Early phase of acute pancreatitis: Assessment and management

Abstract

Acute pancreatitis (AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis.

Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis

“…4 Mortality is uncommon in mild pancreatitis but may reach up to 50% in severe episodes. [5][6][7] Clearly, early prediction of disease severity in acute pancreatitis is important as this will guide management and determine optimum escalation of care. However, this has proved to be difficult in the absence of any established single reliable disease and patient specific surrogate markers.…”

Factors Associated With Outcome of Acute Necrotizing Pancreatitis

“…The BISAP score is a new scoring system first described in 2008 [1]. The BISAP uses five points: urea nitrogen more than 25 mg/dl, impaired mental status by evidence of disorientation or disturbance in mental status, presence of SIRS, age above 60 years, and pleural effusions [9]. The number of patients with BISAP score of 0-5 was 4 (3,5 %), 19 (16,8 %), 44 (38,9 %), 14 (12,4 %), 14 (12,4 %) and 18 (15,9 %) and their mortality rates were 0 %, 0 %, 6,7 %, 35,7 %, 64,3 % and 77,8 %, respectively.…”

“…The mortality rates in the absence of organ failure, in the presence of one organ failure, and in patients with multi-organ failure are 0 %, 3 %, and 47 %, respectively [2]. Different extents of pancreatic necrosis and its subsequent complications may contribute to the occurrence of organ failure and mortality during the admission period [9]. Therefore, the initial determination of severity in acute necrotizing pancreatitis to evaluate organ failure and the complications of pancreatic necrosis as soon as possible is critical for the appropriate management and risk assessment in a clinical setting.…”

“…Three level of severity were defined: 1 st -intolerance of enteral feeding more than 3 days, depressed intestinal peristalsis, preserved intestinal gas evacuation ability; 2 nd -clinical and roentgenological signs of distended intestine with intraabdominal pressure 12-20 mm Hg, suppressed gas evacuation; 3 rd -clinic of paralytic intestinal obstruction with intraabdominal hypertension over 20 mm Hg, acute gastric and duodenal erosions with hemorrhage. Intraabdominal pressure was measured via the bladder, with patients in the supine position, using the closed loop system repeated measurements technique [9]. Additionally, venous blood citrulline concentration was determined as an indicator of intestinal epitheliocytes functional activity [3].…”

“…Acute Physiology and Chronic Health Evaluation (APACHE)-II [9], Bedside Index for Severity in Acute Pancreatitis (BISAP) [1] scores and presence of features of systemic inflammatory response syndrome (SIRS) were calculated using data from the first 24 h after admission. Continuous variables were expressed as mean with standard deviation and com- Hematocrit, % 51,8±0,9* 45,3±1,2…”