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Critical Care Focus 9: The Gut - part 9

có thể là quá lớn để có thể hấp thụ và bị niêm phong bởi sẹo, để tạo thành một tổn thương nang (pseudocyst) chứa đầy các mảnh vụn bán rắn, liquefies và mở rộng. Đây là một quá trình vô trùng phản ánh hoạt động của các enzym tiêu hóa | CRITICAL CARE FOCUS THE GUT may be too large to be absorbed and become sealed off by scarring to form a cystic lesion pseudocyst filled with semi-solid debris which liquefies and expands. This is a sterile process reflecting the activity of the digestive and lysosomal enzymes of pancreatic and leucocyte origin. The ducts in surviving functional areas of the pancreas may drain into pseudocysts so they may contain pancreatic enzymes in high concentrations. Pseudocysts vary in size from 1 to 30 cm in diameter. Large pseudocysts may rupture leading to pancreatopleural or pancreatopericardial fistulae or more commonly pancreatic ascites resulting in chemical peritonitis. Alternatively pseudocysts may cause compression and obstruction of the duodenum and or the common bile duct. Rarely a pseudocyst may extend to erode a major blood vessel causing massive haemorrhage or leading to vascular thrombosis manifesting as bleeding perforation fistulae or late strictures. Necrotic tissue presents a fertile medium for bacterial growth and evolving pseudocysts may become infected by bacteria or fungi yielding a pancreatic abscess in 30-50 of cases. The micro-organisms may reach the pseudocyst by haematogenous or transmural routes. The absence or presence of micro-organisms distinguishes between pseudocysts and abscesses although abscesses and pseudocysts are otherwise generally similar macro- and microscopically. Over 50 of abscesses are polymicrobial with a predominance of enteric bacteria and Candida albicans is often cultured in patients previously treated with broad-spectrum antibiotics. Pancreatic abscesses usually occur when the active phase of pancreatitis is over this often tends to be a more indolent process. Remote complications are less frequent mortality is lower and sometimes a state of relative well-being interplays between the toxaemic phase and the clinical emergence of abdominal sepsis. Remote organ dysfunction The multiple organ dysfunction syndrome seen in severe