Current management and novel insights in acute pancreatitis

@article{Muddana2009CurrentMA,
  title={Current management and novel insights in acute pancreatitis},
  author={Venkata Muddana and David C. Whitcomb and Georgios I. Papachristou},
  journal={Expert Review of Gastroenterology \& Hepatology},
  year={2009},
  volume={3},
  pages={435 - 444}
}
Acute pancreatitis (AP) is a common and potentially lethal acute inflammatory process. Approximately 10–20% of patients develop a severe course and suffer systemic inflammatory response and/or pancreatic necrosis (PNec). To date, there is no single biomarker proven to perform better than clinical judgment in predicting severe AP. The available prognostic clinical scoring systems are used primarily for research purposes. Management of AP is limited to supportive care and treatment of… 

AcUTe PANcReATITIS: PATHoGeNeSIS, DIAGNoSIS AND MANAGeMeNT oTHeR THAN NUTRITIoN

Clinical management of acute pancreatitis is reviewed including the pathophysiology, diagnosis, and therapy excluding the nutritional aspect, which is important to correctly diagnose and manage appropriately.

Advancing the frontiers of clinical management in acute pancreatitis

This thesis demonstrates that enteral nutrition given via the nasogastric route is safe and well tolerated in most patients with acute pancreatitis, and indicates that use of a relatively inexpensive polymeric formulation is as safe and effective as a more costly elemental formulation.

The management of acute and chronic pancreatitis.

Treatment strategies for acute pancreatitis include fasting and short-term intravenous feeding, fluid therapy, and pain management with narcotics for severe pain or nonsteroidal anti-inflammatories for milder cases.

New directions in diagnosis and treatment of canine acute pancreatitis

The new premise of enteral feeding of dogs with acute pancreatitis early in the course of disease is supported, the sensitivity and specificity of two diagnostic tests are determined and an objective marker of disease severity is established.

The importance of timing of decompression in severe acute pancreatitis combined with abdominal compartment syndrome

Well-timed decompression in a porcine model of SAP incorporating 25-mm Hg intra-abdominal hypertension/ACS was associated with significantly reduced mortality, improved systemic hemodynamics and organ function, as well as alleviated histologic injury and inflammatory intensity.

Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis.

Both the subcutaneous fasciotomy and ultrasound-guided drainage of intra-abdominal and/or peripancreatic fluid collections seem to be safe and effective alternatives in the management of abdominal compartment syndrome; however, prospective studies are needed to further evaluate their clinical role.

Nutritional management of acute pancreatitis: the concept of ‘gut rousing’

Nutritional management in acute pancreatitis should aim primarily at maintaining the gastrointestinal function, and providing full nutritional requirements and avoiding pancreatic exocrine stimulation should be considered as secondary aims.

Management of acute pancreatitis in dogs: a critical appraisal with focus on feeding and analgesia.

The level of evidence for the major areas of management of acute pancreatitis in dogs is examined and the premise for early feeding is to improve the health of the intestinal tract, as unhealthy enterocytes are thought to perpetuate systemic inflammation.

Predictors of Critical Acute Pancreatitis: A Prospective Cohort Study

Given that APACHE II score is rather cumbersome, the combination of IAP and CRP appears to be the most practical way to predict critical course of AP early after hospital admission.

Early differential diagnosis of the severity of acute pancreatitis

The basal amplitudes of skin temperature oscillations in patients with AP were much lower than in healthy volunteers and progressively decreased as the disease severity increased, and the dysregulation of vascular tone during the contralateral cold test was observed in all patients withAP.

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