Treatment of severe pancreatitis

Written by Wang Li Bing
Intensive Care Medicine Department
Updated on September 25, 2024
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Severe pancreatitis must be managed with comprehensive measures and aggressive rescue treatment. For medical treatment, the first step is to enhance monitoring of vital signs such as heartbeat, respiration, and blood pressure. The second step involves actively replenishing fluids and electrolytes to maintain effective blood volume. Severe cases often experience shock, and it may be appropriate to administer albumin, plasma, etc. The third step for patients with severe pancreatitis, who typically have high metabolic demands, is to enhance nutritional support, possibly using parenteral nutrition. The fourth step involves routine use of antibiotics for severe pancreatitis to prevent infections related to pancreatic necrosis. The fifth step involves using somatostatin analogs like octreotide to suppress the secretion of pancreatic enzymes and pancreatic juice as part of conservative medical treatment. If pancreatic necrosis is complicated with infection, or if a pancreatic abscess forms, surgical treatment can be considered.

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Written by Wei Shi Liang
Intensive Care Unit
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Severe pancreatitis is what disease

Acute severe pancreatitis is a disease caused by various etiologies, characterized by local necrosis, inflammation, and infection of the pancreas, accompanied by systemic inflammatory response and persistent organ failure. The current mortality rate is still as high as 17%. The course of acute severe pancreatitis can generally be divided into three periods. First, the acute response period, occurring up to about two weeks after onset, is characterized by a systemic inflammatory response. Second, the systemic infection period, from two weeks to about two months, is characterized by infection of pancreatic or peripancreatic necrosis. Third, the residual infection period, occurring two to three months later, where the main clinical manifestation is systemic malnutrition.

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Written by Chen Rong
Gastroenterology
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How is acute pancreatitis treated?

Acute pancreatitis is classified into mild pancreatitis and severe pancreatitis depending on the severity of the condition. Mild cases often recover within a week without residual effects; severe cases are perilous with a poor prognosis, and the mortality rate ranges from 20% to 40%. Treatment for mild pancreatitis includes fasting, gastrointestinal decompression, pain relief, antibiotics, intravenous nutrition, acid suppression, enzyme inhibition, etc. In addition to the aforementioned treatments, severe pancreatitis requires strict medical monitoring to maintain electrolyte balance, early parenteral nutrition transitioning to enteral nutrition, and the use of antibiotics to reduce pancreatic fluid secretion, such as the growth inhibitor octreotide, as well as enzyme activity suppressants like gabexate. If the pancreatitis is biliary in origin, an ERCP with a sphincterotomy of the sphincter of Oddi may be performed. In case of serious complications, surgical treatment may be considered. (Medications should be used under the guidance of a doctor.)

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Written by Chen Rong
Gastroenterology
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How to check for pancreatitis?

The examination of pancreatitis requires laboratory tests and imaging examinations to assess the severity of the condition and to identify the cause. Elevated amylase and lipase levels more than three times the normal values, increased white blood cells, elevated C-reactive protein, increased blood sugar, elevated transaminases and bilirubin, decreased albumin, increased urea nitrogen and creatinine, decreased blood oxygen partial pressure, decreased blood calcium, elevated triglycerides, and abnormalities in blood sodium, potassium, and pH values all reflect the severity of pancreatitis. Abdominal ultrasound is a routine initial screening imaging examination for acute pancreatitis, and abdominal CT is helpful in confirming the presence of pancreatitis, peripancreatic inflammatory changes, and pleural effusion. Enhanced CT is beneficial in determining the extent of pancreatic necrosis and is generally performed about a week after the onset of the condition. However, when searching for the cause of pancreatitis, the sensitivity and accuracy of CT are not as good as MRI, therefore further MRI should be conducted to investigate causes related to the bile duct and to determine the cause of the pancreatitis.

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Written by Chen Rong
Gastroenterology
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Is pancreatitis contagious?

Pancreatitis is a condition where pancreatic tissue damage is caused by self-digestion due to various etiologies. It can be seen in multiple causes and is not a contagious disease itself and does not spread. However, when pancreatitis is caused by infectious diseases such as acute epidemic mumps, influenza A infection, Chlamydophila pneumoniae infection, infectious mononucleosis, Coxsackie virus infection, etc., the pancreas can be affected as a target organ resulting in pancreatitis. In such cases, transmission of the primary disease may occur, but pancreatitis is more commonly associated with biliary diseases such as cholelithiasis, biliary infection, alcohol damage, pancreatic duct obstruction (like pancreatic duct stones, ascariasis, stricture, tumors), diseases of the descending part of the duodenum (such as post-bulbar perforation, ulcers, adjacent papillitis of the duodenum, surgical trauma), hyperlipidemia, autoimmune diseases, drug damage, etc., none of which are contagious.

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Gastroenterology
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How to treat mild pancreatitis

Pancreatitis occurs due to the abnormal activation of pancreatic enzymes, leading to the self-digestion of the pancreas. The primary causes include alcohol, where excessive drinking can induce acute pancreatitis. Another cause is hyperlipidemia, as individuals with high blood lipid levels are prone to acute pancreatitis. Additionally, cholelithiasis, including stones in both the bile ducts and the gallbladder, can also trigger acute pancreatitis. Symptoms of acute pancreatitis manifest as severe pain in the upper abdomen, accompanied by nausea, vomiting, abdominal bloating, and fever. Acute pancreatitis is classified into mild, moderate, and severe categories. Mild cases mainly exhibit edema of the pancreas without bleeding, necrosis, or involvement of other organs. Treatment primarily involves fasting and fluid replacement, typically lasting for more than 48 hours or until abdominal pain ceases. Another aspect of treatment is inhibiting pancreatic enzyme secretion. Some patients with acute pancreatitis might also need antibiotics. Typically, mild acute pancreatitis can heal within one to two weeks of treatment.