Acute pancreatitis

Acute pancreatitis is an acute inflammation of the pancreas with affection of local a/o more distant variable organs as well. The leading symptom is a severe upper abdominal pain. Pancreatitis is diagnosed by increased concentration of pancreas enzymes (blood amylase and lipase) in serum and urine. Most frequently, pancreatitis is caused by gallstones and alcohol. Decisive pathophysiological events are the activation of trypsin within the pancreas, intracellular activation of NF B and a secondary infection of a initially sterile necrosis. Around 20% of all patients with acute pancreatitis develop a severe or critical form of the disease and pose a particular challenge for intensive care due to high mortality rates of 20-50%. There is no specific treatment for acute pancreatitis. As patients' chances of survival mostly depend on the occurrence of complications, the central task of intensive care monitoring is the early recognization of complications and organ dysfunctions. The central therapeutic approach includes early goal-directed volume and cardiovascular therapy, sufficient analgesia and early tube feeding. An ERCP procedure is recommended in case of jaundice or cholangitis. Routine prophylaxis with antibiotics is not recommended. A targeted therapy with antibiotics and an interventional or operative approach is required in case of infected necrosis.