Jurnal: Acute Pancreatitis

JURNAL
ACUTE PANCREATITIS
RASIYDAH HELFIANA 10542052313
INTRODUCTION
A patient complaining of sudden onset of epigastric pain radiating to the back,

associated
with nausea and vomiting, requires rapid exclusion of a wide range of lifethreatening
conditions involving the cardiovascular (myocardial infarction, ruptured,
and/or dissecting aortic aneurysm) and gastrointestinal (peptic ulcer disease with
perforation or bleeding, acute pancreatitis) systems. The clinician’s history and
examination
findings are augmented by relevant investigations in narrowing the differential
diagnoses to eventually guide the management and treatment of a certain condition
and its associated complications.
EPIDEMIOLOGI
The incidence of acute pancreatitis in the UK is ~56 cases per 100,000

persons
per year,1 while in the US over 220,000 hospital admissions annually are
attributed
to acute pancreatitis.2 An epidemiologic study that utilized UK and
European data
demonstrated an increasing incidence in all-cause acute pancreatitis.3
The incidence
of acute pancreatitis was also noted to increase with age.3,4 The male
population had
an incidence that was 10%–30% higher than females.4
ETIOLOGI
• Alcohol-induced acute pancreatitis is more common in middle-aged men.

Idiopathic acute pancreatitis accounts for 20%–34% of cases and its
incidence is similar in both men and women.
• The incidence of gallstone-related acute pancreatitis in both men and
women increases with age, with women over the age of 60 years at higher
risk.
• Microlithiasis causes a functional obstruction at the sphincter of Oddi,
which subsequently results in bile and/or biliarypancreatic secretion reflux
that injures the pancreatic duct
DIAGNOSIS
• The pretest probability of acute pancreatitis is determined by the clinician’s index of

suspicion, which is largely based on the patient’s history and clinician’s examination
findings. The classical teaching is that a serum amylase level that is three or four times
greater than the upper limit of normal is diagnostic of acute pancreatitis. While the
measurement of serum pancreatic enzymes such as amylase is the “gold standard” for
the diagnosis of acute pancreatitis, the measured value for the serum pancreatic
enzymes should be interpreted by considering the duration of patient’s symptoms. In
acute pancreatitis, the pancreatic enzymes amylase, lipase, elastase, and trypsin are
simultaneously released into the bloodstream.
• Imaging plays an important role in the diagnosis and management of acute pancreatitis.
As 50% of acute pancreatitis cases are gallstone-related, transabdominal ultrasound is
the most common initial radiologic investigation of choice.
CLASSIFICATION OF SEVERITY
• This revised classification defines transient organ failure as organ

failure which resolves completely w
• The Acute Physiology and Chronic Health Evaluation (APACHE) II
scoring system has demonstrated the highest accuracy for predicting
severe acute pancreatitis when compared with other scoring
systems.15 Other markers of severe acute pancreatitis b
• ased on evidence from the literature have been outlined in Boxithin 48
hours
TREATMENT
• The initial management of acute pancreatitis is largely supportive, with fluid replacement and
optimization of electrolyte balance, providing adequate caloric support, and preventing or identifying
and treating local and systemic complications.
• Acute pancreatitis results in the rapid metabolism of fat and protein due to the hypercatabolic state.
Nutritional support aims to provide adequate caloric intake and modulate the oxidative stress response
during the initial phase of acute pancreatitis, thereby counteracting the catabolic effects
• The widespread use of antimicrobial therapy across all areas of health care has resulted in the need for
targeted antimicrobial therapy to achieve better outcomes while simultaneously minimizing the risk of
developing antimicrobial resistance Penicillins, first-generation cephalosporins, aminoglycosides, and
tetracyclines are ineffective in acute pancreatitis. Antibiotics that are active against Gramnegative
bacteria such as imipenem, clindamycin, piperacillin, fluoroquinolones, and metronidazole have
adequate tissue penetration and bactericidal properties in infected pancreatic necrosis
CONCLUSION
Acute pancreatitis is frequently encountered on the emergency surgical take. Once the diagnosis
is made, clinical efforts should simultaneously concentrate on investigating for the underlying
etiology and managing the condition by anticipating its complications, which can be aided by
using any of the severity scoring systems described. Management of acute pancreatitis is largely
supportive. There is still no consensus on the ideal type and regimen of fluid for resuscitation, but
goal-directed fluid therapy is associated with better outcomes. Early enteral nutrition modulates
the inflammatory response and improves outcomes by decreasing infective complications of
acute pancreatitis. Antibiotics should be used judiciously as prophylactic antibiotics have not
shown any benefit in preventing infective complications of acute pancreatitis. Patients with mild
acute gallstone pancreatitis should be recommended to undergo a laparoscopic cholecystectomy
at the index admission, while those with severe gallstone pancreatitis and evidence of cholangitis
and/or choledocholithiasis benefit from early ERCP. Patients with mild acute gallstone pancreatitis
and concurrent choledocholithiasis benefit from single-stage laparoscopic cholecystectomy and
bile duct exploration, subject to available local expertise.
TERIMA KASIH

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JURNAL

A patient complaining of sudden onset of epigastric pain radiating to the back,

The incidence of acute pancreatitis in the UK is ~56 cases per 100,000

• Alcohol-induced acute pancreatitis is more common in middle-aged men.

• The pretest probability of acute pancreatitis is determined by the clinician’s index of

• This revised classification defines transient organ failure as organ

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