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01.07.2011 | Schwerpunkt

Diagnostik und Therapie der akuten Pankreatitis

Aktuelle Empfehlungen

verfasst von: PD Dr. W. Huber, R.M. Schmid

Erschienen in: Die Innere Medizin | Ausgabe 7/2011

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Zusammenfassung

Die akute Pankreatitis ist potenziell lebensbedrohlich. Durch den z. T. fulminanten Verlauf ist das Zeitfenster für Diagnostik und Therapie kurz. Unter Berücksichtigung aktueller Leitlinien und mit Hilfe einer elektronischen Literatursuche wurden 12 Schlüsselfragen der Diagnostik und Therapie der akuten Pankreatitis zu beantworten versucht: Die Diagnose kann allein durch Anamnese, Klinik und Serumlipasebestimmung gestellt werden. Zum Nachweis einer biliären Genese sind Cholestaseparameter und Oberbauchsonographie ausreichend. Für die frühe Prognose eines schweren Verlaufs sind die Erhöhung von Blutzucker, Hämatokrit (Hkt) und Harnstoff (BUN, „blood urea nitrogen“) wegweisend. Die Bedeutung von erhöhtem Hkt und BUN legt eine frühe zielgerichtete Volumensubstitution nahe. Zur Schmerztherapie sind meist Opiate erforderlich. Metaanalysen belegen therapeutische Effekte der ERC (endoskopische retrograde Cholangiographie) bei biliärer Pankreatitis, der Antibiose bei nekrotisierender Pankreatitis und der frühzeitigen enteralen Ernährung. Auch beim Nachweis von Nekrosen ist ein konservatives Vorgehen gerechtfertigt. Bleibt dieses erfolglos, kann die chirurgische Therapie sinnvoll sein.

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Titel: Diagnostik und Therapie der akuten Pankreatitis
Aktuelle Empfehlungen
verfasst von: PD Dr. W. Huber
R.M. Schmid
Publikationsdatum: 01.07.2011
Verlag: Springer-Verlag
Erschienen in: Die Innere Medizin / Ausgabe 7/2011
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI: https://doi.org/10.1007/s00108-010-2796-x

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