Treatment

The management of chronic pancreatitis in the emergency department involves ruling out other diagnoses or complications and includes supportive care. Intravenous narcotic analgesics and antiemetics are usually required. Fluid and electrolyte abnormalities should be corrected. The long-term goals of treatment are pain control, relief of mechanical obstruction or complications, correction of malabsorption, and alteration of the disease course. Pancreatic extracts are frequently administered to improve absorption and reduce pain. Cessation of alcohol ingestion is essential because the 5-year mortality rate of chronic pancreatitis in patients who continue to abuse alcohol is 50 percent.17 If pain is increasing or intractable, imaging should be performed to assess for complications such as pseudocyst or mechanical obstruction. Surgery, either open or endoscopic, can be helpful in such cases. Other complications include mechanical obstruction of the duodenum or common bile duct, fistulae, ascites or pleural effusions, splenic vein thrombosis, and pseudoaneurysm. Celiac plexus nerve block is frequently performed for long-term pain control.

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