[Diagnosis and treatment of acute pancreatitis]

In patients with abdominal pain, an acute pancreatitis is likely when lipase is elevated more than 3-fold above normal. The diagnosis should be confirmed by an imaging technique (either sonography or CT). The determination of the severity is difficult as all methods (laboratory values, imaging systems, scores) exhibit a significant uncertainty. The regular clinical investigation of the patients is still needed. In contrast to a severe course, in mild or moderate disease the treatment of the patient in an intensive care unit is not obligatory. In biliary pancreatitis the extraction of biliary stones after papillotomy is indicated and in severe disease the procedure should be done without delay. Meanwhile enteral nutrition is standard treatment although the data are not completely convincing. Further measures are administration of pain killers, volume substitution and treatment of pulmonary and renal failure. Although data are not completely clear the prophylactic administration of antibiotics in necrotizing pancreatitis is routine. Puncture of the necrosis may be used to detect the responsible microorganisms. In patients with infected necrosis who deteriorate during conservative treatment, necrosectomy may be an option. There is a tendency to postpone the operation until the necrosis can be clearly separated from non-necrotic tissue. Although a specific pharmacological agent for the treatment of pancreatitis is still not available, the above procedure has led to a significant reduction of mortality in patients with severe acute pancreatitis.