Principles of Treatment for Severe Pancreatitis

Written by Wang Li Bing

Intensive Care Medicine Department

Updated on September 14, 2024

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The treatment principles for severe pancreatitis mainly include the following points:

First, closely monitor the patient's heartbeat, respiration, blood pressure, blood oxygen, etc., and if possible, transfer them to the intensive care unit.

Second, maintain electrolyte balance and blood volume, and actively rehydrate.

Third, enhance nutritional support, which can include parenteral nutrition outside of gastrointestinal digestion.

Fourth, routinely use antibiotics in severe pancreatitis to prevent infection from necrotizing pancreatitis.

Fifth, reduce the secretion of pancreatic fluid, inhibit the synthesis of pancreatic enzymes, and suppress the activity of pancreatic enzymes. If the patient develops an infection associated with pancreatic necrosis, consider surgical treatment, etc.

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How many days of fasting for acute pancreatitis?

The duration for which patients with acute pancreatitis must fast is determined by the severity of their condition. Some may only need to fast for a day or two, while others may require around three to four days, or even a week. In severe cases of acute pancreatitis, it might be difficult to say how long the fasting could last, potentially around two weeks. Once patients with pancreatitis start eating after a series of active treatments such as anti-infection measures, inhibiting pancreatic secretion, replenishing electrolytes, and balancing acid-base levels, and following treatments like using rhubarb to facilitate bowel movements, if their bowel movements and gas expulsion have mostly returned to normal and amylase levels have largely normalized, they can cautiously start consuming low-fat, high-vitamin, and high-calorie liquid foods.

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Pancreatitis is what?

Pancreatitis is a relatively common disease in gastroenterology, generally believed to be caused by various factors leading to the activation and autodigestion of the pancreas itself, resulting in inflammatory changes in the pancreas. Common causes include bile duct stones, alcohol consumption, and overeating, among others. Clinically, it is most commonly presented with symptoms such as abdominal pain, bloating, nausea, and vomiting. Fever may also accompany these symptoms. The diagnostic criteria for pancreatitis generally include three standards: The first is typical upper abdominal pain, persistent upper abdominal pain; the second is a blood test showing blood amylase levels more than three times the normal value; the third involves typical abdominal imaging, such as ultrasound, CT, or MRI, indicating imaging changes like pancreatic effusion. If two out of these three criteria are met, pancreatitis can generally be diagnosed.

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Severe pancreatitis complications

Complications of severe pancreatitis primarily include: 1. Acute peripancreatic fluid collection and interstitial edematous pancreatitis, where fluid accumulates around the pancreas without necrosis. This can be diagnosed with enhanced CT. 2. Pancreatic pseudocysts, characterized by fluid encapsulated by a clearly defined inflammatory cyst wall around the pancreas, with no or minimal necrosis, commonly occurring around four weeks after an episode of interstitial edematous pancreatitis. 3. Accumulation of acute necrotic material, involving necrotic tissue and liquids from necrotizing pancreatitis, including the parenchyma and peripancreatic tissues, also diagnosable through enhanced CT. 4. Encapsulated necrosis, observable as a clearly defined inflammatory encapsulation of the pancreas and peripancreatic tissues, commonly occurring four weeks post an episode of necrotizing pancreatitis.

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Severe pancreatitis diagnostic criteria

Diagnostic criteria for severe pancreatitis: First, based on the patient's clinical symptoms, symptoms such as restlessness, cold limbs, and mottled skin, indicative of shock, may appear. Second, physical examination signs, such as rigid abdominal muscles indicative of a positive peritoneal irritation sign, and Grey Turner's sign may also be present. Third, according to laboratory tests, the calcium levels generally significantly decrease, usually below 2 mmol/L, and elevated blood sugar levels greater than 11.2 mmol/L, typically without a history of diabetes. There may also be a sudden decrease in urine amylase. Fourth, diagnostic abdominal paracentesis reveals ascitic fluid with high amylase activity. Based on these points, severe pancreatitis can be considered.

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The difference between severe pancreatitis and mild pancreatitis

Generally speaking, mild pancreatitis is just a local inflammation of the pancreas, usually manifested as upper abdominal pain, nausea, vomiting, and bloating — symptoms of the gastrointestinal tract. Severe pancreatitis, however, is much more serious than mild pancreatitis. In severe pancreatitis, not only is the pain in the local pancreas area more intense and the abdominal bloating more pronounced, but there is also a lot of effusion accumulating in the abdomen. Severe pancreatitis can also affect many other organs, such as the lungs, which are most commonly affected. It can lead to patients developing acute respiratory distress syndrome, characterized by severe hypoxemia, with many patients requiring mechanical ventilation treatment. Another organ that is commonly affected is the kidney, with many patients with severe pancreatitis experiencing acute renal failure, reduced urine output, or even anuria. Severe pancreatitis can also affect the heart, brain, and other organs, leading to functional abnormalities in these organs. Therefore, besides affecting the local pancreas, severe pancreatitis can involve other important organs, resulting in multiple organ dysfunctions.