It refers to the chemical inflammation caused by the activation of pancreatic enzymes leading to the self-digestion of pancreatic tissue. Clinically, it is typically characterized by acute upper abdominal pain and elevated serum amylase levels. The severity of the condition varies. In mild cases, the pancreas is primarily edematous, and the disease is self-limiting, with complete recovery within a week and a good prognosis. In severe cases, pancreatic hemorrhage and necrosis occur, accompanied by shock, peritonitis, and various complications, resulting in a high mortality rate.

bubble_chart Diagnosis

1. History Taking

Sudden onset of persistent pain in the mid-upper abdomen, with paroxysmal exacerbation. The pain may be relieved by leaning forward and aggravated after eating, radiating to the left chest and lumbar back. In some patients, the pain is mild. Accompanied by nausea and vomiting, with no relief of pain after vomiting. Some patients may present with fever and jaundice. Persistent or high fever may indicate secondary infection. Mild cases may resolve within 3–5 days, while severe cases can lead to hypotension, shock, and multi-organ damage (see acute hemorrhagic necrotizing pancreatitis). Since this condition is associated with biliary tract diseases, overeating, alcohol consumption, or recurrent episodes, it is important to inquire about predisposing factors before the onset, history of biliary tract diseases or similar episodes, the location and nature of abdominal pain, its relationship with posture and diet, accompanying symptoms, and any signs of dysfunction in major organs to aid in diagnosis and assess the severity and urgency of the condition.

Edematous pancreatitis presents with milder symptoms, often including upper abdominal tenderness, rebound tenderness, and muscle guarding, as well as abdominal distension and fullness, and decreased bowel sounds. If ascites or signs of acute peritonitis appear, progression to acute hemorrhagic necrotizing pancreatitis should be considered.

3. Laboratory Tests

Note the degree of elevation in serum and urinary amylase levels, as the extent of amylase elevation does not always correlate with disease severity (grade III). Elevated white blood cell count and neutrophils may be observed, and some patients may exhibit decreased serum calcium or elevated blood glucose. Chest and abdominal X-rays can detect pleural effusion, elevated diaphragm, lung infiltration, or rule out other causes of acute abdomen (e.g., gastrointestinal perforation). Ultrasound and CT scans can assess pancreatic enlargement, abscess or cyst formation, and biliary tract diseases. ERCP can evaluate abnormalities in the biliary system and examine the pancreatic duct.

4. Differential Diagnosis The condition should be differentiated from other acute abdominal conditions, as well as colicky pain and myocardial infarction.

bubble_chart Treatment Measures

If the clinical presentation meets the diagnostic criteria, a hospitalization order should be issued for admission. If the condition is mild and the patient declines hospitalization, they may be sent to the observation room for monitoring and treatment. For example:

1. NPO (nothing by mouth), with gastrointestinal decompression if necessary. Provide intravenous hydration with sufficient water, electrolytes, and nutrition. The daily fluid intake should not be less than 3000ml.

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3. Administer Sandostatin 0.1mg IM or IV every 6–8 hours, or use Stilamin 3mg mixed with IV fluids for continuous infusion to reduce pancreatic secretion.

4. Administer Cimetidine 800mg IV or Losec 20mg IV to reduce gastric acid secretion. Alternatively, use 654-2 10mg IM every 6 hours.

5. Administer 0.2% Metronidazole 500ml and Ampicillin IV to prevent and control infection. Closely monitor vital signs. Once abdominal pain is relieved, a small amount of light, easily digestible liquid diet may be introduced.