Der Internist

, Volume 52, Issue 7, pp 823–832 | Cite as

Diagnostik und Therapie der akuten Pankreatitis

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Zusammenfassung

Die akute Pankreatitis ist potenziell lebensbedrohlich. Durch den z. T. fulminanten Verlauf ist das Zeitfenster für Diagnostik und Therapie kurz. Unter Berücksichtigung aktueller Leitlinien und mit Hilfe einer elektronischen Literatursuche wurden 12 Schlüsselfragen der Diagnostik und Therapie der akuten Pankreatitis zu beantworten versucht: Die Diagnose kann allein durch Anamnese, Klinik und Serumlipasebestimmung gestellt werden. Zum Nachweis einer biliären Genese sind Cholestaseparameter und Oberbauchsonographie ausreichend. Für die frühe Prognose eines schweren Verlaufs sind die Erhöhung von Blutzucker, Hämatokrit (Hkt) und Harnstoff (BUN, „blood urea nitrogen“) wegweisend. Die Bedeutung von erhöhtem Hkt und BUN legt eine frühe zielgerichtete Volumensubstitution nahe. Zur Schmerztherapie sind meist Opiate erforderlich. Metaanalysen belegen therapeutische Effekte der ERC (endoskopische retrograde Cholangiographie) bei biliärer Pankreatitis, der Antibiose bei nekrotisierender Pankreatitis und der frühzeitigen enteralen Ernährung. Auch beim Nachweis von Nekrosen ist ein konservatives Vorgehen gerechtfertigt. Bleibt dieses erfolglos, kann die chirurgische Therapie sinnvoll sein.

Schlüsselwörter

Pankreatitis Prognose ERCP Antibiose Hämodynamisches Monitoring 

Diagnosis and treatment of acute pancreatitis

Current recommendations

Abstract

Acute pancreatitis is a potentially life-threatening illness, with a short time frame for diagnosis and treatment. A number of recent experimental and clinical multicentre trials as well as meta-analyses have provided more far-reaching recommendations compared to previous guidelines. To answer 12 key questions, we performed a review of recent literature and current guidelines. Diagnosis can be made on the basis of history, physical examination and serum lipase alone. Cholestatic parameters and upper abdominal ultrasound enable verification of biliary etiology. Poor prognostic indicators include elevated blood sugar, BUN and hematocrit. The latter suggests early, adequate volume replacement, which should be tailored to the clinical picture, echocardiography and/or modern hemodynamic parameters. In addition to opiate analgesia, meta-analyses support the use of endoscopic retrograde cholangiography in pancreatitis of biliary origin, antibiotics in necrotizing pancreatitis and early enteral feeding. Even where necrosis is present, conservative management (radiologically or endoscopically placed drains) is appropriate.

Keywords

Pancreatitis Prognosis ERCP Antibiosis Hemodynamic monitoring 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Intensivstation 2/11, II. Medizinische KlinikKlinikum Rechts der IsarMünchenDeutschland

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