MODERN APPROACHES IN THE DIAGNOSIS OF BILIARY PANCREATITIS

Miesoiedova V. А.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Gallstone disease in the structure of diseases of the gastrointestinal tract occupies up to 40% and is one of the most common diseases. In 35-62% of patients, gallstone disease is complicated by acute form of biliary pancreatitis. The aim of our research is to study the possibility of diagnostic use of the test for determination of serum cholecystokinin concentration in the diagnosis of acute biliary pancreatitis, as well as the relationship between the basal level of cholecystokinin in the blood and the thickness of the wall of the gall bladder during the period of exacerbation of cholelithiasis for further qualitative, timely diagnosis and prevention of complications. The main criteria for the selection of patients for examination were: the presence of gallstone disease, an attack of cholecystitis during the hospitalization or in the near anamnesis, and the presence of pancreas lesion syndrome in patients. Object and methods of research: general-clinical, biochemical, instrumental and statistical methods of data processing. Results of the research and their discussion. 120 patients, who were divided into 4 groups, have been directly examined and clinical monitoring has been conducted. For control, the results of surveys of 30 practically healthy volunteers have beem used. Since there are no reference values of cholecystokinin (CCK) serum concentration in literary sources, we determined the average quantity of this indicator in patients with control and experimental groups at the time of admission to the in-patient department. In order to study the possibility of diagnostic use of the CCK serum concentration test for diagnosis of acute biliary pancreatitis, we conducted a parallel study on markers of acute pancreatitis α-amylase and γ-GGT. The level of α-amylase and γ-GGT during the hospitalization of patients was significantly encreased, which confirmed the presence of acute pancreatitis. In the dynamics, these indicators had a positive dynamics to decrease, starting with 3 days of treatment. This parallelism of changes in laboratory indicators is also confirmed by the study of their correlation interrelation. In the process of the study, we observed the consistent pattern of the relationship between the thickness of the wall of the gall bladder (according to the ultrasound investigation) and the basal level of cholecystokinin in the blood. Correlation dependence of these values is established. The form of connection between them is rectilinear, since the change in the value of CCK corresponded to a change in the thickness of the wall of the gall bladder. Conclusions 1. The level of cholecystokinin in patients with acute biliary pancreatitis is a pathogenetically expedient and validated diagnostic marker of edema pancreatitis of biliary etiology. 2. In patients where the wall of the gall bladder exceeds the norm, the risk of pancreatitis during exacerbation is higher. Prospects for further developments in this direction. To investigate the morphological changes of the wall of the gall bladder in different clinical phases, in parallel with the determination of the level of cholecystokinin in the blood, in order to improve the effectiveness of the diagnosis and prevent the development of complications.

gallstone disease, acute biliary pancreatitis, cholecystokinin, wall of the gall bladder

1. Grigoreva IN. Osnovnyie faktoryi riska zhelchokamennoy bolezni. Ros. zh-l. gastroenterol., gepatol., koloproktol. 2007 Iyun;12(6):17-21. [in Russiаn].
2. Nichitaylo ME, Ogorodnik PV, Belyaev VV, Deynichenko AG. Sovremennaya taktika lecheniya holedoholitiaza. Klinichna hirurgiya. 2006;7:13-6. [in Russiаn].
3. Semenyuk YuS. Drenuvannya cherevnoyi porozhnini pri laparoskopichniy holetsistektomiyi. Shpitalna hirurgiya. 2007;4:80-2. [in Ukrainian].
4. FiIippov YuO, Egmur VB. Prognostichne znachennya klinichnih proyaviv zhovchokam’yanoyi hvorobi do operativnogo vtruchannya ta vpliv faktoriv chasu na perebig zahvoryuvannya pislya holetsistektomiyi. Medichni perspektivi. 2006;3:52-8. [in Ukrainian].
5. Chernev VM, Zosim VA, Slobodyanik VP, Tkach KD. Rezultati hirurgichnogo likuvannya hvorih z gostrim ta hronichnim kalkuloznim holetsistitom, uskladnenim holedoholitiazom, iz zastosuvannyam endovideohirurgichnih tehnologiy. Hirurgiya Ukrayini. 2007;1:36-41. [in Ukrainian].
6. Bondarenko MM, Barannik SI, Rodinska GO, Solov’evska TM, Chabanenko GM. Virogidnist laboratornih metodiv doslidzhennya u hvorih na gostriy biliarniy pankreatit. Klinichna hirurgiya. 2007;2-3:89-90. [in Ukrainian].
7. Rodinska GO. Diagnostichna i prognostichna tsinnist laboratornih pokaznikiv gomeostazu u hvorih na gostriy biliarniy pankreatit. Klinichna hirurgiya. 2006;9:142-3. [in Ukrainian].
8. Chars ST. Chronic pancreatitis: classification, relationship to acute pancreatitis, and early diagnosis. J. Gastroenterol. 2007;42(17):58-9.
9. Pavlovskiy MP, Kolomiytsev VI, Shahova TI. Likuvalna taktika pri poednanni gostrogo kalkuloznogo holetsistitu i gostrogo biliarnogo pankreatitu. Klinichna hirurgiya. 2007;2-3:99-100. [in Ukrainian].
10. Kondratenko PG, Konkova MV, Stukalo AA. Nereshennyie problemyi diagnostiki i lecheniya. Klinichna hirurgiya. 2006;4-5:35. [in Russiаn].
11. Alexakis N, Neoptolmos JP. Algorithm for the diagnosis and treatment of acute biliary pancreatitis. Scand. J. Surg. 2005;94(2):124-9.
12. Hristich TN. Podzheludochnaya zheleza: chto svidetelstvuet v polzu uchastiya v adaptivnyih protsessah organizma. Ukr. med. almanah. 2008;2:194-6. [in Russiаn].
13. Raty S, Sand J, Kemppainen E. Cholecystokinin in acute alcoholic and biliary pancreatitis. Int. J. Pancreatol. 2008;28(3):51-7.
14. Chars ST. Chronic pancreatitis: classification, relationship to acute pancreatitis, and early diagnosis. J. Gastroenterol. 2007;42(17):58-9.
15. Szaboles A, Tiszlavicz L, Kaszaki J. Zerumbone exerts a beneficial effect on inflammatory parameters of cholecystokinin octapeptide-induced experimental pancreatitis but fails to improve histology. Pancreas. 2007;35(3):249-55.
16. Konkova MV. Diagnosticheskaya i interventsionnaya sonografiya v neotlozhnoy abdominalnoy hirurgii. Donetsk: Novyiy mir; 2005. 300 s. [in Russiаn].
17. Keim V, Teich N, Fiedler F. A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain. Pancreas. 2008;6:45-9.

«Bulletin of problems biology and medicine» Issue 3 (145), 2018 year, 145-148 pages, index UDK 616 – 071+616.37 – 002

10.29254/2077-4214-2018-3-1-145-145-148