Cronología y estado actual de las conductas terapéuticas en la pancreatitis aguda. / [Chronology and current status of the therapy in acute pancreatitis]

ABSTRACT

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.