Akut Pankreatit Tanı ve Tedavi Yaklaşımı
Özet
Akut pankreatit, pankreas dokusunun kendi kendini sindirmesiyle başlayan ve dünya genelinde insidansı artan akut inflamatuar bir hastalıktır. En yaygın etiyolojik faktörler safra taşları (%40-65) ve alkol tüketimidir (%25-40); bunun yanı sıra hipertrigliseridemi, ilaçlar ve genetik mutasyonlar da rol oynar. Hastalar genellikle epigastriumda başlayan ve sırta yayılan şiddetli karın ağrısı, bulantı ve kusma şikayetleriyle başvururlar. Tanı; karakteristik karın ağrısı, serum amilaz/lipaz düzeylerinin normalin ≥3 katı olması ve bilgisayarlı tomografi (BT) bulgularından en az ikisinin varlığıyla konur. Vakaların yaklaşık %75'i hafif seyirli ve kendi kendini sınırlayan nitelikte olup sıvı replasmanı, oksijen desteği ve ağrı kontrolü gibi destekleyici tedavilerle kontrol altına alınır. Şiddetli vakalarda ise kalıcı organ yetmezliği, sistemik inflamatuar yanıt sendromu (SIRS) ve enfekte nekroz gibi mortalitesi yüksek komplikasyonlar gelişebilir. İlk aşamada Ringer laktat ile agresif hidrasyon ve erken enteral beslenme önerilirken, profilaktik antibiyotik kullanımı dışlanmaktadır. Enfekte nekrotizan komplikasyonlarda minimal invaziv perkütan veya endoskopik drenaj yöntemleri tercih edilir; safra taşına bağlı hafif vakalarda ise nüksü önlemek adına taburcu edilmeden önce kolesistektomi uygulanmalıdır
Acute pancreatitis is an acute inflammatory disease resulting from pancreatic self-digestion, with a rising global incidence driven by lifestyle factors, gallstones, and alcohol. Gallstones (40-65%) and alcohol abuse (25-40%) constitute the primary etiologies, followed by hypertriglyceridemia, trauma, medications, and genetic mutations. Patients typically present with severe, constant epigastric pain radiating to the back, accompanied by nausea and vomiting. Diagnosis requires meeting at least two of three criteria: characteristic abdominal pain, serum amylase and/or lipase levels ≥3 times the upper limit of normal, and diagnostic cross-sectional imaging features. Approximately 75% of cases follow a mild, self-limiting course requiring supportive measures such as intravenous fluid resuscitation, oxygen support, and adequate opioid-based analgesia. Conversely, severe acute pancreatitis can lead to persistent organ failure, systemic inflammatory response syndrome (SIRS), and infected pancreatic necrosis. Early management emphasizes aggressive hydration with Ringer's lactate and early enteral nutrition, while routine prophylactic antibiotics are avoided. For infected necrotizing pancreatitis, a step-up approach using percutaneous or endoscopic drainage is preferred over early surgery, and cholecystectomy should be performed prior to discharge in mild biliary cases to prevent recurrence.
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