title: Current concepts in the management of acute pancreatitis.
abstract: Guidelines for the management of acute pancreatitis (AP) are based on the Western experience, which may be difficult to extrapolate in India due to socioeconomic constraints. Hence, modifications based on the available resources and referral patterns should be introduced so as to ensure appropriate care. We reviewed the current literature on the management of AP available in English on Medline and proposed guidelines locally applicable. Patients of AP presenting with systemic inflammatory response syndrome are at risk of moderate-severe pancreatitis and hence, should be referred to a tertiary center early. The vast majority of patients with AP have mild disease and can be managed at smaller centers. Early aggressive fluid resuscitation with controlled fluid expansion, early enteral nutrition, and culture-directed antibiotics improve outcomes in AP. Infected pancreatic necrosis should be managed in a tertiary care hospital within a multidisciplinary setup. The "step up" approach involving antibiotics, percutaneous drainage, and minimally invasive necrosectomy instituted sequentially based on clinical response has improved the outcomes in this subgroup of patients.
authors.affiliation: Department of HPB and Liver Transplantation, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Gautham
authors.initials: G
authors.lastname: Srinivasan
authors.affiliation: Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: L
authors.initials: L
authors.lastname: Venkatakrishnan
authors.affiliation: Department of HPB and Liver Transplantation, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Swaminathan
authors.initials: S
authors.lastname: Sambandam
authors.affiliation: Department of HPB and Liver Transplantation, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Gursharan
authors.initials: G
authors.lastname: Singh
authors.affiliation: Department of Anaesthesiology and Critical Care, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Maninder
authors.initials: M
authors.lastname: Kaur
authors.affiliation: Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Krishnaveni
authors.initials: K
authors.lastname: Janarthan
authors.affiliation: Department of HPB and Liver Transplantation, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: John
keywords: Acute pancreatitis; concepts; management