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Acute pancreatitis

Jan De Waele (UGent)
Author
Organization
Abstract
Purpose of review: To review the changing insights in the pathophysiology and management of acute pancreatitis. Recent findings: The outdated 1992 Atlanta classification has been replaced by two new classifications, both of which acknowledge the role of organ dysfunction in determining the outcome of acute pancreatitis, and both of which have introduced a new category of moderate' pancreatitis. The new classifications will allow fewer patients to be classified as severe, which better reflects the risk of dying of the disease. Intra-abdominal hypertension has emerged as a relevant issue, and strategies to lower intra-abdominal pressure may often be required. Antibiotic prophylaxis has been discontinued for some time, but aggressive fluid resuscitation is also being questioned, and the role of surgery is further reduced as percutaneous drainage of collections has shown to reduce the need for more surgical interventions. If needed, surgery should be as conservative as possible, with minimally invasive strategies preferable. Newer techniques such as endoscopic transgastric drainage are being developed, but their exact role has yet to be defined. Summary: Management of severe acute pancreatitis is changing fundamentally. Less is more' is the new paradigm in acute pancreatitis - less antibiotics, less fluids, less surgery, which should eventually lead to less morbidity and mortality.
Keywords
organ failure, acute pancreatitis, pancreatic necrosis, fluid resuscitation, intra-abdominal hypertension, ABDOMINAL COMPARTMENT SYNDROME, ACUTE NECROTIZING PANCREATITIS, STEP-UP APPROACH, INTRAABDOMINAL HYPERTENSION, ANTIBIOTIC-TREATMENT, FLUID THERAPY, ORGAN FAILURE, DOUBLE-BLIND, NECROSECTOMY, NECROSIS

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Citation

Please use this url to cite or link to this publication:

Chicago
De Waele, Jan. 2014. “Acute Pancreatitis.” Current Opinion in Critical Care 20 (2): 189–195.
APA
De Waele, Jan. (2014). Acute pancreatitis. CURRENT OPINION IN CRITICAL CARE, 20(2), 189–195.
Vancouver
1.
De Waele J. Acute pancreatitis. CURRENT OPINION IN CRITICAL CARE. 2014;20(2):189–95.
MLA
De Waele, Jan. “Acute Pancreatitis.” CURRENT OPINION IN CRITICAL CARE 20.2 (2014): 189–195. Print.
@article{5698675,
  abstract     = {Purpose of review: To review the changing insights in the pathophysiology and management of acute pancreatitis.
Recent findings: The outdated 1992 Atlanta classification has been replaced by two new classifications, both of which acknowledge the role of organ dysfunction in determining the outcome of acute pancreatitis, and both of which have introduced a new category of moderate' pancreatitis. The new classifications will allow fewer patients to be classified as severe, which better reflects the risk of dying of the disease. Intra-abdominal hypertension has emerged as a relevant issue, and strategies to lower intra-abdominal pressure may often be required. Antibiotic prophylaxis has been discontinued for some time, but aggressive fluid resuscitation is also being questioned, and the role of surgery is further reduced as percutaneous drainage of collections has shown to reduce the need for more surgical interventions. If needed, surgery should be as conservative as possible, with minimally invasive strategies preferable. Newer techniques such as endoscopic transgastric drainage are being developed, but their exact role has yet to be defined.
Summary: Management of severe acute pancreatitis is changing fundamentally. Less is more' is the new paradigm in acute pancreatitis - less antibiotics, less fluids, less surgery, which should eventually lead to less morbidity and mortality.},
  author       = {De Waele, Jan},
  issn         = {1070-5295},
  journal      = {CURRENT OPINION IN CRITICAL CARE},
  keyword      = {organ failure,acute pancreatitis,pancreatic necrosis,fluid resuscitation,intra-abdominal hypertension,ABDOMINAL COMPARTMENT SYNDROME,ACUTE NECROTIZING PANCREATITIS,STEP-UP APPROACH,INTRAABDOMINAL HYPERTENSION,ANTIBIOTIC-TREATMENT,FLUID THERAPY,ORGAN FAILURE,DOUBLE-BLIND,NECROSECTOMY,NECROSIS},
  language     = {eng},
  number       = {2},
  pages        = {189--195},
  title        = {Acute pancreatitis},
  url          = {http://dx.doi.org/10.1097/MCC.0000000000000068},
  volume       = {20},
  year         = {2014},
}

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