine amylase levels.

　　Symptoms of chronic pancreatitis

　　Clinically, it is often accompanied by biliary tract diseases, with symptoms such as abdominal pain, steatorrhea, and sometimes diabetes.

　　The main manifestations

　　1. Psychiatric symptoms: manifested as states of anxiety and irritability, followed by hallucinations, disorientation, delirium, or coma. Psychiatric symptoms recover as the pancreatitis improves.

　　2. Neurological symptoms: manifested as spasms, tremors, aphasia, and can appear with cranial nerve palsy, increased muscle tone, hyperreflexia, pathological reflexes, and ataxia.

　　Pancreatic encephalopathy syndrome is mainly caused by pancreatitis, so in clinical practice, the main focus is on the prevention of pancreatitis. The main preventive measures include the following aspects:

　　1. The preventive measures for acute pancreatitis include eliminating causes and avoiding triggers, such as abstaining from alcohol, avoiding overeating, and treating hyperlipidemia. Eating in moderation. Caution in diet, avoiding overeating, is very important for the prevention of this disease. At the same time, elderly people should have light and simple diets, eat less spicy, fatty, and sweet foods, and avoid excessive alcohol to prevent heat accumulation in the gastrointestinal tract that may lead to the disease.

　　2. The active prevention and treatment of biliary tract diseases is an important measure to prevent chronic pancreatitis in the elderly. In addition, diseases related to the onset of this disease, such as hyperparathyroidism and hyperlipidemia, must also be actively prevented and treated. It is necessary to actively and thoroughly treat acute pancreatitis.

　　3. Abstain from excessive alcohol consumption and limit alcohol intake. Long-term excessive alcohol consumption can lead to chronic alcoholism, which is one of the important causes of chronic pancreatitis. Therefore, it is necessary to develop the good habit of not drinking excessively or only drinking a small amount of alcohol from a young age. If a person has chronic pancreatitis, they must completely abstain from alcohol to prevent the progression of the disease.

　　4. Keep a positive mood and be cheerful. It is advisable to avoid negative mental stimulation such as melancholy and anger, maintain a cheerful mood, and keep the Qi and blood circulation smooth, which can prevent this disease.

　　Patients with pancreatitis encephalopathy syndrome should have a low-fat diet, eat small and frequent meals. It is advisable to eat high-protein, nutritious, vitamin and mineral content, high-calorie and easy-to-digest foods, and avoid greasy and difficult-to-digest, fried, smoked, grilled, cold, stimulating, high-salt and high-fat foods.

　　The treatment of pancreatitis encephalopathy syndrome should be symptomatic, actively treat pancreatitis, prevent intracranial hypertension, as follows:

　　1. Fasting and nasogastric tube decompression Continuous gastrointestinal decompression to prevent vomiting and aspiration. Administration of full gastrointestinal motility drugs can alleviate bloating.

　　2. Fluid replacement and prevention of shock All patients should receive intravenous fluid, electrolytes, and calories to maintain circulatory stability and electrolyte balance. Prevent hypotension and improve microcirculation.

　　3. Antispasmodic analgesics For patients with clear diagnoses, analgesics can be administered early for对症 treatment. However, antispasmodic drugs should also be given. Morphine should be avoided to prevent spasm of the Oddi's sphincter.

　　4. Inhibition of pancreatic exocrine secretion and pancreatic enzyme gastric tube decompression, H2 receptor antagonists, anticholinergic drugs, somatostatin, etc., are generally used for patients with severe conditions. Trypsin inhibitors such as apoproteinase and gabexate have a certain inhibitory effect on trypsin.

　　5. Nutritional support Early fasting, mainly relying on total parenteral nutrition (TPN). After the symptoms of abdominal pain, tenderness, and intestinal obstruction are relieved, diet can be resumed. In addition to hyperlipidemia patients, fat emulsion can be used as a source of heat.

　　6. Early administration of antibiotics can prevent bacterial infections caused by bacterial translocation in severe pancreatitis with pancreatic or peripancreatic necrosis. Broad-spectrum antibiotics or selective intestinal administration of antibiotics can be used via intravenous route.