How Pancreatitis is Treated
An early and accurate diagnosis is critical in treating acute pancreatitis. The Ranson Criteria and APACHE II scores measure the severity the patient’s condition and partially predict recovery.
75% of patients with acute pancreatitis will improve within 3-7 days with supportive therapy and recover without mortality or major morbidity. Therefore, treatment is determined based on the severity of the attack.
Admission to the Hospital
All patients with pancreatitis should be admitted to the hospital; closely observed; given intravenous fluids for rehydration and replacement of calcium, magnesium, and potassium; and be continually monitored for evidence of continued dehydration.
Patients with mild pancreatitis should have blood pressure, pulse rate, and urine output monitored.
Patients with severe pancreatitis who are considered high risk for developing complications should undergo individualized invasive monitoring in the intensive care unit (ICU).
Medication and Pain Relief
Pancreatitis can cause severe pain. Meperidine or Demerol is generally considered the best choice for pain relief. Morphine may worsen acute pancreatitis.
Many treatments for pancreatitis have been proposed, however no single drug or therapy is known to work on all patients. Malabsorption (poor digestion) can be treated with oral tablets that contain pancreatic enzymes.
Food and Liquid
In order for the pancreas to heal it needs to rest, and the best way to rest the pancreas is to not eat.If the patient has nausea and vomiting a nasogastric tube can be inserted through the nose, down the back of the throat, through the esophagus and into the stomach to provide symptomatic relief.
As the patient recovers, pain will resolve and amylase and lipase levels should return to normal. At that time the patient can begin eating by mouth, beginning with clear liquids and eventually a low-fat diet.
Patients with severe pancreatitis treated in an ICU will likely remain in the hospital for several weeks. The recovery of the pancreas should be evaluated with CT scans. If the pancreas does not begin to heal quickly the patient will need to be fed intravenously with hyperalimentation or total parenteral nutrition (TPN).
If the pancreas is severely injured or becomes necrotic antibiotics should be administered to prevent infection. Some patients develop kidney or lung failure and may require dialysis or be placed on a respirator.
Acute pancreatitis is generally not treated surgically unless it can help prevent future attacks or treat complications. Some patients with severe pancreatitis develop complications such as pseudocysts or infection in the diseased pancreas. These complications will most likely require surgery and should be performed by an experienced surgeon in a hospital with an extensive support staff.
Occasionally surgery can be used in patients with chronic pancreatitis to correct problems in the pancreas that cause pain, though the procedure is not always successful. Surgery may also be used to limit pancreatic duct obstruction in chronic patients, with the hope of limiting destruction of the gland.