Editing Pancreatitis (section)

==Treatment==
The treatment for acute pancreatitis will depend on whether the diagnosis is for the mild form of the condition, which typically resolves without treatment, or the severe form, which can cause serious complications. Patients with mild AP should still be [[Inpatient care|hospitalized]], at least briefly, to receive [[IV fluids]] and for clinical monitoring purposes.<ref name=":2" />

=== Pain management ===
Acute pancreatitis typically presents with severe to extreme abdominal pain.<ref name=":2" /><ref name=":3">{{cite journal | vauthors = Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R | title = Acute Pancreatitis: Diagnosis and Treatment | journal = Drugs | volume = 82 | issue = 12 | pages = 1251–1276 | date = August 2022 | pmid = 36074322 | pmc = 9454414 | doi = 10.1007/s40265-022-01766-4 }}</ref> While the mildest cases of pancreatitis may be managed exclusively with [[NSAIDs]] (which are preferred in such scenarios due to the anti-inflammatory effects and the better safety profile), most patients with pancreatitis require heavy [[opioid]] regimens for pain therapy. Severe cases often require continuous IV infusions of opioid medications. It is appropriate for emergent cases of pancreatitis to be treated with these medications immediately, rather than attempting to control the pain with lesser medications first.<ref name=":3" />

The early use of strong pain management therapies does not affect the ability for the physician to diagnose the cause of severe abdominal pain. Thus, pain management should not be reduced or withheld for the purposes of diagnosis in cases of suspected pancreatitis.<ref name=":3" /><ref>{{cite journal | vauthors = Manterola C, Vial M, Moraga J, Astudillo P | title = Analgesia in patients with acute abdominal pain | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD005660 | date = January 2011 | pmid = 21249672 | doi = 10.1002/14651858.CD005660.pub3 | collaboration = Cochrane Colorectal Cancer Group }}</ref>

=== Fluid resuscitation ===
Regardless of disease severity, moderately aggressive [[fluid resuscitation]] is advisable for all patients with acute pancreatitis, especially if they can be diagnosed and treated early in the course of the disease. The preferred fluid for administration is [[Ringer's lactate solution|lactated Ringer solution]], but [[Saline (medicine)|saline]] may also be used. Patients with acute pancreatitis of any severity are typically [[Hypovolemia|hypovolemic]] (decreased blood volume), and this hypovolemia can result in [[hypoperfusion]] of pancreatic cells. Without blood supplying them, the pancreatic cells can become [[Necrosis|necrotic]], resulting in tissue death that can become further worsened by the strong inflammatory response that occurs following necrosis.<ref name=":2" />

=== Managing infection ===
Infection is a major cause of mortality in patients with pancreatitis, and these patients are known to be prone to infections in a variety of organ systems.<ref name=":2" /> The majority of patients with pancreatitis have damage to the [[Gut barrier dysfunction|gut barrier]], allowing gut bacteria to bypass this barrier and cause infection. Some species of gut bacteria are also known to detect pancreatitis and respond by releasing their own pro-inflammatory molecules. Conversely, a healthy [[microbiome]] is beneficial for preventing infection, and several gut bacteria are known to augment human immune defenses and reduce systemic inflammation.<ref>{{cite journal | vauthors = Zhang C, Li G, Lu T, Liu L, Sui Y, Bai R, Li L, Sun B | title = The Interaction of Microbiome and Pancreas in Acute Pancreatitis | journal = Biomolecules | volume = 14 | issue = 1 | pages = 59 | date = December 2023 | pmid = 38254659 | pmc = 10813032 | doi = 10.3390/biom14010059 | doi-access = free }}</ref>

===Mild acute pancreatitis===
The treatment of mild [[acute pancreatitis]] is successfully carried out by admission to a general hospital ward for fluid resuscitation and patient monitoring.<ref name=":2" /> Traditionally, people were not allowed to eat until the inflammation resolved but more recent evidence suggests early feeding is safe and improves outcomes and may result in an ability to leave the hospital sooner, and guidelines have been updated to recommend early feeding for patients able to tolerate it.<ref name=":2" /><ref>{{cite journal | vauthors = Vaughn VM, Shuster D, Rogers MA, Mann J, Conte ML, Saint S, Chopra V | title = Early Versus Delayed Feeding in Patients With Acute Pancreatitis: A Systematic Review | journal = Annals of Internal Medicine | volume = 166 | issue = 12 | pages = 883–892 | date = June 2017 | pmid = 28505667 | doi = 10.7326/M16-2533 | s2cid = 2025443 }}</ref>

Opioids may be used for the pain. When the pancreatitis is due to gallstones, or even for patients without gallstones and no other identifiable cause, early gallbladder removal also appears to improve outcomes.<ref name=":2" /><ref>{{cite journal | vauthors = Moody N, Adiamah A, Yanni F, Gomez D | title = Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis | journal = The British Journal of Surgery | volume = 106 | issue = 11 | pages = 1442–1451 | date = October 2019 | pmid = 31268184 | doi = 10.1002/bjs.11221 | s2cid = 195787962 }}</ref>

===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" />