All of the following are used in the treatment of acute pancreatitis EXCEPT:
In most patients (85-90%) with acute pancreatitis, the disease is self-limited and subsides spontaneously, usually within three to seven days after treatment is instituted. Conventional measures includes *Analgesics for pain *IV fluids and colloids to maintain normal intravascular volume *No oral alimentation. Once it is clear that a patient will not be able to tolerate oral feeding (a determination that can usually be made within 48-72 hours), enteral nutrition should be considered since it maintains gut barrier integrity, thereby preventing bacterial translocation, is less expensive, and has fewer complications than TPN. The route through which enteral feeding is administered is under debate. Nasogastric access is easier to establish and may be as safe as nasojejunal enteral nutrition. However, enteral nutrition that bypasses the stomach and duodenum stimulates pancreatic secretions less and this rationale theoretically suppos the use of the nasojejunal route. It has not been demonstrated whether either route is superior in altering morbidity and moality. When patients with necrotizing pancreatitis begin oral intake of food, consideration should also be given to the addition of pancreatic enzyme supplementation and proton pump inhibitor therapy to assist with fat digestion and reduce gastric acid. About oral antibiotics harrisson states that: "There is currently no role for prophylactic antibiotics in either interstitial or necrotizing pancreatitis. Although several early studies suggested a role for prophylactic antibiotics in patients with necrotizing pancreatitis, two recent double-blind, randomized controlled trials failed to demonstrate a reduction in pancreatic infection with use of antibiotic prophylaxis". Percutaneous aspiration of necrosis with Gram stain and culture should generally not be performed until at least 7-10 days after establishing a diagnosis of necrotizing pancreatitis and only if there are ongoing signs of possible pancreatic infection such as sustained leukocytosis, fever, or organ failure. Once a diagnosis of infected necrosis is established, appropriate antibiotics should be instituted and surgical debridement should be undeaken
Analgesics
IV fluids
Antibiotics
Nasojejunal feeds