Pankreatitis akutua pankrearen gaixotasun onbera eta akutua da. Kasurik gehienetan arina izan ohi da, baina formarik larrienetan hilkortasun- eta konplikazio-tasa handiak izan ditzake. Kasu larri horietarako, oso garrantzitsua da espezialitate anitzeko protokolo bat izatea, maila ezberdinetan eman beharreko arreta hitzartua duena. Berrikuspen-lan honetan maila ezberdin bakoitzean eman beharreko arreta egokia deskribatzen da. Larrialdi Zerbitzuetan: Diagnostikoa egin, Analgesia egokia, Larritasun-mailaren balorazioa, Hidratazio egokia hasi. Ospitaleratze Unitateetan: Ezinbestekoa da pazientearen larritasuna modu kliniko eta analitikoan egiaztatzea, 12 orduan behin, lehen 48 orduetan. Edozein momentutan organo-gutxiegitasun datuak atzematen badira, pazientea Zainketa Intentsiboen Unitatean artatu behar da. Horretaz gain, honako neurri hauek hartuko dira: analgesia mantendu, hidratazio egokia eman, elikadura hasi, sabelalde barneko presioa neurtu, erradiologiaprobak egin. Antibiotiko enpirikoaren erabilera ez da gomendatzen. Kirurgiarako indikazioak: Tratamendu medikoarekin konpontzen ez den sabelalde barneko presioaren igoera larria, nekrosi infektatua (neurri minimoki inbaditzaileez saia liteke lehen urrats moduan, edo step-up estrategia), hesteen zulaketa, hemorragia akutua (erradiologia interbentzionista erabiltzen da normalean). Ondorioak: Pankreatitis akutua gaixotasun arina da gehienetan, baina kasurik larrienetan hilkortasun- eta konplikazio-tasa altua ditu. Horiek artatzeko protokolo bat izatea eta parte hartzen duten espezialista ezberdinen elkarlana ezinbestekoa da.

Gako-hitzak: Pankreatitis akutua, Protokolo klinikoa, Kirurgia

Acute pancreatitis is an acute but benign disease of the pancreas. It is usually a mild illness, but in its most severe forms mortality and morbidity can be high. For these severe forms of the disease, it is very important to have a multidisciplinary protocol for clinical management at the different levels of assistance. In this review, we describe the optimal measures for each level of assistance. Emergency Department: diagnose correctly, adequate analgesia, severity assessment, initiate correct volume replacement. Hospitalization units: clinical and analytical assessment of severity every 12 hours is essential during the first 48 h. If signs of organ failure are present, the patient should be admitted to the Intensive Care unit. The following procedures should be taken: maintain analgesia, appropriate hydration, commence nutrition, measure intra-abdominal pressure and perform radiological tests. The use of antibiotic prophylaxis is not recommended. Indications for surgery: an increase in intra-abdominal pressure in the absence of response to medical treatment, infected necrosis (could be initially managed with minimally invasive measures, step-up approach), intestinal perforation and acute hemorrhage (usually managed by interventional radiology). Conclusions: acute pancreatitis is usually a mild disease, but in its most severe forms it can lead to high mortality and morbidity. The development of a multidisciplinary protocol and the collaboration and coordination of different specialists is imperative for the correct management of these patients.

Keywords: Acute pancreatitis, Clinical protocol, Surgery