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Treatment of acute pancreatitis

Official reprint from UpToDate® ©2012 UpToDate®

Treatment of acute pancreatitis
Author Santhi Swaroop Vege, MD Disclosures All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: feb 2012. |This topic last updated: feb 16, 2012. INTRODUCTION — Acute pancreatitis can be divided into two broad categories [1]: Edematous, interstitial, or mild acute pancreatitis Necrotizing or severe acute pancreatitis Treatment of acute pancreatitis is based upon the severity of the condition, as determined by the clinical, laboratory and a severity scoring system (algorithm 1). (See "Predicting theseverity of acute pancreatitis".) Treatment is aimed at correcting any underlying predisposing factors and at the pancreatic inflammation itself. Most attacks of acute pancreatitis are mild with recovery occurring within five to seven days. Death is unusual in such patients. In contrast, severe necrotizing pancreatitis is associated with a high rate of complications and significant mortality. Asubgroup of patients with severe pancreatitis has early severe acute pancreatitis or fulminant acute pancreatitis characterized by extended pancreatic necrosis with organ failure either at admission or within 72 hours. Early severe acute pancreatitis or fulminant acute pancreatitis has a high mortality of 25 to 30 percent [2-4]. An intermediate group of patients with "moderately severe acutepancreatitis", comprised of patients with local complications but no organ failure, has also been recognized [5]. Moderately severe acute pancreatitis has a low mortality like mild acute pancreatitis but morbidity (requiring prolonged hospital stay and interventions) similar to severe acute pancreatitis. This topic reviews the treatment of acute pancreatitis. Our recommendations are largely consistent withthe American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) guidelines for the treatment of acute pancreatitis [6,7]. The etiology, clinical manifestations, and diagnosis of acute pancreatitis and methods to predict its severity are discussed separately. (See "Etiology of acute pancreatitis" and "Clinical manifestations and diagnosis of acute pancreatitis"and "Predicting the severity of acute pancreatitis".) PRETREATMENT ASSESSMENT OF DISEASE SEVERITY — The first step in managing patients with acute pancreatitis is determining the severity. The severity of acute pancreatitis can be predicted based upon clinical, laboratory, and radiologic risk factors, severity grading systems, and serum markers. Some of these can be performed on admission toassist in triage of patients, while others can only be obtained after the first 48 to 72 hours or later. (See "Predicting the severity of acute pancreatitis".) SUPPORTIVE CARE — Mild acute pancreatitis is treated with supportive care including pain control, intravenous fluids, and correction of electrolyte and metabolic abnormalities. The majority of patients require no further therapy, and recoverand eat within three to seven days. (See "Predicting the severity of acute pancreatitis" and 'Pain management' below and 'Nutrition' below.) In severe acute pancreatitis, intensive care unit monitoring and support of pulmonary, renal, circulatory, and hepatobiliary function may minimize systemic sequelae [8]. Section Editor David C Whitcomb, MD, PhD Deputy Editor Shilpa Grover, MD, MPH

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Treatment of acute pancreatitis

Vital signs and urine output should be monitored every few hours in the first 24 to 48 hours. Patients with severe pancreatitis will need ongoing monitoring for other complications that might arise. (See "Abdominal compartment syndrome".) Sustained hypoxemia,...
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