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Abstract : |
Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems. In about 15-20% of patients with acute pancreatitis, severe damage to the pancreas may lead to a life threatening illness that is often associated with prolong hospitalization, multiple surgical procedure and death in some patients. Incidence is 40 - 250 /millions; 15 -20% develop necrosis, 30 % develop infected, 15 – 20% necrosis and 3- 4 % develop abscess. Infected necrosis causes 80% of all the pancreatitis related mortality. Approximately 2,000 patients per year die from complication related to acute pancreatitis. Mortality varies with aetiology, the development of complication or necrosis and the number and severity of co-morbid medical conditions. There are some consensus conferences about the management of the patients with severe acute pancreatitis (SAP). The problems that must be solved by these conferences were: When should the patient admitted with acute pancreatitis be monitored in an ICU (Intensive Care Unit)? Should patients with SAP receive prophylactic antibiotics? What are the optimal mode and timing of nutritional support for the patient with SAP? What are the indication for surgery in acute pancreatitis? Under which circumstances should patients with gallstones pancreatitis undergo intervention for clearance of the bile duct? Is there a role for therapy targeting the SIRS in the patient with SAP? My opinions about these problems were: 1) regular CT scans with FNA (Fine Needle Aspiration) sampling from necrotic tissue; 2) maximum non-operative support (for avoiding organ dysfunction); 3) operate for infected necrosis but not too early; 3) EN (enteral nutrition) where possible but TPN (Total Parenteral Nutrition) often required; 4) beware of abdominal compartment syndrome; 5) antibiotics only for infected necrosis. , |
