Acute pancreatitis approach
Acute pancreatitis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Overview
The mainstay of treatment in acute pancreatitis involves pain control, bowel rest (NPO or nothing by mouth), and fluid resuscitation. Assessment of the re-introduction of feeding and nutritional support must be made subsequently based on clinical improvement and imaging findings. Serial cross sectional imaging may be used to determine the need for surgical intervention secondary to complications. Antiobiotics may only be used in cases when infection is suspected or confirmed. Clinicians must note that imaging findings almost always lag the clinical findings. Clinicians must make decisions primarily based on the patient's clinical condition. Cross-sectional imaging modalities may shed light to the local complications associated with acute pancreatitis and minimally invasive surgery may be performed to manage some complications (e.g. pancreatic necrosis).
Approach to Therapy
According to the American college of gastroenterology, following are the guidelines for initial assessment and risk stratification for acute pancreatitis:[1]
Recommendation | Evidence Level | Strength of Recommendation |
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Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed | Moderate | Strong |
Risk assessment should be performed to stratify patients into higher- and lower-risk categories to assist triage, such as admission to an intensive care setting | Moderate | Conditional |
Patients with organ failure should be admitted to an intensive care unit or intermediary care setting whenever possible | Low | Strong |
Intrinsic patient related risk factors | |||
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Patient characteristics | Age >55 years | ||
Obesity (BMI>30kg/m) | |||
Altered mental status | |||
Comorbid disease | |||
The systemic inflammatory response syndrome (SIRS)
Presence of >2 of the following criteria |
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References
- ↑ Tenner S, Baillie J, DeWitt J, Vege SS, American College of Gastroenterology (2013). "American College of Gastroenterology guideline: management of acute pancreatitis". Am J Gastroenterol. 108 (9): 1400–15, 1416. doi:10.1038/ajg.2013.218. PMID 23896955.