From the Guidelines
Abdominal distension in pancreatitis is primarily caused by inflammation of the pancreas leading to paralytic ileus, third-spacing of fluids, and direct irritation of the peritoneum. The pathophysiology of abdominal distension in pancreatitis involves several interconnected mechanisms. Inflammation of the pancreas leads to the release of pancreatic enzymes and inflammatory mediators that cause local and systemic inflammation, resulting in paralytic ileus (decreased intestinal motility) 1. This reduced gut movement allows gas and fluid to accumulate in the intestines. Additionally, third-spacing of fluids occurs as inflammation increases vascular permeability, causing fluid to leak into the peritoneal cavity and retroperitoneal spaces. Pancreatic inflammation can also directly irritate the peritoneum, further contributing to distension. Some key points to consider in the management of abdominal distension in pancreatitis include:
- Inflammation of the pancreas and the release of pancreatic enzymes and inflammatory mediators play a crucial role in the development of abdominal distension
- Paralytic ileus and third-spacing of fluids are key mechanisms contributing to abdominal distension
- Direct irritation of the peritoneum by pancreatic inflammation also contributes to distension
- The use of jejunal administration of nutrients may help reduce pancreatic secretory responses and alleviate abdominal distension 1
- Management of abdominal distension in pancreatitis should focus on treating the underlying inflammation and addressing the associated complications, such as paralytic ileus and third-spacing of fluids.
From the Research
Causes of Abdominal Distension in Pancreatitis
- Abdominal distension in pancreatitis can be caused by various factors, including inflammation of the pancreas, fluid accumulation, and intestinal obstruction 2.
- The revised Atlanta classification states that acute pancreatitis can be diagnosed if at least 2 of the following 3 criteria are fulfilled: abdominal pain, serum lipase (or amylase) activity at least 3 times the upper limit of normal, or characteristic findings of acute pancreatitis on contrast-enhanced computed tomography (CT) or other imaging modalities 2.
- In some cases, abdominal distension may occur even with normal lipase and amylase levels, making diagnosis more challenging 2.
- Diagnostic imaging, such as CT scans, is essential in patients with no or slight enzyme elevation to confirm the diagnosis of acute pancreatitis and rule out other life-threatening disorders 2.
Management of Abdominal Distension in Pancreatitis
- Treatment of abdominal distension in pancreatitis typically involves fasting, gastrointestinal decompression, bowel rest, intravenous rehydration, and somatostatin 2.
- Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis, with lactated Ringer's solution being a preferred choice over normal saline due to its ability to reduce systemic inflammation 3.
- Early feeding and minimally invasive approaches to infected necrosis are also important aspects of managing acute pancreatitis 4.