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We review recent advances in medical management of acute pancreatitis. These are based on changes ranging from increased knowledge of the pathophysiology and clinical development of techniques for the management of complications. The recognition of poor prognosis given persistent organ failure (more than 48 hours) and the slow evolution without severity of patients with local complications, has redefined the classification of pancreatitis, stratifying the patient with mild, moderate and severe. Of the many available severity scores to predict severity, APACHE II and BISAP are demonstrating greater value on work done in Peru. Using vigorous hydration to avoid damage to the pancreatic microcirculation level, early enteral nutrition when it predicts a severe or prolonged disease in addition to narcotic analgesia, are some of the measures advocated in the present. I also discuss the evidence of refeeding with solid rather than liquid diet to patients with mild pancreatitis. Finally, evidence of safety and good outcomes of endoscopic necrosectomy is presented as an alternative to surgical necrosectomy. [ABSTRACT FROM AUTHOR]

Purpose. Show diseases of the pancreas and their diagnosis using ultrasonography and other imaging methods such as computed tomography: show the possible clinical and pathological correlations. Introduction. Pancreatic diseases are multiple and varied; they are usually accompanied by pain in the mesogastrium, may be consecutive to disorders such as gallstones and alcoholism or be associated with cirrhosis, or the result of traumatic injuries and inflammatory processes and constitute the basis for tumoral disorders, with different ultrasound findings as the initial diagnostic method and subsequent characterization by computed tomography. Percutaneous biopsy or draining accumulations by means of catheterization helps to evaluate the findings and establish possible correlations. Images allow us to detect manifestations ranging from inflammatory processes with increased pancreatic volume, fluid accumulations due to abscesses, and simple and complex cysts to cystic tumoral lesions such as cystadenomas or solid lesions such as insulinomas and adenocarcinomas, among others. Material and methods. We reviewed 261 files of patients interned at Hospital San José Tec de Monterrey, with diagnosis of pancreatic disease, and evaluated the primary clinical parameters, laboratory results, results obtained with different imaging methods, and histopathology studies to document the diagnosis of tumoral disorder and compile statistics on the most common diseases at the hospital. Results. Inflammatory conditions (pancreatitis) and varying degrees of stratification were identified, as well as pseudocysts and abscesses, in addition to detecting tumors which include ductal adenocarcinomas and serous and mucinous cystadenomas, as well as cystadenocarcinomas and other lesions with cystic components, diagnosed by means of ultrasound and in correlation with computed tomography. Remarks. Pancreatic diseases can be detected using ultrasound for the initial assessment, but require, in addition, a full evaluation to establish a more precise diagnosis and determine the appropriate treatment. [ABSTRACT FROM AUTHOR]

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