Which department should I go to for acute pancreatitis?

Written by Yang Chun Guang
Gastroenterology
Updated on September 16, 2024
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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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Symptoms of Pancreatitis

Pancreatitis is divided into acute pancreatitis and chronic pancreatitis. Acute pancreatitis is a condition caused by various reasons that lead to damage in the pancreatic tissue. This results in the premature activation of enzymes meant for digesting food, which instead begin to digest the pancreas itself. This “self-destructive” behavior leads to a series of consequences known as acute pancreatitis. The symptoms of acute pancreatitis primarily include abdominal pain, predominantly upper abdominal pain, which occurs suddenly and is persistent, severe, or knife-like, with intermittent exacerbation; fever, nausea, vomiting frequently, with vomitus consisting of food, bile, and even blood, and the abdominal pain does not ease after vomiting; some patients may also have jaundice, often caused by gallstones or common bile duct stones inducing pancreatitis, possibly accompanied by itching of the skin. Chronic pancreatitis, on the other hand, is not necessarily caused by repeated attacks of acute pancreatitis, but rather by various causes leading to persistent inflammatory changes in the pancreas, characterized mainly by chronic and persistent inflammation, damage, and fibrosis of the pancreatic parenchyma. This can lead to irreversible morphological changes such as dilation of the pancreatic ducts, pancreatic duct stones, or calcification. Symptoms include abdominal pain, primarily upper abdominal pain, which may radiate to the back, often triggered by alcohol consumption, overeating, a high-fat diet, or fatigue; gastrointestinal symptoms include reduced appetite, bloating, and indigestion; exocrine manifestations include diarrhea, specifically steatorrhea, where the stool contains oil droplets and often has a foul odor; there may also be weight loss, emaciation, and endocrine manifestations, such as what we commonly refer to as diabetes.

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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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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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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.

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Severe pancreatitis treatment process

Severe pancreatitis generally develops rapidly, progresses urgently, and can even be life-threatening. Therefore, the main treatment initially involves fasting, gastrointestinal decompression, suppression of pancreatic enzyme secretion, promotion of gastrointestinal motility, and maintaining regular bowel movements. Antibiotics can be used to prevent infection and necrosis of pancreatic tissue. If necrotic pancreatic tissue and ascites occur in the abdominal cavity, appropriate puncture and drainage may be used.