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By Petr Dite

Acute stipulations in gastroenterology are usually attached with excessive morbidity and mortality; an optimum remedy of those stipulations calls for an in depth cooperation among a number of disciplines, rather gastroenterology and surgical procedure. although, systematic facts for a generalized method of ascertain the optimum diagnostic methods and treatment have up to now now not been to be had. The book available attempts to fill this hole by means of delivering gastroenterologists and surgeons with thoughts for a rational multidisciplinary strategy. Acute states are characterised through multifactorial etiological alterations in addition to polymorbidity, that have an antagonistic impression on diagnostic accuracy and impression of treatment. during this state of affairs, endoscopic exam which allows a simultaneous therapeutical resolution is of basic value. besides the fact that, endoscopy is an invasive procedure, and thanks to sufferers' polymorbidity, endoscopic ways are restricted by way of their basic scientific .

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This increases with the greater extent of pancreatic necrosis. Current advice is that patients with a severe attack of acute pancreatitis should undergo an intravenous contrast-enhanced (dynamic) computed tomography between 3 and 10 days after admission for the assessment of the degree of pancreatic necrosis and surrounding peripancreatic and intra-abdominal fluid collections [36]. The use of the acute-phase protein CRP has been validated by choosing the proper validated cut-off (1120 mg/l) and it is reported to accurately indicate the presence of pancreatic necrosis in up to 90% [13].

Gut 1997;41:832–840. 20 Rau B, Cebulla M, Uhl W, Schoenberg MH, Beger HG: The clinical value of human pancreas-specific protein procarboxypeptidase B as an indicator of necrosis in acute pancreatitis: Comparison to CRP and LDH. Pancreas 1998; 17:134–139. 21 Berney T, Gasche Y, Robert J, Jenny A, Mensi N, Grau G, Vermeulen B, Morel P: Serum profiles of interleukin-6, interleukin-8 and interleukin-10 in patients with severe and mild acute pancreatitis. Pancreas 1999;18:371–377. 22 Appelros S, Thim L, Borgstrom A: Activation peptide of carboxypeptidase B in serum and urine in acute pancreatitis.

In contrast, a pancreatic abscess is a circumscribed intra-abdominal collection of pus, usually in proximity to the pancreatic necrosis, which arises as a consequence of acute pancreatitis. Probably pancreatic abscesses are a consequence of limited necrosis with subsequent liquefaction and secondary infection. It is important to distinguish between infected pancreatic necrosis and pancreatic abscesses since significantly lower mortality rates are described for patients with pancreatic abscesses [83].

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