Upalne bolesti gušterače i kirurško liječenje

master's thesis

• Title (english): Inflammatory diseases of pancreas and surgical treatment
• Author: Marin Peričić
• Mentor: Žarko Rašić (mentor)
• Committee member: Marko Sever (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Žarko Rašić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Upalne bolesti gušterače su jako kompleksna medicinska stanja koja uzrokuju brojne funkcionalne probleme za pacijente. Pankreatitis ,neovisno akutni ili kronični tip, još uvijek ostaje nepredvidljiva i potencijalno fatalna bolest. Može varirati od blagog akutnog intersticijskog oblika pa sve do jakog nekrotizirajućeg oblika. Oba tipa mogu progredirati u kronični oblik pankreatitisa koji pacijenta veže za dugotrajnu terapiju. Pankreatitis je povezan s visokim morbiditetom i mortalitetom. U današnje doba incidencija je u porastu zbog povećanog izlaganja rizičnim čimbenicima kao što su alkohol i masna hrana, ali i ostali faktori. Glavni simptom je probadajuća bol u epigastriju koja se širi u leđa, ali i mučnina i povraćanje te ostali simptomi. Zlatni standard za dijagnostiku pankreatitisa je CT, ali dobar pokazatelj bolesti su drastično povećani enzimi u krvi poput amilaza i lipaza. Također, s trenutnim znanjem i razvojem znanosti, pristup pankreatitisu je drukčiji i zavisi o stupnju i težini bolesti te se s vremenom razvijaju nove tehnike koje u usporedbi s tadašnjim pokazuju bolje i zadovoljavajuće rezultate. Dok je potporna skrb
uglavnom korištena u liječenju blagog intersticijskog oblika pankreatitisa, kirurško liječenje je implementirano kako bi se spriječili teži oblici bolesti poput teškog nekrotizirajućeg pankreatitisa ili komplikacije istih koji su smrtonosni u čak 35% slučajeva. Većinom su kirurški zahvati na gušterači palijativni, a samo neki su kurativni uglavnom zbog opasnih komplikacija koji su destruktivni za gušteraču i okolno tkivo. U prvoj fazi pankreatitis može uzrokovati sindrom sustavnog upalnog odgovora (SIRS) koji može voditi do multiplog zatajenja organa (MOF) pa čak i smrti. Najčešći vitalni organi zahvaćeni komplikacijama pankreatitisa su srce, pluća i bubrezi. U drugoj fazi nekrotizirajući pankreatitis može biti inficiran bakterijama što može zahtijevati hitnu upotrebu antibiotika i kirurški debridman. Bolesnici s kroničnim pankreatitisom koji pate od komplikacija kao što su formiranje pseudociste, fistule ili pseudoaneurizme obližnje arterije uvelike imaju koristi od palijativnih kirurških zahvata koji smanjuju mogućnost progrediranja bolesti ,simptoma i povećavaju kvalitetu života. Moderne tehnike su sve više aktualnije kao što je step-up kirurški pristup koji započinje manje invazivnim endoskopskim zahvatom i završava većim kirurškim zahvatom. Napredak kirurških tehnika uvelike smanjuje smrtnost od ove bolesti i povećava kvalitetu života.

Abstract (english)

Inflammatory diseases of pancreas are very complex medical conditions that cause a lot of functional issues for patient. Pancreatitis, regardless acute or chronic still remains an unpredictable, potentially fatal disease. It may vary from mild acute interstitial pancreatitis to severe necrotizing pancreatitis. Both types may develop into chronic pancreatitis which can cause
long term problems and therapy. Pancreatitis is related to high morbidity and mortality rate. Nowadays, incidence of pancreatitis is rising due to increased risk factor exposure such as alcohol and fatty food. Main symptom is stabbing pain in epigastrium that radiates to the back, nausea, vomiting and others. Golden standard for diagnosis of pancreatitis is CT. High amylase and lipase level in blood are used as diagnostic tool. With current scientific knowledge and with new insights,
pancreatitis management approach is different and it depends on stage and severity of the disease. With time, new techniques are being developed which show much better results. While supportive care is mainly used for treatment of mild cases of acute interstitial pancreatitis, surgical treatment is usually implemented to minimize complications of severe necrotizing pancreatitis which are fatal in almost 35% of cases. Mostly, these surgical procedures are palliative and only some are curative because this disease has a lot of complications which are destructive to pancreas as well as to the other vital tissues. Pancreatitis in the first phase is associated with systemic inflammatory response syndrome (SIRS) which can lead to multi-organ failure (MOF) and death. Vital organs affected by complications of pancreatitis are usually heart, lungs and kidneys. In the second phase, necrotizing pancreatitis may be superinfected which may seek urgent use of antibiotics and surgical procedure like debridement. Individuals suffering from chronic pancreatitis and complications of acute pancreatitis such as pseudocyst, fistula and pseudoaneurysm formation may highly benefit from surgical treatment which improves quality of life (QOL), reduces symptoms and progression of the disease. Modern techniques are being implemented such as step-up approach which is combination of minimally invasive endoscopic technique followed by open
surgical procedure. All in all, recent advances in surgery greatly reduces mortality of this disease and improves quality of life (QOL).

• Keywords: pankreatitis; epigastrij; amilaza; lipaza; palijativni zahvat; SIRS; debridman; pseudocista; step-up pristup
• Keywords (english): pancreatitis; epigastrium; amylase; lipase; palliative procedure; SIRS; debridement; pseudocyst; step-up approach
• Language: croatian
• URN:NBN: urn:nbn:hr:105:696230
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-03-24 13:41:14