Acute Pancreatitis: Management
- Nutritional support
In patients with mild uncomplicated pancreatitis, no benefit is observed from nutritional support, and the energy (caloric) intake received with IV dextrose 5% in water (D5W) suffices; oral feedings should be initiated once the patient’s pain and anorexia resolve
In patients with moderate-to-severe pancreatitis, begin nutritional support early in the course of management, as soon as stabilization of fluid and hemodynamic parameters permits; optimally, nasojejunal feedings with a low-fat formulation should be initiated at admission
Total parenteral nutrition (TPN) may be required when patients cannot meet their caloric needs with enteral nutrition or when adequate jejunal access cannot be maintained; the TPN solution should include fat emulsions in amounts sufficient to prevent essential fatty acid deficiency
If surgery is required for diagnosis or complications of the disease, place a feeding jejunostomy at the time of the operation; use a low-fat formula
Begin oral feedings once abdominal pain has resolved and the patient regains appetite; the diet should be low in fat and protein.
Antibiotics, usually drugs of the imipenem class, should be used in any case of pancreatitis complicated by infected pancreatic necrosis. However, they should not be given routinely for fever, especially early in the disease course, because this symptom is almost universally secondary to the inflammatory response and typically does not reflect an infectious process.
- For patients with gall stone pancreatitis, cholecystectomy should be performed during the same admission
- Patients with severe acute pancreatitis require intensive care. Within hours to days, a number of complications (eg, shock, pulmonary failure, renal failure, gastrointestinal [GI] bleeding, or multiorgan system failure) may develop. The goals of medical management are to provide aggressive supportive care, to decrease inflammation, to limit infection or superinfection, and to identify and treat complications as appropriate.
- Surgical intervention, whether by minimally invasive or conventional open techniques, is indicated when an anatomic complication amenable to a mechanical solution is present (eg, acute necrotizing pancreatitis in which the necrotic phlegmon is excised to limit the source of sepsis or hemorrhagic pancreatitis in which surgical control of bleeding is warranted). Depending on the situation and local expertise, this may require the talents of an interventional radiologist, an interventional endoscopist, or surgeon (individually or in combination).
- For more information click on the link http://gi.org/physicians/guidelines/AcutePancreatitis.pdf