Practical guidelines for acute pancreatitis

R. Pezzilli, A. Zerbi, V. Di Carlo, C. Bassi, G. F. Delle Fave

Research output: Contribution to journalArticle

Abstract

Introduction: The following is a summary of the official guidelines of the Italian Association for the Study of the Pancreas regarding the medical, endoscopic and surgical management of acute pancreatitis. Statements: Clinical features together with elevation of the plasma concentrations of pancreatic enzymes are the cornerstones of diagnosis (recommendation A). Contrast-enhanced computed tomography (CT) provides good evidence for the presence of pancreatitis (recommendation C) and it should be carried out 48-72 h after the onset of symptoms in patients with predicted severe pancreatitis. Severity assessment is essential for the selection of the proper initial treatment in the management of acute pancreatitis (recommendation A) and should be done using the APACHE II score, serum C-reactive protein and CT assessment (recommendation C). The etiology of acute pancreatitis should be able to be determined in at least 80% of cases (recommendation B). An adequate volume of intravenous fluid should be administered promptly to correct the volume deficit and maintain basal fluid requirements (recommendation A); analgesia is crucial for the correct treatment of the disease (recommendation A). Enteral feeding is indicated in severe necrotizing pancreatitis and it is better than total parenteral nutrition (recommendation A). The use of prophylactic broad-spectrum antibiotics reduces infection rates in CT-proven necrotizing pancreatitis (recommendation A). Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention, including surgery and radiological drainage (recommendation B). Conclusions: The participants agreed to revise the guidelines every 3 years in order to re-evaluate each question on the management of acute pancreatitis patients according to the most recent literature.

Original languageEnglish
Pages (from-to)523-535
Number of pages13
JournalPancreatology
Volume10
Issue number5
DOIs
Publication statusPublished - Dec 2010

Keywords

  • Diagnosis
  • Diagnostic imaging
  • Disease management
  • Pancreatic necrosis
  • Pancreatitis
  • Prognosis
  • Therapeutics

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Hepatology

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    Pezzilli, R., Zerbi, A., Di Carlo, V., Bassi, C., & Delle Fave, G. F. (2010). Practical guidelines for acute pancreatitis. Pancreatology, 10(5), 523-535. https://doi.org/10.1159/000314602