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Intensive medical treatment of severe acute pancreatitis

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Abstract

Therapeutic measurements for acute pancreatitis depend on the severity of the disease and its complications. Since complications of acute pancreatitis may develop at any time, patients should be admitted to an intensive care unit for assessment (and frequent reassessment) of the severity of the disease and of the development of complications; they should remain in the intensive care unit for the first 48 hours at least, even if no signs of shock are apparent. The only exceptions to this rule are mild cases without signs of peritonitis. Basic therapy should include relief of pain, total fasting, nasogastric suction, parenteral replacement of fluids, electrolyte, albumin, and blood, and antibiotics. Hyperglycemia should be corrected and heparin should be given in cases of disseminated intravascular coagulation. In renal insufficiency, peritoneal dialysis is important, and in respiratory complications, humidified oxygen or artificial ventilation including positive end expiratory pressure therapy should be applied. Although the effect of peritoneal dialysis has been proven only in animal experiments and in retrospective studies in man, it is recommended in severe cases for shock therapy and for correction of electrolyte imbalance when ascites is present, even before anuria occurs.

Résumé

Les principes de traitement de la pancréatite aigüe dépendent de la gravité de la maladie et de ses complications. Comme cellesci peuvent apparaître n'importe quand, le malade doit être placé dans une unité de soins intensifs pour surveillance constante et appréciation continue de la gravité de son état. Il doit rester dans cette unité pendant les 48 premières heures au moins, même s'il n'a aucun signe de choc. La seule exception à cette règle peut être la pancréatite bénigne sans signe de péritonite. Le traitement de base doit comporter des antalgiques, un jeûne absolu, l'aspiration gastrique, des antibiotiques, le remplacement par voie parentérale de l'eau, des électrolytes, de l'albumine et du sang. Toute hyperglycémie doit être corrigée. Il faut administrer de l'héparine s'il y a coagulation intravasculaire disséminée. La dialyse péritonéale est importante en cas d'insuffisance rénale. Toute complication pulmonaire exige de l'oxygène humidifié ou un respirateur avec PEEP. L'effet bénéfique de la dialyse péritonéale n'a été démontré que chez l'animal et dans des études rétrospectives chez l'homme; il faut cependant la recommander en cas de choc grave et pour corriger les désordres électrolytiques s'il y a de l'ascite, même avant que ne survienne l'anurie.

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References

  1. Sarles, H.: Proposal adopted unanimously by the participants of the symposium on pancreatitis at Marseille, 1963. Bibl. Gastroenterol. (Basel)7:7, 1965

    Google Scholar 

  2. Schmidt, H., Creutzfeldt, W.: Akute rezidivierende Pankreatitis (einschliesslich der sogenannten Begleit-pankreatitis). In Klinische Gastroenterologie, Demling, L., editor, Stuttgart, Thieme Verlag, 1973, vol. 2, pp. 929–957

    Google Scholar 

  3. Adams, J.T., Libertino, J.A., Schwartz, S.I.: Significance of an elevated serum amylase. Surgery63:877, 1968

    Google Scholar 

  4. Warshaw, A.L., Fuller, A.F.: Specificity of increased renal clearance of amylase in diagnosis of acute pancreatitis. N. Engl. J. Med.292:325, 1975

    Google Scholar 

  5. Lankisch, P.G., Koop, H., Otto, J., Oberdieck, U., Winckler, K., Wolfrum, D.I.: Specificity of increased amylase to creatinine clearance ratio in acute pancreatitis. Digestion16:160, 1977

    Google Scholar 

  6. Perez Oteyza, C., Rebollar, J.L., Chantres, M.T., Estella, J.: Alteraciones electrocardiográficas en la pancreatitis aguda. Rev. Clin. Esp.152:287, 1979

    Google Scholar 

  7. Frey, C.F., Lindenauer, S.M., Miller, T.A.: Pancreatic abscess. Surg. Gynecol. Obstet.149:722, 1979

    Google Scholar 

  8. Amundsen, E., Ofstad, E., Hagen, P.O.: Experimental acute pancreatitis in dogs. I. Hypotensive effect induced by pancreatic exudate. Scand. J. Gastroenterol.3:659, 1968

    Google Scholar 

  9. Lankisch, P.G., Koop, H., Winckler, K., Schmidt, H.: Continuous peritoneal dialysis as treatment of acute experimental pancreatitis in the rat. II. Analysis of its beneficial effect. Sci. Dig. Dis.24:117, 1979

    Google Scholar 

  10. Imrie, C.W., Ferguson, J.C., Murphy, D., Blumgart, L.H.: Arterial hypoxia in acute pancreatitis. Br. J. Surg.64:185, 1977

    Google Scholar 

  11. Lankisch, P.G., Koop, H., Rahlf, G.: Pulmonary complications in acute haemorrhagic pancreatitis, abstracted. Gut20:A443, 1979

    Google Scholar 

  12. Schuster, H.P., Neher, M., Schönborn, H., Kümmerle, F.: Akutes Nierenund Lungenversagen bei diffuser Peritonitis und hämorrhagisch-nekrotisierender Pankreatitis. Dtsch. Med. Wochens- chr.105:82, 1980

    Google Scholar 

  13. Ranson, J.H.C., Rifkind, K.M., Roses, D.F., Fink, S.D., Eng, K., Localio, S.A.: Objective early identification of severe acute pancreatitis. Am. J. Gastroenterol.61:443, 1974

    Google Scholar 

  14. Ranson, J.H.C., Rifkind, K.M., Turner, J.W.: Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis. Surg. Gynecol. Obstet.143:209, 1976

    Google Scholar 

  15. Ranson, J.H.C., Spencer, F.C.: The role of peritoneal lavage in severe acute pancreatitis. Ann. Surg.187:565, 1978

    Google Scholar 

  16. Geokas, M.C., Rinderknecht, H., Walberg, C.B., Weissman, R.: Methemalbumin in the diagnosis of acute hemorrhagic pancreatitis. Ann. Intern. Med.81:483, 1974

    Google Scholar 

  17. Andres, S.F., Kregoski, T.J., Frey, C.F., Joseph, R.R., McCann, D.S.: Clinical determination of methemalbumin. Clin. Chem.21:1506, 1975

    Google Scholar 

  18. Lankisch, P.G., Koop, H., Otto, J., Oberdieck, U.: Evaluation of methaemalbumin in acute pancreatitis. Scand. J. Gastroenterol.13:975, 1978

    Google Scholar 

  19. Svensson, J.-O.: Role of intravenously infused insulin in treatment of acute pancreatitis. A doubleblind study. Scand. J. Gastroenterol.10:487, 1975

    Google Scholar 

  20. Hallberg, D., Theve, N.O.: Observations during treatment of acute pancreatitis with insulin and glucose infusion. Acta Chir. Scand.140:138, 1974

    Google Scholar 

  21. Kelly, A.G., Nahrwold, D.L.: Pancreatic secretion in response to an elemental diet and intravenous hyperalimentation. Surg. Gynecol. Obstet.143:87, 1976

    Google Scholar 

  22. Saito, Y., Tokutake, K., Matsuno, S., Noto, N., Honda, T., Sato, T.: Effects of hypertonic glucose and amino acid infusions on pancreatic exocrine function. Tohoku J. Exp. Med.124:99, 1978

    Google Scholar 

  23. Traverso, L.W., Abou-Zamzam, A.M.: Total parenteral nutrition and the pancreas. N. Engl. J. Med.300:1492, 1979

    Google Scholar 

  24. Levant, J.A., Secrist, D.M., Resin, H., Sturdevant, R.A.L., Guth, P.H.: Nasogastric suction in the treatment of alcoholic pancreatitis. A controlled study. J.A.M.A.229:51, 1974

    Google Scholar 

  25. Naeije, R., Salingret, E., Clumeck, N., De Troyer, A., Devis, G.: Is nasogastric suction necessary in acute pancreatitis? Br. J. Med.2:659, 1978

    Google Scholar 

  26. Field, B.A., Hepner, G.W., Shabot, M., Schwartz, A.A., State, D., Worthen, N., Wilson, R.: Nasogastric suction in alcoholic pancreatitis. Dig. Dis. Sci.24:339, 1979

    Google Scholar 

  27. Hadas, N., Wapnick, S., Grosberg, S.J., Sugaar, S.: Cimetidine induced mortality in experimental pancreatitis. Gastroenterology76:1148, 19790

    Google Scholar 

  28. Meshkinpour, H., Molinari, M.D., Gardner, L., Berk, J.E., Hoehler, F.K.: Cimetidine in the treatment of acute alcoholic pancreatitis. A randomized, double-blind study. Gastroenterology77:687, 1979

    Google Scholar 

  29. Cameron, J.L., Mehigan, D., Zuidema, G.D.: Evaluation of atropine in acute pancreatitis.Surg. Gynecol. Obstet.148:206, 1979

    Google Scholar 

  30. Knight, M.J., Condon, J.R., Smith, R.: Possible use of glucagon in the treatment of pancreatitis. Br. Med. J.2:440, 1971

    Google Scholar 

  31. Waterworth, M.W., Barbezat, G.O., Hickman, R., Terblanche, J.: Acute pancreatitis in experimental pancreatitis. Br. J. Surg.63:617, 1976

    Google Scholar 

  32. Condon, R.E., Woods, J.H., Poulin, T.L., Wagner, W.G., Pissiotis, C.A.: Experimental pancreatitis treated with glucagon or lactated Ringer solution. Arch. Surg.109:154, 1974

    Google Scholar 

  33. Lankisch, P.G., Winckler, K., Bokermann, M., Schmidt, H., Creutzfeldt, W.: The influence of glucagon on acute experimental pancreatitis in the rat. Scand. J. Gastroenterol.9:725, 1974

    Google Scholar 

  34. Papp, M., Ribet, A., Fodor, I., Nemeth, P.E., Feher, S., Horvath, J.E., Folly, G.: Glucagon treatment of experimental acute pancreatitis. Acta Med. Acad. Sci. Hung.32:105, 1975

    Google Scholar 

  35. Dürr, H.K., Weihe, W., Bode, C., Bode, J.C.: A controlled trial of glucagon in acute experimental pancreatitis in rats. Z. Gastroenterol.15:728, 1977

    Google Scholar 

  36. Manabe, T., Sterr, M.L.: Experimental acute pancreatitis in mice. Protective effects of glucagon. Gastroenterology76:529, 1979

    Google Scholar 

  37. Death from acute pancreatitis: M.R.C. multicentre trial of glucagon and aprotinin. Lancet2:632, 1977

  38. Dürr, H.K., Maroske, D., Zedler, O, Bode, J.C.: Glucagon therapy in acute pancreatitis. Report of a double-blind trial. Gut19:175, 1978

    Google Scholar 

  39. Gauthier, A., Gillet, M., Di Constanzo, J., Camelot, G., Maurin, P., Sarles, H.: Etude controlée multicentrique de l'aprotinine et du glucagon dans le traitement des pancréatites aiguës. Gastroenterol. Clin. Biol.2:777, 1978

    Google Scholar 

  40. Goebell, H., Ammann, R., Herfarth, C., Horn, J., Hotz, J., Knoblauch, M., Schmid, M., Jaeger, M., Akovbiantz, A., Linder, E., Abt, K., Nüesch, E., Barth, E.: A double-blind trial of synthetic salmon calcitonin in the treatment of acute pancreatitis. Scand. J. Gastroenterol.14:881, 1979

    Google Scholar 

  41. Paul, F., Ohnhaus, E.E., Hesch, R.D., Chemnitz, G., Hoppe-Seyler, R., Henrichs, H.R., Hartung, H., Waldmann, D., Kunze, K., Barth, E. Nüesch, E., Abt, K.: Einfluss von Salm-Calcitonin auf den Verlauf der akuten Pankreatitis. Ergebnisse einer prospektiven Doppelblindstudie. Dtsch. Med. Wochenschr.104:615, 1979

    Google Scholar 

  42. Lankisch, P.G., Koop, H., Winckler, K., Fölsch, U.R., Creutzfeldt, W.: Somatostatin therapy of acute experimental pancreatitis. Gut18:713, 1977

    Google Scholar 

  43. Adler, G., Koch, H., Kern, H.P.: Effect of somatostatin on secretagogue-induced pancreatitis in the rat. Dan. Med. Bull.26 (suppl. 1):12, 1979

    Google Scholar 

  44. Usadel, K.H., Schwedes, U., Mothes, L., Althoff, P.M., Leuschner, U., Raptis, S., Fortmeyer, H.P., Klempa, I.: Einfluss von Somatostatin auf de experimentelle Pankreatitis beim Beagle Hund. Ergeb. Gastroenterol.14:81, 1979

    Google Scholar 

  45. Kasper, H., Sommer, H.: Klinik der akuten Pankreatitis. In Handbuch der Inneren Medizin, Forell, M.M., editor, Berlin, Heidelberg, New York, Springer Verlag, 1976, vol. 3, part 6

    Google Scholar 

  46. Trapnell, J.E., Rigby, C.C., Talbot, C.H., Duncan, E.H.L.: A controlled trial of trasylol in the treatment of acute pancreatitis. Br. J. Surg.61:177, 1974

    Google Scholar 

  47. Imrie, C.W., Benjamin, I.S., Ferguson, J.C., McKay, A.J., Mackenzie, I., O'Neill, J., Blumgart, L.H.: A single-centre double-blind trial of trasylol therapy in primary acute pancreatitis. Br. J. Surg.65:337, 1978

    Google Scholar 

  48. Diwok, K., Gülzow, M., Trettin, H.-J.: Die Wirkung der E-Aminokapronsäure auf die experimentelle Pankreatitis der Ratte. Z. Gesamte Inn. Med.20:111, 1965

    Google Scholar 

  49. Diwok, K., Leithäuser, W. Nowotny, P.: Zur Wirkung von Contrykal L, PAMBA und Heparin auf den Verlauf einer experimentellen Pankreatitis bei Ratten. Dtsch. Z. Verdau. Stoffwechselkr.31: 113, 1971

    Google Scholar 

  50. Lankisch, P.G., Koop, H., Winckler, K., Köstering, H.: Therapie der akuten experimentellen Pankreatitis mit dem Antifibrinolytikum PAMBA. Z. Gastroenterol.15:722, 1977

    Google Scholar 

  51. Konttinen, Y.P.: Epsilon-aminocaproic acid in the treatment of acute pancreatitis. Scand. J. Gastroenterol.6:715, 1971

    Google Scholar 

  52. Elliot, D.W., Zollinger, R.M., Moore, R., Ellison, E.H.: The use of human serum albumin in the management of acute pancreatitis. Gastroenterology28:563, 1955

    Google Scholar 

  53. Lankisch, P.G., Koop, H.: Dopamin-Wirkung auf de basale Pankreassekretion des Menschen. Dtsch. Med. Wochenschr.103:391, 1978

    Google Scholar 

  54. Lankisch, P.G., Koop, H., Winckler, K., Schmidt, H.: Continuous peritoneal dialysis as treatment of acute experimental pancreatitis in the rat. I. Effect on length and rate of survival. Dig. Dis. Sci.24:111, 1979

    Google Scholar 

  55. Warshaw, A.L., Imbembo, A.L., Civetta, J.M., Daggett, W.M.: Surgical intervention in acute necrotizing pancreatitis. Am. J. Surg.127:484, 1974

    Google Scholar 

  56. Balsløv, J.T., Jørgensen, H.E., Nielsen, R.: Acute renal failure complicating severe acute pancreatitis. Acta Chir. Scand.124:348, 1962

    Google Scholar 

  57. Heni, N., Heissmeyer, H., Herkel, L., Jontofson, R., Gerok, W.: Die Therapie der fulminanten Pankreatitis mit der Langzeit-Peritonealdialyse. Innere Medizin3:461, 1976

    Google Scholar 

  58. Imrie, C.W., Blumgart, L.W.: Acute pancreatitis: a prospective study on some factors in mortality. Bull. Soc. Int. Chir.6:601, 1975

    Google Scholar 

  59. Hayes, M.E., Rosenbaum, R.W., Zibelman, M., Matsumoto, T.: Adult respiratory distress syndrome in association with acute pancreatitis. Evaluation of positive end expiratory pressure ventilation and pharmacologic doses of steroids. Am. J. Surg.127:314, 1974

    Google Scholar 

  60. Craig, R.M., Dordal, E., Myles, L.: The use of ampicillin in acute pancreatitis. Ann. Intern. Med.83:831, 1975

    Google Scholar 

  61. Howes, R., Zuidema, G.D., Cameron, J.L.: Evaluation of prophylactic antibiotics in acute pancreatitis. J. Surg. Res.18:197, 1975

    Google Scholar 

  62. Finch, W.T., Sawyers, J.L., Schenker, S.: A prospective study to determine the efficacy of antibiotics in acute pancreatitis. Ann. Surg.183:667, 1976

    Google Scholar 

  63. Roberts, E.A., Williams, R.J.: Ampicillin concentrations in pancreatic fluid or bile obtained at endoscopic retrograde cholangiopancreatography (ERCP). Scand. J. Gastroenterol.14:669, 1979

    Google Scholar 

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  1. Division of Gastroenterology and Metabolism, Department of Medicine, University of Göttingen, West Germany

    Werner Creutzfeldt M.D., F.R.C.P. & Paul G. Lankisch M.D.

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  1. Werner Creutzfeldt M.D., F.R.C.P.
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Creutzfeldt, W., Lankisch, P.G. Intensive medical treatment of severe acute pancreatitis. World J. Surg. 5, 341–348 (1981). https://doi.org/10.1007/BF01657992

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