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Pancreatitis- Management, Emergency, ICU, drugs, herbs, nutrition, evidence from research

Pancreatitis-MANAGEMENT

Medical Management

Management of the patient with acute pancreatitis is directed toward relieving symptoms and preventing or treating complications.

EMERGENCY MANAGEMENT

  • Acute pancreatitis may require patient to be admitted to the hospital
  • Nil per orally is maintain to allow the pancreas to rest and stabilize
  • Intravenous fluids and nutrition (parenteral nutrition)
  • Nasogastric suction may be used to relieve nausea and vomiting, to decrease painful abdominal distention and paralytic ileus, and to remove hydrochloric acid so that it does not enter the duodenum and stimulate the pancreas
  • If the cause is gall-stones, surgery or other procedures to remove them is recommended
  • People with chronic pancreatitis may require treatment for alcohol addiction

INTENSIVE CARE

  • Correction of fluid and blood loss and low albumin levels to maintain fluid volume and prevent renal failure
  • Monitor in the intensive care unit
  • Antibiotic agents
  • Insulin may be required if significant hyperglycemia occurs
  • Intubation and mechanical ventilation if required

DRUG THERAPIES

  • Painkillers: Morphine and morphine derivatives are often avoided because it has been thought that they cause spasm of the sphincter of Oddi; meperidine (Demerol) is often prescribed because it is less likely to cause spasm of the sphincter.
  • Antiemetic agents
  • Histamine-2 (H2) antagonists (eg, Ranitidine)
  • Antibiotics
  • Enzyme supplements, such as pancrelipase may be prescribed to help body absorb food better.
  • Probiotic supplement (Lactobacillus acidophilus and other beneficial bacteria) for maintenance of gastrointestinal and immune health.
  • Multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium.
  • Omega-3 fatty acids (fish oil: 1 – 2 capsules or 1 – 2 tablespoonfuls oil daily) to help decrease inflammation and improve immunity.

NUTRITION AND SUPPLEMENTS

Following nutritional education should be given to the patient

  • Eliminate all suspected food allergens, including dairy (milk, cheese, eggs, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives.
  • Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper) as it reduce free radicals.
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
  • Use healthy oils for cooking, such as olive oil or vegetable oil.
  • Reduce significantly or eliminate trans-fatty acids (baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts).
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 – 8 glasses of filtered water daily.
  • Exercise moderately for 30 minutes daily, 5 days a week.

HERBS

Although herbs should never be used alone to treat pancreatitis, some herbs may be helpful along with conventional medical treatment.

  • Green tea (Camellia sinensis)
  • Holy basil (Ocimum sanctum)
  • Rhodiola (Rhodiola rosea)
  • Cat’s claw (Uncaria tomentosa)
  • Reishi mushroom (Ganoderma lucidum)
  • Indian gooseberry (Emblica officinalis)
  • Grape seed extract (Vinis vinifera)
  • Licorice root (Glycyrrhiza glabra)
  • Ginger root (Zingiber officinale)
  • Asian ginseng (Panax ginseng)
  • Peony root (Paeonia officinalis)
  • Cinnamon Chinese bark (Cinnamomum verum)

Evidence from research

In a RCT (Randomized Control Trial) comparing TPN to Enteral Nutrition in patients with acute pancreatitis, published on Wiley Online Library, It was observed that Total parenteral nutrition (TPN) has been standard practice for providing exogenous nutrients to patients with severe acute pancreatitis. However, recent data suggest that enteral nutrition (EN) is not only feasible, but safer and more effective.

It was concluded that In patients with acute pancreatitis, enteral nutrition significantly reduced mortality, multiple organ failure, systemic infections, and the need for operative interventions compared to those who received TPN. In addition, there was a trend towards a reduction in length of hospital stay. The data suggest that Enteral Nutrition should be considered the standard of care for patients with acute pancreatitis requiring nutritional support.

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