Reviews in basic and clinical GastroenterologyAcute Pancreatitis: Bench to the Bedside
Section snippets
Pathobiologic Processes
Figure 1 represents an overview of processes that need to be considered. This figure illustrates unique extrapancreatic and intrapancreatic cellular events/factors involved in disease pathogenesis. Examples of extracellular factors include vascular and neural participation in pancreatitis. Examples of intracellular events/factors are activation of digestive enzymes, inhibition of secretion, cell calcium, heat shock proteins, inflammatory signaling pathways, and cell death pathways. Figure 1
Causes of Pancreatitis
Figure 3 shows the relative distribution of the conditions associated with acute pancreatitis. We will now discuss our understanding of several of the most important conditions. Of note, autoimmune pancreatitis will be discussed in a future review on chronic pancreatitis.
Acute Pancreatitis: The Clinical Disorder
This section describes current approaches to management of acute pancreatitis and its complications.
Use of Antibiotics
Prophylactic antibiotic therapy does not have a role in the treatment of patients with interstitial pancreatitis.1 Patients with pancreatic necrosis may appear clinically septic early or throughout their long hospitalization. The development of leukocytosis, fever, and, in some cases, organ failure would be suggestive of the development of infected necrosis or bacteremia. Under these circumstances, antibiotic therapy should be initiated during the evaluation period. Once cultures (including
Summary and Future Directions
There have been significant advances in the supportive management and clinical strategies in dealing with complications of severe acute pancreatitis. However, there has been little or no progress in treating the underlying disorder using information about the pathobiology of the disorder from experimental models. Because the disease process progresses during hospital observation in this disorder, it seems very likely that treatments designed to address the pathobiologic process in this disorder
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Supported in part by NIH grants #DK 058694 and DK 072439 and intramural support from the Surgery department and School of Medicine of University of Minnesota to Dr Saluja; and USC-UCLA Center for Alcoholic Liver and Pancreatic Diseases for Dr Pandol.