What is the treatment for acute pancreatitis?
The goals of treatment of acute pancreatitis are to alleviate pancreatic inflammation and to correct the underlying cause. Treatment usually requires hospitalization for at least a few days. The specific treatment measures used depend upon whether a person has mild or moderate to severe pancreatitis. Treatment for acute pancreatitis depends on the severity of the condition. Sometimes the patient needs hospitalization with administration of intravenous fluids to help restore blood
volume. Antibiotics are often prescribed if infection occurs and pain medications are often used to provide relief. Surgery is sometimes needed when complications such as infection, cysts or bleeding occur).
Mild pancreatitis is typically self-limited, and the symptoms usually resolve with simple supportive care, which entails monitoring, drugs to control the pain, and intravenous fluids. Although doctors typically discourage eating during the first few days, most people with mild pancreatitis are able to gradually resume eating within five to seven days. Moderate to severe pancreatitis requires more extensive monitoring and supportive care. In cases of necrotizing pancreatitis, treatment may also entail antibiotics and surgery.
People with severe acute pancreatitis generally are admitted to an intensive care unit, where vital signs (pulse, blood pressure, and rate of breathing) and urine production can be monitored continuously. Blood samples are repeatedly drawn to monitor various components of the blood, including hematocrit, sugar (glucose) levels, electrolyte levels, white blood cell count, and amylase and lipase levels. A tube may be inserted through the nose and into the stomach to remove fluid and air, particularly if nausea and vomiting persist and gastrointestinal ileus is present.
About 30 percent of people with severe acute pancreatitis will develop an infection of the damaged pancreatic tissue. Antibiotics can prevent this infection and control infections that are already present. Studies have shown that antibiotics reduce the likelihood of infection and death in people with severe necrotizing pancreatitis. This treatment may entail intravenous antibiotics and oral antibiotics. Because these antibiotics increase the risk of fungal infection, treatment may also include antifungal drugs.
Acute pancreatitis is sometimes complicated by extensive damage to the pancreatic tissue and/or infection. In these cases, doctors usually recommend removal of the damaged and/or infected tissue, a procedure referred to as a "necrosectomy." It can be performed by open surgical procedure or at times by less invasive procedures, e.g., endoscopic or radiologic placement of drainage tubes into the area. Whether the procedure should be done surgically or by a non-surgical procedure depends upon the clinical condition of the patient and the expertise available in the hospital.
Most gallstones that cause attacks of acute pancreatitis clear on their own, but some stones cause prolonged blockage that leads to complications. In people with gallstone pancreatitis who also have jaundice (yellowing of the skin) or a gallbladder infection, a procedure called endoscopic papillotomy can be used to quickly relieve the obstruction. In contrast, this procedure is not necessary for people who have already passed their gallstones. Because many patients are very ill, doctors sometimes place a stent (a thin plastic tube) to drain the obstructed bile duct rather than attempting to remove the stone. Placement of a stent is usually faster and safer than endoscopic papillotomy.
Gallstone pancreatitis recurs in 30 to 50 percent of people after an initial attack of pancreatitis. Doctors usually recommend cholecystectomy (surgical removal of the gallbladder) to prevent this recurrence. This surgery can now be performed through a tiny incision in the abdominal wall, a procedure called laparoscopic cholecystectomy. During surgery, the ducts joining the gallbladder, pancreas, and small intestine are examined for residual gallstones. If any stones remain after surgery, they can be detected and removed during endoscopic retrograde cholangiopancreatography (ERCP).