Optimizing outcomes in acute pancreatitis

Murray Orbuch

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

In maximizing the odds for surviving acute pancreatitis, the clinicianneeds to be cognizant of the shortcomings of existing diagnostic tools andparadigms while appreciating the dynamic nature of the illness. With that in mind, several management points should be considered whenconfronted with a case of suspected pancreatitis. Physical examinationand measurement of serum amylase and lipase are notoriously unreliableand represent a mere snapshot in time. The use of newer serum markers atthe time of suspected diagnosis, such as uTAP, CRP, and procalcitonin,may add to the task of severity stratification, but are not universallyavailable or of fully proven value. Judicious use of imaging, whenindicated, can point quickly to a readily correctable cause of acutepancreatitis, but often has risks and limitations. Various grading schemeshave improved severity assessment, but at best, are reliable only 48 hoursafter diagnosis.Vigilance is essential after the diagnosis of acute pancreatitis is madeand must be accompanied by a readiness to transfer the patient to anintensive care setting when parameters change adversely. The use of theAPACHE II scoring system often meets with resistance because of its "complexity," but in truth, the variables that make up the system are onesthat are measured readily. The availability of therapeutic ERCP hasreduced the dependence on emergency surgery in cases of acute biliarypancreatitis and a better understanding of the natural history of sterilenecrosis, combined with the use of antibiotic prophylaxis, has decreasedthis reliance further. The appreciation that nutrition plays a greater rolethan was understood previously in the survival of this profoundly catabolicstate led to its reintroduction earlier in the course of illness. The safety ofenteral nutrition by way of a jejunal feeding tube (bypassing potentialpancreatic stimulation) seems to be established and carries a lowercomplication rate and cost compared with TPN.

Original languageEnglish
Pages (from-to)607-629
Number of pages23
JournalClinics in Family Practice
Volume6
Issue number3
DOIs
StatePublished - Sep 2004
Externally publishedYes

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