Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1996 May;72(847):277–283. doi: 10.1136/pgmj.72.847.277

Acute pancreatitis: assessment and management.

P Skaife 1, A N Kingsnorth 1
PMCID: PMC2398463  PMID: 8761500

Abstract

In the 1920s Moynihan described acute pancreatitis as "..the most terrible of all intra-abdominal calamities". He established a practice of immediate surgical intervention to remove the toxic products accumulating in the peritoneal cavity, and this treatment was endorsed by most centres, remaining the standard therapy for the next 20 years. In the 1940s, the mortality of patients treated surgically was shown to be far higher than those treated conservatively, and a more conservative line of management was recommended, comprising nasogastric stomach decompression, intravenous fluid therapy, opiate analgesia, and the administration of atropine. Despite half a century passing, a clinician would not be criticised for adopting such a regime today, which in part reflects the lack of understanding of this condition and the failure of seemingly appropriate therapy. Reduction in mortality is a consequence of advances in intensive care preventing the high early mortality of organ failure, but the area of specific therapy remains elusive. While this is so, the mortality rates for these patients will remain static, while the doctor continues to feel clinically impotent.

Full text

PDF
277

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acosta J. M., Rossi R., Galli O. M., Pellegrini C. A., Skinner D. B. Early surgery for acute gallstone pancreatitis: evaluation of a systematic approach. Surgery. 1978 Apr;83(4):367–370. [PubMed] [Google Scholar]
  2. Balthazar E. J., Ranson J. H., Naidich D. P., Megibow A. J., Caccavale R., Cooper M. M. Acute pancreatitis: prognostic value of CT. Radiology. 1985 Sep;156(3):767–772. doi: 10.1148/radiology.156.3.4023241. [DOI] [PubMed] [Google Scholar]
  3. Bradley E. L., 3rd, Murphy F., Ferguson C. Prediction of pancreatic necrosis by dynamic pancreatography. Ann Surg. 1989 Oct;210(4):495–504. doi: 10.1097/00000658-198910000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cameron J. L., Mehigan D., Zuidema G. D. Evaluation of atropine in acute pancreatitis. Surg Gynecol Obstet. 1979 Feb;148(2):206–208. [PubMed] [Google Scholar]
  5. Fernández-del Castillo C., Rattner D. W., Warshaw A. L. Acute pancreatitis. Lancet. 1993 Aug 21;342(8869):475–479. doi: 10.1016/0140-6736(93)91598-g. [DOI] [PubMed] [Google Scholar]
  6. Fernández-del Castillo C., Schmidt J., Warshaw A. L., Rattner D. W. Interstitial protease activation is the central event in progression to necrotizing pancreatitis. Surgery. 1994 Sep;116(3):497–504. [PubMed] [Google Scholar]
  7. Gamble J. R., Harlan J. M., Klebanoff S. J., Vadas M. A. Stimulation of the adherence of neutrophils to umbilical vein endothelium by human recombinant tumor necrosis factor. Proc Natl Acad Sci U S A. 1985 Dec;82(24):8667–8671. doi: 10.1073/pnas.82.24.8667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gjørup I., Roikjaer O., Andersen B., Burcharth F., Hovendal C., Pedersen S. A., Christiansen P., Wara P., Andersen J. C., Balslev I. A double-blinded multicenter trial of somatostatin in the treatment of acute pancreatitis. Surg Gynecol Obstet. 1992 Nov;175(5):397–400. [PubMed] [Google Scholar]
  9. Harada H., Miyake H., Ochi K., Tanaka J., Kimura I. Clinical trial with a protease inhibitor gabexate mesilate in acute pancreatitis. Int J Pancreatol. 1991 Summer;9:75–79. doi: 10.1007/BF02925581. [DOI] [PubMed] [Google Scholar]
  10. Imrie C. W., Benjamin I. S., Ferguson J. C., McKay A. J., Mackenzie I., O'Neill J., Blumgart L. H. A single-centre double-blind trial of Trasylol therapy in primary acute pancreatitis. Br J Surg. 1978 May;65(5):337–341. doi: 10.1002/bjs.1800650514. [DOI] [PubMed] [Google Scholar]
  11. Kelly T. R., Wagner D. S. Gallstone pancreatitis: a prospective randomized trial of the timing of surgery. Surgery. 1988 Oct;104(4):600–605. [PubMed] [Google Scholar]
  12. Knaus W. A., Draper E. A., Wagner D. P., Zimmerman J. E. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed] [Google Scholar]
  13. Koike H., Steer M. L., Meldolesi J. Pancreatic effects of ethionine: blockade of exocytosis and appearance of crinophagy and autophagy precede cellular necrosis. Am J Physiol. 1982 Apr;242(4):G297–G307. doi: 10.1152/ajpgi.1982.242.4.G297. [DOI] [PubMed] [Google Scholar]
  14. Largman C., Reidelberger R. D., Tsukamoto H. Correlation of trypsin-plasma inhibitor complexes with mortality in experimental pancreatitis in rats. Dig Dis Sci. 1986 Sep;31(9):961–969. doi: 10.1007/BF01303217. [DOI] [PubMed] [Google Scholar]
  15. London N. J., Neoptolemos J. P., Lavelle J., Bailey I., James D. Serial computed tomography scanning in acute pancreatitis: a prospective study. Gut. 1989 Mar;30(3):397–403. doi: 10.1136/gut.30.3.397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Mayer A. D., McMahon M. J., Bowen M., Cooper E. H. C reactive protein: an aid to assessment and monitoring of acute pancreatitis. J Clin Pathol. 1984 Feb;37(2):207–211. doi: 10.1136/jcp.37.2.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Mayer A. D., McMahon M. J., Corfield A. P., Cooper M. J., Williamson R. C., Dickson A. P., Shearer M. G., Imrie C. W. Controlled clinical trial of peritoneal lavage for the treatment of severe acute pancreatitis. N Engl J Med. 1985 Feb 14;312(7):399–404. doi: 10.1056/NEJM198502143120703. [DOI] [PubMed] [Google Scholar]
  18. McMahon M. J., Bowen M., Mayer A. D., Cooper E. H. Relation of alpha 2-macroglobulin and other antiproteases to the clinical features of acute pancreatitis. Am J Surg. 1984 Jan;147(1):164–170. doi: 10.1016/0002-9610(84)90052-7. [DOI] [PubMed] [Google Scholar]
  19. McMahon M. J., Bowen M., Mayer A. D., Cooper E. H. Relation of alpha 2-macroglobulin and other antiproteases to the clinical features of acute pancreatitis. Am J Surg. 1984 Jan;147(1):164–170. doi: 10.1016/0002-9610(84)90052-7. [DOI] [PubMed] [Google Scholar]
  20. Moynihan B. ACUTE PANCREATITIS. Ann Surg. 1925 Jan;81(1):132–142. doi: 10.1097/00000658-192501010-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Neoptolemos J. P., Carr-Locke D. L., London N. J., Bailey I. A., James D., Fossard D. P. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet. 1988 Oct 29;2(8618):979–983. doi: 10.1016/s0140-6736(88)90740-4. [DOI] [PubMed] [Google Scholar]
  22. Patti M. G., Pellegrini C. A. Gallstone pancreatitis. Surg Clin North Am. 1990 Dec;70(6):1277–1295. doi: 10.1016/s0039-6109(16)45284-9. [DOI] [PubMed] [Google Scholar]
  23. Steer M. L. How and where does acute pancreatitis begin? Arch Surg. 1992 Nov;127(11):1350–1353. doi: 10.1001/archsurg.1992.01420110098019. [DOI] [PubMed] [Google Scholar]
  24. Steer M. L., Meldolesi J. The cell biology of experimental pancreatitis. N Engl J Med. 1987 Jan 15;316(3):144–150. doi: 10.1056/NEJM198701153160306. [DOI] [PubMed] [Google Scholar]
  25. Suzuki M., Isaji S., Stanten R., Frey C. F., Ruebner B. Effect of protease inhibitor FUT-175 on acute hemorrhagic pancreatitis in mice. Int J Pancreatol. 1992 Feb;11(1):59–65. [PubMed] [Google Scholar]
  26. Söling H. D., Fest W. Synthesis of 1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine (platelet-activating factor) in exocrine glands and its control by secretagogues. J Biol Chem. 1986 Oct 25;261(30):13916–13922. [PubMed] [Google Scholar]
  27. Tjoelker L. W., Wilder C., Eberhardt C., Stafforini D. M., Dietsch G., Schimpf B., Hooper S., Le Trong H., Cousens L. S., Zimmerman G. A. Anti-inflammatory properties of a platelet-activating factor acetylhydrolase. Nature. 1995 Apr 6;374(6522):549–553. doi: 10.1038/374549a0. [DOI] [PubMed] [Google Scholar]
  28. Viedma J. A., Pérez-Mateo M., Agulló J., Domínguez J. E., Carballo F. Inflammatory response in the early prediction of severity in human acute pancreatitis. Gut. 1994 Jun;35(6):822–827. doi: 10.1136/gut.35.6.822. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Wilson C., Imrie C. W. Effective intraperitoneal antiprotease therapy for taurocholate-induced pancreatitis in rats. Br J Surg. 1990 Nov;77(11):1252–1255. doi: 10.1002/bjs.1800771118. [DOI] [PubMed] [Google Scholar]
  30. Wisner J. R., Jr, Renner I. G., Grendell J. H., Niederau C., Ferrell L. D. Gabexate mesilate (FOY) protects against ceruletide-induced acute pancreatitis in the rat. Pancreas. 1987;2(2):181–186. doi: 10.1097/00006676-198703000-00010. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES