Classification, Severity Assessment, and Prevention of Recurrences in Acute Pancreatitis

Abstract

Background: Acute pancreatitis is a common disease, the incidence of which is 75–100/100,000/year in Finland. The worldwide incidence of acute pancreatitis is increasing. The identified mildcases usually show rapid recovery with conservative treatment allowing early discharge. Severe cases need early intensive care to reduce the risk of serious complications such as multi-organ failure. The revised Atlanta classification of acute pancreatitis was introduced in 2012–2013. A recurrent acute pancreatitis is defined as two or more well-documented separate attacks of acute pancreatitis with complete resolution in between. Alcoholic pancreatitis is the most common recurrent acute pancreatitis type. Methods: In this review current severity classifications and literature on the prevention of recurrent acute pancreatitis are analyzed. Results: The severity of the disease is classified as mild, moderately severe, and severe acute pancreatitis. Novel entities include acute peripancreatic fluid collections in mild acute pancreatitis and acute necrotic collections in necrotizing acute pancreatitis lesser than 4 weeks after the onset and pancreatic pseudocyst in mild acute pancreatitis and walled-off necrosis in necrotizing acute pancreatitis more than 4 weeks after the onset of the disease. After the first attack of alcohol-induced acute pancreatitis, 46% of the patients develop at least one recurrence within 10- to 20-year follow-up. With repeated intervention against alcohol consumption, it is possible to reduce the recurrences. Removing the gall bladder after biliary pancreatitis is the key preventing recurrences. In mild cases, even during the index admission; in severe cases, it is recommended to wait until the inflammatory changes have resolved. Of total, 59% of the idiopathic pancreatitis had sludge of stones in the gall bladder. In other etiologies, addressing the etiological factor may prevent recurrent acute pancreatitis. Conclusions: This review describes current use of novel severity classifications and also different possibilities to prevent recurrent acute pancreatitis with different etiologies including idiopathic.

Different clinical characteristics between recurrent and non-recurrent acute pancreatitis

“…In alcohol-induced acute pancreatitis, 46% of the patients developed RAP within more than a 10-year follow-up. [ 10 ]…”

Managing severe acute and necrotizing pancreatitis

“…Necrotizing pancreatitis, although less common, accounts for 15% of fluid collections and has a higher rate of morbidity and mortality 15. The complications associated with necrotizing pancreatitis include acute necrotic collections (pancreatic or peripancreatic necrosis without a defined wall) or chronic walled-off necrosis (pancreatic or peripancreatic necrosis with a defined wall, with a mix of solids/fluid) 14. Pancreatic necrosis can be seen as nonenhancement of pancreatic parenchyma on contrast-enhanced CT, best assessed more than 72 hours after presentation 3,7,16.…”

“…The infl ammatory cascade leads to the leaking of pancreatic enzymes into the peritoneal cavity causing interstitial edematous pancreatitis (IEP) and necrotizing pancreatitis. 14 Classifi cation of these pancreatic fl uid collections is based on three factors: content (fl uid versus necrosis), degree of encapsulation (walled-off versus undefi ned wall), and chronicity (acute if less than 4 weeks, or chronic if more than 4 weeks from the episode of pancreatitis). 14 IEP is more common, accounting for about 85% of fl uid collections in patients with acute pancreatitis.…”

“…14 Classifi cation of these pancreatic fl uid collections is based on three factors: content (fl uid versus necrosis), degree of encapsulation (walled-off versus undefi ned wall), and chronicity (acute if less than 4 weeks, or chronic if more than 4 weeks from the episode of pancreatitis). 14 IEP is more common, accounting for about 85% of fl uid collections in patients with acute pancreatitis. 15 Complications associated with IEP include acute peripancreatic fl uid collections or chronic pancreatic pseudocyst.…”

Cuidado a la persona con pancreatitis aguda en el servicio de urgencias

“…Por último, en la pancreatitis severa o necrotizante, hay falla orgánica persistente (mayor a 48 horas), este tipo de necrosis puede ser estéril o infectada, y su localización puede ser pancreática o peripancreática (17,18) .…”