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Pancreatite aguda

  • 概述
  • 理论
  • 诊断
  • 治疗
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最后审阅： 20 Aug 2025
最后更新： 06 Aug 2024
06 Aug 2024

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.

Ver Tratamento: abordagem

Fonte original da atualização

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • dor abdominal
  • náuseas e vômitos
  • anorexia
  • sinais de hipovolemia
Detalhes completos

Outros fatores diagnósticos

  • sinais de disfunção orgânica
  • sinal de Grey-Turner
  • sinal de Cullen
  • sinal de Fox
  • distensão abdominal
Detalhes completos

Fatores de risco

  • 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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • 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
Detalhes completos

Investigações a serem consideradas

  • tomografia computadorizada (TC) abdominal
  • ressonância nuclear magnética/colangiopancreatografia por ressonância magnética (RNM/CPRM)
  • ultrassonografia endoscópica (USE)
Detalhes completos

Novos exames

  • procalcitonina

Algoritmo de tratamento

AGUDA

todos os pacientes

CONTÍNUA

com piora ou com dificuldade de melhorar

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.

Disclosures

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

Peer reviewers

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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