Pancreatitis aguda

Notas del editor

• #19: Patients with AP typically present with epigastric or left upper quadrant pain. The pain is usually described as constant with radiation to the back, chest, or fl anks, but this description is nonspecifi c. The intensity of the pain is usually severe, but can be variable. The intensity and location of the pain do not correlate with severity. Pain described as dull, colicky, or located in the lower abdominal region is not consistent with AP and suggests an alternative etiology. Abdominal imaging may be helpful to determine the diagnosis of AP in patients with atypical presentations.
• #21: Abdominal imaging is useful to confirm the diagnosis of AP. CECT provides over 90 % sensitivity and specifi city for the diagnosis of AP ( 20 ). Routine use of CECT in patients with AP is unwarranted, as the diagnosis is apparent in many patients and most have a mild, uncomplicated course. However, in a patient failing to improve aft er 48 – 72 (e.g., persistent pain, fever, nausea, unable to begin oral feeding), CECT or MRI imaging is recommended to assess local complications such as pancreatic necrosis ( 21 – 23 ). Computed tomography (CT) and MRI are comparable in the early assessment of AP ( 24 ). MRI, by employing magnetic resonance cholangiopancreatography (MRCP), has the advantage of detecting choledocholithiasis down to 3 mm diameter and pancreatic duct disruption while providing high-quality imaging for diagnostic and / or severity purposes. MRI is helpful in patients with a contrast allergy and renal insuffi ciency where T2-weighted images without gadolinium contrast can diagnose pancreatic necrosis ( 24 ).