1. Can mild acute pancreatitis be prevented?
Mild acute pancreatitis can be effectively prevented, mainly in the following aspects.
(1) prevention of dietary management: eat a light, easily digestible diet (high carbohydrate, high vitamin), regular rationing, avoid drinking alcohol. If you have abdominal discomfort, avoid raw, cold, hard and hot food as much as possible, and mainly eat semi-liquid food, and reduce the amount of food appropriately, reaching 80% to 90% full, and then eat normally when the symptoms are relieved.
(2) Prevention of environmental adaptation: adapt to the work and living environment.
(3) Prevention of improving sleep quality: regular work and rest system, appropriate exercise, but should avoid strenuous activities and exertion. Go to bed on time, or simulate the sleep time in advance according to the maritime training time, and adjust your sleep pattern to meet the physiological requirements as much as possible.
(4) Prevention of mental and psychological adjustment: pay attention to the regularity of life, keep the spirit happy, avoid anger and excessive excitement.
(5) the prevention of drug application: the appearance of epigastric symptoms such as the need to follow medical advice to take drugs, such as abdominal discomfort, should promptly find a doctor according to the symptoms of reasonable drug consumption, trying to quickly relieve symptoms, not to make the disease, to achieve the purpose of prevention.
(6) Standardized treatment, timely consultation and treatment according to treatment norms.
2.What is mild acute pancreatitis?
Mild acute pancreatitis refers to pancreatitis diagnosed with only very mild organ dysfunction and a tendency to heal on its own, without obvious signs of peritonitis and serious metabolic disorders and other clinical manifestations.
3.What are the symptoms and manifestations of mild acute pancreatitis or what are the physical discomforts?
(1) abdominal pain: often located in the upper abdomen, is continuous, there are also left or right, can be radiated to the waist and back in a band, bending knees or sitting forward to reduce pain. Due to the special anatomical location of the pancreas, which is located behind the stomach and in front of the spine, patients often cannot accurately describe the exact location of the pain, and even mistake it for stomach pain. The nature of the pain is mostly distension, and some of it is colic. The degree is mild to moderate and the duration is short, usually not more than 5 days.
(2) Abdominal distension: often accompanied by abdominal pain, most of them are accompanied by reduced anal discharge and defecation, or even anal cessation of defecation and defecation.
(3) Vomiting: often occurs at the same time as abdominal pain, and the vomit is basically food eaten before the onset of the disease, and lasts for a short period of time, usually relieved about 2 days after the onset of the disease along with the relief of abdominal distension.
(4) Fever: most of the body temperature does not exceed 38.5 degrees, usually lasts 3-5 days to relieve.
4.What factors can cause mild acute pancreatitis?
(1) Biliary tract disease: It is the most important cause of pancreatitis, including cholelithiasis, acute and chronic cholecystitis or cholangitis, biliary ascariasis, etc., especially cholelithiasis is the most common. The bile duct and pancreatic duct together drain bile and pancreatic juice to the duodenum through the duodenal papilla. When inflammation of the bile duct occurs, the duodenal papilla will become edematous, resulting in poor drainage of pancreatic juice or bile reflux into the pancreatic duct, inducing pancreatitis.
(2) Heavy drinking and overeating: Long-term heavy drinking can stimulate excessive secretion of pancreatic juice, resulting in overburdening of the pancreas and easily inducing inflammation. Overeating makes a lot of food enter the duodenum in a short time, causing duodenal papilla edema, while stimulating a lot of pancreatic juice and bile secretion, resulting in increased pancreatic juice and bile secretion and poor drainage, triggering acute pancreatitis.
(3) pancreatic duct obstruction: pancreatic duct tumor, stone or inflammatory stenosis, stone or tumor in the abdomen can cause pancreatic duct obstruction, partially or completely blocking the drainage of pancreatic juice, increasing the pressure in the pancreatic duct, rupture of small branches of the pancreatic duct or alveoli, and overflow of pancreatic juice into the pancreatic parenchyma, causing acute pancreatitis.
(4) Abdominal trauma: such as blunt trauma or penetrating trauma.
(5) Infection: can be secondary to certain viral, mycoplasma or bacterial infectious diseases. Such as acute mumps, infectious mononucleosis, viral hepatitis, coxsackievirus and Mycoplasma pneumoniae infection.
(6) Drugs: There are more than 30 drugs associated with the development of pancreatitis, including adrenal glucocorticoids, thiazide diuretics, azathioprine, tetracycline, sulfonamide, oral contraceptives, etc.
(7) Endocrine and metabolic disorders: such as hyperparathyroidism, hyperlipidemia, diabetic ketoacidosis, uremia, etc.
(8) Pancreatic schizophrenia: the pancreatic duct is malformed due to abnormal embryonic development of the pancreas, the ventral and dorsal segments of the pancreas are not fused, the main pancreatic duct only drains pancreatic fluid from the hook and part of the head of the pancreas, while the secondary pancreatic duct drains pancreatic fluid from most of the rest of the pancreas through the opening in the narrow secondary papilla, which is prone to poor drainage due to relative stenosis.
(10) Other: familial hereditary pancreatitis often occurs in early childhood with typical acute pancreatitis, which later turns into chronic recurrent episodes. About 5% to 25% of patients with acute pancreatitis cannot find the cause, and it is called idiopathic pancreatitis.
5.Why does mild acute pancreatitis occur?
The pathways of acute pancreatitis caused by the above-mentioned pathogenic factors are different, but they have a common pathogenic process, namely, obstruction of the pancreatic duct, resulting in poor drainage of pancreatic juice, activation of pancreatic enzymes in the pancreatic tissue, and the active pancreatic enzymes cause the pancreas to digest itself and induce the inflammatory process. There are two types of digestive enzymes secreted by the normal pancreas, one is biologically active enzymes such as amylase and lipase, and the other is inactive enzymes in the form of zymogens, such as trypsinogen, chymotrypsinogen, elastase, phospholipase progenitor A, kininogen, and pancreatic diastase progenitor. Under normal conditions, pancreatic juice enters the duodenum and is activated by enterokinase, which first activates trypsinogen into trypsin, which in turn causes a cascade of other enzymes to activate and digest food. In the physiological state, the pancreas is protected from self-digestion by various defense mechanisms of the body. Only when some of the defense mechanisms are disrupted by various pathological factors and the pancreatic digestive enzymes are activated prematurely, the pathological process of pancreatic self-digestion occurs. Digestive enzymes work together to cause damage and necrosis of the pancreatic parenchyma and adjacent tissues, which further promotes the release of digestive enzymes, forming a vicious circle. Digestive enzymes and necrotic tissue fluid are transported to the whole body via blood circulation and lymphatic channels, which can cause damage to multiple organs of the body. In the pathogenesis of mild acute pancreatitis, the pancreatic ducts are rapidly restored to patency after the onset of the disease, so that the subsequent vicious cycle is terminated in time and the disease eventually stays at the level of mild disease.
6.How to diagnose mild acute pancreatitis? How to self-judge whether there is mild acute pancreatitis?
(1) When patients have sudden onset of persistent upper abdominal pain accompanied by abdominal distension, nausea, vomiting, and even anal stoppage of exhaustion and defecation symptoms, especially if they have a previous history of gallstone disease or if the symptoms occur after overeating, they should be alert to the occurrence of acute pancreatitis. The diagnosis of acute mild pancreatitis can be made when the blood and urine amylase levels are significantly elevated, the pancreas is enlarged or there is exudation around the pancreas on abdominal ultrasound or CT, and the patient does not have obvious symptoms of shock and electrolyte disturbance.
(2) When examination and laboratory conditions are not available, the presence of acute mild pancreatitis can often be judged based on previous history of cholelithiasis, diet before the onset of the disease, persistent epigastric pain and abdominal distension, and non-remission after vomiting.
7.Which diseases are easily confused with mild acute pancreatitis or which diseases need to be differentiated?
(1) Peptic ulcer perforation: Most have a history of peptic ulcer, sudden onset, severe abdominal pain, and abdominal muscle plate-like ankylosis, loss of hepatic turbinates, free gas under the diaphragm on X-ray abdominal plain film, moderate elevation of blood amylase, usually not more than two times the normal value.
(2) Cholelithiasis and acute cholecystitis: there is often a history of colic attacks; the pain is mostly in the right upper abdomen, mostly with right shoulder involvement pain; jaundice is often present during attacks, Murphy’s sign is positive, there may be pressure pain, rebound pain and muscle tension in the right upper abdomen; blood and urine amylase may be mildly elevated; ultrasound and CT examination show signs of cholecystitis and gallstones. If the blood amylase exceeds 3 times the normal value, it indicates the combination of acute pancreatitis at the same time.
(3) Acute intestinal obstruction: paroxysmal abdominal cramps, mostly located around the umbilicus; accompanied by vomiting, abdominal distension, anal discharge and cessation of defecation; high-pitched bowel sounds, visible intestinal pattern; serum amylase may be mildly increased, X-ray plain film shows signs of intestinal obstruction such as air-fluid plane.
(4) Mesenteric vascular embolism: Most commonly seen in the elderly, patients with hyperlipidemia or heart disease; acute onset, severe abdominal pain, abdominal distension, fever, blood in stool, bloody ascites, shock and signs of peritoneal irritation; serum amylase may be mildly elevated, and mesenteric angiography may show signs of vascular obstruction.
(5) Angina pectoris or myocardial infarction: history of coronary artery disease; mostly presenting with episodes of pressure or pain in the precordial region. Individual patients may have pain in the upper abdomen, resembling acute pancreatitis; blood and urine amylase are normal, while ECG shows myocardial ischemia or myocardial infarction changes, and cardiac enzymes such as creatine kinase, glutamate transaminase, and lactate dehydrogenase are elevated in myocardial infarction.
(6) Others: There are fashions that need to be differentiated from acute appendicitis, renal colic, splenic rupture, ectopic pregnancy rupture and diabetic ketoacidosis with acute abdominal pain, uremia, etc.
8. What tests can help to confirm the diagnosis of mild acute pancreatitis?
(1) Blood leukocyte count: most cases have leukocytosis, and the count is usually between 10×109/L and 20×109/L.
(2) Amylase measurement: blood and urine amylase are the most commonly used laboratory indicators for the diagnosis of acute adenitis. In most patients, serum amylase begins to rise 6-8 hours after the onset of the disease, mostly exceeding 3 times the upper limit of normal values, with peaks within 24-48 hours after the onset of the disease, and can last 3-5 days or longer. It acute abdominal diseases such as acute biliary tract infection, cholelithiasis, gastrointestinal perforation, acute peritonitis, intestinal obstruction and mesenteric vascular embolism can have mild elevation of serum amylase, but generally not more than 2 times the normal value, and most of them not more than 3 times.
(3) Serum lipase: The elevation of serum lipase is later than that of serum amylase, usually starts 24~72 hours after the onset of the disease and lasts for 7~10 days. It has diagnostic value and high specificity for patients with acute pancreatitis who are seen late after the onset of the disease.
(4) Blood biochemical examination: temporary elevation of blood glucose in some patients. About 5% to 10% of patients with acute pancreatitis have elevated blood lipids, mainly elevated serum triglycerides, which may be the cause of pancreatitis or a consequence secondary to pancreatitis. Hyperbilirubinemia is seen in about 10% of patients with acute pancreatitis and is mostly transient, caused by pancreatic edema, and can return to normal 4-7 days after the onset. Serum transaminase, lactate dehydrogenase and alkaline phosphatase may also have a transient increase. Serum calcium is often mildly decreased.
(5) Abdominal plain film: It can exclude other causes of acute abdomen and provide indirect evidence to support acute pancreatitis.
(6) Ultrasound examination of the abdomen: enlarged pancreas and abnormal intrapancreatic and peripancreatic echogenicity are seen, and sometimes dilated pancreatic ducts are seen. If ultrasound finds biliary stones or dilated common bile duct, it suggests that pancreatitis may be biliary in origin.
(7) CT examination: It is of great value for the diagnosis and differential diagnosis of acute pancreatitis and for the assessment of the severity of pancreatitis. CT examination of mild acute pancreatitis shows changes such as enlarged pancreas, irregular margins and small amount of peripancreatic exudate.
9.How to treat mild acute pancreatitis?
Acute mild pancreatitis has a tendency to heal itself, often recovering in about 1 week, so the treatment is relatively simple.
(1) The principles are as follows: reduce pancreatic secretion of pancreatic juice, prevent continuous self-digestion of the pancreas, and prevent and control the emergence of various complications.
(2) specific measures: bed rest; fasting, continuous suction gastrointestinal decompression by nasogastric tube for severe abdominal pain, abdominal distension and vomiting; intravenous fluids to replenish blood volume and maintain water, electrolyte and acid-base balance, and pay attention to maintaining heat supply; symptomatic analgesic treatment, pethidine hydrochloride for severe abdominal pain; the use of drugs to inhibit pancreatic secretion and inhibit pancreatic enzyme activity; biliary pancreatitis must use antibacterial drugs. The use of H2 receptor antagonists or proton pump inhibitors to inhibit gastric acid secretion is beneficial to the recovery of the disease.
10. What are the precautions in the drug treatment and prevention of mild acute pancreatitis?
(1) The rehydration treatment should be mainly crystalloid, and the amount of rehydration should be large to prevent the occurrence of hypovolemic shock and disorders of water-electrolyte and acid-base balance.
(2) It is advisable to choose broad-spectrum antibiotics that are sensitive to bacteria with intestinal displacement (Escherichia coli, Pseudomonas spp., Staphylococcus aureus, etc.) and have good permeability to the pancreas, such as imipenem-cistatin (Tylenol), ciprofloxacin, ofloxacin, etc. Second- and third-generation cephalosporins can also be considered. Combined application of metronidazole is effective for anaerobic bacteria.
(3) Growth inhibitor or its long-acting analogue octreotide can effectively inhibit pancreatic secretion, and must be used as appropriate according to blood amylase levels and symptoms.
(4) Gabexate or peptidase has an inhibitory effect on pancreatic enzymes and should be used early.
(5) Laxatives such as magnesium sulfate and Chinese herbal medicine Qing Pancreatic Tang can effectively relieve the symptoms of abdominal distension and should be used at an early stage.
(6) Active treatment of biliary tract diseases can prevent the occurrence of biliary pancreatitis.
(7) Alcohol cessation and reasonable diet can also prevent the occurrence of pancreatitis.
(8) Weight control can prevent the occurrence of hyperlipidemic pancreatitis.
11. What should be the dietary management for the prevention and treatment of mild acute pancreatitis?
(1) Avoid high-fat diet.
(2) Avoid eating too much at one time.
(3) Avoid alcohol abuse, and patients with biliary tract disease should completely abstain from alcohol.
During treatment, when abdominal pain is completely relieved, abdominal pressure disappears, and bowel sounds return to normal, you can start with fat-free fluids, and then gradually resume a normal diet, and the recovery process should be gradual, avoiding rapidly starting to eat foods with high fat content.