[Acute pancreatitis: diagnosis and conservative therapy]

Despite our increasing knowledge in pathophysiology of acute pancreatitis therapeutic strategies based on this knowledge, such as inhibition of proteases, are non convincing. It is most likely that these strategies are initiated to late after the onset of pancreatitis. It is of utmost importance to clarify the severity of the disease for planning interdisciplinary approaches: therapy of pain, enteral nutrition via a jejunal tube, treatment of extrapancreatic complications, such as respiratory insufficiency, coagulopathy, renal insufficiency. A key role plays the exact balance of potential high fluid losses. Prophylactic application of antibiotics such as imipenem, in necrotizing pancreatitis to prevent infection is widely used. Infected necroses are an indication for surgery. In biliary pancreatitis one has to remove impacted bile duct stones via ERCP and papillotomy followed by elective cholecystectomy.