Severe pancreatitis complications

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 06, 2024
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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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Written by Yang Chun Guang
Gastroenterology
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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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What can be eaten with severe pancreatitis?

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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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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Written by Wang Li Bing
Intensive Care Medicine Department
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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.

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Written by Zhu Dan Hua
Gastroenterology
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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.