Dishomeostatic phenomena in acute pancreatitis of variable severity

   Acute pancreatitis remains one of the most dangerous pathologies in the structure of emergency abdominal surgery. This is due to many reasons, including an increase in the frequency of destructive forms of the disease, high mortality, and frequent unfavorable outcomes.

   The aim of this study was to investigate a number of leading components of homeostasis in patients with acute pancreatitis of varying severity.

   A retrospective study was conducted on 50 patients with acute pancreatitis of diff erent severity levels who were hospitalized at the Republican Clinical Hospital named after S.V. Katkovа (Saransk, Russia). The patients were divided into groups: the fi rst group (control, n = 30) consisted of patients with mild acute pancreatitis, and the second group (main, n = 20) consisted of patients with severe acute pancreatitis. The study evaluated the endogenous intoxication syndrome, the activity of lipid peroxidation and phospholipase systems, microcirculation status, liver function, and the activity of the coagulation-lytic blood system. The results showed that in the early stages of acute pancreatitis, several pathological processes were observed: the development of endotoxemia syndrome, activation of lipid peroxidation and phospholipase systems, microcirculation disorders, changes in the coagulation and fibrinolytic links of the hemostasis system, and liver function suppression. The severity of these disorders was associated with the severity of the pathology. In cases of mild severity, the changes in the parameters studied were reversible, while in severe cases they were stable and often
irreversible.

   The presence of toxemia, oxidative stress, dysmicrocirculation, and hemostatic disorders should be considered as risk factors for disease progression and complications.

1. Akhmedov V.A., Gaus O.V. Infl ammatory diseases of the pancreas: what new do we know about the mechanisms of their development in the 21^st century? Terapevticheskii arkhiv. 2021;93 (1):66–70. (In Russian)

2. Styazhkina S.N., Akhmadeeva A.R., Okorokova T.O., Khaidarova N.H. Problem of acute destructive pancreatitis in emergency surgery (literature review) Modern Science. 2020;12(2):257–261. (In Russian)

3. Rim D., Kaye A., Choi C., Ahlawat S. Inpatient outcomes of acute pancreatitis among patients with systemic lupus erythematosus: a nationwide analysis. Cureus. 2021;13(7).E16349. DOI: 10.7759/cureus.16349. PMID: 34306896; PMCID: PMC8279928

4. Kiselev V.V., Zhigalova M.S., Klychnikova E.V. Interaction between systemic infl ammatory reaction and disorders in the hemostasis system in patients with acute severe pancreatitis. Hospital medicine: science and practice. 2021;4(1):10–16. (In Russian)

5. Portelli M., Jones C.D. Severe acute pancreatitis: pathogenesis, diagnosis and surgical management. Hepatobiliary Pancreat. Dis. Int. 2017;16(2):155–159. DOI: 10.1016/s1499-3872(16)60163-7. PMID: 28381378

6. Adilov M.M., Zdzitovetsky D.E., Borisov R.N. Modern aspects of surgical treatment of pancreonecrosis. Modern problems of science and education. 2021;2:184. (In Russian)

7. Majidi S., Golembioski A., Wilson S.L., Thompson E.C. Acute pancreatitis: etiology, pathology, diagnosis, and treatment. South Med. J. 2017;110(11):727–732. DOI: 10.14423/SMJ.0000000000000727. PMID: 29100225

8. Vakhitova A.I., Anisimova Yu.O., Styazhkina S.N. Modern aspects of the etiology and classifi cation of acute pancreatitis Modern Science. 2021;5 (2):30–31. (In Russian)

9. James T.W., Crockett S.D. Management of acute pancreatitis in the first 72 hours. Curr. Opin. Gastroenterol. 2018;34(5):330–335. DOI: 10.1097/MOG.0000000000000456. PMID: 29957661; PMCID: PMC6245573.

10. Vlasov A.P., Vlasova T.I., Muratova T.A., Al-Kubaisi Sh.S., Bolotsky V.A. Systemic markers of acute pancreatitis severity in the aseptic phase. News of higher educational institutions. Volga region. Medical sciences. 2017;1:5–17. (In Russian)

11. Fonseca Sepúlveda E.V., Guerrero-Lozano R. Acute pancreatitis and recurrent acute pancreatitis: an exploration of clinical and etiologic factors and outcomes. J. Pediatr. (Rio J.). 2019;95(6):713–719. DOI: 10.1016/j.jped.2018.06.011. PMID: 30075118.

12. Simonov S.N., Shuvalova Y.O., Baranov A.V., Simonova D.L. Modern methodological approaches to the organization of the therapeutic and diagnostic process in acute pancreatitis (scientifi c review) . Medicine and physical culture: science and practice. 2021;3 (2;10):31–46. (In Russian)

13. Janisch N.H., Gardner T.B. Advances in management of acute pancreatitis. Gastroenterol. Clin. North. Am. 2016;45(1):1–8. DOI: 10.1016/j.gtc.2015.10.004. PMID: 26895677

14. Vlasov A.P., Trofi mov V.A., Al-Kubaysi Sh.S., Anaskin S.G., Malakhova O.S., Morozova M.M., Muratova T.A., Vasiliev V.V., Vlasova T.I., Kuzmin A.N. Factors of progression acute pancreatitis. Modern problems of science and education. 2018;5. (In Russian) URL: http://www.science-education.ru/ru/article/view?id=28045

15. Ismail O.Z., Bhayana V. Lipase or amylase for the diagnosis of acute pancreatitis? Clin. Biochem. 2017;50(18):1275–1280. DOI: 10.1016/j.clinbiochem.2017.07.003. PMID: 28720341.

16. Martusevich A.K., Karuzin K.A. Oxidative stress and its role in the formation of dysadaptation and pathology. Bioradicals and antioxidants. 2015;2 (2):5–18. (In Russian)

17. Timann K., Schnekenburger Yu., Shik V., Demus W., Muller-Verdan W., Atyakshin D.A., Becker V., Samoilova V.E., Bukhvalov I.B. Oxidative stress and NO generation in cerulein-induced acute pancreatitis in rats. Journal of Anatomy and Histopathology. 2019;8(1):68–76. DOI: 10.18499/2225-7357-2019-8-1-68-76.

18. Revishvili A.S., Fedorov A.V., Sazhin V.P., Tin V.E. State of emergency surgical care. Russian Federation Pirogov Russian Journal of Surgery. 2019;3:88–97. (In Russian)

19. Lancaster A., Zwijacz M. Acute Pancreatitis and Fluid-Filled Collections: Etiology and Endoscopic Management. Gastroenterol. Nurs. 2019;42(5):417–419. DOI: 10.1097/SGA.0000000000000396. PMID: 31574068

20. Guda N.M., Trikudanathan G., Freeman M.L. Idiopathic recurrent acute pancreatitis. Lancet. Gastroenterol. Hepatol. 2018;3(10):720–728. DOI: 10.1016/S2468-1253(18)30211-5. PMID: 30215363

21. DiMaio C.J. Management of complications of acute pancreatitis. Curr. Opin. Gastroenterol. 2018;34(5):336–342. DOI: 10.1097/MOG.0000000000000462. PMID: 29901514.