Changes in the Management of Treatment in Acute Pancreatitis Patients

Abstract

Acute pancreatitis is an inflammatory condition with a variable clinical course from mild to the most severe with serious complications that attempt the life of a patient. According to the Atlanta classifications the severe acute pancreatitis occurs approximately at 25% of all patients with acute pancreatitis and it is associated with 10-20% of mortality. Death of the acute pancreatitis patients is often connected of at least one organ. There are two phases of the severe acute pancreatitis relating to the mortality. The first phase, two weeks after onset of syndrome, is characterized by hypovolemia or even by the shock. It is accompanied by the systemic inflammatory responsive syndrome with production of inflammatory mediators and cytokines, which cause consecutive injury of lungs, livers and cardiovascular system. The multi organ failure is a very common appearance in the case of the severe acute pancreatitis and it happens very often even when the infection is absent. The second phase of this disease (third-forth week) is characterized by the complications caused by the infection of pancreatic necrosis. About 40-70% patients with necrotic acute pancreatitis is afflicted by the infection of the pancreatic necrosis, which causes the deaths of acute pancreatitis patients (Beger et al., 1997). The extent of the pancreatic necrosis and the duration of disease are the risk factors of the local pancreatic infection. Its incidence tends to culminate in third week of disease, though it may appear in whichever phase of the disease (Buchler et al., 2000). Severe acute pancreatitis requires treatment at the hospital, which is developed from personal, professional and technical point of view, where is a possibility to do the full diagnosis and therapy and the interdivisional cooperation, what is the basic presumption for treatment and diagnosis of acute pancreatitis. Diagnosis is based upon clinical presentation, laboratory indicates and imaging studies, whilst illness severity can be assessed by clinical scoring systems, such as Ranson, Glasgow or Apache II criteria, or by radiological assessments such as the computer tomography severity index. Mild disease is often self-limiting and inflammation resolves with simple medical management. However, a minority of patients (up to 20%) will develop severe disease that carries substantial morbidity and mortality. Over the past decades, management of severe acute pancreatitis changed from an early operative treatment to a more conservative approach. Nowadays there is clearly no more doubt that surgery is not the first choice of treatment for patients suffering from severe acute