Open AccessCurrent concepts in the management of acute pancreatitis
Author(s) -
Gautham Srinivasan,
L Venkatakrishnan,
Swaminathan Sambandam,
Gursharan Singh,
Maninder Kaur,
Krishnaveni Janarthan,
Biku Joseph John
Publication year - 2016
Publication title -
journal of family medicine and primary care
Language(s) - English
Resource type - Journals
eISSN - 2278-7135
pISSN - 2249-4863
DOI - 10.4103/2249-4863.201144
Subject(s) - medicine , acute pancreatitis , intensive care medicine , multidisciplinary approach , systemic inflammatory response syndrome , pancreatitis , percutaneous , medline , referral , disease , resuscitation , emergency medicine , surgery , sepsis , family medicine , social science , sociology , political science , law
Guidelines for the management of acute pancreatitis (AP) are based on the Western experience, which may be difficult to extrapolate in India due to socioeconomic constraints. Hence, modifications based on the available resources and referral patterns should be introduced so as to ensure appropriate care. We reviewed the current literature on the management of AP available in English on Medline and proposed guidelines locally applicable. Patients of AP presenting with systemic inflammatory response syndrome are at risk of moderate-severe pancreatitis and hence, should be referred to a tertiary center early. The vast majority of patients with AP have mild disease and can be managed at smaller centers. Early aggressive fluid resuscitation with controlled fluid expansion, early enteral nutrition, and culture-directed antibiotics improve outcomes in AP. Infected pancreatic necrosis should be managed in a tertiary care hospital within a multidisciplinary setup. The "step up" approach involving antibiotics, percutaneous drainage, and minimally invasive necrosectomy instituted sequentially based on clinical response has improved the outcomes in this subgroup of patients.