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"Emergency medicine" 3 (66) 2015

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Role of Organ Microthrombosis in Patients with Acute Pancreatitis in the Formation of Multiple Organ Dysfunction

Authors: Pidhirnyi B.Ya. - Lviv Regional Clinical Hospital, Lviv, Ukraine

Categories: Medicine of emergency

Sections: Specialist manual

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Acute pancreatitis is the 3rd most frequent acute abdominal condition, after appendicitis and cholecystitis. The number of acute pancreatitis cases has almost doubled over the last 30 years, with constant rise in morbidity among the young patients. Patients with severe pancreatitis and various complications, inclusing multiple organ dysfunction syndrome (MODS) are a special subgroup. These patients often develop local or total pancreatic necrosis, which increases mortality to 80%. 

Disorders of hemostasis in different forms of pancreatitis causes further progression of the pathologic process and affects the prognosis. The course and progression of acute pancreatitis is largely related to changes in blood clotting profile. However, there are still few studies of hemostatic dysfunction and its role in acute pancreatitis.

Our objective was to perform retrospective analysis of autopsy reports from patients with severe forms of acute pancreatitis, including cause of death and the incidence of microscopic thrombi in different organs.

APACHE II score at time of admission was 21.13±0.8, severity of pancreatitis was assessed using the Ranson score and measured 5.5 ±0.2, multiple organ failure was assessed using the SOFA score and measured 10.11±1.1. Upon admission the patients received intensive care treatment in accordance with the Standard of diagnosis and treatment of acute pancreatitis (Guidance. Kyiv. 2005), Protocol of diagnosis and treatment of acute pancreatitis (Guidance for physicians. Kyiv 2007) and the International Guidance for Treatment of Severe Sepsis and Septic Shock: 2012

We performed retrospective analysis of autopsy reports from 32 patients with destructive acute pancreatitis treated in Lviv Regional Clinical Hospital from January through December 2013.

Immediate cause of death was identified as refractory acute cardiovascular and respiratory failure.

According to autopsy reports, in 81% cases thrombosis of microvessels was detected. Almost in 85% cases thrombosis of microvessels was observed in several organs, while only in 15% of cases impairment of microcirculation was restricted to one organ only.

Microthrombosis did not always correlate with clinical and laboratory signs of dysfunction of some organs (particularly the liver and kidneys).  

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