Prophylaxis

The prophylaxis of pancreatitis consists in removing the causes, e.g. avoiding alcohol and certain drugs or removing gallstones from the bile ducts. If gallstones occur repeatedly, removal of the gallbladder should be considered. The risk of developing gallstones can be reduced by a low-fat and balanced diet.

Therapy

Once pancreatitis has been diagnosed, the cause should be eliminated if possible. In most cases this means that alcohol consumption must be stopped. Any stones in the bile duct that may be the cause of the inflammation should also be removed endoscopically or, if necessary, surgically.

Afterwards, as a rule, an attempt is first made to treat the inflammation conservatively. This is mainly done by closely monitoring the patient in the intensive care unit. Painkillers are administered medically and attention is paid to a balanced fluid balance.

Laboratory tests should also be carried out in close proximity to the patient to determine whether the inflammation is worsening or tending to recede. Once the triggering cause has been eliminated, it is not uncommon for pancreatitis to heal completely with this conservative treatment. Conservative treatment also includes a corresponding food ration as long as the patient still complains of pain.

After that, the patient can slowly start to rebuild his or her diet. Antibiotics can also be administered (both as tablets and as an infusion) but should only be used if the pancreatitis is a necrotizing form or if an abscess has been seen near the pancreas. If conservative treatment is unsuccessful and the patient’s health condition deteriorates, surgical intervention should be considered.

It is usually performed endoscopically. Three devices are placed near the inflamed area and severely inflamed tissue or already dead (necrotic) tissue is removed. If the inflammation is very advanced or the anatomical conditions do not allow an alternative, the operation must be performed openly in exceptional cases.

Very pronounced inflammatory findings may also lead to peritonitis (inflammation of the peritoneum). In this case, a so-called lavage must be performed in addition to the exposure and ablation of the affected area. This procedure is a kind of irrigation of the abdominal cavity with a sterile fluid, which is intended to ensure that bacterial foci that are not immediately visible are cleared out. If the findings are very extensive, it may be necessary to repeat this lavage several times. An accompanying antibiotic treatment should also be considered in this case.

Nutrition

Depending on how far the pancreatitis has progressed and how much of the organ’s tissue has already been destroyed, patients have to take the enzyme lipase. This plays an important role in the digestion of fat. Patients should also seek advice from a nutritional expert on how they can better cope with the disease by changing their diet.

If the inflammation of the pancreas is diagnosed, the pancreas should first be relieved and the patient should not eat any food. Nutrition is supplied via the blood (parenterally). If the course of the acute pancreatitis is mild, this usually takes 3 to 5 days.

After symptoms have improved, the patient can start to build up his diet. Initially, the patient should eat easily digestible carbohydrate food consisting of rusk, white bread with jam, cereal mash and sweetened tea. If this is well tolerated, protein-rich, low-fat foods such as low-fat milk and cheese, lean poultry, low-fat fish, vegetables and low acid fruit can be added.

The fat content of the food can then be slowly increased, but should initially be in very small portions. Once all symptoms have subsided, the dietary build-up is complete and the patient can eat anything he can tolerate. If the inflammation becomes more severe, the patient may need to be fed artificially.

This is done by means of a small intestine tube and is usually maintained for about 2 to 3 weeks before the food build-up can slowly begin. This takes place in the same stages as mentioned above. It is important to permanently avoid alcohol and nicotine in any type of pancreatitis.