Current management and novel insights in acute pancreatitis.
Acute pancreatitis (AP) is a common and potentially lethal acute inflammatory process. Approximately 10-20% of patients develop a severe course and suffer systemic inflammatory response and/or pancreatic necrosis (PNec). To date, there is no single biomarker proven to perform better than clinical judgment in predicting severe AP. The available prognostic clinical scoring systems are used primarily for research purposes. Management of AP is limited to supportive care and treatment of complications when they develop. Patients with mild AP require regular ward admission, fluid administration, bowel rest and pain management. Patients with signs of severe AP should be identified early and admitted promptly to an intensive-care unit. Nutrition support via nasojejunal feedings should be initiated. Sterile PNec is managed conservatively. Infected PNec requires minimally invasive debridement via endoscopic or surgical approaches. The lack of scientific advancements in the management of AP reflects the limited understanding of the early pathogenetic mechanisms and our moderate-to-poor ability to predict severe course at the time of admission.
Muddana
Venkata
V
Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, PA 15219, USA.
Whitcomb
David C
DC
Papachristou
Georgios I
GI
D000700:Analgesics / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003131:Combined Modality Therapy; D003646:Debridement; D018450:Disease Progression; D005440:Fluid Therapy; D006801:Humans; D018529:Nutritional Support; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D012307:Risk Factors; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome
D000700:Analgesics