Organ Failure and Acute Pancreatitis
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This chapter discusses the relationship of organ failure to outcome in acute pancreatitis. Current definition of severe acute pancreatitis includes the persistence of organ failure for more than 48 h, such patients have at least 35 % mortality. Organ failure that resolves is termed transient and defines moderately severe disease.
Most patients with organ failure show signs of the systemic inflammatory response syndrome (SIRS), and this may be an early marker of severe pancreatitis.
Treatment measures currently available are supportive, with provision of adequate (but not excessive) fluid resuscitation, oxygen supplements, and pain relief. The use of intravenous contrast for CT should be avoided if possible during the first week.
The evidence to support the choice of resuscitation fluid (Ringer lactate) and the use of early goal-directed therapy is described. Future advances will come from better understanding of the complex pathways that mediate SIRS and the development of agents able to block this response.
KeywordsAcute Pancreatitis Organ Failure Systemic Inflammatory Response Syndrome Severe Acute Pancreatitis Hydroxyethyl Starch
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