Chapter 25. Pancreatitis

ACUTE PANCREATITIS

• Factors that can contribute to acute pancreatitis should be corrected, including discontinuation of medications that could be potential causes.
• Patients with acute pancreatitis without the systemic inflammatory response syndrome should receive aggressive fluid replacement, but goal-directed therapy has not been defined.
• Patients with severe acute pancreatitis and the systemic inflammatory response syndrome require early and aggressive IV fluid resuscitation and should be managed similarly to patients with sepsis.
• Parenteral opioid analgesics are used to control abdominal pain associated with acute pancreatitis.
• The only definitive indication for antibiotic use in acute pancreatitis is to treat known or suspected infection.

CHRONIC PANCREATITIS

• Chronic pain, malabsorption with resultant steatorrhea, and diabetes mellitus are the hallmark complications and symptoms of chronic pancreatitis.
• Pain from chronic pancreatitis can initially be treated with nonopioid analgesics, but opioids will eventually be required as the disease progresses.
• Reduction in dietary fat intake and pancreatic enzyme supplementation are the primary treatments for malabsorption due to chronic pancreatitis.
• Enteric-coated pancreatic enzyme supplements are the preferred dosage form in the treatment of malabsorption and steatorrhea due to chronic pancreatitis.
• The addition of an antisecretory agent to pancreatic enzyme supplementation may increase the effectiveness of enzyme therapy for malabsorption and steatorrhea due to chronic pancreatitis.

1. Describe the epidemiology, etiology, and prognosis of acute pancreatitis.

2. Identify medications with possible, probable, or definite associations with acute pancreatitis.

3. Discuss the usual course of acute pancreatitis and strategies for predicting severity of illness.

4. Discuss the role of fluid replacement in the treatment of acute pancreatitis.

5. Recommend appropriate nutritional support for patients with acute pancreatitis.

6. Compare the place in therapy for various opioid analgesics used in the treatment of acute pancreatitis.

7. Apply evidence from the literature on the use of prophylactic antibiotics in acute pancreatitis.

8. Differentiate between the different pathophysiologic mechanisms involved in the development of chronic pancreatitis.

9. Assess a patient for chronic pancreatitis based on presenting signs and symptoms, laboratory values, and diagnostic studies.

10. Recommend appropriate nonpharmacologic therapy for patients with chronic pancreatitis.

11. Design individualized pharmacotherapeutic regimens for treating the pain associated with chronic pancreatitis.

12. Justify the use of pancreatic enzyme supplements for the treatment of malabsorption associated with chronic pancreatitis.

13. Discuss the advantages and disadvantages of the various dosage forms of the currently available pancreatic enzyme supplements.

14. Justify the use of adjunctive antisecretory agents in the treatment of patients with chronic pancreatitis.

15. Design an evaluation and monitoring plan for patients receiving therapy for chronic pancreatitis.

Pancreatitis is inflammation of the pancreas with variable involvement of regional tissues or remote organ systems.1,2 Acute pancreatitis is characterized by severe pain in the upper abdomen and elevations of pancreatic enzymes in the blood.2 In the majority of patients, acute pancreatitis is a mild, self-limiting disease that resolves spontaneously without complications. Approximately 20% of adults with acute pancreatitis have a severe course, and 10% to 30% of those with severe acute pancreatitis die.1...