Treatments for Acute Pancreatitis
Treatments for Acute Pancreatitis
The list of treatments mentioned in various sources
for Acute Pancreatitis
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Acute Pancreatitis: Is the Diagnosis Correct?
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Hospital statistics for Acute Pancreatitis:
These medical statistics relate to hospitals, hospitalization and Acute Pancreatitis:
- 0.14% (18,109) of hospital consultant episodes were for acute pancreatitis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 74% of hospital consultant episodes for acute pancreatitis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 62% of hospital consultant episodes for acute pancreatitis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 38% of hospital consultant episodes for acute pancreatitis were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 90% of hospital consultant episodes for acute pancreatitis required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
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Hospitals & Medical Clinics: Acute Pancreatitis
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Discussion of treatments for Acute Pancreatitis:
Treatment depends on how bad the attack is. If no complications in the
form of kidney failure or lung problems occur, acute pancreatitis usually
improves on its own. Treatment is designed to support vital functions and
prevent complications. A hospital stay will be necessary so that fluids
can be replenished intravenously.
Acute pancreatitis can also cause breathing problems. Many people
develop hypoxia, which means that cells and tissues are not receiving
enough oxygen. Doctors treat hypoxia by giving oxygen through a face mask.
Despite treatment, some people still experience lung failure and require a
ventilator.
If pancreatic cysts occur and are considered large enough to interfere
with the pancreas's healing, your doctor may drain or surgically remove
the cysts.
Sometimes a person cannot stop vomiting and needs to have a tube placed
in the stomach to remove fluid and air. In mild cases, a person may not
eat for 3 or 4 days and instead may receive fluids and pain relievers
through an IV (intravenous) line.
Unless the pancreatic duct or bile duct is blocked by gallstones, an
acute attack usually lasts only a few days. In severe cases, a person may
be fed intravenously for 3 to 6 weeks while the pancreas slowly heals.
This process is called total parenteral nutrition. However, for mild cases
of the disease, total parenteral nutrition offers no benefit.
If an infection develops, the doctor may prescribe antibiotics. Surgery
may be needed for extensive infections. Surgery may also be necessary to
find the source of bleeding, to rule out problems that resemble
pancreatitis, or to remove severely damaged pancreatic tissue.
Before leaving the hospital, a person will be advised not to drink
alcohol and not to eat large meals. After all signs of acute pancreatitis
are gone, the doctor will try to decide what caused it in order to prevent
future attacks. In some people, the cause of the attack is clear, but in
others, more tests are needed.
(Source: excerpt from Pancreatitis: NIDDK)
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Pancreatic cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of pancreatic cancer is rarely successful because this disease has usually metastasized widely at diagnosis. Therapy consists of surgery and, possibly, radiation and chemotherapy. Standard chemotherapy for patients with locally unresectable cancer includes gemcitabine. Gemcitabine has been demonstrated to improve the quality of life through better pain control, adequate performance status, decreased analgesic consumption, shrinkage of tumor, and prolonged survival. (See Staging pancreatic cancer, page 90.)
Other medications used in pancreatic cancer include:
❑antacids (by mouth or by nasogastric [NG] tube) — to decrease secretion of pancreatic enzymes and to suppress peptic activity, thereby reducing stress-induced damage to gastric mucosa
❑ antibiotics (oral, I.V., or I.M.) — to prevent infection and relieve symptoms
❑ anticholinergics (particularly propantheline) — to decrease GI tract spasm and motility and reduce pain and secretions
❑ diuretics — to mobilize extracellular fluid from ascites
❑ insulin — to provide adequate exogenous insulin after pancreatic resection
❑ opioids — to relieve pain, but only after analgesics fail because morphine, meperidine, and codeine can lead to biliary tract spasm and increase common bile duct pressure
❑ pancreatic enzymes (average dose 0.5 to 1 mg with meals) — to assist in digestion of proteins, carbohydrates, and fats when pancreatic juices are insufficient because of surgery or obstruction.
Small advances have been made in the survival rate with surgery:
❑ Total pancreatectomy may increase survival time by resecting a localized tumor or by controlling postoperative gastric ulceration.
❑ Cholecystojejunostomy, choledochoduodenostomy, and choledochojejunostomy have partially replaced radical resection to bypass obstructing common bile duct extensions, thus decreasing the incidence of jaundice and pruritus.
❑ Whipple's operation, or pancreatoduodenectomy, has high mortality but can produce wide lymphatic clearance, except with tumors located near the portal vein, superior mesenteric vein and artery, and celiac axis. This rarely used procedure removes the head of the pancreas, the duodenum, and portions of the body and tail of the pancreas, stomach, jejunum, pancreatic duct, and distal portion of the bile duct.
❑Gastrojejunostomy is performed if radical resection isn't indicated and duodenal obstruction is expected to develop later.
Radiation therapy is usually ineffective except as an adjunct to chemotherapy or as a palliative measure.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Pancreatitis:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
I.V. fluid replacement, morphine, diazepam, antibiotics, calcium gluconate, insulin
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Diabetes mellitus:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment normalizes blood glucose and decreases complications using insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump. Insulin may be rapid acting, intermediate acting, long acting, or a combination of rapid acting and intermediate acting; it may be standard or purified, and it may be derived from beef, pork, or human sources. Purified human insulin is used commonly today. Pancreas transplantation is experimental and requires chronic immunosuppression.
Successful treatment requires an extensive dietary education. The patient’s diet is specifically tailored to include the right amount and combination of foods. Almost all foods may be eaten occasionally. The diet should address dietary prescriptions as well as personal and cultural preferences to improve adherence and control. For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1 diabetes, the calorie allotment may be high, depending on growth stage and activity level.
Type 2 diabetes may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, and suppress hepatic gluconeogenesis.
Five types of drugs have been used to treat diabetes. Sulfonylureas stimulate pancreatic insulin release, increase tissue sensitivity to insulin, and require insulin’s presence to work. Meglitinides cause immediate, brief release of insulin and are taken immediately before meals. Biguanides decrease hepatic glucose production and increase tissue sensitivity to insulin. Alpha-glucosidase inhibitors slow the breakdown of glucose and decrease postprandial glucose peaks. The thiazolidinediones enhance the action of insulin; however, insulin must be present for them to work. These drugs also reduce insulin resistance by decreasing hepatic glucose production and increasing glucose uptake. They have also been shown to lower blood pressure in diabetic hypertensive patients. Cholesterol and triglyceride levels may also be reduced.
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
Alert Any patient with a wound that has lasted more than 8 weeks and who has tried standard wound care and revascularization without improvement should consider hyperbaric oxygen therapy. This treatment may speed healing by allowing more oxygen to get to the wound and may therefore result in fewer amputations.
Keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy, nephropathy, and neuropathy. In type 2 diabetes, blood pressure control as well as smoking cessation reduces the onset and progression of complications, including cardiovascular disease.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Pancreatic cancer:
Treatment
(Handbook of Diseases)
Treatment of pancreatic cancer is rarely successful because this disease has usually metastasized widely by the time it’s diagnosed.
Therapy consists of surgery and, possibly, radiation and chemotherapy. Small advances have been made in the survival rate with surgery:
❑ Total pancreatectomy may increase survival time.
❑ Cholecystojejunostomy, choledochoduodenostomy, and choledochojejunostomy have partially replaced radical resection to bypass obstructing common bile duct extensions, thus decreasing the incidence of jaundice and pruritus.
❑ Whipple’s operation, or pancreatoduodenectomy, has a high mortality but can produce wide lymphatic clearance, except with tumors located near the portal vein, superior mesenteric vein and artery, and celiac axis. This procedure removes the head of the pancreas, the duodenum, gall bladder, end of the common bile duct, and possibly portions of the body and tail of the pancreas and stomach.
❑ Gastrojejunostomy is performed if radical resection isn’t indicated and duodenal obstruction is expected to develop later.
If the tumor is confined to the pancreas and can’t be removed, a combination of radiation and chemotherapy may be used. If the tumor has metastasized to other organs such as the liver, chemotherapy is usually the lone treatment. Gemcitabine is the standard agent and produces improvement in 50% of patients.
Other medications used in the treatment of pancreatic cancer include:
❑ anticholinergics (particularly propantheline) — to decrease GI tract spasm and motility and reduce pain and secretions
❑ antacids (oral or by nasogastric [NG] tube) — to decrease secretion of pancreatic enzymes and suppress peptic activity, thereby reducing stress-induced damage to gastric mucosa
❑ insulin — to provide adequate exogenous insulin supply after pancreatic resection
❑ narcotics — to relieve pain, but only after analgesics fail because morphine, meperidine, and codeine can lead to biliary tract spasm and increase common bile duct pressure
❑ pancreatic enzymes (average dose is 0.5 to 1 mg with meals) — to assist in the digestion of proteins, carbohydrates, and fats when pancreatic juices are insufficient because of surgery or obstruction.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Pancreatitis:
Treatment
(Handbook of Diseases)
The goal of therapy is to maintain circulation and fluid volume. Treatment measures must also relieve pain and decrease pancreatic secretions. In 90% of patients with acute pancreatitis, the disease occurs as a mild self-limiting illness and requires only simple supportive care alone. In the remaining 10% of patients, the disease can evolve into a severe form of acute pancreatitis with significant complications, a lengthy duration of illness and, for many, death.
Emergency measures
Emergency treatment of shock (which is the most common cause of death in early-stage pancreatitis) consists of vigorous I.V. replacement of electrolytes and proteins. The patient receives nothing by mouth, a nasogastric tube is inserted for abdominal distention, and an anticholinergic may be administered.
Metabolic acidosis that develops secondary to hypovolemia and impaired cellular perfusion requires vigorous fluid volume replacement.
Drug treatment may include morphine sulfate for pain, diazepam for restlessness and agitation, and antibiotics for documented bacterial infections.
Specific metabolic complications — such as hypokalemia, hypocalcemia, hemorrhage, and coagulopathy — must be treated with appropriate replacement products, such as potassium chloride, I.V. calcium gluconate or chloride, red blood cells, and fresh frozen plasma. Hyperglycemia and glycosuria are manifestations of altered carbohydrate metabolism. Treatment consists of careful titration of glucose and insulin to maintain a euglycemic state.
CLINICAL TIP: Treating the underlying condition may prevent recurrent attacks.
After the emergency
After the emergency phase, continuing I.V. therapy should provide adequate electrolytes and protein solutions. If the patient is unable to resume oral feedings, total parenteral nutrition may be necessary. Nonstimulating enteral feedings may be safer because of the decreased risk of infection and maintenance of normal physiology.
Surgery for acute pancreatitis is reserved for treating specific complications and correcting anatomic problems. Surgery is usually required for patients with necrotizing pancreatitis to debride devitalized tissue and to provide external drainage. Debridement, usually at 24- to 48-hour intervals, until the necrotic tissue is replaced by a granulating wound, is commonly required.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Diabetes mellitus:
Treatment
(Handbook of Diseases)
Effective treatment for both types of diabetes normalizes blood glucose and decreases complications.
Type 1 diabetes
Treatment includes insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump.
Human insulin may be rapid-acting (Regular), intermediate-acting (NPH or Lente), long-acting (Ultralente, Lantus), or a combination of rapid-acting and intermediate-acting (70/30, 75/25, or 50/50 of NPH and Regular).
Clinical tip Insulin Lispro or Novalogue may be used in place of Regular insulin. It’s rapid in onset (15 minutes) and makes waiting to eat after injection unnecessary. It has a short duration of action (4 hours), which decreases between-meal and nocturnal hypoglycemia.
Islet cell or pancreas transplantation is available and requires chronic immunosuppression.
Type 2 diabetes
Patients may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis, and delay GI absorption of carbohydrates.
UNDER STUDY: Studies have shown that treatment with a lipase inhibitor (such as orlistat) combined with a low-calorie diet significantly decreases the weight of overweight patients with type 2 diabetes. Patients following this therapy also displayed improvements in glycemic control and cardiovascular risk profile; levels of glycosylated hemoglobin, fasting glucose, and postprandial glucose improved significantly.
Both types
Treatment of both types of diabetes requires a diet planned to meet nutritional needs, to control blood glucose levels, and to reach and maintain appropriate body weight.
For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1, the calorie allotment may be high, depending on growth stage and activity level. For success, the diet must be followed consistently and meals eaten at regular times.
UNDER STUDY: Vitamin E is under investigation for its cellular effects that can possibly reduce the risk of macrovascular disease in patients with type 2 diabetes mellitus. The antioxidant effects of vitamin E were supported, and it was found that, in high doses, vitamin E acts as an anti-inflammatory. It’s postulated that heart disease and stroke risk can be decreased because vitamin E reduces plaque formation at the endothelial level. Vitamin E may also have an effect on the metabolic syndrome that causes diabetes mellitus and may prevent the disease from occurring.
Complications
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
The Diabetes Control and Complications Trial has proved that intensive insulin therapy that focuses on keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy (up to 63%), nephropathy (up to 54%), and neuropathy (up to 60%).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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