Dtsch Med Wochenschr 2020; 145(12): 850-862
DOI: 10.1055/a-0949-0878
CME-Fortbildung

Diagnostik und Therapie der schweren akuten Pankreatitis in der Intensivmedizin

Diagnosis and treatment of severe acute pancreatitis in critical care
Theresa H. Wirtz
,
Tobias Puengel
,
Lukas Buendgens
,
Tom Luedde
,
Christian Trautwein
,
Alexander Koch

Abstract

Acute pancreatitis is a potentially life-threatening disease that requires intensive care, especially in severe cases. The present article is intended to illustrate the possibilities of a rational diagnosis of acute pancreatitis as well as to provide an overview of the stage-adapted therapy, which includes both conservative measures and interventional interdisciplinary treatment strategies.

Die akute Pankreatitis ist eine potenziell lebensbedrohliche Erkrankung, die insbesondere bei schweren Verläufen einer intensivmedizinischen Therapie bedarf. Dieser Artikel soll sowohl die Möglichkeiten einer rationalen Diagnostik der akuten Pankreatitis darstellen als auch einen Überblick über die Stadien-adaptierte Therapie geben, die sowohl konservative Maßnahmen als auch interventionelle interdisziplinäre Behandlungsstrategien umfasst.



Publication History

Article published online:
17 June 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • Literatur

  • 1 Rosendahl J, Landt O, Bernadova J. et al CFTR, SPINK1, CTRC and PRSS1 variants in chronic pancreatitis: is the role of mutated CFTR overestimated?. Gut 2013; 62: 582-592 . doi:10.1136/gutjnl-2011-300645
  • 2 Howes N, Lerch MM, Greenhalf W. et al Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol 2004; 2: 252-261 . doi:10.1016/s1542-3565(04)00013-8
  • 3 Toouli J, Brooke-Smith M, Bassi C. et al Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol 2002; 17: S15-S39 . doi:10.1046/j.1440-1746.17.s1.2.x
  • 4 Fagenholz PJ, Castillo CF, Harris NS. et al Increasing United States hospital admissions for acute pancreatitis, 1988–2003. Ann Epidemiol 2007; 17: 491-497 . doi:10.1016/j.annepidem.2007.02.002
  • 5 Banks PA, Bollen TL, Dervenis C. et al Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111 . doi:10.1136/gutjnl-2012-302779
  • 6 Swaroop VS, Chari ST, Clain JE. Severe acute pancreatitis. JAMA 2004; 291: 2865-2868 . doi:10.1001/jama.291.23.2865
  • 7 Banks PA, Freeman ML. Practice Parameters Committee of the American College of G. Practice guidelines in acute pancreatitis. J Am Gastroenterol 2006; 101: 2379-2400 . doi:10.1111/j.1572–0241.2006.00856.x
  • 8 Dervenis C, Johnson CD, Bassi C. et al Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol 1999; 25: 195-210 . doi:10.1007/bf02925968
  • 9 Working Group IAPAPAAPG. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13: e1-e15 . doi:10.1016/j.pan.2013.07.063
  • 10 Arvanitakis M, Dumonceau JM, Albert J. et al Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524-546 . doi:10.1055/a-0588-5365
  • 11 Larvin M. Assessment of severity and prognosis in acute pancreatitis. Eur J Gastroenterol Hepatol 1997; 9: 122-130 . doi:10.1097/00042737-199702000-00004
  • 12 Brown A, Orav J, Banks PA. Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas 2000; 20: 367-372 . doi:10.1097/00006676-200005000-00005
  • 13 Wu BU, Bakker OJ, Papachristou GI. et al Blood urea nitrogen in the early assessment of acute pancreatitis: an international validation study. Arch Intern Med 2011; 171: 669-676 . doi:10.1001/archinternmed.2011.126
  • 14 Tenner S, Baillie J, DeWitt J. et al American College of Gastroenterology guideline: management of acute pancreatiti*s. J Am Gastroenterol 2013; 108: 1400-1416 . doi:10.1038/ajg.2013.218
  • 15 Haydock MD, Mittal A, Wilms HR. et al Fluid therapy in acute pancreatitis: anybody’s guess. Ann Surg 2013; 257: 182-188 . doi:10.1097/SLA.0b013e31827773ff
  • 16 Mao EQ, Tang YQ, Fei J. et al. Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J 2009; 122: 169-173
  • 17 Wu BU, Johannes RS, Sun X. et al Early changes in blood urea nitrogen predict mortality in acute pancreatitis. Gastroenterology 2009; 137: 129-135 . doi:10.1053/j.gastro.2009.03.056
  • 18 Basurto OnaX, Rigau ComasD, Urrutia G. Opioids for acute pancreatitis pain. Cochrane Database Syst Rev 2013; DOI: 10.1002/14651858.CD009179.pub2.
  • 19 Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Guidelines for intensive care unit admission, discharge, and triage. Crit Care medicine 1999; 27: 633-638
  • 20 Reintam Blaser A, Starkopf J, Alhazzani W. et al Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intens Care med 2017; 43: 380-398 . doi:10.1007/s00134-016-4665-0
  • 21 Elke G, Hartl WH, Kreymann KG. et al Clinical nutrition in critical care medicine – Guideline of the German Society for Nutritional Medicine (DGEM). Clin Nutrit ESPEN 2019; 33: 220-275 . doi:10.1016/j.clnesp.2019.05.002
  • 22 da Costa DW, Bouwense SA, Schepers NJ. et al Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. Lancet 2015; 386: 1261-1268 . doi:10.1016/S0140-6736(15)00274-3
  • 23 van Grinsven J, van Santvoort HC, Boermeester MA. et al Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol 2016; 13: 306-312 . doi:10.1038/nrgastro.2016.23
  • 24 van Brunschot S, van Grinsven J, van Santvoort HC. et al Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018; 391: 51-58 . doi:10.1016/S0140-6736(17)32404-2
  • 25 van Santvoort HC, Besselink MG, Bakker OJ. et al A step-up approach or open necrosectomy for necrotizing pancreatitis. NEJM 2010; 362: 1491-1502 . doi:10.1056/NEJMoa0908821
  • 26 Hollemans RA, Hallensleben NDL, Mager DJ. et al Pancreatic exocrine insufficiency following acute pancreatitis: Systematic review and study level meta-analysis. Pancreatology 2018; 18: 253-262 . doi:10.1016/j.pan.2018.02.009