TREATMENT OF ACUTE PANCREATITIS AT USC
What happens in severe acute pancreatitis?
Severe pancreatitis causes the death of parts of the pancreas. The injured and dying pancreas releases digestive enzymes into the abdomen, which causes extensive death of fatty tissue in the abdomen. As a consequence patients with severe pancreatitis have dead pancreatic tissue and also widespread death of fatty tissue around the pancreas. This dead pancreatic tissue is the source of the all problems in patients with severe pancreatitis. Toxins released from it cause the different organs to fail, while infection of the dead material cause most of the deaths from acute pancreatitis.
Patients with severe pancreatitis go through well defined stages in their illness that require specific care. Our treatment protocols are directed towards anticipating the problems as they arise and providing appropriate level of care based on our understanding of the disease.
In the first week failure of multiple organs develop due damage from toxins that are released into the blood stream from the dead pancreas. Aggressive support in the intensive care unit of multiple organs such as heart, lungs and kidneys may be required.
Following the second week onwards, infection of the dead pancreas is an important cause of the continuing illness. The treatment of infected dead pancreas is complex and the patient may benefit from treatment in a specialty center that treat a high volume of these conditions. Aggressive treatment of any infection that develops is a key element for survival in critically ill patients.
Management by a team of experienced pancreatic physiciansThe treatment of severe acute pancreatitis is complex and requires a day-by-day and week-by-week re-evaluation of the patients' condition with the treatment tailored to the changes that rapidly occur in critically patients. For best outcome from severe pancreatitis, patients should be managed in a center such a USC that is experienced in the treatment of severe acute pancreatitis.
Our management approach usually involves a coordinated effort by a team of physicians from multiple specialties that are skilled in a treatment of patients with severe acute pancreatitis such as a a pancreatic surgeon experienced in the treatment of severe pancreatitis, a critical care specialist (ICU specialist), gastroenterologists and radiologists who may be required to perform complex interventional procedures, and a nutritional specialist since patients with severe pancreatitis are not able to eat for prolonged periods often from extending two weeks to many months.
At USC, Dilip Parekh M.D. leads a team of physicians from different specialties that have a large experience in managing patients with severe pancreatitis.
Critical care support
During the first two weeks after a severe attack of acute pancreatitis our treatment is directed at providing intensive critical care (ICU) to support the cardiopulmonary (heart and lung), liver and kidneys that often fail from the severity of the insult to the body that is associated with the release of large amounts toxins from the dead pancreas in the abdomen.
During this period the patient is in the ICU and may require intense medical support for heart, ventilation for the lungs if they fail and sometimes dialysis to support the kidneys. Almost all patients require intravenous nutrition.
Aggressive treatment of infection
After the second week we direct meticulous attention towards providing nutritional support and preventing infections. Patients often develop infection of the necrotic (dead) pancreas in the abdomen after the first first week after their illness. This type of infection can be fatal and requires early and aggressive treatment to remove the infected dead pancreas.
Necrotic (dead) infected pancreas may be removed by the surgical or a non-surgical route. Drainage catheters are placed into the infected collection by the radiologist for non- surgical treatment of the infection.
Our experience has suggested that operative drainage of the infected area is preferred since non-operative drainage is often ineffective to remove the thick chunks of dead pancreas present in the abdomen through the small tiny tubes that are placed by the radiologist for non-operative drainage of the infection. In some patients non-operative drainage may cause a worsening of the patient’s condition due to introduction of skin bacteria into the area of necrosis (dead pancreatic tissue) by placement of the drainage tubes through the skin.
The decision to use a surgical or non-surgical treatment route is done in our Center by skilled pancreatic physicians from different specialties that can provide optimal care.
Surgical treatment for severe acute pancreatitis
The surgical treatment of severe pancreatitis is complex and demanding and requires a high level of expertise. The treatment is preferably given in a tertiary medical center that has a large experience in dealing with patients with severe pancreatitis. At USC Dilip Parekh M.D. is developing a novel method for treatment of pancreatic abscess and pancreatic necrosis (dead pancreas) utilizing laparoscopic techniques.
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