Acute pancreatitis during pregnancy

　　There are many causes of acute pancreatitis during pregnancy. Recent studies have shown that biliary tract diseases are the most common, accounting for about 50%, among which cholelithiasis accounts for 67% to 100%. Other causes may be related to severe morning sickness during pregnancy, increased uterine mechanical compression leading to increased intrapancreatic pressure, pre-eclampsia of pregnancy-induced hypertension syndrome, long-term vasoconstriction and infection of pancreatic vessels, hypercalcemia induced by hyperparathyroidism, the use of thiazide diuretics and tetracyclines and other drugs, alcoholism, and so on.

　　Gestational acute pancreatitis can easily lead to complications such as preterm labor and abortion caused by uterine contractions induced by the stimulation of pancreatic necrosis and inflammatory exudate. Pancreatic inflammatory necrotic tissue and digestive enzymes can enter various organs of the body through the blood circulation and lymphatic vessels, leading to uteroplacental circulation disorders, resulting in severe hypoxia or stillbirth in the fetus. Symptoms can include tachycardia, hypotension, hypovolemia, and even shock. Patients with acute pulmonary dysfunction may have shortness of breath, difficulty breathing, and cyanosis, and may also have psychiatric symptoms, gastrointestinal bleeding (hematemesis and melena) and other symptoms.

　　The common symptoms of gestational acute pancreatitis are mainly the following, and patients can refer to them.

　　1. Abdominal pain

　　Abdominal pain is the main clinical symptom of this disease, originating from the middle and upper abdomen, which can also be more severe on the right upper abdomen or left upper abdomen, and radiating to the back.

　　2. Nausea and vomiting

　　Nausea and vomiting often occur with abdominal pain, characterized by severe and frequent vomiting, with the contents of the stomach and duodenum vomited out, occasionally with coffee-like contents, and the pain does not subside after vomiting.

　　3. Abdominal distension

　　Abdominal distension is mainly above the abdomen, and in the early stage, it is due to reflexive ileus. In severe cases, it is caused by inflammatory stimulation. When there is ascites, abdominal distension is more obvious, the bowel sounds are weakened or disappear, defecation and flatus stop, and bloodstained or purulent ascites may occur.

　　4. Signs of peritonitis

　　In cases of edematous pancreatitis, tenderness is limited to the upper abdomen, and there is usually no obvious muscle tension. During pregnancy, the fundus of the uterus rises, and the position of the pancreas is relatively deep, causing delayed and often unobvious signs of peritonitis. In cases of hemorrhagic necrotic pancreatitis, tenderness is marked, accompanied by muscle tension and rebound tenderness, with a wider range and extending to the entire abdomen.

　　5. Other

　　Initially, it often presents with moderate fever around 38°C, and when complicated with cholangitis, it can have chills and high fever. One of the main symptoms of pancreatic necrosis with infection is high fever.

　　For any patient with upper abdominal pain during pregnancy, the possibility of acute pancreatitis should be considered. Treat the primary disease actively. Preventive measures include eliminating the cause and avoiding triggers, such as quitting alcohol, avoiding overeating, treating hyperlipidemia, etc. Gallstones play an important role in the onset of acute pancreatitis, so patients with a history of acute pancreatitis should consider gallbladder removal and common bile duct exploration at an appropriate time.

　　The main manifestation of gestational acute pancreatitis is abdominal pain, which can be diagnosed by the following examinations:

　　1. Blood and urine amylase

　　The serum amylase level generally starts to rise within 2 to 6 hours after onset, reaches its peak between 12 to 24 hours, and begins to decline after 48 to 72 hours, usually lasting for 3 to 5 days.

　　2. Serum lipase

　　After the pancreatic duct is blocked, the level of lipase in the serum can rise, usually starting to increase after 72 hours post-onset, and lasting for 7 to 10 days.

　　3. Other acute pancreatitis cases show serum trypsin levels

　　The levels of amylase creatinine clearance, blood leukocyte count, hematocrit, blood glucose, blood lipids, bilirubin, alkaline phosphatase, and other enzymes can all increase.

　　4. Imaging Examination

　　Ultrasound can show an increase in pancreatic volume, uneven实质 structure, blurred boundaries, bleeding, and large, strong echoes around the pancreas when necrosis occurs. There is no acoustic shadow zone around the pancreas.

　　Patients with acute pancreatitis during pregnancy should avoid spicy and刺激性 food, such as onions, garlic, ginger, chili, pepper, curry, and alcoholic beverages. Do not eat animal fats and greasy foods. A light diet is an effective measure to reduce the incidence.

　　Acute pancreatitis during pregnancy is a common clinical surgical acute abdomen, with a sudden onset, rapid progression, and extremely poor prognosis. It is one of the diseases with a high maternal and fetal mortality rate during pregnancy. Once diagnosed, the severity of the condition should be determined to determine the treatment principle, and early diagnosis of severe pancreatitis is the key to reducing maternal and fetal mortality.

　　First, Non-Surgical Treatment

　　Applicable to the early stage of acute pancreatitis, mild edematous pancreatitis, and those without infection. The main treatment for acute pancreatitis during pregnancy is conservative treatment:

　　1. NPO and Gastrointestinal Decompression: Maintain an empty stomach, reduce abdominal distension, and decrease gastric acid secretion. Administering full gastrointestinal motility drugs can reduce abdominal distension.

　　2. Fluid Resuscitation to Prevent Shock: All fluids, electrolytes, and calories (relying on total parenteral nutrition) are administered intravenously to maintain circulatory stability and electrolyte balance, and to improve microcirculation to ensure adequate blood perfusion to the pancreas.

　　3. Antispasmodic Analgesia: For those with clear diagnosis, antispasmodic analgesics can be given in the early stage of onset, such as pethidine, antispasmodic atropine, and scopolamine. Morphine should be avoided to prevent spasm of the Oddi's sphincter.

　　4. Inhibition of Pancreatic Exocrine Secretion and Pancreatic Enzyme Inhibitors: Such as trypsin inhibitor intravenous infusion, H2 receptor antagonist, cimetidine, although the drugs can pass through the placenta, they still need to be weighed for the benefits and risks when the condition is critical.

　　5. Antibiotic Application: Select sensitive antibiotics through bacterial culture and drug sensitivity testing.

　　6. Traditional Chinese Medicine Treatment: After the vomiting is basically controlled, traditional Chinese medicine is injected into the stomach through a gastric tube.

　　Second, Surgical Treatment

　　Applicable to those with uncertain diagnosis, secondary pancreatic infection, concurrent biliary tract diseases, and those whose clinical symptoms continue to worsen despite reasonable supportive treatment. Severe biliary pancreatitis with ampullary stone impaction and concurrent biliary obstruction and infection should be treated with emergency or early surgery to promptly relieve obstruction.