Acute pancreatitis can be treated through resuscitation of fluid. The optimal amount of resuscitation has been determined to be six to eight liters of fluid per day. The fluid provided tot the patient should be supplemented with electrolytes, in order to avoid dehydration because the patient has symptoms of vomiting and nausea. The volume of six to 8 liters of fluid per day will also ensure that the patient will not be prone to develop necrosis of the pancreatic tissues due to dehydration.
This condition is also involved with high levels of fat in the diet hence it is also recommended that the patient be subjected to fasting until the lipase and amylase levels have normalized. Fasting is also needed to be implemented until the pain and tenderness that the patient is experiencing has subsided. An intravenous line should be connected to the patient to prevent dehydration and to allow supplementation of fluids, glucose and any other medications such as antibiotics or painkillers. Painkillers or opioids are administered to the patient in order to assist him in relieving of the pain he is experiencing (Conwell et al. , 2002).
In the case that the patient is vomiting, he may also be connected to a nasogastric tube for feeding. It is also important that the patient be provided with acid blockers in order to control to the further secretion of digestive acids that can worsen the patient’s condition. The patient should also be provided with antibiotics because it is possible that the patient’s pancreatitis was caused by a microbial infection. Ample drainage of the gastrointestinal tract should also be performed in order to remove any possible pseudocysts that may exist in the patients.
In addition, any infectious microorganisms in the digestive tract will also be flushed out through the employment of ample drainage. Severe conditions of pancreatitis require that the patient be taken care of in the intensive care unit. There may be chances that patients have low blood pressure or hypotension, or is experiencing frequent urination. During the patient’s stay in the intensive care unit, hourly monitoring of vital signs and amount of urine produced are noted. In addition, the hematocrit as well as glucose levels are monitored.
The electrolyte levels of the patient are also checked on an hourly basis. Acid blood gas is also another parameter that is constantly checked, as well as the central venous pressure. In the case where the patient is unstable in terms of hemodynamics, the complete blod count, as well as platelet count, are monitored every six hours at the intensive care unit (Conwell et al. , 2002). The coagulation parameters of the patient are also checked, together with the levels of albumin. The patient is also monitored with regards to calcium and magnesium levels and creatinine concentrations.
A patient with pancreatitis and sign of hypoxemia is administered an oxygen mask that will help the patient attain normal oxygenation. Should the patient show signs of respiratory distress, the patient may be provided with assisted ventilation. The patient with hyperglycemic conditions of above 170 mg/dL will be treated with intravenous insulin and monitored for the next hours. In cases where the patient indicates hypocalcemia, this symptom is not treated because it has been observed that the nerves and muscles of a patient with pancreatitis experience irritability right after treatment of this symptom.
Patients who are also alcoholics are treated with magnesium sulfate which replaces the fluid in their body and normalizes the levels of magnesium. In case that renal failure had occurred, the levels of magnesium in the serum are checked and magnesium is administered to the patient through an intravenous line. It is understood that when the magnesium levels of the patient returns to normal, the calcium levels will follow in attaining normal levels. A patient with pancreatitis should also be given antibiotics such as imipenem to avoid infection of the pancreas and prevent further development of necrosis.
It may be possible that the patient may require debridementation of the pancreas in order to remove any necrotic tissues that have developed. There may also be cases wherein a pseudocyte has developed in the panrease and that it is infected. Inflammation of the pseudocyst may also result in bleeding and the drainage of this fluid may be performed subcutaneously. Another option for drainage of the bleeding of the pseudocyst is through endoscopy. However, the success of the endoscopy may depend on the location of the pseudocyst and the expertise of the surgeon.
It is common to conduct surgical procedures on a patient with pancreatitis if severe pain is being experienced by the patient. Sepsis of the biliary tract is also another indicator for surgical treatment (Go et al. , 1970). It has been observed that majority of pancreatitis patients with gall stones are capable of passing the stone eventually, the ERCP coupled with sphincterotomy is always an option, especially when the patient does not improve within 24 hours of medical treatment. Pancreatitis patients who improve subsequently voluntarily elect to undergo laparoscopic cholecystectomy in order to prevent future episodes of pancreatitis.
The actual mechanisms wherein a gall stone obstructs the sphinter of Oddi and subsequently causing pancreatitis remain unclear. It has been postulated that the increase in the pressure of the ducts may result in the symptoms of pancreatitis. It is also possible that alcohol consumption for an extended period of time may result in the accumulation of pancreatic enzymes in the serum. These particular enzymes are phospholipase, elastase and trypsin, which are involved in the digestion process. These enzymes can inflict damages to the lining of the tissue, which in turn will result in the inflammation of the pancreas.
It is also possible the edema occurs and necrosis. It is also probable that hemorrhage may occur once significant damage has been accumulated. References Ceryak, S. , Steinberg, W. M. , Marks, Z. H. and Ruiz, A. (2001). Feasibility of an endoscopic secretin test: preliminary results. Pancreas, 23,216-218. Conwell, D. L. , Zuccaro, G, Morrow JB, Van Lente F, O’Laughlin C, Vargo JJ, Dumot JA. (2002). Analysis of duodenal drainage fluid after cholecystokinin (CCK) stimulation in healthy volunteers. Pancreas, 25,350-354.
Conwell DL, Zuccaro G, Morrow JB, Van Lente F, Obuchowski N, Vargo JJ, Dumot JA, Trolli P, Shay SS. (2002). Cholecystokinin-stimulated peak lipase concentration in duodenal drainage fluid: a new pancreatic function test. American Journal of Gastroenterology, 97,1392-1397. Go VL, Hofmann AF, Summerskill WH. (1970). Simultaneous measurements of total pancreatic, biliary, and gastric outputs in man using a perfusion technique. Gastroenterology, 58,321-328. Gupta, V. and Toskes, P. P. (2005). Diagnosis and management of chronic pancreatitis. Postgraduate Medical Journal, 81,491-497.