مکانیسم و مدیریت پانکراتیت حاد Mechanisms and Management of Acute Pancreatitis

1. Introduction Acute pancreatitis (AP), simply defined, represents a disorder characterized by acute necroinflammatory changes of the pancreas. The purpose of this review is to explore the historical, epidemiologic, histologic, and pathologic mechanisms underpinning the disease and the current evidenced-based management algorithms. 2. Historical Perspective From the Greek roots “pan” (all) and “kreas” (flesh or meat), the term “pancreas” was first coined by Ruphos of Ephesus (c. 100 CE), to describe an organ that had no cartilage or bone. Despite its early roots, it was not until much later that the first clinical description of acute pancreatitis by Nicholaes Tulp (1593–1674), a Dutch anatomist, was published [1]. However, amidst much speculation of causality, the first systematic assessment of acute pancreatitis was authored by Reginald Fitz (1843–1913) in his entitled review “Acute Pancreatitis: A Consideration of Hemorrhage, Hemorrhagic, Suppurative, and Gangrenous Pancreatitis, and of Disseminated Fat Necrosis,” highlighting alcohol, gallstones, and other etiologic factors. Claude Bernard (1813–1878) is credited as one of the early pioneers of pancreatic physiology, identifying pancreatic juice’s capability of converting starch into sugar and emulsifying lipids into their constituents. Further classification, prognostication, and understanding of the pathogenic mechanisms have led to the burgeoning field of pancreatology, and the management of this complex pancreatic disease is the subject of this review. 3. Epidemiology Acute pancreatitis is the number one gastrointestinal diagnosis prompting inpatient admission and ranks 21st on the list of all diagnoses requiring hospitalization. The incidence of acute pancreatitis ranges from 13 to 45/100,000 with equal affinity for each gender (though with differing etiologies) [2]. Acute pancreatitis secondary to alcohol is more common in men, whereas gallstone pancreatitis is more common in women and appears to affect African Americans disproportionately for unclear reasons. In 2009, the Healthcare Cost and Utilization Project National Inpatient Sample identified 274,119 individuals discharged from the hospital with acute pancreatitis, representing a 30% increase from 2000 and necessitating a median length of stay of 4 days. Acute pancreatitis contributed to, and/or was responsible for, 8653 deaths in 2009, representing an underlying cause of death rate of 1 per 100,000 and ranking it as the 14th leading cause of gastrointestinal death with a cost of 2.6 billion dollars in inpatient expenses [3].