The initial considerations in managing patients with acute pancreatitis are the etiology and the severity of the underlying inflammatory process. Drugs and biliary causes are the primary etiologies among elderly patients. In addition, when the clinical condition of the hospitalized patient worsens, especially in the postoperative period and in the presence of multiple organ system failure, acute pancreatitis should be considered. The mortality associated with acute pancreatitis is greater among older than among younger patients, requiring rapid and aggressive intervention. The use of dynamic computed tomography (CT) with rapid bolus administration of intravenous contrast medium as well as various prognostic scoring systems will identify patients requiring urgent diagnostic and therapeutic procedures, including CT-guided fine-needle aspiration to search for infection, or endoscopic retrograde cholangiopancreatography (ERCP). Necrosectomy with local lavage or open drainage is the appropriate surgical treatment for sterile or infected pancreatic necrosis. Laparoscopic cholecystectomy with intraoperative cholangiography and common bile duct exploration is the treatment of choice in the presence of cholelithiasis, preoperative ERCP being reserved for the more severe cases.
|Original language||English (US)|
|Number of pages||13|
|State||Published - Jan 1 1995|
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