The risk factors for development of an acute biliary pancreatitis and its signs in obstruction of extrahepaic bilairy ducts

I N Mamontov,O M Reshetniak,E A Shakalova,K A Kramarenko,S G Belov,A P Zakharchuk,A Ya Bardiuk,T I Tamm,V V Nepomniashchyi

doi:10.26779/2522-1396.2019.10.03

I N Mamontov, O M Reshetniak + Show 7 more

Open Access

https://doi.org/10.26779/2522-1396.2019.10.03

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Abstract

Objective. A search for factors, promoting development of an acute biliary pancreatitis, and peculiarities of its signs in patients, suffering obstruction of extrahepatic biliary ducts. Materials and methods. Retrospective analysis of treatment in 283 patients, suffering obstruction of extrahepaic biliary ducts, was conducted, together with various indices analysis in patients, suffering an acute biliary pancreatitis and without acute biliary pancreatitis. Results. An acute biliary pancreatitis was diagnosed in 30 (10.6%) patients. Trustworthy differences (p < 0.05) were revealed, concerning pronounced pain syndrome, hyperthermia, leukocytosis, young neutrophils, general bilirubin, amylase in the blood, the gallbladder volume, choledocholithiasis, the fixed calculus and stenosis of duodenal papilla magna, cholangitis. Big calculi of hepaticocholedochus did not associated with development of an acute biliary pancreatitis, and a sludge in common biliary duct and stenosis of duodenal papilla magna were characteristic for an acute biliary pancreatitis (p < 0.001). Conclusion. Sludge of common biliary duct, stenosis and fixed calculus of duodenal papilla magna, bilirubinemia 70 mcmol/l and higher constitute the risk factors for development of an acute biliary pancreatitis, and the pronounced abdominal pain syndrome, hyperthermia, hyperamylasemia, leucocytosis, increase of the young neutrophils content up to 7% and higher, the volume of a gallbladder 50 cm3 and more - served as the signs of an acute biliary pancreatitis in obstruction of extrahepatic biliary ducts. In obstruction of extrahepatic biliary ducts with an acute biliary pancreatitis, comparing with obstruction of extrahepatic biliary ducts without an acute biliary pancreatitis, cholangitis is revealed trustworthily: 16.7 and 5.1% accordingly (p < 0.05).

Highlights

The risk factors for development of an acute biliary pancreatitis and its signs in obstruction of extrahepaic bilairy ducts
Big calculi of hepaticocholedochus did not associated with development of an acute biliary pancreatitis, and a sludge in common biliary duct and stenosis of duodenal papilla magna were characteristic for an acute biliary pancreatitis (p < 0.001)
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Summary

Kharkov Medical Academy of Postgraduate Education

Способствующих развитию острого билиарного панкреатита, и особенностей его проявления у больных с обструкцией внепеченочных желчных путей. Изучали различные показатели у больных с острым билиарным панкреатитом и без острого билиарного панкреатита. Факторами риска развития острого билиарного панкреатита являются сладж общего желчного протока, стеноз и фиксированный камень большого сосочка двенадцатиперстной кишки, билирубинемия 70 мкмоль/л и выше, а признаками острого билиарного панкреатита при обструкции внепеченочных желчных путей – выраженный абдоминальный болевой синдром, гипертермия, гиперамилаземия, лейкоцитоз, увеличение содержания палочкоядерных нейтрофилов до 7% и выше, объем желчного пузыря 50 см и более. При обструкции внепеченочных желчных путей с острым билиарным панкреатитом в сравнении с обструкцией внепеченочных желчных путей без острого билиарного панкреатита достоверно чаще наблюдается холангит: 16,7 и 5,1% соответственно (p < 0,05).

Objective

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Findings

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