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Akute Pankreatitis

  • Schwerpunkt: Gastroenterologische Notfälle
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Zusammenfassung

Die interstitielle akute Pankreatitis nimmt meist einen guten, die nekrotisierende Form dagegen durch häufige lokale und systemische Komplikationen einen schweren Verlauf. Notwendig ist nach einer raschen Diagnosestellung die Beurteilung des Schweregrades zur Einschätzung der Prognose. Dabei stimmen klinisches Bild und das Ergebnis bildgebender Verfahren nicht immer überein. Zur Basistherapie gehört die Behandlung der Schmerzsymptomatik sowie eine Flüssigkeits-, Elektrolyt-, Eiweiß- und Kaloriensubstitution. Hinzu kommt die systemische Therapie von Komplikationen, vor allem von Schock, respiratorischer und renaler Insuffizienz. Beim Nachweis von Pankreasnekrosen wird die prophylaktische Gabe von pankreasgängigen Antibiotika diskutiert. Bei infizierten Nekrosen und schwerem klinischen Bild ist die Operation die Therapie der Wahl. In etwa 10% der Fälle mit einer alkoholinduzierten Pankreatitis kommt es zu einem allmählichen Übergang in eine chronische Pankreatitis.

Abstract

While interstitial acute pancreatitis usually takes a benign course, necrotizing acute pancreatitis takes a severe course, mainly because of severe local and systemic complications. After a quick diagnosis it is necessary to rapidly assess a degree of severity of the disease and thus the prognosis. The clinical picture and the result of imaging procedures do not always correspond. The management basically includes to treat pain as well as to administer fluid, electrolyte, protein and calories. In addition, systemic treatment of complications such as shock or respiratory and renal insufficiency—if occurring—is necessary. In case of pancreatic necrosis, prophylactic administration of pancreas-penetrable antibiotics is recommended to avoid infection. In the severely ill with infected pancreatic necrosis, surgery is the treatment of choice. In approximately 10% of all patients with alcohol-induced pancreatitis, there is a gradual transition to chronic pancreatitis.

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Wagner, S., Lübbers, H., Mahlke, R. et al. Akute Pankreatitis. Internist 44, 557–569 (2003). https://doi.org/10.1007/s00108-003-0910-z

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