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Acute pancreatitis: Difference between revisions
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The most common causes are alcoholism and gallstones in the biliary tract distal to the pancreatic duct. These two factors are responsible for 80% of all cases of acute pancreatitis. | The most common causes are alcoholism and gallstones in the biliary tract distal to the pancreatic duct. These two factors are responsible for 80% of all cases of acute pancreatitis. | ||
There are multiple possible causes, memorised by the acronym ''GET SMASHED'' | There are multiple possible causes, memorised by the acronym "''I GET SMASHED"'' | ||
* Idiopathic | |||
* [[Gallstone disease|Gallstones]] | * [[Gallstone disease|Gallstones]] | ||
* [[Alcohol|Ethanol]] (Alcoholism) | * [[Alcohol|Ethanol]] (Alcoholism) | ||
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== Treatment == | == Treatment == | ||
Management of acute pancreatitis is conservative and supportive. This involves pain control, IV fluids, correction of electrolyte and metabolic abnormalities | Management of acute pancreatitis is conservative and supportive, as it's usually self-limiting. This involves pain control, IV fluids (large amounts), and correction of electrolyte and metabolic abnormalities. Mild (oedematous) pancreatitis is self-limited, and so these measures are usually sufficient, and the patient recovers within a week. Feeding should be initialised early but slowly with a soft diet when the pain is decreasing and the inflammatory markers are improving. In more severe cases, the patient should be nil per os (no oral feeding). | ||
Patients with severe pancreatitis require <abbr>NPO</abbr> for longer time, and so should receive a nasojejunal or nasogastric tube for feeding (rather than parenteral nutrition) for long-term NPO. ''Up until recently, it was believed that food had to be delivered distally to the sphincter of Oddi to prevent the food from stimulating the pancreas. However, it | Patients with severe pancreatitis require <abbr>NPO</abbr> for longer time, and so should receive a nasojejunal or nasogastric tube for feeding (rather than parenteral nutrition) for long-term NPO. ''Up until recently, it was believed that food had to be delivered distally to the sphincter of Oddi to prevent the food from stimulating the pancreas. However, it has recently been established that feeding through nasogastric tube does not stimulate the pancreas either.'' | ||
Local complications should only be treated if they become infected, never if they’re sterile. This involves antibiotic therapy and percutaneous or endoscopic drainage. Surgery is a last-line option. | Local complications should only be treated if they become infected, never if they’re sterile. This involves antibiotic therapy and percutaneous or endoscopic drainage. Surgery is a last-line option. | ||