Treatment Information Summary for Acute Pancreatitis

1. Definition

Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas caused by abnormal activation of pancreatic enzymes within the pancreas due to various underlying causes. This process can result in local tissue injury, damage to surrounding organs, or systemic inflammation leading to multiple organ failure. Depending on its severity, ranging from mild to severe, AP can cause serious complications and may be life-threatening. Approximately 10–15% of cases progress to severe disease, with an overall mortality rate of approximately 5%.

2. Causes

• Alcohol consumption (30–45%).
• Gallstones (30–45%).
• Hypertriglyceridemia (10–30%).
• Other causes (10%), including medications, trauma, endoscopic retrograde cholangiopancreatography (ERCP), infection, metabolic disorders, obstruction, cancer, genetic factors, and others.

2.1. Classification and Severity

Acute pancreatitis can vary in severity, ranging from mild inflammation and swelling of the pancreas to severe forms associated with pancreatic hemorrhage and necrosis. AP is generally classified into three levels of severity: mild, moderately severe, and severe.

3. Diagnosis of Acute Pancreatitis

3.1. Diagnosis of AP Is Based on the Following Criteria

• Acute abdominal pain: sudden-onset pain in the epigastric region, often radiating to the back, accompanied by nausea and vomiting. Vomiting does not relieve the pain.
• Elevated pancreatic enzymes: serum lipase or amylase levels ≥3 times the upper limit of normal.
• Imaging findings consistent with AP: detected by abdominal ultrasonography, contrast-enhanced CT scan, or MRI.

3.2. Differential Diagnosis

AP should be differentiated from other causes of acute abdominal pain, including:

• Peptic ulcer disease, perforation of a hollow viscus, acute cholecystitis, cholangitis, and others.
• Complications of AP.
• Peripancreatic fluid collections.
• Infected pancreatic necrosis.
• Multiple organ failure, including respiratory failure, renal failure, and circulatory failure.
• Pancreatic pseudocyst, including infection, rupture, bleeding into the pseudocyst, compression of adjacent organs, or pain.
• Pancreatic abscess.

4. Treatment

• Temporary restriction of oral intake: In the initial phase, oral intake may be temporarily withheld in selected patients, with oral feeding resumed early as soon as tolerated and when abdominal pain and nausea/vomiting improve. Nasogastric tube placement may be considered in patients with significant abdominal distension or persistent vomiting. Current guidance supports early oral feeding in mild AP rather than routine prolonged fasting.
• Intravenous fluid therapy: Intravenous fluids, preferably isotonic crystalloid solutions such as lactated Ringer’s solution when appropriate, are administered to maintain hydration and electrolyte balance and to support circulation. Fluid status should be closely monitored, particularly during the first 6–12 hours.
• Pain relief: Paracetamol may be administered for pain relief and fever reduction when appropriate. Stronger analgesics, such as meperidine or fentanyl, may be administered by intravenous or intramuscular injection for severe pain, according to the physician’s assessment.
• Reduction of pancreatic secretion: Octreotide may be administered subcutaneously in selected cases of severe AP according to the treating physician’s assessment.
• Acid suppression: Acid-suppressive medications may be used when clinically indicated.
• Antibiotics: Antibiotics are not routinely recommended for uncomplicated AP or sterile pancreatic necrosis. They should be used when there is evidence or strong suspicion of infection, including infected pancreatic necrosis.
• Management of severe AP: Patients with severe AP and signs of persistent organ failure should be treated in an intensive care setting. Depending on the clinical condition, treatments may include renal replacement therapy, plasma exchange, mechanical ventilation, and other supportive measures.
• Treatment of the underlying cause and complications: ERCP may be performed to remove obstructing bile duct stones when AP is associated with biliary obstruction or acute cholangitis. Drainage or minimally invasive intervention may be required for infected or symptomatic fluid collections, pancreatic necrosis, or pseudocysts. Surgical intervention may be considered when clinically indicated.

5. Prevention of Acute Pancreatitis

• Limit or discontinue alcohol consumption if AP is alcohol-related.
• In gallstone-related AP, cholecystectomy should be considered to prevent recurrence, with the timing determined according to the severity of the disease and the patient’s clinical condition.
• Use lipid-lowering medications when indicated, control blood glucose levels, maintain a balanced diet, and limit foods high in sugar and fat.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.