What can be eaten with severe pancreatitis?

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 02, 2024
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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.

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Written by Wei Shi Liang
Intensive Care Unit
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Severe pancreatitis symptoms

Severe pancreatitis, due to different stages of pathological changes, presents diverse systemic responses. Generally, mild symptoms of pancreatitis include abdominal pain, nausea, vomiting, and fever. In severe pancreatitis, apart from these symptoms, due to bleeding, necrosis, and autolysis of the pancreas, additional symptoms such as shock, high fever, jaundice, abdominal distension, and paralytic ileus, peritoneal irritation signs, and subcutaneous ecchymosis may also occur. Abdominal pain is the earliest symptom, while nausea and vomiting are manifestations due to inflammatory factors stimulating the vagus nerve. The likelihood of jaundice is relatively low in acute edematous pancreatitis but is more common in severe pancreatitis. Extensive inflammatory exudation in the pancreas can lead to pancreatic necrosis and localized abscesses, which may cause varying degrees of fever increase.

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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 Wang Li Bing
Intensive Care Medicine Department
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Principles of Treatment for Severe Pancreatitis

The treatment principles for severe pancreatitis mainly include the following points: First, closely monitor the patient's heartbeat, respiration, blood pressure, blood oxygen, etc., and if possible, transfer them to the intensive care unit. Second, maintain electrolyte balance and blood volume, and actively rehydrate. Third, enhance nutritional support, which can include parenteral nutrition outside of gastrointestinal digestion. Fourth, routinely use antibiotics in severe pancreatitis to prevent infection from necrotizing pancreatitis. Fifth, reduce the secretion of pancreatic fluid, inhibit the synthesis of pancreatic enzymes, and suppress the activity of pancreatic enzymes. If the patient develops an infection associated with pancreatic necrosis, consider surgical treatment, etc.

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Written by Zhu Dan Hua
Gastroenterology
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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.

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Written by Chen Rong
Gastroenterology
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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.)