Treatment of acute pancreatitis: drugs, diet, antibiotics, ERCP to surgery

Hydration

One of the primary therapies for acute pancreatitis is adequate early fluid resuscitation, especially within the first 24 hours of onset. Pancreatitis is associated with a variety of edema and inflammation.

Intravenous fluid administration prevents dehydration. It ensures that other organs of the body receive adequate blood flow to support the healing process.

Nutritional support

Initially, no nutrition is given by mouth to rest the pancreas and intestines during the first 24 to 48 hours.

After 48 hours, a plan should be put in place to provide nutrition. Acute pancreatitis is a highly active state of inflammation and injury that requires many calories to support the healing process.

In most cases, patients can start to take food on their own from 48 hours. If this is not possible, then a feeding tube can be used to provide nutrition and introduced through the nose into the intestines.

This method is safer than giving nutrition intravenously. The use of probiotics in acute pancreatitis does not provide any benefit.

Antibiotic therapy

Antibiotics, usually drugs from the imipenem group, should be used in any case of pancreatitis complicated by infected pancreatic necrosis.

However, they should not be given routinely when fever is present, especially early in the course of the disease. This symptom is almost universally secondary to an inflammatory reaction and does not usually reflect an infectious process.

Pain control

Intravenously administered analgesics are effective in controlling the pain associated with acute pancreatitis. Nausea is a common symptom. It may be caused by pancreatitis as well as by bowel retardation.

Effective intravenous medications are available for nausea. Pain and nausea are relieved when the inflammation subsides.

Treatment of underlying problems

In addition to providing supportive care, the underlying causes should be promptly evaluated.

If acute pancreatitis is thought to be caused by gallstones, medications, high triglyceride levels, or high calcium levels in the patient's body, controlled treatment may be instituted.

Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography is a procedure in which a specialist doctor threads a flexible thin tube with a camera attached to the end through the patient's mouth into the first part of the small intestine where the bile ducts and pancreatic duct exit.

Using this device, a small catheter can be inserted into the bile duct to remove gallstones that may have become stuck and caused pancreatitis.

In certain situations, a special catheter can also be inserted into the pancreatic duct to help with the healing of the pancreas.

Considerations for the treatment of severe acute pancreatitis

Necrotizing pancreatitis:

The definition of severe acute pancreatitis includes cases in which part of the pancreatic tissue is no longer viable due to injury. This is called necrosis.

Over time, the body absorbs this dead tissue. However, in some cases, this dead tissue can become a source of infection and can cause a septic condition (shock). Therefore, surgical management is needed in indicated cases.