Preface

The book "Pancreatitis" is devoted to the actual and, in some cases, controversial and unresolved problems associated with acute and chronic pancreatitis. Acute pancreatitis is one of the most common causes of acute abdomen. Along with an increase in the number of patients with acute pancreatitis in recent years, there has been an increase in the incidence of its destructive forms. Despite the progress in improving the diagnostics of the disease, pathogenetically substantiated intensive therapy, antibiotic therapy, and minimally invasive surgical treatment, mortality in acute pancreatitis has remained at the same level over the past few decades. The most important objective in improving treatment results in acute pancreatitis is the use of standardized approaches to diagnostics and treatment of various forms of the disease and its complications, taking into account the modern, generally accepted international classification. Chronic pancreatitis is characterized by inflammation of the pancreas, which is replaced by fibrosis and progressing pancreatic tissue destruction. The three main clinical signs of chronic pancreatitis are pain, maldigestion, and diabetes. Although the disease is still difficult to treat, the development of new approaches has reduced the severity of clinical manifestations and improved the life quality of patients with chronic pancreatitis. This book will be of interest to anyone who considers pancreatology their specialty.

> **Dmitry Victorovich Garbuzenko** Professor, Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russia

**1**

**Chapter 1**

Pancreatitis

*Dmitry Garbuzenko*

patients with acute and chronic pancreatitis.

**1. Introduction**

**2. Acute pancreatitis**

dence of its destructive forms [1].

and reaches 100% in fulminant acute pancreatitis [2].

Introductory Chapter: Current

Challenges in the Management of

Patients with Acute and Chronic

As part of medical science, pancreatology reflects the level of technological progress and modern achievements in the natural sciences. Over the past five centuries, since A. Vesalius first described the pancreas and its topography, tremendous work has been done to determine the physiological role of the pancreas in the process of digestion, to study the causes and patterns characteristic of pancreatic diseases, and to find the ways of treatment. In this regard, the current challenges in modern pancreatology include the development and implementation of methods for early and accurate diagnosis and selection of the optimal tactics for treating

Acute pancreatitis is an acute surgical disease of the pancreas, which consists of primary edema or aseptic necrosis of pancreatic parenchyma with the possible infection of the pancreas and retroperitoneal tissue. Acute pancreatitis is one of the most common causes of acute abdomen, ranking third after acute appendicitis and acute cholecystitis. Along with an increase in the number of patients with acute pancreatitis in recent years, there has been a tendency to an increase in the inci-

Despite the progress achieved in improving the diagnostics of acute pancreatitis, pathogenetically substantiated intensive therapy, antibiotic therapy, and minimally invasive surgical treatment, mortality in acute pancreatitis has remained at the same level over the past decades. Moreover, while the overall mortality is within 3–6%, depending on the fluctuation of destructive pancreatitis incidence, the mortality rate is 15–30% in pancreatic necrosis, is 85% in infected pancreatic necrosis,

Currently, the immediate prescription of antibiotics in severe forms of acute pancreatitis is no longer debatable. However, there are still different opinions on the effectiveness of existing methods of delivering antibacterial drugs to the site of pancreatic destruction. The situation is aggravated by the increasing polyresistance of microorganisms to most antimicrobial chemotherapeutic agents [3]. According to modern conception, immune disorders are considered as a factor that largely determines the course of acute pancreatitis, helps maintain the inflammatory
