Acute pancreatitis. Diagnostics and modern therapy

The timely diagnosis of acute pancreatitis is important for developing a therapeutic strategy. Differential diagnosis, clarification of the etiology, evaluation of severity and determination of a prognosis are crucial for the course of the disease. Due to the lack of specific therapy, modern therapeutic options aim to optimize the conservative treatment by exploiting ITU care. These benefit especially from the experience of new insights in sepsis and ventilation treatment. The major aims are to stabilize the course and postpone possible complications, such as infection of the necrosis, in the late phase of the disease. Sterile necrosis can be treated medically, but surgery for infected necrosis is still usual. However, timing of the intervention is under discussion, and there is evidence that medical treatment only may be as beneficial as surgery. Percutaneous or minimally invasive strategies in case of infected necrosis are under evaluation. In general, with the use of a careful, modern therapeutic approach, mortality in severe necrotizing pancreatitis has decreased to 15-25%.