MANAGEMENT OF ACUTE PANCREATITIS

Abstract

Acute pancreatitis is a non-bacterial inflammatory disease, results from varing d,egrees. of autodigestion of the pancreas by activated enzymes. The exact mechanisms are unknown, but passage of gallstones with or without their impaction at the papilla is an undoubted cause, also excessive alcohol intake is another cause, both mechanisms represent about 90% of all causes of acute pancreatitis.

The incidence of this fatal disease is about 5 per I 00.000 per year and about 25% of patients show severe fonn with local and systemic complications result in profound shock and multiple organ failure, so early diagnosis by special laboratory tests and radiology are needed, such as serum amylase, lipase and plasma trypsin with plain x-ray abdomen and chest, U.S, C.T, M.R.I., ERCP, in addation to peritoneal fluid aspiration and diagnostic laparotomy. However, .the treatment is usually non-operative including reliefe of pain, antibiotics, corticosteroids, with rest or the pancreas by nasogastric suction, total parenteral nutrition illld somatostatin which directly suppress the exocrine pancreas. . '

This conservait've treatment IS guided by clinical status and laboratory fiiidings with an avarge duration of 5 to 7 days. ERCP is helpful in relie ing the biliary obstruction by endoscpic papillotomy with extraction of any bile duct stones.