Clinical management of acute pancreatitis

The incidence of acute pancreatitis (AP) is 30-45cases per 100,000 person-years. In Germany, more than two-thirds of cases are caused by gallstones or alcohol. Iatrogenic, metabolic or malignant etiologies are markedly less frequent. Diagnosis is established based on the typical epigastric pain radiating to the back and athree-fold increase in serum lipase or amylase. In case of doubt, sonographic or radiological findings support the diagnosis. Early risk assessment is crucial to optimize therapy in patients with severe AP which carries amortality of up to 40%. Early predictors of outcome are blood urea nitrogen (BUN), hematocrit or blood glucose. Various scores are used for risk assessment. The severity of AP on long-term-course is classified according to the Atlanta classification. Endoscopic retrograde cholangiography (ERC) with removal of the incarcerated gallstone is the only causal therapy. Symptomatic measures include pain therapy and fluid substitution. Opioids are required in most cases. Peridural anesthesia is restricted to critical care patients. Early appropriate fluid resuscitation is considered to mitigate severe courses of AP. Enteral nutrition should be provided as early as feasible. Fluid collection and necrosis should be treated by less invasive techniques such as endoscopic or percutaneous drainage and video-assisted percutaneous retroperitoneal debridement. Only if these approaches fail, or in case of complications such as intra-abdominal compartment or bleeding, is surgery recommended (step-up approach).     «

The incidence of acute pancreatitis (AP) is 30-45cases per 100,000 person-years. In Germany, more than two-thirds of cases are caused by gallstones or alcohol. Iatrogenic, metabolic or malignant etiologies are markedly less frequent. Diagnosis is established based on the typical epigastric pain radiating to the back and athree-fold increase in serum lipase or amylase. In case of doubt, sonographic or radiological findings support the diagnosis. Early risk assessment is crucial to optimize therap...     »