BAB I PENDAHULUAN Pankreatitis akut adalah penyakit umum yang paling sering disebabkan oleh penyakit batu empedu atau konsumsi alkohol berlebih. Diagnosis biasanya didasarkan pada gejala karakteristik, seringkali dalam hubungannya dengan peningkatan serum enzim pankreas. Foto tidak selalu diperlukan, tetapi mungkin dilakukan untuk berbagai alasan, seperti untuk mengkonfirmasikan diagnosis pankreatitis, mengesampingkan penyebab lain dari sakit perut, menjelaskan penyebab pankreatitis, atau untuk mengevaluasi komplikasi seperti nekrosis atau pseudocysts. Meskipun sebagian besar pasien akan memiliki ringan, self limitting disesase, beberapa orang akan berkembang menjadi penyakit parah yang terkait dengan kegagalan organ. Pasien-pasien yang berisiko untuk mengembangkan komplikasi dari peradangan pankreas yang berlangsung seperti nekrosis pankreas, koleksi cairan, pseudocysts, dan gangguan saluran pankreas. divalidasi sistem penilaian dapat membantu memprediksi tingkat keparahan pankreatitis, dan dengan demikian, panduan pemantauan dan intervensi. Pengobatan pankreatitis akut melibatkan perawatan suportif dengan penggantian cairan, mengontrol rasa nyeri, dan inisiasi terkontrol dari asupan makanan biasa. antibiotik profilaksis tidak dianjurkan dalam pankreatitis akut jika tidak ada bukti infeksi pankreas. Pada pasien yang gagal untuk meningkatkan, evaluasi lebih lanjut diperlukan untuk menilai komplikasi yang memerlukan intervensi seperti pseudocysts atau nekrosis pankreas. Endoskopi, termasuk ERCP dan EUS, dan/atau kolesistektomi mungkin diindikasikan dalam setting klinis yang sesuai. Pada akhirnya, pengelolaan pasien dengan pankreatitis akut yang berat akan membutuhkan pendekatan multidisiplin. Pankreatitis akut menyumbang lebih dari 220.000 penerimaan rumah sakit di Amerika Serikat setiap tahunnya. 1 Dalam review berikut, dibahas garis besar etiologi pankreatitis akut, komplikasi, dan memberikan tinjauan terbaru pada manajemen untuk pasien rawat inap. 1
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BAB I
PENDAHULUAN
Pankreatitis akut adalah penyakit umum yang paling sering disebabkan
oleh penyakit batu empedu atau konsumsi alkohol berlebih. Diagnosis biasanya
didasarkan pada gejala karakteristik, seringkali dalam hubungannya dengan
peningkatan serum enzim pankreas. Foto tidak selalu diperlukan, tetapi mungkin
dilakukan untuk berbagai alasan, seperti untuk mengkonfirmasikan diagnosis
pankreatitis, mengesampingkan penyebab lain dari sakit perut, menjelaskan
penyebab pankreatitis, atau untuk mengevaluasi komplikasi seperti nekrosis atau
pseudocysts. Meskipun sebagian besar pasien akan memiliki ringan, self limitting
disesase, beberapa orang akan berkembang menjadi penyakit parah yang terkait
dengan kegagalan organ. Pasien-pasien yang berisiko untuk mengembangkan
komplikasi dari peradangan pankreas yang berlangsung seperti nekrosis
pankreas, koleksi cairan, pseudocysts, dan gangguan saluran pankreas.
divalidasi sistem penilaian dapat membantu memprediksi tingkat keparahan
pankreatitis, dan dengan demikian, panduan pemantauan dan intervensi.
Pengobatan pankreatitis akut melibatkan perawatan suportif dengan
penggantian cairan, mengontrol rasa nyeri, dan inisiasi terkontrol dari asupan
makanan biasa. antibiotik profilaksis tidak dianjurkan dalam pankreatitis akut jika
tidak ada bukti infeksi pankreas. Pada pasien yang gagal untuk meningkatkan,
evaluasi lebih lanjut diperlukan untuk menilai komplikasi yang memerlukan
intervensi seperti pseudocysts atau nekrosis pankreas. Endoskopi, termasuk
ERCP dan EUS, dan/atau kolesistektomi mungkin diindikasikan dalam setting
klinis yang sesuai. Pada akhirnya, pengelolaan pasien dengan pankreatitis akut
yang berat akan membutuhkan pendekatan multidisiplin.
Pankreatitis akut menyumbang lebih dari 220.000 penerimaan rumah
sakit di Amerika Serikat setiap tahunnya.1 Dalam review berikut, dibahas garis
besar etiologi pankreatitis akut, komplikasi, dan memberikan tinjauan terbaru
Pankreatitis akut adalah penyakit umum yang sering disebabkan oleh
choledocholithiasis atau konsumsi alkohol kelebihan. Pada pankreatitis akut
idiopatik, microlithiasis dan SOD harus dipertimbangkan. Meskipun CT scan
tetap menjadi modalitas pencitraan pilihan, metode baru seperti MRCP dan EUS
dapat membantu untuk memberikan informasi tambahan dan peningkatan
diagnostik.
Manajemen pankreatitis akut sering menantang, dan skala keparahan
membantu untuk memprediksi kemungkinan komplikasi, menentukan intervensi
yang diperlukan, dan membimbing tingkat perawatan yang tepat. Nutrisi sangat
penting pada pasien dengan SAP, dan makanan enteral jelas lebih disukai
daripada TPN. Saat ini, antibiotik profilaksis tampaknya tidak memiliki peran
dalam SAP. Akhirnya, meskipun tidak selalu mudah, rekomendasi memang ada
untuk memandu pengelolaan banyak komplikasi pankreatitis akut, seperti
pembentukan pseudokista dan penyakit necrotizing. Pendekatan multidisiplin
harus digunakan dalam mengelola pasien dengan penyakit berat, dan dokter
rawat inap primer tidak perlu ragu untuk melibatkan spesialis, termasuk
gastroenterologists, ahli radiologi, dan ahli bedah.
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