With respect to the management of patients presenting with acute pancreatitis, briefly discuss the following issues:
a) The optimal timing and method of delivery of nutrition.(40% marks)
b) The role of antimicrobials.(40% marks)
c) The role of endoscopic retrograde cholangio-pancreatography (ERCP).(20% marks)
(a) Method of delivery of nutrition
(b) Use of antimicrobials
(c) Role of ERCP
Nutrition in acute pancreatitis:
Antibiotics in pancreatitis:
The role of ERCP in pancreatitis:
"May be cause", the college say economically, as if to type a "the" into their answer would incur an intolerable time cost.
Specifically, section L of the 2016 statement
ESPEN guidelines :
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Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut. 1998;42: 431-435.
Ragins H, Levenson SM, Signer R, Stamford W, Seifter E Intrajejunal administration of an elemental diet at neutral pH avoids pancreatic stimulation. Studies in dog and man. .Am J Surg. 1973 Nov;126(5):606-14.
B. W. M. Spanier,1, M. J. Bruno, E. M. H. Mathus-Vliegen Enteral Nutrition and Acute Pancreatitis: A Review Gastroenterol Res Pract. 2011; 2011: 857949. Published online 2010 August 3.
Casaer, Michael P., et al. "Early versus late parenteral nutrition in critically ill adults." N Engl J Med 365.6 (2011): 506-517.
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Al-Omran, Mohammed, Ala Groof, and Derek Wilke. "Enteral versus parenteral nutrition for acute pancreatitis." Cochrane Database Syst Rev 1.1 (2003).
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Oh's Intensive Care manual: Chapter 43 (pp. 495) Severe acute pancreatitis by Duncan LA Wyncoll
Heinrich, Stefan, et al. "Evidence-based treatment of acute pancreatitis: a look at established paradigms." Annals of surgery 243.2 (2006): 154-168.
Pederzoli, Paolo, et al. "A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem." Surgery, gynecology & obstetrics 176.5 (1993): 480-483.
Wilmer, Alexander. "ICU management of severe acute pancreatitis." European journal of internal medicine 15.5 (2004): 274-280.
Villatoro, Eduardo, Mubashir Mulla, and Mike Larvin. "Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis."Cochrane Database Syst Rev 5.5 (2010).
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Baltatzis, Minas, et al. "Antibiotic use in acute pancreatitis: Global overview of compliance with international guidelines." Pancreatology (2016).
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Cherian, Jijo V., et al. "ERCP in acute pancreatitis." Hepatobiliary Pancreat Dis Int 6.3 (2007): 233-240.
Zhu, Youfeng, et al. "Nasogastric nutrition versus nasojejunal nutrition in patients with severe acute pancreatitis: a meta-analysis of randomized controlled trials." Gastroenterology research and practice 2016 (2016).