Acute pancreatitis in children – symptoms of the disease, prevention and treatment of Acute

To understand what it is – cardites, it is worth studying their types and forms. They are classified according to various criteria. First of all, rheumatic and non-rheumatic.

Rheumatic carditis develops against the background of a systemic autoimmune disease – rheumatism. At the same time, all the membranes of the heart are involved in the pathological process, the myocardium is first affected, as a result of which endocarditis, pericarditis can occur.

According to statistics, in 90-95% of adult patients (70-85% in children), even the first rheumatic attack affects the lining of the heart.

In 20-25% of cases, the disease leads to acquired heart disease. The majority – 59% of the number of patients – thanks to timely active treatment heals, there are no changes in the heart.

Non-rheumatic carditis is due to other reasons. Also quite common in medical practice. Adults (both age and gender do not matter) and children are prone to rheumatic carditis. In the latter, non-rheumatic carditis is more common than in the “adults” category.

According to experts, 0,5% of all hospitalized are children with non-rheumatic carditis. Autopsy of deceased minors shows 2,3–8% of carditis. The percentage can rise to 10-15 if a viral infection is confirmed.

Non-rheumatic carditis has the following ethology:

  • Viral It is caused by influenza, polio, rubella, chickenpox, adenoviruses; enteroviruses – herpes, Coxsackie, ECHO.
  • Bacterial Reason: typhoid fever or diphtheria.
  • Allergic Reason: medication, vaccine, serum.
  • Fungal. Reason: coccidiomycosis.
  • Parasitic. Reason: toxoplasmosis, histoplasmosis, schistosomiasis.
  • Unknown etymology.

Non-rheumatic inflammation of the membranes of the heart is also classified according to the periods of occurrence, the nature of the course, severity and outcome.

By the period of occurrence:

Congenital carditis is early or late, determined in newborns in the first days or months of life. Cause: intrauterine viral / bacterial infection transmitted by the mother during pregnancy.

Acquired carditis occurs in infants due to infection with a viral, bacterial infection or rheumatic fever.

By the duration of the course:

  • acute (the inflammatory process lasts less than three months)
  • subacute (inflammation lasts up to eighteen months)
  • chronic (the disease lasts more than a year and a half)

In 9 out of 10 cases of acute pericarditis, it is impossible to unambiguously indicate the cause of inflammation. At the same time, protracted forms of pericarditis are almost always a complication of another severe or sluggish chronic disease. In the absence of timely treatment, pericarditis quickly comes to the fore, since this disease is not only accompanied by acute pain, but is more dangerous than most conditions that can lead to inflammation of the pericardium.

Viral infectious diseases are the most commonly reported cause of most forms of pericarditis. In this case, violations in the work of the pericardium are associated exclusively with the weakening of the body under a viral infectious attack: the pathogen does not enter the internal organs of the chest cavity, so there is no need to talk about re-infection.

Also, the following infections can cause pericarditis:

  • Bacterial As in the case of a viral infectious disease, bacteria, as a rule, do not have time to get to the pericardium. Accordingly, pericarditis develops according to the standard forecast.
  • Fungus. The most “insidious” factor: patients live with fungal infections for years, but pericarditis will appear only in the late stages of infection, when the functioning of the internal organs will fail. Such pericarditis is more common in older people.
  • Protozoal. The rarest species: as a rule, a person can become infected from protozoa only when the immune system is weakened by other diseases. Pericarditis that develops as a result of a protozoal infectious disease occurs in no more than 1% of cases.

Infectious factors also include a chronic disease such as rheumatism. It affects the cardiovascular system and joints, as a result of which the body produces antibodies that attack its own tissues and cells. Diagnosis of pericarditis in this case is complicated by the primary symptoms of rheumatism, which hide the secondary causes of the general weakness of the patient. Also, mandatory tests for pericarditis are patients who have had tuberculosis.

With the infectious nature of pericarditis, the disease that provoked inflammation has priority. Identification of an infectious agent is the first step in developing a treatment program.

Heart disease affects not only the intensity of a heart beat, but also on adjacent tissues. Even with timely treatment, the membrane is at risk. The highest risk of subsequent development of pericarditis in these cases:

  • Myocardial infarction. The condition is characterized by an irrevocable failure of a certain area of ​​the heart due to lack of oxygen. The body cannot grow a new muscle section in the heart; coarse scar tissue builds up on the injured site. Pericarditis after myocardial infarction occurs due to the increased work of the layers of the pericardium, releasing more lubrication than necessary. Acute forms occur within 1-2 days; the development of other forms of pericarditis reaches up to 2 months.
  • Heart surgery (closed or open). Even minor heart surgery requires intervention in the pericardium with mechanical damage. During the healing process, malfunctions of the protective organ, plasma leakage or hardening of the protective membrane are possible.
  • Pericardial surgery.

The likelihood of pericarditis increases if the diaphragmatic nerves were affected during the operation. An incorrect reaction of mechanical nerves to the current situation leads to acute pain and a sharp increase in the volume of fluid accumulated in the pericardium.

The acute form of the disease is the most dangerous, since the spread of change is rapid. The disease is characterized by inflammation, accompanied by a quick overflow of the pericardium with fluid, or by the dehydration of the heart sac, leading to adhesion of the walls and the formation of bows.

If the development of inflammation in the pericardium requires more than one and a half to two weeks, it is defined as subacute pericarditis; while acute forms in the absence of timely treatment can also take on a subacute or even chronic nature. An infectious agent can cause the return of pericarditis in acute forms, but such variants of the disease are not considered chronic.

In acute pericarditis, the rhythm beat by the heart, as a rule, does not go astray, although there is a risk of cardiac tamponade when the membrane overflows with plasma or blood. Even the short-term course of the disease can provoke a severe inflammatory process in the epicardial myocardium.

In most cases, acute inflammation of the pericardium is accompanied by a bright pain syndrome in the first hours; soon the condition goes into a fever. The nature of the pain varies depending on the position of the body: if the patient is standing, the pain impulse is felt more strongly in the left shoulder; in a lying position, the pain is more strongly given to the left hand.

It is not recommended to lie down with acute pericarditis: this multiplies the pain syndrome. Pain impulses are provoked by the following actions:

  • swallowing food (water is swallowed almost painlessly);
  • coughing, especially frequent and dry;
  • deep breath (additional load on the heart).

By increasing the amount of plasma ultrafiltrate in the pericardium or overfilling the organ with blood, pressure on the heart increases many times. As a result of such loads, the heart temporarily loses the ability to even, frequent contractions. If critical values ​​are exceeded, cardiac tamponade occurs with a potential fatal outcome.

CauseSymptomsFeatures
Viral infectious diseaseSevere pain in the heart; weakness, increased fatigue.Short-term infectious pericarditis, in most cases not leading to complications and the formation of chronic pericarditis. The priority is the treatment of an infectious disease.
Myocardial infarction (after 1-2 days)Pain in the chest, shortness of breath, loss of consciousness.Symptoms overlap with symptoms of myocardial infarction; acute pericarditis often goes unnoticed, goes into the subacute stage.
TuberculosisInfectious infection. Asymptomatic during the first 1-3 days; fever, general weakness, rare and incomplete breathing are possible.Difficult to recognize due to lack of primary symptoms. Reduced resistance to infectious diseases and inflammation due to tuberculosis; increased risk of cardiac tamponade.
Idiopathic pericarditisPain, weakness, shortness of breath.Multiple relapses of pericardial inflammation are possible over several years.

Comprehensive diagnostics can distinguish the symptoms of acute pericarditis from signs of concomitant diseases and timely prescribe treatment.

The evidence of the patient, indicating the source and nature of the pain, as well as the results of the initial diagnosis – listening with a stethoscope, are considered to be a suspicion of a diagnosis of acute pericarditis. The tool is located on the chest, in the region of the heart. The presence of the disease is evidenced by the sounds:

  • crunch and crackle;
  • light creaking;
  • rhythmic rustling.

Sounds resembling friction of sheets of paper or dry foliage are the first signs of disturbances in the heart membrane. They can be heard only if pericarditis causes uncharacteristic friction in the pericardium. This symptom allows you to determine inflammation both 1-2 hours after the development of the disease, and 5-7 days later: the noise remains intense at each stage of pericarditis.

To clarify the diagnosis, the following procedures are prescribed:

  • Electrocardiogram. Viewing the results of the ECG allows you to get an exhaustive idea of ​​the deviations in the rhythm with which the heart beats and the protective membrane surrounding the heart.
  • Chest x-ray. X-ray methods are used to determine the exact location and volume of effusion: the allocation of fluid from the pericardium, which may be accompanied by acute pericarditis.
  • Echocardiography. An alternative technique for obtaining a picture of the distribution of fluid in the pericardium. If the heart is injured, such changes will also be reflected in the results of the study. Diagnostics is carried out by ultrasonic waves.

Pericardial inflammation can be infectious and non-infectious (aseptic). The most common causes of pericarditis are rheumatism and tuberculosis. With rheumatism, pericarditis is usually accompanied by damage to other layers of the heart: endocardium and myocardium. Pericarditis of rheumatic and in most cases of tuberculous etiology is a manifestation of an infectious-allergic process. Sometimes tuberculous lesion of the pericardium occurs when the infection migrates through the lymphatic ducts from the foci in the lungs and lymph nodes.

The risk of developing pericarditis increases in the following conditions:

  • infections – viral (influenza, measles) and bacterial (tuberculosis, scarlet fever, tonsillitis), sepsis, fungal or parasitic lesions. Sometimes the inflammatory process goes from organs adjacent to the heart to the pericardium with pneumonia, pleurisy, endocarditis (lymphogenous or hematogenous)
  • allergic diseases (serum sickness, drug allergy)
  • systemic diseases of the connective tissue (systemic lupus erythematosus, rheumatism, rheumatoid arthritis, etc.)
  • heart disease (as a complication of myocardial infarction, endocarditis and myocarditis)
  • heart damage due to injuries (wound, strong blow to the heart), operations
  • malignancy
  • metabolic disorders (toxic effect on the pericardium with uremia, gout), radiation damage
  • pericardial malformations (cysts, diverticulums)
  • general edema and hemodynamic disturbances (lead to the accumulation of liquid contents in the pericardial space)
  • cholelithiasis. Between 10% and 30% of children with pancreatitis can suffer from gallstones. Treating this condition can help restore normal pancreatic function;
  • polyorganic diseases. Twenty percent of cases of acute pancreatitis are caused by conditions that affect several organs or organ systems, such as sepsis, hemolytic-uremic syndrome, or systemic lupus erythematosus;
  • metabolic diseases. Metabolic disorders can cause 2 – 7% of cases of acute pancreatitis. This is a metabolic disorder in children with high levels of lipids or calcium in the blood:
  • infections. Acute pancreatitis is sometimes diagnosed when a child suffers from an infection. However, it is difficult to establish a direct relationship between these two conditions. Some of the infectious diseases that have been associated with pancreatitis include mumps, rubella, cytomegalovirus infection, human immunodeficiency virus, adenovirus, and Coxsackie virus group B;
  • anatomical anomalies. Disturbances in the structure of the pancreas or biliary tract can lead to pancreatitis;
  • pancreatitis can be triggered by medications. Medicines are believed to cause one quarter of cases of pancreatitis. It is not clear why some drugs can cause pancreatitis. One of the factors is that children treated with these drugs have additional disorders or conditions that predispose them to pancreatitis;
  • pancreatitis is sometimes caused by trauma. Pancreatic injury can trigger acute pancreatitis. Mechanical damage can occur in a car accident, during sports, in the fall, or due to mistreatment of children;
  • Pancreatitis is hereditary, which means that it was transmitted by one or both parents. This is due to cystic fibrosis, a genetic mutation that is found in the child, but not in the parents;
  • finally, there are a large number of cases of pancreatitis where the cause is unknown. This is called idiopathic pancreatitis.

Acute pancreatitis in children is an acute lesion of the pancreas of an inflammatory and destructive nature, which is associated with the activation of pancreatic enzymes inside the gland itself and enzymatic toxemia. In children, this form of pancreatitis is not as common as in adults. However, there are clinical cases around the world.

Types of acute pancreatitis:

The latter species is also known as pancreatic necrosis.

Among the most common causes of the disease in question are:

  • infections,
  • obstruction and increased pressure in the pancreatic ducts,
  • blunt pancreatic injury,
  • hypercalcemia
  • hepatobiliary pathology
  • drug and toxic lesions

Acute pancreatitis in children can be caused by infections such as viral hepatitis, mumps, Coxsackie B, enterovirus, herpes, chicken pox, pseudotuberculosis, influenza, salmonellosis, dysentery, sepsis, etc. A child may be bluntly injured as a result of a blow to the abdomen.

The increase in pressure and obstruction in the pancreatic ducts cause the following diseases:

  • choledocholithiasis
  • papillitis
  • duodenostasis with duodenopancreatic reflux
  • cyst or stricture of the common bile duct
  • opisthorchiasis
  • clogging of the duodenal nipple with roundworms
  • clonorchiasis
  • fascioliasis

As for hepatobiliary pathology, this includes chronic cholecystitis and gallstone disease. Hypercalcemia occurs as a result of hypervitaminosis D or hyperparathyroidism in a child. Toxic lesions are poisoning with lead, arsenic, mercury, phosphorus. A drug pancreatic lesions arise from taking drugs:

  • hypothiazide
  • azathioprine
  • metronidazole,
  • furosemide
  • sulfonamides,
  • tetracyclines
  • glucocorticoids in high doses

An additional factor affecting the manifestations of the disease is the consumption of fatty and / or fried foods in large quantities. About a quarter of children with acute pancreatitis fail to identify the cause of the onset of the disease.

Damage to pancreatic tissue leads to the development of an inflammatory process. Lysosomal enzymes are released that carry out the intrapancreatic activation of enzymes (trypsinogen) that damage the gland. The level of biologically active substances in the blood rises, which leads to general volemic and microcirculatory disorders, collapse is likely.

For children, in most cases, an interstitial form of acute pancreatitis is characteristic. The main symptom is abdominal pain with this characteristic:

  • felt in the epigastrium or navel
  • piercing, intense
  • accompanied by a feeling of heaviness, flatulence and belching
  • “Give” more often to the left hypochondrium, the left lumbar region

There may be such a symptom as vomiting, perhaps repeated. The temperature is normal or subfebrile. A doctor’s examination makes it possible to fix the following symptoms:

  • slight bloating
  • increase in pain after abdominal palpation
  • sometimes – muscle resistance in epigastrium
  • tachycardia, tendency to arterial hypotension
  • positive symptoms of Frenkel, Mayo-Robson, Bergman and Kalk
  • pallor or hyperemia of the face
  • persistent soreness with deep palpation in the Shoffar area

A laboratory blood test shows a small leukocytosis, neutrophilia, there may also be an increase in ALT, hypoglycemia. With interstitial pancreatitis, lipase, amylase and trypsin levels are moderately elevated, but only for a short time.

Destructive acute pancreatitis in children is much less common. The following symptoms are typical for him:

  • indomitable vomiting
  • very intense persistent persistent pain in the left side
  • possible fatty necrosis of subcutaneous fat on the abdomen, less often on the face and limbs
  • hemodynamic disorders: shock, collapse
  • ecchymoses, hemorrhagic rash, jaundice are probable
  • subfebrile or febrile body temperature
  • frequent weak pulse
  • arterial hypotension
  • tension and bloating
  • difficulty palpation due to tension of the anterior abdominal wall

A blood test shows severe neutrophilic leukocytosis, thrombocytopenia, ESR above normal. Pronounced and persistent hyperfermentemia is observed. Pancreatic necrosis can occur with complications: early and late. The early ones include liver failure, shock, DIC, renal failure, diabetes mellitus, and bleeding. The latter include abscesses and phlegmon of the pancreas, pseudocysts of the pancreas, peritonitis, fistulas.

In severe forms of acute pancreatitis, children can be fatal (death). It occurs as a result of bleeding, shock, purulent peritonitis.

Diagnose acute pancreatitis in children on the basis of history and symptoms. Take into account the increase in the level of pancreatic enzymes in the blood and urine: amylase, lipase and trypsin. As a diagnostic method, ultrasound and computed tomography are used. In acute pancreatitis, there is a diffuse increase in the size of the pancreas, a decrease in tissue echogenicity, and fuzzy visualization of the contours.

Acute pancreatitis in children in diagnosis is distinguished from diseases in which there are also intense abdominal pains:

  • acute cholecystitis
  • acute appendicitis
  • acute intestinal obstruction
  • ulcer perforation
  • biliary colic

The acute form of the disease is treated in a hospital. The child needs both physical and mental peace. To do this, adhere to bed rest. As for the diet, the pancreas needs peace. Observe the principles of mechanical and chemical sparing of the digestive tract. For this, 1-2 days the child should be completely starving. These days he is given only alkaline mineral water of the Borjomi type without gas, warm. The dose is 5 ml per 1 kg, taken 5-6 times a day. On the third or second day, you can enter gentle nutrition. An individual diet for 10-15 days is required.

On the first day, glucose is administered parenterally. If there is evidence, also plasma and protein preparations. From the 2nd day, you can mashed buckwheat or oatmeal, tea without sugar with breadcrumbs, steam omelet. From the 4th day they give stale white bread, mashed porridge, cottage cheese, milk jelly. From the fifth day they give vegetable mashed potatoes, mashed vegetable soups.

From 8-10 days you can give your child steam cutlets, minced meat from boiled meat, fish. From the 14th day, baked apples and fruit jelly are introduced into the diet. A few days later you can fresh fruits and vegetables in limited quantities. When the food adaptation is carried out, a diet No. 5p with a calorie content of 2500–2700 kcal is prescribed. It respects the principle of increasing protein by 30%, reducing fats and carbohydrates by 20%.

The child must eat 5-6 times a day in small portions only boiled and stewed dishes. It is strictly forbidden to give the patient dishes with pronounced choleretic, sokogonny, cholekinetic effects, raw vegetables and fruits, meat and fish broths, smoked meats, chocolate, marinades.

Drug treatment of acute pancreatitis in children is carried out with the help of antispasmodics: no-shpa, platifillina, etc. At the same time they give painkillers in a dosage according to age. One of the key points of treatment is detoxification therapy by intravenous administration of 5-10% glucose solution, plasma. Depending on the severity and form of the disease, corticosteroid drugs are prescribed in short courses.

If there is evidence, doctors give the child calcium preparations, antihistamines, rutin, ascorbic acid, etc. In severe cases, protease inhibitors are used to treat acute pancreatitis in children: contracal (trasilol), gordox. In connection with the deficiency of the child’s pancreas, enzyme preparations are prescribed, the most popular is pancreatin. With severe cholestasis, light choleretic drugs are used, decoctions of herbs: corn stigmas, chamomile flowers.

Prevention of primary and recurrent acute pancreatitis begins with a diet. It is forbidden to consume large amounts of food for 1 time. Alcohol is strictly prohibited. It is necessary for parents to monitor the health of the child and timely treat the diseases of the digestive system that appear in it.

In acute and chronic calculous cholecystitis, choledocholithiasis, obstruction of biliopancreatic ducts, surgical treatment should be carried out as early as possible. Relapse of acute pancreatitis or its transition to chronic pancreatitis can be prevented by early and proper treatment of the primary forms of acute pancreatitis. Treatment of patients in a hospital should be carried out before the elimination of acute changes in the pancreas. Contribute to the prevention of acute pancreatitis by systematic dispensary monitoring of patients with a gastroenterological profile, their treatment in the outpatient clinic and clinic.

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Viral pericarditis

The human heart is surrounded by a sheath of connective tissue that protects it from contact with other organs. Friction is prevented by the accumulation of fluid in the cavity, which prevents the displacement of the heart during movement or intense physical activity. Normally, the amount of fluid between the petals of the pericardium does not exceed 5-30 ml.

Cardiac pericarditis is a common name for conditions associated with a malfunction of the pericardial membrane. Since only such an organ as the heart has such a membrane, the term is used exclusively for heart diseases.

The main sign of pericarditis is the flow of fluid outside the bag that protects the heart. This is due to the increased activity of the pericardium, compensating for the problems by the release of additional volumes of lubricating fluid. One of the main dangers that characterizes pericarditis is sweating in the pericardium. In this case, plasma ultrafiltrate rarely retains its original composition:

With a sharp increase in the volume of effusion in the pericardial cavity, a high risk of cardiac tamponade appears. The visceral and parietal pericardium are not designed to rapidly change in volume. Elastic tissue cannot stretch instantly to compensate for critical changes. Thus, even a small amount of excess fluid (100-150 ml) can completely block cardiac output and lead to complete cardiac arrest.

If the inflamed pericardial sheets cannot cope with the release of sufficient amounts of plasma ultrafiltrate, the heart does not run the risk of being squeezed in its own membrane. Nevertheless, the health risk is great: pericardial sheets may stick together, preventing the movement of blood to the heart; pericarditis forms adhesions that will interfere with the rhythmic activity of the heart.

The risk of developing pericardial inflammation is increased for patients suffering from common diseases of the body. If the condition causes lesions in the connective tissue, affects the composition of the blood, it is likely that pericarditis will become one of the many complications of the disease.

Pericarditis also occurs for such reasons:

  • Allergy. Some allergic diseases and seasonal reactions lead to autoimmune reactions affecting the pericardium. In the early phases, the body independently damages its own tissues; then the disease proceeds according to the standard scheme.
  • AIDS virus. HIV-infected patients have an increased chance of developing acute pericarditis. Patients receiving treatment in hospitals located in disadvantaged areas are most at risk.
  • Malignant tumor. The greatest chance of inflammation is with the formation of a tumor in the chest area.

Anticonvulsants and antiarrhythmic drugs (phenytoin, procainamide, etc.) are taken only on the recommendation of a doctor. Uncontrolled intake leads to violations of the uniform release of lubricant, overflow or drying out of the heart sac – the pericardium. They take heparin, warfarin and other such blood thinners with caution: they affect the composition and quality of plasma.

Rheumatic inflammation of the pericardium is most dangerous for children: acute and dry pericarditis were diagnosed on average in 9 out of 10 children who died as a result of complications of the underlying disease – rheumatism.

With the development of inflammation, the likelihood of transmission of the rheumatic process to the heart membrane is high. In the early days, the leaves of the pericardium swell, there is a risk of developing cirrhosis. If untreated, a critical mass of fibrin fibers accumulates; fibrinous deposits increase pressure on the heart and significantly reduce the natural flexibility of the pericardium. Sweating serous fluid also contains a large number of fibrin fibers, which can provoke the formation of adhesions in the pericardial region.

The presence of rheumatic fever is not a sufficient sign to determine pericarditis: the first attack almost never leads to inflammation of the pericardium, the probability of involvement of the heart membrane in the process does not exceed 1%. Rheumatism is accompanied by pericarditis only in the case of a genetic predisposition.

With rheumatism, pericarditis of various types occurs; the variety of manifestations and the non-obviousness of signs in the early stages often lead to the inability to diagnose inflammation of pericardial tissue in time. The disease, which begins as an exacerbation of a rheumatic attack, gradually turns into exudative or chronic pericarditis.

FormDeadlinesSymptomsFeatures
Acute rheumatic pericarditisEnd of first week or beginning of 2nd week after rheumatic feverAcute rheumatic fever, pain in the region of the heart, confused breathing.It manifests itself in the first days of an attack with cardiac rheumatism; a symptom of the acute phase of rheumatic heart disease and rheumatic pancreatitis.
Dry pericarditis10-12 days after the attackRegular rhythmic chest pain, palpitations, increased fatigue.Listening reveals distinct rustles and creaks: sounds of friction of pericardial sheets.
Pericardial effusion2 weeks or more after the attackLabored breathing; shortness of breath, aggravated by lying on your side or back. Perhaps palpable or visible swelling of the cervical veins; in some cases, the heart protrudes significantly from the chest, intercostal spaces are smoothed out.It develops from acute rheumatic pericarditis; accompanied by the disappearance of pain. In some cases, an infectious disease develops in parallel. The disappearance of pain indicates isolation of the pericardium up to the opening of the leaves forming the protective membrane. Further accumulation of exudate leads to an increase in the load on the heart, invisible to the patient.
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In about 14 cases, rheumatic pericarditis, including and with the accumulation of exudate, they are not dangerous for the body and diverge on their own. The effusion is absorbed by auxiliary systems, the heart restores normal activity, the inflammation completely disappears.

It is considered the most common form of acute pericarditis; Moreover, modern diagnostic methods do not allow 100% accuracy to confirm seasonal viral infectious disease as a cause of inflammation or completely refute the effect of the virus on the amount and composition of fluid in the pericardium.

Difficulties in the diagnosis of viral infectious pericarditis are associated with the fact that signs of an inflammatory process in the heart sac in combination with intermittent breathing, fever and general weakness of the body can indicate the presence of serious diseases that have priority in the order of diagnosis.

Acute viral infectious diseases provoke inflammation due to multiple disorders in the functioning of the human immune systems; while the virus does not penetrate the pericardial fluid, as a rule. Only in some cases, laboratory analysis of the intake of pericardial fluid can determine the presence of one of the following types of viruses:

  • pathogens of influenza;
  • adenoviruses;
  • herpes
  • parotitis;
  • Koksaki A, B;
  • chickenpox virus;
  • echovirus type 8.

The absence of an infectious agent in the collected fluid is not a sufficient sign to confirm isolation of the pericardium. An increased number of antibodies to certain viruses also indicates a link between viral infectious disease and inflammation of the leaves of the heart sac.

If the tests did not reveal signs of the presence of the virus in the pericardium, but there is a recent history of a viral infection, the nature of pericarditis is defined as acute idiopathic. A negative reaction to tests measuring serological deposits is also necessary for making a diagnosis: the virus is able to change the structure of the fluid, increasing the likelihood of a spontaneous relapse of the inflammatory process 1-2 weeks after treatment.

Type of infectionViralBacterialAutoimmune (allergic)Fungus
Self remission25% of reported casesnoPractically not foundno
The likelihood of relapse after recoveryHigh (30 – 50%)Practically not foundFrequent (in more than 25% of cases)Medium (no more than 25% of cases)
Fatal outcome without medical attention100% with the development of tamponade; virus dependent100% of cases100% with the development of tamponadeUntil 85%
Compression of the heart muscle (pain)Very rarelyOftenRarelyOften

Remission for viral pericarditis has a greater chance of passing unnoticed due to the long term of the underlying disease and the absence of sharp pain symptoms in the first phase of inflammation. The increased frequency of relapses of inflammation caused by the virus is a sufficient reason not to lose vigilance even 1-3 months after the end of treatment.

Manifestations of pericarditis depend on its form, stage of the inflammatory process, the nature of the exudate and the rate of its accumulation in the pericardial cavity, the severity of the adhesive process. In acute inflammation of the pericardium, fibrinous (dry) pericarditis is usually noted, the manifestations of which change in the process of exudate isolation and accumulation.

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Dry pericarditis

It manifests itself as pain in the region of the heart and the noise of pericardial friction. Pain in the chest – dull and pressing, sometimes extending to the left shoulder blade, neck, both shoulders. Mild pain often occurs, but there are severe and painful, resembling an attack of angina pectoris. Unlike heart pain with angina pectoris, pericarditis is characterized by its gradual increase, duration from several hours to several days, lack of reaction when taking nitroglycerin, temporary subsidence from taking narcotic analgesics. Patients can simultaneously feel shortness of breath, palpitations, general malaise, dry cough, chills, which brings the symptoms of the disease closer to manifestations of dry pleurisy. A characteristic sign of pain with pericarditis is its intensification with deep breathing, swallowing, coughing, a change in body position (decrease in a sitting position and strengthening in a supine position), surface breathing and frequent.

Pericardial friction noise is detected by listening to the patient’s heart and lungs. Dry pericarditis can end in a cure in 2-3 weeks or go into exudative or adhesive.

Pericardial effusion

Exudative (effusion) pericarditis develops as a result of dry pericarditis or on its own with rapidly developing allergic, tuberculous or tumor pericarditis.

There are complaints of pain in the heart, a feeling of tightness in the chest. With the accumulation of exudate, there is a violation of blood circulation through the hollow, hepatic and portal veins, shortness of breath develops, the esophagus is compressed (the passage of food is disturbed – dysphagia), the phrenic nerve (hiccups appear). Almost all patients have a fever. The appearance of the patients is characterized by a swollen face, neck, front surface of the chest, swelling of the veins of the neck (“Stokes collar”), and pale skin with cyanosis. On examination, smoothing of the intercostal spaces is noted.

Therapy of acute pericarditis

The method of treatment of pericarditis is chosen by the doctor depending on the clinical and morphological form and cause of the disease. A patient with acute pericarditis is shown bed rest before the activity subsides. In the case of chronic pericarditis, the regimen is determined by the patient’s condition (restriction of physical activity, diet: high-grade, fractional, with limited salt intake).

In acute fibrinous (dry) pericarditis, mainly symptomatic treatment is prescribed: non-steroidal anti-inflammatory drugs (acetylsalicylic acid, indomethacin, ibuprofen, etc.), analgesics to relieve severe pain, drugs that normalize metabolic processes in the heart muscle, potassium preparations.

Treatment of acute exudative pericarditis without signs of compression of the heart, basically, is similar to that with dry pericarditis. At the same time, regular strict monitoring of the main hemodynamic parameters (blood pressure, CVP, heart rate, cardiac and stroke indices, etc.), the volume of effusion, and signs of the development of acute cardiac tamponade are required.

If exudative pericarditis has developed against a background of bacterial infection, or in cases of purulent pericarditis, antibiotics are used (parenterally and locally – through a catheter after drainage of the pericardial cavity). Antibiotics are prescribed taking into account the sensitivity of the identified pathogen. With the tuberculosis genesis of pericarditis, 2–3 anti-TB drugs are used for 6–8 months. Drainage is also used to introduce cytostatic agents into the pericardial cavity in case of tumor damage to the pericardium; for aspiration of blood and the introduction of fibrinolytic drugs for hemopericardium.

Treatment of secondary pericarditis

The use of glucocorticoids (prednisone) contributes to a more rapid and complete absorption of effusion, especially with allergic pericarditis and developing connective tissue diseases against the background. is included in the treatment of the underlying disease (systemic lupus erythematosus, acute rheumatic fever, juvenile rheumatoid arthritis).

With a rapid increase in the accumulation of exudate (threatened cardiac tamponade), pericardial puncture (pericardiocentesis) is performed to remove the effusion. Pericardial puncture is also used for prolonged resorption of the effusion (during treatment for more than 2 weeks) to identify its nature and nature (tumor, tuberculosis, fungal, etc.).

Patients with constrictive pericarditis in case of chronic venous stasis and cardiac compression perform pericardial surgery: resection of cicatricial sections of the pericardium and adhesions (subtotal pericardectomy).

Clinical symptoms of pancreatitis

Children’s pancreatitis in most cases develops in a mild form. Purulent-inflammatory processes relate to isolated episodes in medical practice. Symptoms of acute and chronic disease are different. In the first case, seizures occur suddenly and are accompanied by severe pain. In the second – manifestations of pancreatitis are less pronounced, but are regular in nature.

Symptoms of chronic DP depend on the degree of damage to the pancreas. Pain is regular. Exacerbation is observed after eating harmful foods (spicy, fatty, fried foods, fast food). Excessive physical or emotional stress can provoke an attack.

ClassRecommended remedyTreatment effectRecommended dosageRisk of side effects
Main drugNSAIDs (non-steroidal anti-inflammatory drugs)IbuprofenRestoration of activity in the coronary circulation; complete resorption of pericardial effusion within 2-3 to 30 days.Up to 250-600 mg once every 5-9 hours.Minimum
Additional drugHomomorphinansColchicineMitigation of the acute phases of the disease until the complete elimination of pericardial overflow; reduction in the likelihood of recurrence of inflammation.Up to 0,5 mg twice daily.Almost absent
Prophylactic agentsCorticosteroids *PrednisoloneReducing the risks of exacerbations, restoring the structure of the pericardium with uremic or autoactive pericarditis.Depending on the anamnesis.Minimum

* Only for patients with chronic and acute diseases that damage the structure of connective tissues; cancel gradually. Before completely discontinuing corticosteroids, start daily use of non-steroidal anti-inflammatory drugs or colchicine.

With cardiac tamponade, pericardial puncture (pericardiocentesis) is an effective measure. The permissible volume of drained fluid is not more than 25-30 ml: upon reaching the daily norm, the drainage (catheter) is removed. The same procedure is performed with suspected tumor inflammation of the pericardium or accumulation of pus in order to reduce pressure on the heart. Non-surgical treatment of such complications of pericarditis gives a lasting result without risk to the heart.

After recovery, patients should undergo regular examinations and diagnostics to detect changes in the structure of the heart: acute pericarditis has an increased likelihood of relapse; changes in the structure and shape of the pericardium can lead to constriction of the heart without obvious pain symptoms.

A completely different scenario is observed with necrotic damage to the parenchyma, which occurs in 15% of patients. The course of this form is always moderate or extremely severe and is characterized by two phases – early and late.

The first (early) phase has two periods – IA and I B. IA corresponds to the first days of the disease, when foci of necrosis are formed in the organ and surrounding tissues, endotoxemia develops. On average, the destruction of the parenchyma takes up to 3 days, less often – 24-36 hours. At the same time, exudate from enzymes is formed in the abdominal cavity, leading to enzymatic peritonitis.

The second week of the disease is the transition to the IB period. At this moment, the body responds to the resulting foci of destructive changes in the near pancreatic tissues and the pancreas itself. An infiltrate is formed around the pancreas – amentobursitis.

The second phase begins with the third week. Its other name is the sequestration phase. Its duration reaches several months, during which pancreatic sequestration (rejected necrotic elements) is formed. Complications of the late phase are fistulas, abscesses, purulent peritonitis, etc.

Signs of pancreatitis largely depend on the cause, severity of the disease and the age of the patient, i.e. pancreatitis in children will differ in its manifestation from the pathology of adults.

If we are talking about an acute process, then the Mondor triad comes to the fore in the clinic:

  • intense pain in the epigastric region, not passing after taking antispasmodic drugs;
  • continuous, debilitating vomiting, possibly with impurities of bile;
  • bloating.

In this case, due to edema and, accordingly, an increase in the head of the pancreas, the appearance of obstructive jaundice is possible. The patient turns yellow skin and sclera of the eyes, mucous membranes, the color of his bowel movements changes: the urine becomes dark, feces acholic (white).

With complicated forms, other symptoms of pancreatitis also appear:

  • high (hectic) fever with chills;
  • pallor of the skin with acrocyanosis (bluish skin color);
  • constipation and discomfort in the intestine, as signs of intestinal obstruction.

Chronic pancreatitis has less vivid, but quite voluminous symptoms. The entire set of manifestations can be combined into a number of syndromes:

  • exocrine insufficiency syndrome is caused by a violation of the digestive function of the pancreas. The patient notes weight loss, changes in appearance and other properties of feces. Characteristic is the so-called “pancreatic stool”, which differs from the normal grayish color, stench, a large amount of bowel movements (polyphycal) and a greasy sheen (steatorrhea). The skin changes, the condition of the hair and nails worsens: dryness, brittleness, dullness;
  • syndrome of inflammatory and destructive changes. The morphological signs of pancreatitis discussed above (cysts, edema, sclerosis) often lead to compression of the common bile duct. In this case, jaundice phenomena begin to prevail in the clinic picture. A feature in this case is a pain attack preceding icteric staining of the skin and mucous membranes;
  • pain in chronic pancreatitis is most often associated with obstructed outflow of pancreatic juice and the transition of chronic inflammation to the peritoneum. The pains are usually long, almost constant. Pain occurs in the area of ​​the projection of the gland – above the navel. They are of a girdling nature, they are given to the right hypochondrium in case of damage to the head or body, the left hypochondrium in case of tail damage. The patient notes their gain after an error in the diet;
  • insulin deficiency syndrome. Due to the low level of glucagon in the blood due to prolonged inflammation of the pancreas, patients develop a triad of symptoms resembling a diabetes clinic. In such patients, a feeling of hunger and thirst intensifies, a feeling of dry mouth appears. At the same time, ketoacidotic states (characterized by an increase in the level of ketone bodies in the blood) do not develop;
  • asthenic syndrome – a syndrome of “general weakness”. A fairly typical syndrome that is not specific to this disease, but, nevertheless, helps in the diagnosis. Asthenic syndrome is characterized by malaise, irritability, sleep disturbance and performance;
  • dyspeptic changes syndrome is manifested by a decrease in appetite up to anorexia, nausea, hypersalivation, and vomiting without a sense of relief;
  • dyskinetic syndrome – a violation of intestinal motility. There is an alternation of diarrhea and constipation, bloating.

Pancreatitis in children is clinically different from adult pathology in the diffuse nature of pain (preschool children have difficulty localizing pain due to an imperfect nervous system), the rapid development of inflammation and destructive processes.

The presence of signs of inflammation and their severity depend on the type of disease. In most cases, a child’s pancreatitis is mild or moderate. The severe course of the disease with necrosis and suppuration of tissues is extremely rare. The severity of symptoms may depend on the age category of the patient. Acute and chronic pancreatitis are characterized by specific signs.

This form of the disease causes a strong inflammatory process and pain near the epigastric region, extending to the back. Teenagers feel pain near the navel, preschool patients complain of severe discomfort throughout the abdomen. Chronic inflammation of the pancreas in children has the following symptoms:

  • bouts of nausea, vomiting;
  • fatigue, drowsiness, lethargy, nervousness;
  • pallor, subictericity (yellowing) of the skin;
  • chronic constipation / diarrhea, flatulence;
  • allergic dermatitis, rashes on the skin;
  • decreased appetite, weight.

Acute

The main feature of this type of inflammation is that the severity of symptoms depends on the age of the patient: the older the child, the brighter the clinical picture. Signs of pancreatitis in children:

  • newborns and infants tighten their legs to the stomach, show frequent anxiety;
  • severe indigestion (diarrhea);
  • heartburn, nausea, frequent bouts of vomiting;
  • inflammation of the pancreas causes an increase in temperature to subfebrile indicators (37-38ºС), hyperthermia (accumulation of excess heat in the body);
  • general poor health, sleep disturbance, apathy, weakness (astheno-vegetative syndrome);
  • dry mouth, whitish or yellow plaque on the tongue.

The primary symptoms of inflammation of the heart membranes are difficult and require special attention of the attending physician. The nature of the course of the disease rarely directly indicates heart problems. Especially in cases of acquired carditis after an infectious disease.

The patient complains of weakness, fatigue, lack of appetite, nausea, decreased attention. These common symptoms accompany many diseases.

The development of the process gives more definite signs of cardiac pathology: tachycardia, arrhythmia, deafness of heart sounds, shortness of breath, edema, cyanosis.

But they also often coincide with the characteristic features of other cardiovascular diseases such as mitral stenosis, arrhythmia of extracardiac origin, rheumatism, heart disease, tumor processes in the myocardium.

In babies, carditis is accompanied by coughing, pain in the heart. The child can not say about pain, he tries to avoid sudden movements, breathe superficially.

The diagnosis is confirmed by signs of conduction and automatism disturbance that persist for a long time with ECG results, along with other indicators that speak of left ventricular hypertrophy and myocardial ischemia. The x-ray reveals changes in shape, an increase in the heart tissue of the left ventricle, and a slowed pulsation (80-85% of patients).

Viral pericarditis

ElementStructureappointment
Visceral pericardiumThe elastic membrane of mesothelial cells adjacent to the myocardium.The first leaf forming a protective bag for the heart; protects against shock and shock, forms a cavity for fluid accumulation.
Parietal pericardiumFibrous leaf located behind large cardiac vessels.The second leaf, covering the heart and holding it in the correct position. Prevents evaporation or leakage of liquid.
MechanoreceptorsSensitive nerve fiber endings that respond to mechanical stress.They respond to the intensity of stretching, record acute changes, including in the volume of the increased heart and pressure. A pain signal is sent from the pericardium warning of damage.
Phrenic nervesNerve plexuses passing into the chest cavity from the anterior branches of the cervical spinal nerves.Responsible for the innervation of the pericardial branch, incl. pleura and pericardium.
Ultrafiltrate plasmaThe fluid filtered through the membrane. The composition is similar to blood plasma, but does not have proteins and other elements.Lubricates the heart and petals of the pericardium, protecting organs from friction. It provides protection for such a vulnerable organ as the heart from sharp blows and helps to maintain the heart in one position.

Pericarditis often occurs against the background of infectious and chronic diseases, when the body systems are weakened and cannot take part in the normalization of the work of internal organs with increased load. In the early stages, pericarditis makes the membrane less dense, more permeable: the petals that hold the heart cease to cope with the insulating function.

The chronic nature of inflammation is said to be if the duration of the disease is between 8-12 or more weeks. The reasons for the long course are in repeated inflammation of the healing organ.

Treatment of symptoms is similar to acute pericarditis. A positive result is given by nonabsorbable corticosteroids in crystalloid form, administered directly into the heart bag. Measures also apply:

  • Pericardiocentesis It is used both to pump out excess fluid from the pericardial cavity, and to clarify the diagnosis.
  • Intrapericardial fenestration. Surgical intervention: a pleuropericardial window is formed through which the natural absorption of effusion occurs. The heart is freed from excess pressure. This effect stabilizes the patient’s condition with complications of pericarditis.
  • Balloon pericardiotomy. A method of non-surgical drainage, characterized by minimal risks for the pericardium. Preferred heart surgery.
  • Pericardectomy It is prescribed if it was not possible to divert the desired volume of fluid using other procedures. The heart bag is excised at the main vessels; in the case of total pericardectomy – from the vessels to the diaphragm, with the bypass of the diaphragmatic nerves.

A mandatory element of successful treatment is the diagnosis of removable diseases that cause multiple relapses of inflammation and effusion in the heart sac. Therapy is prescribed in accordance with the specifics of the disease; Common causes of chronic pericarditis are toxoplasmosis, tuberculosis, systemic and autoimmune diseases.

  • Intermittent pericarditis. Characterized by intermittent remission with changing periods; after discontinuation of therapy, symptoms may not return for a week, 1-2 months, six months, etc. It is impossible to predict relapse.
  • Stable inflammatory process. Cancellation of NSAIDs as soon as possible leads to repeated inflammation of the tissues.

In about half of the cases, relapses are explained by a short treatment period, improper selection of anti-inflammatory drugs or insufficient dosage. Diseases such as pericarditis can return dozens of times: immune defense is not produced. In this case, pericarditis develops without abnormalities; risks associated with overstatement of positive forecasts.

Other medical errors include the untimely administration of corticosteroid drugs: under the influence of corticosteroids, the intensity of replication of viral chains in the tissues of the heart membrane can increase several times. Repeated treatment with an extension of therapy or a change in the main drug eliminates the likelihood of subsequent relapses.

Among other causes of recurrent pericarditis is re-infection with a viral or fungal infection, complications of systemic diseases and diseases that affect the condition of connective tissues.

Therapy is carried out similarly to acute pericarditis; The course takes into account the following nuances:

  • With the recurrent nature of inflammation, the reaction to corticosteroids is several times faster.
  • The condition may be accompanied by allergic reactions, including and on prescribed drugs.
  • If corticosteroids are prescribed for recurrent inflammation, the duration of gradual withdrawal should be at least 3-3,5 months. With complete cancellation, NSAIDs or colchicine are prescribed for a period of 3 months.
  • If a decrease in the dosage of the main drug is accompanied by a return of symptoms, they return to the minimum effective dose for a period of at least 8-12 weeks.

Surgical intervention (pericardiectomy) is recommended only in the absence of a reaction to drug therapy. At least 3-4 weeks before surgery, corticosteroid drugs are completely canceled.

The exact anatomical form of constrictive pericarditis is established in accordance with the area in which the heart is compressed. Before starting treatment, a comprehensive diagnosis with tissue Doppler or Doppler echocardiography is mandatory. According to the results of the study, changes in the respiratory system are monitored to diagnose restrictive cardiomyopathy, a condition similar in other ways to compressive pericarditis.

At the moment, there is only one method for treating constrictive pericarditis – pericardectomy. The operation provides for partial or complete removal of the heart membrane, due to which the removal of mechanical compression is achieved. Carrying out the procedure involves risks:

  • the probability of death is 6-11%;
  • increased risk of complications of pericarditis, including acute heart failure, irritation and rupture of the wall of the left ventricle;
  • complete recovery with restoration of normal hemodynamics of the heart occurs only in 3 out of 5 cases.

Patients with undiagnosed fibrosis or myocardial atrophy are most at mortal risk. In this case, pericarditis becomes a fatal disease. To achieve a positive result in patients who do not suffer from chronic myocardial diseases, immediate surgery is recommended: timely partial or complete removal of the pericardium increases the chance of successful rehabilitation.

The development of cysts in the protective membrane of the heart occurs as a result of operations on the heart, transfer of bacterial infectious diseases and rheumatic pericarditis.

Cases of the formation of congenital cysts in the pericardium are extremely rare. Such seals do not exceed 5 centimeters in diameter and have virtually no effect on how the heart works.

An asymptomatic course is characteristic of both single and multiple cases of pericardial cysts. As a rule, changes are detected during the x-ray examination of the thoracic region. In some cases, patients may complain of a feeling of tightness in the heart, an unproductive cough, shortness of breath and rapid heartbeat.

Several treatments for pericardial cysts are available:

  • Percutaneous aspiration. Unproductive tissue is pulled from the pericardium through a catheter under pressure.
  • Sclerotherapy with ethanol. Percutaneous injection of the drug (96% alcohol) into the cavity of the cyst: leads to complete resorption.
  • Silver nitrate aspiration. The removal of cyst tissue occurs alternately with the filling of the cavity with an absorbable preparation. 3-4 weeks before the procedure, up to 800 mg of albendazole per day is prescribed.

Surgical removal of the cyst is not recommended, since damage to the integrity of the pericardium is fraught with numerous complications of diseases and chronic forms of pericarditis.

Timely recognition of complications of the disease eliminates the problem without surgery in 75% of cases.

The main complication that accompanies most pericardial inflammation. Most often diagnosed are small, but quick fluid spills. They are characterized by increased soreness: a sharp increase in the amount of lubricant presses on the walls of the pericardium, increasing pressure on the heart, which causes a rhythmic pain syndrome.

Large volumes of effusion accumulate gradually, slowly deforming the pericardium. Among the diseases that provoke a similar complication:

  • tuberculosis
  • cholesterol and uremic pericarditis;
  • malignant tumors in the heart and related diseases;
  • parasitosis (the presence of parasites in the body, usually helminths or arthropods);
  • myxedema (mucous edema caused by disorders of the thyroid gland).

Such effusions grow slowly and gradually; the patient may complain of chest pain, but rarely feels sharp pain. If the release of moisture is exudative, filling can develop within 3-4 months.

As a rule, the heart is compressed evenly during effusion, pericarditis does not have a zonal effect on the heart. Localization of fluid accumulation is possible in the case of recently undergone surgical operations with violation of the integrity of the pericardium, physical injuries (strong blows, falls, cutting and stab wounds) and prolonged purulent processes in the tissues forming the heart bag. Local effusions are characterized by the following symptoms:

  • shortness of breath both with minor physical exertion, and at rest;
  • dysphagia: difficulty swallowing up to the complete inability to swallow food, food and fluid getting into the nose, trachea, and larynx;
  • hoarseness without concomitant colds or mechanical irritation without a clinical cause;
  • nausea: occurs due to pressure in the diaphragm.
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Acute pericarditis and its symptoms

If there is a suspicion of inflammation of the pancreas of the child, a pediatrician and a gastroenterologist are examined. It is important to differentiate the disease with other pathological processes that cause similar symptoms (ulcer of the duodenum and stomach, appendicitis, acute cholecystitis, hypothyroidism). The main measures for the diagnosis of pancreatitis in a child:

  1. Palpation (palpation, manual examination) of the peritoneum is necessary to identify the focus of the disease.
  2. A positive symptom of Mayo-Robson speaks of an acute form of pancreatitis (there is a sharp pain when pressing on a certain point of the abdomen).
  3. A general blood test helps to determine the number of white blood cells – in the inflammatory process, their level rises.
  4. A urinalysis and a biochemical blood test show an excess of enzymes: pancreatic amylase, trypsin and lipase.
  5. Ultrasound (ultrasound) of the peritoneal organs reveals changes in their size, structure and functioning.
  6. A coprogram is being carried out to detect poorly digested food, which indicates a lack of enzymes.
  7. Sonography of the abdominal cavity establishes an accumulation of necrotic areas, an increase in the pancreas in size and heterogeneity of the parinechal structure of the organ.
  8. To maximize the accuracy of the diagnosis, a panoramic radiography, computed tomography and magnetic resonance imaging of the peritoneum are performed.
  9. Endoscopic retrograde cholangiopancreatography (ERCP) is a type of X-ray in which the patency of the pancreatic ducts is checked by introducing a special contrast agent into them.

In the diagnosis of pancreatitis in children, methods of instrumental and laboratory studies are used. On palpation of the abdominal part, severe pain is manifested. The child may have all or only some of the symptoms characteristic of the disease.

Laboratory tests confirm the presence of an inflammatory process, and the final diagnosis is made after instrumental procedures.

  1. fecal lipid profile;
  2. biochemical and general blood analysis;
  3. ESR analysis;
  4. fecal caprogram;
  5. Ultrasound of the abdominal cavity;
  6. survey radiography;
  7. Ultrasound of the pancreas;
  8. CT or MRI of the abdomen.

Differential diagnosis should be carried out with intestinal obstruction, acute cholecystitis or appendicitis, as well as peptic ulcer. Symptomatic DP resembles renal or biliary colic. These diseases should also be excluded. The diagnosis of pancreatitis in children is complicated by numerous factors. The wider the set of examination procedures, the higher the chance of an accurate diagnosis.

It is very important to diagnose pericardial inflammation in a timely manner, since it can pose a threat to the patient’s life. Such cases include compressive pericarditis, pericardial effusion with acute cardiac tamponade, purulent and tumor pericarditis. It is necessary to differentiate the diagnosis with other diseases, mainly with acute myocardial infarction and acute myocarditis, to identify the cause of pericarditis. Diagnosis of pericarditis includes collecting an anamnesis, examining a patient (listening to and tapping the heart), and conducting laboratory tests.

  1. Analyzes. General, immunological and biochemical (total protein, protein fractions, sialic acids, creatine kinase, fibrinogen, seromucoid, CRP, urea, LE cells) blood tests are performed to clarify the cause and nature of pericarditis.
  2. Electrocardiography ECG is of great importance in the diagnosis of acute dry pericarditis, the initial stage of exudative pericarditis and adhesive pericarditis (when compressing the cavities of the heart). In the case of exudative and chronic inflammation of the pericardium, a decrease in the electrical activity of the myocardium is observed. FKG (phonocardiography) notes systolic and diastolic murmurs that are not associated with the functional heart cycle, and periodically occurring high-frequency fluctuations.
  3. Radiation diagnostics. X-ray of the lungs is informative for the diagnosis of exudative pericarditis (there is an increase in size and a change in the silhouette of the heart: a spherical shadow is characteristic of an acute process, triangular for a chronic one). With the accumulation of up to 250 ml of exudate in the pericardial cavity, the size of the heart shadow does not change. A weakened pulsation of the contour of the shadow of the heart is noted. The shadow of the heart is poorly distinguishable behind the shadow of the pericardial sac filled with exudate. With constrictive pericarditis, fuzzy contours of the heart are visible due to pleuropericardial adhesions. A large number of adhesions can cause a “motionless” heart, which does not change the shape and position during breathing and changing body position. With a “shell” heart, calcareous deposits in the pericardium are noted. CT of the chest, MRI and MSCT of the heart diagnoses thickening and calcification of the pericardium.
  4. Echocardiography. Echocardiography is the main method for the diagnosis of pericarditis, which reveals the presence of even a small amount of liquid exudate (

15 ml) in the pericardial cavity, a change in heart movements, the presence of adhesions, thickening of the leaves of the pericardium.

  • Diagnostic puncture of the pericardium. In the case of effusion pericarditis, it allows the study of exudate (cytological, biochemical, bacteriological, immunological). The presence of signs of inflammation, pus, blood, and tumor helps to establish the correct diagnosis.
  • CT OGK. Exudative pericarditis. A significant amount of fluid in the pericardial cavity.

    All diagnostic methods that help identify pancreatic disease can be divided into:

    • anamnestic;
    • physical method with a general examination;
    • instrumental methods;
    • laboratory diagnostic methods.

    To make a diagnosis, first of all, attention is paid to the course of the disease and the patient’s complaints, which were mentioned above.

    Upon examination and physical examination, the doctor discovers the following signs of pancreatitis:

    • cyanotic (violet, cyanotic) spots on the face – a symptom of Mondor;
    • Gray Turner spots – cyanotic elements on the sides of the abdomen;
    • Grunwald’s symptom is navel cyanosis;
    • small-dot burgundy-red spots (angiomas) up to 4 mm throughout the skin and especially in the left hypochondrium – a symptom of Tuzhilin (a consequence of damage to the capillaries due to enzymes released into the blood during an exacerbation of the process);
    • soreness of the projection points of the pancreas (Shoffar zone, Mayo-Robson point, etc.).

    Among the instrumental methods that play a large role in the diagnosis of pancreatitis, it should be noted:

    Laboratory diagnosis involves the conduct of paraclinical studies (blood, urine, feces) and specific tests:

    • determination of amylolytic activity of the patient’s urine;
    • the ratio of serum amylase and lipase enzymes;
    • study of the catalytic ability of phospholipase, elastase and other enzymes;
    • probe test (secretin-pancreosimine);
    • determination of the level of acute phase indicators (leukocytosis, C-reactive protein, etc.).

    Acute inflammation treatment

    Therapy for pancreatic inflammation in a child should be carried out in a hospital. Need bed rest, conservative treatment. Stages of the classical therapeutic scheme:

    • it is necessary to provide functional rest to the inflamed organ;
    • removal of the cause of the disease;
    • adherence to a strict diet;
    • taking medications to combat the symptoms of childhood pancreatitis.

    Surgical intervention is prescribed for the ineffectiveness of drug therapy, the appearance of complications or the rapid development of pancreatitis. The surgeon performs resection (removal, cutting off part of the organ) of the pancreas, necrectomy (excision of the dead parts of the gland) or drainage of the abscess that has developed in the tissues.

    Medication

    First, drugs are injected, the use of tablets is allowed after the disappearance of pain (about a week after the development of inflammation). The main drugs for the treatment of childhood pancreatitis are classified by the mechanism of action.

    Painkiller, antispasmodics, narcotic analgesics for severe pain. Often prescribed drugs:

    • No-spa in injections or tablets is a strong painkiller, antispasmodic. The tool works very quickly, 10-12 minutes after use. The maximum daily dose of any form of medication is 240 mg (single – 80 mg). In case of an overdose, arrhythmia can be observed, in some severe cases, cardiac arrest occurs. Contraindications: renal, heart or liver failure, age up to 6 years.
    • Analgin gives an antipyretic and moderate anti-inflammatory effect, relieves pain well. The dosage is calculated depending on the weight of the child (5-10 mg per kilogram). Reception of funds 1-3 per day. It can not be used for acute cardiovascular pathology, children under 3 months old and babies under 5 years of age who are treated with cytostatics. S >

    Enzymatic medications are prescribed to stimulate the digestive function and support the normal functioning of the pancreas. These include:

    • Pancreatin tablets stimulate the work of the gland, eliminate pain and discomfort. Small patients from 2 to 4 years of age are prescribed 1 tablet (8000 active units) per 7 kg of weight. Children 4-10 years old – 8000 units per 14 kg, adolescents – 2 tablets with meals. The maximum daily dose is 50 units. Contraindications: acute form of pancreatitis and exacerbation in the chronic type of the disease, obstruction of the small intestine, pathology of the gallbladder, intolerance to the components of the drug.
    • Creon gelatin capsules are used for chronic childhood pancreatitis. The drug effectively fights pain, stabilizes the gastrointestinal tract. Children can take Creon 10000. Babies up to a year are given half the contents of the capsule before each meal, children from 12 months old – 1 pill. Treatment is prohibited in case of acute or exacerbated inflammation, with hypersensitivity to the drug.
    • Similar action: Mezim, Festal, Pangrol, Fermentium.

    Medications to improve blood microcirculation. Often prescribed such drugs from this group:

    • Tablets or Dipyridamole Injection. The medication gives an anti-aggregation, vasodilator and anti-adhesive effect. The permitted daily dose for the child is calculated by the weight of the patient (from 5 to 10 mg per 1 kg). Contraindications: age up to 12 years, renal failure, arterial hypotension, tendency to bleeding, sensitivity to the components of the drug.
    • Curantil is a drug from the group of antiplatelet agents, immunomodulators. Prescribe to children from 12 years. The daily dosage of tablets is from 3 to 6 times 25 mg each. Do not take with hypersensitivity to dipyridamole, renal and hepatic insufficiency, angina pectoris, arterial hypotension. Side effects: heart rhythm disturbance, dizziness, diarrhea, abdominal pain, rash.

    Drugs to reduce the release of pancreatic enzymes are also necessary in the complex treatment of pancreatitis. Most popular remedies:

    • In the acute form of inflammation, famotidine is used. It refers to H-2 receptor blockers that reduce the production of hydrochloric acid. Pills help to suppress pancreatic secretion, reduce pain, eliminate nausea, belching and other symptoms. Do not prescribe to a child younger than 12 years old and with high sensitivity to the drug. Take 1-2 tablets twice a day (morning and evening).
    • Gastrogen antisecretory drug (tablets, lyophilisate for intravenous injection) is not prescribed for a child under 14 years of age. Dosage is assigned individually. Contraindications: allergy to the components of the drug, renal / liver failure. Side effects: constipation or diarrhea, dry mouth, headache, skin rashes.

    In the case of a purulent or bacterial form of pancreatitis in a child, antibiotic therapy is needed. The course of treatment lasts about a week. Antibacterial agents should be combined with probiotics, which restore the intestinal microflora. Tablets: Azithromycin, Amoxiclav, Abactal, Sumamed. Preparations for intramuscular injections: Ceftriaxone, Doxycycline, Cefatoxime, Ampioks.

    One of the stages of the effective treatment of pancreatitis is diet. The first few days after the start of treatment should stick to therapeutic fasting (you can drink warm water). The basic rules of the diet:

    1. The daily calorie intake is a maximum of 3000 kcal.
    2. Servings should be equal, small, eat 6-8 times a day, preferably at the same time.
    3. It is allowed to eat warm food (grated or liqu >

    The menu of a sick child should be varied. The list of allowed products looks like this:

    • mashed vegetable soups;
    • dairy products: cheese, kefir, yogurt, low-fat cottage cheese;
    • boiled, baked or steamed fish of low-fat varieties (pike perch, pike, pollock, common carp, bream);
    • herbal teas, mineral water without gas;
    • meat: turkey, chicken, rabbit, veal (in boiled, baked form);
    • various cereals (buckwheat, rice, oat, millet);
    • You can add a little vegetable or butter.

    To avoid complications of the disease, it is necessary to remove certain foods from the diet. It is forbidden to use:

    • sugar, white bread (can be replaced with honey and whole grain bread);
    • fatty, fried, spicy foods;
    • allergen products (whole milk, soy, eggs, corn);
    • carbonated drinks;
    • confectionery;
    • red meat;
    • some vegetables, greens (spinach, sorrel, rutabaga, radish, radish, cabbage).

    The need for surgical intervention for pericarditis is determined in accordance with the nature and rate of effusion. There are four types of fluid that fill the pericardial cavity in inflammatory processes:

    • transudate (hydropericardium; often accompanied by myocardial infarction);
    • exudate (fluid of mixed composition, released from the tissues of the pericardium during inflammation);
    • pyopericardium (purulent discharge provoked by cell decomposition);
    • hemopericardium (blood).

    The greatest danger to the patient is a sharp effusion with the simultaneous release of significant volumes of fluid. Diseases such as pericarditis provoke them constantly, which is a great stress for the body. Such processes lead to tamponade of the heart – a state of extreme transmission in the heart due to excess volumes of effusion in the pericardium, which did not have time to stretch out and take a new shape.

    An effusion that develops gradually (over several weeks) allows the pericardium to adjust to increasing volumes of fluid. In this case, surgery is not required: enough drug therapy, similar to the treatment of acute pericarditis. Also, operations are not performed with minimal volumes of effusion: excess fluid is redistributed by the body without medical intervention.

    If the processes develop rapidly, the following procedures are shown to stabilize the state:

    • Pericardiocentesis Surgical drainage of effusion without excessive irritation of the protective membrane of the heart. Minimal risk of relapse; the absence of serious complications of pericarditis, even with concomitant diseases. Necessarily carried out with cardiac tamponade; the procedure is necessary with recorded changes in the heart rhythm. If excessive pressure on the heart is caused by dehydration, pericardiocentesis is used to inject extra volumes of fluid into the veins entering the heart ventricles. You can not perform the procedure for pericardial injuries leading to the filling of the heart bag with blood. Even small blood clots can block the hole in the needle, making fluid drainage impossible.
    • Thoracoscopic drainage. An emergency technique to eliminate large volumes of fluid in intense limited effusions.
    • Open heart surgery. It is used to stop bleeding in the heart cavity, drain significant volumes of fluid, partially or completely remove the pericardium.

    The maximum effect is exerted not by the elimination of pericardial effusion, but by the detection and timely elimination of the factor contributing to its appearance. To reduce the intensity of relapses, gradual drainage is better: procedures lasting from a day to two weeks reduce the frequency of repeated effusions in comparison with exclusively medical therapy.

    After drainage of any duration, patients should be monitored: even short-term drainage can provoke decompensation, causing a rapid increase in pressure in the heart.

    Pancreatitis Prevention

    The prognosis in most cases is favorable, with the right treatment started in a timely manner, the patients’ working ability is restored almost completely. In the case of purulent pericarditis in the absence of urgent medical measures, the disease can be life threatening. Adhesive (adhesive) pericarditis leaves persistent changes, because surgery is not effective enough.

    Only secondary prophylaxis of pericarditis is possible, which consists of clinical supervision by a cardiologist, rheumatologist, regular monitoring of electrocardiography and echocardiography, rehabilitation of foci of chronic infection, a healthy lifestyle, moderate physical activity.

    Prevention of childhood pancreatitis includes basic rules. It is important to observe the diet (the menu should correspond to the age of the child). If a small patient has diseases of the digestive system, then they must be treated fully and in a timely manner. Uncontrolled medication and self-medication should not be allowed.

    Video on the topic: Pancreatitis – an effective diet treatment. Treatment of the pancreas without medication or medication.

    Specialists divide preventive measures to prevent carditis into primary and secondary.

    Primary

    Primary prevention involves measures to prevent the occurrence of the disease. With rheumatic carditis, prevention is primarily aimed at preventing the onset and development of rheumatism in the human body.

    In practice, this is a complex of general strengthening actions, such as hardening, physical exercises, balanced nutrition, intake of vitamins, etc.

    In cases of non-rheumatic carditis, the goal of prevention is to prevent infection by different types of infections. Particular attention is required during periods of epidemic. A set of measures: general strengthening and healing procedures, intake of vitamins and drugs that increase immunity.

    In pediatrics, primary prevention is measures to prevent infection of pregnant women with infections, identification and rehabilitation of foci of infection in the body of the expectant mother, compliance with vaccination rules. Particular attention is paid to risk groups: pregnant women with burdened heredity, cardiovascular diseases.

    Prevention of carditis in children: hardening of the newborn, dispensary observation of children at risk.

    Secondary

    Secondary prevention includes a number of measures to prevent relapse and the development of complications. Constant monitoring of specialists, timely diagnosis, therapy, preventive treatment courses.

    With rheumatic carditis, these are measures that prevent relapse of rheumatism. Usually include the introduction of prolonged-acting atibiotics (bicillin, penicillin, retarpen, pendepon).

    The timing of anti-relapse treatment is determined individually. Patients with established heart failure will have to take preventive measures for life.

    Carditis is a disease that is successfully treated with modern medicine. Nevertheless, the risk of complications remains serious in all age groups of patients. In order not to make yourself a chronic cardiovascular disease, you should contact a specialist in a timely manner, accurately describe all the disturbing symptoms, require a thorough examination, timely diagnosis and treatment.

    To avoid the development of the disease and prevent its exacerbation, you must adhere to simple rules. Prevention of pancreatitis includes such measures:

    • proper diet;
    • prevention of diseases of the digestive organs;
    • drawing up a rational menu for the child in accordance with his age;
    • timely detection and treatment of infections, helminthic infestations;
    • compliance with the exact dosage with drug therapy.

    The main preventive method for exacerbating pancreatitis, the symptoms and treatment of which are discussed above, remains a specific diet, although there is no clear scientific justification for it. There are suggestions that to a greater extent provoke the development of the disease is not so much food as their excessive consumption, concomitant obesity and weak motility of the gastrointestinal tract.

    According to cohort studies, abstinence from drinking alcohol and smoking actually reduce the risk of exacerbations of pancreatitis and its progression. For people with cholelithiasis and other pathologies of the biliary system, cholecystectomy may be indicated as a preventive measure.

    Summarizing all the known data, as recommendations to a patient with pancreatitis should offer:

    • fractional nutrition in moderate portions;
    • variety in the diet, while eating foods low in fat and cholesterol;
    • selection of foods high in fiber (fruits, vegetables, cereals);
    • rejection of bad habits;
    • struggle with physical inactivity, i.e. maintaining physical activity;
    • fight against excess weight;
    • timely treatment of diseases, including Gastrointestinal tract.

    Treatment of chronic pericarditis

    With pericarditis, the inflammatory process affects the serous tissue of the heart – the serous pericardium (parietal, visceral plate and pericardial cavity). Pericardial changes are characterized by an increase in permeability and expansion of blood vessels, leukocyte infiltration, fibrin deposition, adhesions and scar formation, calcification of the pericardial leaves and compression of the heart.

    Like other types of this disease, pericardial effusion can lead to cardiac tamponade. In this case, the condition occurs due to the fact that a viscous, excess exudate prevents the filling of the ventricles of the heart with sufficient blood. Without immediate intervention, cardiac arrest is possible.

    Since exudative pericarditis in many ways coincides with the diseases of which it is a complication, a comprehensive examination is carried out to identify the true nature of the disease.

    Diagnostic methodCharacteristic signs of effusion pericarditis / critical factors
    Patient Complaint AnalysisRegular deaf or sharp pains in the chest, a feeling of general weakness, shortness of breath when moving and in a resting position, swelling of the hands and the whole body.
    A history of the diseaseSymptoms of pericarditis after viral diseases or injuries in the chest; surgical operations preceding the development of the disease; progression of symptoms within 1-4 weeks.
    General history analysisChronic systemic and cardiac diseases; previous injuries; habits and preferences; heredity (heart failure, heart disease and other cardiological diseases, disorders, disorders in immediate relatives).
    General inspectionIntense, forced posture; pallor or blueness of the skin; deaf heart sounds during auscultation; characteristic noises and rustles in the pericardial region; an increase in the area occupied by the heart (detected by tapping).
    Laboratory analysis of blood and urineCritical disturbances in the work of metabolic systems, residual signs of viral diseases.
    Immunological examinationThe presence in the tissues of the pericardium of antibodies of the heart and atrium, evidence of autoimmune processes – impaired immunity, leading to the body’s struggle with its own tissues and cells.
    ElectrocardiographyThe presence of specific changes in the region of the heart on ECG images.
    RadiographyThe heart casts an enlarged shadow; a change in the shape of the shadow of the heart; Blurry, fuzzy borders.
    Analysis of fluid intake from the pericardial cavityThe presence of extraneous structures, purulent formations, blood cells, proteins, etc. in lubricating fluid.

    Diagnosis of exudative pericarditis is complicated by the fact that such conditions are often accompanied by infection. Only an analysis of the exudative fluid in the heart and the surrounding cavity will give information about the causes of the disease and preferred treatment methods.

    Therapies

    With exudative pericarditis, mild drug treatment is acceptable. An exception is cases with developed tamponade: it is always treated promptly.

    The first step to cure is to determine the underlying disease that provokes inflammation with the release of exudate. In parallel with the elimination of the symptoms and causes of the underlying disease, the following remedies are used:

    • Therapeutic preparations intended for the general strengthening of the body. Vitamin and hormonal complexes, stimulants of metabolic processes.
    • Immunodulators: agents that normalize immune processes in the body. Eliminate autoimmune reactions, help fight the consequences of severe viral diseases.
    • Non-hormonal anti-inflammatory therapy. It has a minimum of contraindications, it is used without restrictions.
    • Hormonal anti-inflammatory drugs. Gradual increase in dosage, smooth withdrawal. It is recommended for adult patients who have no contraindications, because of the long-term positive effect on the formation of new tissues and the intensity with which the heart works.
    • Antibiotic drugs. They are used for the infectious nature of exudative pericarditis.
    • Cardiopreparations. These heart-stimulating drugs prevent the development of tamponade. They are prescribed according to indications, or if the heart cannot cope with the load (hereditary diseases).
    • Puncture with the removal of excessive volumes of exudate. It is used both to ease the load on the heart, and to collect material for laboratory research. Such treatment of the disease gives a quick result; the heart stabilizes, manifestations of pericarditis return less often.
    • Surgical intervention. Such methods of treating diseases give a long-term effect on the heart, but are characterized by a high degree of risk. It is recommended with a sharp increase in the load on the heart or in the absence of a reaction to drug therapy.

    Treatment of exudative pericarditis gives a long-term positive result if drugs are started during the first three months of the course of the disease. The timely provision of medical care leads to a complete cure without obvious consequences in the vast majority of cases; the greatest effect is the use of drugs with anti-inflammatory effect. With reduced resistance to acute diseases, pericarditis leads to a slight decrease in stamina, imperceptible in everyday life.

    Preventive measures

    Exudative pericarditis is not an independent disease, but a complication. Accordingly, there are no specific ways to prevent this form of pericarditis.

    Among the factors that can reduce the likelihood of developing exudative pericarditis, there are:

    • Reducing the risk of physical injury to the chest. Contact sports, parkour, risky riding, hard physical work are just some of the situations that greatly increase the chance of a critical hit.
    • Full passage of the therapeutic course in the development of infectious diseases. As a rule, exudative pericarditis is of a viral nature. Since inflammatory processes can be asymptomatic, it is necessary to continue the course of treatment even after the symptoms have completely disappeared.
    • Prompt consultation with a doctor at the first sign of exudative pericarditis. Timely diagnosis of pericarditis allows you to cure inflammation without surgical intervention.

    The last factor is decisive. The greatest number of complications of exudative pericarditis is associated with a late visit to a specialist. The appearance of shortness of breath, pulling rhythmic pains, pallor and fatigue is a good reason to visit a doctor and undergo a full medical examination.

    Heart diseases are treated by a cardiologist. It is he who will make an accurate diagnosis, prescribe a qualified treatment. When identifying the specifics of the disease, a narrow specialist, for example, a cardiac rheumatologist, can continue treatment.

    The primary diagnosis of heart problems is performed by the therapist. At the slightest suspicion, he will refer the patient to a cardiologist. In case of a viral disease, the signs of carditis should be detected by an infectious disease specialist and also refer the patient to a cardiologist for consultation.

    Physical damage and injuries

    Any severe stroke in the heart region is potentially a factor that can lead to the development of pericarditis. The maximum risk for pericardium is noted in the following cases:

    • Direct injuries of the heart membrane. Stab and cutting wounds with knives, gunshot wounds.
    • Closed pericardial injury. A blow to the chest without the use of knives, falling from a great height (including onto the back, into the water), a strong shock (traffic accident).
    • Radiation sickness. Occurs with prolonged or intense radiation exposure. Damage can occur immediately or gradually, including and a few months after radiation damage to the body. The risk group includes patients undergoing radiation therapy for breast and lung cancer.

    It is recommended that you pay more attention to the sensations under the heart or on the left side of the chest, even if you hit your back or got a stab wound below (above) the heart. Timely diagnosis will reveal the primary symptoms of pericarditis long before the onset of life-threatening complications of the disease.

    Metabolic disorders

    To isolate a sufficient amount of plasma ultrafiltrate, all body systems must work in concert. The lack of volume of the released lubricant can be triggered by the following conditions:

    • Renal failure. If the kidneys do not cope with the function of blood purification, pericarditis still does not interfere with the filtration of plasma by its own membranes, but the functionality of the organ has a limited resource. The accumulation of a critical level of toxins leads to the entry of plasma containing foreign fibers and elements. This leads to suppuration and sluggish inflammatory processes.
    • Hypothyroidism The composition of the plasma is also affected by hormones secreted by the thyroid gland. A decrease in the intake of such hormones leads to a sharp deterioration in the quality of the lubricant and a decrease in its quantity.
    • Gout. Metabolic changes in gout affect purines, the elements that make up the cell nucleus. The disease provokes long-term changes in the pericardium.

    There were no cases of pericarditis associated with short-term general metabolic disorders. From this we can conclude that without the accompanying acute or chronic disease of inflammation of the pericardium, one can not be afraid.

    Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

    He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

    Detonic