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Akute Pankreatitis: Pathophysiologie, Ätiologie und Management

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DGIM Innere Medizin

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Die akute Pankreatitis ist die häufigste Erkrankung der exokrinen Bauchspeicheldrüse und der häufigste Grund für eine stationäre Krankenhausaufnahme unter allen nicht malignen Erkrankungen des Gastrointestinaltraktes. Die akute Pankreatitis ist gekennzeichnet durch eine primär sterile Entzündung des Pankreas unterschiedlichster Ursache in deren Folge ein teils irreversibler Funktionsverlust fortbestehen kann. Aufgrund der heterogenen Ätiologie und des teils schweren, gelegentlich tödlichen Verlaufes stellt das klinische Management der akuten Pankreatitis noch heute eine Herausforderung dar.

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Literatur

  • Banks PA, Bollen TL, Dervenis C et al (2013) Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–111

    Article  PubMed  Google Scholar 

  • Besselink MG, van Santvoort HC, Buskens E et al (2008) Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet 371(9613):651–659

    Article  PubMed  Google Scholar 

  • Brown A, Orav J, Banks PA et al (2000) Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas 20:367–372

    Article  CAS  PubMed  Google Scholar 

  • Buchler M, Malfertheiner P, Schoetensack C et al (1986) Value of biochemical and imaging procedures for the diagnosis and prognosis of acute pancreatitis – results of a prospective clinical study. Z Gastroenterol 24:100–110

    CAS  PubMed  Google Scholar 

  • Buter A, Imrie CW, Carter CR et al (2002) Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg 89:298–302

    Article  CAS  PubMed  Google Scholar 

  • Dellinger EP, Tellado JM, Soto NE et al (2007) Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind, placebo-controlled study. Ann Surg 245:674–683

    Article  PubMed Central  PubMed  Google Scholar 

  • Fan ST, Lai EC, Mok FP et al (1993) Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med 328:228–232

    Article  CAS  PubMed  Google Scholar 

  • Farkas G, Marton J, Mandi Y et al (1998) Progress in the management and treatment of infected pancreatic necrosis. Scand J Gastroenterol Suppl 228:31–37

    Article  CAS  PubMed  Google Scholar 

  • Fölsch UR, Nitsche R, Ludtke R et al (1997) Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. The German Study Group on Acute Biliary Pancreatitis. N Engl J Med 336:237–242

    Article  PubMed  Google Scholar 

  • Gardner TB, Vege SS, Chari ST et al (2009) Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology 9:770–776

    Article  PubMed  Google Scholar 

  • Gress TM, Müller-Pillasch F, Lerch MM et al (1994) Balance of expression of genes coding for extracellular matrix proteins and extracellular matrix degrading proteases in chronic pancreatitis. Z Gastroenterol 32(4):221–225

    CAS  PubMed  Google Scholar 

  • Hernández CA, Lerch MM (1993) Sphincter stenosis and gallstone migration through the biliary tract. Lancet 341(8857):1371–1373

    Article  PubMed  Google Scholar 

  • Hirota M, Takada T, Kitamura N et al (2010) Fundamental and intensive care of acute pancreatitis. J Hepatobiliary Pancreat Sci 17:45–52

    Article  PubMed  Google Scholar 

  • Imrie CW, Carter CR, McKay CJ et al (2002) Enteral and parenteral nutrition in acute pancreatitis. Best Pract Res Clin Gastroenterol 16:391–397

    Article  PubMed  Google Scholar 

  • Johnson CD, Abu-Hilal M (2004) Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut 53:1340–1344

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Keim V, Bauer N, Teich N et al (2001) Clinical characterization of patients with hereditary pancreatitis and mutations in the cationic trypsinogen gene. Am J Med 111(8):622–626

    Article  CAS  PubMed  Google Scholar 

  • Krüger B, Lerch MM, Tessenow W (1998) Direct detection of premature protease activation in living pancreatic acinar cells. Lab Invest 78(6):763–764

    PubMed  Google Scholar 

  • Lankisch PG, Lowenfels AB, Maisonneuve P (2002) What is the risk of alcoholic pancreatitis in heavy drinkers? Pancreas 25:411–412

    Article  PubMed  Google Scholar 

  • Levy P, Heresbach D, Pariente EA et al (1997) Frequency and risk factors of recurrent pain during refeeding in patients with acute pancreatitis: a multivariate multicentre prospective study of 116 patients. Gut 40:262–266

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Maléth J, Balla Z, Kui B et al (2014) Alcohol disrupts levels and function of the cystic fibrosis transmembrane conductance regulator to promote development of pancreatitis. Gastroenterology. doi:10.1053/j.gastro.2014.11.002

    PubMed  Google Scholar 

  • Mao EQ, Tang YQ, Fei J et al (2009) Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl) 122:169–173

    Google Scholar 

  • Mayerle J, Schnekenburger J, Krüger B et al (2005) Extracellular cleavage of E-cadherin by leukocyte elastase during acute experimental pancreatitis in rats. Gastroenterology 129(4):1251–1267

    Article  CAS  PubMed  Google Scholar 

  • Mier J, Leon EL, Castillo A et al (1997) Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg 173:71–75

    Article  CAS  PubMed  Google Scholar 

  • Mofidi R, Duff MD, Wigmore SJ et al (2006) Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 93:738–744

    Article  CAS  PubMed  Google Scholar 

  • Muckart DJ, Bhagwanjee S (1997) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 25:1789–1795

    Article  CAS  PubMed  Google Scholar 

  • Nealon WH, Bawduniak J, Walser EM et al (2004) Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstone-associated acute pancreatitis with peripancreatic fluid collections. Ann Surg 239:741–749

    Article  PubMed Central  PubMed  Google Scholar 

  • Niesel HC, Klimpel L, Kaiser H et al (1991) Epidural blockade for analgesia and treatment of acute pancreatitis. Reg Anaesth 14:97–100

    CAS  PubMed  Google Scholar 

  • Nieuwenhuijs VB, Besselink MG, van Minnen LP et al (2003) Surgical management of acute necrotizing pancreatitis: a 13-year experience and a systematic review. Scand J Gastroenterol 38(Suppl):111–116

    Article  Google Scholar 

  • Nojgaard C, Becker U, Matzen P et al (2011) Progression from acute to chronic pancreatitis: prognostic factors, mortality, and natural course. Pancreas 40:1195–1200

    Article  PubMed  Google Scholar 

  • Peery AF, Dellon ES, Lund J et al (2012) Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143(5):1179–1187

    Article  PubMed Central  PubMed  Google Scholar 

  • Rau BM, Kemppainen EA, Gumbs AA et al (2007) Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicenter study. Ann Surg 245(5):745–754

    Article  PubMed Central  PubMed  Google Scholar 

  • Seifert H, Biermer M, Schmitt W et al (2009) Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 58(9):1260–1266

    Article  CAS  PubMed  Google Scholar 

  • Singh VK, Wu BU, Bollen TL et al (2009) Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol 7:1247–1251

    Article  PubMed  Google Scholar 

  • Singh VK, Bollen TL, Wu BU et al (2011) An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol 9:1098–1103

    Article  PubMed  Google Scholar 

  • Teich N, Aghdassi A, Fischer J et al (2010) Optimal timing of oral refeeding in mild acute pancreatitis: results of an open randomized multicenter trial. Pancreas 39:1088–1092

    Article  PubMed  Google Scholar 

  • Thompson DR (2001) Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis. Am J Gastroenterol 96:1266–1272

    Article  CAS  PubMed  Google Scholar 

  • van Santvoort HC, Besselink MG, Bakker OJ et al (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362:1491–1502

    Article  PubMed  Google Scholar 

  • Vazquez-Iglesias JL, Gonzalez-Conde B, Lopez-Roses L et al (2004) Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients. Surg Endosc 18:1442–1446

    Google Scholar 

  • Vege SS, Gardner TB, Chari ST et al (2009) Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include „moderately severe acute pancreatitis“. Am J Gastroenterol 104:710–715

    Article  PubMed  Google Scholar 

  • Whitcomb DC, Muddana V, Langmead CJ et al (2010) Angiopoietin-2, a regulator of vascular permeability in inflammation, is associated with persistent organ failure in patients with acute pancreatitis from the United States and Germany. Am J Gastroenterol 105(10):2287–2292

    Article  CAS  PubMed  Google Scholar 

  • Working Group IAP/APA Acute Pancreatitis Guidelines (2013) IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 13(4 Suppl 2):e1–e15

    Google Scholar 

  • Wu BU, Johannes RS, Sun X et al (2009) Early changes in blood urea nitrogen predict mortality in acute pancreatitis. Gastroenterology 137:129–135

    Article  CAS  PubMed  Google Scholar 

  • Wu BU, Hwang JQ, Gardner TH et al (2011) Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol 9:710–717

    Article  PubMed  Google Scholar 

  • Yang AL, Vadhavkar S, Singh G et al (2008) Epidemiology of alcohol-related liver and pancreatic disease in the United States. Arch Intern Med 168:649–656

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Körperschaft des öffentlichen Rechts Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Deutschland

    Felix Lämmerhirt, Julia Mayerle, Markus M. Lerch & Peter Simon

  2. Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald, Fleischmannstr. 41, 17475, Greifswald, Deutschland

    F. Ulrich Weiss

Authors
  1. Felix Lämmerhirt
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  2. F. Ulrich Weiss
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  3. Julia Mayerle
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  4. Markus M. Lerch
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  5. Peter Simon
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Corresponding author

Correspondence to Felix Lämmerhirt .

Editor information

Editors and Affiliations

  1. Medizinische Klinik I, Universitätsklinikum Schleswig-Hoslstein, Campus Lübeck, Lübeck, Schleswig-Holstein, Germany

    Hendrik Lehnert

  2. TU Dresden Universitätsklinikum Carl Gustav Carus, Dresden, Germany

    Sebastian M. Schellong

  3. FB Gastroenterologie und Hepatologie, Universitätsklinikum Leipzig Medizinische Klinik und Poliklinik II, Leipzig, Sachsen, Germany

    Joachim Mössner

  4. Krankenhaus Barmherzige Brüder, Regensburg, Germany

    Cornel C. Sieber

  5. Nürnberg, Bayern, Germany

    Walter Swoboda

  6. Universitätsklinikum Giessen und Marburg Klinik für Innere Medizin, Marburg, Hessen, Germany

    Andreas Neubauer

  7. Interdisziplinärer Schwerpunkt für Hämos, Universitätsklinikum Gießen und Marburg, Gießen, Germany

    Bettina Kemkes-Matthes

  8. Klinik für Gastroenterologie,Hepatologie, Medizinische Hochschule Hannover, Hannover, Germany

    Michael P. Manns

  9. Sektion für Molekulare und Klinische Inf, Universitätsklinikum Schleswig-Holstein,, Lübeck, Germany

    Jan Rupp

  10. Abt. Kardiologie und Pneumologie, Universitätsklinikum Göttingen Herzzentrum Göttingen, Göttingen, Germany

    Gerd Hasenfuß

  11. Abt. Nephrologie und Klinische Immunologie, Univ.Klinikum Aachen Medizinische Klinik II, Aachen, Germany

    J. Floege

  12. Universitätsklinikum Köln Klinik I für Innere Medizin, Köln, Germany

    Michael Hallek

  13. Klinik für Pneumologie, Medizinische Hochschule Hannover (MHH) Zentrum Innere Medizin, Hannover, Germany

    Tobias Welte

  14. Klinik u. Poliklinik für Innere Medizin, Universitätsmedizin Greifswald, Greifswald, Germany

    Markus Lerch

  15. Dr.-Horst-Schmidt-Kliniken GmbH, Wiesbaden, Germany

    Elisabeth Märker-Hermann

  16. Klinische Toxikologie, Giftinformation, Universitätsklinikum Mainz II. Medizinische Klinik und Poliklinik, Mainz, Germany

    Ludwig Sacha Weilemann

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Lämmerhirt, F., Weiss, F.U., Mayerle, J., Lerch, M.M., Simon, P. (2015). Akute Pankreatitis: Pathophysiologie, Ätiologie und Management. In: Lehnert, H., et al. DGIM Innere Medizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54676-1_103-1

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  • DOI: https://doi.org/10.1007/978-3-642-54676-1_103-1

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Online ISBN: 978-3-642-54676-1

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