Pankreatit
Özet
Pankreatit, klinik seyri hafif ve kendini sınırlayan tablolardan, ciddi sistemik komplikasyonlar ve yüksek mortalite ile seyreden ağır formlara kadar geniş bir spektrum gösteren önemli bir gastrointestinal hastalıktır. Akut pankreatit, çoğunlukla ani başlangıçlı epigastrik ağrı ile ortaya çıkar. Tanı klinik bulguların biyokimyasal ve gerekli durumlarda radyolojik verilerle birlikte değerlendirilmesini gerektirir. Hastalığın prognozunu belirleyen en kritik faktör, erken dönemde gelişen ve persistan hale gelen organ yetmezliğidir. Kronik pankreatit ise tekrarlayan veya sürekli inflamasyon sonucunda pankreas dokusunda geri dönüşümsüz yapısal hasar, fibrozis ve fonksiyon kaybı ile karakterizedir. Klinik olarak kronik abdominal ağrı, ekzokrin ve endokrin yetmezlik ön plandadır. Etiyoloji, patofizyoloji, tanı ve tedavi yaklaşımlarındaki ortak ve ayırt edici yönlerin anlaşılması, özellikle acil servis ve klinik pratikte risk sınıflamasının doğru yapılması, uygun izlem ve zamanında yapılan müdahale açısından büyük önem taşımaktadır.
Pancreatitis is an important gastrointestinal disorder with a broad clinical spectrum, ranging from mild and self-limiting disease to severe forms associated with serious systemic complications and high mortality. Acute pancreatitis typically presents with the sudden onset of epigastric pain. Diagnosis relies on the integrated assessment of clinical findings together with biochemical parameters and, when indicated, radiological imaging. The most decisive determinant of prognosis is the development of early and persistent organ failure. Chronic pancreatitis, in contrast, results from recurrent or ongoing inflammatory injury and is characterized by irreversible structural damage to the pancreatic parenchyma, progressive fibrosis, and loss of function. Clinically, chronic abdominal pain and features of exocrine and endocrine insufficiency are prominent. A clear understanding of the shared and distinct aspects of etiology, pathophysiology, diagnostic evaluation, and therapeutic approaches is essential, particularly in emergency and routine clinical practice, to ensure accurate risk stratification, appropriate follow-up, and timely intervention.
Referanslar
Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–2400.
Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–1415.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–111.
Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144(6):1252–1261.
Xiao AY, Tan MLY, Wu LM, Asrani VM, Windsor JA, Yadav D, et al. Global incidence and mortality of pancreatic diseases: a systematic review. Pancreatology. 2016;16(4):548–556.
Roberts SE, Morrison-Rees S, John A, Williams JG, Brown TH, Samuel DG, et al. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology. 2017;17(2):155–165.
Sadr-Azodi O, Andrén-Sandberg Å, Orsini N, Wolk A. Cigarette smoking, smoking cessation and acute pancreatitis. Gut. 2012;61(2):262–267.
Tolstrup JS, Kristiansen L, Becker U, Grønbæk M. Smoking and risk of acute and chronic pancreatitis among women and men. Arch Intern Med. 2009;169(6):603–609.
Sadr-Azodi O, Orsini N, Andrén-Sandberg Å, Wolk A. Abdominal and total adiposity and the risk of acute pancreatitis. Am J Gastroenterol. 2013;108(1):133–139.
Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response and mortality in acute pancreatitis. Br J Surg. 2006;93(6):738–744.
van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver AM, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141(4):1254–1263.
Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis. Pancreas. 2006;33(4):323–330.
Tenner S. Initial management of acute pancreatitis: critical issues during the first 72 hours. Am J Gastroenterol. 2004;99(12):2489–2494.
Whitcomb DC. Acute pancreatitis. N Engl J Med. 2006;354(20):2142–2150.
Sadr-Azodi O, Orsini N, Wolk A. Cigarette smoking and the risk of chronic pancreatitis: a population-based study. Gut. 2012;61(4):509–514.
Scherer J, Singh VP, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol. 2014;48(3):195–203.
Stevens T, Conwell DL, Zuccaro G. Pathogenesis of chronic pancreatitis: an evidence-based review of past theories and recent developments. Am J Gastroenterol. 2004;99(11):2256–2270.
Zheng Z, Ding YX, Qu YX, Wang JB, Li ZS, Jin ZD. A narrative review of acute pancreatitis: pathogenesis, diagnosis and treatment. Ann Transl Med. 2021;9(7):554.
Lee PJ, Papachristou GI. New insights into acute pancreatitis. Nat Rev Gastroenterol Hepatol. 2019;16(8):479–496.
Gukovskaya AS, Gukovsky I. Autophagy and pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2012;303(9):G993–G1003.
Criddle DN. Reactive oxygen species, Ca²⁺ signaling and acute pancreatitis. Cell Calcium. 2016;60(1):1–7.
Li XY, He C, Zhu Y, Lu NH. Role of gut microbiota on intestinal barrier function in acute pancreatitis. World J Gastroenterol. 2020;26(16):2187–2199.
de-Madaria E, Herrera-Merino N, Sánchez-Payá J, Lluís F, Gómez-Escolar L, Zapater P, et al. Fluid resuscitation with lactated Ringer’s solution vs normal saline in acute pancreatitis: a randomized controlled trial. United European Gastroenterol J. 2018;6(1):63–72.
Greenberg JA, Hsu J, Bawazeer M, Marshall J, Friedrich JO, Nathens A, et al. Clinical practice guideline: management of acute pancreatitis. Can J Surg. 2016;59(2):128–140.
Ke L, Ni HB, Sun JK, Tong ZH, Li WQ, Li N, et al. Percutaneous catheter drainage in infected pancreatic necrosis: a systematic review and meta-analysis. Pancreatology. 2016;16(4):606–615.
Aliosmanoğlu İ, Erten R, Yıldırım E, Akgün IE, Yılmaz S, Yıldırım S. Surgical treatment results of acute necrotizing pancreatitis and factors affecting mortality. J Clin Exp Investig. 2012;3(1):1–6.
Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, et al. International consensus diagnostic criteria for autoimmune pancreatitis. Pancreas. 2011;40(3):352–358.
Okazaki K, Kawa S, Kamisawa T, Naruse S, Ito T, Inui K, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2011;46(7):784–794.
Referanslar
Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–2400.
Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–1415.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–111.
Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144(6):1252–1261.
Xiao AY, Tan MLY, Wu LM, Asrani VM, Windsor JA, Yadav D, et al. Global incidence and mortality of pancreatic diseases: a systematic review. Pancreatology. 2016;16(4):548–556.
Roberts SE, Morrison-Rees S, John A, Williams JG, Brown TH, Samuel DG, et al. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology. 2017;17(2):155–165.
Sadr-Azodi O, Andrén-Sandberg Å, Orsini N, Wolk A. Cigarette smoking, smoking cessation and acute pancreatitis. Gut. 2012;61(2):262–267.
Tolstrup JS, Kristiansen L, Becker U, Grønbæk M. Smoking and risk of acute and chronic pancreatitis among women and men. Arch Intern Med. 2009;169(6):603–609.
Sadr-Azodi O, Orsini N, Andrén-Sandberg Å, Wolk A. Abdominal and total adiposity and the risk of acute pancreatitis. Am J Gastroenterol. 2013;108(1):133–139.
Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response and mortality in acute pancreatitis. Br J Surg. 2006;93(6):738–744.
van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver AM, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141(4):1254–1263.
Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis. Pancreas. 2006;33(4):323–330.
Tenner S. Initial management of acute pancreatitis: critical issues during the first 72 hours. Am J Gastroenterol. 2004;99(12):2489–2494.
Whitcomb DC. Acute pancreatitis. N Engl J Med. 2006;354(20):2142–2150.
Sadr-Azodi O, Orsini N, Wolk A. Cigarette smoking and the risk of chronic pancreatitis: a population-based study. Gut. 2012;61(4):509–514.
Scherer J, Singh VP, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol. 2014;48(3):195–203.
Stevens T, Conwell DL, Zuccaro G. Pathogenesis of chronic pancreatitis: an evidence-based review of past theories and recent developments. Am J Gastroenterol. 2004;99(11):2256–2270.
Zheng Z, Ding YX, Qu YX, Wang JB, Li ZS, Jin ZD. A narrative review of acute pancreatitis: pathogenesis, diagnosis and treatment. Ann Transl Med. 2021;9(7):554.
Lee PJ, Papachristou GI. New insights into acute pancreatitis. Nat Rev Gastroenterol Hepatol. 2019;16(8):479–496.
Gukovskaya AS, Gukovsky I. Autophagy and pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2012;303(9):G993–G1003.
Criddle DN. Reactive oxygen species, Ca²⁺ signaling and acute pancreatitis. Cell Calcium. 2016;60(1):1–7.
Li XY, He C, Zhu Y, Lu NH. Role of gut microbiota on intestinal barrier function in acute pancreatitis. World J Gastroenterol. 2020;26(16):2187–2199.
de-Madaria E, Herrera-Merino N, Sánchez-Payá J, Lluís F, Gómez-Escolar L, Zapater P, et al. Fluid resuscitation with lactated Ringer’s solution vs normal saline in acute pancreatitis: a randomized controlled trial. United European Gastroenterol J. 2018;6(1):63–72.
Greenberg JA, Hsu J, Bawazeer M, Marshall J, Friedrich JO, Nathens A, et al. Clinical practice guideline: management of acute pancreatitis. Can J Surg. 2016;59(2):128–140.
Ke L, Ni HB, Sun JK, Tong ZH, Li WQ, Li N, et al. Percutaneous catheter drainage in infected pancreatic necrosis: a systematic review and meta-analysis. Pancreatology. 2016;16(4):606–615.
Aliosmanoğlu İ, Erten R, Yıldırım E, Akgün IE, Yılmaz S, Yıldırım S. Surgical treatment results of acute necrotizing pancreatitis and factors affecting mortality. J Clin Exp Investig. 2012;3(1):1–6.
Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, et al. International consensus diagnostic criteria for autoimmune pancreatitis. Pancreas. 2011;40(3):352–358.
Okazaki K, Kawa S, Kamisawa T, Naruse S, Ito T, Inui K, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2011;46(7):784–794.
