Severe pancreatitis symptoms

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 04, 2024
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Severe pancreatitis, due to different stages of pathological changes, presents diverse systemic responses. Generally, mild symptoms of pancreatitis include abdominal pain, nausea, vomiting, and fever. In severe pancreatitis, apart from these symptoms, due to bleeding, necrosis, and autolysis of the pancreas, additional symptoms such as shock, high fever, jaundice, abdominal distension, and paralytic ileus, peritoneal irritation signs, and subcutaneous ecchymosis may also occur. Abdominal pain is the earliest symptom, while nausea and vomiting are manifestations due to inflammatory factors stimulating the vagus nerve. The likelihood of jaundice is relatively low in acute edematous pancreatitis but is more common in severe pancreatitis. Extensive inflammatory exudation in the pancreas can lead to pancreatic necrosis and localized abscesses, which may cause varying degrees of fever increase.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Treatment of severe pancreatitis

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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Symptoms of severe pancreatitis

The main symptom of severe pancreatitis is abdominal pain. This type of abdominal pain manifests as intense pain in the upper-middle abdomen, which radiates to the back and both sides of the body. The pain is widespread and severe, with about 95% of patients experiencing abdominal pain. Onset often occurs following binge eating or excessive drinking, and the pain worsens after eating. Another symptom is abdominal distension, which is also a common symptom. It is caused by extensive effusion in the abdominal cavity and retroperitoneum, as well as intestinal paralysis. Fever in the early stage of the disease is also a common symptom, resulting from the absorption of a large amount of necrotic tissue. Fever occurring in the later stages is often caused by infections triggered within the abdominal cavity.

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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 Wu Hai Wu
Gastroenterology
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Can pancreatitis be contagious?

Pancreatitis is not contagious; it is a serious digestive system disease. The main causes of pancreatitis include gallstones, binge eating, alcohol abuse, and consumption of greasy foods among other factors. Once an attack of pancreatitis occurs, the patient must immediately refrain from eating and drinking, undergo gastrointestinal decompression, and have gastric juices, acids, and stomach contents suctioned out. Meanwhile, treatments for pancreatitis may involve the use of somatostatin or octreotide to inhibit the secretion of pancreatic juice, as well as the use of third-generation cephalosporins or quinolone antibiotics for anti-infection treatment. (Please use medications under the guidance of a physician.)

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Written by Wei Shi Liang
Intensive Care Unit
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Principles of Treatment for Severe Acute Pancreatitis

The treatment of severe pancreatitis requires care in an ICU, involving a multidisciplinary team. Early treatment of severe pancreatitis focuses on non-surgical management centered on organ function support, and sterile necrosis is preferably treated non-surgically. Surgical treatment is applied once necrotic infection occurs. Non-surgical treatment principally involves intensive care monitoring and mainly consists of fluid replacement, maintenance of electrolyte and acid-base balance, energy support, and prevention of local and systemic complications. Additionally, current non-surgical treatments for severe pancreatitis include bedside blood filtration, abdominal lavage, etc. Moreover, minimally invasive treatments are supplementary methods for managing severe pancreatitis, including biliary drainage, minimally invasive techniques, and treatment of infected pancreatic necrosis. Surgical intervention, involving the removal of necrotic tissue, is necessary during the infection phase.