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Acta Scientific Gastrointestinal Disorders (ISSN: 2582-1091)
Volume 4 Issue 10 October 2021
Acute Pancreatitis: Review Article
Jesús Velázquez Gutiérrez1* and Morella Vargas Useche2
1Digestive Tract Surgeon, Specialist in Clinical Nutrition, Spain
2Nutritionist Doctor, Magister in Clinical Nutrition, Spain
*Corresponding Author: Jesús Velázquez Gutiérrez, Digestive Tract Surgeon,
Specialist in Clinical Nutrition, Spain.
Review Article
Received: August 17, 2021
Published: September 20, 2021
© All rights are reserved by Jesús Velázquez
Gutiérrez and Morella Vargas Useche.
Abstract
-
-
Keywords: Acute Pancreatitis; Early Enteral Nutrition; Review Article
Introduction
-
-
-
Methods
For this review, the most recent international evidenced-based
guidelines on acute pancreatitis, American Gastroenterological
(ESPEN) guideline on clinical nutrition in acute and chronic pan-
-
atitis.
Etiology:
Citation: Jesús Velázquez Gutiérrez and Morella Vargas Useche. “Acute Pancreatitis: Review Article". 4.10
-
-
giopancreatography, hypercalcemia, hypertriglyceridemia, surgery
and trauma [1].
Pathophysiology:
transporters. Once within the cell, bile acids increase intra-acinar
signaling pathways causing pancreatic parenchymal damage. Pan-
-
vacuoles leads to digestive enzymes autodigesting the pancreas.
mitochondrial damage and adenosine triphosphate depletion in
pancreatic ductal cells driving the cell death, ultimately leading to
pancreatic necrosis [2].
-
al state. As in sepsis, patients with AP present a typical metabolic
-
ids, accelerated ureagenesis, and decreased glutamine concentra-
mortality .
Similarly, there is an alteration in carbohydrate metabolism
-
[4].
it can result in hypertriglyceridemia with increased mortality
.
patients, increases in calcitonin and hypoalbuminemia. Chronic
ethanol abuse predisposes patients to hypomagnesemia, decreased
-
.
therapy to modulate the response to oxidative stress and counter-
1.
-
-
-
oral route [6].
2. Moderately severe AP: It is characterized by local complica-
[6]. Organ
[2].
[7] and is de-
-
cular, respiratory or renal) and high mortality [6]. Patients
-
unit whenever possible .
-
[9].
Acute Pancreatitis: Review Article
Citation: Jesús Velázquez Gutiérrez and Morella Vargas Useche. “Acute Pancreatitis: Review Article". 4.10
-
-
-
AP index (BISAP), Glasgow-Imrie scale, DCT severity index, and the
Japanese severity scale.
BISAP, a recently developed prognostic scoring system, is a sim-
-
-
[10,11].
-
ties, oliguria, rebound abdominal pain, altered mental status, and
[12].
Diagnosis:
characteristics: abdominal pain accompanied by nausea and vomit-
-
cations
[6]
-
-
.
-
agnosis is important, or better yet, predicting a severe AP episode
[16].
Medical management
[2]
[12]. Supplemental oxygen, especially in elderly pa-
tients, also improves results. Analgesia is another important aspect
increased mortality [11].
Nutritional therapy
AP patient have undergone important changes in recent years. Fail-
-
-
-
permeability . Nutrition therapy reduces the general severity
reduction in hospital stay [17].
-
been shown to help protect the intestinal mucosal barrier and re-
peri-pancreatic necrosis [14].
In recent years, several studies have shown that septic compli-
cations can be reduced when the patient receives early EN. A meta-
analysis by Petrov., et al. included 11 randomized controlled trials,
Acute Pancreatitis: Review Article
Citation: Jesús Velázquez Gutiérrez and Morella Vargas Useche. “Acute Pancreatitis: Review Article". 4.10
et al. dem-
reduced in patients who received EN within 24 hours compared
[20,21].
Jiang K [22]
-
patients were evaluated, the meta-analysis showed that there were
-
Three randomized clinical trial that compared nasojejunal with
showed no
meta-analysis [26-29]
-
will experience digestive intolerance, mainly due to delayed gas-
tric emptying [26,27]
and the
administered by nasogastric tube, nasojejunal tube should be used
[16].
randomized controlled trial and a previous meta-analysis .
-
-
patients in the late group) .
EN in patients with severe AP: In patients who present intoler-
-
containing small peptides and medium chain triglycerides, and
.
EN include intestinal obstruction, abdominal compartment syn-
drome, prolonged paralytic ileus, and mesenteric ischemia
When it is impossible to access the gastrointestinal tract or
when there is intolerance to EN, it may be necessary to provide nu-
trients through the parenteral route. The most important thing at
-
to 7 days, total parenteral nutrition (TPN) should be started, which
must be progressively increased by controlling glucose levels be-
-
sepsis.
Parenteral glutamine supplements in patients receiving PN
-
.
-
-
clear liquid diets [16]. Patients with moderate AP are less prone to
Acute Pancreatitis: Review Article
Citation: Jesús Velázquez Gutiérrez and Morella Vargas Useche. “Acute Pancreatitis: Review Article". 4.10
days.
-
crosis in a symptomatic patient require intervention, indicating a
stepped treatment that begins with percutaneous or endoscopic
drainage
or endoscopic drainage is clinical deterioration with signs or sus-
. Most patients with
sterile necrotizing pancreatitis can be treated without interven-
tions .
Surgical management: Surgery is indicated when the patient
presents complications such as abdominal compartment syn-
drome, continuous acute bleeding, intestinal ischemia, or acute
.
disease onset results in lower mortality . With late surgery,
-
-
other indications, drainage or necrosectomy is not routinely rec-
ommended .
Minimally invasive surgical strategies, such as transgastric en-
doscopic necrosectomy or video-assisted retroperitoneal debride-
but require more interventions .
-
these. In general, it is assumed that open surgery elicits a more
-
. Recent meta-analysis suggest similar short-term mortality
-
crosectomy could be associated with an increase in adverse events
.
.
Conclusion
-
-
-
tion to subside was the only management option. New approaches
-
-
-
cated when there is intolerance to NE.
-
agement beginning with percutaneous drainage, minimally inva-
sive surgical drainage, or open necrosectomy.
Bibliography
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Techniques
Gurusamy KS., et al
Volume 4 Issue 10 October 2021
© All rights are reserved by Jesús Velázquez Gutiérrez
and Morella Vargas Useche.
Acute Pancreatitis: Review Article
Citation: Jesús Velázquez Gutiérrez and Morella Vargas Useche. “Acute Pancreatitis: Review Article". 4.10
