Severe pancreatitis is what disease

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 23, 2024
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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 Li Qiang
Intensive Care Unit
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How do you get acute severe pancreatitis?

There are many causes of acute severe pancreatitis, and the mechanisms of onset are not completely the same. Biliary pancreatitis is caused by small gallstones falling into the bile duct, becoming lodged at the distal end of the duct. At this time, the opening of the pancreatic duct is blocked, causing a disorder in pancreatic juice secretion, increasing pancreatic duct pressure, and spilling out of the pancreatic duct. This can corrode pancreatic cells and other abdominal organ cells. Alcohol and drug-induced pancreatitis is due to the direct damage of alcohol and drugs to the pancreatic cells, causing the leakage of pancreatic secretions. Overeating-induced pancreatitis is caused by consuming too much food at once, especially a high-fat diet, leading to a massive secretion of pancreatic juice. If there is an obstacle in the expulsion of this juice, it can also lead to pancreatitis. Hyperlipidemic pancreatitis is caused by excessively high blood lipid levels, which form blockages. These lipids obstruct the secretion of the pancreatic duct, causing pancreatitis. In all types of pancreatitis, the leakage of pancreatic secretions corrodes the pancreatic cells and these secretions enter the abdominal cavity, corroding abdominal organs and leading to a series of severe inflammatory responses and potentially leading to abdominal infections.

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What medicine is used for pancreatitis?

In clinical practice, it is advised that patients with pancreatitis be hospitalized for treatment. The primary medications used during hospitalization mainly involve nutritional support, as patients with pancreatitis cannot eat and must refrain from ingesting food and water, necessitating the supplementation of water and electrolyte balance. Treatment primarily consists of using medications that reduce pancreatic secretion, such as choosing octreotide or similar drugs. Other drugs can be combined to inhibit pancreatic enzyme activity. However, while using these medications, it is important to consider using antibiotics to prevent infections in cases of pancreatitis. Overall, it is crucial to receive standardized treatment in a hospital for pancreatitis, as the condition can change rapidly and is relatively dangerous. (The use of medications should be under the guidance of a doctor.)

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Written by Wei Shi Liang
Intensive Care Unit
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Severe pancreatitis intestinal nutrition

In different stages of severe pancreatitis, the energy requirements vary. At the early onset of the disease, the principle of nutritional support is to provide the minimum metabolic substrates needed to maintain basic metabolic demands, correct metabolic disorders, and minimize protein loss to a reasonable level. Caloric provision should be between 20 to 25 kcal per kilogram per day. As the condition progresses, the focus of nutritional support gradually shifts towards increasing or balancing nutrient intake. Early intervention using jejunal tube feeding is considered safer. Formulas used should be tolerable by the intestines; initially, glucose water is used to help the intestines adapt to nutrition. Early use of low-fat formulas containing amino acids or short peptides is advisable. Additionally, whole proteins, after being digested by stomach acid and entering the intestines directly, may lead to poor absorption.

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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 Criteria

Acute pancreatitis with persistent organ failure lasting more than 48 hours is considered severe pancreatitis. In the early stages of the disease, organ failure starts with a systemic inflammatory response produced by the activation of a cytokine cascade, involving the continuous failure of single or multiple organs. Such patients often have one or more local complications, with organ failure that can persist for several days after onset. The mortality rate can reach 36% to 50% once organ failure occurs. Infections in such patients can dramatically increase the mortality rate. CT imaging may show gas bubbles in peripancreatic necrotic tissue and fluid collections. Diagnosis is confirmed by positive results from either a smear of aspirate obtained via image-guided fine-needle aspiration or from bacterial cultures.