Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 117

Acute pancreatitis (AP) is a very complex entity, and a global perspective of the patient is crucial for improving outcomes. While interstitial AP is usually associated with few or no systemic manifestations, local complications frequently induce a systemic inflammatory response syndrome (SIRS) that may evolve to organ failure [1]. There are two peaks in the incidence of organ failure, the first within the first week after disease onset, most frequently due to the aseptic pancreatic inflammation itself (the clinician should rule out coexisting acute cholangitis and cholecystitis in patients with gallstone AP in this scenario); and the second, after the first week, is usually caused by infections [2]. The most frequent infections in AP are bacteremia, followed by infection of necrosis and pneumonia [2]. Other relatively frequent sources of organ failure are pulmonary thromboembolism, intestinal ischemia (colon necrosis is a complication of AP), exacerbation of preexisting comorbidity, or iatrogenic perforation of the digestive tract. Organ failure is linked to increased risk of death, so early detection by monitoring the patient and efficient treatment are of extreme importance. In this context, a complete multidisciplinary protocol for the management of AP, adapted to the characteristics of each center, can help us in clinical practice. In a recent experience, the application of such a protocol in a series of patients with AP in an intensive care unit (ICU) setting was associated with improved outcomes [3].