Page 2 - Acute Pancreatitis (Viêm tụy cấp)

58 Acute Pancreatitis 58

Santhi Swaroop Vege

CHAPTER OUTLINE

INCIDENCE AND BURDEN OF DISEASE . . . . . . . . . . . . . .893 Chest Radiography . . . . . . . . . . . . . . . . . . . . . . . . . . . .907
DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .894 Abdominal US . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .907
COURSE OF THE DISEASE . . . . . . . . . . . . . . . . . . . . . . . .895 EUS and ERCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .908
CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .908
PATHOGENESIS AND PATHOPHYSIOLOGY . . . . . . . . . . . .896 MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .908
PREDISPOSING CONDITIONS . . . . . . . . . . . . . . . . . . . . . .897 DISTINGUISHING ALCOHOLIC FROM GALLSTONE
Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .898 PANCREATITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .908
Ethyl Alcohol and Other Toxins . . . . . . . . . . . . . . . . . . . .899 PREDICTORS OF DISEASE SEVERITY . . . . . . . . . . . . . . . .909
Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .899 Scoring Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .910
Metabolic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . .900 CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .910
Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .901 Chest Radiography . . . . . . . . . . . . . . . . . . . . . . . . . . . .910
Vascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .901
Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .901 TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .910
Post-ERCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .902 Initial Management During the First Week . . . . . . . . . . .910
Postoperative State . . . . . . . . . . . . . . . . . . . . . . . . . . . .903 Intravenous Fluid and Electrolyte Resuscitation . . . . . . .912
Hereditary and Genetic Disorders . . . . . . . . . . . . . . . . .903 Respiratory Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .912
Miscellaneous Causes . . . . . . . . . . . . . . . . . . . . . . . . . .903 Cardiovascular Care . . . . . . . . . . . . . . . . . . . . . . . . . . .912
Controversial Causes . . . . . . . . . . . . . . . . . . . . . . . . . . .904 Metabolic Complications . . . . . . . . . . . . . . . . . . . . . . . .912
CLINICAL FEATURES . . . . . . . . . . . . . . . . . . . . . . . . . . . .904 Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .912
Urgent ERCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .913
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .904 Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .913
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . .905 Other Non-Interventional Treatments . . . . . . . . . . . . . . .914
DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . .906 Interventional Treatments . . . . . . . . . . . . . . . . . . . . . . .914
LABORATORY DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . . .906 Other Complications . . . . . . . . . . . . . . . . . . . . . . . . . . .915
Pancreatic Enzymes . . . . . . . . . . . . . . . . . . . . . . . . . . .906 Long-Term Sequelae of Acute Pancreatitis . . . . . . . . . . .916
Standard Blood Tests . . . . . . . . . . . . . . . . . . . . . . . . . . .907 Abdominal Compartment Syndrome . . . . . . . . . . . . . . .916
DIAGNOSTIC IMAGING . . . . . . . . . . . . . . . . . . . . . . . . . . .907 Miscellaneous Complications . . . . . . . . . . . . . . . . . . . .916
Abdominal Plain Film . . . . . . . . . . . . . . . . . . . . . . . . . . .907

INCIDENCE AND BURDEN OF DISEASE
of incidence are inaccurate because the diagnosis of mild disease
The human and financial burden of acute pancreatitis (AP) con- may be missed and death may occur before diagnosis in 10% of
6
tinues to grow, and it is now one of the most common reason for patients with severe disease. Conversely, many patients with
hospitalization with a GI condition. Many studies demonstrate a abdominal pain from other sources who present with a slight ele-
1
variable yet consistent increasing worldwide incidence, generally vation in the serum amylase and/or lipase are falsely diagnosed
in the range of 20 to 40 per 100,000 population. Studies from as having AP.
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Europe suggest an increase overall, with differences in underlying The rising incidence of AP has likewise been associated with
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etiology based upon the region studied. For example, gallstones increasing costs. In 2014 the United States, AP was one of the
are the dominant etiology in Southern Europe and alcohol in top 3 leading hospital discharge diagnoses, along with GI bleed-
Eastern Europe, with intermediate gallstone-to-alcohol ratios in ing and gallstone disease. There were 279,145 annual admissions,
Northern and Western Europe. Studies from EDs likewise have with a 30-day readmission rate of 14.3% and 0.7% mortality. The
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shown a rise in visits for AP, with a 12% rise in a 6-year period in health care cost was 2.6 billion dollars. In the same year, there
one study; a 15% increase in hospital admissions; and that AP was were 2834 deaths directly related to AP and 5392 deaths contrib-
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the 12th most common GI condition seen in the ED in 2012. uted to by AP in the USA, making it the 14th most common cause
This continued escalation in ED visits and associated costs appear of death due to GI diseases. Although the length of hospital stay
to be driven by younger patients with alcohol-associated and and mortality have decreased from 1997 to 2012 in the USA, the
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acute on chronic pancreatitis. Based on population-based cohort mean hospital costs have increased by 120% to nearly $34,000.
studies, globally, AP is the most common pancreatic disease, The overall mortality rate from AP has substantially dropped
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whereas pancreatic cancer is the most lethal. A large increase from >10% several years ago to less than 2% in recent years. 1,7,9
in pediatric cases also accounts for the rising increase in the inci- The following sections are written with the main focus on clinical
dence of AP. This increase is presumably—as in adults—due to management based on recent evidence-based literature and are
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the rise in obesity-associated cholelithiasis. However, estimates not meant to be an encyclopedic description of the topic.
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