Editor’s preface for the special issue “ACUTE PANCREATITIS” (original) (raw)
Related papers
The management of the patient with acute pancreatitis: from evidence to clinical practice
Italian Journal of Medicine, 2017
Acute pancreatitis is an inflammatory disorder of the pancreas characterized by abdominal pain and elevation of pancreatic enzymes in the blood. The pathogenesis is complex and partly unknown and the evolution is often unpredictable. Many efforts have been made to define this disease and its complications and to classify different grades of severity in order to formulate prognostic scores that could guide the physician in choosing the optimal therapeutic setting and procedures. The management of the patient with pancreatitis is not always optimal and differs among internist, gastroenterologist or surgeon. We think that a patient with clinical suspicion of acute pancreatitis is admitted to medical or surgical department depending on the availability of beds and not according to evidence-based medicine. The aim of this monograph is to identify the optimal management of patients with acute pancreatitis admitted to hospital.
Background: There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach. Methods: Twelve multidisciplinary review groups performed systematic literature reviews to answer 38 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The review groups presented their recommendations during the 2012 joint IAP/APA meeting. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting. Results: The 38 recommendations covered 12 topics related to the clinical management of acute pancreatitis: A) diagnosis of acute pancreatitis and etiology, B) prognostication/predicting severity, C) imaging, D) fluid therapy, E) intensive care management, F) preventing infectious complications, G) nutritional support, H) biliary tract management, I) indications for intervention in necrotizing pancre-atitis, J) timing of intervention in necrotizing pancreatitis, K) intervention strategies in necrotizing pancreatitis, and L) timing of cholecystectomy. Using the GRADE system, 21 of the 38 (55%) recommendations , were rated as 'strong' and plenary voting revealed 'strong agreement' for 34 (89%) recommendations. Conclusions: The 2012 IAP/APA guidelines provide recommendations concerning key aspects of medical and surgical management of acute pancreatitis based on the currently available evidence. These recommendations should serve as a reference standard for current management and guide future clinical research on acute pancreatitis.
Acute Pancreatitis, Actualization and Evidence Based Management
Archives of Clinical Gastroenterology, 2017
Acute pancreatitis (AP) is a systemic immunoinfl ammatory response to auto-digestion of the pancreas and peri-pancreatic organs. It is a frequent gastrointestinal disease with an important morbimortality, reaching 30% in severe cases. Different studies and reviews by international groups have developed multiple classifi cation systems to assess the severity and address the correct management along time, identifying the better molecular markers, clinical outcome determinants and reaching conservative management as the angular piece in AP. In this review we present a compilation of the latest studies and international consensus about AP physiology, etiology, risk factors, diagnosis, severity assessment, imaging and treatment.
BACKGROUND Acute pancreatitis includes a wide spectrum of disease, from one with mild self-limiting symptoms, to fulminant processes with multiorgan failure and high mortality. Given the wide spectrum of disease seen, the care of patients with pancreatitis should be highly personalized. Patients with mild acute pancreatitis generally can be managed with resuscitation and supportive care. Those with severe and necrotizing pancreatitis require intensive therapy, which may include surgical management. Because of frequent emergencies, multimodality presentation, complications, this challenging subject is taken up for the present study in which we studied the clinical profile and management of acute pancreatitis in our hospital. METHODS This study is hospital based observational study conducted in Department of General Surgery, S.V.R.R.G.G.H, Tirupati. 100 Patients fulfilling the inclusion and exclusion criteria are selected and Four sequential steps have been followed. 1. Establishing the diagnosis of acute pancreatitis excluding other abdominal conditions that have similar clinical features. 2. Identify the presence of biliary tract disease, excluding other possible etiologies of the acute pancreatitis. 3. Assess the severity of the disease. 4. Detect any complications. RESULTS This prospective study conducted at SVRRGGH, Tirupathi, included 100 patients with acute pancreatitis, 93 males and 7 females (M:F ~ 13.28:1). The peak incidence was noted in the fourth decade, with the mean age of 38.54 years. The commonest etiology was alcohol accounted for 85% of cases followed by gall stone disease (7%). Pain and vomiting were the commonest presenting complaints. Ten patients had jaundice. Serum amylase and serum lipase together gave high sensitivity (95%) for diagnosis. Computed tomography was a very sensitive, non-invasive tool for diagnosis and imaging of complications. The enteral route was used for nutritional support in 12 patients and total parenteral nutrition was given to 9 patients. The mean hospital stay was 12.13 days (Range-6 to 34 days). Out of 100 patients, 69% had mild disease, while 31% had a severe attack. The overall mortality rate was 4%. CONCLUSION The incidence of acute pancreatitis was more in a younger age group in our study. Serum Amylase and Lipase both were (95% sensitivity) used for diagnosis wherever possible. Ideally, all cases should be stratified during the first 48 hours, according to one of the scoring systems. Scoring systems help to identify patients who are more likely to have a severe attack. Severe cases should be managed in well-equipped ICU since they may require massive fluid resuscitation, mechanical ventilation, and hemodialysis. Further attacks should be prevented by early cholecystectomy and avoiding alcohol.
Acute pancreatitis by New england journal of Medicine
The incidence of acute pancreatitis is increasing in the United States, and the disorder is now one of the most common reasons for hospitalization with a gastrointestinal condition. In this review, we consider recent changes in the management of acute pancreatitis, as well as common misunderstandings and areas of ongoing controversy.
Study of recent trends in acute pancreatitis
International Journal of Medical Science and Public Health, 2014
Background: Acute pancreatitis is an acute condition presenting with abdominal pain and usually associated with raise pancreatic enzyme level in the blood or urine as a result of inflammatory disease of pancreas. Pancreatitis is a disease of wide clinical variation ranging from mild discomfort alone to a severe illness with hypotension, metabolic derangement, sepsis, multiple organ failure and death. Mortality from acute pancreatitis has decreased from around 12 to 2 percent, according to a large epidemiologic study of acute pancreatitis. However, mortality rates remain much higher in subgroups of patients with severe disease. Aims & Objective: To study recent trends in acute pancreatitis, to study the various etiological factors for development of acute pancreatitis, assessment of various clinical features, complication, investigations and diagnosis of acute pancreatitis and its complications, to evaluate various modalities of the treatment for acute pancreatitis and its complications. Material and Methods: Material of this study consists of 50 patients of acute pancreatitis who were admitted in our Hospital. The clinical presentation clinical examination was carried out, and physical findings, associated medical conditions, laboratory and radiological investigations, severity, management and outcome were studied and the etiology was determined by reviewing the medical records of all cases documented to have acute pancreatitis during the period of study. Results: Average hospital stay for 50 patients in our study is approximately 7 days. The diagnosis of acute pancreatitis was considered when abdominal pain is associated with elevation of serum amylase level. Abdominal pain (100%), fever (82%), vomiting (86%), abdominal distension (40%) and dyspnoea (50%) are its common clinical symptoms. Conclusion: Gallstones and alcohol abuse are the main causes of acute pancreatitis. There is no mortality in our study. Among all the patients, only 4 patients in the follow-up developed complications approximately after 2 months of duration of attack; and they undergone for operation. Clinical examination, serum amylase and ultrasonography are still the diagnostic tool for pancreatitis. Most cases of pancreatitis can be managed conservatively with early diagnosis, aggressive medical management and by treatment of cause.
A Clinical Overview of Acute and Chronic Pancreatitis: The Medical and Surgical Management
Cureus, 2021
An inflammatory process involving the pancreas, known as pancreatitis, can be categorized as either acute or chronic and may present in one of many ways. The clinical manifestations of acute pancreatitis are generally limited to epigastric or right upper quadrant pain, while manifestations of chronic pancreatitis are broader and may include abdominal pain in tandem with signs and symptoms of pancreatic endocrine and exocrine insufficiency. An understanding of the initial insult, proper classification, and prognosis are all factors that are of paramount importance as it pertains to managing patients who are afflicted with this disease. Our review delves into the depths of pancreatitis by exploring the embryology and anatomy of the pancreas, the pathophysiology and etiology of acute and chronic pancreatitis, and the medical and surgical management of acute and chronic pancreatitis.