Current trends in acute pancreatitis: Diagnostic and therapeutic challenges

Table 1 Etiology of acute pancreatitis

Causes of acute pancreatitis
Toxic and metabolic
	Alcohol
	Hyperlipidemia (triglycerides > 600 mg)
	Hypercalcemia (hyperparathyroidism)
	Diabetes mellitus
	Hypothyroidism
	Uremia
	Drugs (medicaments)
	Scorpion venom
Mechanical
	Gallstones, biliary sludge
	Ampullary obstruction (Crohn’s disease, villous tumors of the ampulla)
	Pancreatic obstruction (pancreatic tumor, chronic pancreatitis)
	Sphincter of Oddi dysfunction
	Pancreas divisium
	Post ERCP-pancreatitis
	Congenital malformation
	Trauma
Others
	Ischemia
	Organ transplantation (bone marrow transplantation)
	Iatrogenic injury
	Infection
	Hereditary
	Autoimmune
	Cystic fibrosis
	Tropical (Ascaris lumbricoides)
	Idiopathic pancreatitis

ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Management of acute pancreatitis

Cornerstone treatment measures
Intensive monitoring and support of cardiac, pulmonary, renal, and hepatobiliary functions
	Fluid resuscitation with monitoring of vital constants and urine output
	Electrolyte solutions and Plasma expanders
	Humidified oxygen administration
	Catecholamine (dopamine, dobutamine) to prevent renal failure
Appropriate nutritional support
Early treatment of systemic complications
	Mechanical ventilation with positive end-expiratory pressure
	Catecholamine (epinephrine) if shock develops
	Hemofiltration, dialysis
	Insulin and calcium substitution to treat metabolic complications
Prevention of infectious complications
Biliary tract management
Management of necrotizing pancreatitis
	Conservative, Imaging, Endoscopic, Surgical management
Management of late complications
	Pancreatic pseudocysts
	Walled-off pancreatic necrosis
	Disconnected pancreatic duct syndrome/pancreatic fistula
	Acute non-infectious complications in acute pancreatitis
		Intra-abdominal hypertension
		Pseudoaneurysm
		Venous thrombosis
		Bowel fistula
Management of special types of acute pancreatitis
	Pediatric
	Hyperparathyroidism
	Hypertriglyceridemia
	Post-ERCP pancreatitis
	Trauma
	Pregnancy
Long term complications and long-term care

ERCP: Endoscopic retrograde cholangiopancreatography.