Questioning Medicine3 Mai 2024

Episode 283: 282. New Guidelines For Management of Acute Pancreatitis

https://journals.lww.com/ajg/fulltext/2024/03000/american_college_of_gastroenterology_guidelines_.14.aspx

2 of the 3 following criteria: (i) abdominal pain consistent with the disease, (ii) serum amylase and/or lipase greater than 3 times the upper limit of normal, and/or (iii) characteristic findings from abdominal imaging

Fluid--

Moderately aggressive fluid resuscitation with lactated Ringer's solution should be started (NEJM JW Gen Med Oct 1 2023 and Am J Gastroenterol 2023; 118:2258), defined as a bolus of 10 mL/kg followed by infusion of 1.5 mL/kg/hour (NEJM JW Gen Med Oct 15 2022 and N Engl J Med 2022; 387:989), and additional boluses can be given if a patient has evidence of hypovolemia.

Feeding-- Early oral feeding (within 24–48 hours) should begin with a low-fat solid diet (as opposed to liquid) for patients with mild AP.

Surgery-

Patients with mild acute biliary pancreatitis should undergo cholecystectomy early, preferably before discharge.

Following a second episode of AP with no identifiable cause, in patients fit for surgery, we suggest performing a cholecystectomy to reduce the risk of recurrent episodes of AP.

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