Consensus of primary care in acute pancreatitis in Japan.
The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis. The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital. Monitoring of blood pressure, pulse and respiratory rate, body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as the diagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases.
Otsuki
Makoto
M
Department of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyushu, Japan. mac-otsk@med.uoeh-u.ac.jp
Hirota
Masahiko
M
Arata
Shinju
S
Koizumi
Masaru
M
Kawa
Shigeyuki
S
Kamisawa
Terumi
T
Takeda
Kazunori
K
Mayumi
Toshihiko
T
Kitagawa
Motoji
M
Ito
Tetsuhide
T
Inui
Kazuo
K
Shimosegawa
Tooru
T
Tanaka
Shigeki
S
Kataoka
Keisho
K
Saisho
Hiromitsu
H
Okazaki
Kazuichi
K
Kuroda
Yosikazu
Y
Sawabu
Norio
N
Takeyama
Yoshifumi
Y
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005440:Fluid Therapy; D017583:Hemodiafiltration / Q000379:methods; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007564:Japan; D010195:Pancreatitis / Q000175:diagnosis* / Q000628:therapy*; D010360:Patient Transfer; D011480:Protease Inhibitors / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D011480:Protease Inhibitors