Acute pancreatitis is a kind of local or systemic inflammatory disease originating from the pancreas, with high morbidity and mortality. The most common cause of morbidity of acute pancreatitis is pancreatic duct obstruction secondary to biliary calculi. Other causes include hypertriglyceridemia, alcohol, endoscopic retrograde cholangiopancreatography (ERCP), and various drugs, which ultimately lead to acute pancreatitis by triggering pathological cell pathways and organelle dysfunction. The main pathophysiological manifestations are acinar cell death and local and systemic inflammatory responses. The main pathophysiological events of morbidity mechanism in acute pancreatitis include pathological calcium signaling pathway activation, mitochondrial dysfunction, premature activation of trypsinogen in acinar cells, endoplasmic reticulum stress and unfolded protein response, impaired autophagy and inflammatory cell infiltration.
Acute pancreatitis is diagnosed
when two of the following three criteria are met: ① symptoms of typical abdominal pain; ② elevation of serum amylase and/or lipase to more than 3 times the upper limit of normal; and ③ radiological characteristic consistent with acute pancreatitis. Abdominal CT examination is the most commonly used imaging examination for the diagnosis of acute pancreatitis. Findings included pancreatic tissue edema and peripancreatic fatty infiltration and peripancreatic fluid accumulation. Diagnosis of necrotizing pancreatitis requires contrast-enhanced CT. Necrosis usually occurs 72 hours after the onset of symptoms. The commonly used severity classification of acute pancreatitis is mainly RAC classification: mild acute pancreatitis (MAP), accounting for 80% ~ 85% of acute pancreatitis, is not accompanied by organ dysfunction and local or systemic complications, usually recovers within 1 ~ 2 weeks, with a very low mortality rate; Moderate and severe acute pancreatitis (moderately severe acute pancreatitis, MSAP), with transient (≤ 48h) organ dysfunction and (or) local complications, early mortality rate is low, such as necrotic tissue combined with infection, the mortality rate is increased; Severe acute pancreatitis (severe acute pancreatitis, SAP), accounting for 5% to 10% of acute pancreatitis, is associated with persistent (> 48 H) organ dysfunction and high mortality rate. The diagnostic criteria for organ dysfunction were based on the modified Mar. Shall scoring system, with the presence of organ dysfunction defined by a score of ≥ 2 for any organ.
At present, there is no specific drug treatment for acute pancreatitis. The treatment of acute pancreatitis, especially SAP with various complications, is a complex problem involving surgery, digestive medicine, emergency department, critical care medicine, infection department, intervention department, nutrition department, rehabilitation department and other disciplines. The MDT model should be used. The early treatment of acute pancreatitis mainly includes fluid therapy, analgesia and nutritional support, as well as the treatment of etiology and early complications. According to the guidelines, early and appropriate fluid resuscitation is the cornerstone of the treatment of acute pancreatitis, and lactated Ringer’s solution, normal saline and other crystalloid solutions are the first choice for fluid resuscitation. Pain is the main symptom of acute pancreatitis, so pain relief is an important goal of clinical treatment. Patients with acute pancreatitis with obvious pain should receive analgesic treatment within 24 hours of admission. Studies have shown that compared with parenteral nutrition, enteral nutrition is safe and tolerable for patients with acute pancreatitis of different severity, and can reduce the incidence of infectious complications, multiple organ dysfunction and mortality rate. Other treatments include lipid-lowering treatment for acute pancreatitis caused by hyperlipidemia, antimicrobial therapy for infectious pancreatic necrosis, interventional therapy such as abdominal puncture and catheterization, and surgical intervention.
Acute pancreatitis
