Intensive Treatment of Acute Pancreatitis

Abstract

The first important step before treatment of acute pancreatitis is to determine the severity of the disease on which the prognosis depends. Pathologists differentiate an edematous from an hemorrhagic necrotizing form of the disease. However, there is no single clinical sign or laboratory test which, by itself, indicates the severity of acute pancreatitis. In 1976, Ranson et al., have described a prognostic index based upon multiple clinical and laboratory criteria collected during the first 48 h of evolution. We agree with McMahon et al. that the time required to complete Ranson’s prognostication, i.e. 48 h, is to long because, in the mean time, adequate therapeutic measures are delayed. Thus, there is a need for simple and early parameters for the recognition of acute necrotic hemorrhagic pancreatitis (ANHP). Pancreatic ascitis (the presence of brown free fluid or blood in the peritonium, rich in amylases, lipases) and methemalbuminemia, are two early signs of the severity of disease. The role of computerized tomography in assessing the severity of the disease has also been determined. The final correct diagnosis is obtained at laboratory or autopsy.