Der Gastroenterologe

, Volume 7, Issue 2, pp 121–126

Akute Pankreatitis

Schwerpunkt
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Zusammenfassung

Die akute Pankreatitis verläuft bei etwa 20% der Patienten schwer, d. h., es treten Komplikationen auf (Organversagen, Sepsis). Initial ist die Beurteilung des Schweregrads ein Problem, da sich mit keinem Verfahren der schwere Verlauf sicher vorhersagen lässt. Bei Normalwerten von Harnstoff, Hämatokrit oder Blutglukose ist ein milder Verlauf wahrscheinlich.

Die Behandlung des Patienten erfolgt auf einer interdisziplinären Intensivstation. Die enterale Ernährung ist bei schwerem Verlauf Standard. Ein Stellenwert der Antibiotikaprophylaxe bei nekrotisierendem Verlauf ist fraglich. Eine ausreichende Analgesie, (auch mit zentral wirksamen Substanzen) ist obligat. Die Therapie der infizierten Nekrose erfolgt erst dann, wenn sich die Nekrose demarkiert hat (z. B. nach 3 Wochen). Ein primär interventionelles Verfahren ist dem chirurgischen Zugang überlegen. Trotz der Fortschritte in Diagnostik und Therapie liegt die Letalität bei diesem Krankheitsbild bei 15%.

Schlagwörter

Pankreatitis Lipase Nekrose Antibiotika Interventionelle Therapie 

Acute pancreatitis

Abstract

Severe pancreatitis is characterized by organ failure or sepsis and is present in approximately 20% of patients. The severity of the disease is difficult to judge at onset. Mild disease is present in patients with normal urea, hematocrit and blood glucose.

Patients should be treated in an intensive care unit. Enteral nutrition is now obligatory. The role of prophylactic antibiotics in necrotizing pancreatitis is unclear. High dose analgesics may be used, including opioids. The treatment of infected necrosis should be performed not earlier than 3 weeks when the necrosis has become demarcated. The primary interventional procedure is superior to a surgical approach. Nevertheless, this disease has a mortality of approximately 15%.

Keywords

Pancreatitis Lipase Necrosis Antibiotics Interventional therapy 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Medizinische Klinik und Poliklinik für Gastroenterologie und RheumatologieUniversitätsklinikum LeipzigLeipzigDeutschland

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