[Conservative treatment of acute pancreatitis].
The incidence of acute pancreatitis per 100,000 population ranges from 10 to 46. The mortality of acute edematous interstitial pancreatitis is < 1%, while patients suffering from hemorrhagic necrotizing pancreatitis die from their disease in 10-24%. 80% of all cases of acute pancreatitis are etiologically correlated to diseases of the biliary tract or an excess alcohol consumption. As of today, no specific and causal treatment for acute pancreatitis has been established. Early prognostic factors for the evaluation of the clinical course of acute eipancreatitis are three or more indicators of organ failure in the Ranson or Imrie score, the development of extrapancreatic complications or the detection of pancreatic necrosis on contrast-enhanced CT scans. Elevated C-reactive protein (CRP) levels > 130 mg/l can predict a severe course of acute pancreatitis with a high sensitivity. The foundation of medical treatment in acute pancreatitis is the substitution of fluids to counteract hypovolemia. Furthermore, the relief of sometimes severe visceral pain has the highest priority. Infusion of procaine has been found to be ineffective for this purpose. The use of antibiotics should be restricted to patients with pancreatic necrosis. Enteral nutrition has no adverse effect compared to parenteral nutrition and is likely to be beneficial to the course of pancreatitis.
Mayerle
Julia
J
Abteilung Gastroenterologie, Endokrinologie und Ernährungsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald.
Simon
Peter
P
Kraft
Matthias
M
Meister
Tobias
T
Lerch
Markus M
MM
D018806:APACHE; D000208:Acute Disease; D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002986:Clinical Trials as Topic; D004195:Disease Models, Animal; D004311:Double-Blind Method; D004750:Enteral Nutrition; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D007930:Leucine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D009102:Multiple Organ Failure / Q000209:etiology; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000401:mortality; D010919:Placebos; D010972:Platelet Activating Factor / Q000037:antagonists & inhibitors; D011379:Prognosis; D011480:Protease Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D000276:Adjuvants, Immunologic; D000700:Analgesics; D000900:Anti-Bacterial Agents; D007093:Imidazoles; D010919:Placebos; D010972:Platelet Activating Factor; D011480:Protease Inhibitors; D002097:C-Reactive Protein; D007930:Leucine; C103289:lexipafant