Recent Management Of Acute Pancreatitis In I.C.U
Marwa Gouda Matbolley Hassan;
Abstract
Acute pancreatitis is one of the most common and serious gastro-intestinal diseases. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications.
Pathogenesis of acute pancreatitis is thought to begin with inflammatory cascades which are extremely complex in both initiating leukocyte migration and perpetuating disease. Recently, nitric oxide (NO) and altered microcirculation of the pancreas have been proposed as major initiators of inflammation. In addition, the role of the gut is becoming increasingly explored as a cause of oxidative stress and potentiation of systemic inflammation in pancreatitis. Pancreatitis develops when there is excessive activation of trypsin and other pancreatic proteases within the pancreas that overwhelms both the local safeguards within the acinar cell and antiproteases in the circulation.
Long-standing alcohol consumption and biliary stone disease cause most cases of acute pancreatitis, but numerous other etiologies are known. In 10-30% of cases, the cause is unknown, though studies have suggested that as many as 70% of cases of idiopathic pancreatitis are secondary to biliary microlithiasis.
Acute pancreatitis is diagnosed when two of the following three criteria are present: pain in the upper abdominal region, raised levels of lipase or amylase at least three times the upper limit of normal, and characteristic findings on cross-sectional abdominal imaging. Findings of acute pancreatitis frequently seen on CT include diffuse or segmental enlargement of the gland, irregular pancreatic contour, obliteration of peripancreatic fat planes, parenchymal heterogeneity, and ill-defined fluid collections within the pancreas or in the lesser sac and pararenal spaces.
Severe acute pancreatitis complications may systemically involve multiple organs (sepsis, SIRS, ARDS, ARF, DIC… etc.) or locally as: (Acute fluid collection. pancreatic necrosis, pancreatic pseudocyst, pancreatic abscess… etc.)
Management of a patient with acute pancreatitis consists of supportive care with (fluid resuscitation, pain control, and nutritional support), management of systemic and local complications and management of underlying predisposing causes.
Pathogenesis of acute pancreatitis is thought to begin with inflammatory cascades which are extremely complex in both initiating leukocyte migration and perpetuating disease. Recently, nitric oxide (NO) and altered microcirculation of the pancreas have been proposed as major initiators of inflammation. In addition, the role of the gut is becoming increasingly explored as a cause of oxidative stress and potentiation of systemic inflammation in pancreatitis. Pancreatitis develops when there is excessive activation of trypsin and other pancreatic proteases within the pancreas that overwhelms both the local safeguards within the acinar cell and antiproteases in the circulation.
Long-standing alcohol consumption and biliary stone disease cause most cases of acute pancreatitis, but numerous other etiologies are known. In 10-30% of cases, the cause is unknown, though studies have suggested that as many as 70% of cases of idiopathic pancreatitis are secondary to biliary microlithiasis.
Acute pancreatitis is diagnosed when two of the following three criteria are present: pain in the upper abdominal region, raised levels of lipase or amylase at least three times the upper limit of normal, and characteristic findings on cross-sectional abdominal imaging. Findings of acute pancreatitis frequently seen on CT include diffuse or segmental enlargement of the gland, irregular pancreatic contour, obliteration of peripancreatic fat planes, parenchymal heterogeneity, and ill-defined fluid collections within the pancreas or in the lesser sac and pararenal spaces.
Severe acute pancreatitis complications may systemically involve multiple organs (sepsis, SIRS, ARDS, ARF, DIC… etc.) or locally as: (Acute fluid collection. pancreatic necrosis, pancreatic pseudocyst, pancreatic abscess… etc.)
Management of a patient with acute pancreatitis consists of supportive care with (fluid resuscitation, pain control, and nutritional support), management of systemic and local complications and management of underlying predisposing causes.
Other data
| Title | Recent Management Of Acute Pancreatitis In I.C.U | Other Titles | الطرق الحديثة لعلاج إلتهاب البنكرياس الحاد في الرعاية المركزة | Authors | Marwa Gouda Matbolley Hassan | Issue Date | 2014 |
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