ABSTRACT
Acute severe pancreatitis typically causes: severe continuous abdominal pain, respiratory failure, hypovolaemia and distributive shock, and other complications, such as acute kidney injury and pyrexia. Oedema and distension of the pancreatic capsule, biliary tree obstruction or chemical peritoneal burning by chemicals such as phospholipidase A cause severe acute abdominal pain, requiring opioid analgesics such as morphine. Half of patients with severe pancreatitis develop intra-abdominal hypertension, which can cause multi-organ failure. Pancreatitis is usually sterile, so prophylactic antibiotics should not be prescribed. Overall mortality for pancreatitis is about 5%, but about one fifth progress to severe disease, which has a mortality of about 15–20%. Severe pancreatitis therefore necessitates intensive care unit (ICU) admission, but, although progression is often rapid, predicting which patients will progress to severe pancreatitis remains problematic. Enteral nutrition is usually possible, and preferable, with pancreatitis. It has been shown to boost immunity.
