III. Western Medical Treatment

1. Spasmolytic and analgesic agents: Atropine 0.5 mg combined with promethazine 25 mg administered via intramuscular injection, repeated every 4–8 hours as needed. For severe pain that does not respond to conventional medications, morphine 50–100 mg can be given via intramuscular injection, or diamorphine 10 mg can be administered intramuscularly, but both must be repeated every 4–8 hours. Intravenous infusion of 100 ml of 0.1% procaine saline solution is also effective.

2. Inhibition of pancreatic enzyme activity: Early application yields better results; however, once obvious hemorrhage or necrosis has occurred, the effect diminishes. Trypsin inhibitor 100,000 units administered via intravenous drip once or twice daily; once the condition stabilizes and urine amylase levels return to normal, the medication can be discontinued.

3. Anti-shock treatment: For hemorrhagic acute pancreatitis, plasma or whole blood transfusions should be given to correct hypovolemia. Before blood transfusions are available, low-molecular-weight dextran or glucose-saline solutions can be administered. If blood pressure drops significantly, vasopressors should be used—typically dopamine 10 mg and metaraminol 20 mg added to 250–500 ml of saline solution, infused at a rate of 8 drops per minute. If there are subcutaneous petechiae or suspected disseminated intravascular coagulation (DIC), heparin can be administered.

4. Correction of water, electrolyte, and acid-base balance disorders: Fasting patients receive intravenous infusion of 1,000 ml of 5% glucose saline solution and 2,000 ml of 10% glucose solution daily. If hypokalemia occurs, potassium chloride should be administered as appropriate; if hypocalcemia occurs, intravenous injection of 10–20 ml of 10% calcium gluconate is recommended. In addition, patients experiencing vomiting should be monitored for alkalosis and corrected promptly.

5. Control of hyperglycemia: Insulin can be administered subcutaneously when blood sugar is elevated. When using glucose-containing fluids for treatment, calculate 1 unit of regular insulin for every 5 grams of glucose.

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6. Anti-infective Drugs
   Edematous pancreatitis is a form of chemical inflammation and does not require the use of antibacterial agents. Hemorrhagic necrotizing pancreatitis, on the other hand, is prone to secondary infections that can lead to abscesses or peritonitis; therefore, antibiotic therapy should be administered. Options include penicillin, ampicillin, gentamicin, dibekacin, streptomycin, chloramphenicol, and others. However, with the exception of penicillin and ampicillin, special attention must be paid to the nephrotoxicity and ototoxicity of other antibiotics, and prolonged use is not recommended.

7. Diet
   Patients with mild cases may be given liquid or semi-liquid diets, but fatty foods should be avoided. For more severe cases with significant pain, fasting for 1–3 days is advisable. In critical cases, not only should fasting be implemented, but gastrointestinal decompression should also be performed.

8. Surgical Treatment May Be Considered in the Following Situations:
   ① When the diagnosis remains unclear and there is suspicion of perforation of intra-abdominal organs or intestinal necrosis;
   ② When jaundice continues to deepen;
   ③ When suppurative cholangitis or pseudocysts develop as complications;
   ④ When antibiotic therapy and comprehensive medical treatment have proven ineffective.

IV. Prognosis and Outcome

The prognosis for edematous acute pancreatitis is generally favorable, but if the underlying cause is not eliminated, recurrence is common. The mortality rate for mild cases of necrotizing pancreatitis ranges from 20% to 30%, while severe cases carry an even graver prognosis due to numerous complications, with mortality rates exceeding 60% to 70%. Even patients who survive severe cases often suffer from varying degrees of pancreatic dysfunction or progress to chronic pancreatitis. Factors that adversely affect the prognosis of acute pancreatitis include age, hypotension, hypocalcemia, and various complications.

Chapter 11 Chronic Pancreatitis

Section 1 Overview

Chronic pancreatitis refers to chronic, progressive inflammation of the pancreatic acini and ducts. This chronic inflammation often leads to fibrosis and calcification of the pancreatic parenchyma, as well as narrowing or dilation of the pancreatic ducts, resulting in pathological changes such as pseudocysts and even abscesses. Clinically, it mainly manifests as abdominal pain, weight loss, diarrhea or steatorrhea, and in later stages, abdominal masses, jaundice, and diabetes. In China, the most common cause is recurrent, prolonged acute pancreatitis that eventually evolves into chronic pancreatitis. Although there are also cases of chronic pancreatitis with insidious onset and slow progression, these are often overlooked due to their subtle symptoms. The disease predominantly affects individuals over the age of 40, with a higher incidence in males than females. The course of the disease typically lasts more than 10 years, and some patients (such as those with slowly developing chronic pancreatitis) may progress directly from asymptomatic states to manifestations of pancreatic insufficiency. The primary causes of chronic pancreatitis in China are biliary stones, inflammation, and roundworm infestation. These conditions can lead to bile reflux into the pancreatic duct, causing acute pancreatitis; repeated episodes of acute pancreatitis ultimately result in chronic pancreatitis. Prolonged, unresolved chronic pancreatitis can further complicate the condition by causing pancreatic duct obstruction or stone formation, thereby exacerbating the disease. Additionally, long-term alcohol abuse can cause degeneration and necrosis of pancreatic cells or damage to the pancreatic duct epithelium; inflammation of adjacent organs, severe malnutrition, endocrine disorders (such as hypercalcemia), and other factors can also contribute to chronic pancreatitis.

Section 2 Diagnosis