Gastrointestinale Notfälle – Akute Pankreatitis

Übersichten

Zusammenfassung

Die akute Pankreatitis ist ein häufiges und klinisch eindrucksvolles Krankheitsbild. Eine spezifische Therapie existiert nicht. Ziel der ärztlichen Maßnahmen ist die Linderung der Symptome und die Verhinderung von Komplikationen. In den letzten Jahren gab es einen erheblichen Zugewinn an Wissen über die korrekte Behandlung der Erkrankung. Neben einer Spezifizierung der Empfehlungen zur Flüssigkeitstherapie betrifft das vor allem die Ernährungstherapie, die Ökonomisierung der Bildgebung, den Einsatz von Antibiotika bei Komplikationen und vor allem Maßnahmen zur Entlastung von großen oder infizierten Nekrosen. Der derzeitige Stand der Erkenntnisse wird im Beitrag zusammengefasst.

Schlüsselwörter

Nekrose Nekrosektomie Endoskopische Papillotomie Systemische inflammatorische Reaktion Mikrozirkulation 

Gastrointestinal emergencies — acute pancreatitis

Abstract

The acute pancreatitis is a frequent event with an impressive clinical presentation. Specific treatment does not exist. The goals of the medical measures are to ameliorate complaints and to prevent complications. During recent years, insights into adequate treatment have significantly increased. Recommendations on volume therapy have now been specified. Moreover, progress has been made in the efficient employment of nutritional support, imaging and antibiotic treatment. In addition, the treatment of large or infected necrosis has significantly improved. The article reviews the current state-of-the-art care of acute pancreatitis.

Keywords

Necrosis Necrosectomy Endoscopic papillotomy  Systemic inflammatory response syndrome Microcirculation 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Bakker OJ, Santvoort HC van, Brunschot S van et al (2012) Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 307:1053–1061PubMedCrossRefGoogle Scholar
  2. 2.
    Bernhardt A, Kortgen A, Niesel HC, Goertz A (2002) Anwendung der Epiduralanästhesie bei Patienten mit akuter Pankreatitis – Prospektive Untersuchung an 121 Patienten. Anaesthesiol Reanim 27:16–22PubMedGoogle Scholar
  3. 3.
    Besselink MG, Santvoort HC van, Boermeester MA et al (2009) Timing and impact of infections in acute pancreatitis. Br J Surg 96:267–273PubMedCrossRefGoogle Scholar
  4. 4.
    Bollen TL, Singh VK, Maurer R et al (2012) A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am J Gastroenterol 107:612–619PubMedCrossRefGoogle Scholar
  5. 5.
    Bradley EL III (1993) A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 128:586–590PubMedCrossRefGoogle Scholar
  6. 6.
    Brown A, Baillargeon JD, Hughes MD, Banks PA (2002) Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis? Pancreatology 2:104–107PubMedCrossRefGoogle Scholar
  7. 7.
    Buchler M, Malfertheiner P, Friess H et al (1992) Human pancreatic tissue concentration of bactericidal antibiotics. Gastroenterology 103:1902–1908PubMedGoogle Scholar
  8. 8.
    De Lisi S, Leandro G, Buscarini E (2011) Endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis: a systematic review. Eur J Gastroenterol Hepatol 23:367–374CrossRefGoogle Scholar
  9. 9.
    Madaria E de, Soler-Sala G, Sanchez-Paya J et al (2011) Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol 106:1843–1850CrossRefGoogle Scholar
  10. 10.
    Demirag A, Pastor CM, Morel P et al (2006) Epidural anaesthesia restores pancreatic microcirculation and decreases the severity of acute pancreatitis. World J Gastroenterol 12:915–920PubMedGoogle Scholar
  11. 11.
    Eatock FC, Chong P, Menezes N et al (2005) A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol 100:432–439PubMedCrossRefGoogle Scholar
  12. 12.
    Eckerwall GE, Tingstedt BB, Bergenzaun PE, Andersson RG (2007) Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery: a randomized clinical study. Clin Nutr 26:758–763PubMedCrossRefGoogle Scholar
  13. 13.
    Fölsch UR, Nitsche R, Lüdtke 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 336:237–242PubMedCrossRefGoogle Scholar
  14. 14.
    Haghshenasskashani A, Laurence JM, Kwan V et al (2011) Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc 25:3724–3730PubMedCrossRefGoogle Scholar
  15. 15.
    Isenmann R, Rau B, Beger HG (2001) Early severe acute pancreatitis: characteristics of a new subgroup. Pancreas 22:274–278PubMedCrossRefGoogle Scholar
  16. 16.
    Khaliq A, Dutta U, Kochhar R, Singh K (2010) Management of acute pancreatitis: „PANCREAS“ contains eight easy steps to remember the treatment. JOP 11:492–493PubMedGoogle Scholar
  17. 17.
    Kuwabara K, Matsuda S, Fushimi K et al (2011) Early crystalloid fluid volume management in acute pancreatitis: association with mortality and organ failure. Pancreatology 11:351–361PubMedCrossRefGoogle Scholar
  18. 18.
    Lankisch PG (2010) Treatment of acute pancreatitis: an attempted historical review. Pancreatology 10:134–141PubMedCrossRefGoogle Scholar
  19. 19.
    Lankisch PG, Weber-Dany B, Hebel K et al (2009) The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease. Clin Gastroenterol Hepatol 7:702–705PubMedCrossRefGoogle Scholar
  20. 20.
    Löwenfels AB, Maisonneuve P, Sullivan T (2009) The changing character of acute pancreatitis: epidemiology, etiology, and prognosis. Curr Gastroenterol Rep 11:97–103PubMedCrossRefGoogle Scholar
  21. 21.
    Mao EQ, Fei J, Peng YB et al (2010) Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. Chin Med J 123:1639–1644PubMedGoogle Scholar
  22. 22.
    Mao EQ, Tang YQ, Fei J et al (2009) Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J 122:169–173PubMedGoogle Scholar
  23. 23.
    Mole DJ, Hall A, McKeown D et al (2011) Detailed fluid resuscitation profiles in patients with severe acute pancreatitis. HPB (Oxford) 13:51–58Google Scholar
  24. 24.
    Mirtallo JM, Forbes A, McClave SA et al (2012) International consensus guidelines for nutrition therapy in pancreatitis. JPEN J Parenter Enteral Nutr 36:284–291PubMedCrossRefGoogle Scholar
  25. 25.
    Oria A, Cimmino D, Ocampo C et al (2007) Early endoscopic intervention versus early conservative management in patients with acute gallstone pancreatitis and biliopancreatic obstruction: a randomized clinical trial. Ann Surg 245:10–17PubMedCrossRefGoogle Scholar
  26. 26.
    Petrov MS (2009) Early use of ERCP in acute biliary pancreatitis with(out) jaundice: an unjaundiced view. JOP 10:1–7PubMedGoogle Scholar
  27. 27.
    Petrov MS, Loveday BP, Pylypchuk RD et al (2009) Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis. Br J Surg 96:1243–1252PubMedCrossRefGoogle Scholar
  28. 28.
    Petrov MS, Pylypchuk RD, Uchugina AF (2009) A systematic review on the timing of artificial nutrition in acute pancreatitis. Br J Nutr 101:787–793PubMedCrossRefGoogle Scholar
  29. 29.
    Rickes S, Uhle C, Kahl S et al (2006) Echo enhanced ultrasound: a new valid initial imaging approach for severe acute pancreatitis. Gut 55:74–78PubMedCrossRefGoogle Scholar
  30. 30.
    Schmid SW, Uhl W, Friess H et al (1999) The role of infection in acute pancreatitis. Gut 45:311–316PubMedCrossRefGoogle Scholar
  31. 31.
    Solanki NS, Barreto SG (2011) Fluid therapy in acute pancreatitis. A systematic review of literature. JOP 12:205–208PubMedGoogle Scholar
  32. 32.
    Spanier BW, Bruno MJ, Mathus-Vliegen EM (2011) Enteral nutrition and acute pancreatitis: a review. Gastroenterol Res Pract 2011:1–9CrossRefGoogle Scholar
  33. 33.
    Spanier BW, Nio Y, Hulst RW van der et al (2010) Practice and yield of early CT scan in acute pancreatitis: a Dutch Observational Multicenter Study. Pancreatology 10:222–228PubMedCrossRefGoogle Scholar
  34. 34.
    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 96:1266–1272PubMedCrossRefGoogle Scholar
  35. 35.
    Santvoort HC van, Bakker OJ, Bollen TL et al (2011) A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 141:1254–1263PubMedCrossRefGoogle Scholar
  36. 36.
    Santvoort HC van, Besselink MG, Bakker OJ et al (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362:1491–1502PubMedCrossRefGoogle Scholar
  37. 37.
    Villatoro E, Mulla M, Larvin M (2010) Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev:CD002941Google Scholar
  38. 38.
    Warndorf MG, Kurtzman JT, Bartel MJ et al (2011) Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol 9:705–709PubMedCrossRefGoogle Scholar
  39. 39.
    Wijffels NA, Walraven LA van, Ophof PJ et al (2007) Late development of pancreas necrosis during acute pancreatitis: an underestimated phenomenon associated with high morbidity and mortality. Pancreas 34:215–219PubMedCrossRefGoogle Scholar
  40. 40.
    Windsor AC, Kanwar S, Li AG et al (1998) Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 42:431–435PubMedCrossRefGoogle Scholar
  41. 41.
    Wittau M, Mayer B, Scheele J et al (2011) Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis. Scand J Gastroenterol 46:261–270PubMedCrossRefGoogle Scholar
  42. 42.
    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 9:710–717PubMedCrossRefGoogle Scholar
  43. 43.
    Wu BU, Johannes RS, Sun X et al (2008) The early prediction of mortality in acute pancreatitis: a large population-based study. Gut 57:1698–1703PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Medizinische Klinik IUniversitätsklinikum Schleswig-Holstein Campus LübeckLübeckDeutschland

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