Management of Acute Pancreatitis-edited

8/18/2019 Management of Acute Pancreatitis-edited

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Management


2/18

Conventional Measures iManagement of Acute

Pancreatitis

IV fuidsand

colloids

Analgesics orpain

No OAlimen

on


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AcutePancreati

tis

Abdominal painconsistent with

the disease

Serum amylase and/orlipase greater than

times the upper limit onormal! and/or

"harac

#ndingabdoimag

rican $ournal o %astroenterology %uideline& Management o Acute Pancreatitis! $uly


4/18

APa

"ontrast enhanced "*and/or M+I o pancreas in

whom the diagnosis isunclear or who ail to

impro,e clinically withinthe #rst -.0' hours ater

hospital admission or toe,aluate complications

rican $ournal o %astroenterology %uideline& Management o Acute Pancreatitis! $uly


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Initial Assessment and +is1Strati#cation

2 3 M O 4 5 N A M I "

S * A * 6 S73%IN

+3S6S"I*A*IV3

M3AS6+3S

S * + A * I 8 5

P A * I 3 N * S9O:+IS

2I%2+IS

with orgailure I"6

admissio


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Initial Management

'


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3+"


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3+"P in Acute

PancreatitisPatients with acutepancreatitis andconcurrent acutecholangitis should

undergo ERCPwithin 24 hours of

admission

In the absenccholangitis an

Caundice! MRCendoscop

ultrasound E

rather than diag3+"P should beto screen o

choledocholithihighly suspec


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3+"P in Acute

PancreatitisPancreatic duct stentsand/or postprocedurerectal NSAI4

suppositories should

be utiliDed toPREVE! P"S!#ERCP PACREA!$!$S

in high ris1 patients

3+"P is "! Ein most patientgallstone pancrwho lac1 laborat

clinical e,idenongoing bilia

obstructio


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+ole o AntibioticsE&trapancreat

ic infectionsuch ascholangitis!catheteracuired

inections!bacteremia!urinary tractinections!

pneumonia

$nfectednecrosis shouldbe considered in

patients withpancreatic or

eBtrapancreatic

necrosis whodeteriorate or ail

to impro,e ater 0)( days o

hospitaliDation

In pati

infectedantibioticpenetrate

necroscar'ap

)uinolometronidbe useulor somet

a,ointer,


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+ole o Antibiotics

Routine use oprophylacticantibiotics inpatients with

se,ere acutepancreatitis isnot

recommended

*he use o

antibiotics inpatients with

sterilenecrosis to

pre,entde,elopment oinected

necrosis is notrecommended

Rou

adminnantif

agentw

prophytheraantib

n

recom


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Nutrition in Acute Pancreatitis

• oral eedings can be started immediatis no nausea and ,omiting! and abdominresol,ed

• initiation o eeding with low fat solid das sae as clear li)uid diet

MI94AP

• enteral nutrition is recommended to pinectious complications

• Parenteral nutrition should be avoidethe enteral route is not a,ailable! toleratmeeting caloric reuirements

S3V3+3 AP


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Nutrition in Acute Pancreatitis

•"lear liuiddiet is usuallystarted on rd to Eth day and

regular diet bythe


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+eintroduction o Oral Inta1e

4ecrease in orresolution o

abdominal pain

Patient ishungry

Organdysunction! ipresent has

resol,ed


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+ole o Surgery in Acute PancreIn patients with mild AP! ound to ha,e gallsto

the bladder! a cholec+stectom+ should be perbeore discharge to pre,ent recurrence o A

In patients with necroti*ing 'iliar+ AP! in orpre,ent inection! cholec+stectom+ is to

deferred until acti,e infammatory subsides ancollections resol,e or stabiliDe

*he presence o as+mptomatic pseudoc+stspancreatic and,or e&trapancreatic necrosis

warrant inter,ention regardless o siDe! location!eBtension


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+ole o Surgery in Acute Pancre$n sta'le patients with infected necrsurgical! radiologic and/or endoscopic dra

should be dela+ed preerable or more thwee1s to allow li)uefaction o the cont

and the development of a -'rous waround the necrosis

$n s+mptomatic patients with infectnecrosis! minimally in,asi,e methods

necrosectom+ are preerred to open

necrosectomy


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Acute Pancreatitis secondar+ to "'structed C.ile %uct pro'a'l+ secondar+ to parasite $nfe

/Ascariasis0

3+"P

4iagnostic F *herapeutic

Shows the eBactsite and number o

parasites

F endoscopsphincterotomtreatment o ch

or eBtractionparasites

F adCuantihelm

treatm


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Acute Pancreatitis secondar+ to "'structed C.ile %uct pro'a'l+ secondar+ to parasite $nfe

/Ascariasis0

MebendaDole or AlbendaDole• 3Gecti,e in eradicating Ascariasis in .-)((H o ca• Inhibit phosphorylation in the mitochondria deple

the worm>s glucose

Pyrantel Pamoate• Neuromuscular bloc1ing agent paralysis o the w

eBpelled by normal gastrointestinal persitalsis

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Management of Acute Pancreatitis-edited