The treatment of pancreatitis depends on its modality and clinical evolution. Pancreatitis can be acute or chronic. Each of them requires specific management, which can vary in the event of complications.
Acute pancreatitis is a hospital emergency, in that it can cause pancreatic tissue destruction, edema and the passage of toxins and enzymes into the blood. In that case, the treatment of pancreatitis could require surgery.
Chronic pancreatitis has a slower evolution, and therefore the treatment is mainly aimed at improving the quality of life of the patient. However, episodes of acute pancreatitis during the course of this disease are not ruled out.
Treatment of acute pancreatitis
The treatment of acute pancreatitis is carried out in the hospital. The first option is to perform a conservative management, that is, without surgery. If the inflammation is mild, it is usual to apply only support measures during the first week. These include absolute diet, intravenous rehydration, and administration of analgesics.
The measures frequently used in the treatment of acute pancreatitis that does not present complications are the following:
- Analgesia or analgesic administration
- Pancreatic rest. The fasting Total is the first step to take and held until the pain subsides. Then, a progressive, low-fat diet should be applied
- Fluidotherapy. Rehydration is one of the fundamental support measures and the main factor to avoid complications. It must be applied parenterally
- Antiproteases. Administer pancreatic protease inhibitors, lipases, and antisecretory drugs
Management of metabolic alterations. Hyperglycemia, hypocalcemia, and hyponatremia should be controlled
- Antibiotics. They are used to prevent abscesses and control the infection of pancreatic necrosis in the most complicated cases
- Endoscopic papillotomy. It is a diagnostic procedure that is performed with endoscopy and allows to determine the state of the bile ducts, to confirm or rule out an obstruction. Also, eventually, it allows eliminating gallstones
- Peritoneal washes. It is a therapeutic maneuver that allows determining with precision if surgical intervention is required. A variant of this procedure allows draining fluids from the pancreas
In summary, the treatment of acute pancreatitis includes administration of analgesics, total fasting and intravenous administration of fluids, nutrients, and electrolytes. If the patient improves, they are given food progressively, avoiding fats, alcohol, and coffee. If the situation is complicated, the need for surgery should be evaluated.
Surgery in the treatment of pancreatitis
If the conservative treatment does not show results for more than five days, the indicated thing is to perform an early surgery. The signs that a surgical intervention is necessary are massive pancreatic hemorrhage, intestinal perforation, pancreatic necrosis of more than 50% that persists and pancreatic abscess, among others.
The use of surgery is controversial as a treatment for pancreatitis. Surgical intervention causes a significant level of morbidity and mortality, especially in cases of pancreatitis of biliary origin. Some studies show that the efficacy of early surgery is equal to that of peritoneal lavages.
The surgical techniques used depend on the patient’s condition. They are of three types: necrosectomy with drainage, necrosectomy with washing and open drainage with packing. The first procedure yields a mortality rate of 25%. The second, of 8% and the third oscillates between 11% and 55%.
Treatment of chronic pancreatitis
The objectives of the treatment of chronic pancreatitis are those of avoiding complications and improving the quality of life of the patient. It is mainly based on the control of pain, diabetes mellitus, and malabsorption.
The most important thing is to rest the pancreas, using a light diet. It should completely eliminate alcohol consumption and maintain a healthy lifestyle.
Short-acting analgesics are used to control pain. It has been shown that local anesthetics and corticosteroids are suitable for the treatment of chronic pancreatitis. As the pancreas loses its functionality, at some point it is necessary to administer enzymes orally.
Any healthy person can suffer an episode of pancreatitis. People with gallbladder problems are more likely to develop them, as well as those who consume alcohol. The evolution of pancreatitis is very unpredictable. It ranges from a slight difficulty to death. It is estimated that at least 25% of those who suffer an episode of pancreatitis present complications during the course of the disease.