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Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies
Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe with an unpredictable natural course. Majority of cases (80%) are mild and self-limiting. However, severe AP (SAP) has a mortality risk of up to 30%. Establishing aetiology and risk stratification are essential pillars of clin...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Baishideng Publishing Group Inc
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9727576/ https://www.ncbi.nlm.nih.gov/pubmed/36504520 http://dx.doi.org/10.4240/wjgs.v14.i11.1179 |
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author | Chan, Kai Siang Shelat, Vishal G |
author_facet | Chan, Kai Siang Shelat, Vishal G |
author_sort | Chan, Kai Siang |
collection | PubMed |
description | Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe with an unpredictable natural course. Majority of cases (80%) are mild and self-limiting. However, severe AP (SAP) has a mortality risk of up to 30%. Establishing aetiology and risk stratification are essential pillars of clinical care. Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause. Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence. In SAP, patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit. Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP. Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition. If unable to tolerate per-orally, nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit. Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis. Delayed step-up strategy including percutaneous retroperitoneal drainage, endoscopic debridement, or minimal-access necrosectomy are sufficient in most SAP patients. Patients should be monitored for diabetes mellitus and pseudocyst. |
format | Online Article Text |
id | pubmed-9727576 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-97275762022-12-08 Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies Chan, Kai Siang Shelat, Vishal G World J Gastrointest Surg Review Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe with an unpredictable natural course. Majority of cases (80%) are mild and self-limiting. However, severe AP (SAP) has a mortality risk of up to 30%. Establishing aetiology and risk stratification are essential pillars of clinical care. Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause. Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence. In SAP, patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit. Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP. Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition. If unable to tolerate per-orally, nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit. Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis. Delayed step-up strategy including percutaneous retroperitoneal drainage, endoscopic debridement, or minimal-access necrosectomy are sufficient in most SAP patients. Patients should be monitored for diabetes mellitus and pseudocyst. Baishideng Publishing Group Inc 2022-11-27 2022-11-27 /pmc/articles/PMC9727576/ /pubmed/36504520 http://dx.doi.org/10.4240/wjgs.v14.i11.1179 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/ |
spellingShingle | Review Chan, Kai Siang Shelat, Vishal G Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies |
title | Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies |
title_full | Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies |
title_fullStr | Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies |
title_full_unstemmed | Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies |
title_short | Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies |
title_sort | diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9727576/ https://www.ncbi.nlm.nih.gov/pubmed/36504520 http://dx.doi.org/10.4240/wjgs.v14.i11.1179 |
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