Treatment of Acute Pancreatitis With Pancreonecrosis
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Acute pancreatitis is an inflammation of the pancreas responsible for producing such vital hormones as insulin and glucagon. It also secretes pancreatic juice, which primarily assists digestion and helps to absorb useful nutrients in the small intestine. Pancreas is located right behind the stomach, which makes it difficult to access it during surgery or to examine it with usual imaging tests. Acute pancreatitis manifests itself primarily in the pancreas. In some cases this condition can be fatal. According to the National Pancreas Association 10% of all acute pancreatitis cases result in death. The most common cause of acute pancreatitis are gallstones. These gallstones create obstruction in the bile duct, which obstructs the flow of pancreatic juice to other organs such as small intestine. Long-term alcoholism and high calcium levels in the blood can also result in acute pancreatitis in some cases. Certain medicines, which did not digest in the blood circulation can cause acute pancreatitis. Previous pancreatic injury or surgery can also be a cause. Approximately 300,000 Americans are diagnosed with acute pancreatitis annually. On average, 20% of these people experience recurrent acute pancreatitis in the years to follow. The most dangerous complication of acute pancreatitis is pancreonecrosis, which is the beginning of pancreatic tissue death, when part of pancreas stops receiving appropriate amount of the blood supply. This is a medical emergency, which requires immediate surgical intervention.
- Upper abdominal pain
- Nausea
- Dizziness
- Vomiting
- Pain radiating to the back or intensifying after food consumption
- Fever
- Quick pulsation
- During a physical examination a doctor will determine by simple palpation the exact source of acute pain.
- Blood test can determine if there is abnormal amount of digestive enzymes of the pancreas in the blood.
- Transabdominal ultrasound is used to determine if there are gallstones, which could have caused development of acute pancreatitis.
- Endoscopic ultrasound also let doctor to examine pancreas and the gallbladder and determine if there is pancreatic inflammation.
- Conservative treatment includes intravenous fluid and nutritional support to expedite the healing process and lower the risk of complications. Pain killers and certain anti-inflammatory drugs can be used to alleviate the pain.
- Surgery is primarily used to remove the gallstones or widen bile duct obstruction if these condition were the one that caused development of an acute pancreatitis.
- Necrosectomy without artificial lung ventilation is used in case acute pancreatitis resulted in pancreonecrosis. Necrosectomy is a surgery whereby the necrotic part of pancreas is resected. After that a person needs to stay in the hospital for several days or weeks until the pancreas adjusts to its reduced size and starts to function properly again.
Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko
