THE TREATMENT of acute pancreatitis varies with its severity. In the milder attacks, presumably those due largely to edema of the organ, the need for control of pain often is the major and sometimes the sole indication for treatment. In the severer cases, in which necrosis of varying extent occurs, gastrointestinal and systemic symptoms, including disturbances of fluid and electrolyte balance; ileus with nausea, vomiting, and abdominal distention; shock; secondary infection, and food and vitamin deficiency states, develop and require management.
1. Control of Pain.
—Drugs that relax the sphincter of Oddi, such as glyceryl trinitrate (nitroglycerin) given sublingually in doses of 0.6 mg. (1/100 grain) or papaverine hydrochloride in doses of 0.13 gm. (2 grains), theoretically should be tried first, because increased pressure within the pancreatic duct, which presumably follows spasm of the musculature of the duodenum and sphincter of Oddi induced by most opiates,