The difference between severe pancreatitis and mild pancreatitis

Written by Li Qiang
Intensive Care Unit
Updated on December 01, 2024
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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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Written by Wei Shi Liang
Intensive Care Unit
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Rescue of severe pancreatitis

Severe pancreatitis involves severe illness impacting multiple systems and organs across the body. The rescue of severe pancreatitis should be based in the ICU, with multidisciplinary cooperation. The first step is early fluid resuscitation, with crystalloid solution preferred, and it should be rapidly completed within 48 hours of onset. The second step involves support for circulation and respiration. The third step involves the maintenance of organ functions and the use of blood purification treatments. Early use of blood purification in acute pancreatitis can remove inflammatory mediators, regulate immune dysfunctions, and protect organ functions, potentially extending the survival time of patients with severe pancreatitis. The fourth step includes monitoring intra-abdominal pressure and preventing and treating abdominal compartment syndrome. Further treatments mainly include the use of agents to inhibit pancreatic enzymes and platelet activation, as well as early jejunal nutrition. Additionally, prophylactic use of antibiotics is required, and in cases of biliary acute pancreatitis, ERCP or sphincterotomy should be performed. The final approach is surgical treatment, which is reserved for patients who do not respond to or have poor results from conservative treatment.

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Written by Wei Shi Liang
Intensive Care Unit
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Severe pancreatitis is what disease

Acute severe pancreatitis is a disease caused by various etiologies, characterized by local necrosis, inflammation, and infection of the pancreas, accompanied by systemic inflammatory response and persistent organ failure. The current mortality rate is still as high as 17%. The course of acute severe pancreatitis can generally be divided into three periods. First, the acute response period, occurring up to about two weeks after onset, is characterized by a systemic inflammatory response. Second, the systemic infection period, from two weeks to about two months, is characterized by infection of pancreatic or peripancreatic necrosis. Third, the residual infection period, occurring two to three months later, where the main clinical manifestation is systemic malnutrition.

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Written by Wu Hai Wu
Gastroenterology
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What should I do if pancreatitis keeps recurring?

After recovering from acute pancreatitis, the recurrence rate varies depending on the cause of the disease. Especially in cases of biliary pancreatitis, if gallstones or bile duct stones are not removed in time, the probability of recurrence of acute pancreatitis is still very high. Therefore, for patients with acute pancreatitis, we must emphasize treating the cause of the condition. For example, surgical removal of the gallbladder or extraction of stones from the bile duct. At the same time, patients should avoid overeating and drinking alcohol, and consume more fresh vegetables and fruits rich in vitamins. Their diet should also be light.

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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 Ren Zheng Xin
Gastroenterology
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Where does pancreatitis hurt?

Pancreatitis refers to the disease caused by the digestion of its own tissues by pancreatic fluid, with the main symptoms being pain, vomiting, and nausea. The pain is generally located in the upper left abdomen and can radiate to the left shoulder or left back. If it is biliary pancreatitis, there is generally pain in the upper right abdomen that gradually moves to the left side, may involve the entire abdomen, and radiates to the back in a belt-like manner. It often occurs suddenly after a full meal or drinking alcohol. The abdominal pain is very severe and unbearable, and active medication treatment should be used. (Specific medications should be used under the guidance of a physician.)