Acute pancreatitis: Sound the alarm and protect the vitality of the pancreas

Author: Li Teng, Suzhou Hospital Affiliated to Anhui Medical University

Reviewer: Cao Jie, Chief Physician, Suzhou Hospital Affiliated to Anhui Medical University, Vice President of Gastroenterology Society of Anhui General Practice Association, Standing Committee Member of Digestive Endoscopy Society of Anhui Medical Association, Standing Committee Member of Digestive Endoscopy Professional Committee of Anhui Anti-Cancer Association

In today's society, food temptations are everywhere, from exquisite desserts to sumptuous buffets, all kinds of delicious food are hard to resist. As the weather turns cooler, people's appetite increases, but the rich diet options also bring potential health risks. Excessive drinking and intake of high-fat, high-calorie foods not only put a heavy burden on the digestive system, but may also cause acute pancreatitis - a serious health problem that we must pay enough attention to.

1. Overview of acute pancreatitis

The pancreas is both a digestive organ and an endocrine organ. It is the second largest digestive gland in the human body and is located behind the stomach. It can secrete pancreatic juice and insulin, and is responsible for food digestion and blood sugar regulation. Acute pancreatitis refers to an inflammatory reaction caused by the activation of pancreatic enzymes in the pancreas due to various reasons, which causes the pancreas to digest itself, edema, bleeding, and even necrosis.

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In layman's terms, the digestive enzymes secreted by the pancreas do not digest the food eaten, but instead begin to digest the pancreas itself, similar to "eating itself". Clinically, most acute pancreatitis presents as mild symptoms, but 20% to 30% of patients may develop pancreatic necrosis, 25% of patients face life-threatening complications, and the mortality rate of severe patients is as high as 30%.

2. Causes of acute pancreatitis

1. Overeating

If you do not eat in moderation and consume a lot of high-protein and high-fat foods, such as chicken, duck, fish, seafood, etc., it will stimulate the pancreas to secrete a large amount of pancreatic juice to digest these greasy foods, thereby increasing the pressure on the duodenum, causing papillary edema, and pancreatic juice reflux into the pancreatic tissue, thereby causing acute pancreatitis.

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2. Metabolic diseases such as obesity and diabetes

With the improvement of living standards, the number of patients with metabolic diseases is increasing. Hyperlipidemia can not only cause atherosclerosis and cardiovascular and cerebrovascular damage, but also may cause acute pancreatitis. When the triglyceride content in the blood is too high, pancreatic lipase hydrolyzes too much, which can damage pancreatic cells and capillaries. In patients with severe hyperlipidemia, the blood color may be milky white or turbid like lard, which is called chylomicronized blood. Increased blood viscosity can easily form thrombi and chylomicronized blood, leading to vascular occlusion, pancreatic ischemia and necrosis, and thus acute pancreatitis.

3. Biliary tract diseases

Diseases of the biliary system may also cause acute pancreatitis, especially gallstones. The pancreatic duct and common bile duct open at the duodenal papilla, where bile and pancreatic juice merge and enter the duodenum. If gallstones block this door to the duodenum, pancreatic juice secretion will be blocked. At the same time, the pressure in the bile duct increases due to excessive bile accumulation, causing bile to flow back into the pancreatic duct, activating the digestive enzymes in the pancreatic juice, thereby inducing acute pancreatitis.

4. Drinking a lot of alcohol

Drinking a lot of alcohol can stimulate gastric acid secretion, making the duodenal environment acidic, which in turn stimulates the vagus nerve and increases pancreatic juice secretion. At the same time, the protein embolus formed by alcohol stimulating the pancreas will block the pancreatic duct, leading to pancreatic edema and pancreatic juice accumulation. Vomiting after drinking can also cause a sudden increase in duodenal pressure, spasm of the sphincter of Oddi, and reflux of duodenal fluid into the pancreatic duct, thus causing acute pancreatitis.

3. Symptoms of acute pancreatitis

1. Abdominal pain is the earliest and most typical symptom of acute pancreatitis. It is characterized by acute onset of persistent severe pain in the upper abdomen or left upper abdomen, which may radiate to the back and chest. The pain is aggravated when lying on your back, relieved when sitting or bending forward, and aggravated by eating.

2. Nausea and vomiting are common accompanying symptoms that cannot be relieved in the short term.

3. Jaundice is more common in patients with common bile duct stones.

4. Abdominal distension is caused by reflex intestinal paralysis in the early stage, which causes the patient to stop defecating and passing gas.

5. The degree of fever is consistent with the severity of the disease.

6. Severely ill patients may experience symptoms of shock such as pallor, cold sweat, weak pulse, low blood pressure, and altered consciousness.

7. Complications include pancreatic pseudocyst, multiple organ failure, sepsis, intra-abdominal hypertension, pancreatic encephalopathy, and even death. Most patients with acute pancreatitis will have a moderate fever, which usually lasts for 3 to 5 days.

4. Dietary conditioning for patients with acute pancreatitis

1. Acute attack

During the acute attack of acute pancreatitis, patients should not drink water or eat food, because food will stimulate pancreatic secretion and aggravate the condition. Patients can receive intravenous infusion of glucose, amino acids, etc. to maintain nutrition and water and electrolyte balance, and should avoid eating too early.

2. Recovery period

During the treatment, when abdominal pain and bloating disappear and intestinal peristalsis is restored, you can consider eating. It is advisable to drink a small amount of water first, and then give fat-free, protein-free, high-carbohydrate liquid food, such as rice soup, lotus root powder, etc., without discomfort, in small and frequent meals. After 2 to 3 days, transition to non-irritating, easily digestible semi-liquid diet, such as rice paste, porridge, soft noodles, etc.

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3. Stable period

After the patient's condition stabilizes, they should eat low-fat soft food and pay attention to balanced nutrition intake. The cooking methods are mainly steaming, boiling, stewing and braising, and stir-frying, deep-frying, frying and other methods should be used less or avoided. Peanuts, walnuts, fatty meat and other high-fat foods are forbidden. At the same time, the patient's digestion and absorption should be observed at any time. If digestive symptoms such as abdominal pain, bloating, diarrhea, etc. occur, it means that the patient cannot tolerate the digestion and absorption of fat, and the fat content in the diet needs to be further reduced. If necessary, the protein content should also be reduced.

4. In daily life

Patients should adhere to the principle of eating small meals frequently, and eat 5 to 6 times a day. Avoid overeating, and avoid fried, deep-fried, high-fat foods, smoking, alcohol, and spicy foods. At the same time, the cause should be actively removed. For example, acute pancreatitis caused by biliary disease should be actively treated for biliary stones after the condition stabilizes; patients with alcoholic pancreatitis should strictly abstain from alcohol; overeaters should change their bad eating habits; patients with hyperlipidemia should take lipid-lowering drugs for a long time and eat a low-fat, light diet.

Reasonable nutritional support therapy, especially dietary and early enteral nutrition, is necessary and important for preventing and treating malnutrition, maintaining the integrity of intestinal barrier function and improving clinical outcomes.

5. Prevention of acute pancreatitis

1. Reduce triggers

Avoid the occurrence of biliary diseases. Gallstones are the main cause of acute pancreatitis. If gallstones fall and pancreatic bile cannot be discharged smoothly, pancreatitis will occur. Therefore, if you have gallstones and the stones are large or you have recurrent abdominal pain, you can undergo cholecystectomy according to the doctor's evaluation to prevent pancreatitis.

2. Combine work and rest

Maintain a healthy lifestyle, choose the right exercise method and maintain good exercise habits. Avoid excessive fatigue that may lead to a decrease in body resistance, thereby preventing the invasion of germs and bacteria.

3. Eat a healthy diet

Develop a regular eating habit and maintain a balanced intake of protein, fat and carbohydrates. Avoid overeating, smoking and drinking. Eat a low-salt, low-fat and low-oil diet, and insist on eating fresh vegetables and fruits every day. Avoid consuming irritating, gas-producing, high-fat and high-protein foods, and eat small meals frequently to avoid overeating.

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4. Disease control

Timely treatment of systemic diseases, such as diabetes, hyperlipidemia, etc. People with hyperlipidemia, obesity, and hyperglycemia should actively exercise and try to maintain their body mass index (BMI) = weight (kg) ÷ height 2 (m2) within the normal range (18.5-23.9 kg/m2).

Acute pancreatitis has an acute onset and can induce a series of serious diseases, so it needs to be taken seriously. We should develop the habit of eating regularly, eat a reasonable diet, eat a healthy and balanced diet, and avoid high-fat and high-cholesterol foods. We should exercise actively, maintain a healthy weight, and prevent overweight and obesity. Only by combining work and rest and living a healthy life can we effectively prevent the recurrence of acute pancreatitis. Let us control our mouths, protect our health, and leave no "pancreas" regrets!