Acute pancreatitis: Principles of management. Article four in the series

V. R. Mujica, J. S. Barkin

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The treatment of patients with acute pancreatitis depends primarily on the etiology and severity of the disease. The goals of therapy are to control the inflammatory process and manage any complications that arise. The finding of complications such as respiratory impairment, sepsis, and renal failure importantly influences treatment planning. Intravascular volume repletion and maintenance is vital in acute pancreatitis because it prevents further extension of the inflammatory process. A new treatment modality that involves the use of dextran seems to provide additional benefits in this regard. Patients with acute pancreatitis should be kept fasting until the inflammatory process is deemed to be controlled. Nutritional support with parenteral feeding is indicated for patients with severe pancreatitis and those expected to fast for a prolonged period. Pain, a cardinal symptom in acute pancreatitis, can be treated with parenteral meperidine. Octreotide seems to decrease the exocrine secretory activity of the pancreas. However, its benefit in terms of reduction of mortality has yet to be defined. Prophylaxis with antibiotics may be considered for patients with severe forms of the disease. A new specific cytokine antagonist, lexipafant, has been shown to be effective in decreasing complications in severe acute pancreatitis. Endoscopic treatment of severe gallstone pancreatitis in its early stages decreases the frequency of biliary sepsis. Surgical treatment is indicated in cases of infected necrotizing pancreatitis. This state is usually identified by bolus-enhanced computed tomography (CT) for necrosis and CT-guided aspiration of the necrotic pancreatic tissue for infection. Extensive necrosectomy and profuse lavage of the involved areas should be performed in such situations. The optimal treatment for noninfected necrotizing pancreatitis remains to be defined. Intensive medical treatment should be provided initially, with failure to respond requiring a surgical approach.

Original languageEnglish (US)
Pages (from-to)26-40
Number of pages15
JournalPractical Gastroenterology
Issue number6
StatePublished - Jan 1 1996

ASJC Scopus subject areas

  • Gastroenterology


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