Pancreatitis Management Update急性胰腺炎的更新管理课件.ppt

Value of Percutaneous Aspiration of the Pancreas (CT-FNA) CT-FNA is safe and accurate in distinguishing sterile from infected necrosis CT-FNA results dictate that appropriate antibiotics can be initiated based on the results of culture and sensitivity and surgical debridement Observation and support to overcome organ failure should be maintained during the first several weeks of acute pancreatitis in patients with sterile necrosis based on CT-FNA therapy because of the high mortality associated with early surgical debridement Pappas TN. Am J Gastroenterol 2005;100:2371-2374 Treatment Guideline V:Treatment of Infected Necrosis CT-guided percutaneous aspiration with Gram’s stain and culture aspirate is recommended when infected necrosis is suspected Treatment of choice in infected necrosis is surgical debridement Level of Evidence III ACG Practice Guidelines in Acute Pancreatitis. Am J Gastroenterol 2006;101:2379-2400 Route of Alimentation TPN Cost – high No pancreas stimulation Increased infections Electrolyte disturbances Detrimental to gut integrity Enteral Cost – moderate May stimulate pancreas Reduced infections Electrolytes undisturbed May retain gut integrity Acute Pancreatitis: Nutrition Route of Alimentation Acute Pancreatitis Negative effects of TPN Increased gut permeability Increased central catheter-related sepsis Immunosuppressive effects Increased incidence of septic complications Greatly increased costs Total Parenteral Nutrition (TPN) andEnteral Nutrition (EN) TPN – causes intestinal mucosal atrophy alterations in the gut associated lymphoid tissue (GALT) system and a reduction in intestinal secretory IgA (S-IgA) levels EN – prevents hypermetabolism, maintains immunocompetence and improves wound healing; considered to reduce septic complications, shorten hospital stay and reduce the risk of death Levine GM, et al Gastro 1974:67:975 King BK, et al. Arch Surg Kudsk KA, et al Ann Surg 1996:223:629 Mochizuk H, et al Ann Surg 1984;200:297-310 Al