Symptoms of severe pancreatitis

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 26, 2024
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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.

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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.

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Written by Li Xue Qing
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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.

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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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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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How many days of fasting for acute pancreatitis?

The duration for which patients with acute pancreatitis must fast is determined by the severity of their condition. Some may only need to fast for a day or two, while others may require around three to four days, or even a week. In severe cases of acute pancreatitis, it might be difficult to say how long the fasting could last, potentially around two weeks. Once patients with pancreatitis start eating after a series of active treatments such as anti-infection measures, inhibiting pancreatic secretion, replenishing electrolytes, and balancing acid-base levels, and following treatments like using rhubarb to facilitate bowel movements, if their bowel movements and gas expulsion have mostly returned to normal and amylase levels have largely normalized, they can cautiously start consuming low-fat, high-vitamin, and high-calorie liquid foods.