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pancreatitis
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.
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.
Severe pancreatitis diagnostic criteria
Diagnostic criteria for severe pancreatitis: First, based on the patient's clinical symptoms, symptoms such as restlessness, cold limbs, and mottled skin, indicative of shock, may appear. Second, physical examination signs, such as rigid abdominal muscles indicative of a positive peritoneal irritation sign, and Grey Turner's sign may also be present. Third, according to laboratory tests, the calcium levels generally significantly decrease, usually below 2 mmol/L, and elevated blood sugar levels greater than 11.2 mmol/L, typically without a history of diabetes. There may also be a sudden decrease in urine amylase. Fourth, diagnostic abdominal paracentesis reveals ascitic fluid with high amylase activity. Based on these points, severe pancreatitis can be considered.
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.
What fruits can you eat with pancreatitis?
Patients with pancreatitis can eat some mild fruits, such as apples, bananas, peaches, kiwis, and strawberries. It is best to avoid more acidic fruits like oranges, lemons, and hawthorns. For cooler fruits, they can be soaked in warm water for a certain period before eating. Also, regardless of the type of food, fruit, or daily diet, it is important not to overeat.
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.
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.
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.)
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.
Pancreatitis is what?
Pancreatitis is a relatively common disease in gastroenterology, generally believed to be caused by various factors leading to the activation and autodigestion of the pancreas itself, resulting in inflammatory changes in the pancreas. Common causes include bile duct stones, alcohol consumption, and overeating, among others. Clinically, it is most commonly presented with symptoms such as abdominal pain, bloating, nausea, and vomiting. Fever may also accompany these symptoms. The diagnostic criteria for pancreatitis generally include three standards: The first is typical upper abdominal pain, persistent upper abdominal pain; the second is a blood test showing blood amylase levels more than three times the normal value; the third involves typical abdominal imaging, such as ultrasound, CT, or MRI, indicating imaging changes like pancreatic effusion. If two out of these three criteria are met, pancreatitis can generally be diagnosed.