Treatment and prevention of hepatic failure in acute biliary pancreatitis in patients with diabetes mellitus

S.I. Savoliuk, Ya.V. Tomashevsky, T.O. Melnik

Abstract


Background. The purpose of the study was to evaluate the effectiveness of traditional and optimized programs for integrated treatment and prevention of clinical and laboratory manifestations of hepatic dysfunction in acute biliary pancreatitis in patients with diabetes mellitus by observing the dynamics of markers of cytopathic hypoxia, erythron system and iron metabolism. Materials and methods. The work is based on the analysis of the results of the comprehensive treatment of 122 patients with acute biliary pancreatitis against the background of diabetes mellitus. Laboratory analysis was performed to monitor markers of cytopathic hypoxia, erythron system and iron metabolism depending on the morphological form of acute pancreatitis and the effectiveness of optimized and traditional treatment. Results. The interstitial form of acute biliary pancreatitis in diabetes mellitus is characterized by significant changes in the dynamics of carbonyl groups, the content of arginine and adenosine deamination on the background of physiological fluctuations of the remaining markers of cytopathic hypoxia, and the signs of a distinct functional iron deficiency state in the form of microcytosis and hypochromia were detected. The emergence of pancreatic parenchyma necrosis of different planes, depending on the morphological form of acute biliary pancreatitis, is accompanied by reliable evidence of an absolute iron deficiency state of varying intensity and negative dynamics of indicators of endothelial dysfunction with a separate form. In patients with widespread necrotizing acute biliary pancreatitis, the pathological changes in the systemic metabolism are associated with the catabolism of purine nucleotides — the growth of xanthine and hypoxanthine levels. The stage of decompensation of systemic disorders of homeostasis is observed in patients with subtotal-total forms, when additional increase in the concentrations of enzymes responsible for utilization of the products of purine nucleotide catabolism (xanthine oxidase, xanthine dehydrogenase) capable of producing reactive oxygen species, stimulating oxidative stress. Conclusions. The course of acute biliary pancreatitis in patients with diabetes mellitus is accompanied by regular changes in the markers of the syndrome of cytopathic hypoxia, the erythron system and iron metabolism, the severity of these disorders has a direct correlation with the area of morphological changes in the pancreas and the dynamics of markers of liver failure. Using the methods of protocol therapy, you can not carry out preventive correction of existing metabolic disorders that requires the inclusion into the standard conservative treatment for edema form of acute biliary pancreatitis of systemic multifunctional metabolic corrector (Berlithion®) for systemic preventive correction of homeostasis and mechanisms of escalation of hepatic insufficiency manifestations, which, in the presence of necrotic forms, requires additional application of low molecular weight heparins (Zibor®) for the restoration of hemorheological and hemocoalogulative disorders on the systemic and intraorganic levels.


Keywords


acute biliary pancreatitis; diabetes mellitus; cytopathic hypoxia; erythron system; iron metabolism; hepatic failure; treatment; prevention; metabolic correction

References


Boiko VV, LykhmanVN, Merkulova EV, et al. Repeated operative interventions at open and closed tactics of treatment of destructive pancreatitis. Harkivs'ka hirurgichna shkola. 2017;2(83):62-65. (in Russian).

Zaporozhchenko BS, Borodaev IE, Kachanov VN, et al. A certain technical approaches to the surgical treatment of acute severe pancreatitis. Visnyk Vinnyc'kogo nacional'nogo medychnogo universytetu. 2016;20(1):202-206. (in Russian).

Dronov OI, Koval's'ka IO, Gorlach AI, Zadorozhnja KO. Modern surgical approaches in treatment of acute pancreatitis. Klinichna hirurgija. 2016;10(892):27-30 (in Ukrainian).

Kryvoruchko IA, Antonova MS. Prognostication of probability of lethal result and origin of postoperative complications at surgical treatment of patients with abdominal sepsis. Galyc'kyj likars'kyj visnyk. 2016;23(3):36-38. (in Ukrainian).

Mishalov VG, Markulan LYu, Matveev RM. Outcomes for acute necrotizing pancreatitis treatment in the early phase with standard membrane plasmapheresis. Hirurgija Ukrai'ny 2015;4:33-38. (in Ukrainian).

Tamm TI, Datzenko BM, Zakharchuk AP, et al. Special features of clinics, diagnostics and treatment of acute cholecystitis in patients with diabetes mellitus. Visnyk Vinnyc'kogo nacional'nogo medychnogo universytetu. 2017;21(1):46-48. (in Ukrainian).

Khomiak IV, Rotar OV, Petrovsky GG, Rotar VI, Hrushko OI. Endotoxin aggression in intestinal failure syndrome in patients with acute necrotizing pancreatitis. Hirurgija Ukrai'ny. 2016;2:51-55. (in Ukrainian).




DOI: https://doi.org/10.22141/2224-0721.13.7.2017.115746

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