From the Guidelines
Pancreatitis symptoms include severe upper abdominal pain, nausea, vomiting, fever, and tenderness when touching the abdomen, and if left untreated, can lead to life-threatening complications, therefore, immediate medical attention is necessary. The pain often worsens after eating, especially fatty foods, and may be relieved by leaning forward 1. Acute pancreatitis symptoms typically appear suddenly and severely, while chronic pancreatitis symptoms may develop gradually and persist over time. Other symptoms include:
- Bloating
- Diarrhea
- Oily stools (steatorrhea)
- Unintended weight loss In severe cases, patients may develop:
- Jaundice (yellowing of the skin and eyes)
- Confusion
- Difficulty breathing
- Low blood pressure These symptoms occur because the pancreas becomes inflamed, releasing digestive enzymes that damage the organ itself and surrounding tissues. According to the 2019 WSES guidelines for the management of severe acute pancreatitis, severe acute pancreatitis is associated with persistent organ failure and high mortality, and both the Revised Atlanta Classification and Determinant-based Classification of Acute Pancreatitis Severity are similar in establishing the diagnosis and severity of acute pancreatitis 1. Patients who have persistent organ failure with infected necrosis have the highest risk of death, and should be admitted to an intensive care unit whenever possible. Treatment typically involves hospitalization for pain management, intravenous fluids, and fasting to rest the pancreas. Identifying and addressing the underlying cause, such as gallstones or alcohol use, is essential for preventing recurrence 1.
From the Research
Pancreatitis Symptoms
- The symptoms of pancreatitis include epigastric abdominal pain, elevated lipase, and imaging findings of pancreatic inflammation 2
- The diagnosis of pancreatitis requires two of the following three criteria: epigastric abdominal pain, an elevated lipase, and imaging findings of pancreatic inflammation 2
- Patients with acute pancreatitis may present with varying degrees of severity and may lead to significant morbidity and mortality 3
Common Etiologies
- The most common etiologies of pancreatitis include gallbladder disease and alcohol use 2
- Other etiologies may include biliary pancreatitis, which should be treated with cholecystectomy during the same admission to prevent future acute pancreatitis episodes 3, 4
- Patients with acute pancreatitis secondary to alcohol should receive alcohol counseling 3
Management and Treatment
- The initial management of choice for pancreatitis is fluid resuscitation and pain control 2
- Recent data have suggested that more cautious fluid resuscitation in the first 24 hours might be more appropriate for some patients 2
- Early oral feeding should be encouraged, and the use of parenteral nutrition is discouraged 3, 4
- Prophylactic antibiotic administration is recommended to prevent infectious complications in patients with severe acute pancreatitis 5
- Enteral feeding is superior to parenteral nutrition when it comes to the nutritional support of patients with severe acute pancreatitis 5