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Akute Pankreatitis

Leitlinienbasierte Diagnostik und Therapie

Acute pancreatitis

Guideline-based diagnosis and treatment

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Zusammenfassung

Eine akute Pankreatitis ist am häufigsten biliärer oder äthyltoxischer Genese, seltener iatrogen (ERCP, Medikamente) oder metabolisch bedingt. Meist kann die Diagnose bei abdominellen Schmerzen und mehr als 3-fach erhöhter Serum-Lipase gestellt werden. Die akute Pankreatitis kann entweder nach einer ödematösen Schwellung schnell ausheilen oder als schwere, nekrotisierende Form verlaufen. Eine große Gefahr ist das SIRS („systemic inflammatory response syndrome“), das zu Multiorganversagen führen kann. Die Abschätzung des Krankheitsverlaufs ist initial schwierig, sodass eine schnelle Therapie und regelmäßige Reevaluationen notwendig sind. Zur Abklärung einer möglichen biliären Genese muss zunächst eine Abdomensonographie durchgeführt werden, ggf. eine Endosonographie. Zur Basistherapie gehört die schnelle und richtig dosierte Flüssigkeitssubstitution. Die biliäre Pankreatitis wird kausal behandelt. Bei Cholangitis muss eine sofortige Steinextraktion erfolgen, ohne Cholangitis kann ein spontaner Steinabgang abgewartet werden, auf jeden Fall muss zeitnah cholezystektomiert werden.

Abstract

Acute pancreatitis is most frequently of biliary or alcoholic origin and less frequently due to iatrogenic (ERCP, medication) or metabolic causes. Diagnosis is usually based on abdominal pain and elevation of serum lipase to more than three-times the normal limit. Acute pancreatitis can either resolve quickly following an oedematous swelling or present as a severe necrotizing form. A major risk is the systemic inflammatory response syndrome (SIRS), which can cause multi-organ failure. Prediction of disease course is initially difficult, thus necessitating immediate therapy and regular re-evaluation. In order to prove or exclude biliary genesis, abdominal ultrasonography should first be performed and endoscopic ultrasound may also be required. Primary therapy includes rapid and correctly dosed fluid substitution. Biliary pancreatitis requires causal treatment. In the case of cholangitis, stone extraction must be performed immediately; in the absence of cholangitis, it might be advisable to wait for spontaneous stone clearance. Timely cholecystectomy is necessary in all cases of biliary pancreatitis.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Tuennemann, J. Mössner und S. Beer geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland

    J. Tuennemann, J. Mössner &  S. Beer

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  1. J. Tuennemann
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  2. J. Mössner
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  3. S. Beer
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Correspondence to S. Beer.

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Tuennemann, J., Mössner, J. & Beer, S. Akute Pankreatitis. Internist 55, 1045–1056 (2014). https://doi.org/10.1007/s00108-014-3580-0

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