How to diagnose and treat acute pancreatitis caused by eating 3 hairy crabs?

*It is only for medical professionals to read for reference and easily master the treatment of acute pancreatitis
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The autumn breeze is cool, and it's the crab-eating season again, don't you know if you have realized the freedom of "hairy crabs"? However, hairy crabs are not friendly to patients with digestive system diseases
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Recently, 54-year-old Mr.
Zhuang ate 3 crabs and induced acute pancreatitis.
His condition was so severe that he was once admitted to the ICU.
Fortunately, Mr.
Zhuang received timely treatment and has now recovered and discharged
.

In addition to eating crabs, overeating and drinking alcohol can also induce acute pancreatitis
.

There are many causes of acute pancreatitis, so how do you judge whether you have acute pancreatitis? Diagnosis of acute pancreatitis Acute pancreatitis is a common disease in hepatobiliary and pancreatic surgery and gastroenterology.
It refers to the digestive effect of pancreatic enzymes on the pancreas itself and surrounding organs due to abnormal activation of pancreatic enzymes.
It is mainly characterized by local inflammatory reaction of the pancreas, and may even be Acute abdomen that causes organ dysfunction
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Abdominal pain is the earliest symptom, and it often occurs suddenly after overeating or drinking a lot of alcohol, and it is located in the middle or to the left of the upper abdomen
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The pain is mostly colic, and the pain is strong, radiating to the back and waist
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Clinically, as long as it meets 2 of the 3 characteristics of symptoms, laboratory examinations and imaging examinations, the diagnosis of acute pancreatitis can be made
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In addition, it is more important to judge whether there are complications and assess the degree of risk.
Commonly used clinical severity classifications of acute pancreatitis include the revised Atlanta classification (RAC) and the classification based on determinants (DBC).
Currently, the former is mostly used.

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Critically severe acute pancreatitis patients are accompanied by persistent organ dysfunction and pancreatic (peripancreatic) necrosis infection, with a high mortality rate, which must be taken seriously
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Early treatment of acute pancreatitis Because acute pancreatitis is a pathophysiological process with complex etiology and multiple factors, the development process of the disease may involve the intersection of multiple disciplines, and treatment also requires a multidisciplinary collaborative diagnosis and treatment model, especially It is a patient with multiple complications
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In terms of early treatment, it is currently recognized that fluid resuscitation should be actively performed early, and it is most effective within 12 to 24 hours of onset
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The effect of fluid rehydration over 24 hours may be limited .

Monitoring urine output, mean arterial pressure, serum urea nitrogen level and hematocrit are used as reference indicators to determine whether resuscitation is effective
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Analgesia treatment is recommended to treat acute pain in the perioperative period
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The analgesic drugs used mainly include non-steroidal drugs, opioids, etc.
The analgesic methods mainly include epidural analgesia, self-controlled analgesia, and multimodal combined analgesia
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The traditional view is that patients with acute pancreatitis need strict fasting, the purpose is to make the gastrointestinal tract get adequate rest, so as not to further stimulate the secretion of pancreatic juice and increase the burden on the pancreas
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However, recent studies have shown that early enteral nutrition support promotes the recovery of patients with acute pancreatitis, helps protect the intestinal mucosal barrier, inhibits bacterial translocation in the gastrointestinal tract, and thereby reduces infectious pancreatic necrosis and systemic inflammation.
Risk of reaction
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The late treatment of acute pancreatitis is mainly surgical treatment for the late local complications
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The timing of surgical intervention should be delayed at least 4 weeks after the onset
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Minimally invasive surgical treatment methods based on video-assisted debridement and endoscopic debridement are recommended, and open surgery can be used as a supplementary method for the failure of the above-mentioned minimally invasive treatment
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In addition to diagnosis and treatment, prevention of recurrence and follow-up are also very important.
About 20% of patients with acute pancreatitis progress to recurrent acute pancreatitis.
Treatment for the cause can help prevent the recurrence of acute pancreatitis
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After Mr.
Zhuang is discharged from the hospital, not only should alcohol and low-fat diet be strictly prohibited, overeating should be avoided, and regular eating habits should be developed.
In addition, patients with gallstone pancreatitis and gallbladder stones like Mr.
Zhuang also recommend cholecystectomy as soon as possible.

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Reference materials: [1] Pancreatic Surgery Group, Chinese Medical Association Surgery Branch.
Guidelines for the diagnosis and treatment of acute pancreatitis in China (2021)[J].
Chinese Journal of Practical Surgery, 2021,41(07):739-746.
[2] Zhejiang Provincial Expert Consensus on the Diagnosis and Treatment of Severe Acute Pancreatitis[J].
Zhejiang Medicine,2017,39(14):1131-1150.
[3]Ge Junbo.
Internal Medicine 9th Edition[M].
People's Medical Publishing House,2018:434.