Metabolic Management of Severe Acute Pancreatitis

Abstract

The metabolic management of severe acute pancreatitis involves early identification of patients with severe pancreatitis, aggressive fluid resuscitation, organ support, and careful monitoring in an intensive care environment. Recent evidence has helped to define the roles of enteral feeding, prophylactic antibiotics, endoscopic retrograde cholangiopancreatography, computed tomography, and fine-needle aspiration for bacteriology. The most difficult decision in the management of these patients is whether surgery is required and which of the complementary approaches to necrosectomy and drainage is appropriate. Key metabolic events in the acinar cell, pancreas, and intestines are now being unraveled, as is the basis for the systemic manifestations and organ dysfunction associated with pancreatitis. This gives hope for the development of more specific metabolic interventions, which will likely target the maintenance of intestinal integrity and function, preservation of pancreatic microcirculation, and balanced modulation of the inflammatory response.

Early Enteral Nutrition Reduces the Rate of Life-Threatening Complications after Thoracic Esophagectomy in Patients with Esophageal Cancer

“…Poor nutritional status is common in patients with esophageal carcinoma [21], and esophageal surgery is associated with a high rate of life-threatening postoperative complications, such as anastomotic leakage and pneumonia. Local inflammation is occasionally associated with systemic inflammatory response syndrome after thoracic esophagectomy, and reactive changes in most organ systems lead to multiple organ dysfunction syndrome in the most severe cases [22,23]. Indeed previous studies have shown that EN can reduce the incidence of pulmonary complications, such as pneumonia [24], which supports the findings of the present study.…”

Clinical Significance of Increased Intraabdominal Pressure in Severe Acute Pancreatitis

“…Clinical course of SAP is much more complicated in this category of patients with significantly more pulmonary complications, development and progression of MODS. One cornerstone of the intensive conservative treatment of SAP is improvement of organ microcirculation, maintenance of the fluid balance and reduction of the losses in the third space (23). However, aggressive fluid replacement can lead to the increase of the IAP due to increased vascular and gut permeability (6,24).…”

The effects of contrast agent and intraductal pressure changes on the development of pancreatitis in an ERCP model in rats

“…CRP is the most important acute phase reactant that is used to assess the severity of the disease and the stage of the inflammation in acute pancreatitis. The increase in serum CRP levels with acute pancreatitis has been found significant in many clinical trial series [22][23][24][25][26].…”