Editing Pancreatitis (section)

===Severe acute pancreatitis===
Severe pancreatitis can cause [[organ failure]], [[necrosis]], infected necrosis, [[pseudocyst]], and [[abscess]]. If diagnosed with severe acute pancreatitis, people will need to be admitted to a [[high-dependency unit]] or [[intensive care unit]]. It is likely that the levels of fluids inside the body will have dropped significantly as it diverts bodily fluids and nutrients in an attempt to repair the pancreas. The drop in fluid levels can lead to a rapid and severe reduction in the volume of blood within the body, which is known as [[hypovolemic shock]]. This condition represents a major life threat and may be prevented in some cases by prompt and aggressive fluid resuscitation.<ref name=":2" />

Patients with severe AP are often unable to receive oral nutrition, and so [[Feeding tube|nasogastric feeding tubes]] are commonly used for these patients. Feeding tubes may be used to provide calories and nutrients, combined with appropriate analgesia.<ref name=":2" /> Early enteral feeding within 48 hours of admission to the hospital has been associated with better outcomes.<ref>{{cite journal | vauthors = Li JY, Yu T, Chen GC, Yuan YH, Zhong W, Zhao LN, Chen QK | title = Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis | journal = PLOS ONE | volume = 8 | issue = 6 | pages = e64926 | date = Jun 6, 2013 | pmid = 23762266 | pmc = 3675100 | doi = 10.1371/journal.pone.0064926 | bibcode = 2013PLoSO...864926L | doi-access = free }}</ref>

The lungs can be inflamed as a result of the systemic inflammatory response and can manifest as [[acute respiratory distress syndrome]] (ARDS).<ref name=":2" /> Supplemental oxygen is frequently required in the treatment of severe AP, and a patient may be given anything from supplemental oxygen via [[nasal cannula]], to full [[mechanical ventilation]]. In many cases, even the most intensive respiratory therapies are not enough, and many patients with severe pancreatitis die as a result of [[respiratory failure]].<ref>{{cite journal | vauthors = Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, Ball CG, Parry N, Sartelli M, Wolbrink D, van Goor H, Baiocchi G, Ansaloni L, Biffl W, Coccolini F, Di Saverio S, Kluger Y, Moore E, Catena F | title = 2019 WSES guidelines for the management of severe acute pancreatitis | journal = World Journal of Emergency Surgery | volume = 14 | issue = 1 | pages = 27 | date = December 2019 | pmid = 31210778 | pmc = 6567462 | doi = 10.1186/s13017-019-0247-0 | doi-access = free }}</ref><ref>{{Cite journal | vauthors = Thunaibat A, Omeish H, Rashid M |date=October 2023 |title=S2157 Necrotizing Pancreatitis Complicated by ARDS and GI Bleeding: A Case Report |url=https://journals.lww.com/ajg/fulltext/2023/10001/s2157_necrotizing_pancreatitis_complicated_by_ards.3034.aspx |journal=American Journal of Gastroenterology |language=en |volume=118 |issue=10S |pages=S1555–S1556 |doi=10.14309/01.ajg.0000958268.44340.46 |issn=0002-9270}}</ref>

As with mild pancreatitis, it will be necessary to treat the underlying cause—gallstones, discontinuing medications, cessation of alcohol, etc. If the cause is gallstones, it is likely that an [[Endoscopic retrograde cholangiopancreatography|ERCP]] procedure or [[Cholecystectomy|removal of the gallbladder]] will be recommended. There is also evidence that, even for patients without gallstones, surgical removal of the gallbladder may reduce the risk of recurrence, and as of 2024, guidelines recommend the procedure for any patient with severe pancreatitis with no clear cause.<ref name=":2" />

If the cause of pancreatitis is alcohol, cessation of alcohol consumption and treatment for [[Alcohol dependence|alcohol dependency]] may improve pancreatitis. Even if the underlying cause is not related to alcohol consumption, many doctors recommend avoiding it for at least six months as this can cause further damage to the pancreas during the recovery process.<ref>{{cite web | work = E Medicine Health | vauthors = Balentine JR, Stöppler MC | title = Symptoms and Signs of Acute and Chronic Pancreatitis Differences | url = https://www.emedicinehealth.com/pancreatitis/symptom.htm }}</ref> Patients whose pancreatitis can be linked to alcoholism are known to have a much higher risk of recurrence.<ref name=":2" />