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Pancreatitis aguda

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Last reviewed: 3 Dec 2025
Last updated: 06 Aug 2024
06 Aug 2024

La orientación actualizada del American College of Gastroenterology incluye nuevas recomendaciones de rehidratación para pacientes con pancreatitis aguda

Tras una revisión de la evidencia, el American College of Gastroenterology (ACG) ha actualizado sus orientaciones sobre el tratamiento de la pancreatitis aguda.

El ACG recomienda:

  • Rehidratación moderadamente agresiva para pacientes con pancreatitis aguda

  • Reevaluación de los volúmenes de líquido a intervalos frecuentes

  • Bolos de líquidos adicionales si hay evidencia de hipovolemia

  • Monitorización estrecha de parámetros clínicos como la frecuencia cardíaca, la presión arterial y la diuresis, especialmente en personas mayores y con antecedentes de enfermedad cardíaca y/o renal

  • Medición de hematocrito y BUN en las 6-8 horas posteriores a la presentación

Anteriormente, se recomendaba la hidratación intravenosa agresiva temprana para todos los pacientes con pancreatitis aguda. La guía de práctica clínica actualizada enfatiza la importancia de una monitorización estrecha y el ajuste de los volúmenes de líquido según los parámetros clínicos y las características del paciente.

Ver Tratamento: abordagem

Fonte original da atualização

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presencia de factores de riesgo
  • dolor abdominal
  • náuseas y vómitos
  • anorexia
  • signos de hipovolemia
Detalhes completos

Outros fatores diagnósticos

  • signos de disfunción de los órganos
  • signo de Grey-Turner
  • signo de Cullen
  • signo de Fox
  • distensión abdominal
Detalhes completos

Fatores de risco

  • mujeres de mediana edad
  • hombres jóvenes y de edad mediana
  • cálculos biliares
  • alcohol
  • hipertrigliceridemia
  • hipercalcemia
  • uso de fármacos causales
  • paperas
  • virus Coxsackie
  • Mycoplasma pneumoniae
  • colangiopancreatografía retrógrada endoscópica (CPRE)
  • traumatismo
  • páncreas divisum
  • cáncer de páncreas
  • disfunción del esfínter de Oddi
  • antecedentes familiares de pancreatitis
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • lipasa y amilasa en suero
  • pruebas de función hepática
  • hemograma completo (HC) y con diferencial
  • hematocrito
  • urea y electrolitos séricos
  • gasometría arterial
  • proteína C-reactiva
  • ecografía de abdomen
  • radiografía del tórax (RT)
  • proporción de lipasa sérica:amilasa sérica
  • triglicéridos séricos
Detalhes completos

Investigações a serem consideradas

  • tomografía computarizada (TC) abdominal
  • estudios por imágenes magnéticas/colangiopancreatografía por resonancia magnética (RM/CPRM)
  • ultrasonido endoscópico (UE)
Detalhes completos

Novos exames

  • procalcitonina

Algoritmo de tratamento

AGUDA

todos los pacientes

CONTÍNUA

deterioro o falta de mejora

Colaboradores

Autores

Scott Tenner, MD, MPH, JD, FACG

Clinical Professor of Medicine

Director, The Greater New York Endoscopy Surgical Center

Director, Brooklyn Gastroenterology and Endoscopy

State University of New York

NY

Declarações

ST is an author of references cited in this topic. He declares that he has no other competing interests.

Craig T. Tenner, MD, FACP

Associate Professor

Medicine

New York University School of Medicine

NY

Declarações

CTT declares that he has no competing interests.

Agradecimentos

Dr Scott Tenner and Dr Craig T. Tenner would like to gratefully acknowledge Dr Nicholas J. Zyromski, Dr Brian Daley, Dr Catherine Lindsay McKnight, and Dr Fernando Aycinena, previous contributors to this topic. They would also like to thank Dr Camille Blackledge for her contribution to this topic.

Declarações

NJZ is an author of a reference cited in this topic. BD, CLM, FA, and CB declare that they have no competing interests.

Revisores

Tamas A. Gonda, MD

Assistant Professor of Medicine

Attending Physician and Director of Research

Columbia University Medical Center

New York

NY

Disclosures

TAG declares that he has no competing interests.

Alan Moss, MD

Harvard Medical Faculty Physician

Division of Gastroenterology

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

AM declares that he has no competing interests.

Derek O'Reilly, MD

Consultant Hepatobiliary & Pancreatic Surgeon

Department of Surgery

North Manchester General Hospital

Manchester

UK

Disclosures

DOR is an author of a reference cited in this topic. He declares that he has no other competing interests.

Eric Frykberg, MD

Professor

Department of Surgery

Division General Surgery

Shands Jacksonville Medical Center

FL

Disclosures

At the time of the peer review, Dr E. Frykberg declared no competing interests. We were made aware that Dr Frykberg is now deceased.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Tenner S, Vege S, Sheth S, et al. American College of Gastroenterology guidelines: management of acute pancreatitis. Am J Gastroenterol. 2024 Mar 119(3):419-37.Full text  Abstract

Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019 Jun 13;14:27.Full text  Abstract

Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: acute pancreatitis. 2019 [internet publication].Full text

Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology. 2018 Mar;154(4):1096-101.

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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