As orientações atualizadas do American College of Gastroenterology incluem novas recomendações de ressuscitação fluídica para os pacientes com pancreatite aguda
Após uma análise da evidência, o American College of Gastroenterology (ACG) atualizou suas orientações sobre o manejo da pancreatite aguda.
O ACG recomenda:
Ressuscitação moderadamente agressiva com fluidos para os pacientes com pancreatite aguda
Reavaliação do volume de fluidos a intervalos frequentes
Fluido em bolus adicionais se houver evidências de hipovolemia
Monitoramento rigoroso de parâmetros clínicos, como frequência cardíaca, pressão arterial e débito urinário, particularmente nos idosos e pacientes com história de doença cardíaca e/ou renal
Medição do hematócrito e do nitrogênio ureico no sangue (BUN) 6-8 horas após a apresentação
Antes, a hidratação intravenosa precoce agressiva era recomendada para todos os pacientes com pancreatite aguda. As diretrizes atualizadas enfatizam a importância do monitoramento rigoroso e do ajuste do volume fluidico de acordo com os parâmetros clínicos e as características do paciente.
Summary
Definition
病史和体格检查
关键诊断因素
- presença de fatores de risco
- dor abdominal
- náuseas e vômitos
- anorexia
- sinais de hipovolemia
其他诊断因素
- sinais de disfunção orgânica
- sinal de Grey-Turner
- sinal de Cullen
- sinal de Fox
- distensão abdominal
危险因素
- mulheres de meia-idade
- homens jovens e de meia-idade
- cálculos biliares
- bebidas alcoólicas
- hipertrigliceridemia
- hipercalcemia
- uso de medicamentos causadores
- parotidite
- vírus Coxsackie
- Pneumonia por micoplasma
- colangiopancreatografia retrógrada endoscópica (CPRE)
- trauma
- pancreas divisum
- câncer de pâncreas
- disfunção no esfíncter de Oddi
- história familiar de pancreatite
诊断性检查
首要检查
- lipase e amilase séricas
- testes da função hepática
- hemograma completo e diferencial
- hematócritos
- ureia e eletrólitos séricos
- gasometria arterial
- proteína C-reativa
- ultrassonografia transabdominal
- radiografia torácica
- razão de lipase/amilase séricas
- triglicerídeos séricos
需考虑的检查
- tomografia computadorizada (TC) abdominal
- ressonância nuclear magnética/colangiopancreatografia por ressonância magnética (RNM/CPRM)
- ultrassonografia endoscópica (USE)
新兴检查
- procalcitonina
治疗流程
todos os pacientes
com piora ou com dificuldade de melhorar
撰稿人
作者
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
利益声明
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
利益声明
CTT declares that he has no competing interests.
鸣谢
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.
利益声明
NJZ is an author of a reference cited in this topic. BD, CLM, FA, and CB declare that they have no competing interests.
同行评议者
Tamas A. Gonda, MD
Assistant Professor of Medicine
Attending Physician and Director of Research
Columbia University Medical Center
New York
NY
利益声明
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
利益声明
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
利益声明
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
利益声明
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.
参考文献
关键文献
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.全文 摘要
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.全文 摘要
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.全文 摘要
American College of Radiology. ACR appropriateness criteria: acute pancreatitis. 2019 [internet publication].全文
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.
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
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