SEVERE ACUTE PANCREATITIS (SAP) REVIEW OF LITERATURE
Abstract:
In acute pancreatitis, infection of pancreatic or peripancreatic necrosis is the most important risk factor, determining the patientsş outcome. The mortality in patients with hemorrhagic necrotizing (severe) pancreatitis is of 10-24%. Pancreatic necrosis develops within the first 4 days after the onset of the disease. Infections occur in 40-70% of patients with SAP. The incidence of pancreatic infection is of 24, 36 and 71% in the first, second, and third weeks respectively. The detection of the infection of pancreatic or peripancreatic necrosis is reliably by ultrasound or by CT (computer tomography) guided fine needle puncture, followed by bacterial determination in culture. The surgery in acute pancreatitis is indicated in patients with SAP and proven infection. In SAP, which occurs in 15- 20% of the patients, is still a life threatening disease with mortality rates of up to 60% in old patients, with comorbidities. In the early phase, in the first 4 days in evolutions, the release of pancreatic enzymes and vasoactive substances leads to cardiovascular, pulmonary and renal disturbances. In the second phase of SAP, septic complications are the major cause of death.
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