Management of Severe Acute Pancreatitis

Abstract

Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis. Severity of acute pancreatitis is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis.

Acute kidney injury following acute pancreatitis: A review

“…In addition, broad spectrum antibiotics with good tissue penetration are necessary to prevent infection in SAP after CT-proven pancreatic necrosis 66 . Patients suffering from infected necrosis, massive hemorrhage, bowel perforation, sterile necrosis with clinical deterioration or symptomatic organized necrosis are usually indicated for surgical intervention 67 . Experimental animal studies, have reported the protective effects of dexamethasone on multiple organ injury in rats with SAP.…”

Analysis of Treatment-Related Factors Affecting Mortality in Patients with Severe Necrotizing Acute Pancreatitis

“…It occurs in about 15-20 % of all cases of acute pancreatitis (AP) and is considered the most serious disease course due to high complications and death rates despite recent diagnostic and therapeutic advancements; the mortality may be particularly high if necrotic areas become infected, exceeding 50 % when infection and persistent organ failure develop during the first week of the illness (1)(2)(3)(4).…”

“…In the light of these facts, taking also into account variable and unpredictable course of AP, current recommendations emphasize appropriate early management based on careful initial risk assessment in all patients presenting with AP on admission to hospital (1,4). Dealing with this issue, previous studies have identified numerous factors that are only associated with or may contribute to the development of severe disease and increased mortality rate in patients with AP.…”

“…Many of them are well-documented, such as older age, obesity, idiopathic AP, important comorbidities, as well as certain clinical, laboratory and radiologic parameters of disease severity on initial evaluation (signs of systemic inflammatory response syndrome, hypotension, altered mental status, high packed cell volume, elevated creatinine and blood urea nitrogen, increased fasting blood glucose, high level of C-reactive protein, pleural effusion and/or pulmonary infiltrates, and others), while the factors relating to various treatment options (including medication choice and dose regimens) are still not clearly defined (1). As a matter of fact, the only measures that have shown unequivocal effectiveness in reducing the risk of complications and death in patients with severe AP were early aggressive fluid replacement and early enteral nutritional support (1,4). On the other hand, roles of antibiotic prophylaxis and of other medication remain controversial in terms of possible beneficial or detrimental effects (1,4).…”

In vitro effects of emodin on peritoneal macrophage intercellular adhesion molecule-3 in a rat model of severe acute pancreatitis/systemic inflammatory response syndrome

“…Approximately 20-25% of patients with acute pancreatitis develop severe acute pancreatitis (SAP), which tends to be complicated by systemic inflammatory response syndrome (SIRS), with a high mortality rate >30% (1)(2)(3). SIRS is an early manifestation of multiple organ dysfunction syndrome and multiple organ failure.…”