What antibiotics cause pancreatitis

Pancreatitis, acute

Acute inflammation of the pancreas(acute pancreatitis): Sudden non-infection inflammation of the pancreas. The most common causes are alcohol abuse and trapped gallstones in the mouth of the pancreatic duct. It mainly affects people between the ages of 30 and 50. Depending on the severity, the disease is fatal in 1–15% of cases. Treatment and monitoring in the clinic as quickly as possible are important.

Leading complaints

  • Sudden, violent, long-lasting pain in the upper abdomen, often belt-shaped around the abdomen, but also radiating in other directions
  • Nausea and vomiting
  • Severe feeling of illness
  • Often fever
  • Drop in blood pressure, in severe cases shock with palpitations, cold sweat and fear up to circulatory failure
  • Occasionally yellowing of the skin if a gallstone is trapped.

When to the doctor

Call the (emergency) doctor immediately,

  • if the above complaints occur!

The illness

Triggers and Risk Factors

The most common triggers for acute pancreatitis are a gallstone trapped at the mouth of the pancreatic duct (45%), which causes digestive intestinal juices and bile to enter the pancreatic duct, as well as alcohol abuse (35%). In 15% of the cases no cause can be found, the remaining 5% are spread out

Forms, course and complications

In the most common form, the mild acute pancreatitis (interstitial-edematous pancreatitis), the above-mentioned triggers lead to inflammatory reactions and increased permeability of the pancreatic ducts. This causes fluid to enter the tissue of the pancreas and cause it to swell. Death of pancreatic tissue and other serious complications does not occur in the mild form; it has a good prognosis with a mortality rate of less than 1%.

The severe acute inflammation of the pancreas (acute necrotizing pancreatitis) is characterized by proper self-digestion, which leads to the partial or complete death of pancreatic tissue with serious complications.

During self-digestion, the gland cells are so directly damaged by the triggering stimulus that digestive enzymes are released in massive quantities on the spot instead of reaching their actual destination, the intestines. Unlike in the intestine, where the enzymes break down food components, here they attack the pancreatic tissue itself and lead to the death of cells (necrosis). In about a third of the cases, intestinal bacteria migrate into the dead pancreatic tissue, so-called infected necroses form.

If the digestive enzymes reach the abdominal cavity beyond the limits of the pancreas, they also cause great damage there. The necroses expand, blood vessels become thickened and blood flows into the abdominal cavity or behind the peritoneum. Up to a third of the total blood can be withdrawn from the circulation in this way, the consequences are lowering of blood pressure and circulatory shock.

Peritonitis, pleural effusions, pneumonia, abscesses and blood poisoning and intestinal paralysis are further complications. The mortality rate is therefore high in severe pancreatitis, it is around 10-25%.

Long-term consequences

After an acute pancreatic inflammation has healed, pancreatic pseudocysts persist in the pancreas in 5% of patients. Pseudocysts are fluid-filled cavities that can cause pressure in the upper abdomen and, if inflamed, cause a fever. If the tissue of the pancreas is partially or even completely digested, it leads to pancreatic insufficiency and diabetes.

Diagnostic assurance

The most important clues for the diagnosis are the severe, persistent pain in the upper abdomen, the poor general condition with fever, nausea, drop in blood pressure and a feeling of severe illness, and the increase in pancreatic enzymes (lipase in the blood).

In the ultrasound, the enlarged pancreas due to fluid retention can be clearly seen, as can dead areas or trapped gallstones. To accurately assess the severity of the inflammation, the doctor usually orders a CT scan with contrast agent.

Laboratory tests and imaging tests are used to find the cause. For example, an increased Gamma-GT and an increased MCV speak in favor of alcohol abuse; an increased calcium in the blood for an overactive parathyroid and an increased ALT for a stone in the bile duct. Tumors and gallstones, in turn, can be easily detected using endoscopic ultrasound, ERCP and MRCP.

Differential diagnoses. Acute severe upper abdominal pain z. B also before at

treatment

Patients with acute pancreatitis have to be hospitalized, in severe cases, the intensive care unit. There, on the one hand, the body functions are stabilized, the pain is treated and, if possible, the underlying causes are addressed. In addition, the doctors closely monitor every acute pancreatitis with laboratory analyzes and ultrasound examinations in order to identify impending complications at an early stage.

  • One of the most important treatment measures is the administration of fluids in the form of infusions, as there is usually a pronounced lack of fluids. As a rule, at least 3–4 liters / day are necessary.
  • If the pancreatitis is mild and the patient has an appetite, they can eat normal, low-fat foods. In the severe form, doctors initially feed the patient with infusions, so the necessary nutrients get directly into the blood. Because early nutrition via the intestine lowers the complication rate, a tube is placed through the nose into the small intestine from the 2nd or 3rd day and the patient is fed with food. Once the pain is gone and the pancreatic enzymes decrease, the tube is removed and the patient is allowed to begin a careful diet.
  • Doctors use novaminsulfone and / or opioids such as pethidine or buprenorphine (e.g. Temgesic®) to relieve the pain, which is often severe.
  • To prevent stress ulcers from developing, doctors use proton pump inhibitors such as proton pump inhibitors to inhibit the secretion of gastric juice. B. pantoprazole.
  • In the event of severe vomiting or an incipient intestinal obstruction due to intestinal paralysis, doctors insert a gastric tube to relieve the strain.
  • In the case of fever, abscesses, biliary inflammation and pseudocysts, the patient is given antibiotics.
  • If the acute pancreatitis is caused by a pinched gallstone, doctors immediately remove the stone using ERCP, i. H. with small forceps or a basket, which is pushed through the mouth into the pancreatic duct under the camera view (endoscopic retrograde cholangio-pancreatography)
  • Abscesses and cysts are punctured and suctioned under imaging control (ultrasound or CT); however, the latter only if they are large and cause discomfort.

Surgical treatment of complications

Sometimes the above measures are not enough to contain the progression of acute pancreatitis. Then the doctors have to operate. Here they remove z. B. infected, dead tissue areas (necrosis), stop bleeding from enlarged vessels or remove abscesses that have not receded despite the puncture. Emergency operations in particular are risky; around 15% of patients die from it.

Aftercare

  • For the next few years, the patient has to forego anything that could damage the pancreas, especially alcohol.
  • If you plan to take medication, your doctor must check whether it is possibly harmful to the pancreas. This applies to certain active substances from the groups of diuretics, beta blockers, ACE inhibitors, estrogens and antibiotics as well as to some anti-inflammatory drugs (e.g. mesalazine).
  • If the patient has gallstones, the gallbladder is removed about 6 weeks after it has healed to prevent further inflammation of the pancreas.
  • Pseudocysts that have not resolved by themselves after 6 weeks are punctured and drained again by the doctor.

forecast

The prognosis depends on the severity of the acute inflammation. In the mild form without necrosis and complications, around 1% of patients die from the disease. Necrotizing pancreatitis has a mortality of 10-25%. If total necrosis of the pancreas occurs, every second person affected dies from it.

Your pharmacy recommends

An acute inflammation of the pancreas leads to such severe symptoms that self-therapy is strongly discouraged.

Authors

Dr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 09:25


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.