How to take care of acute pancreatitis

Written by Wu Hai Wu
Gastroenterology
Updated on September 01, 2024
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Patients with pancreatitis should pay attention to their diet during the recovery period. The basic dietary principle for pancreatitis patients is to consume small amounts of easily digestible foods, with low protein and fat content, primarily carbohydrates. During acute episodes, it's crucial to strictly control the intake of fatty foods. Once the condition has improved, patients may gradually consume protein-rich, high-vitamin, high-carbohydrate foods, along with non-irritating, easily digestible foods. Patients should avoid consuming large amounts of meat and alcohol, and can eat rice soup, lotus root starch, noodles, etc.

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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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How to check for pancreatitis?

Pancreatitis can cause acute abdominal pain, along with symptoms of nausea and vomiting, and severe cases can lead to hypotensive shock. In laboratory tests, the diagnosis is generally made by assessing serum or urine amylase levels. An amylase level that exceeds three times the normal value can diagnose pancreatitis. Additionally, ultrasound and CT scans can reveal an enlarged or exuding pancreas, and the presence of a small amount of fat necrosis around the pancreas can be diagnosed as pancreatitis. The onset time of serum amylase in pancreatitis varies; typically, serum amylase begins to increase between 6 and 12 hours and starts to decline after 48 hours, and can be detected within 3 to 5 days. Lipase levels typically start to rise between 24 to 72 hours and remain elevated longer, up to 7 to 10 days. Thus, lipase has diagnostic value for later stages of pancreatitis and tends to have higher specificity compared to amylase.

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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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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.

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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.