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Akute Pankreatitis

Diagnostik und moderne Therapie

Acute pancreatitis

Diagnostics and modern therapy

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Der Gastroenterologe Aims and scope

Zusammenfassung

Bei klinischem Verdacht auf eine akute Pankreatitis ist es vordringlich, zeitgerecht die Diagnose zu sichern, da die konzeptionelle Planung des therapeutischen Vorgehens hiervon unmittelbar abhängig ist. Der Ausschluss von Differenzialdiagnosen, die Klärung der Ätiologie und vor allem die Evaluierung von Schweregrad und Prognose der akuten Pankreatitis sind für den Verlauf von entscheidender Bedeutung. Eine spezifische Therapie steht nicht zur Verfügung. Moderne Therapieoptionen zielen auf die konservative Optimierung eines schweren, komplizierten Verlaufes durch Ausschöpfung der Intensivtherapie ab und sind geeignet, eine häufig im frühen Verlauf der schweren Entzündung geplante operative Nekrosektomie in ein späteres Intervall mit geringerem Mortalitätsrisiko zu verschieben. Nicht selten ist die Nekrosektomie auch vermeidbar (bei sterilen Nekrosen regelhaft) und nur in besonderen Fällen als lokaler Eingriff durchzuführen. Trotz der prognoserelevanten Nekroseinfektion haben gerade die intensivmedizinischen Therapieoptionen zu einem Absenken der Mortalität von ca. 30–50% auf 15–25% in Zentren bei der schweren nekrotisierenden Verlaufsform geführt.

Abstract

The timely diagnosis of acute pancreatitis is important for developing a therapeutic strategy. Differential diagnosis, clarification of the etiology, evaluation of severity and determination of a prognosis are crucial for the course of the disease. Due to the lack of specific therapy, modern therapeutic options aim to optimize the conservative treatment by exploiting ITU care. These benefit especially from the experience of new insights in sepsis and ventilation treatment. The major aims are to stabilize the course and postpone possible complications, such as infection of the necrosis, in the late phase of the disease. Sterile necrosis can be treated medically, but surgery for infected necrosis is still usual. However, timing of the intervention is under discussion, and there is evidence that medical treatment only may be as beneficial as surgery. Percutaneous or minimally invasive strategies in case of infected necrosis are under evaluation. In general, with the use of a careful, modern therapeutic approach, mortality in severe necrotizing pancreatitis has decreased to 15–25%.

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  1. Klinik für Gastroenterologie und Stoffwechselerkrankungen, Zentrum für Innere Medizin der Kliniken Essen Süd

    M. Rünzi & K. U. Rehbehn

  2. Klinik für Gastroenterologie und Stoffwechselerkrankungen, Zentrum für Innere Medizin der Kliniken Essen Süd, Propsteistraße 2, 45239, Essen

    M. Rünzi

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Rünzi, M., Rehbehn, K.U. Akute Pankreatitis. Gastroenterologe 1, 10–17 (2006). https://doi.org/10.1007/s11377-006-0006-0

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