Cronología y estado actual de las conductas terapéuticas en la pancreatitis aguda / Chronology and current status of the therapy in acute pancreatitis
Salazar, J R.
Rev. Fac. Cienc. Méd. (Córdoba)
; 62(1): 46-51, 2005.
Artículo
en Español
| BINACIS | ID: bin-123351
Un análisis retrospectivo del intrincado curso de las pancreopatías agudas permite evidenciar cambios desde el punto de vista conceptual tanto en aspectos fisiopatológicos como en la historia natural de la enfermedad y en las conductas terapéuticas. Si bien la responsabilidad del factor biliar no se discute, el clásico mecanismo del reflujo bilio-pancreático por canal común es controvertido. En relación a la historia natural, apesar que aún presentan interrogantes algunos aspectos que deben ser redefinidos en el futuro, se acepta la evolución bifásica de la pancreatitis aguda grave, con un período inicial o de ataque y otro tardío en el curso de la 2a o 3a semana, cuando suelen surgir complicaciones sépticas o bien evolucionar hacia la resolución del proceso. .El concepto de respuesta a la injuria o reacción inflamatoria sistemática resulta fundamental para Interpretar las nefastas consecuencias de una conducta quirúrgica mal indicada en la etapa temprana de una pancreatitis grave. De manera esquemático se presentan las distintas conductas terapéuticas en el curso de los años desde la lejana y dogmática cirugía por principio, hasta el momento actual, en que el tratamiento conservador es aceptado por unanimidad en el período crítico inicial de la enfermedad, dejando lugar a la cirugía en la fase de complicaciones sépticas y reactivación o persistencia del síndrome de reacción inflamatoria.(AU)
This article realize a retrospective analysis of the course of acute pancreatitis and evidence changes of concepts upon physiopathogenesis aspects, the natural history of the disease and the therapeutic management. The responsability of the biliary factor its accepted but the classic mechanism of the biliopancreatic reflux by common chanel its on discussion. Relativeness to natural history of the acute pancreatitis, however of to remain un known sone aspects to ellucidate on the future, today its accepted the biphasic course of the severe pancreatitis, with one initial period and other tardif, to second or their week, with septic complications or evolution to resolution of process. The concept of systemic inflammatory response syndrome and failure of organ systems (renal insufficiency, pulmonary insufficiency) its essential for interpretation of the ominous consequences of one inopportune surgical approach on the early period, associated with high mortality. One schematic personnel square present the different therapeutics procedures along the years, from the distant and dogmatic surgery for principle, until the actual moment where the conservative attitude its of unanimous acquiescence on critic period of disease. The surgery its indicated on second phase, with developing of septic complications, reactivation or persistence of systemic inflammatory response syndrome with increasing severity of pancreatitis.(AU)
This article realize a retrospective analysis of the course of acute pancreatitis and evidence changes of concepts upon physiopathogenesis aspects, the natural history of the disease and the therapeutic management. The responsability of the biliary factor its accepted but the classic mechanism of the biliopancreatic reflux by common chanel its on discussion. Relativeness to natural history of the acute pancreatitis, however of to remain un known sone aspects to ellucidate on the future, today its accepted the biphasic course of the severe pancreatitis, with one initial period and other tardif, to second or their week, with septic complications or evolution to resolution of process. The concept of systemic inflammatory response syndrome and failure of organ systems (renal insufficiency, pulmonary insufficiency) its essential for interpretation of the ominous consequences of one inopportune surgical approach on the early period, associated with high mortality. One schematic personnel square present the different therapeutics procedures along the years, from the distant and dogmatic surgery for principle, until the actual moment where the conservative attitude its of unanimous acquiescence on critic period of disease. The surgery its indicated on second phase, with developing of septic complications, reactivation or persistence of systemic inflammatory response syndrome with increasing severity of pancreatitis.(AU)
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