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 Wei Shi Liang
Intensive Care Unit
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Two major signs of severe pancreatitis

In patients with severe pancreatitis, physical examination may reveal abdominal distension with tympanic percussion sounds, prominent tenderness in the upper middle abdomen, and potentially widespread abdominal pain centered in the upper middle area. Some may exhibit rebound tenderness, moderate muscle tension is common, and a few cases may demonstrate shifting dullness. Occasionally, a mass in the upper middle abdomen can be palpated, possibly due to fluid in the lesser sac. Auscultation may reveal diminished or absent bowel sounds, accompanied by cessation of passing gas or stool, indicating features of paralytic ileus.

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Written by Yang Chun Guang
Gastroenterology
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Which department should I go to for acute pancreatitis?

If acute pancreatitis occurs, it is recommended to register with the Department of Gastroenterology. Acute pancreatitis is generally divided into acute edematous pancreatitis and acute necrotizing pancreatitis. The common form of pancreatitis in daily life is acute edematous pancreatitis, which can be treated conservatively with medication in the gastroenterology department. If acute necrotizing pancreatitis occurs, surgery may be required. In such cases, after registering with the gastroenterology department and identifying a severe condition, an appropriate transfer to another department for treatment can be made. After all, when initially arriving at the hospital, without a detailed examination, it is unclear whether it is edematous or necrotic pancreatitis.

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Written by Zhu Dan Hua
Gastroenterology
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Causes of Pancreatitis

Common causes of pancreatitis in clinical settings include biliary tract diseases, alcohol consumption, overeating, and hyperlipidemia, among others, with biliary tract diseases being the most common. Pancreatitis is generally defined as inflammatory changes in the pancreas due to self-digestion caused by various reasons. Clinical manifestations include abdominal pain, bloating, nausea, and vomiting, etc. Therefore, for patients with upper abdominal pain, it is necessary to further complete some examinations, such as liver function, amylase, lipase, abdominal ultrasound, and even abdominal CT scans, to clarify the diagnosis, which is generally straightforward for pancreatitis. The treatment of pancreatitis, in addition to symptomatic treatment, requires etiological treatment, combining different causes of pancreatitis. For instance, if caused by hyperlipidemia, lipid-lowering treatment is generally needed; if biliary tract disease is considered, active treatment of the biliary disease is required.

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Written by Wu Hai Wu
Gastroenterology
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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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Written by Wei Shi Liang
Intensive Care Unit
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What can be eaten with severe pancreatitis?

Patients with severe pancreatitis should not eat orally. Historically, suppressing pancreatic enzyme secretion by resting the intestines has been considered an important means of controlling the progression of acute pancreatitis. Currently, the implementation of early enteral nutrition is proposed. Early enteral nutrition should be administered via a jejunal tube, which is safer. The nutritional formulation should be chosen based on the patient's condition and intestinal tolerance. Initially, only glucose water may be used to allow the intestines to adapt to the nutrition. Early nutrition should use low-fat preparations containing amino acids or short peptides, because whole proteins entering the intestine directly without being digested by stomach acid can cause indigestion. As the condition enters the recovery phase, the feeding amount and rate can be gradually increased, and preparations containing whole proteins may be given.