What is New in Gastroenterology and Hepatology

What is New in Gastroenterology and Hepatology

Note: This book has been published under Bentham’s FAST TRACK OPEN ACCESS publication option upon the author’s request. The finalized book will be published soon.

Gastroenterology and hepatology represent dynamic fields of study and practice in internal medicine, with numerous innovations manifesting over the last 30 years. What is New in Gastroenterology and ...
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Management of Severe Acute Pancreatitis

Pp. 172-185 (14)

DOI: 10.2174/9781681087870121010018

Author(s): Mircea Manuc*, Doina Istratescu

Abstract

One of the most important gastroenterological emergencies is acute pancreatitis. It is classified into mild, moderately severe, and severe pancreatitis depending on occurring complications. Establishing etiology and assessing disease severity is the first step of the management. Severe pancreatitis is encountered in 25% of patients and carries the highest mortality. The therapy in these cases is structured on 4 interventions: fluid resuscitation, nutritional support, pain management, specific measures addressed to etiology or complications. Fluid resuscitation for prevention of necrotizing pancreatitis is the foundation of early management. Quality of life in these patients relies on prompt pain management. Early enteral nutrition might reduce mortality, multiple organ failure and infection rate when compared to late enteral nutrition and parenteral nutrition. Pseudocysts and infected necrosis can complicate severe pancreatitis. These symptomatic patients will need appropriate interventional maneuvers depending on imaging and disease extension. Antibiotics should only be given when infection is highly suspected, particularly when necrotizing pancreatitis is involved. Percutaneous drainage is recommended when the collected necrosis has less than 1 month from constitution. In walled-off pancreatic necrosis, endoscopic drainage and subsequent necrosectomy is preferred to percutaneous drainage. Surgery has to be taken into account after failure of endoscopical/percutaneous procedures, intra-abdominal compartment syndrome, or acute on-going bleeding.

Keywords:

Management, Pancreatic necrosis, Severe acute pancreatitis