Treatment of acute pancreatitis

For acute pancreatitis, initial treatment is conservative.

Analgesics, spasmolytics. Narcotic analgetics are dangerous in patients with acute pancreatitis because of Oddi’s sphincter constriction.

Relief of vomiting. Drainage of the stomach with a probe, metaclopramid (cerucal, reglan) 10–20 mg; osetron (ondansetron, navoban, tropisetron).

Fluid replacement. The most important requirement in the early treatment of pancreatitis is maintenance of adequate hydration. If the patient becomes hypovolaemic, and the splainchnic circulation is compromised, the pancreas may become ischaemic, with the potential for the development of complicated pancreatitis.

With considerable reduction of arterial blood pressure – dopamine 5–7 mkg/kg of the body weight; for relief of angiospasm – benzohexamethonium 0.15 mg / kg of the body weight or pentamine 0.25 – 0.3 mg/kg of the body weight every 6 hours; for reduction of vascular permeability – hydrocortisone 1000–1500 mg/day.

Treatment of hypoxaemia. Fluid replacement, normalization of peripheral microcirculation is adequate in majority of patients. In the most severely ill patients intubation and ventilatory support is indicated.

Minimizing of pancreatic secretion

Bowel rest, nasogastric tube.

Local hypothermia.

H2-receptor or H-pomp blockers. They are useful for inhibition of pancreatic enzymes secretion and prevention of acute upper digestive tract ulcerations.

Atropine.

5-ftoruracyl (500 mg /d).

Nutritional support. Patients with severe acute pancreatitis often cannot be fed for several days. Once severe pancreatitis has developed total parenteral nutrition should be instituted. Intravenous fat emulsions do not exacerbate pancreatitis in patients with normal triglyceride levels. If triglyceride levels are raised, however, fat emulsion should not be used. Total parenteral nutrition should be continued until the patient appears clinically well.

Antibiotic therapy. Antibiotics are generally ineffective in preventing the late septic complications of acute pancreatitis, and their use may even promote selection of organisms that are more difficult to treat later on. The best variants are:

• third and fourth generations of cephalosporin;

• quinolones and metronidazole;

• carbapenems.

Antiprotease therapy. Gordox, Contrical. They are useful and effective only as inhibitors of kinins.

Treatment of metabolic disturbansis includes correction of hypocalcaemia, hypoalbuminaemia, hypomagnesaemia, hypokalaemia, control of blood glucose.

Surgical care

In patients with acute pancreatitis common indications for surgery are:

• Progressive peritonitis.

• Progressive multiorgan system failure.

• Gallstones pancreatitis without effect of conservative treatment during 24–48 h.

• Erosive haemorrhage.

• Bowel perforations.

• Septic complications.

Operations

• Peritoneal lavage.

• Gallstones pancreatitis: cholecystectomy and, if still necessary, common bile duct tube.

• Abdominization.

• Necrektomy.

• Surgycal management in necrotizing process into the retroperitoneum, perirenal spaces, and mesentery.

• Drainage by percutaneous aspiration of peripancreatic fluid collections.

• Percutaneous drainage of pancreatic abscesses (under CT or US control).