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Ayurvedic Management of Acut Anagement of Acute Pancreatitis- a Case Report Itis- a Case Report

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Ayurvedic Management of Acut Anagement of Acute Pancreatitis- a Case Report Itis- a Case Report Case Report International Ayurvedic Medical Journal ISSN:2320 5091 AYURVEDIC MANAGEMENT OF ACUTE PANCREATITIS- A CASE REPORT Harish Kumar Singhal1, Radhey Shyam Sharma2 1Assistant Professor, Department of Kaumarbhritya, University College of Ayurved; 2Vice-chancellor Dr. S.R. Rajasthan Ayurved University, Jodhpur, Rajasthan, India ABSTRACT Acute pancreatitis is an emerging problem in children which is rising in last two dec- ades. A case of acute pancreatitis of 15 yr old child was reported. The diagnosis was made on the basis elevated Serum Amylase, Serum Lipase and Ultrasonography. The patient has shown interest to Ayurveda treatment. An Ayurveda medicinal management was done and found effec- tive in the case of acute pancreatitis. Serum markers return to normal on fourth day of treatment. Patient was advised to follow the Ayurveda management for 3 weeks. Follow up report has shown encourageous results. Key words: Acute pancreatitis, Ayurveda, Serum Amylase, Serum Lipase and Ultrasonography. INTRODUCTION Acute pancreatitis is the most com- acutely ill. The abdomen may be distended mon pancreatic disorder in children.1 Blunt and tender. A mass may be palpable. The abdominal injuries, biliary microlithiasis, pain increases in intensity for 24–48 hr, dur- multisystem disease, congenital anomalies, ing which time vomiting may increase and mumps and other viral illnesses account for the patient may require hospitalization for most known etiologies,2 many cases are of dehydration and may need fluid and electro- unknown etiology or are secondary to a sys- lyte therapy. The prognosis for the acute un- temic disease process. Child abuse is recog- complicated case is excellent. Acute pan- nized with increased frequency as a cause of creatitis is usually diagnosed by measure- traumatic pancreatitis in young children. The ment of serum amylase and lipase activi- precise sequence of events leading to pan- ties.4,5 The serum amylase level is typically creatitis has not been completely defined. elevated for up to 4 days. Ultrasound and The classic theory suggests that following an computed tomography (CT) scanning have initial insult, such as ductal obstruction, ly- major roles in the diagnosis and follow-up sosomal hydrolase co-localizes with pan- of children with pancreatitis. Findings may creatic proenzymes within the acinar cell. include pancreatic enlargement, a hypoe- The patient with acute pancreatitis has ab- choic, sonolucent edematous pancreas, pan- dominal pain, persistent vomiting, and fev- creatic masses, fluid collections, and ab- er.3 The pain is epigastric and steady, often scesses at least 20% of children with acute resulting in the child's assuming an antalgic pancreatitis initially have normal imaging position with hips and knees flexed, sitting studies.6 The medical management of acute upright, or lying on the side. The child is pancreatitis is to relieve pain and restore me- very uncomfortable and irritable and appears tabolic homeostasis. Therefore Analgesia, Harish Kumar Singhal & Radhey Shyam Sharma: Ayurvedic Management Of Acute Pancreatitis- A Case report fluid therapy, nasogastric suction (especially mia, no icterus, no cyanosis and no clubbing useful in patients who are vomiting), proph- except facial puffiness. Pulse rate was 90 / ylactic antibiotics are employed. Endoscopic min, BP 114/70 mmHg, respiratory rate therapy and surgical therapy rarely needed 25/min along with normal body temperature. in acute pancreatitis. The entire medical On systemic examination abdominal pain therapy employed in the management of was started from epigastric region and ra- acute pancreatitis is having their own side diating to back with local tenderness in epi- effect. gastrium region. Case was taken up and There is no exact correlation to acute pan- some essential investigation was suggested creatitis in Ayurveda. Acute pancreatitis can to patient like complete blood count, liver be indirectly correlated with Pittaja Guluma. function test, serum amylase, serum lipase, On the basis of involving doshas its aetiopa- random blood sugar, routine urine examina- thogenesis should be understood as Pitta tion and whole abdomen Ultrasonography. Prakopa in term of Ushna Tikashna Vriddhi All the reports were suggested acute pan- which led to Paka Karma Vriddhi in Pitta creatitis.(Table No-1 & 2) Sthana (Pittaja Gulum) Agnisaad (Pittavrita TREATMENT Samana). In this disease clinical features Patient was advised to hospitalization but on like pain, rise in body temperature and vo- refusal, treatment was planned on OPD lev- miting due to Aavrita Samana Vata.7 Pitta el. Following treatment was prescribed for Vridhi Vata Marga Avarodha cause Rakta- three days. pitta collection in Udara which later on 1. Tab Septilin (Himalaya Herbal Health created Jalodara (Ascites). Pitta Vridhi Care) two tablet thrice daily Prakopa and Vata Gati Hanana result in 2. Syrup Liv 52 (Himalaya Herbal Health Gulum and Jalodara, Aavrita Samana lead- Care) two T.S.F thrice daily ing Agnisaad. Apatarpana is severely 3. Giloy juice 10ml TDS (Utkarsha Aro- present. Management includes Laghu San- gaya Pvt.Ltd.) tarpana Deepaniya Yavagu, Shrita Yoosha, 4. Tab Vomitab (Charak Pharma Pvt.Ltd.) Pitta Sammana, Agni Vardhana. one if required. CASE PRESENTATION 5. Shoolvajarini vati one tablet if required. A male patient aged 15 yrs was visited to During this treatment patient was advised to pediatric OPD with complaint of severe ab- take liquid for first day and if no vomiting dominal pain with vomiting since last night then semi liquid diet was taken from second on 08/12/2014 (OPD No.40733/ 14-15). Be- day, if accepts well then semisolid diet from fore reaching OPD patient was received third day onward with reporting in OPD af- painkiller injection from local physician in ter three days. morning. No history of any drug intake, Follow up trauma and infectious disease like measles, After four days patient was attending OPD mumps and chicken pox etc. Past history of for first follow up on 12/12/2014 with relief such type of abdominal pain six month back in abdominal pain with no vomiting with which was relived on taking modern treat- acceptance of semi liquid diet. On abdomin- ment but no obvious diagnosis was made. al examination there was no tenderness in On examination patient was found no ane- epigastric region. Patient was suggested to 1573 www.iamj.in IAMJ: Volume 3; Issue 5; May - 2015 Harish Kumar Singhal & Radhey Shyam Sharma: Ayurvedic Management Of Acute Pancreatitis- A Case report repeat serum amylase and lipase. Reports Prashamana,8immunomodulation9, anti bac- were found to be normal. Patient was sug- terial9 and anti inflammatory.10 Liv 52 con- gested to continue the same treatment for 5 tains number of herbs which shows hepato- days with normal diet. After 5 days patient protective,11 rejuvenative, digestive and anti was attending OPD for second follow up. infective property. Septilin is also herbal Patient was suggested to repeat serum amy- compound which shows anti-inflammatory, lase and lipase which were found normal. antimicrobial, immunomodulatory, and anti- Patient was advised to continue same treat- oxidant actions. 12 All these treatment help ment for two weeks. After two weeks patient to bring serum amylase and lipase to normal was attended OPD for third follow up. It level with normal shape, size and echo tex- was observed that all the symptoms and ture of pancreas. signs were subsided with no obvious abdo- minal finding. Patient was advised to repeat CONCLUSION all blood investigation along with whole ab- Acute pancreatitis is quiet common abdo- domen Ultrasonography. All the investiga- minal disorder for which patients seeks med- tion was tabulated. (Table No 1 & 2) ical intervention. Although modern medical treatment is quiet effective but have side ef- DISCUSSION fects. Acute pancreatitis can be indirectly Abdominal pain is very common problem correlated with pittaj Gulma. Here in this among all children in which acute pancreati- case Ayurveda medicinal Management has tis is one of the causes. In this case clinical shown a remarkable recovery. It may open a diagnosis was made initially which were lat- new path to the clinicians and researchers er on supported by increased serum amylase for finding the medicinal option for the and lipase level with abdominal Ultrasono- treatment of acute abdominal disorders. graphy. The present finding (clinical im- There are lots of Ayurvedic formulation provements) was observed with effective which are quiet effective and safe to treat management of acute pancreatitis with abdominal disorders. But they are needed to Ayurvedic formulations without untoward be time tested now. Over all present study effects which highlights the future scope of proves effective and safe management of traditional therapy in acute pancreatitis. In acute pancreatitis through herbal medicine. acute pancreatitis there is exocrine insuffi- ACKNOWLEDGEMENT ciency which leads less secretion of pancrea- The author is thankful to Prof. Radhey tic enzyme resulting indigestion and malab- Shyam Sharma, Vice-chancellor, sorption. It causes diarrhea & steatorrhea (in Dr.S.R.Rajasthan Ayurved University, acute phase severe abdominal pain, vomiting Jodhpur, Rajasthan, India for continuous and fever). Agnivardhan Chikitasa was de- encouragement for the short clinical study. creased the load on pancreas that result fast Table No 1 showing Blood investigation recovery from inflammatory changes. reports before, during and after treat- Guduchi (Tinospora
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