If you experience acute abdominal pain after a heavy meal, be careful!

Author: Guo Shubin, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Mi Yuhong, Chief Physician, Beijing Anzhen Hospital, Capital Medical University

Many people have had this experience: acute abdominal pain after excessive drinking or overeating, and after going to the hospital, they were diagnosed with acute pancreatitis.

Figure 1 Original copyright image, no permission to reprint

1. Why can excessive drinking or overeating easily cause acute pancreatitis?

Under normal circumstances, after we eat, the digestive organs will secrete digestive juices such as gastric acid, pancreatic juice, and bile to digest food.

Drinking too much or overeating will cause the pancreas to secrete excessively and the intestinal wall to swell. A large amount of pancreatic juice cannot pass through the pancreatic and bile ducts quickly, which will cause the pressure at the pancreatic outlet to increase, making it difficult for pancreatic juice to discharge and even flow back into the pancreatic duct, increasing the pressure inside the pancreatic duct and further causing the pancreatic alveoli to rupture and release pancreatic enzymes.

Under normal circumstances, the pancreatic enzymes in the pancreatic acinus are inactive. Once released, they will be activated and digest their own tissues, which may cause damage to various organs and systems.

Figure 2 Original copyright image, no permission to reprint

Therefore, high-fat meals, excessive drinking, or overeating may be high-risk factors for inducing acute pancreatitis.

In addition to alcoholism and overeating, conditions such as gallstones, viral infections, drugs, and hyperlipidemia can also cause pancreatic damage and lead to pancreatitis, which is also very common.

Everyone knows that acute pancreatitis attacks can cause abdominal pain. So what are the specific manifestations or characteristics of the abdominal pain caused by pancreatitis?

2. What are the characteristics of abdominal pain caused by acute pancreatitis?

The pain caused by pancreatitis is different from that caused by cholecystitis.

The gallbladder is close to the body surface, so the specific pain location can be felt directly (right upper abdomen and under the xiphoid process); the pancreas is close to the retroperitoneum, and since it is a transverse organ, it can appear on the right, middle, and left sides of the upper abdomen, so the pain may be deeper and more inward, and may spread to the left upper and middle abdomen, and is often related to eating.

The abdominal pain caused by pancreatitis is usually dull pain, muffled pain or bloating in the early stage. Many patients have abdominal pain but do not have a typical history of pancreatitis. The pancreas is only slightly affected and there will be no typical clinical manifestations.

When pancreatitis does not affect the peritoneum, the location of pain is not particularly clear, because there is the stomach and other abdominal organs in front, and pain can only be felt when deep pressure is applied. When lying flat, the pancreas is pressed backwards, and the pain is aggravated; when lying prone, the pancreas will be away from the retroperitoneal plexus, and the pain will be alleviated. This is a characteristic manifestation of pancreatitis.

In severe pancreatitis, the celiac plexus is stimulated by inflammation and other factors, and the abdominal pain will worsen. The intestines will become bloated, and the entire left colon and ascending colon will be filled with gas. At the same time, bloating will also occur after inflammation stimulates the small intestine.

Severe pancreatitis causes pancreatic fluid to leak out, forming abdominal inflammation. At this time, pressing the abdomen will cause typical abdominal tenderness, and rebound pain will occur when raising the hand. In the early stage of abdominal pain, there will be no clear tenderness, rebound pain, and muscle tension, which will only occur in the later stage. This is also a characteristic of pancreatitis.

Severe pancreatitis can affect local areas and spread to the whole body, affecting the respiratory, circulatory, digestive, blood, and endocrine systems. It is not a simple specialized disease.

If this kind of acute abdominal pain occurs and pancreatitis is suspected, you should seek medical attention immediately. Determine whether it is pancreatitis based on your diet, medical history, abdominal pain, and bloating, and most importantly, laboratory test indicators.

3. How to treat acute abdominal pain diagnosed as pancreatitis?

Most pancreatitis patients have mild symptoms. First, do not eat or drink anything, because eating will secrete pancreatic juice, which will increase the pressure of the pancreas and cause the gallbladder to contract. Then, the liquid in the stomach is pumped out, which is called gastrointestinal decompression. If it is not pumped out, the gastric juice will flow directly downward, which will also stimulate pancreatic secretion. Some drugs can also be used to reduce gastric juice secretion, such as acid inhibitors.

If the pancreatic duct is unobstructed and pancreatic secretion is reduced, some drugs that prevent and reduce pancreatic enzyme secretion can be used, and the damage to organs and systems caused by reduced pancreatic enzyme secretion will be reduced. For these enzymes released into the blood, some enzyme inhibitors should be used to inactivate these enzymes in the blood as soon as possible to prevent damage to various organs and systems.

Pancreatitis can cause intestinal bloating and obstruction. More importantly, some drugs are used to improve intestinal function. After the intestinal function is restored, the pressure in the abdominal cavity is reduced, which is conducive to the recovery of the pancreas.

In addition, if pancreatitis causes damage to the heart and poor circulatory function, circulatory support is required, including infusion and the use of some vasoactive drugs; if breathing is poor, oxygen therapy, high-flow oxygen therapy, non-invasive ventilation or invasive ventilation, that is, a ventilator, can be used to solve these problems; if kidney function is affected, blood purification can be performed; if the damage is particularly severe, extracorporeal membrane oxygenation therapy may even be required.

Mild pancreatitis can be relieved with appropriate treatment, but severe pancreatitis requires high-intensity comprehensive support for all organs and systems in the body to save the patient.