Importance of early diagnostic and therapeutic procedures in patients with acute pancreatitis

Akutni pankreatitis je bolest karakterizirana nekroinflamatornim promjenama u pankreasnom i peripankreasnom tkivu. Opažen je porast incidencije u posljednja dva desetljeća, a trenutno je ova bolest jedan od najčešćih gastroenteroloških indikacija za hospitalizaciju. Najčešći etiološki čimbenici su žučni kamenci i alkohol. Smatra se da je patogeneza upale autodigestija, koja je rezultat prerane aktivacije pankreasnih enzima. Klinička slika uključuje bol u trbuhu praćen mučninom i povraćanjem. U diferencijalnoj dijagnozi treba misliti na druge bolesti s kliničkom slikom akutnog abdomena. U laboratorijskoj dijagnostici, najvažniji pokazatelji su trostruki porast amilaze i lipaze. Endoskopski ultrazvuk omogućuje rano otkrivanje žučnih kamenaca, dok CT detektira nekrozu. U procjeni težine bolesti koriste se različiti sustavi bodovanja, npr. Ransonovi kriteriji i APACHE II. Blaži oblici akutnog pankreatitisa imaju samoograničavajući tijek te zahtjevaju samo osnovnu skrb i potpornu terapiju. Teži slučajevi su često praćeni lokalnim i/ili sustavnim komplikacijama koje mogu zahtjevati primjenu invazivnog liječenja, kao što su endoskopski i kirurški postupci. Infekcija je komplikacija koja najviše doprinosi mortalitetu. Rana dijagnoza teškog akutnog pankreatitisa, kao i primjena odgovorajućih terapijskih postupaka, dovela je do smanjenja mortaliteta.Acute pancreatitis is a disease characterized by necroinflammatory changes in pancreatic and peripancreatic tissue. Rising incidence has been noted in last two decades, and this disease is now one of the most common gastrointestinal indications for hospitalization. The most common etiologic factors are gallstones and alcohol. Suspected pathogenesis of inflammation is autodigestion, which is a result of premature activation of pancreatic enzymes. Clinical features include abdominal pain, accompanied with nausea and vomiting. Other diseases, with acute abdomen as a clinical presentation, should be considered in a differential diagnosis. In laboratory diagnostics, most immportant indicators are three times elevated levels of amylase and lipase. Endoscopic ultrasound allows early detection of gallstanos, while CT detects necrosis.Various scoring systems, such as Ranson criteria and APACHE II, are used in assessment of disease severity. Mild cases of acute pancreatitis run a self- limiting course and require only basic care and supportive therapy. More severe cases are often accompanied with local and/or systemic complications, which may require use of invasive therapy such as endoscopic and surgical procedures. Infection is a complication with highest contribution to mortality. Early diagnosis of severe acute pancreatitis, and application of appropriate therapeutic procedures, have led to decrease in mortality