Managing severe acute and necrotizing pancreatitis

Abstract

2002 to 2005. 4 Gallstone-related disorders may be the cause of this increase in the United States, because of increases in obesity and the aging population, although it also may be related to an increased frequency of testing (Figure 1). 4 This comes at a huge cost to the healthcare system, with more than $2.4 billion spent per year in the United States alone. 5 Management of acute pancreatitis has changed considerably in the past 10 years, including a multidisciplinary methodology, and tailored interventions with a minimally invasive endoscopic approach rather than open surgical intervention for complications. 6 To reduce patient morbidity and mortality, clinicians must be familiar with the presentation, diagnosis, and management of this disease.© MEDICALSTOCKS/SHUTTERSTOCK.COM I n most patients, acute pancreatitis is mild, self-limited, and follows an uncomplicated course. 1 However, 15% to 20% of all patients have severe acute pancreatitis, and 5% to 10% of them will develop necrosis of the pancreatic glands, peripancreatic tissue, or both. 2 In severe cases, if the necrotic collection becomes infected, patient mortality can reach 30%. 3 The incidence of acute pancreatitis requiring hospitalization in the United States continues to rise, with a 13.2% increase between 2009 and 2012 compared with ABSTRACT Acute pancreatitis is associated with signifi cant morbidity and mortality, and is one of the most common gastrointestinal disorders requiring hospitalization. This article describes current concepts in the diagnosis and management of severe acute and necrotizing pancreatitis. Management of this disease requires IV fl uids, pain control, and advanced medical and interventional care. Early identifi cation and intervention may help to prevent patient morbidity and mortality.

Public Values in Power: An Exploratory Framework Applied to the Case of the Netherlands

“…Some electricity system actors (e.g. local energy communities and small energy platforms) rely on AI programs to be an active participant in the electricity system [29][30][31][32][33]49]. These programs coordinate and manage assets and electricity market biddings; activities these actors would otherwise have to employ people for.…”

“…This contrasts with (local) aggregators and ICT parties, who stress additional privacy measures (e.g. privacy by design or additional caution in the use of data) are necessary [29,30,45,55]. In short: none of the actors indicate privacy is irrelevant but some actors rely on existing regulation.…”

“…This could increase their autonomy. In practice, however, consumers rarely act on these opportunities [30,31,46,59]. The implementation of AI could also decrease consumer autonomy, as other electricity system actors could create personal profiles to curtail electricity use.…”

“…For this study, various actors in the Dutch electricity system were asked about their perception of AI in the (Dutch) electricity system and the effect of the application thereof on the public values from the public value framework. Nine in-depth interviews were held with experts working for the Dutch Transmission Operator (TSO) [24,25], Distribution System Operators (DSOs) [26], government advisory groups [27], electricity retailers [28], Information and Communication Technology (ICT) providers [29,30], researchers [31] and local energy communities [32]. These interviewees were invited, as they represent a broad variety of the different aspects, tasks, and responsibilities in the Dutch electricity system.…”

Wernicke's encephalopathy after acute pancreatitis with upper gastrointestinal obstruction: A case report and literature review

“…Acute pancreatitis includes acute edematous pancreatitis and acute necrotizing pancreatitis. The latter is prone to cause a variety of complications, such as hemorrhage, necrosis, infection, systemic inflammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS), and multiple organ dysfunction syndrome (MODS) (2). Additional complications that have been reported include pancreatic encephalopathy, intestinal fistulae, and upper gastrointestinal tract obstruction, which makes the treatment of acute pancreatitis difficult (3).…”