Principles of Treatment for Severe Acute Pancreatitis

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 05, 2024
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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.

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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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Is it okay to drink alcohol occasionally with pancreatitis?

Patients with pancreatitis absolutely must not drink alcohol, as it can lead to malnutrition and cause damage to organs such as the liver and pancreas, thereby reducing the patient's immunity. Even a single drinking session can provoke an episode of acute pancreatitis. Therefore, patients with pancreatitis must decidedly abstain from alcohol. Additionally, they should avoid overeating, as it can disturb gastrointestinal function, hinder normal bowel movements and emptying, and obstruct the normal secretion of bile and pancreatic juice, thus triggering a recurrence of pancreatitis.

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Written by Li Qiang
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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.

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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.)