Acute pancreatitis: update on management

Abstract

Acute pancreatitis is a common acute surgical condition associated with high morbidity and mortality in severe cases. New guidelines for management have recently been published by the American College of Gastroenterology and by the International Association of Pancreatology in collaboration with the American Pancreatic Association. The main differences between the new and previous versions of the guidelines relate to the use of endoscopic retrograde cholangiopancreatography (ERCP) and the addition of the new severity category of 'moderately severe acute pancreatitis' All patients with pancreatitis should have its cause determined by features of the history, results of laboratory tests (liver function tests, serum calcium triglyceride levels) and findings on transabdominal ultrasound. Those with idiopathic pancreatitis should have endoscopic ultrasound as a first-line investigation. Acute pancreatitis should be managed with aggressive hydration with intravenous fluids and fasting. Oral feeding can be recommenced in mild pancreatitis once pain and nausea and vomiting have resolved. Patients with mild biliary pancreatitis should have a laparoscopic cholecystectomy during their index admission. In addition to aggressive intravenous fluid resuscitation and fasting, patients with severe pancreatitis should have enteral feeding (nasoenteric or nasogastric feeds) commenced 48 hours after presentation. Total parenteral nutrition should be avoided where possible. All patients with organ failure or severe pancreatitis as defined by the revised version of the Atlanta classification should be managed in an intensive care setting. Patients with biliary pancreatitis and concurrent cholangitis should have endoscopic retrograde cholangiopancreatography within 24 hours of presentation.

Changes of Serum Procalcitonin (PCT), C-Reactive Protein (CRP), Interleukin-17 (IL-17), Interleukin-6 (IL-6), High Mobility Group Protein-B1 (HMGB1) and D-Dimer in Patients with Severe Acute Pancreatitis Treated with Continuous Renal Replacement Therapy (CRRT) and Its Clinical Significance

“…Inclusion criteria were: 1) patients complying with SAP diagnostic criteria [7], who have pancreatic enlargement and peripancreatic fluid exudation shown in imaging examination, 2) patients with Acute Physiology and Chronic Health Evaluation (APACHE) II score of more than 8 points, and 3) patients who signed the informed consent. Exclusion criteria were: 1) patients with autoimmune diseases, or 2) pancreatic cancer patients.…”

The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis

“…Majority of patients have mild and self-limiting disease, but the mortality rate of patients with severe and complicated forms can reach up to 30 % [1–4]. Non-complicated forms of AP can be treated in smaller regional hospitals, but the patients with the severe course of AP should be timely transferred to the high volume centers [5].…”

Urinary trypsinogen-2 dipstick test for point-of-care screening of acute pancreatitis

“…2,[18][19][20] Early (within 24 hours) aggressive fluid resuscitation is recommended by clinical practice guidelines and is a long-established cornerstone of the initial management of AP. [8][9][10] By providing micro-and microcirculatory support, fluid resuscitation is associated with reduced SIRS, organ failure and in-hospital mortality. 8,9 However, for instituting this early fluid therapy, the diagnosis of AP needs to be confirmed at the earliest.…”

“…6,7 Early aggressive intravenous hydration with isotonic crystalloid solution in the first 12-24 hours of presentation is considered essential in the management of AP. [8][9][10] This strategy helps in reducing the risk and extent of pancreatic necrosis, leading to improved clinical outcomes, possibly by improvement in pancreatic perfusion. A rapid and accurate method to identify AP is necessary to achieve this.…”