Diagnosis of acute pancreatitis

The diagnosis of acute pancreatitis is still mainly based on the clinical signs and symptoms of the patients. Systemic organ failure, peritonitis and/or shock indicate severe disease, but to obtain optimal results of treatment the diagnosis of individual patients at high risk should be done before the development of systemic manifestations. A number of laboratory tests are valuable in the follow-up of the patients, but immediate onset of intensive therapy cannot be based on these tests. At present, contrast enhanced CT seems to be the most accurate method for the early detection of hemorrhagic/necrotizing forms of acute pancreatitis.     

Diagnosis of acute destructive biliary pancreatitis

The article presents an analysis of results of examinations and treatment of 98 patients and an assessment of the clinical picture, laboratory and instrumental findings. The significance of USI as a method of screening diagnosis is stressed. The indications and possible endoscopic and videolaparoscopic interventions for the diagnosing and treatment of acute destructive biliary pancreatitis (ADP) are determined. The author proposes an algorithm of the diagnosing and treatment of ADP. The use of the algorithm allowed the postoperative lethality after ADP to be decreased from 20.8% to 14%.     

Diagnosis and treatment of acute pancreatitis

In diagnosis of acute pancreatitis of special importance is determination of the activity of transamidinase, phospholipase A, lipase, concentration of copper, calcium and triglycerides in blood serum as well as laparoscopy with biopsy and local thermometry of the pancreas. The dosage of 5-fluoruracil in the complex treatment of patients should be differentiated corresponding to the form of the disease: 3 mg/kg in the endomatous form, 5 mg/kg in the destructive form. The general lethality was 1.4%. In conservative treatment there were no lethal outcomes.     

Therapy of acute pancreatitis]

From 1973 to 1990 190 consecutive patients were admitted to the department of surgery of the Stadtspital Waid, Zurich, with a diagnosis of acute pancreatitis. 53 patients received conservative treatment, 93 patients with acute pancreatitis thought to be due to gallstones underwent cholecystectomy, in 23 cases combined with choledochotomy. 44 patient underwent pancreatic surgery. 10 diagnostic laparotomies, 14 necrosectomies, 6 pancreatic left resections and one subtotal pancreatectomy were performed. 9 pseudocysts and 4 pancreatic abscesses had to be drained. Over all mortality for operated patients was 29.5%, exceeding 50% for patients with operation within the first week of the disease. During the first ten years of our study we performed operations earlier and more often than in the following years (26 versus 17%). This more conservative management resulted in a marked reduction of mortality and complications. Today we try to control the first 8 to 10 days of the attack by intensive care and postpone pancreatic operations whenever possible to the second week.     

Treatment of acute pancreatitis]

The results of the treatment of 274 patients with acute pancreatitis are analysed. 221 patients were subjected to conservative treatment (mortality--5.4%) and 53 patients were operated upon (mortality--30%). The best results were obtained in conservative treatment with the use of fluorofur and fluorouracil (62 patients), which had no fatal outcomes.