Document Detail


Current management of acute pancreatitis.
MedLine Citation:
PMID:  16224479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The incidence of acute pancreatitis varies considerably between regions and is estimated at 5-80 per 100,000 population. The mortality rate of acute edematous-interstitial pancreatitis is below 1%, whereas 10-24% of patients with severe acute pancreatitis die. The early prognostic factors that can be used to determine whether the clinical course is likely to be severe are three or more signs of organ failure according to the Ranson or Imrie scores, the presence of nonpancreatic complications, and the detection of pancreatic necrosis by imaging techniques. Elevated C-reactive protein levels above 130 mg/l can also predict a severe course of acute pancreatitis with high sensitivity. Although no causal treatment exists, replacing the dramatic fluid loss that takes place in the early disease phase is critical and determines the patient's prognosis. Adequate pain relief with opiates is another therapeutic priority. In patients with pancreatic necrosis, the high mortality rate between the third and fourth week after the initial episode is determined largely by the development of pancreatic infection, and can therefore be reduced by early antibiotic treatment. Early enteral nutrition for the treatment of acute pancreatitis has been shown to be superior and much more cost-effective than parenteral nutrition. Infected pancreatic necrosis or pancreatic abscess are two of the few remaining indications for open surgery in acute pancreatitis. Even when indicated, surgery is frequently delayed or even replaced by minimally invasive surgical techniques.
Authors:
Julia Mayerle; Verena Hlouschek; Markus M Lerch
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Nature clinical practice. Gastroenterology & hepatology     Volume:  2     ISSN:  1743-4378     ISO Abbreviation:  -     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-14     Completed Date:  2005-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101226510     Medline TA:  Nat Clin Pract Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  473-83     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, Endocrinology and Nutrition, Klinik für Innere Medizin A, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Analgesics / therapeutic use
Anti-Bacterial Agents / therapeutic use
Biological Markers / blood
Diagnostic Imaging
Digestive System Surgical Procedures
Fluid Therapy
Humans
Nutritional Support
Pain / drug therapy,  etiology
Pancreatitis / diagnosis*,  etiology,  therapy*
Chemical
Reg. No./Substance:
0/Analgesics; 0/Anti-Bacterial Agents; 0/Biological Markers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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