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Current Opinion in Gastroenterology Sep 2018Acute pancreatitis is a common condition that affects patients with varying degrees of severity and may lead to significant morbidity and mortality. The present article... (Review)
Review
PURPOSE OF REVIEW
Acute pancreatitis is a common condition that affects patients with varying degrees of severity and may lead to significant morbidity and mortality. The present article will review the current paradigm in acute pancreatitis management within the first 72 h of diagnosis.
RECENT FINDINGS
Patients presenting with acute pancreatitis should be evaluated clinically for signs and symptoms of organ failure in order to appropriately triage. Initial management should focus on fluid resuscitation, with some data to support Ringer's lactate over physiological saline. Routine use of prophylactic antibiotics in acute pancreatitis is not recommended, nor is urgent endoscopic retrograde cholangiopancreatography in the absence of concomitant acute cholangitis. Early oral feeding should be encouraged, not avoided, and use of parenteral nutrition is discouraged. Cholecystectomy during the same admission of biliary pancreatitis should be performed in order to prevent future acute pancreatitis episodes. Patients with acute pancreatitis secondary to alcohol should receive alcohol counseling. Finally, there is ongoing interest in the development of prognostic laboratory tests in acute pancreatitis and pharmacological therapies to reduce the inflammation that occurs in acute pancreatitis.
SUMMARY
Acute pancreatitis is a common and heterogeneous condition with the potential for significant morbidity. Best practices in acute pancreatitis management focus on triage, hydration and enteral feeding.
Topics: Acute Disease; Enteral Nutrition; Fluid Therapy; Humans; Pancreatitis; Patient Care Management; Time Factors; Triage
PubMed: 29957661
DOI: 10.1097/MOG.0000000000000456 -
Gut Nov 2017Acute pancreatitis is one of the most common GI conditions requiring acute hospitalisation and has a rising incidence. In recent years, important insights on the... (Review)
Review
Acute pancreatitis is one of the most common GI conditions requiring acute hospitalisation and has a rising incidence. In recent years, important insights on the management of acute pancreatitis have been obtained through numerous randomised controlled trials. Based on this evidence, the treatment of acute pancreatitis has gradually developed towards a tailored, multidisciplinary effort, with distinctive roles for gastroenterologists, radiologists and surgeons. This review summarises how to diagnose, classify and manage patients with acute pancreatitis, emphasising the evidence obtained through randomised controlled trials.
Topics: Acute Disease; Aftercare; Combined Modality Therapy; Humans; Pancreatitis; Prognosis; Randomized Controlled Trials as Topic; Recurrence; Secondary Prevention; Severity of Illness Index
PubMed: 28838972
DOI: 10.1136/gutjnl-2016-313595 -
Digestive and Liver Disease : Official... Jul 2015This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe...
This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments.
Topics: Acute Disease; Anti-Bacterial Agents; Cholangiopancreatography, Endoscopic Retrograde; Combined Modality Therapy; Drainage; Enteral Nutrition; Fluid Therapy; Humans; Magnetic Resonance Imaging; Pancreatitis; Pancreatitis, Acute Necrotizing; Parenteral Nutrition; Severity of Illness Index; Tomography, X-Ray Computed
PubMed: 25921277
DOI: 10.1016/j.dld.2015.03.022 -
Radiologia 2019Acute pancreatitis is common and requires multidisciplinary management. The revised Atlanta classification, published in 2012, defines the terminology necessary to... (Review)
Review
Acute pancreatitis is common and requires multidisciplinary management. The revised Atlanta classification, published in 2012, defines the terminology necessary to enable specialists from different backgrounds to discuss the morphological and clinical types of acute pancreatitis. Radiologists' role depends fundamentally on computed tomography (CT), which makes it possible to classify the morphology of this disease and to predict its clinical severity by applying imaging severity indices. Furthermore, CT- or ultrasound-guided drainage is, together with endoscopy, the current technique of choice in the initial approach to collections that appear as a complication. This paper aims to disseminate the concepts coined in the revised Atlanta classification and to describe the current role of radiologists in the diagnosis and treatment of acute pancreatitis.
Topics: Acute Disease; Humans; Multidetector Computed Tomography; Pancreatitis
PubMed: 31153603
DOI: 10.1016/j.rx.2019.04.001 -
Current Problems in Pediatric and... Aug 2020Acute pancreatitis (AP), manifesting as acute onset of abdominal pain, vomiting, and nausea, is increasingly being recognized in children secondary to increased... (Review)
Review
Acute pancreatitis (AP), manifesting as acute onset of abdominal pain, vomiting, and nausea, is increasingly being recognized in children secondary to increased awareness, more identifiable etiologies as well as advances in diagnostic capabilities, like imaging. Despite this increased awareness and ability for more frequent diagnoses, the natural history of AP remains poorly understood leading to gaps in approach and management, especially in children. Coupled with poor epidemiologic and management awareness, there remains a lack of understanding of the long term implications of severe acute pancreatitis (SAP). Hence, the role of the primary care clinician in the early diagnosis, and management, remains critical and may affect the need for consultation with pediatric sub-specialists like gastroenterologists. This review provides guidelines regarding epidemiology, diagnosis, and management strategies to address some of these gaps.
Topics: Diet; Fluid Therapy; Humans; Pain Management; Pancreatitis; Pediatrics; Primary Health Care; Severity of Illness Index
PubMed: 32859510
DOI: 10.1016/j.cppeds.2020.100839 -
World Journal of Gastroenterology Oct 2014Severe acute pancreatitis (SAP), which is the most serious type of this disorder, is associated with high morbidity and mortality. SAP runs a biphasic course. During the... (Review)
Review
Severe acute pancreatitis (SAP), which is the most serious type of this disorder, is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk, a pro-inflammatory response results in systemic inflammatory response syndrome (SIRS). If the SIRS is severe, it can lead to early multisystem organ failure (MOF). After the first 1-2 wk, a transition from a pro-inflammatory response to an anti-inflammatory response occurs; during this transition, the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue, which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However, despite the reduction in overall mortality in the last decade, SAP is still associated with high mortality. In the majority of cases, sterile necrosis should be managed conservatively, whereas in infected necrotizing pancreatitis, the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently, the step-up approach (delay, drain, and debride) may be considered as the reference standard intervention for this disorder.
Topics: Disease Progression; Humans; Inflammation Mediators; Pancreatitis; Pancreatitis, Acute Necrotizing; Severity of Illness Index; Treatment Outcome
PubMed: 25320523
DOI: 10.3748/wjg.v20.i38.13879 -
Clinical and Translational... Aug 2023Drug induced acute pancreatitis is a difficult diagnosis for clinicians. We previously published an "Evidence-Based Classification System" on Drug-Induced Acute...
INTRODUCTION
Drug induced acute pancreatitis is a difficult diagnosis for clinicians. We previously published an "Evidence-Based Classification System" on Drug-Induced Acute Pancreatitis widely used by clinicians to assist in the identification of drugs. Unfortunately, this prior analysis based only on published case reports has been misunderstood. The prior review did not include studies with higher evidentiary value, such as randomized trials, case-control studies, and/or pharmacoepidemiologic studies. The use of the prior classification system has led to many patients being inappropriately labeled as having drug-induced acute pancreatitis. We now propose a "Revised" Evidence- Based Classification System for the purpose of determining which drugs cause acute pancreatitis based on the Grading of Recommendations, Development, and Evaluation criteria.
METHODS
A search of the English Language literature was performed to identify all case reports with medication and/or drug induced acute pancreatitis. We divided the drugs implicated as causing acute pancreatitis into four groups based on the quality of evidence as defined by GRADE quality parameters.
RESULTS
Although 141 drugs were identified in the literature as causing acute pancreatitis, only 106 drugs published in the literature as causing acute pancreatitis were high quality case reports. Only 3 drugs had evidence as causing acute pancreatitis from randomized controlled clinical trials, including 6-mercaptopurine and azathioprine.
DISCUSSION
The vast majority of drugs implicated as causing acute pancreatitis in the literature have low or very low quality of evidence supporting those claims.
Topics: Humans; Pancreatitis; Acute Disease; Case-Control Studies
PubMed: 37440319
DOI: 10.14309/ctg.0000000000000621 -
Polskie Archiwum Medycyny Wewnetrznej 2013Recently, the original Atlanta classification of 1992 was revised and updated by the Working Group using a web-based consultative process involving multiple... (Review)
Review
Recently, the original Atlanta classification of 1992 was revised and updated by the Working Group using a web-based consultative process involving multiple international pancreatic societies. The new understanding of the disease, its natural history, and objective description and classification of pancreatic and peripancreatic fluid collections make this new 2012 classification a potentially valuable means of international communication and interest. This revised classification identifies 2 phases of acute pancreatitis - early (first 1 or 2 weeks) and late (thereafter). Acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis, the latter involving necrosis of the pancreatic parenchyma and peripancreatic tissues (most common), pancreatic parenchyma alone (least common), or just the peripancreatic tissues (~20%). Severity of the disease is categorized into 3 levels: mild, moderately severe, and severe. Mild acute pancreatitis lacks both organ failure (as classified by the modified Marshal scoring system) and local or systemic complications. Moderately severe acute pancreatitis has transient organ failure (organ failure of <2 days), local complications, and/or exacerbation of coexistent disease. Severe acute pancreatitis is defined by the presence of persistent organ failure (organ failure that persists for ≥2 days). Local complications are defined by objective criteria based primarily on contrast-enhanced computed tomography; these local complications are classified as acute peripancreatic fluid collections, pseudocyst (which are very rare in acute pancreatitis), acute (pancreatic/peripancreatic) necrotic collection, and walled-off necrosis. This classification will help the clinician to predict the outcome of patients with acute pancreatitis and will allow comparison of patients and disease treatment/management across countries and practices.
Topics: Disease Progression; Humans; Multiple Organ Failure; Pancreas; Pancreatitis; Severity of Illness Index; Tomography, X-Ray Computed
PubMed: 23396317
DOI: 10.20452/pamw.1627 -
Jornal de Pediatria 2019To describe the epidemiology and clinical features of acute pancreatitis and recurrent acute pancreatitis in children.
OBJECTIVE
To describe the epidemiology and clinical features of acute pancreatitis and recurrent acute pancreatitis in children.
METHODS
Observational and retrospective study with an analytical component. Patients were classified into two groups: Acute pancreatitis and recurrent pancreatitis. The relationship with each parameter obtained was analyzed using the chi-squared test, Student's t-test, or the Mann-Whitney U test.
RESULTS
There were 130 patients with acute pancreatitis; recurrent pancreatitis was diagnosed in 23.8% of the cases. The most frequent causes were anatomical (29.6%), pharmacological (19.2%), and biliary (14.6%), although in 29.2% etiology was not identified. Fasting lasted 3.5±3.8 days and parenteral nutrition was indicated in 26.9% of the cases for 10.8±11.3 days. A statistical association with anatomical (p=0.02) and pharmacological causes (p=0.01) was found in the recurrent pancreatitis group; no other differences between acute pancreatitis and recurrent pancreatitis groups were observed. The mortality rate was 3.1%, it was not attributable to acute pancreatitis in any cases.
CONCLUSION
Acute pancreatitis is associated with a high frequency of acute recurrent pancreatitis. Severity and complications did not show statistically significant differences in this investigation. Anatomical etiologies were the most relevant cause in this cohort. Fasting time and parenteral nutrition use were relevant. Genetics testing is required in this population.
Topics: Acute Disease; Child; Child, Preschool; Colombia; Comorbidity; Cross-Sectional Studies; Fasting; Female; Humans; Male; Pancreatitis; Parenteral Nutrition; Recurrence; Retrospective Studies
PubMed: 30075118
DOI: 10.1016/j.jped.2018.06.011 -
Seminars in Diagnostic Pathology Nov 2004Acute pancreatitis is characterized by the occurrence of necroinflammatory changes in the pancreas. Three types of necrosis may be distinguished: (1) interstitial tissue... (Review)
Review
Acute pancreatitis is characterized by the occurrence of necroinflammatory changes in the pancreas. Three types of necrosis may be distinguished: (1) interstitial tissue necrosis, which subsequently may also involve acinar and ductal cells, (2) ductal necrosis, and (3) acinar necrosis. The first type of necrosis is autodigestive in nature and is typical of the most common forms of acute pancreatitis, which are associated with alcohol, bile duct disease, metabolic conditions, and other rare factors. Clinically, these types of pancreatitis may be either mild or severe (Atlanta classification). The mild form is also known as edematous pancreatitis, because there is edematous swelling of the pancreas combined with tiny foci of interstitial (fat) necrosis. Severe or necrotizing pancreatitis shows large areas of often hemorrhagic necrosis of the pancreatic and particularly the peripancreatic tissue. The ductal type of necrosis is rare and may be seen in pancreatitis associated with prolonged circulatory failure. The acinar type of necrosis is caused by infectious agents. Complications of acute pancreatitis, such as pseudocyst, bleeding, and infection, determine the course of the disease.
Topics: Humans; Necrosis; Pancreatitis
PubMed: 16273940
DOI: 10.1053/j.semdp.2005.07.001