Recent Developments in Acute Pancreatitis (original) (raw)
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Recent advances in understanding and managing acute pancreatitis [version 1; referees: 2 approved
This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.
https://www.ijrrjournal.com/IJRR\_Vol.7\_Issue.1\_Jan2020/Abstract\_IJRR0076.html, 2020
Acute pancreatitis is thought to be a local inflammatory process involving premature intra-cellular activation of digestive enzymes within acinar cells leading to auto digestion of the tissue that can progress to involve distant organs. AP was one of the most common diseases in gastroenterology. Practical understanding of etiology and severity will accommodate in advocate the appropriate treatment. The aim of our study was to provide safe and effective management by evaluating the cause, severity and appropriate treatment and outcomes in patients with AP. General Medicine department Rajiv Gandhi Institute of Medical sciences, a south Indian tertiary care teaching hospital Kadapa, Andhra Pradesh. A prospective interventional study was conducted in 60 patients with AP. Data collected from 60 patients was initially assessed for isolation of etiology by using specially self designed etiology assessment form, severity based on Atlanta severity assessment scale (ASAS). Treatment was given according to American college of gastroenterology (ACG) guidelines, and outcome was measured in terms of length of stay in hospital. Out of 60 patients 24(40%) patients with alcohol, 33(55%) with alcohol and smoking, 3(5%) with gall stones. On severity assessment 42(70%) patients were mild and 18(30%) were moderate. On measurement of outcomes 23(38.3%) patients were better, 25(41.6%) patients were moderate, and 7(11.6%) patients were poor control. we conclude that evaluating cause, severity and management based on the standard guidelines are found to be the safe and effective management of AP to reduce the hospital stay.
Evidence-Based Treatment of Acute Pancreatitis
Annals of Surgery, 2006
The management of acute pancreatitis (AP) is still based on speculative and unproven paradigms in many centers. Therefore, we performed an evidence-based analysis to assess the best available treatment. Methods: A comprehensive Medline and Cochrane Library search was performed evaluating the indication and timing of interventional and surgical approaches, and the value of aprotinin, lexipafant, gabexate mesylate, and octreotide treatment. Each study was ranked according to the evidence-based methodology of Sackett; whenever feasible, we performed new meta-analyses using the random-effects model. Recommendations were based on the available level of evidence (A ϭ large randomized; B ϭ small randomized; C ϭ prospective trial). Results: None of the evaluated medical treatments is recommended (level A). Patients with AP should receive early enteral nutrition (level B). While mild biliary AP is best treated by primary cholecystectomy (level B), patients with severe biliary AP require emergency endoscopic papillotomy followed by interval cholecystectomy (level A). Patients with necrotizing AP should receive imipenem or meropenem prophylaxis to decrease the risk of infected necrosis and mortality (level A). Sterile necrosis per se is not an indication for surgery (level C), and not all patients with infected necrosis require immediate surgery (level B). In general, early necrosectomy should be avoided (level B), and single necrosectomy with postoperative lavage should be preferred over "open-packing" because of fewer complications with comparable mortality rates (level C). Conclusions: While providing new insights into key aspects of AP management, this evidence-based analysis highlights the need for further clinical trials, particularly regarding the indications for antibiotic prophylaxis and surgery. (Ann Surg 2006;243: 154 -168) Indication for surgery not defined. MOF indicates multiorgan failure; db, randomized double-blind trial; rand, randomized trial; cont inf, continuous infusion; sc, subcutaneous injection.
Management of the patient with acute pancreatitis
BJA Education, 2019
By reading this article you should be able to: Classify acute pancreatitis and list its common causes. Explain the principles of investigation and supportive management of patients with acute pancreatitis. Describe the local complications of acute pancreatitis and understand the indications and options for intervention. Discuss the potential long-term sequelae after acute pancreatitis and strategies to prevent its recurrence. Acute pancreatitis (AP) is an acute inflammatory disorder of the pancreas. It is a leading cause of hospital admission for gastrointestinal (GI) disorders and the incidence is rising. 1 Although the vast majority of patients have a self-limiting illness, those with severe AP account for 2.4% of ICU beds occupied in England and Wales, and have an in-hospital mortality of 40%. 2 A previous article on severe AP was Matrix codes: 1A02,
A Retrospective Study of Patients with Acute Pancreatitis in an Internal Medicine Clinic
Bagcilar Medical Bulletin, 2020
Acute pancreatitis (AP) is the rapid inflammation of the pancreas which may be life threatening, even though the disease course may range from mild to severe. We sought to investigate the characteristics of cases followed with a diagnosis of AP at our clinic. Method: Patients diagnosed and followed with AP from 2015 to 2017 at the Istanbul Kanuni Sultan Süleyman Education and Research Hospital were analyzed retrospectively. Demographic features, etiological factors, duration of hospitalization, antibiotic usage and complications were investigated. Results: Of the 160 patients with AP, 65 (40.6%) were male and 95 (59.4%) were female. The mean age of the patients was 56.2±19.1 years. At hospital admission, fever and abdominal pain were observed in 5% of the patients, abdominal pain and itching were present in 1.3%, while abdominal pain and jaundice were reported in 3.8%. Etiology of AP was defined as gallstones in 42.5%, alcohol in 4.4%, hyperlipidemia in 0.6%, posttraumatic causes (including endoscopic retrograde cholangiopancreatography) in 5.6%, drugs in 3.8%, malignancy in 1.3%, and autoimmunity in %3.8, and the remaining 38% were evaluated as idiopathic pancreatitis. Three patients with cardiac complications were either admitted to the intensive care unit (2 patients) or died (1 patient). Conclusion: Gallstone-related AP was determined to be the most common cause of AP in this study, and idiopathic causes were shown in the second rank. Endoscopic retrograde cholangiopancreatography should be planned if there is clinical deterioration and cholangitis. Serious complications (such as cardiac) may develop in patients defined to have mild disease. Thus, clinicians must be aware of this possibility and should be on high alert for possible cardiac complications which may lead to mortality or intensive care admission.
Acute pancreatitis, an infl ammatory disorder of the pancreas, is the leading cause of admission to hospital for gastrointestinal disorders in the USA and many other countries. Gallstones and alcohol misuse are long-established risk factors, but several new causes have emerged that, together with new aspects of pathophysiology, improve understanding of the disorder. As incidence (and admission rates) of acute pancreatitis increase, so does the demand for eff ective management. We review how to manage patients with acute pancreatitis, paying attention to diagnosis, diff erential diagnosis, complications, prognostic factors, treatment, and prevention of second attacks, and the possible transition from acute to chronic pancreatitis.