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DOCTOR AT THE DESK

Treatment of Pancreatitis

"Surgical and non-surgical"
By: Stef dela Cruz, MDTreatment of Pancreatitis

In acute pancreatitis, management is largely medical instead of surgical. Intravenous fluid therapy is necessary because as fluid leaves the circulation and accumulates in the abdomen, blood volume becomes depleted. Aggressive fluid resuscitation, in fact, helps save lives in the early stages of acute pancreatitis and remains a vital step in its treatment. Controlled fluid therapy, especially in the first 72 hours of severe acute pancreatitis, offers better outcomes, according to a 2009 study published in Chinese Medical Journal.

Intervention is aimed at alleviating pain, allowing the pancreas to heal, supplementing any pancreatic enzyme deficiency, and treating hormone insufficiency due to pancreatic damage. Also important is behavior modification: an alcoholic should be given advice and support on how to cope with his addiction. A low-fat diet is recommended. If a person with pancreatitis already has fat malabsorption, supplementation with fat-soluble vitamins (vitamins A, K, D, and E) is necessary.

Surgery may be done in select cases. The presence of a structural anomaly may be corrected surgically if surgery ensures pancreatic duct patency. The type of operation depends on the kind of abnormalities present. Admission to the intensive care unit may be necessary for patients with severe acute pancreatitis. Respiratory failure, gastrointestinal bleeding, kidney failure, shock, and even multi-organ system failure may ensue. Monitoring for signs of these complications is therefore vital.

Antibiotic therapy to prevent future infection is not necessary. It may even cause fungal super-infections, leading to worse outcomes. Antibiotic use, therefore, should not be used routinely, even if patients have elevated body temperature.

A patient is normally not discharged until he is capable of eating on his own. Pain should be tolerable and properly managed with oral medications. Complications should have been addressed as well.

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