Acute pancreatitis.

Link to article at PubMed

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Acute pancreatitis.

Curr Opin Crit Care. 2014 Feb 16;

Authors: De Waele JJ

PURPOSE OF REVIEW: To review the changing insights in the pathophysiology and management of acute pancreatitis.
RECENT FINDINGS: The outdated 1992 Atlanta classification has been replaced by two new classifications, both of which acknowledge the role of organ dysfunction in determining the outcome of acute pancreatitis, and both of which have introduced a new category of 'moderate' pancreatitis. The new classifications will allow fewer patients to be classified as severe, which better reflects the risk of dying of the disease. Intra-abdominal hypertension has emerged as a relevant issue, and strategies to lower intra-abdominal pressure may often be required. Antibiotic prophylaxis has been discontinued for some time, but aggressive fluid resuscitation is also being questioned, and the role of surgery is further reduced as percutaneous drainage of collections has shown to reduce the need for more surgical interventions. If needed, surgery should be as conservative as possible, with minimally invasive strategies preferable. Newer techniques such as endoscopic transgastric drainage are being developed, but their exact role has yet to be defined.
SUMMARY: Management of severe acute pancreatitis is changing fundamentally. 'Less is more' is the new paradigm in acute pancreatitis - less antibiotics, less fluids, less surgery, which should eventually lead to less morbidity and mortality.

PMID: 24553339 [PubMed - as supplied by publisher]


  1. “At this point, adopting a more restrictive early
    fluid resuscitation strategy seems prudent, but
    an appropriate resuscitation endpoint cannot be
    Finally a review that recognizes the lack of evidence behind the dogma of aggresive hydration in acute pancreatitis. This concept was based on Dr Tenner’s theory that adding 6 liters (from the Ranson criteria of 6 liters fluid sequestration) to maintainance fluid in the first 48 hours would prevent bad outcomes. This has made it into guidelines without any evidence to support it. It makes as much sense to replete Calcium prophylactically to avoid another Ranson criteria.
    Seek the evidence for guideline recommendations!

  2. Lots of non-evidence based practice regarding fluid replacement in acute pancreatitis. There are surrogate markers (CVP, fluid responsiveness, etc) that are now non-invasive and could guide therapy. Ripe for study.

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