Related Experiment Videos
[Acute pancreatic necrosis complicated by infection and gastro-intestinal translocation: pathogenesis correlation and
S Miniello1, M Testini, M Amoruso
1Dipartimento per le Applicazioni in Chirurgia delle Tecnologie Innovative (D.A.C.T.I.), Università degli Studi di Bari.
Abstract:
The authors define pathogenetics correlations as a acute necrotizing pancreatitis complicated by infection and bacterial translocation. Acute necrotizing pancreatitis infection occurs for gastrointestinal bacterial translocation due to structural and functional modifications of intestinal mucosa. These modifications are results of mucosa ischemic-reperfusion system caused by systemic emodynamic instability in micro- and macro-circulation of splanchnic district. Emodynamic systemic instability has a central role in different multiple physiopathologic phenomena (ipovolemic shock; pancreatic shock, SIRS), which is caused by acute pancreatic necrosis and carries to common way established by severe systemics emodinamics modifications; these changes promote growth of adverse events which conduce by means of process previously described to bacterial translocation and infection of acute pancreatic necrosis. Indeed, emodynamic systemic instability of any etiology, can determine for one way bacterial translocation and on the other acute ischemic pancreatitis; both phenomena concur lead to cause beginning of acute necrotizing pancreatitis complicated by infection. The authors confirm that improved knowledge of acute pancreatic necrosis complicated by infection and own pathogenetic correlations with bacterial translocation, allows the realization of therapeutic measures aimed to prophylaxis of infection of acute pancreatic necrosis. Central emodynamic stability regularization of splanchnic perfusion and antibiotic prophylaxis, have a central role in prophylaxis of infection of acute pancreatic necrosis. Antibiotic is given by systemic (imipenem e.v.) and selective decontamination of gastrointestinal tract (SDD). SDD provides for oral antibiotic prophylaxis (PTA protocol) and systemic antibiotic prophylaxis (cefotaxime and gentamicin), in addition to microbiologic and gastrointestinal monitoring. If on the one hand the role of SDD about mortality reduction is not clear, however, on the other it is well recognized capacity of reduction the intercurrents and pulmonary infections. Other Authors think that SDD is insignificant on early mortality, whereas, is a good option to reduce late and overall mortality of acute pancreatic necrosis complicated by infection.
Insights
Pathogenetics correlations link acute necrotizing pancreatitis infection to bacterial translocation. Stabilizing hemodynamics and using antibiotic prophylaxis, like selective decontamination of the gastrointestinal tract (SDD), are key for preventing infection.
Area of Science:
- Gastroenterology and Hepatology
- Infectious Diseases
- Critical Care Medicine
Context:
- Acute necrotizing pancreatitis (ANP) is frequently complicated by infection, driven by bacterial translocation from the gut.
- Intestinal mucosal damage, stemming from ischemic-reperfusion injury due to systemic hemodynamic instability, facilitates bacterial translocation.
- Hemodynamic instability is a central factor in ANP, leading to shock, SIRS, and promoting adverse events including infection.
Purpose:
- To elucidate the pathogenetic correlations between acute necrotizing pancreatitis infection and bacterial translocation.
- To highlight the importance of understanding these correlations for developing effective prophylactic strategies against ANP infection.
- To evaluate the role of hemodynamic stability and antibiotic prophylaxis in preventing ANP infection.
Summary:
- Systemic hemodynamic instability triggers intestinal damage and bacterial translocation, initiating ANP infection.
- Therapeutic strategies should focus on central hemodynamic stability, splanchnic perfusion, and antibiotic prophylaxis.
- Selective decontamination of the gastrointestinal tract (SDD) shows promise in reducing infectious complications, particularly pulmonary infections, and potentially overall mortality in ANP.
Impact:
- Improved understanding of ANP pathogenesis can lead to targeted prophylactic measures, reducing infection rates.
- Central hemodynamic stabilization and antibiotic strategies, including SDD, are crucial for managing ANP.
- SDD may reduce intercurrent and pulmonary infections and potentially decrease late and overall mortality in infected ANP patients.