Acute pancreatitis

• Acute pancreatitis may be clinically mild or severe.
• Severe acute pancreatitis is usually a result of pancreatic glandular necrosis.
• The morbidity and mortality associated with acute pancreatitis are substantially higher when necrosis is present
• has a rapid onset manifested by upper abdominal pain, vomiting, fever,tachycardia, leukocytosis, and elevated serum levelsof pancreatic enzymes
• Gallstones and alcohol abuse are the most common causes in the United States.
• Ranson's score is based on 11 clinical signs with prognostic importance; 5 are measured at the time of admission and the other 6 in the first 48 hours after admission
• Necrosis is present in approximately 20 to 30 percent of acute pancreatitis per year in the United States.
• In a recent prospective trial: the incidence of gram-negative pancreatic infection and late mortality were significantly reduced in patients with necrotizing pancreatitis who were treated with selective gut decontamination.
• At the present time, intravenous administration of imipenem-cilastatin is recommended. ,continue for at least two to four weeks.
• Selection of appropriate agent should be made based on ability to penetrate the pancreas. Third generation cephs, pipericillin, metronidazole, imipenem/cilistatin, and certain quinolones.

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