In milder cases treatment of acute pancreatitis consists of hospitalizing the patient and placing the patient on intravenous fluids without any fluids or food by mouth.
By fasting, the gut rests and the gastrointestinal tract ceases to produce secretin and cholecystokinin, two hormones that would have stimulated the pancreas to produce lots of pancreatic juice. A nasogastric tube is being used to suck out any gastric juice as this too will help to settle the pancreatic activities.
Some mortality statistics of acute pancreatitis
Often within a few days the pancreatitis settles down. For most cases the mortality rate is less than 4 to 5%. However, the severe cases described above can have a mortality rate of 15 to 20%. Simchuk et al.( Ref. 6) found that with a CT severity index of 5 or more patients were 17 times more likely to have a longer hospital stay.
They were 10 times more likely to need surgery (resection of dead tissue called “necrosectomy”) and 8 times more likely to die from their severe acute pancreatitis. In these more severe cases treatment needs to be done in the ICU setting and people need to fast for 2 to 4 weeks. This usually requires intravenous nutrition. These patients often have cardiovascular complications due to pancreatic enzymes that have leaked into the system.
Complications of acute pancreatitis
Lung function is suboptimal as lung tissue is very sensitive to phospholipase A2, which originated from the pancreas and traveled via the blood steam to the lungs and damaged them in the process. Blood sugar values have to be watched as in these severe cases the endocrine apparatus in the pancreas( the Langerhans cells) is also damaged. On the other hand blood sugars must not be controlled too closely as these patients are extremely sensitive to developing low blood sugar (hypoglycemia) after insulin injections. This is so because glucagon, another pancreatic hormone which stabilizes blood sugar, is usually no longer produced in the pancreas after severe damage. Many times, because of tissue damage around the pancreas there is leakage of bacteria from the gut such as E. coli and this can quickly lead to a dangerous sepsis and shock.
Treatment Of Acute Pancreatitis
Intravenous antibiotics and tissue necrosis
Intravenous antibiotics have to be utilized and all of the medical staff have to work very hard to rescue this very sick patient. You can easily see that often so many problems happen at the same time that there one point is easily reached beyond which there is no more help. If there is a sign that the patient might be helped with surgery, a CT scan is usually done, the amount of fluid around the pancreas and the area of tissue necrosis is defined. Ref. 8 showed that the fluid in the vicinity of the pancreas was a better predictor to decide to do surgery than the amount of dead pancreatic tissue.
Minimum procedure to remove dead tissue
This helps the surgeon to plan the appropriate procedure. Often the best procedure is to just do the minimum that has to be done to remove dead tissue and to drain the pancreas into a nearby bowel structure. There are some more fancy Latin words (more doctor language) for some of these procedures, but this would be too technical.
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