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Position paper: timely interventions in severe acute pancreatitis are crucial for survival

Severe acute pancreatitis has high mortality, but multiple and timely interventions can improve survival. Early in the course of the disease aggressive fluid resuscitation is needed for the prevention and treatment of shock. In conjunction with leaking capillaries this results in increased tissue ed...

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Autores principales: Mentula, Panu, Leppäniemi, Ari
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926684/
https://www.ncbi.nlm.nih.gov/pubmed/24512891
http://dx.doi.org/10.1186/1749-7922-9-15
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author Mentula, Panu
Leppäniemi, Ari
author_facet Mentula, Panu
Leppäniemi, Ari
author_sort Mentula, Panu
collection PubMed
description Severe acute pancreatitis has high mortality, but multiple and timely interventions can improve survival. Early in the course of the disease aggressive fluid resuscitation is needed for the prevention and treatment of shock. In conjunction with leaking capillaries this results in increased tissue edema, which may lead to intra-abdominal hypertension and abdominal compartment syndrome. Invasive hemodynamic monitoring is essential for optimizing fluid therapy while monitoring of intra-abdominal pressure is necessary for identification patients at risk of developing abdominal compartment syndrome. Abdominal compartment syndrome develops usually within the first days after hospitalization. Conservative treatment modalities are useful in prevention but also in the treatment of abdominal compartment syndrome. If conservative management fails surgical decompression of abdomen may be needed. Multiple organ dysfunction syndrome and increased intra-abdominal pressure predispose patients with severe pancreatitis to secondary infections. Extrapancreatic infections predominate during the first week of the disease, whereas infection of pancreatic necrosis usually develops later. Early enteral nutrition reduces the risk of infections whereas advantage of prophylactic antibiotics is lacking evidence. Surgery for infected pancreatic necrosis is associated with high mortality when performed within the first two weeks of the disease. Therefore surgery should be postponed as late as possible, preferably later than four weeks after disease onset.
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spelling pubmed-39266842014-02-18 Position paper: timely interventions in severe acute pancreatitis are crucial for survival Mentula, Panu Leppäniemi, Ari World J Emerg Surg Review Severe acute pancreatitis has high mortality, but multiple and timely interventions can improve survival. Early in the course of the disease aggressive fluid resuscitation is needed for the prevention and treatment of shock. In conjunction with leaking capillaries this results in increased tissue edema, which may lead to intra-abdominal hypertension and abdominal compartment syndrome. Invasive hemodynamic monitoring is essential for optimizing fluid therapy while monitoring of intra-abdominal pressure is necessary for identification patients at risk of developing abdominal compartment syndrome. Abdominal compartment syndrome develops usually within the first days after hospitalization. Conservative treatment modalities are useful in prevention but also in the treatment of abdominal compartment syndrome. If conservative management fails surgical decompression of abdomen may be needed. Multiple organ dysfunction syndrome and increased intra-abdominal pressure predispose patients with severe pancreatitis to secondary infections. Extrapancreatic infections predominate during the first week of the disease, whereas infection of pancreatic necrosis usually develops later. Early enteral nutrition reduces the risk of infections whereas advantage of prophylactic antibiotics is lacking evidence. Surgery for infected pancreatic necrosis is associated with high mortality when performed within the first two weeks of the disease. Therefore surgery should be postponed as late as possible, preferably later than four weeks after disease onset. BioMed Central 2014-02-10 /pmc/articles/PMC3926684/ /pubmed/24512891 http://dx.doi.org/10.1186/1749-7922-9-15 Text en Copyright © 2014 Mentula and Leppäniemi; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Mentula, Panu
Leppäniemi, Ari
Position paper: timely interventions in severe acute pancreatitis are crucial for survival
title Position paper: timely interventions in severe acute pancreatitis are crucial for survival
title_full Position paper: timely interventions in severe acute pancreatitis are crucial for survival
title_fullStr Position paper: timely interventions in severe acute pancreatitis are crucial for survival
title_full_unstemmed Position paper: timely interventions in severe acute pancreatitis are crucial for survival
title_short Position paper: timely interventions in severe acute pancreatitis are crucial for survival
title_sort position paper: timely interventions in severe acute pancreatitis are crucial for survival
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926684/
https://www.ncbi.nlm.nih.gov/pubmed/24512891
http://dx.doi.org/10.1186/1749-7922-9-15
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