Diagnosis,severity stratification and management of adult acute pancreatitis–current evidence and controversies  

作　　者：Kai Siang Chan Vishal G Shelat 

机构地区：[1]Department of General Surgery,Tan Tock Seng Hospital,Singapore 308433,Singapore [2]Lee Kong Chian School of Medicine,Nanyang Technological University,Singapore 308232,Singapore [3]Yong Loo Lin School of Medicine,National University of Singapore,Singapore 117597,Singapore

出　　处：《World Journal of Gastrointestinal Surgery》2022年第11期1179-1197,共19页世界胃肠外科杂志（英文版）（电子版）

摘　　要：Acute pancreatitis(AP)is a disease spectrum ranging from mild to severe with an unpredictable natural course.Majority of cases(80%)are mild and self-limiting.However,severe AP(SAP)has a mortality risk of up to 30%.Establishing aetiology and risk stratification are essential pillars of clinical care.Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause.Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence.In SAP,patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit.Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP.Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition.If unable to tolerate per-orally,nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit.Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis.Delayed step-up strategy including percutaneous retroperitoneal drainage,endoscopic debridement,or minimal-access necrosectomy are sufficient in most SAP patients.Patients should be monitored for diabetes mellitus and pseudocyst.

关 键 词：Atlanta classification Drainage INFECTIONS NECROSECTOMY PANCREATITIS Risk stratification 

分 类 号：R576[医药卫生—消化系统]