Early phase of acute pancreatitis: Assessment and management

Abstract

Acute pancreatitis (AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis.

Keywords: Acute pancreatitis; Antibiotic prophylaxis; Etiology; Fluid therapy; Incidence; Nutrition; Pain management; Pathophysiology; Risk stratification; Severity.

Figure 1

Regional differences in frequency of biliary (black) and alcoholic (gray) etiology of acute pancreatitis.

Figure 2

Two-phase course of severe acute pancreatitis. CARS: Compensatory anti-inflammatory response syndrome; MARS: Mixed anti-inflammatory response syndrome; SIRS: Systemic inflammatory response syndrome.