Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-15_Managing Complications Of Acute Pancreatitis

15_Managing Complications Of Acute Pancreatitis

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This document covers the management and complications of acute pancreatitis, particularly focusing on various phases and their management strategies. Acute pancreatitis is categorized into early and late phases, with three severity levels: mild, moderately severe, and severe. Initial assessment considers patient characteristics such as age, obesity, and the systemic inflammatory response syndrome, assessing laboratory findings like blood urea nitrogen and creatinine. Moderately aggressive intravenous hydration with isotonic crystalloids within the first 24 hours is emphasized.<br /><br />Endoscopic retrograde cholangiopancreatography (ERCP) is recommended urgently only in cases of cholangitis. In the second week of illness, interventions like antibiotics or percutaneous drainage are decided cautiously based on the presence of necrotic collections. The document advocates postponing drainage unless there's organ failure.<br /><br />By the fourth week, indications for drainage include documented infected necrosis and ongoing organ failure. Decisions between plastic and metal stents in endoscopic drainage are informed by meta-analysis findings.<br /><br />Vascular complications such as splanchnic vein thrombosis are common, yet the benefit of therapeutic anticoagulation remains unproven, although a 3-6 month treatment could increase recanalization and decrease complications. An episode of acute portal vein thrombosis may warrant a CT scan for assessment.<br /><br />The document also touches on the long-term development of Type 3c diabetes mellitus and steatorrhea post-acute pancreatitis, showing prevalence rates of exocrine insufficiency. Risk stratification and targeted IV fluid management are key initial steps; urgent ERCP is rarely necessary; conservative approaches dominate the 2nd to 4th-week plans; vascular complications and the need for cholecystectomy to prevent recurrence are highlighted.<br /><br />Overall, the management of acute pancreatitis involves a thorough and strategic approach focusing on timing, assessment, and appropriate intervention depending on various evolving factors and complications.

Keywords

acute pancreatitis

management strategies

severity levels

intravenous hydration

endoscopic retrograde cholangiopancreatography

necrotic collections

vascular complications

Type 3c diabetes mellitus

exocrine insufficiency

risk stratification