Current developments in diagnosis and treatment of acute pancreatitis

Akutni pankreatitis upalna je bolest nastala pretjeranom aktivacijom enzima gušterače, osobito tripsina, koja nastaje djelovanjem različitih etioloških čimbenika kod osoba s određenom genetskom predispozicijom. Iako je učestalost bolesti u porastu, posljednjih desetljeća smrtnost se smanjila uslijed brojnih napredaka u dijagnostičkom i terapijskom pristupu. Rutinska upotreba endoskopskog ultrazvuka dovela je do boljeg dijagnosticiranja etiologije, poboljšanog razumijevanja i klasificiranja peripankreatičnih kolekcija, te naročito razvoja endoskopskih, minimalno invazivnih metoda liječenja inficiranih nekrotičnih kolekcija, koje predstavljaju glavni uzrok odgođenog mortaliteta. Utjecaj na prognozu bolesti imali su i pomaci u konzervativnom liječenju, osobito vezano za enteralnu i parenteralnu prehranu, izbjegavanje rutinske, prijevremene primjene antibiotika i sprečavanje razvoja sindroma abdominalnog kompartmenta. Revidirana je klasifikacija peripankreatičnih kolekcija, a osim endoskopskih, razvijene su i minimalno invazivne, perkutane kirurške metode, koje su znatno smanjile smrtnost ranijih otvorenih kirurških zahvata. Prepoznata je važnost sustavnog pristupa liječenju ove bolesti u specijaliziranim jedinicama, te se najbolji rezultati postižu uz kvalitetnu multidisciplinarnu suradnju visokospecijaliziranih stručnjaka.Acute pancreatitis is an inflammatory disease caused by excessive activation of pancreatic enzymes, especially trypsin, which is caused by various etiological factors in people with a certain genetic predisposition. Although, there is a rising incidence of acute pancreatitis, during the last few decades mortality decreased due to better diagnostic and therapic procedures. Routine use of endoscopic ultrasound has led to better diagnosis of etiology, improved understanding and classification of peripancreatic collections, and especially to the development of endoscopic, minimally invasive methods of treating infected necrotic collections, which are a major cause of delayed mortality. Advances in conservative treatment, especially in enteral and parenteral nutrition, avoidance of routine premature administration of antibiotics and prevention of the development of abdominal compartment syndrome, also had an impact on the prognosis of the disease. The classification of peripancreatic collections has been revised, and besides endoscopic, minimally invasive, percutaneous surgical methods have been developed, which have significantly reduced the mortality of previously open surgical procedures. The importance of a systematic approach to the treatment of this disease in specialized units has been recognized, and the best results are achieved with quality multidisciplinary cooperation of highly specialized experts