From the Guidelines
Viral pancreatitis should be managed with a supportive treatment approach, focusing on pain management, hydration, and bowel rest, as antiviral medications are rarely indicated except in specific cases. The management of viral pancreatitis involves a multidisciplinary approach, considering the patient's overall condition and the severity of the disease. According to the most recent guidelines 1, the management of severe acute pancreatitis, which can be caused by viral infections, includes:
- Enteral nutrition (oral, NG, or NJ) and parenteral nutrition if not tolerated
- IV pain medications
- Early fluid resuscitation
- Mechanical ventilation if necessary It is essential to note that prophylactic antibiotics are not recommended for all patients with acute pancreatitis, as they are not associated with a significant decrease in mortality or morbidity 1. However, antibiotics are always recommended to treat infected severe acute pancreatitis. In cases of infected pancreatic necrosis, percutaneous drainage as the first line of treatment (step-up approach) is recommended, as it can delay the surgical treatment to a more favorable time or even result in complete resolution of infection in 25–60% of patients 1. Minimally invasive surgical strategies, such as transgastric endoscopic necrosectomy or video-assisted retroperitoneal debridement (VARD), can result in less postoperative new-onset organ failure but require more interventions 1. The treatment approach should be individualized, taking into account the patient's specific condition, local expertise, and the severity of the disease. In terms of outcome measures, it is essential to consider not only mortality but also complete resolution of symptoms, quality of life, time to return to normal daily activities or work, and the need for further interventions 1. Overall, the management of viral pancreatitis requires a supportive and individualized approach, focusing on the patient's overall condition and the severity of the disease.
From the Research
Definition and Causes of Viral Pancreatitis
- Viral pancreatitis is not explicitly defined in the provided studies, but acute pancreatitis is described as a common gastrointestinal disease leading to hospitalization 2.
- The causes of acute pancreatitis include gallstones, ethanol, hypertriglyceridaemia, and drugs, with viral infections being a possible cause, although not explicitly mentioned in the provided studies 3.
Diagnosis and Treatment of Viral Pancreatitis
- The diagnosis of acute pancreatitis requires two of the following: upper abdominal pain, amylase/lipase ≥ 3 × upper limit of normal, and/or cross-sectional imaging findings 3.
- Treatment priorities include intravenous fluid resuscitation, analgesia, and enteral nutrition, with critical care and organ support, parenteral nutrition, antibiotics, and pancreatic exocrine and endocrine replacement therapy as needed 3.
- Patients with local complications, such as pancreatic pseudocysts or walled-off necrosis, may require endoscopic management, including drainage and/or necrosectomy 4, 5.
Complications and Management of Viral Pancreatitis
- Acute pancreatitis can lead to complications such as pancreatic pseudocysts, walled-off necrosis, and abdominal compartment syndrome, which require prompt recognition and management 5, 6.
- Endoscopic transmural drainage followed by necrosectomy is a recommended treatment strategy for patients with symptomatic or infected walled-off pancreatic necrosis 5.
- The management of acute pancreatitis should be personalized, with a focus on early phase medical interventions, supportive treatment, and minimally invasive interventions for infected necrosis 2.