| Title: |
Practice guidelines in acute pancreatitis |
| Authors: |
Banks, PA; Freeman, ML; Fass, R; Baroni, DS; Mutlu, EA; Bernstein, DE; Parkman, HP; Bharucha, AE; Prather, C; Brugge, WR; Pratt, DS; Chang, L; Roach, AC; Chey, W; Sampliner, RE; Cohen, ME; Sridhar, S; Cunningham, JT; Vakil, N; Edmundowicz, SA; Valdovinos, MA; Inadomi, JM; Wong, BCY; Koch, TR; Zfass, AM |
| Publisher Information: |
//www.nature.com/ajg/index.html; United States |
| Publication Year: |
2006 |
| Collection: |
University of Hong Kong: HKU Scholars Hub |
| Subject Terms: |
Humans; Pancreatitis - Complications - Diagnosis - Therapy; Severity Of Illness Index |
| Description: |
The diagnosis of acute pancreatitis requires two of the following three features: 1) characteristic abdominal pain, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on CT scan. Risk factors of severity of acute pancreatitis at admission include older age, obesity, and organ failure. Tests at admission that are also helpful in distinguishing mild from severe acute pancreatitis include APACHE-II score ≥8 and serum hematocrit (a value 150 mg/L within the first 72 h strongly correlates with the presence of pancreatic necrosis. The two most important markers of severity in acute pancreatitis are organ failure (particularly multisystem organ failure) and pancreatic necrosis. Contrast-enhanced CT scan is the best available test to distinguish interstitial from necrotizing pancreatitis, particularly after 2-3 days of illness. Mortality of sustained multisystem organ failure in association with necrotizing pancreatitis is generally >36%. Supportive care includes vigorous fluid resuscitation that can be monitored in a variety of ways including a progressive decrease in serum hematocrit at 12 and 24 h. Supplemental oxygen should be administered during the first 24-48 h, bedside oxygen saturation monitored at frequent intervals, and blood gases obtained when clinically indicated, particularly when oxygen saturation is ≤95%. Transfer to an intensive care unit is recommended if there is sustained organ failure or if there are other indications that the pancreatitis is severe including oliguria, persistent tachycardia, and labored respiration. Patients who are unlikely to resume oral nutrition within 5 days because of sustained organ failure or other indications require nutritional support. Nutiritional support can be provided by TPN or by enteral feeding. There ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISBN: |
978-0-00-240915-5; 0-00-240915-1 |
| Relation: |
American Journal of Gastroenterology; http://www.scopus.com/mlt/select.url?eid=2-s2.0-33749170457&selection=ref&src=s&origin=recordpage; 880292; 2400; WOS:000240915100031; 10; 2379; https://hub.hku.hk/handle/10722/163028; 101 |
| DOI: |
10.1111/j.1572-0241.2006.00856.x |
| Availability: |
https://hub.hku.hk/handle/10722/163028; https://doi.org/10.1111/j.1572-0241.2006.00856.x |
| Accession Number: |
edsbas.E4A6AE30 |
| Database: |
BASE |