Cord-like thrombophlebitis. Acute and Chronic Pancreatitis What Symptoms Include

1. The presence of an ulcer history

2. "Stabbing pains"

Stages of perforated ulcer:

1 tbsp. shock (6 hours) characterized by a sharp pain in the epigastric region, which arose suddenly as a "blow with a dagger".

At the onset of the disease, vomiting is possible.

The patient is motionless, takes a forced position, pulls his legs to the stomach, leans forward (embryonic posture)

Holds his stomach with his hands

The expression on the face is suffering. Facial features are pointed

Pallor of the skin

Bradycardia alternating with tachycardia

BP lowered to collapse (shock)

Tongue dry

board-shaped abdomen (pronounced muscle tension of the anterior abdominal wall)

diffuse soreness on palpation of the abdomen

dullness in the sloping places of the abdomen

sharp pain in the abdomen when coughing

positive symptoms of peritoneal irritation:

Symptom Shchetkin - Blumberg - after pressing on the abdominal wall, the fingers are abruptly torn off the anterior abdominal wall, while the pain is stronger than with pressure.

The symptom of Voskresensky - when quickly holding the palm over the stretched shirt from the right costal edge down, the patient experiences abdominal pain.

Razdolsky's symptom is pain during percussion on the anterior abdominal wall.

Sitkovsky's symptom is an increase in abdominal pain in the position on the left side.

With rectal examination, pain is noted when pressing on the anterior wall of the rectum.

Leukocytosis in the shock stage is not pronounced.

Plain roentgenogram br. cavities - free gas in the abdominal cavity under the diaphragm.

2 tbsp. - imaginary well-being (6-12 hours) characterized by a decrease in pain and tension of the abdominal muscles, an improvement in the patient's well-being.

tachycardia,

temperature increase,

dry tongue

increasing bloating

possible gas and stool retention due to intestinal paresis,

percussion can determine the presence of gas in the upper sections

dullness in the sloping places of the abdomen,

intestinal motility is sluggish.

muscle tension,

disappearance of hepatic dullness

symptom of Shchetkin-Blumberg and Voskresensky, Razdolsky, Obraztsov positive

Leukocytosis is progressively increasing.

3 tbsp. - peritonitis- develops in 10-12 and corresponds to a pronounced clinical picture of diffuse peritonitis.

Atypical forms of gastric ulcer perforation:

1. Perforation between the omentum leaves - peritoneal symptoms are poorly expressed, the disease develops slowly, with the formation of an infiltrate, then an abscess, followed by a breakthrough into the abdominal cavity.

2. Perforation of an ulcer of the posterior wall of the stomach or intestines into the retroperitoneal tissue - epigastric pain radiating to the back, swelling and crepitus are determined in the lumbar region (air from the hollow organ into the retroperitoneal tissue

Urgent care :

1. Lay down the patient, allow the patient to take a comfortable position for him. The preferred position is on the left side.

3. Coldness on the stomach

4. Install a nasogastric tube for the outflow of gastric contents.

5. In case of hypotension, infusion therapy - sodium chloride solution 0.9% - 400.0 i / v.

6. Urgent hospitalization on a stretcher in a surgical hospital.

Acute pancreatitis is an acute aseptic inflammation of the pancreas of the demarcation type, which is based on necrobiosis of pancreatocytes and enzymatic autoaggression, followed by necrosis and degeneration of the gland and the addition of a secondary purulent infection.

Etiology and pathogenesis of acute pancreatitis

Acute pancreatitis is a polyetiological disease. The predisposing factors primarily include the features of the anatomical structure of the pancreas and a close relationship with biliary excretory system... Anomalies of development, narrowing of the ductal system of the gland, violation of innervation, compression by neighboring organs are also important. An important role is played by systematic overeating, the abuse of abundant, especially fatty, meat and spicy foods in combination with the intake of alcoholic beverages. The effect of alcohol on the pancreas is complex and consists of several components: increased pancreatic secretion, impaired patency of the pancreatic duct due to edema of the mucous membrane of the duodenum and large duodenal nipple, which leads to an increase in pressure in the pancreatic ducts. The most common cause of acute pancreatitis is cholelithiasis... The presence of calculi in the bile ducts or gallbladder is detected in 41-80% of patients with pancreatitis.

The explanation for this was given back in 1901 by Opie. The theory of the "common channel" developed by him explains the development of pancreatitis in cholelithiasis by the possibility of throwing bile into the pancreatic ducts in the presence of calculi in the ampulla common to the pancreatic duct and common bile duct.

Currently, most scientists adhere to the enzymatic theory of the pathogenesis of acute pancreatitis.

Acute pancreatitis is characterized by the phase development of a local pathological process. With progressive forms of pancreatitis, the initial phase of serous and then hemorrhagic edema is replaced by a phase of parenchymal and fatty necrosis, after which the phase of melting and sequestration of dead areas of the pancreas and retroperitoneal tissue begins. Thus, these three phases create three periods of the development of the disease.

Classification of acute pancreatitis

Forms of acute pancreatitis: I. Edematous (interstitial) pancreatitis.

II. Pancreatic necrosis is sterile

    by the nature of the necrotic lesion: fatty, hemorrhagic, mixed;

    by the prevalence of the lesion: small-focal, large-focal, subtotal;

    by localization: capitate, caudal, with damage to all parts of the pancreas.

III. Infected pancreatic necrosis. Complications of acute pancreatitis: 1. Parapancreatic infiltration. 2. Pancreatic abscess. 3. Peritonitis: enzymatic (abacterial), bacterial. 4. Septic phlegmon of retroperitoneal tissue: parapancreatic, paracolic, pelvic. 5. Arosive bleeding. 6. Obstructive jaundice... 7. Pseudocyst: sterile, infected. 8. Internal and external digestive fistulas.

Stages of development of destructive pancreatitis

1) Stage of hemodynamic disturbances and pancreatogenic shock- begins with the onset of the disease and lasts 3-5 days; at this time, the symptoms of enzymatic toxemia, excessive formation and accumulation of biologically active substances in the blood (various kinds of kinins, decay products of protein bodies) in the gland itself and the surrounding cellular space prevail; 2) Stage of functional insufficiency of internal organs when it is during this period of the clinical course of pancreatic necrosis that the local signs of the disease are most pronounced, although the symptoms of multiple organ failure predominate, which mainly depends on the area of ​​the lesion of the pancreas (starts from the third day); 3) Stage of local complications- parapancreatic infiltrate, "immature" pseudocyst of the pancreas, abscess or phlegmon of the gland or retroperitoneal tissue, subphrenic abscess or widespread purulent peritonitis.

Phases of the course of acute destructive pancreatitis

Acute destructive pancreatitis has a phase course, and each phase corresponds to a certain clinical form. Phase I - enzymatic, the first five days of the disease, during this period there is the formation of pancreatic necrosis of various lengths, the development of endotoxicosis (the average duration of hyperenzymemia is 5 days), and in some patients there is multiple organ failure and endotoxin shock. The maximum term for the formation of pancreatic necrosis is three days, after this period it does not progress further. However, in severe pancreatitis, the period of formation of pancreatic necrosis is much shorter (24-36 hours). It is advisable to distinguish two clinical forms: severe and mild acute pancreatitis.

    Heavy acute pancreatitis. The frequency of occurrence is 5%, the mortality rate is 50-60%. The morphological substrate of severe acute pancreatitis is widespread pancreatonecrosis (macrofocal and total-subtotal), which corresponds to severe endotoxicosis.

    Not heavy acute pancreatitis. The incidence rate is 95%, the mortality rate is 2-3%. Pancreatic necrosis in this form of acute pancreatitis either does not form (edema of the pancreas), or is limited and does not spread widely (focal pancreatic necrosis - up to 1.0 cm). Mild acute pancreatitis is accompanied by endotoxicosis, the severity of which does not reach a severe degree.

Phase II - reactive(2nd week of the disease), characterized by the body's reaction to the formed foci of necrosis (both in the pancreas and in the parapancreatic tissue). The clinical form of this phase is peripancreatic infiltration. Phase III - melting and sequestration(starts from the 3rd week of the disease, can last for several months). Sequesters in the pancreas and in the retroperitoneal tissue begin to form from the 14th day from the onset of the disease. There are two possible options for the course of this phase:

    aseptic melting and sequestration- sterile pancreatic necrosis; characterized by the formation of postnecrotic cysts and fistulas;

    septic melting and sequestration- infected pancreatic necrosis and necrosis of parapancreatic tissue with further development of purulent complications. The clinical form of this phase of the disease is purulent-necrotizing parapancreatitis and its own complications (purulent-necrotic leaks, abscesses of the retroperitoneal space and abdominal cavity, purulent omentobursitis, purulent peritonitis, arrosive and gastrointestinal bleeding, digestive fistulas, sepsis, etc.) ...

Cord-like thrombophlebitis is a rare venous pathology, it was first diagnosed in 1939. The disease is characterized by inflammation of the veins of the sternum and abdominal cavity, manifested by symptoms characteristic of other types of phlebitis. What are the indirect causes of the development of pathology and the main symptoms? Diagnostic and treatment methods? What complications arise and what is the prognosis for recovery.

What is Mondor disease

What is cord thrombophlebitis? This is a localized pathology of the veins of the anterior and lateral surfaces of the abdominal wall and chest, refers to vasculitis.

Expressed in the form of thrombosis with inflammation of the wall of the lateral or superficial vein of the chest. This disease occurs mainly in women.

During the development of pathology in the axillary region, a seal forms on the anterior chest wall. Its length varies from 3 to 30 cm. The seal is spliced ​​and moves with the skin.

Many doctors attribute this disease to damage to the venous vessels of the forearm, shoulder, armpit, penis and testicles.

The problem occurs in people aged 25–40 years, less often after 60 years.

The mechanism of development of the disease

Phlebitis of Mondor does not particularly affect the general well-being of a person. Signs of intoxication and inflammation are weak or absent.

The primary form of the disease has an unexplained genesis, and malfunctions of the immune system can provoke its development. Secondary - occurs against the background of other pathological processes in the body.

Symptoms of cord thrombophlebitis:

  • in the area of ​​the mammary glands, armpits, a solid, elongated vertical thickening with a length of 3–30 cm is formed, which moves with the skin; palpation of the formation causes a pronounced pain syndrome;
  • pain can radiate to the armpits, epigastrium, increases with inhalation, raising the arms;
  • worried about a constant burning sensation in the affected area;
  • the inflamed area swells, turns red;
  • age spots appear, rosacea around the affected area, symmetrical rash;
  • rarely, the body temperature rises to subfebrile levels, while weakness, drowsiness, headaches are observed;
  • axillary lymph nodes become inflamed;
  • as the disease progresses, the pathological process covers nearby tissues, and ray-shaped wrinkles form on the skin along the veins.

Filamentous thrombophlebitis is diagnosed more often in women than in men.

The disease develops after difficult childbirth, prolonged lactation, with chronic mastitis, constant wearing of narrow bras.

Causes

The reasons for the development of thrombophlebitis of the veins of the peritoneum and thoracic region are poorly understood.

Pathology can occur as a complication of respiratory infections, furunculosis, allergies. After surgery and chest trauma, in the presence of malignant neoplasms.

Causes contributing to the development of the disease:

  • removal of the appendix;
  • hydradenitis;
  • infectious processes in the sebaceous glands;
  • sharp or constant tension of the hands when working.

In women with Mondor syndrome, pathological processes occur on the one hand. In men, the disease is bilateral.

Risks of Mondor Syndrome

Complications with cord thrombophlebitis are rare. More often in people of advanced age, with advanced forms of pathology, the presence of chronic diseases.

The most dangerous consequence of phlebitis is pulmonary embolism. The disease develops suddenly and is often fatal.

Diagnostics

It is possible to determine the filamentous phlebitis already during the initial examination, palpation of the veins in the affected area.

To confirm the diagnosis, to determine the severity of the pathological process, the doctor prescribes additional tests.

Methods for diagnosing cord-like thrombophlebitis:

  • clinical blood test - there is eosinophilia, monocytosis, leukocytosis;
  • general urine analysis;
  • blood chemistry;
  • coagulogram;
  • ultrasound angioscanning - determine the degree of thickening of the venous walls, the presence of blood clots, reveal problems with blood flow in the affected vein;
  • chest x-ray;
  • phlebography - x-ray examination of veins using a contrast agent;
  • test for tumor markers - pathology often occurs in cancer.

Based on the results of the examination, the doctor selects drugs for home treatment, or writes out a referral to the hospital.

Which doctor should be consulted

If signs of cord thrombophlebitis appear, you should visit your local therapist.

After examination and initial diagnosis, the doctor will write out a referral to Sometimes an oncologist's consultation is required.

Treatment of phlebitis of Mondor

When diagnosing Mondor's syndrome, symptomatic drug therapy, physiotherapy, and diet are prescribed.

Treatment of cord thrombophlebitis includes taking the following medications:

  • non-steroidal anti-inflammatory drugs - Dikloberl, Ortofen, Butadion;
  • antiplatelet agents - Aspirin, eliminate increased blood viscosity;
  • vasotonics - Eskuzan, Anavenol;
  • polyenzyme preparations - Wobenzym;
  • antibiotics of the penicillin group - rarely prescribed, when nearby tissues are involved in the inflammatory process;
  • heparin ointment to strengthen the venous walls, reduce the risk of blood clots;
  • Vishnevsky ointment - eliminates inflammatory processes;
  • with severe pain syndrome, novocaine blockade is prescribed;
  • physiotherapy - electrophoresis with drugs, UHF, mud therapy, hydrotherapy, hirudotherapy, acupuncture, magnetotherapy;
  • if frequent relapses are observed, excision of the affected vein is performed.

From folk methods, sea buckthorn oil helps well - the product has an antiseptic and anti-inflammatory effect.

Soak sterile gauze with an oil solution, apply a compress overnight, fix with a woolen scarf.

The duration of treatment is 30-40 days.

With phlebitis, the basis of the diet is vegetables, fruits, herbs, dairy products, fish and seafood.

It is forbidden to eat fast carbohydrates, fatty, fried, smoked foods. All meals should be steamed, stewed, boiled or baked.

Reduce the amount of salt. Drink at least 2 liters of clean water per day without gas.

Forecasts

Cord-like phlebitis often proceeds without pronounced symptoms, there are often cases of self-healing, so the prognosis for full recovery is favorable.

In the presence of impaired renal function, diseases of the central nervous system, organs of the digestive system, in patients over 50 years of age, the pathology proceeds in a more severe form. Constant dispensary supervision is required.

Painful sensations and increased sensitivity of the skin disappears within 7 days. The burning sensation is disturbing for 3-4 weeks. Consolidation and pigmentation remain for several months.

Mondor's syndrome is a rare and harmless venous pathology, the inflammatory process is localized in the chest and abdominal regions.

The disease responds well to treatment, relapses and complications are rare, with proper therapy, you can get rid of the disease in 1-2 months.

Useful video: Mondor's disease or cord thrombophlebitis

K85.0 Acute pancreatitis

Interstitial-edematous form, destructive form (pancreatic necrosis).

Anamnesis

Alcohol abuse, history of cholelithiasis. Eating fatty, fried, spicy foods (fatty meat, pickles, confectionery, etc.).

Stenosis of the Wirsung duct or large duodenal nipple, pancreatic cysts, tumors of the gland itself or other organs that compress the Wirsung duct or grow into it. Blunt trauma to the abdomen. Viral infection (epidparotitis, adenovirus, Coxsackie virus), mycoplasmosis. Taking drugs for hemoblastosis - HCC and L-asparaginase.

Clinical picture

Pancreatic colic ... Sudden severe constant pain in the upper abdomen, radiating to the back, right and left scapula, hypochondrium, behind the sternum (girdle pain). Loss of consciousness from severe pain is possible. The pain almost does not increase with coughing and deep inhalation (unlike cholecystitis and appendicitis). Postprandial (after eating) increased pain. Nausea, frequent vomiting, which does not bring relief, on the contrary - intensifying pain.

Lateral position with bent legs. Suffering facial expression. Possible excitement, a change in the psyche.

Symptoms of acute pancreatitis:

Pain on palpation in the projection of the pancreas, at a point Desjardins, in the zone Shoffara(to the right of the midline), at the point Gubergritsa, in the zone Gubergrits-Skulsky(to the left of the midline of the abdomen).

Pallor, marbling of the skin, acrocyanosis. Obstructive jaundice (swelling of the head of the gland, causing compression of the bile duct; choledocholithiasis, provoking the onset of pancreatitis).

S. Curte - local swelling along the transverse colon and resistance of the muscles of the abdominal wall in the form of a belt.

S. Mayo —Robson- pain on palpation in the left costal-vertebral angle.

Resurrection symptom - absence of pulsation of the abdominal aorta.
Pain at the point Mayo-Robson(on the border of the outer and middle third of the line connecting the navel with the middle of the left costal arch.

S. Shchetkina —Blumberg- with the development of peritonitis.

Gray-Turner symptoms - ecchymosis on the lateral surface of the abdomen on the left;
Galstedt - cyanosis of the skin of the abdomen; Mondora- purple spots on the face and trunk, cyanosis of the face, combined with abdominal pain and signs of irritation of the peritoneum. The Triad of Mondor: pain, vomiting, bloating

The temperature in the edematous form is normal. May be subfebrile.

Complications of acute pancreatitis

1. Parapancreatic infiltration. 2. Parapancreatic abscess. 3. Peritonitis: enzymatic (abacterial), bacterial. 4. Septic phlegmon of retroperitoneal tissue (parapancreatic, paracolytic, pelvic).

5. Arrosive bleeding. 6. Obstructive jaundice. 7. Pseudocyst: sterile; infected. 8. Internal and external digestive fistulas.

HELP:

ECG (ECP). Cold on the stomach (cryopackages)

Atropine sulfate 0.1% -1 ml s / c

Drotaverinum 40 mg i / m

Oxygen inhalation (with ODN)

With repeated vomiting and / or intoxication:

Vein catheterization.

Metoclopramide 10 mg i.v.

Acesol, Chlosol 400 ml IV drip.

Polyionic solutions 500 ml intravenous drip.

Tactics

Hospitalization in a surgical hospital. Transport on a stretcher. In case of refusal of hospitalization - an asset at "03" after 2 hours, in case of repeated refusal - an asset in the OKMP.

K86.0 Chronic pancreatitis of alcoholic etiology
K86.1 Other chronic pancreatitis

Symptoms

The pain is sudden, acute, with a gradual increase, or constant dull, pressing, aggravated by eating.

Several of the most common types of pain syndrome:

1) in the left hypochondrium to the left of the navel, at the point Mayo-Robson- with damage to the tail of the pancreas (resembles renal colic);

2) in the epigastrium - with damage to the body (resembles a peptic ulcer);

3) to the right of the midline in the zone Shoffara, at the point Desjardins- if the pancreas head is damaged, it can occur with cholestasis (reminiscent of cholecystitis, gallstone disease);

4) with total defeat - pain of a diffuse nature in the form of a "belt" or "half-belt" in the upper abdomen without clear localization.

5) irradiation can be in the region of the heart, in the left scapula, in the left shoulder, simulating angina pectoris, sometimes irradiation in the left iliac region.

Pain occurs or intensifies 40-60 minutes after eating (especially profuse, spicy, fried, oily). The pain increases with supine position and decreases with sitting position with a slight forward bend.

Belching, heartburn, nausea are associated with dyskinesia of the descending duodenum, duodenostasis.

Positive phrenicus symptom, symptoms Grotte(hypotrophy of the subcutaneous fat layer to the left of the navel) and Kacha(pain on palpation in the projection of the transverse processes of the thoracic vertebrae on the right Th 9-11 and on the left Th 8-9). On the skin of the abdomen, chest, back, there may be point angiomas - small bright red spots of a rounded shape in the form of droplets 1 to 3 mm in size, which do not disappear when pressed (symptom Tuzhilin).

Dryness and peeling of the skin, glossitis, stomatitis are typical.

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