Cherish the pancreas, truly love life

This is the 4967th article of Da Yi Xiao Hu

Acute pancreatitis is one of the most common acute abdominal diseases. However, because most of the pancreas is "hidden" behind the peritoneum, the pancreas is far less well-known than the stomach, duodenum, liver, and gallbladder. Therefore, whenever acute pancreatitis occurs with upper abdominal pain, people often think that there is something wrong with the gastrointestinal tract, so it is often misdiagnosed or missed, which can easily delay the disease. How much do you know about acute pancreatitis, a disease called "three musts" in clinical practice? Let's learn together!

Acute pancreatitis is an inflammatory reaction caused by multiple causes, in which pancreatic enzymes are activated in the pancreas, leading to self-digestion, edema, bleeding and even necrosis of the pancreatic tissue. Its "three demands" refer to: life, money and time.

The word "fatal" is used to describe the severity of acute severe pancreatitis, which can be life-threatening in a short period of time.

The cost of treatment is very high even if the life is saved;

The time required means that even if the cost is huge and life is maintained, the entire hospitalization time is relatively long. Once serious complications occur, the time will be even longer.

What are the common causes of the disease?

1. Excessive drinking and overeating : They can lead to excessive secretion of pancreatic juice, affecting the drainage of the pancreatic duct. Due to the excessive pancreatic juice, the pressure of the pancreaticobiliary system increases, which makes the excretion of protease obstructed, and when the pancreatic alveoli rupture, it is easy to cause acute pancreatitis.

2. Diseases of the biliary system : including bile duct inflammation, bile duct stones, parasites, spasms, etc., which cause obstruction of the ampulla, bile reflux into the pancreatic duct, activate pancreatic enzymes, and induce pancreatitis.

3. Surgery : The stomach, intestines, gallbladder, spleen, etc. are adjacent to the pancreas. When these organs undergo surgery, the pancreas is squeezed, causing excessive pressure in the pancreatic and bile ducts and triggering pancreatitis.

4. Embolism or obstruction : Bile reflux is caused by biliary ascariasis, incarceration of ampulla of Vater stones, stenosis of duodenal papilla, etc. If the lower end of the bile duct is obviously obstructed, the pressure in the bile duct is very high, and the high-pressure bile flows back into the pancreatic duct, causing the pancreatic alveoli to rupture, and pancreatic enzymes to enter the pancreatic interstitium, resulting in pancreatitis.

5. Metabolic diseases : may be related to diseases such as hypercalcemia and hyperlipidemia

6. Infection factors : After viruses or bacteria enter the blood and lymphatic tissue, they will enter the pancreatic tissue and cause pancreatitis.

What are the common symptoms of an attack?

1. Abdominal pain : The earliest symptom is usually sudden onset, manifested as severe upper abdominal pain, which often occurs suddenly within 12 to 48 hours after a full meal or drinking. It is usually sudden onset and located in the middle or left side of the upper abdomen. The pain is continuous and progressive, like a knife cutting. The pain radiates to the back and flank. If it is hemorrhagic necrotizing pancreatitis, the whole abdomen will be painful and bloated within a short period of time after the onset of the disease, and shock of varying severity will soon occur.

2. Nausea and vomiting : often accompanied by abdominal pain, vomiting is severe and frequent, the vomitus is the contents of the stomach and duodenum, occasionally coffee-colored, and the abdominal pain does not ease after vomiting. The condition progressively worsens and soon enters intestinal paralysis, and the vomitus is fecal-like.

3. Fever and jaundice :

The degree of fever is usually consistent with the severity of the disease. In edematous pancreatitis, there may be no fever or only a mild fever; in hemorrhagic necrotizing pancreatitis, there may be a high fever. If the fever does not subside, there may be complications such as pancreatic abscess. The occurrence of jaundice may be caused by concurrent biliary disease or compression of the common bile duct by the enlarged pancreatic head. Acute edematous pancreatitis occurs less frequently, accounting for about 1/4. In acute hemorrhagic pancreatitis, it occurs more frequently.

How to treat it?

1. Non-surgical treatment

Prevent and treat shock, improve microcirculation, relieve spasms, relieve pain, inhibit pancreatic enzyme secretion, fight infection, provide nutritional support, prevent the occurrence of complications, and strengthen some measures for intensive care.

2. Surgery

Although there is localized pancreatic necrosis and exudation, if there is no infection and the systemic poisoning symptoms are not very serious, there is no need to rush for surgery. If there is infection, appropriate surgical treatment should be given.

Keep in mind the following prevention points

1. Develop good living habits and eat three meals a day regularly. Avoid skipping one meal and eating too much at one meal. Avoid overeating and consuming large amounts of oily foods at one time. Eat vegetables and fruits regularly and avoid excessive drinking.

2. Treat biliary factors at an early stage. Regularly check the color Doppler ultrasound to understand the situation of gallstones and hepatic duct stones, and intervene early.

3. Friends with hyperlipidemia should have blood drawn regularly to check blood lipids, actively control blood lipid levels with medication, exercise more daily, and eat a healthy diet.

4. Obese people should lose weight appropriately, exercise regularly, control their diet, move their legs, try to eat a light diet, and pay attention to eating less but better.

5. Avoid pancreatic trauma. We know that the pancreas is located in the upper abdomen and is a retroperitoneal organ, close to the spine at the back, so violent trauma to the upper abdomen can easily damage the pancreas.

6. In addition, infection, diabetes, emotions, drugs, etc. may also cause pancreatitis, so maintaining a good mood, strengthening physical fitness, actively controlling diabetes, and avoiding the intake of unknown drugs can also play a preventive role.

Warm Tips

If you have any discomfort symptoms such as abdominal pain, please do not take medicine on your own. Please go to the hospital in time to avoid delaying the golden time for treatment.

Author: Lingang Branch of Shanghai Sixth People's Hospital

Emergency Department Nurse Chen Qingmiao