6. PANCREATITIS AGUDA
GRAVE
• COMENTARIOS
– Antecedente de la etiologia
– Diagnostico de necrosis pancreática por TAC
a veces es díficil ( RNM )
– Profilaxis infección de la necrosis
– Nutricion enteral vs parenteral en PAG
– Tratamiento de necrosis pancreatica
infectada
7. PANCREATITIS AGUDA
GRAVE
• Pancreatitis aguda idiopatica: demostar
que no es biliar, con 2º prueba de imagen
y estudio de bilis
8. PANCREATITIS AGUDA
GRAVE
Profilaxis de la infeccion de la
necrosis pancreatica
14. PANCREATITIS AGUDA
GRAVE
• Conclusiones profilaxis de la infeccion de
la necrosis pancreatica.
– Imipenen previene la infeccion de la necrosis
– Reduce la mortalidad
15. PANCREATITIS AGUDA
GRAVE
Nutricion enteral vs parentral en
pancreatitis grave
22. PANCREATITIS AGUDA
GRAVE
• No hay suficiente evidencia para
recomendar una frente a otra, faltando
estudios de calidad
• Hay una recomendación al uso de n
enteral
23. PANCREATITIS AGUDA
GRAVE
Tratamiento de la necrosis
infectada
• Cirugia
• Endoscopia
• Drenaje percutaneo
• Otros
30. PANCREATITIS AGUDA
GRAVE
TRATAMIENTO ENDOSCOPICO
•Transmural approach
• ASGE guideline: the role of endoscopy in the diagnosis and
management of cystic lesions and inflammatory fluid collections of
the pancreas. Jacobson BC; Baron TH; Adler DG et al. Gastrointest
Endosc 2005; 61(3):363-70
31. PANCREATITIS AGUDA
GRAVE
TRATAMIENTO ENDOSCOPICO
• Mithöfer K, Mueller PR, Warshaw AL. Interventional and surgical
tratment of pancreatic abscess. World J Surg 1997; 21:162-68
32. PANCREATITIS AGUDA
GRAVE
TRATAMIENTO ENDOSCOPICO
• Endoscopic Therapy for organized Pancreatic Necrosis. Baron TH, Thaggard
WG, Morgan DE; Stanley RJ. Gastroenterology 1996; 111:755-764.
33. PANCREATITIS AGUDA
GRAVE
• JPN Guidelines for the management of acute pancreatitis: surgical
treatment. Isaji S, TaKada T, Kawarada Y et al. J Hepatobiliary
Pancreat Surg 2006; 13:48-55
•CQ1. Which procedure will best result in a definite diagnosis of infected
pancreatic necrosis ?
•CQ2. What is the indication for surgical intervention in necrotizing pancreatitis ?
•CQ3. How should sterile pancreatic necrosis be managed ?
•CQ4. What is the optimal timing for surgical intervention ?
•CQ5. What is the optimal surgical procedure for infected pancreatic necrosys?
•CQ6. What is the optimal drainage procedure after necrosectomy ?
•CQ7. How should pancreatic abscess be managed ?
•CQ8. What is the indication for surgical drainage in pancreatic abscess?
•CQ9. What are the indications for drainage treatment in pancreatic pseudocysts?
•CQ10. What is the indication for surgical intervention in pancreatic pseudocysts ?
34. PANCREATITIS AGUDA
GRAVE
• How should sterile pancreatic necrosis be
managed ?
Conservadora salvo complicaciones sistemicas persistentes o
deterioro clinico severo a pesar de manejo UCI. RECOMENDACIÓN
B
35. PANCREATITIS AGUDA
GRAVE
• What is the optimal surgical procedure for
infected pancreatic necrosys?
Necrosectomia. RECOMENDACIÓN A
36. PANCREATITIS AGUDA
GRAVE
• What is the optimal drainage procedure
after necrosectomy ?
37. PANCREATITIS AGUDA
GRAVE
otros
• Percutaneous pancreatic necrosectomy
NICE December 2003
• Endoscopic transmural necrosectomy
38. PANCREATITIS AGUDA
GRAVE
• How should pancreatic abscess be managed ?
• What is the indication for surgical drainage in
pancreatic abscess?
Puede ser manejado tanto quirurgicamente como con drenaje percutaneo RECOMENDACIÓN B
Si hay deterioro clínico cirugia RECOMENDACIÓN A
39. PANCREATITIS AGUDA
GRAVE
• Conclusiones
• En PAG recomendar uso precoz de Nutricion
enteral
• Imipenen si se demuestra Necrosis
• Tratamiento evacuador si de demuestra
infeccion de la necrosis, quirurgico,
(recomendación grado A) y si el paciente no
está septico podria ser valido otras alternativas
dada la alta mortalidad de la cirugia