MANAGEMENT OF SEVERE ACUTE PANCREATITIS: AN INTENSIVE CARE PRESPECTIVE

Abstract

Acute pancreatitis (AP) is an acute inflammatory disorder of the pancreas which has many causes. Inacute pancreatitis, intracellular activation of pancreatic digestive enzymes occurs and leads to destruction of pancreatic parenchymathat induces a systemic activation of coagulation, complement and fibrinolytic cascades with liberation of cytokines and reactive oxygen metabolites. If severe and overwhelming, the inflammation can lead to shock, acute renal failure and acute respiratory distress syndrome. In approximately 45% of cases the disorder is associated with cholelithiasis, with ethanol abuse accounting for a further 35% of patients. In 10% of patients no cause may be found. The diagnosis of acute pancreatitis requires two of the followingthree features: characteristic abdominal pain, serumamylase and/or lipase≥3 times the upper limit of normal, and characteristic findings of acute pancreatitis on CT scan. Assessment of the severity of acute pancreatitis (AP) is important for proper management and prediction of outcome.Multiple prognostic scoring systems have been developed todiscriminate between patients with mild acute pancreatitis andthose at high risk for developing severe pancreatitis such asRansonscore and APACHE IIscore.