| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 2.13 MB | Adobe PDF |
Advisor(s)
Abstract(s)
A pancreatite aguda define-se como um processo inflamatório do
pâncreas e a sua incidência tem aumentado mas últimas décadas, em vários
países. Apesar do processo patológico poder ser limitado ao pâncreas, a
chamada pancreatite aguda ligeira, também pode condicionar envolvimento
local e sistémico. Um episódio de pancreatite aguda grave tem uma taxa de
mortalidade elevada e a sua abordagem correcta é ainda alvo de controvérsia.
O conhecimento limitado da fisiopatologia e a multi-causalidade da doença
dificultam o seguimento e a terapêutica. A estratificação do risco, com
identificação precoce dos sinais de gravidade é fulcral para a correcta
abordagem terapêutica do episódio.
Este trabalho tem como objectivo fazer uma revisão das complicações
associadas à pancreatite aguda e recolher a informação mais actualizada
acerca da sua correcta abordagem. Para isso, foi realizada uma revisão
bibliográfica, utilizando obras de referência nas áreas da Cirurgia Geral e
Medicina Interna e bases de dados electrónicas, como Pubmed, Medscape e
Cochrane library.
Têm sido propostas novas terapêuticas para a abordagem inicial da
pancreatite aguda, mas os resultados têm sido desanimadores. A pancreatite
aguda grave implica envolvimento loco-regional e/ou sistémico. Os pulmões
são o órgão mais frequentemente atingido e a falência multi-orgânica é
responsável por grande parte das mortes devido a pancreatite aguda. As
complicações loco-regionais incluem colecções líquidas agudas, necrose
pancreática, pseudoquistos, abcessos, ascite e fístulas pancreáticas, trombose
da veia esplénica e pseudoaneurismas. Com o desenvolvimento de novas
técnicas, tratamentos alternativos estão a ser propostos e velhos paradigmas
começam a ser abandonados. As técnicas radiológicas e endoscópicas surgem
como opções terapêuticas de primeira linha, mas recomendações consensuais
para o seu uso são ainda limitadas a algumas situações. Este trabalho defende
a necessidade de mais estudos para a optimização do tratamento da
pancreatite aguda complicada.
Acute pancreatitis is a reversible inflammatory process of the pancreas. Its overall incidence has increased in many countries in the last decades. Although the disease process may be limited to the pancreas and called mild pancreatitis, it can also have local and systemic involvement with compromise of other organs. An acute attack of severe pancreatitis has a high death rate and its correct management is still controversial. Dealing with the clinical course of acute pancreatitis and management of severe acute pancreatitis are complicated by limited knowledge of pathogenesis and multi-causality of the disease. Accurate risk assessment with early recognition of severity signs is central to the correct management of the episode. This work intends to make a review of the various complications associated with acute pancreatitis and collect the most updated recommendations about their management. For that purpose a review of the literature was made, including reference books on general surgery and internal medicine and online databases like Pubmed, Medscape and Cochrane library. New therapeutic approaches are being proposed for the initial management of acute pancreatitis, but results are being disappointing. Severe acute pancreatitis implies systemic and/or loco-regional involvement. Lungs are the most common affected organ by systemic involvement of acute pancreatitis and multi-organic failure is one of the responsible for the high mortality of the disease. Local and regional complications include acute fluid collections, pancreatic necrosis with eventual necrosis, pseudocysts, abscesses, ascitis and pancreatic fistulas, splenic vein thrombosis and false aneurysms. With the advent of new techniques, alternative treatments are being proposed and old paradigms are being abandoned. Endoscopic and radiological approaches are now the first line therapeutic in many cases, but consensual recommendations are limited. This study concludes that more studies are necessary to determine the optimal management of severe acute pancreatites.
Acute pancreatitis is a reversible inflammatory process of the pancreas. Its overall incidence has increased in many countries in the last decades. Although the disease process may be limited to the pancreas and called mild pancreatitis, it can also have local and systemic involvement with compromise of other organs. An acute attack of severe pancreatitis has a high death rate and its correct management is still controversial. Dealing with the clinical course of acute pancreatitis and management of severe acute pancreatitis are complicated by limited knowledge of pathogenesis and multi-causality of the disease. Accurate risk assessment with early recognition of severity signs is central to the correct management of the episode. This work intends to make a review of the various complications associated with acute pancreatitis and collect the most updated recommendations about their management. For that purpose a review of the literature was made, including reference books on general surgery and internal medicine and online databases like Pubmed, Medscape and Cochrane library. New therapeutic approaches are being proposed for the initial management of acute pancreatitis, but results are being disappointing. Severe acute pancreatitis implies systemic and/or loco-regional involvement. Lungs are the most common affected organ by systemic involvement of acute pancreatitis and multi-organic failure is one of the responsible for the high mortality of the disease. Local and regional complications include acute fluid collections, pancreatic necrosis with eventual necrosis, pseudocysts, abscesses, ascitis and pancreatic fistulas, splenic vein thrombosis and false aneurysms. With the advent of new techniques, alternative treatments are being proposed and old paradigms are being abandoned. Endoscopic and radiological approaches are now the first line therapeutic in many cases, but consensual recommendations are limited. This study concludes that more studies are necessary to determine the optimal management of severe acute pancreatites.
Description
Keywords
Pancreatite Pancreatite aguda Necrose pancreática Ascite pancreática Veia esplénica - Trombose Pancreatite aguda - Terapêutica
Pedagogical Context
Citation
Publisher
Universidade da Beira Interior