Classification, Severity Assessment, and Prevention of Recurrences in Acute Pancreatitis

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Seppänen , H & Puolakkainen , P 2020 , ' Classification, Severity Assessment, and Prevention of Recurrences in Acute Pancreatitis ' , Scandinavian Journal of Surgery , vol. 109 , no. 1 , pp. 53-58 . https://doi.org/10.1177/1457496920910007

Title: Classification, Severity Assessment, and Prevention of Recurrences in Acute Pancreatitis
Author: Seppänen, H.; Puolakkainen, P.
Contributor: University of Helsinki, CAN-PRO - Translational Cancer Medicine Program
University of Helsinki, HUS Abdominal Center
Date: 2020-03
Language: eng
Number of pages: 6
Belongs to series: Scandinavian Journal of Surgery
ISSN: 1457-4969
URI: http://hdl.handle.net/10138/314703
Abstract: Background: Acute pancreatitis is a common disease, the incidence of which is 75-100/100,000/year in Finland. The worldwide incidence of acute pancreatitis is increasing. The identified mildcases usually show rapid recovery with conservative treatment allowing early discharge. Severe cases need early intensive care to reduce the risk of serious complications such as multi-organ failure. The revised Atlanta classification of acute pancreatitis was introduced in 2012-2013. A recurrent acute pancreatitis is defined as two or more well-documented separate attacks of acute pancreatitis with complete resolution in between. Alcoholic pancreatitis is the most common recurrent acute pancreatitis type. Methods: In this review current severity classifications and literature on the prevention of recurrent acute pancreatitis are analyzed. Results: The severity of the disease is classified as mild, moderately severe, and severe acute pancreatitis. Novel entities include acute peripancreatic fluid collections in mild acute pancreatitis and acute necrotic collections in necrotizing acute pancreatitis lesser than 4 weeks after the onset and pancreatic pseudocyst in mild acute pancreatitis and walled-off necrosis in necrotizing acute pancreatitis more than 4 weeks after the onset of the disease. After the first attack of alcohol-induced acute pancreatitis, 46% of the patients develop at least one recurrence within 10- to 20-year follow-up. With repeated intervention against alcohol consumption, it is possible to reduce the recurrences. Removing the gall bladder after biliary pancreatitis is the key preventing recurrences. In mild cases, even during the index admission; in severe cases, it is recommended to wait until the inflammatory changes have resolved. Of total, 59% of the idiopathic pancreatitis had sludge of stones in the gall bladder. In other etiologies, addressing the etiological factor may prevent recurrent acute pancreatitis. Conclusions: This review describes current use of novel severity classifications and also different possibilities to prevent recurrent acute pancreatitis with different etiologies including idiopathic.
Subject: acute pancreatitis
severity
recurrent pancreatitis
prevention
DETERMINANT-BASED CLASSIFICATION
ALCOHOL-ASSOCIATED PANCREATITIS
IDIOPATHIC ACUTE-PANCREATITIS
PERSISTENT ORGAN FAILURE
TERM-FOLLOW-UP
ATLANTA CLASSIFICATION
EARLY PREDICTION
RISK-FACTORS
LAPAROSCOPIC CHOLECYSTECTOMY
NATURAL-HISTORY
3126 Surgery, anesthesiology, intensive care, radiology
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