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Sample records for acute pancreatitis mechanisms

  1. Cardiocirculatory pathophysiological mechanisms in severe acute pancreatitis

    Mónica; García; José; Julián; Calvo

    2010-01-01

    Acute pancreatitis (AP) is a common and potentially lethal acute inflammatory process. Although the majority of patients have a mild episode of AP, 10%-20% develop a severe acute pancreatitis (SAP) and suffer systemic inflammatory response syndrome (SIRS) and/or pancreatic necrosis. The main aim of this article is to review the set of events, f irst localized in the pancreas, that lead to pancreatic inflammation and to the spread to other organs contributing to multiorganic shock. The early pathogenic mechanisms in SAP are not completely understood but both premature activation of enzymes inside the pancreas, related to an impaired cytosolic Ca2+ homeostasis, as well as release of pancreatic enzymes into the bloodstream are considered important events in the onset of pancreatitis disease. Moreover, afferent f ibers within the pancreas release neurotransmitters in response to tissue damage. The vasodilator effects of these neurotransmitters and the activation of pro-inflammatory substances play a crucial role in amplifying the inflammatory response, which leads to systemic manifestation of AP. Damage extension to other organs leads to SIRS, which is usually associated with cardiocirculatoryphysiology impairment and a hypotensive state. Hypotension is a risk factor for death and is associated with a signif icant hyporesponsiveness to vasoconstrictors. This indicates that stabilization of the patient, once this pathological situation has been established, would be a very diff icult task. Therefore, it seems particularly necessary to understand the pathological mechanisms involved in the f irst phases of AP to avoid damage beyond the pancreas. Moreover, efforts must also be directed to identify those patients who are at risk of developing SAP.

  2. Acute Pancreatitis and Pregnancy

    ... Acute Pancreatitis > Acute Pancreatitis and Pregnancy test Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is ... of acute pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for ...

  3. Acute pancreatitis

    Bo-Guang Fan; Åke Andrén-Sandberg

    2010-01-01

    Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline) addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingest...

  4. Acute pancreatitis

    Bo-Guang Fan; Åke Andrén-Sandberg

    2010-01-01

    Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline) addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion....

  5. Cellular Mechanisms of L-arginine Induced Experimental Acute Pancreatitis

    Masood, Omar

    2013-01-01

    AbstractThe University Of ManchesterOmar MasoodMD Thesis 2013Cellular Mechanisms of L-arginine Induced Experimental Acute Pancreatitis. IntroductionImpairment of cytosolic calcium ([Ca2+]i) signaling and in particular calcium overload has emerged as a possible unifying mechanism for precipitating acute pancreatitis (AP.)In the L-arginine (L-arg) experimental model of AP, nitric oxide (NO) has been implicated however the disease progression is largely unaffected by nitric oxide synthase (NOS) ...

  6. Signaling and Adhesive Mechanisms in Acute Pancreatitis

    Awla, Darbaz

    2011-01-01

    Acute pancreatitis (AP) is an inflammatory disease with variable severity ranging from mild interstitial edematous to severe necrotizing disease. The overall mortality rate of AP is 8-9%. Specific treatment of AP is lacking which is partly related to an incomplete understanding of the basic pathophysiology behind the disease. It is widely held that premature intra-cellular trypsinogen activation and leukocyte recruitment play key roles in the pathophysiology of the AP. However, the signaling ...

  7. Acute pancreatitis

    Bo-Guang Fan

    2010-05-01

    Full Text Available Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  8. Acute pancreatitis

    Bo-Guang Fan

    2010-01-01

    Full Text Available Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions : Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  9. Acute pancreatitis

    ... page: //medlineplus.gov/ency/article/000287.htm Acute pancreatitis To use the sharing features on this page, ... fatty foods after the attack has improved. Outlook (Prognosis) Most cases go away in a week. However, ...

  10. EFFECTS AND MECHANISMS OF EMODIN OF PANCREA-TIC REGENERATION IN ACUTE PANCREATITIS IN RATS

    袁耀宗; 楼恺娴; 涂水平; 翟祖康; 徐家裕; 龚自华

    2002-01-01

    Objective To investigate the effects and mechanisms of emodin ( extraction from Chineseherb Rhubard ) on pancreatic repair and regeneration in caerulein-induced pancreatitis in rats. Methods Six-ty rats were randomly divided into three groups: Group Ⅰ ( control group ), Group Ⅱ ( non-treated group),Group Ⅲ (emodin treated group). Acute pancreatitis was induced by intra-peritoneal infusion of caerulein inrats, emodin was administered intravenously at the time of induction of pancreatitis and 24, 48 and 72h after-wards. Rats were sacrificed at 6,24,48,72 and 96h after induction of pancreatitis. The expression of TGFβ1and EGF mRNA were evaluated by reverse transcription-polymerase chain reaction ( RT-PCR ) ; pancreatic tissueDNA synthesis was measured by 3H-thymidine incorporation method in vitro; and total protein content was as-sessed by Lowry' s method. Results The serum amylase level decreased significantly in Group Ⅲ in compar-ison with Group Ⅱ . Expressions of TGFβ1 mRNA and EGF mRNA were undetectable in normal pancreas and inthe pancreas of Group Ⅱ at 6h but could be observed from 24h up to 96h after the induction of pancreatitis.TGFβ1 mRNA could be detected at 6h after treatment with emodin , and it was increased significantly in GroupⅢ as compared with Group Ⅱ at 24 and 48h. EGF mRNA increased significantly in Group Ⅲ as compared withGroup Ⅱ at 48h. Pancreatic tissue DNA synthesis showed a significant decrease at 72h following the inductionof pancreatitis, and a marked increase was observed at 96h after treatment with emodin. Within 48h of the in-duction of pancreatitis , total protein content in pancreatic tissue declined, and there was a remarkable increasein Group Ⅲ at 96h. Conclusion Effects of emodin on pancreatic tissue regeneration of acute pancreatitis inrats might be attributed to the enhancement of TGFβ1 and EGF expression which subsequently increases totalprotein content and DNA synthesis, thus accelerates pancreatic

  11. Acute pancreatitis

    Al Mofleh Ibrahim

    1997-01-01

    Full Text Available The past few years have witnessed a tremendous progress in our knowledge regarding the pathogenesis, diagnosis, prognostic evaluation and classification of acute pancreatitis. The role of ischemia, lysosomal enzymes, oxygen free radicals, polymorphnuclear cells-byproducts and inflammatory mediators in the pathogenesis of pancreatic necrosis and multiple organ failure has been emphasized. Furthermore, the recent knowledge about agents infecting pancreatic necrosis, routes of infection, bacteriological examination of fine needle aspirate and appropriate antibiotics have changed the concept of acute pancreatitis. New diagnostic tests such as rapid urinary trypsinogen-2 test and inflammatory mediators including polymorphnuclear elastase, C-reactive protein and interleukin-6 contribute to early diagnosis, prognostic evaluation and initiation of an appropriate therapy.

  12. Lung injury in acute pancreatitis: mechanisms, prevention, and therapy.

    Shields, Conor J

    2012-02-03

    Lung injury is the most pertinent manifestation of extra-abdominal organ dysfunction in pancreatitis. The propensity of this retroperitoneal inflammatory condition to engender a diffuse and life-threatening lung injury is significant. Approximately one third of patients will develop acute lung injury and acute respiratory distress syndrome, which account for 60% of all deaths within the first week. The variability in the clinical course of pancreatitis renders it a vexing entity and makes demonstration of the efficacy of any specific intervention difficult. The distinct pathologic entity of pancreatitis-associated lung injury is reviewed with a focus on etiology and potential therapeutic maneuvers.

  13. Acute pancreatitis

    A prospective study was performed on the relationship of CT findings to the clinical course of 148 patients with acute pancreatitis. The type of pancreatic inflammation seen on CT was classified into six categories based on an overall assessment of size, contour and density of the gland, and peripancreatic abnormalities. The majority (94%) of patients in whom CT showed mild pancreatic changes (grades A, B and C) had two or less positive clinical indicaters of severe pancreatitis (Ranson's signs). In contrast, 92% of patients in whom CT showed more severe changes of pancreatitis (grades D, E or F) had three or more positive signs. The nine patients who died with pancreatitis-related complications were in grades D, E or F. We wish to draw attention to a CT appearance which we have called 'fat islets' (low density intrapancreatic or peripancreatic areas, the contents of which approach fat in attenuation values); there was a strong correlation between this appearance and subsequent infection. (author). 24 refs.; 7 figs.; 4 tabs

  14. Lung Injury in Acute Pancreatitis

    Raffaele Pezzilli; Lara Bellacosa; Cristina Felicani

    2009-01-01

    Most knowledge has been accumulated on the mechanisms involved in the development of distant organ injuries during the course of severe acute pancreatitis. Among the various distant organ dysfunctions, both the development of acute lung injury and acute respiratory distress syndrome represent serious complications. In the following paragraphs the pathophysiological mechanisms capable of determining lung injury during the course of acute pancreatitis will be reviewed. Pancreatic Enzymes and...

  15. Metformin induced acute pancreatitis

    Alsubaie, Sadeem; Almalki, Mussa H.

    2013-01-01

    Acute pancreatitis frequently presents with abdomen pain but may presents with various skin manifestations as rash and rarely, pancreatic panniculitis. Metformin, one of the most effective and valuable oral hypoglycemic agents in the biguanide class was linked to acute pancreatitis in few cases. Here, we report a case of metformin induce acute pancreatitis in young healthy man with normal renal function.

  16. Acute pancreatitis: Etiology and common pathogenesis

    Guo-Jun Wang; Chun-Fang Gao; Dong Wei; Cun Wang; Si-Qin Ding

    2009-01-01

    Acute pancreatitis is an inflammatory disease of the pancreas. The etiology and pathogenesis of acute pancreatitis have been intensively investigated for centuries worldwide. Many causes of acute pancreatitis have been discovered, but the pathogenetic theories are controversial. The most common cause of acute pancreatitis is gallstone impacting the distal common bile-pancreatic duct. The majority of investigators accept that the main factors for acute billiary pancreatitis are pancreatic hyperstimulation and bile-pancreatic duct obstruction which increase pancreatic duct pressure and active trypsin reflux. Acute pancreatitis occurs when intracellular protective mechanisms to prevent trypsinogen activation or reduce trypsin activity are overwhelmed. However, little is known about the other acute pancreatitis. We hypothesize that acute biliary pancreatitis and other causes of acute pancreatitis possess a common pathogenesis. Pancreatic hyperstimulation and pancreatic duct obstruction increase pancreatic duct pressure, active trypsin reflux, and subsequent unregulated activation of trypsin within pancreatic acinar cells. Enzyme activation within the pancreas leads to auto-digestion of the gland and local inflammation. Once the hypothesis is confirmed, traditional therapeutic strategies against acute pancreatitis may be improved. Decompression of pancreatic duct pressure should be advocated in the treatment of acute pancreatitits which may greatly improve its outcome.

  17. ERCP in acute pancreatitis

    Jijo V Cherian; Joye Varghese Selvaraj; Rajesh Natrayan; Jayanthi Venkataraman

    2007-01-01

    BACKGROUND:The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute pancreatitis has evolved over years since its introduction in 1968. Its importance in diagnosing the etiology of pancreatitis has steadily declined with the advent of less invasive diagnostic tools. The therapeutic implications of ERCP in acute pancreatitis are many fold and are directed towards management of known etiological factors or its related complications. This article highlights the current status of ERCP in acute pancreatitis. DATA SOURCES:An English literature search using PubMed database was conducted on ERCP in acute pancreatitis, the etiologies and complications of pancreatitis amenable to endotherapy and other related subjects, which were reviewed. RESULTS: ERCP serves as a primary therapeutic modality for management of biliary pancreatitis in speciifc situations, pancreatitis due to microlithiasis, speciifc types of sphincter of Oddi dysfunction, pancreas divisum, ascariasis and malignancy. In recurrent acute pancreatitis and smoldering pancreatitis it has a deifnite therapeutic utility. Complications of acute pancreatitis including pancreatic-duct disruptions or leaks, benign pancreatic-lfuid collections and pancreatic necrosis can be beneifcially dealt with. Intraductal ultrasound and pancreatoscopy during ERCP are useful in detecting pancreatic malignancy. CONCLUSIONS:The role of ERCP in acute pancreatitis is predominantly therapeutic and occasionally diagnostic. Its role in the management continues to evolve and advanced invasive procedures should be undertaken only in centers dedicated to pancreatic care.

  18. Hypocalcemia in acute pancreatitis revisited

    Armin Ahmed

    2016-01-01

    Full Text Available Hypocalcemia is a frequent finding in acute pancreatitis. Severe hypocalcemia can present with neurological as well as cardiovascular manifestations. Correction of hypocalcemia by parenteral calcium infusion remains a controversial topic as intracellular calcium overload is the central mechanism of acinar cell injury in pancreatitis. The current article deals with the art and science of calcium correction in pancreatitis patients.

  19. Acute Pancreatitis in Children

    ... a feeding tube or an IV to prevent malnutrition and improve healing. Does my child have to ... intestines. Can my child die from acute pancreatitis? Death from acute pancreatitis is quite rare in children– ...

  20. [Etiological factors of acute pancreatitis].

    Spicák, J

    2002-09-01

    Acute pancreatitis develops immediately after the causative impulse, while chronic pancreatitis develops after the long-term action of the noxious agent. A typical representative of acute pancreatitis is biliary pancreatitis, chronic pancreatitis develops in alcoholism and has a long latency. As alcoholic pancreatitis is manifested at first as a rule by a potent attack, it is classified in this stage as acute pancreatitis. The most frequent etiological factors in our civilization are thus cholelithiasis and alcoholism (both account for 20-50% in different studies). The assumed pathogenetic principles in acute biliary pancreatitis are the common canal of both efferent ducts above the obturated papilla, duodenopancreatic reflux and intrapancreatic hypertension. A detailed interpretation is however lacking. The pathogenesis of alcoholic pancreatitis is more complicated. Among others some part is played by changes in the calcium concentration and fusion of cellular membranes. Idiopathic pancreatitis occurs in up to 10%, part of the are due to undiagnosed alcoholism and cholelithiasis. Other etiologies are exceptional. Similarly as in cholelithiasis pancreatitis develops also during other pathological processes in the area of the papilla of Vater such as dysfunction of the sphincter of Oddi, ampulloma and juxtapapillary diverticulum, it is however usually mild. The incidence of postoperative pancreatitis is declining. Its lethality is 30% and the diagnosis is difficult. In the pathogenesis changes of the ion concentration are involved, hypoxia and mechanical disorders of the integrity of the gland. Pancreatitis develops in association with other infections--frequently in mumps, rarely in hepatitis, tuberculosis, typhoid and mycoses. Viral pancreatitis is usually mild. In parasitoses pancreatitis develops due to a block of the papilla Vateri. In hyperparathyroidism chronic pancreatitis is more likely to develop, recent data are lacking. As to dyslipoproteinaemias

  1. Acute pancreatitis

    ... rate Lab tests that show the release of pancreatic enzymes will be done. These include: Increased blood amylase level Increased serum blood lipase level Increased urine amylase ... include: Abdominal CT scan Abdominal MRI Abdominal ultrasound

  2. Acute Pancreatitis after Percutaneous Mechanical Thrombectomy: Case Report and Review of the Literature

    Purpose: We describe a case of severe acute pancreatitis after percutaneous mechanical thrombectomy (PMT) and review the literature for the occurrence of this complication. Materials and Methods: A 53-year-old man with a history of bilateral external iliac artery stent placement sought care for acute onset of lifestyle-limiting left claudication. Angiography confirmed left external iliac stent occlusion, and PMT with the AngioJet Xpeedior catheter (Possis Medical, Minneapolis MN) was performed. Results: After PMT of the occluded external iliac artery, a residual in-stent stenosis required the placement of a second iliac stent. The procedure was complicated by severe acute pancreatitis. Other causes of pancreatitis were eliminated during the patient’s hospital stay. A literature review revealed nine cases of acute pancreatitis after PMT. Conclusion: Although rare, pancreatitis can be a devastating complication of PMT. The development of pancreatitis seems to be related to the products of extensive hemolysis triggering an inflammatory process. To prevent this complication, we recommend that close attention be paid to the duration and extent of PMT, thereby avoiding extensive hemolysis and subsequent complications.

  3. Review: Study progress on mechanism of severe acute pancreatitis complicated with hepatic injury

    ZHANG Xi-ping; WANG Lei; ZHANG Jie

    2007-01-01

    Study on the action mechanism of inflammatory mediators generated by the severe acute pancreatitis (SAP) in multiple organ injury is a hotspot in the surgical field. In clinical practice, the main complicated organ dysfunctions are shock, respiratory failure, renal failure, encephalopathy, with the rate of hepatic diseases being closely next to them. The hepatic injury caused by SAP cannot only aggravate the state of pancreatitis, but also develop into hepatic failure and cause patient death. Its complicated pathogenic mechanism is an obstacle in clinical treatment. Among many pathogenic factors, the changes ofvasoactive substances, participation of inflammatory mediators as well as OFR (oxygen free radical), endotoxin, etc. may play important roles in its progression.

  4. Progress in research into the mechanism of Radix salviae miltiorrhizae in treatment of acute pancreatitis

    Xi-Ping Zhang; Zhi-Jun Li; Da-Ren Liu

    2006-01-01

    BACKGROUND: Acute pancreatitis (AP) is a common acute abdomen with high mortality, multiple complications and complicated causes. There is no effective therapy for AP. Radix salviae miltiorrhizae (Danshen), a traditional herbal medicine, has a low price and a wide range of clinical applications. It is effective to promote blood lfow, eliminate stagnancy, and relieve pain. It is also found to be effective in treating AP. We reviewed the progress in research into the mechanism of Radix salviae miltiorrhizae in treatment of AP. DATA SOURCES: An english-language literature search was conducted using MEDLINE (1988-2005) on Radix salviae miltiorrhizae (Danshen) and acute pancreatitis. RESULTS:The mechanisms of Danshen in the treatment of AP include improvement of microcirculatory disturbances;elimination of oxygen free radicals; modulation of the metabolism of lipid inlfammatory mediator;and blocking of calcium inlfow and prevention of calcium overload. CONCLUSION:Danshen can effectively reduce the mortality and complications of AP.

  5. Acute pancreatitis; Pancreatite aigue

    Mehdi, M.; Deutsch, J.P.; Arrive, L.; Ayadi, K.; Ladeb, M.F.; Tubiana, J.M. [Centre Hospitalier Universitaire Saint-Antoine, 75 - Paris (France)

    1996-12-31

    The diagnosis of acute pancreatitis is based on clinical examination and basic laboratory tests. The main role of sonography in acute pancreatitis is to evaluate gallstones and small fluid collections. However, sonography is frequently difficult due to intestinal ileus related to pancreatitis. CT is indicated early in the clinical course of acute severe pancreatitis when the diagnosis is uncertain or when complications such as abscess, hemorrhage, or necrosis, are suspected. In addition, CT may be used to assess the prognosis and follow-up of patients. (authors). 20 refs., 12 figs., 4 tabs.

  6. Mechanisms of dexamethasone-mediated chemokine down-regulation in mild and severe acute pancreatitis

    Yubero, S.; Ramudo, L.; Manso, M.A.; De Dios, I.

    2009-01-01

    Abstract This study aimed to investigate the role of therapeutic dexamethaxone (Dex) treatment on the mechanisms underlying chemokine expression during mild and severe acute pancreatitis (AP) experimentally induced in rats. Regardless of the AP severity, Dex (1 mg/kg), administered 1 hour after AP, reduced the acinar cell activation of extracellular signal-regulated kinase (ERK) and c-Jun-NH2-terminal kinase (JNK) but failed to reduce p38-mitogen activated protein kinas (MAPK) in s...

  7. Nutrition, Inflammation, and Acute Pancreatitis

    Max Petrov

    2013-01-01

    Acute pancreatitis is acute inflammatory disease of the pancreas. Nutrition has a number of anti-inflammatory effects that could affect outcomes of patients with pancreatitis. Further, it is the most promising nonspecific treatment modality in acute pancreatitis to date. This paper summarizes the best available evidence regarding the use of nutrition with a view of optimising clinical management of patients with acute pancreatitis.

  8. Imaging of acute pancreatitis

    Merkle, Elmar M.; Goerich, Johannes [Department of Radiology, University Hospitals of Ulm, Steinhoevel Strasse 9, 89075 Ulm (Germany)

    2002-08-01

    Acute pancreatitis is defined as an acute inflammatory process of the pancreas with variable involvement of peripancreatic tissues or remote organ systems. This article reports the current classification, definition and terminology, epidemiology and etiology, pathogenesis and pathological findings, clinical and laboratory findings, and finally imaging findings of acute pancreatitis with emphasis on cross-sectional imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging. (orig.)

  9. Mechanism of acute pancreatitis complicated with injury of intestinal mucosa barrier

    2007-01-01

    Acute pancreatitis (AP) is a common acute abdomen in clinic with a rapid onset and dangerous pathogenetic condition.AP can cause an injury of intestinal mucosa barrier, leading to translocation of bacteria or endotoxin through multiple routes,bacterial translocation (BT), gutorigin endotoxaemia, and secondary infection of pancreatic tissue, and then cause systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS), which are important factors influencing AP's severity and mortality. Meanwhile, the injury of intestinal mucosa barrier plays a key role in AP's process. Therefore, it is clinically important to study the relationship between the injury of intestinal mucosa barrier and AP. In addition, many factors such as microcirculation disturbance, ischemical reperfusion injury, excessive release of inflammatory mediators and apoptosis may also play important roles in the damage of intestinal mucosa barrier. In this review, we summarize studies on mechanisms of AP.

  10. Acute pancreatitis in pregnancy

    Pitchumoni, Capecomorin S; Yegneswaran, Balaji

    2009-01-01

    Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 pregnancies. The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts and multiple organ dysfunction syndromes. Pregnancy related hematological and biochemical alterations influence the interpretation of diagnostic tests and assessment of severity of AP. As in any other disease associated with pregnancy, AP is associated wit...

  11. Treatment of acute pancreatitis

    Al-Mofleh Ibrahim

    1998-01-01

    Full Text Available There is no specific treatment for acute pancreatitis. Majority of patients with acute pancreatitis respond to medical therapy. Supportive measures and close observations represent the cornerstone of the medical therapy. Failure to respond to medical treatment may indicate choledocholithiasis or infected necrosis. Endoscopic papillotomy with stone retrieval is beneficial in patients with severe biliary pancreatitis. Image-guided fine needle aspiration and bacteriological examination of aspirate is reliable in detecting infection and deliniating causative pathogen. Surgical debridement is the method of choice for treatment of infected necrosis. In contrast, in pancreatic abscess, surgery is preserved for those, who do not respond to percutaneous drainage combined with antibiotics. The benefit of antisecretory and antiproteolytic agents is debatable. A combination of antioxidants, calcium channel antagonists and antibiotics may play a major role in the treatment of acute pancreatitis in the future.

  12. Biliary acute pancreatitis: a review

    Osvaldo M. Tiscomia; Susana Hamamura; Enriqueta S. de Lehmann; Graciela Otero; Hipólito Waisman; Patricia Tiscornia-Wasserman; Simmy Bank

    2000-01-01

    @@INTRODUCTION It is axiomatic that the most effective and soundly based plan of treatment of any disorder is one aimed at the mechanism or mechanisms responsible for its development[1]. This basic notion, coupled with recent reports[2- 11] in which, surprisingly there is a total lack of reference to the probable involvement of autonomic-arc-reflexes in the physiopathogenesis of biliary acute pancreatitis have prompted this presentation. Undoubtedly, this disease entity has numerous causes, an obscure physiopathology, few effective remedies, and, often, an unpredictable outcome. At the turn of the century, Opie[12,13] brought to light the association between gallstone migration and acute pancreatitis.

  13. Loperamide-Induced Acute Pancreatitis

    Halla Vidarsdottir; Hanna Vidarsdottir; Pall Helgi Moller; Einar Stefan Bjornsson

    2013-01-01

    Acute pancreatitis is a common disease leading to hospitalizations, most often caused by gallstones or alcohol. We present a case of a patient diagnosed with acute pancreatitis considered to be due to loperamide treatment for diarrhea.

  14. Drug-induced acute pancreatitis

    Eland, I.A.

    2008-01-01

    textabstractAcute pancreatitis is an inflammatory disease of the pancreas with sudden onset. The severity of acute pancreatitis may vary from mild to life threatening. There are many risk factors for acute pancreatitis, among which gallstones and alcohol abuse are most widely known. Drugs are considered as potential risk factors for acute pancreatitis, but have received relatively little attention in the medical literature. In this thesis, several epidemiological studies were performed to ass...

  15. Drug-induced acute pancreatitis

    I.A. Eland

    2003-01-01

    textabstractAcute pancreatitis is an inflammatory disease of the pancreas with sudden onset. The severity of acute pancreatitis may vary from mild to life threatening. There are many risk factors for acute pancreatitis, among which gallstones and alcohol abuse are most widely known. Drugs are consid

  16. Acute pancreatitis and Cushing's syndrome.

    Clague, H W; B. Warren; Krasner, N.

    1984-01-01

    A case of acute necrotizing pancreatitis in a 53-year-old man with an ectopic adrenocorticotrophin (ACTH) producing bronchial carcinoma is described. The aetiology of acute pancreatitis in relation to steroid therapy and malignancy is discussed and it is suggested that excess endogenous steroid production may also cause acute pancreatitis.

  17. Gadolinium induced recurrent acute pancreatitis.

    Blasco-Perrin, H; Glaser, B; Pienkowski, M; Peron, J M; Payen, J L

    2013-01-01

    Acute pancreatitis is a sudden swelling and inflammation of the pancreas. The two most common causes are alcohol use and biliary stones. Drug-induced acute pancreatitis are rare (1.4-2%). In this present study, we present a case of recurrent acute pancreatitis induced by a specific magnetic-resonance-imaging (MRI) contrast agent called gadobenate dimeglumine. PMID:23395575

  18. Ischemic Acute Necrotizing Pancreatitis in a Marathon Runner

    Jay J Mast

    2009-01-01

    Full Text Available Context Acute pancreatitis due to pancreatic ischemia is a rare condition. Case report In this case report we describe a 57-year-old male who developed an acute necrotizing pancreatitis after running a marathon and visiting a sauna the same evening, with an inadequate fluid and food consumption during both events. Conclusions Pancreatic ischemia imposed by mechanical and physical stress and dehydration can induce the development of acute pancreatitis. Separately, these factors are rare causes of ischemic acute pancreatitis. But when combined, as in this particular case, the risk of an acute necrotizing pancreatitis cannot be neglected

  19. Recurrent Acute Pancreatitis in Anorexia and Bulimia

    Marti JL; Herring S; Stephenson KE; Morris LG

    2004-01-01

    CONTEXT: Mild pancreatitis has been reported as a consequence of anorexia nervosa, bulimia nervosa, or what has been termed the "dietary chaos syndrome". Either chronic malnutrition, or refeeding after periods of malnutrition, may precipitate acute pancreatitis through several pathogenetic mechanisms. CASE REPORT: A 26-year-old woman with a ten-year history of anorexia and bulimia presented with a third episode of acute pancreatitis in three months. The patient had been abstinent from alcohol...

  20. Acute pancreatitis in pregnancy

    Capecomorin S Pitchumoni; Balaji Yegneswaran

    2009-01-01

    Acute pancreatitis (AP) is a rare event in pregnancy,occurring in approximately 3 in 10 000 pregnancies.The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts and multiple organ dysfunction syndromes. Pregnancy related hematological and biochemical alterations influence the interpretation of diagnostic tests and assessment of severity of AP. As in any other disease associated with pregnancy, AP is associated with greater concerns as it deals with two lives rather than just one as in the nonpregnant population. The recent advances in clinical gastroenterology have improved the early diagnosis and effective management of biliary pancreatitis. Diagnostic studies such as endoscopic ultrasound,magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography and therapeutic modalities that include endoscopic sphincterotomy, biliary stenting, common bile duct stone extraction and laparoscopic cholecystectomy are major milestones in gastroenterology. When properly managed AP in pregnancy does not carry a dismal prognosis as in the past.

  1. Research status of the mechanism and treatment for acute pancreatitis complicated with hepatic injury

    Xiping Zhang; Jie Zhang; Ping Yang

    2008-01-01

    Acute pancreatitis(AP) is characterized by its sudden onset and rapid progression and is often complicated by liver injury. AP induced liver injury may develop into hepatic failure and even result in death. Thus, it is of importance to protect liver function and block injury-related pathways. In the pathogenesis of liver injury in AP, inflammatory cytokines, nuclear factor-kappa B(NF- K B) and oxygen free radicals play important roles. The complexity of the mechanism underlying the development of liver injury exerts, to some extent, a contribution to the difficulties in the treatment of this disease. Currently, the drugs used to treat the disease include L-arginine (L-Arg),calcium ion antagonists, somatostatin and a variety of inflammatory mediator inhibitors. Additionally, some traditional Chinese medicines such as tfipterygium, wiifordii, rhubarb and salvia miltiorrhizae may also have some effects. In this article, the pathogenesis of liver injury in AP and its therapy are reviewed.

  2. [Acute pancreatitis and pregnancy].

    Scollo, P; Licitra, G

    1993-12-01

    Aetiologic factors (gallstones, hyperlipidemia I-IV, hypertriglyceridaemia) make their occurrence, mainly, in the third trimester of gestation. Two cases of acute pancreatitis in pregnancy are described; in both cases patients referred healthy diet, no habit to smoke and no previous episode of pancreatitis. An obstructive pathology of biliary tract was the aetiologic factor. Vomiting, upper abdominal pain are aspecific symptoms that impose a differential diagnosis with acute appendicitis, cholecystitis and obstructive intestinal pathology. Laboratory data (elevated serum amylase and lipase levels) and ultrasonography carry out an accurate diagnosis. The management of acute pancreatitis is based on the use of symptomatic drugs, a low fat diet alternated to the parenteral nutrition when triglycerides levels are more than 28 mmol/L. Surgical therapy, used only in case of obstructive pathology of biliary tract, is optimally collected in the third trimester or immediately after postpartum. Our patients, treated only medically, delivered respectively at 38th and 40th week of gestation. Tempestivity of diagnosis and appropriate therapy permit to improve prognosis of a pathology that, although really associated with pregnancy, presents high maternal mortality (37%) cause of complications (shock, coagulopathy, acute respiratory insufficiency) and fetal (37.9%) by occurrence of preterm delivery. PMID:8139793

  3. Co-localization hypothesis: A mechanism for the intrapancreatic activation of digestive enzymes during the early phases of acute pancreatitis

    Gijs JD van Acker; George Perides; Michael L Steer

    2006-01-01

    Acute pancreatitis is generally believed to be a disease in which the pancreas is injured by digestive enzymes that it normally produces. Most of the potentially harmful digestive enzymes produced by pancreatic acinar cells are synthesized and secreted as inactive zymogens which are normally activated only upon entry into the duodenum but, during the early stages of acute pancreatitis, those zymogens become prematurely activated within the pancreas and, presumably, that activation occurs within pancreatic acinar cells. The mechanisms responsible for intracellular activation of digestive enzyme zymogens have not been elucidated with certainty but, according to one widely recognized theory (the "co-localization hypothesis"), digestive enzyme zymogens are activated by lysosomal hydrolases when the two types of enzymes become co-localized within the same intracellular compartment. This review focuses on the evidence supporting the validity of the co-localization hypothesis as an explanation for digestive enzyme activation during the early stages of pancreatitis.The findings, summarized in this review, support the conclusion that co-localization of lysosomal hydrolases with digestive enzyme zymogens plays a critical role in permitting the intracellular activation of digestive enzymesthat leads to acinar cell injury and pancreatitis.

  4. Nutrition Support in Acute Pancreatitis

    Orestis Ioannidis; Athina Lavrentieva; Dimitrios Botsios

    2008-01-01

    The management of acute pancreatitis differs according to its severity. Approximately 75% of patients with acute pancreatitis have mild disease with a mortality rate below 1%. Mortality increases up to 20% if the disease progresses to its severe necrotizing form and, in the most severe cases, mortality can increase to 30-40%. Severe acute pancreatitis is usually accompanied by systemic inflammatory response syndrome (SIRS) which results in hypermetabolism with prominent protein catabolism. Ac...

  5. Pancreatic blood flow in experimental acute pancreatitis

    The etiology and pathogenesis of acute necrotizing hemorrhagic pancreatitis remain controversial. Recent work has suggested that an early fall in pancreatic blood flow, causing ischemia, may be the initiating factor. Using an established rat model of hemorrhagic pancreatitis and the fractional indicator distribution technique with 86RbCl, pancreatic blood flow and tissue perfusion have been measured at various times in the condition. Six groups of ten rats were studied: control sham operation and pancreatitis groups were sacrificed at 1, 6, and 24 hr. Pancreatic blood flow (% of cardiac output) and perfusion (blood flow/g tissue) were measured. Blood flow was increased by a maximum of 53% at 1 hr (P less than 0.001) and remained elevated for 24 hr, and perfusion was increased by a maximum of 70% (P less than 0.001) at 1 hr and remained elevated at 6 hr. Pancreatic perfusion declines after 6 hr due to increasing gland edema. The results demonstrate a significant increase in pancreatic blood flow and perfusion in experimentally induced acute pancreatitis, suggesting a primary inflammatory response, and refute the ischemic etiological theory

  6. ACUTE PANCREATITIS - THE SEVERE FORM

    Ioana Grigoras

    2005-01-01

    Full Text Available Acute pancreatitis is an acute inflammatory disease. Frequently it is a challenging condition for the surgeon and for the intensive care physician, taking into account that etiology is sometimes obscure, the pathophysiology is complex and incompletely understood, the timing of surgical treatment is still under debate and the general treatment is mostly supportive. The incidence is about 30 – 50 / 100.000 / year. In 80% of cases the disease is associated with interstitial edema, mild infiltration with inflammatory cells and intra- or peripancreatic fat necrosis. Evolution is benign and self-limited with proper treatment. The severe form occurs less frequent (15 - 20%, results in long lasting hospitalization and is associated with high mortality (30 - 40%, due to infected necrosis and multiple organ failure. Alcoholism and biliary disease account for 80% of cases. Rare etiologies of disease include metabolic factors (hypercalcemia, hyperlipoproteinemia, drug ingestion, obstructive factors (abdominal tumors, trauma, endoscopic retrograde cholecistopancreatography, and s.o., infections (viral, parasitic and hemodynamic factors. Postoperative pancreatitis is a complication after major abdominal surgery (abdominal aorta aneurism repair, extensive upper abdominal surgery, hepatic or cardiac transplant, so.. The common pathophysiological mechanism is pancreatic hypoperfusion. Acute pancreatitis is not a stable disease, being characterized by time-dependent stages with specific morphologic and clinical patterns. The terminology used to designate these stages is stated in the Ulm classification. Since the consensus Conference in Atlanta (1992 the severe form of acute pancreatitis is defined by the presence of organ dysfunction/failure or by the presence of local complications. The initiating event is the premature zymogene activation and the impairment of the exocytosis process with local consequences (ongoing tissue necrosis and general consequences

  7. Nutritional support for acute pancreatitis.

    Pisters, P W; Ranson, J H

    1992-09-01

    The current review has summarized current data relevant to the nutritional support of patients with acute pancreatitis. Selection of the most appropriate form of nutritional support for patients with acute pancreatitis is intimately linked to a thorough understanding of the effects of various forms of enteral and parenteral nutrition on physiologic exocrine secretory mechanisms. Two basic concepts have emerged from the multiple studies that have addressed these issues to date: 1, enteral feeds should have low fat composition and be delivered distal to the ligament of Treitz to minimize exocrine pancreatic secretion and 2, parenteral substrate infusions, alone or in combinations similar to those administered during TPN, do not stimulate exocrine pancreatic secretion. From a practical standpoint, most patients with acute pancreatitis are diagnosed by nonoperative means and will manifest some degree of paralytic ileus during the early phase of the disease. Therefore, jejunal feeds are usually not a therapeutic option early in the course of this disease. On the basis of the clinical studies reviewed herein we propose general guidelines for the nutritional support of patients with acute pancreatitis: 1, most patients with mild uncomplicated pancreatitis (one to two prognostic signs) do not benefit from nutritional support; 2, nutritional support should begin early in the course of patients with moderate to severe disease (as soon as hemodynamic and cardiorespiratory stability permit); 3, initial nutritional support should be through the parenteral route and include fat emulsion in amounts sufficient to prevent essential fatty acid deficiency (no objective data exist to recommend specific amino acid formulations); 4, patients requiring operation for diagnosis or complications of the disease should have a feeding jejunostomy placed at the time of operation for subsequent enteral nutrition using a low fat formula, such as Precision HN (Sandoz, 1.3 percent calories as fat

  8. [Latest advances in acute pancreatitis].

    de-Madaria, Enrique

    2015-09-01

    The present article analyses the main presentations on acute pancreatitis at Digestive Disease Week 2015. Arterial pseudoaneurysm is an uncommon complication of acute pancreatitis (incidence 0.7%) and mortality from this cause is currently anecdotal. Diabetes mellitus has little impact on the clinical course of acute pancreatitis, unlike cirrhosis, which doubles the risk of mortality. Intake of unsaturated fat could be associated with an increased severity of acute pancreatitis and is a confounding factor in studies evaluating the relationship between obesity and morbidity and mortality. PET-CT (positron emission tomography-computed tomography) could be a non-invasive tool to detect infection of collections in acute pancreatitis. Peripancreatic fat necrosis is less frequent than pancreatic fat necrosis and is associated with a better clinical course. If the clinical course is poor, increasing the calibre of the percutaneous drains used in the treatment of infected necrosis can avoid surgery in 20% of patients. The use of low molecular-weight heparin in moderate or severe pancreatitis could be associated with a better clinical course, specifically with a lower incidence of necrosis. In acute recurrent pancreatitis, simvastatin is a promising drug for prophylaxis of new episodes of acute pancreatitis. Nutritional support through a nasogastric tube does not improve clinical course compared with oral nutrition. PMID:26520203

  9. Severe Acute Pancreatitis in Pregnancy

    Bahiyah Abdullah

    2015-01-01

    Full Text Available This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes.

  10. Contemporary Management of Acute Biliary Pancreatitis

    Orhan Ozkan

    2014-01-01

    Acute biliary pancreatitis is one of the major causes of acute pancreatitis.Gallstones, biliary sludge and microlithiasis, especially in pancreatitis without detectable reason, can be the cause of acute pancreatitis. Acute biliary pancreatitis has many controversions in the literature, and its classification and guidelines are being updated very frequently. Atlanta classifications which determine the definitions and guidelines about acute pancreatitis were renewed and published in 2013. It ha...

  11. Mechanism and dose-effect of Ginkgolide B on severe acute pancreatitis of rats

    Wei Xu

    2011-01-01

    Full Text Available AIM: To determine the optimal dosage and mechanism of Ginkgolide B (BN52021 on severe acute pancreatitis (SAP of rats. METHODS: Seventy male Wistar rats were randomly divided into seven groups (10 for each group. Sham-operation group (SO, SAP model group (SAP, dimethyl sulfoxide (DMSO contrast group (DMSO, and groups treated with 2.5 mg/kg BN52021 (BN1, 5 mg/kg BN52021 (BN2, 10 mg/kg BN52021 (BN3, and 20 μg/kg Sandostatin (SS. The SAP model was established in Wistar rats by injecting 5% sodium taurocholate retrogradely into the common bilio-pancreatic duct. The rats of SO, DMSO and BN52021 were injected with 0.9% NaCl, 0.5% DMSO and BN52021 through femoral vein 15 min after the operation. The SS group was injected with Sandostatin subcutaneously. All rats were anaesthetized at 6 h after operation, and venous blood was collected to determine the levels of serum amylase and phospholipase A2 (PLA2, and pancreas tissue was harvested and stained. RESULTS: There was no significant difference between the SAP and DMSO groups in serum amylase level, PLA2, ascites and pathologic score, but significant difference was found in SAP/DMSO groups compared with those in SO group (P < 0.05 and the levels of serum amylase, PLA2, ascites, and pathologic score were lower in the BN1, BN2, BN3 and SS groups than in the SAP and DMSO groups (P < 0.05. However, among BN1, BN2, BN3 and SS groups, BN2 had the best effect in decreasing the levels of serum amylase and PLA2 (P < 0.05. Expression of platelet activating factor (PAF receptor (PAFR mRNA and protein showed no significant difference between the SAP and DMSO groups, or among BN1, BN2, BN3 and SS groups, but there was remarkable difference between SAP/DMSO group and SO group (P < 0.05, and expression of PAFR mRNA and protein was higher in the BN1, BN2, BN3 and SS groups than in the SAP and DMSO groups (P < 0.05. PAFR expression was observed in the nucleus and cytoplasm of pancreatic islet cells in Wistar rats by

  12. Acute pancreatitis following paracetamol overdose

    Fernandes, Roland

    2009-01-01

    A 17-year-old woman presented with acute abdominal pain and vomiting 3 h after she attempted to commit suicide by ingesting 30×500 mg paracetamol tablets. The woman was found to have a raised amylase level, and a CT scan confirmed the diagnosis of acute pancreatitis. According to the Naranjo adverse drug reaction probability scale, it is likely that the pancreatitis was induced by the paracetamol ingestion. A literature search reported 36 cases of pancreatitis following excessive doses of par...

  13. Acute pancreatitis complicating severe dengue

    Vishakha Jain; O P Gupta; Tarun Rao; Siddharth Rao

    2014-01-01

    Dengue is an arthropod borne viral infection endemic in tropical and subtropical continent. Severe dengue is life threatening. Various atypical presentations of dengue have been documented. But we present a rare and fatal complication of severe dengue in form of acute pancreatitis. A 27-year-old male had presented with severe dengue in decompensated shock and with pain in abdomen due to pancreatitis. The pathogenesis of acute pancreatitis in dengue is not clearly understood, but various mecha...

  14. Acute Pancreatitis. Studies on smoking and protease activation.

    Lindkvist, Björn

    2005-01-01

    Background and aims: Activation of pancreatic proteases is considered to be a crucial event in the early phase of acute pancreatitis but the cause of this activation is not known. Most cases of acute pancreatitis can be attributed to either gallstone disease or alcohol abuse. However, little is known about other risk factors. The aim of this thesis is to investigate the mechanisms involved in the initiation of acute pancreatitis, trends in the incidence, and risk factors for the disease. The ...

  15. Acute necrotizing pancreatitis in rats

    B. van Ooijen (Baan)

    1988-01-01

    textabstractThe specific aim of the present study was to investigate whether eicosanoids play a role in acute necrotizing pancreatitis. Because of the limited number of patients with acute pancreatitis admitted to the hospital each year, as well as the practical difficulties encountered in studying

  16. Pancreatic Enzyme Supplementation in Acute Pancreatitis

    R. V. Patankar; R. Chand; Johnson, C. D.

    1995-01-01

    This study evaluates the effect of oral pancreatic enzyme supplements on pain, analgesic requirement and the incidence of complications in patients with acute pancreatitis. This double blind, prospectively randomised placebo controlled study included 23 patients. Pain was monitored using a visual analogue scale; the analgesic requirement was assessed with a numerical score. No significant differences were noted between the median (range) pain scores of patients who received placebo: 22 (17.1–...

  17. Acute Pancreatitis: Surgery, Pathophysiology and Probiotic Prophylaxis

    Minnen, L.P. van

    2006-01-01

    Acute pancreatitis is a challenging disease with a clinical course that is often difficult to predict. In severe acute pancreatitis, mortality increases significantly if intestinal bacteria translocate from the intestine and infect pancreatic necrosis. Surgical and prophylactic treatment strategies

  18. Acute pancreatitis in acute viral hepatitis

    2007-01-01

    AIM: To elucidate the frequency and characteristics of pancreatic involvement in the course of acute (nonfulminant) viral hepatitis.METHODS: We prospectively assessed the pancreatic involvement in patients with acute viral hepatitis who presented with severe abdomimanl pain.RESULTS: We studied 124 patients with acute viral hepatitis, of whom 24 presented with severe abdominal pain. Seven patients (5.65%) were diagnosed to have acute pancreatitis. All were young males. Five patients had pancreatitis in the first week and two in the fourth week after the onset of jaundice. The pancreatitis was mild and all had uneventful recovery from both pancreatitis and hepatitis on conservative treatment.The etiology of pancreatitis was hepatitis E virus in 4,hepatitis A virus in 2, and hepatitis B virus in 1 patient.One patient had biliary sludge along with HEV infection.The abdominal pain of remaining seventeen patients was attributed to stretching of Glisson's capsule.CONCLUSION: Acute pancreatitis occurs in 5.65% of patients with acute viral hepatitis, it is mild and recovers with conservative management.

  19. Magnetic resonance imaging for acute pancreatitis

    Xiao, Bo; Zhang, Xiao-Ming

    2010-01-01

    Acute pancreatitis is characterized by acute chemical injury of the pancreatic parenchyma and peripancreatic tissue. The increased frequency of death in acute pancreatitis is directly correlated with the degree and progress of pancreatic necrosis. Moreover, the occurrence of some local complications in acute pancreatitis, such as pancreatic hemorrhage, peripancreatic abscess or large pseudocyst, and pseudoaneurysm, could influence the choice of treatment for these patients. Magnetic resonance...

  20. On obesity in acute pancreatitis

    Segersvärd, Ralf

    2005-01-01

    Over-nutrition is one of today s most visible public health problems. Currently over 40% of the Swedish population is either overweight or obese. Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable involvement of regional tissues and/or remote organ systems. The morbidity and mortality associated with acute pancreatitis is largely determined by the involvement of distant organs such as the liver and lung and by the development of organ fail...

  1. Pancreatic Panniculitis: A rare manifestation of Acute Pancreatitis

    Ronak Patel

    2015-05-01

    Full Text Available Context Pancreatic panniculitis is a very rare complication associated with pancreatic disease and perhaps even a presage to pancreatic pathology. Case report We present a case of pancreatic panniculitis in a 61 year old patient who was treated for sudden onset of abdominal pain associated with nausea and vomiting secondary to acute pancreatitis of unknown etiology. He subsequently developed skin lesions consistent with pancreatic panniculitis which gradually improved after resolution of his acute condition and treatment with topical steroid cream. Conclusion We discuss and review the literature along with highlighting for the readers the important clinical and histopathologic features of acute pancreatitis associated pancreatic panniculitis.

  2. Nutrition Support in Acute Pancreatitis

    Orestis Ioannidis

    2008-07-01

    Full Text Available The management of acute pancreatitis differs according to its severity. Approximately 75% of patients with acute pancreatitis have mild disease with a mortality rate below 1%. Mortality increases up to 20% if the disease progresses to its severe necrotizing form and, in the most severe cases, mortality can increase to 30-40%. Severe acute pancreatitis is usually accompanied by systemic inflammatory response syndrome (SIRS which results in hypermetabolism with prominent protein catabolism. Acute malnutrition, commonly observed in patients with acute pancreatitis, is associated with immunological disturbances, septic complications and delayed healing of surgical wounds, and may lead to multiorgan dysfunction or failure syndrome (MODS or MOFS and increased morbidity and mortality [1].

  3. Carbofuran-Induced Acute Pancreatitis

    Rizos E

    2004-01-01

    Full Text Available CONTEXT: Carbamate insecticides are widely used in commercial agriculture and home gardening. A serious side effect of organophosphate and carbamate intoxication is the development of acute pancreatitis. CASE REPORT: A 36-year-old Caucasian woman was admitted to our hospital with cholinergic crisis and pancreatitis soon after the ingestion of a carbamate insecticide (carbofuran. An abdominal CT scan disclosed pancreatic necrosis with intrapancreatic fluid collection, consistent with the development of a pancreatic pseudocyst in a subsequent CT scan. No predisposing factor for pancreatitis was evident. Pseudocholinesterase levels returned to normal 7 days later and the patient was discharged in good physical condition one month after admission. DISCUSSION: Although acute pancreatitis is not infrequent after organophosphate intoxication, it is quite rare after carbamate ingestion and has not been previously reported after carbofuran intoxication.

  4. Protective Effect of Melatonin on Acute Pancreatitis

    Jolanta Jaworek

    2012-01-01

    Full Text Available Melatonin, a product of the pineal gland, is released from the gut mucosa in response to food ingestion. Specific receptors for melatonin have been detected in many gastrointestinal tissues including the pancreas. Melatonin as well as its precursor, L-tryptophan, attenuates the severity of acute pancreatitis and protects the pancreatic tissue from the damage caused by acute inflammation. The beneficial effect of melatonin on acute pancreatitis, which has been reported in many experimental studies and supported by clinical observations, is related to: (1 enhancement of antioxidant defense of the pancreatic tissue, through direct scavenging of toxic radical oxygen (ROS and nitrogen (RNS species, (2 preservation of the activity of antioxidant enzymes; such as superoxide dismutase (SOD, catalase (CAT, or glutathione peroxidase (GPx, (3 the decline of pro-inflammatory cytokine tumor necrosis α (TNFα production, accompanied by stimulation of an anti-inflammatory IL-10, (4 improvement of pancreatic blood flow and decrease of neutrophil infiltration, (5 reduction of apoptosis and necrosis in the inflamed pancreatic tissue, (6 increased production of chaperon protein (HSP60, and (7 promotion of regenerative process in the pancreas. Conclusion. Endogenous melatonin produced from L-tryptophan could be one of the native mechanisms protecting the pancreas from acute damage and accelerating regeneration of this gland. The beneficial effects of melatonin shown in experimental studies suggest that melatonin ought to be employed in the clinical trials as a supportive therapy in acute pancreatitis and could be used in people at high risk for acute pancreatitis to prevent the development of pancreatic inflammation.

  5. Acute pancreatitis: clinical vs. CT findings

    In a prospective study of 91 patients with acute pancreatitis, computed tomographic (CT) findings were correlated with the clinical type of acute pancreatitis. In acute edematous pancreatitis (63 patients; 16 with repeat CT), CT was normal (28%) or showed inflammation limited to the pancreas (61%). Phlegmonous changes were present in 11%, including one patient with focal pancreatic hemorrhage, indicating that clinically unsuspected hemorrhagic pancreatitis can occur. In acute necrotizing (hemorrhagic, suppurative) pancreatitis (nine patients; eight with repeat CT), no patient had a normal CT scan and 89% had phlegmonous changes. One patient had hemorrhagic pancreatitis and three had abscesses. In acute exacerbation of chronic pancreatitis (10 patients; three with repeat CT), there were pancreatic calcifications (70%), a focal mass (40%), and pancreatic ductal dilation (30%). On follow-up CT, the findings of acute pancreatitis did not always disappear with resolution of the clinical symptons. This was especialy true of phlegmonous pancreatitis, where the CT findings could persist for months

  6. Pharmacological approach to acute pancreatitis

    Bang, Ulrich-Christian; Semb, Synne; Nojgaard, Camilla;

    2008-01-01

    The aim of the present review is to summarize the current knowledge regarding pharmacological prevention and treatment of acute pancreatitis (AP) based on experimental animal models and clinical trials. Somatostatin (SS) and octreotide inhibit the exocrine production of pancreatic enzymes and may....... Evidence based pharmacological treatment of AP is limited and studies on the effect of potent anti-inflammatory drugs are warranted....

  7. Acute pancreatitis after a course of clarithromycin.

    Schouwenberg, B.J.J.W.; Deinum, J.

    2003-01-01

    We present a case of acute pancreatitis after a course of clarithromycin. An 84-year-old woman died of suspected pneumonia and cardiac failure. Autopsy surprisingly revealed acute pancreatitis. Except for the use of clarithromycin no other cause for her acute pancreatitis was obvious. Pancreatitis i

  8. Acute chylous peritonitis due to acute pancreatitis.

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-04-28

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide. PMID:22563182

  9. Acute chylous peritonitis due to acute pancreatitis

    Georgios K Georgiou; Haralampos Harissis; Michalis Mitsis; Haralampos Batsis; Michalis Fatouros

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse.The development of chylous ascites is usually a chronic process mostly involving malignancy,trauma or surgery,and symptoms arise as a result of progressive abdominal distention.However,when accumulation of "chyle" occurs rapidly,the patient may present with signs of peritonitis.Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation,appendicitis or visceral ischemia.Less than 100 cases of acute chylous peritonitis have been reported.Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis.This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis,and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis.The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer,since,due to hypertriglyceridemia,serum amylase values appeared within the normal range.Moreover,abdominal computed tomography imaging was not diagnostic for pancreatitis.Following abdominal lavage and drainage,the patient was successfully treated with total parenteral nutrition and octreotide.

  10. Diagnosis of acute necrotizing pancreatitis and acute hemorrhagic pancreatitis in 5 severe acute pancreatitis by plain computed tomography

    The diagnosis of acute pancreatitis is still mainly based on the clinical signs and symptoms of patients. In a prospective study of 64 patients with acute pancreatitis, computed tomography (CT) findings were correlated with the clinical types of acute pancreatitis. We were able to correctly diagnose 3 acute necrotizing pancreatitis with autopsy and 2 acute hemorrhagic pancreatitis by plain CT about 48 hours after onset. At present, CT about 48 hours after onset seems to be the most accurate method for the early detection of necrotizing, hemorrhagic and edematous forms of acute pancreatitis. (author)

  11. Surgical treatment of acute pancreatitis

    Klose, K.J.; Neher, M.; Kuhn, F.P.; Kuemmerle, F.; Thelen, M.

    1983-03-31

    The diagnosis of acute pancreatitis is based on anamnestic, clinical and chemical data. Ultrasound and computed tomography permit direct visualisation of the pancreas and establish the diagnosis. In cases of haemorrhagic-necrotising pancreatitis they demonstrate the extent of morphological changes and permit exclusion of other causes of an acute abdomen. The imaging methods support indications for operation in cases of subtotal or total parenchymatous necrosis and in pancreatic abscesses. Conservative expectant approaches in patients with severe clinical course and slight morphological changes as well as in agreement of clinical and morphological findings are facilitated. Complete demonstration of parenchymatous and peripancreatic necroses furnishes useful additional information for total extirpation. Gallstone disease can be demonstrated or excluded preoperatively. Since introduction of ultrasound and computed tomography for the diagnosis of acute pancreatitis a marked diminution of early surgical intervention and delayed operation has been achieved.

  12. Is acute recurrent pancreatitis a chronic disease?

    Mariani, Alberto; Testoni, Pier Alberto

    2008-01-01

    Whether acute recurrent pancreatitis is a chronic disease is still debated and a consensus is not still reached as demonstrated by differences in the classification of acute recurrent pancreatitis. There is major evidence for considering alcoholic pancreatitis as a chronic disease ab initio while chronic pancreatitis lesions detectable in biliary acute recurrent pancreatitis (ARP) seem a casual association. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation, hereditary a...

  13. Acute chylous peritonitis due to acute pancreatitis

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of “chyle” occurs rapidly, the patient may present with signs of peritonitis. Preoperative...

  14. NF-κB in acute pancreatitis: Mechanisms and therapeutic potential.

    Jakkampudi, Aparna; Jangala, Ramaiah; Reddy, B Ratnakar; Mitnala, Sasikala; Nageshwar Reddy, D; Talukdar, Rupjyoti

    2016-01-01

    The incidence of acute pancreatitis (AP) is increasing globally and mortality could be high among patients with organ failure and infected necrosis. The predominant factors responsible for the morbidity and mortality of AP are systemic inflammatory response syndrome and multiorgan dysfunction. Even though preclinical studies have shown antisecretory agents (somatostatin), antioxidants (S-adenosyl methionine [SAM], selenium), protease inhibitors, platelet activating factor inhibitor (Lexipafant), and anti-inflammatory immunomodulators (eg. prostaglandin E, indomethacin) to benefit AP in terms of reducing the severity and/or mortality, most of these agents have shown heterogeneous results in clinical studies. Several years of experimental studies have implicated nuclear factor-kappa B (NF-κB) activation as an early and central event in the progression of inflammation in AP. In this manuscript, we review the literature on the role of NF-κB in the pathogenesis of AP, its early intraacinar activation, and how it results in progression of the disease. We also discuss why anti-protease, antisecretory, and anti-inflammatory agents are unlikely to be effective in clinical acute pancreatitis. NF-κB, being a central molecule that links the initial acinar injury to systemic inflammation and perpetuate the inflammation, we propose that more studies be focussed towards targeted inhibition of NF-κB activity. Direct NF-κB inhibition strategies have already been attempted in patients with various cancers. So far, peroxisome proliferator activator receptor gamma (PPAR-γ) ligand, pyrrolidine dithiocarbamate (PDTC), proteasome inhibitor and calpain I inhibitor have been shown to have direct inhibitory effects on NF-κB activation in experimental AP. PMID:27282980

  15. Prevention and Intervention Strategies in Acute Pancreatitis

    Besselink, M.G.H.

    2008-01-01

    Acute pancreatitis is a common, costly, potentially lethal, and poorly understood disease, mostly caused by gallstones. In the past decade the incidence of acute pancreatitis in the Netherlands increased by 50% to over 3400 admissions in 2006, most likely due to an increase of gallstone disease. About 20% of patients will develop severe acute pancreatitis, a disease characterized by organ failure and/or pancreatic necrosis, resulting in a high mortality rate. Because the incidence of acute pa...

  16. Acute pancreatitis - severity classification, complications and outcome

    Andersson, Bodil

    2010-01-01

    Acute pancreatitis, with an annual incidence of approximately 35 per 100 000 inhabitants in Sweden, is in most cases mild and self-limiting. Severe acute pancreatitis, affecting 10-15% of the cases is, however, associated with severe complications and even death. The optimal management of acute pancreatitis includes accurate early prediction of the disease severity. The aims of this thesis were to investigate early severity classification, complications and outcome in acute pancreatitis patie...

  17. Acute pancreatitis in children and adolescents

    SUZUKI, Mitsuyoshi; Sai, Jin Kan; Shimizu, Toshiaki

    2014-01-01

    In this Topic Highlight, the causes, diagnosis, and treatment of acute pancreatitis in children are discussed. Acute pancreatitis should be considered during the differential diagnosis of abdominal pain in children and requires prompt treatment because it may become life-threatening. The etiology, clinical manifestations, and course of acute pancreatitis in children are often different than in adults. Therefore, the specific features of acute pancreatitis in children must be considered. The e...

  18. Drug induced acute pancreatitis: Does it exist?

    Tenner, Scott

    2014-01-01

    As the incidence of acute pancreatitis continues to rise, establishing the etiology in order to prevent recurrence is important. Although the etiology of acute pancreatitis is not difficult in the majority of patients, almost a quarter of patients are initially labeled as having idiopathic acute pancreatitis. When confronted with a patient with acute pancreatitis and no clear etiology defined as an absence alcoholism, gallstones (ultrasound and/or MRI), a normal triglyceride level, and absenc...

  19. Liraglutide-induced acute pancreatitis.

    Jeyaraj, Santhosh; Shetty, Ananth Samith; Kumar, Champat Raj Roopesh; Nanditha, Arun; Krishnamoorthy, Satheesh; Raghavan, Arun; Raghavan, K; Ramachandran, Ambady

    2014-01-01

    An obese lady of 51 year with Type 2 Diabetes Mellitus for 13 years was prescribed Liraglutide, a glucagon like peptide (GLP-1) analogue (Victoza) for glycaemic control and reduction of weight. She was on gliclazide and Insulin prior to initiation of Liraglutide. Eight weeks after initiation of GLP -1 analogue, she developed severe abdominal pain, nausea and vomiting. She was admitted to a private hospital and evaluated. Biochemical tests and CT scan revealed presence of pancreatitis and she was treated for acute pancreatitis. Liraglutide was withdrawn and symptoms subsided. Subsequent follow-up showed that pancreatic enzyme levels were normal. PMID:25327099

  20. Acute pancreatitis caused by bortezomib.

    Solakoglu, Tevfik; Akyol, Pinar; Guney, Tekin; Dilek, Imdat; Atalay, Roni; Koseoglu, Huseyin; Akin, Ebru; Demirezer Bolat, Aylin; Buyukasik, Naciye Semnur; Ersoy, Osman

    2013-01-01

    Drug-induced pancreatitis has been reported rarely. Bortezomib is a selective and reversible proteasome inhibitor used for the treatment of patients with multiple myeloma (MM). Recently, one case report about acute pancreatitis (AP) caused by bortezomib was published in the international literature. Herein we report a case of AP in a 67-year-old male on bortezomib therapy. On the fourth day after the first administration of bortezomib, the patient admitted to the hospital with symptoms of AP. The common etiological factors for AP were all excluded. Than the patient was diagnosed as bortezomib-induced pancreatitis. PMID:23561979

  1. Acute Pancreatitis-Induced Thrombotic Thrombocytopenic Purpura

    Mohan Gurjar

    2012-01-01

    Full Text Available Context Acute pancreatitis due to thrombotic thrombocytopenic purpura is a well recognized condition. Here, we are reporting a rare converse phenomenon, in which thrombocytopenic purpura occurred secondary to acute pancreatitis. Case report A 19-year-old male referred to our intensive care unit with diagnosis of acute pancreatitis with multi-organ dysfunction. He had history of severe abdominal pain and recurrent vomiting about one month ago, requiring hospital admission. There, on diagnostic work-up at admission, abdominal ultrasonography was suggestive of pancreatitis. His serum amylase and lipase were 1,900 and 1,582 U/L, respectively. Other laboratory parameters were within normal limits. He was managed conservatively with intravenous fluids, antibiotics and analgesics; and discharged after about 2 weeks One week after discharge he was readmitted in same hospital with abdominal pain, multiple episodes of bilious vomiting and abdominal distention. Later on he was referred to our intensive care unit; having classical pentad of thrombocytopenic purpura, i.e., thrombocytopenia, micro-angiopathic hemolytic anemia, renal failure, encephalopathy, and fever. His condition improved with plasma exchange therapy and transferred out from our ICU to ward after 10 days of stay. Conclusion Thrombocytopenic purpura may be precipitate by acute pancreatitis due to multiple mechanisms. A high clinical suspicion is required to make an early diagnosis and allow early initiation of plasma exchange therapy, resulting in a goodprognosis.

  2. Pancreatic panniculitis: a cutaneous manifestation of acute pancreatitis

    Laureano, A; Mestre, T; Ricardo, L; Rodrigues, AM; Cardoso, J.

    2014-01-01

    Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thi...

  3. Fatal Pancreatic Panniculitis Associated with Acute Pancreatitis: A Case Report

    Lee, Woo Sun; Kim, Mi Yeon; Kim, Sang Woo; Paik, Chang Nyol; Kim, Hyung Ok; Park, Young Min

    2007-01-01

    Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thi...

  4. Pancreatic encephalopathy- a rare complication of severe acute biliary pancreatitis

    Vlad Denis Constantin; Alexandru Carȃp; Bogdan Socea; Simona Bobic

    2014-01-01

    Background. Pancreatic encephalopathy is a rare complication of severe acute pancreatitis, with high mortality, being difficult to diagnose and treat, thus requiring continuous research regarding its management. Materials and Methods. Of 20 patients diagnosed with severe acute pancreatitis on admission at Department of Emergency and Admission (DEA), from January 1st 2010 to March 31st 2014, 5 cases complicated by pancreatic encephalopathy were analyzed using a descriptive observational...

  5. Is acute recurrent pancreatitis a chronic disease?

    Alberto Mariani; Pier Alberto Testoni

    2008-01-01

    Whether acute recurrent pancreaUtis is a chronic disease is still debated and a consensus is not still reached as demonstrated by differences in the classification of acute recurrent pancreatitis.There is major evidence for considering alcoholic pancreatitis as a chronic disease ab initio while chronic pancreatitis lesions detectable in biliary acute recurrent pancreatitis (ARP) seem a casual association.Cystic fibrosis transmembrane con ductance regulator (CFTR) gene mutation,hereditary and obstructive pancreatitis seem an acute disease that progress to chronic pancreatitis,likely as a consequence of the activation and proliferation of pancreatic stellate cells that produce and activate collagen and therefore fibrosis.From the diagnostic point of view,in patients with acute recurrent pancreatitis Endoscopic ultrasound (EUS) seems the more reliable technique for an accurate evaluation and follow-up of some ductal and parenchymal abnormalities suspected for early chronic pancreatitis.

  6. Key Molecular Mechanisms of Chaiqinchengqi Decoction in Alleviating the Pulmonary Albumin Leakage Caused by Endotoxemia in Severe Acute Pancreatitis Rats

    Wu, Wei; Luo, Ruijie; Lin, Ziqi; Xia, Qing

    2016-01-01

    To reveal the key molecular mechanisms of Chaiqinchengqi decoction (CQCQD) in alleviating the pulmonary albumin leakage caused by endotoxemia in severe acute pancreatitis (SAP) rats. Rats models of SAP endotoxemia-induced acute lung injury were established, the studies in vivo provided the important evidences that the therapy of CQCQD significantly ameliorated the increases in plasma levels of lipopolysaccharide (LPS), sCd14, and Lbp, the elevation of serum amylase level, the enhancements of systemic and pulmonary albumin leakage, and the depravation of airways indicators, thus improving respiratory dysfunction and also pancreatic and pulmonary histopathological changes. According to the analyses of rats pulmonary tissue microarray and protein-protein interaction network, c-Fos, c-Src, and p85α were predicted as the target proteins for CQCQD in alleviating pulmonary albumin leakage. To confirm these predictions, human umbilical vein endothelial cells were employed in in vitro studies, which provide the evidences that (1) LPS-induced paracellular leakage and proinflammatory cytokines release were suppressed by pretreatment with inhibitors of c-Src (PP1) or PI3K (LY294002) or by transfection with siRNAs of c-Fos; (2) fortunately, CQCQD imitated the actions of these selective inhibitions agents to inhibit LPS-induced high expressions of p-Src, p-p85α, and c-Fos, therefore attenuating paracellular leakage and proinflammatory cytokines release.

  7. Pancreas Divisum and Acute or Chronic Pancreatitis

    Raffaele Pezzilli

    2012-01-01

    Full Text Available The role of pancreas divisum as a pancreatic ductal anomaly able to induce acute or chronic pancreatitis is still under debate; some authors consider the pancreas as a variant of the pancreatic ductal system able to induce acute or chronic pancreatitis as a result of relative outflow obstruction [1, 2, 3], whereas others consider this finding a simple morphological anomaly of the pancreatic ductal system without any clinical consequence [4, 5, 6].

  8. Endoscopic therapy in acute recurrent pancreatitis

    John Baillie

    2008-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a largely diagnostic to a largely therapeutic rnodality.Cross-sectional imaging,such as computed tomography (CT) and magnetic resonance imaging (MRI),and less invasive endoscopy,especially endoscopic ultrasound (EUS),have largely taken over from ERCP for diagnosis.However,ERCP remains the"first line" therapeutic tool in the management of mechanical causes of acute recurrent pancreatitis,including bile duct stones(choledocholithiasis),ampullary masses (benign and malignant),congenital variants of biliary and pancreatic anatomy (e.g.pancreas divisum,choledochoceles),sphincter of Oddi dysfunction (SOD),pancreatic stones and strictures,and parasitic disorders involving the biliary tree and/or pancreatic duct(e.g Ascariasis,Clonorchiasis).

  9. Lessons Learnt in Management of Acute Pancreatitis

    Deshpande Aparna; Velhal Rishikesh; Thanky Harsh; Soman Sundeep; Shah Ritesh

    2008-01-01

    Objective Acute Pancreatitis continues to be a confounding clinical problem and can pose a formidable challenge in its management. This invited review discusses the various clinical studies done while managing cases of acute pancreatitis and the possible avenues for further studies. Method Clinical studies done on various aspects of pancreatitis viz. severity prediction using bedside index of severity in acute pancreatitis score and its validation in Indian patients, current status of interve...

  10. Diet and risk of acute pancreatitis

    Oskarsson, Viktor

    2016-01-01

    Acute pancreatitis is a sudden inflammation of the pancreas. It has a broad spectrum of clinical outcomes, ranging from mild and self-limiting to severe and potentially fatal, and is often followed by recurrent attacks and/or progression to a chronic disease state (so-called chronic pancreatitis); especially if it is classified as non-gallstone-related acute pancreatitis. Alcohol abuse is considered to be the most important risk factor for non-gallstone-related acute pancreatitis. Even though...

  11. Acute Pancreatitis: Surgery, Pathophysiology and Probiotic Prophylaxis

    van Minnen, L. P.

    2006-01-01

    Acute pancreatitis is a challenging disease with a clinical course that is often difficult to predict. In severe acute pancreatitis, mortality increases significantly if intestinal bacteria translocate from the intestine and infect pancreatic necrosis. Surgical and prophylactic treatment strategies are challenged by complex pathophysiology of the disease. This thesis addresses some key aspects of acute pancreatitis: surgical management, pathophysiology and probiotic prophylaxis. Outcome in pa...

  12. The outcome of management of acute pancreatitis

    T. R. Nagarjuna; Prasad H. L.

    2016-01-01

    Background: Acute pancreatitis is a potentially life threatening disease. The initial management of patients with pancreatitis focuses on establishing the diagnosis, estimating its severity, addressing the major symptoms (i.e., pain, nausea, vomiting, and hypovolemia), and limiting its progression. Therefore, the present study has been undertaken to record the outcome of management of acute pancreatitis. Methods: The study population consisted of 40 cases of acute pancreatitis that fulfill...

  13. CLINICAL STUDY ON ACUTE PANCREATITIS

    Suhaib Rehaman

    2015-07-01

    Full Text Available INTRODUCTION : Early diagnosis and severity evaluation on patients with acute pancreatitis are very important due to its potential morbidity and mortality. Given the wide spectrum of disease seen, the care of patients with pancreatitis must be highly individualized. Sev eral clinical, laboratory and radiologic factors and many scoring systems have been proposed for outcome prediction. AIMS AND OBJECTIVES: To study the symptomatology, clinical presentation and management in pancreatitis . To study the severity of acute panc reatitis according to Glasgow Scale . METHODS: Present study includes consecutive 38 patients hospitalized in CSI Holdsworth Memorial Hospital over the period of 2 years. All patients were thoroughly investigated and were stratified according to the Glasgow criteria. Data was collected on complications, investigations and interventions undertaken, outcome, duration of stay in hospital and ICU. STATISTICAL ANALYSIS USED: Descriptive, Chi square tests, Crosstabs (Contingency coefficient analysis . RESULTS : Mean age of presentation in our study was 43.1 years. There was a male predominance accounting for 68.4% compared to 31.6% females. Alcohol was the main etiological factor in about 50% of the patients. Sensitivity to S. amylase was about 100%. Accuracy of USG abdomen in diagnosing pancreatitis was about 88.5%. Ascitis was the commonest complication seen in 13.2%. Mean duration of hospital stay was 6.2 days. The patient were stratified according to Glasgow scoring system into mild (0 - 3 and severe (>3 panc reatitis. In our study 32 people were graded with mild pancreatitis, all improved and in 6 people who were graded with severe pancreatitis, 83.3 % improved and 2.6% expired because of complications. Test statistics showed Contingency coefficient 0.355 and P 0.019 (NS. CONCLUSION : Glasgow scoring system remains a valid predicting system for the outcome in patients with acute pancreatitis. It is simple easy to apply with

  14. Acute pancreatitis: Manifestation of acute HIV infection in an adolescent

    Bitar, Anas; Altaf, Muhammad; Sferra, Thomas J.

    2012-01-01

    Summary Background: Pancreatitis in the pediatric age group is not as common as in adults. Etiologies are various and differ from those in adults. Although infectious etiology accounts for a significant number of cases of pancreatitis, acute infection with Human Immunodeficiency Virus (HIV) was rarely reported as a possible etiology for acute pancreatitis in adults. Acute pancreatitis has never been reported as a presenting manifestation of acute HIV infection in children. Case Report: We des...

  15. Prognostic Indicators in Acute Pancreatitis

    2003-01-01

    Several approaches have been used in an attempt to predict the severity and prognosis of attacks of acute pancreatitis. The Ranson and Glasgow criteria include a variety of simple laboratory parameters that are measured on admission and again within 48 h. They are the most widely used indices in clinical practice. The Acute Physiological and Chronic Health Evaluation II system is more complicated, but can be applied to a wide variety of conditions, especially in intensive care settings. The u...

  16. [Prolonged acute pancreatitis after bone marrow transplantation].

    De Singly, B; Simon, M; Bennani, J; Wittnebel, S; Zagadanski, A-M; Pacault, V; Gornet, J-M; Allez, M; Lémann, M

    2008-04-01

    Acute pancreatitis is not infrequent after allogenic marrow transplantation. Several causes can predispose to pancreatitis, including Graft-Versus-Host Disease (GVHD), a condition which is probably underestimated. In the literature, few description of pancreatic GVHD can be found. Pancreatic GVHD diagnosis can be difficult if pancreatic involvement occurs without other typical manifestations of GVHD. We report the case of a woman, 54 years old, suffering from prolonged, painful pancreatitis two months after allogenic bone marrow transplantation for acute myeloid leucemia. Pancreatic GVHD diagnosis was performed after five weeks on duodenal biopsies despite the absence of diarrheoa. The patient dramatically improved within few days on corticosteroids. PMID:18378104

  17. Respiratory failure in acute pancreatitis.

    Banerjee, A K; Haggie, S J; Jones, R B; Basran, G. S.

    1995-01-01

    There are a number of important pulmonary complications of acute pancreatitis which make a significant contribution to the morbidity and mortality of the condition. The pathophysiology and management guidelines are given for each and approaches towards better treatment in the future are discussed.

  18. Acute biliary pancreatitis: Diagnosis and treatment

    Hazem Zakaria

    2009-01-01

    Full Text Available Gallstones are the commonest cause of acute pancreatitis (AP, a potentially life-threatening condition, worldwide. The pathogenesis of acute pancreatitis has not been fully understood. Laboratory and radiological investigations are critical for diagnosis as well prognosis prediction. Scoring systems based on radiological findings and serologic inflammatory markers have been proposed as better predictors of disease severity. Early endoscopic retrograde cholangiopancreatography (ERCP is beneficial in a group of patients with gallstone pancreatitis. Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for acute biliary pancreatitis. The timing of cholecystectomy, following ERCP, for biliary pancreatitis can vary markedly depending on the severity of pancreatitis

  19. Action of Antiproteases on the Inflammatory Response in Acute Pancreatitis

    Chun-Chia Chen

    2007-07-01

    Full Text Available The spectrum of acute pancreatitis ranges from mild edematous disease to a severe necrotizing process which is usually accompanied by local or systemic complications and even mortality. Early deaths (within the first week due to severe acute pancreatitis are generally caused by massive inflammatory responses which result in multiple organ failure. Although the exact mechanisms which trigger the inflammatory and necrotizing processes are not completely understood, it is generally accepted that autodigestion and activated leukocytes play important roles in the pathogenesis of acute pancreatitis. Proinflammatory cytokines are associated with systemic inflammatory response syndrome and multiple organ failure syndrome in acute pancreatitis. A compensatory anti-inflammatory response occurs in parallel with systemic inflammatory response syndrome. Trypsin secreted by the pancreatic acinar cells activates proteaseactivated receptor-2 which can result in the production of cytokines. Protease inhibitors such as aprotinin, gabexate mesilate, nafamostat mesilate, ulinastatin, etc. can inhibit the various enzymes and inflammatory response in experimental and clinical studies. Thus, protease inhibitors have been considered as a potential treatment to inhibit the pancreatic inflammation in acute pancreatitis. The beneficial effects of antiproteases on experimental severe acute pancreatitis may be, in part, due to the modulation of inflammatory cytokine responses. The effect of protease inhibitors on the inflammatory response in human acute pancreatitis deserves further study.

  20. Radiological observation of acute pancreatitis

    The radiologic study of the pancreas oriented in the upper retroperitoneal space is difficult because the specific density of this viscus is the same as that of its surrounding tissue. so that it cannot be visualized directly. Furthermore, it is one of the few viscera in the abdomen which cannot be outlined by a contrast medium. In the abdomen, the diagnosis of acute pancreatitis is very important since the present treatment of this disease is conservative, which emergency laparatomy is indicated in most other abdominal crisaes. However, the diagnosis of acute pancreatitis cannot be made by roentgen studies alone, yet such studies can at times confirm an uncertain clinical diagnosis when evaluated with clinical findings and can occasionally alert the unsuspecting clinician to the possible presence of this disease. Because a radiologic examination plays such an important role in the differential diagnosis of the acute abdomen and at present augmenting interest for pancreatic disease, we present this discussion in order to focus attention on the radiologic features of acute pancreatitis.1. From Nov. 1968 to June 1978, roentgenologic studies of 275 patients diagnosed as acute pancreatitis were reviewed. 2. In this series, the important findings on the chest roentgenograms of 275 cases were as follows. 1) Fifty-five cases (20.0%) of these represented pleural effusion. 2) Platelike atelectasis at the lung bases was noted in 44 cases (16.0%). 3) There was elevation of the diaphragm in 33 cases (12.0%). 3. The significant findings on the simple abdomen of 247 cases were as follows. 1) The presence of a sentinel loop occurred in 168 cases (68.0%). 2) Colon 'cut-off' sign was noted in 106 cases (42.9%). 3) Obliteration of psoas shadows in 8 cases (3.2%). 4) Gastrocolic separation in 4 cases (1.6%). 4. One hundred and seventy-five barium meal studies of the stomach and duodenum were available for review.

  1. Pulmonary Thromboembolism Complicating Acute Pancreatitis With Pancreatic Ascites: A Series of 4 cases

    Ruchir Patel

    2016-05-01

    Full Text Available Acute pancreatitis is an inflammatory disease often associated with local and systemic complications. Portosplenic and splanchnic vascular complications of acute pancreatitis are common, but extrasplanchnic vessel thrombosis is less commonly seen. Among them, pulmonary thromboembolism is a very rare complication to be encountered with. We report four cases of acute pulmonary thromboembolism in patients with acute pancreatitis superimposed on chronic pancreatitis. All the patients had abdominal pain on presentation and distention of abdomen during the course. Dyspnea was present in all the patients. All patients were found to have pancreatic ascites, whose association with pulmonary thromboembolism is reported only in two patients till date upto our knowledge. Two of them had deep vein thrombosis and rest two had no venous thrombosis. All of them were managed conservatively using subcutaneous heparin, intravenous fluids and analgesics. We provide the causative mechanism for occurrence of pulmonary thromboembolism in acute on chronic pancreatitis. We have also hypothesized pancreatic ascites as the possible cause for pulmonary thromboembolism and provide explanation for it. We conclude that pulmonary thromboembolism in acute pancreatitis has good prognosis if diagnosed timely. Whenever patient with pancreatic ascites presents with dyspnea, pulmonary thromboembolism must be ruled out.

  2. Molecular mechanisms of alcohol associated pancreatitis

    Dahn; L; Clemens; Mark; A; Wells; Katrina; J; Schneider; Shailender; Singh

    2014-01-01

    Alcohol abuse is commonly associated with the development of both acute and chronic pancreatitis. Despite this close association, the fact that only a small percentage of human beings who abuse alcohol develop pancreatitis indicates that alcohol abuse alone is not sufficient to initiate clinical pancreatitis. This contention is further supported by the fact that administration of ethanol to experimental animals does not cause pancreatitis. Because of these findings, it is widely believed that ethanol sensitizes the pancreas to injury and additional factors trigger the development of overt pancreatitis. How ethanol sensitizes the pancreas to pancreatitis is not entirely known. Numerous studies have demonstrated that ethanol and its metabolites have a number of deleterious effects on acinar cells. Important acinar cells properties that are affected by ethanol include: calcium signaling, secretion of zymogens, autophagy, cellular regeneration, the unfolded protein response, and mitochondrial membrane integrity. In addition to the actions of ethanol on acinar cells, it is apparent that ethanol also affects pancreatic stellatecells. Pancreatic stellate cells have a critical role in normal tissue repair and the pathologic fibrotic response. Given that ethanol and its metabolites affect so many pancreatic functions, and that all of these effects occur simultaneously, it is likely that none of these effects is "THE" effect. Instead, it is most likely that the cumulative effect of ethanol on the pancreas predisposes the organ to pancreatitis. The focus of this article is to highlight some of the important mechanisms by which ethanol alters pancreatic functions and may predispose the pancreas to disease.

  3. Immunomodulatory therapies for acute pancreatitis

    Li, Jing; Yang, Wen-Juan; Huang, Lu-Ming; Tang, Cheng-Wei

    2014-01-01

    It is currently difficult for conventional treatments of acute pancreatitis (AP), which primarily consist of anti-inflammatory therapies, to prevent the progression of AP or to improve its outcome. This may be because the occurrence and progression of AP, which involves various inflammatory cells and cytokines, includes a series of complex immune events. Considering the complex immune system alterations during the course of AP, it is necessary to monitor the indicators related to immune cells...

  4. ERCP in acute biliary pancreatitis

    Kapetanos, Dimitrios J

    2010-01-01

    The role of urgent endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis is for many years a subject for disagreement among physicians. Although the evidence seemed to be in favor of performing ERCP, endoscopists usually hesitate to conform to the guidelines. ERCP is an invasive procedure, with complications which can affect patients’ outcome. Recent evidence suggests that we should probably modify our policy, recruiting less invasive procedures, like magnetic re...

  5. Rapid Evolution from the First Episode of Acute Pancreatitis to Chronic Pancreatitis in Human Subjects

    Elie Aoun; Adam Slivka; Papachristou, Dionysios J.; David C. Whitcomb; Ferga C. Gleeson; Georgios I Papachristou

    2007-01-01

    Context Growing evidence suggests that recurrent acute pancreatitis leads to chronic pancreatitis, but this sequence is seldom reported in human subjects. The sentinel acute pancreatitis event hypothesis suggests that an initial episode of acute pancreatitis is the first step in a complicated series of events ultimately leading to chronic pancreatitis. Objective To identify patients who evolved from recurrent acute pancreatitis to chronic pancreatitis. Setting The Severity of Acute Pancreatit...

  6. Acute pancreatitis : a newly recognised potential complication of canine babesiosis

    A.J. Möhr

    2000-07-01

    Full Text Available This retrospective study describes 4 cases of canine babesiosis with histologically confirmed acute pancreatitis. In addition, 16 dogs with babesiosis are reported with serum amylase (>3500 U/l and/or lipase (>650 U/l activity elevations of a magnitude that would support a diagnosis of probable acute pancreatitis, although extra-pancreatic sources of the enzymes could not be excluded in these cases. Median time of pancreatitis diagnosis was 2.5 days post-admission, with primarily young (median age 3 years, sexually intact dogs affected. The development of pancreatitis was unrelated to the degree of anaemia at time of admission. In addition to pancreatitis, 80 % of cases suffered from other babesial complications, namely icterus (13, acute respiratory distress syndrome (6, immune-mediated haemolytic anaemia (6, renal failure (3, haemoconcentration (2 and cerebral syndrome (2. Acute respiratory distress syndrome, renal failure and cerebral syndrome were associated with a poor prognosis, with 4 of the 5 dogs included in the overall 26 % mortality rate having at least 1 of these complications. Haemolytic anaemia with ischaemia-reperfusion injury to the pancreas is proposed as a possible primary pathophysiological mechanism in babesial pancreatitis. Hypotensive shock, immune-mediated haemolytic anaemia, haemoconcentration and possibly altered lipid metabolism in babesiosis may also be involved. The previously postulated pro-inflammatory cytokine milieu of complicated babesiosis may underlie the progression, if not the primary initiation, of pancreatic pathology. Acute pancreatitis may represent the previously reported 'gut' form of babesiosis.

  7. Pazopanib-Induced Severe Acute Pancreatitis

    Kawakubo, Kazumichi; Hata, Hiroo; Kawakami, Hiroshi; Kuwatani, Masaki; Kawahata, Shuhei; Kubo, Kimitoshi; Imafuku, Keisuke; Kitamura, Shinya; Sakamoto, Naoya

    2015-01-01

    Pazopanib is an oral angiogenesis inhibitor targeting vascular endothelial growth factor receptors, platelet-derived growth factor receptors, and c-Kit approved for the treatment of renal cell carcinoma and soft tissue sarcoma. Nonselective kinase inhibitors, such as sunitinib and sorafenib, are known to be associated with acute pancreatitis. There are few case reports of severe acute pancreatitis induced by pazopanib treatment. We present a case of severe acute pancreatitis caused by pazopan...

  8. Acute Pancreatitis Due to Pravastatin Therapy

    Anagnostopoulos GK

    2003-05-01

    Full Text Available CONTEXT: Few data exist about the incidence of drug-induced pancreatitis in the general population. Drugs are related to the etiology of pancreatitis in about 1.4-2% of cases. Statins are generally well tolerated. Acute pancreatitis has been reported in a few cases treated with atorvastatin, fluvastatin, lovastatin and simvastatin. CASE REPORT: We report the case of a 56-year-old patient who, after 6 months of treatment with pravastatin 20 mg once daily for hypercholesterolemia, presented with acute pancreatitis. Other causes of the disease were ruled out. Five months later, the patient, on his own initiative, reintroduced pravastatin and acute pancreatitis recurred after 3 days. CONCLUSION: To our knowledge this is the first report of pravastatin-induced pancreatitis and further strengthens the fact that statins may cause acute pancreatitis.

  9. Acute pancreatitis following medical abortion: Case report

    Amini Hashem

    2004-04-01

    Full Text Available Abstract Background Acute pancreatitis rarely complicates pregnancy. Although most pregnant women with acute pancreatitis have associated gallstones, less common causes such as drugs have been reported. Case presentation We report the case of a 34-year-old woman who underwent medical abortion with mifepristone and gemeprost and received codeine as pain-relief during the induction of abortion. She developed a severe acute necrotizing pancreatitis which required 14 days of intensive care. Other possible etiological factors, i.e. gallstone, alcohol intake and hyperlipidemia, were excluded. Conclusions The reported case of acute pancreatitis was most likely drug-induced.

  10. Acute pancreatitis in children and adolescents

    Mitsuyoshi; Suzuki; Jin; Kan; Sai; Toshiaki; Shimizu

    2014-01-01

    In this Topic Highlight, the causes, diagnosis, and treat-ment of acute pancreatitis in children are discussed. Acute pancreatitis should be considered during the dif-ferential diagnosis of abdominal pain in children and requires prompt treatment because it may become life-threatening. The etiology, clinical manifestations, and course of acute pancreatitis in children are often differ-ent than in adults. Therefore, the specific features of acute pancreatitis in children must be considered. The etiology of acute pancreatitis in children is often drugs, infections, trauma, or anatomic abnormalities. Diagnosis is based on clinical symptoms(such as abdominal pain and vomiting), serum pancreatic enzyme levels, and im-aging studies. Several scoring systems have been pro-posed for the assessment of severity, which is useful for selecting treatments and predicting prognosis. The basic pathogenesis of acute pancreatitis does not greatly dif-fer between adults and children, and the treatments for adults and children are similar. In large part, our under-standing of the pathology, optimal treatment, assess-ment of severity, and outcome of acute pancreatitis in children is taken from the adult literature. However, we often find that the common management of adult pan-creatitis is difficult to apply to children. With advances in diagnostic techniques and treatment methods, severeacute pancreatitis in children is becoming better under-stood and more controllable.

  11. Contemporary Management of Acute Biliary Pancreatitis

    Orhan Ozkan

    2014-03-01

    Full Text Available Acute biliary pancreatitis is one of the major causes of acute pancreatitis.Gallstones, biliary sludge and microlithiasis, especially in pancreatitis without detectable reason, can be the cause of acute pancreatitis. Acute biliary pancreatitis has many controversions in the literature, and its classification and guidelines are being updated very frequently. Atlanta classifications which determine the definitions and guidelines about acute pancreatitis were renewed and published in 2013. It has various clinical aspects, ranging from a mild form which is easily treated, to a severe form that causes complications leading to mortality. The pathogenesis of this disease has not been fully elucidated and several theories have been suggested. New scoring systems and laboratory methods such as proteomics have been suggested for both diagnosis and to predict disease severity, and research on these topics is still in progress. Novel therapeutic approaches with technological developments such as ERCP, ES, MRCP, and EUS are also suggested.

  12. Pancreatic encephalopathy- a rare complication of severe acute biliary pancreatitis

    Vlad Denis Constantin

    2014-10-01

    Full Text Available Background. Pancreatic encephalopathy is a rare complication of severe acute pancreatitis, with high mortality, being difficult to diagnose and treat, thus requiring continuous research regarding its management. Materials and Methods. Of 20 patients diagnosed with severe acute pancreatitis on admission at Department of Emergency and Admission (DEA, from January 1st 2010 to March 31st 2014, 5 cases complicated by pancreatic encephalopathy were analyzed using a descriptive observational, retrospective, single-center study. Results. The study shows different types of diagnostic algorithm and therapeutical approaches, in correlation with morbidity and mortality rates. Conclusions. Our study highlighted the fact that speed is critical, early management being the key to outcome.

  13. Burkitt lymphoma mimicking acute pancreatitis

    Lívia Moscardi Bacchi

    2012-12-01

    Full Text Available Burkitt lymphoma (BL is a highly aggressive B cell lymphoma, presenting in extranodal sites or as an acute leukemia. Three clinical variants of BL are recognized: endemic BL, sporadic BL and immunodeficiency associated BL. Sporadic BL is seen worldwide, mainly in children and young adults involving the abdominal organs mostly the ileocaecal area. Pancreatic involvement is rare. The authors report a unique case of abdominal Burkitt lymphoma, initially diagnosed and treated as acute pancreatitis. Clinically, the patient presented severe abdominal pain and vomiting. Imaging findings were suggestive of inflammatory involvement of the pancreas, heading treatment towards this hypothesis. Unfortunately, the patient died during the diagnostic work up, and the autopsy findings demonstrated advanced Burkitt lymphoma with extensive involvement of pancreatic parenchyma and other organs within the abdominal cavity. Once Burkitt lymphoma is a potentially curable disease, early diagnosis is crucial for better outcomes.

  14. Plasmablastic Lymphoma Mimicking Acute Pancreatitis.

    Inayat, Faisal; Virk, Hafeez Ul Hassan; Cheema, Ahmad R; Saif, Muhammad Wasif

    2016-01-01

    Background. Plasmablastic lymphoma (PBL) is a rare B-cell neoplasm. It predominantly occurs in the oral cavity of human immunodeficiency virus (HIV)-positive patients and exhibits a highly aggressive clinical behavior. Case Presentation. We describe an unusual case of a 37-year-old HIV-positive male who presented with acute pancreatitis secondary to multiple peripancreatic masses compressing the pancreas. Histopathological examination of the lesions showed diffuse and cohesive pattern of large B-cells resembling immunoblasts or plasmablasts. The neoplastic cells were positive for BOB1 and MUM1, partially positive for CD79a, and negative for CD20, CD56, CD138, CD3, CD5, AE1/AE3, and HHV8. Epstein-Barr virus-encoded RNA in situ hybridization was positive. These features were consistent with PBL. The patient was initiated on cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy, demonstrating a striking response. Conclusion. To our research, this is the first report of PBL with the initial presentation of acute pancreatitis. The findings in this case suggest that PBL should be included in the differential diagnosis of pancreatic and peripancreatic tumors. PMID:27034868

  15. Acute Pancreatitis in the Course of Meprobamate Poisoning

    Neila Fathallah

    2011-07-01

    Full Text Available Context We report a case of massive poisoning with meprobamate leading to acute pancreatitis. Case report A 43-year-old patient with a history of schizophrenia and multiple suicide attempts was admitted to the intensive care unit for severe poisoning with meprobamate (voluntary ingestion of 60 g. On admission, the patient was deeply comatose with low blood pressure and hypothermia. Laboratory analysis revealed leukocytosis and high lipase and amylase serum levels. There was no eosinophilia. Abdominal computed tomography showed pancreatitis grade A. The patient was intubated and ventilated, and intravenous dopamine was infused. The patient regained consciousness and was extubated five days later. Improvement in pancreatic tests was noted several days later. The outcome was favorable. Discussion According to the Naranjo probability scale, meprobamate-induced acute pancreatitis was probable. Acute pancreatitis in meprobamate poisoning is exceptional. The pathogenesis of pancreatitis-induced meprobamate poisoning may be explained by two mechanisms: stimulation of pancreatic secretion secondary to cholinergic activation and pancreatic ductal hypertension. Conclusions The signs of severe meprobamate toxicity are numerous including cardiovascular and central nervous symptoms. Acute pancreatitis should also be added as a possible manifestation of meprobamate poisoning.

  16. Severe acute pancreatitis and non occlusive mesenteric ischemia

    The mechanism and pathology of patients with severe acute pancreatitis with non-occlusive mesenteric ischemia (NOMI) are still unclear. Currently, there are some reports that vasoconstriction associated factors (angiopoietin-2, endothelin-1 and VEGF et al.) have important role in the development of NOMI with severe acute pancreatitis. In our experience, one of characteristic pathological findings of NOMI is the non-consecutive enterointestinal damage. The diagnosis of NOMI is not easy in the early stage, so we attempt to use hepatic perfusion CT to diagnose it. Hepatic perfusion CT can evaluate hepatic portal flow (HPF) and hepatic arterial flow (HAF), separately. In our study, HPF of acute pancreatitis patients with NOMI was significantly slower than those without NOMI. Therefore, evaluation of hepatic perfusion in the early stage might be extremely helpful in the diagnosis of NOMI. In this paper, we would like to report the mechanism, pathology, diagnosis and treatment of NOMI in severe acute pancreatitis. (author)

  17. Acetaminophen-Induced Acute Pancreatitis. A Case Report

    Hisato Igarashi

    2009-09-01

    Full Text Available Context Drug-induced acute pancreatitis is rare but should not be overlooked in a patient who presents with idiopathic acute pancreatitis. More than 100 drugs have been implicated in causing the disease: acetaminophen has been associated with acute pancreatitis in cases where there has been an overdose of drugs; however, the frequency is rare. Case report We report the case of a 35-year-old woman who presented with acute pancreatitis and severe metabolic acidosis after overdosing on a drug containing acetaminophen. She improved dramatically after intensive care; however, she showed recurrent episodes after re-overdosing on the same drug. With her self re-challenge test, she was diagnosed as having acetaminophen-induced pancreatitis and metabolic acidosis. A review of the relevant literature is also presented. Conclusions Drug-induced acute pancreatitis is often challenging for clinicians and a detailed mechanism is unknown. It is very important to rule out drug-induced pancreatitis when treating pancreatitis with an unknown etiology.

  18. STUDY ANALYSIS OF ACUTE PANCREATITIS BY CT

    Bulabai; Hemhnath

    2015-01-01

    AIM: Study analysis of pancreatitis by computed tomography in terms of morphology of pancreas in acute pancreatitis, complications of pancreatitis and duration of hospital stay by grading the severity of disease using Modified CT severity index. MATERIAL AND METHOD: This prospective study of 100 patients suspected of pancreatitis was evaluated with multidetector spiral CT scanner, somatom, (Spirit) Siemens at Tertiary care center, for period of one year. The series consists of pat...

  19. Computerized tomography in acute and chronic pancreatitis

    Modern imaging techniques have revolutionized the diagnostic evaluation of pancreatitis, primarily demonstrating its complications. Computerized tomography (CT) is a more sensitive method than ultrasonography and pancreatic ductography. A chart review revealed 214 patients at our hospital with a discharge diagnosis of pancreatitis. Sixty patients had CT for evaluation of possible complications. Only five scans were normal. Of 37 cases of acute pancreatitis, 92% demonstrated localized or diffuse enlargement, and 65% showed loss of pancreatic outline. Other frequent findings included thickening of perirenal fascia (49%), ileus (43%), edema of mesentery (35%), and inflammatory exudate (32%). Abscess and pseudocyst were each detected in 8% of cases. In chronic pancreatitis 65% of patients showed localized or diffuse pancreatic enlargement. Atrophy of the gland (30%), calcification (30%), pseudocyst (26%), and dilated pancreatic ducts (17%) were also seen. CT is effective in evaluating pancreatitis and its complications. 14 references, 5 figures, 2 tables

  20. Action of Antiproteases on the Inflammatory Response in Acute Pancreatitis

    Chun-Chia Chen; Sun-Sang Wang; Fa-Yauh Lee

    2007-01-01

    The spectrum of acute pancreatitis ranges from mild edematous disease to a severe necrotizing process which is usually accompanied by local or systemic complications and even mortality. Early deaths (within the first week) due to severe acute pancreatitis are generally caused by massive inflammatory responses which result in multiple organ failure. Although the exact mechanisms which trigger the inflammatory and necrotizing processes are not completely understood, it is generally accepted tha...

  1. An unreported complication of acute pancreatitis

    Muthukumarasamy, G; V. Shanmugam; Yule, SR; Ravindran, R

    2007-01-01

    Acute pancreatitis constitutes 3% of all admissions with abdominal pain. There are reports of osteal fat necrosis leading to periosteal reactions and osteolytic lesions following severe pancreatitis, particularly in long bones. A 54-year-old man was admitted to our hospital with acute pancretitis, who later developed spinal discitis secondary to necrotizing pancreatitis. He was treated conservatively with antibiotics and after a month he recovered completely without any neurological deficit. ...

  2. Tamoxifen-induced hypertriglyceridemia causing acute pancreatitis

    Hemant Kumar Singh; Mahendranath S Prasad; Kandasamy, Arun K.; Kadambari Dharanipragada

    2016-01-01

    Tamoxifen has both antagonistic and agonistic tissue-specific actions. It can have a paradoxical estrogenic effect on lipid metabolism resulting in elevated triglyceride and chylomicron levels. This can cause life-threatening complications like acute pancreatitis. To our knowledge, very few cases of tamoxifen-induced pancreatitis have been reported in the literature. We report a case of severe hypertriglyceridemia and acute pancreatitis following tamoxifen use. A 50-year-old diabetic lady was...

  3. Prevention and Intervention Strategies in Acute Pancreatitis

    Besselink, M.G.H.

    2008-01-01

    Acute pancreatitis is a common, costly, potentially lethal, and poorly understood disease, mostly caused by gallstones. In the past decade the incidence of acute pancreatitis in the Netherlands increased by 50% to over 3400 admissions in 2006, most likely due to an increase of gallstone disease. Abo

  4. The outcome of management of acute pancreatitis

    T. R. Nagarjuna

    2016-07-01

    Conclusions: Predicting the prognosis of a patient with acute pancreatitis at admission forms a very important strategy in management of acute pancreatitis, which will enable to practice guidelines for standardization of management of the patient which will in turn translate into improved outcomes. [Int J Res Med Sci 2016; 4(7.000: 2998-3001

  5. Acute Biliary Pancreatitis: Diagnosis and Treatment

    Hazem Zakaria

    2009-01-01

    Gallstones are the commonest cause of acute pancreatitis (AP), a potentially life-threatening condition, worldwide. The pathogenesis of acute pancreatitis has not been fully understood. Laboratory and radiological investigations are critical for diagnosis as well prognosis prediction. Scoring systems based on radiological findings and serologic inflammatory markers have been proposed as better predictors of disease severity. Early endoscopic retrograde cholangiopancreatography (ERCP) is benef...

  6. Cytokines and organ failure in acute pancreatitis

    Malmstrøm, Marie Louise; Hansen, Mark Berner; Andersen, Anders Møller;

    2012-01-01

    We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP).......We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP)....

  7. Atorvastatin-induced acute pancreatitis

    Deshpande, Prasanna R.; Kanav Khera; Girish Thunga; Manjunath Hande; Gouda, Siddalingana T. G.; Anantha Naik Nagappa

    2011-01-01

    Atorvastatin-induced acute pancreatitis (AP) is one of the rare adverse effects available in the literature. We report a case of 53-year-old patient developed AP after treatment with atorvastatin monotherapy which resolved after drug withdrawal. Extensive workup on AP failed to reveal any other etiology for it. To our knowledge, this is one of the rare case reports of AP caused due to atorvastatin monotherapy and it further strengthens the fact that statins may cause AP. There is need of cont...

  8. Atorvastatin-induced acute pancreatitis

    Prasanna R Deshpande

    2011-01-01

    Full Text Available Atorvastatin-induced acute pancreatitis (AP is one of the rare adverse effects available in the literature. We report a case of 53-year-old patient developed AP after treatment with atorvastatin monotherapy which resolved after drug withdrawal. Extensive workup on AP failed to reveal any other etiology for it. To our knowledge, this is one of the rare case reports of AP caused due to atorvastatin monotherapy and it further strengthens the fact that statins may cause AP. There is need of continued reporting of such a rare adverse effect of atorvastatin for increasing awareness and to manage and avoid the same.

  9. Pharmacological approach to acute pancreatitis

    Ulrich Christian Bang; Synne Semb; Camilla Nφjgaard; Flemming Bendtsen

    2008-01-01

    The aim of the present review is to summarize the current knowledge regarding pharmacological prevention and treatment of acute pancreatitis (AP)based on experimental animal models and clinical trials.Somatostatin (SS) and octreotide inhibit the exocrine production of pancreatic enzymes and may be useful as prophylaxis against Post Endoscopic retrograde cholangiopancreatography Pancreatitis (PEP). The protease inhibitor Gabexate mesilate (GM) is used routinely as treatment to AP in some countries, but randomized clinical trials and a meta-analysis do not support this practice. Nitroglycerin (NGL) is a nitrogen oxide (NO) donor, which relaxes the sphincter of Oddi.Studies show conflicting results when applied prior to ERCP and a large multicenter randomized study is warranted. Steroids administered as prophylaxis against PEP has been validated without effect in several randomized trials. The non-steroidal anti-inflammatory drugs (NSAID) indomethacin and diclofenac have in randomized studies showed potential as prophylaxis against PEP. Interleukin 10 (IL-10) is a cytokine with anti-inflammatory properties but two trials testing IL-10 as prophylaxis to PEP have returned conflicting results.Antibodies against tumor necrosis factor-alpha (TNF-α)have a potential as rescue therapy but no clinical trials are currently being conducted. The antibiotics betalactams and quinolones reduce mortality when necrosis is present in pancreas and may also reduce incidence of infected necrosis. Evidence based pharmacological treatment of AP is limited and studies on the effect of potent anti-inflammatory drugs are warranted.

  10. Advances in Management of Acute Pancreatitis.

    Janisch, Nigeen H; Gardner, Timothy B

    2016-03-01

    This article reviews advances in the management of acute pancreatitis. Medical treatment has been primarily supportive for this diagnosis, and despite extensive research efforts, there are no pharmacologic therapies that improve prognosis. The current mainstay of management, notwithstanding the ongoing debate regarding the volume, fluid type, and rate of administration, is aggressive intravenous fluid resuscitation. Although antibiotics were used consistently for prophylaxis in severe acute pancreatitis to prevent infection, they are no longer used unless infection is documented. Enteral nutrition, especially in patients with severe acute pancreatitis, is considered a cornerstone in management of this disease. PMID:26895677

  11. Pancreatic microcirculatory impairment in experimental acute pancreatitis in rats

    Zong-Guang Zhou; You-Dai Chen; Wei Sun; Zhong Chen

    2002-01-01

    AIM: To study the feature of pancreatic microcirculatoryimpairment, especially the initial changes, in caerulein-induced experimental acute pancreatitis (AP).METHODS: The pancreatic microcirculation of caerulein-induced AP model was studied by intravital fluorescencemicroscopy with FITC-labeled erythrocytes (FITC-RBC),scanning electron microscopy of vascular corrosion casts,and light microscopy of Chinese ink-injected/cleared tissues.RESULTS: Animals in caerulein-treated group showedhyperamylemia (× 2), pancreatic oedema, infiltration ofinflammatory cells in pancreas. Constrictions of intralobulararteriolar sphincters, presence of vacuoles in all layers ofsphincter, and gross irregularity in capillary network of aciniwere found in the AP specimens. The decrease of pancreaticcapillary blood flow (0.34±0.10 nl @ min-1 vs0.910.06 nl @rain-1 of control, P<0.001), reduction of functional capillarydensity(277± 13 cm-1 vs349±8 cm-1 of control, P<0.001),and irregular intermittent perfusion were observed incaerulein-induced groups.CONCLUSION: Impairment and constriction of pancreaticintralobular arteriolar sphincter are the initial microcirculatorylesions in the early phase of acute pancreatitis, and play akey role in the pancreatic ischaemia and pancreaticmicrovascular failure in acute pancreatitis.

  12. Acute recurrent pancreatitis: An autoimmune disease?

    Raffaele Pezzilli

    2008-01-01

    In this review article,we will briefly describe the main characteristics of autoimmune pancreatitis and then we will concentrate on our aim,namely,evaluating the clinical characteristics of patients having recurrence of pain from the disease.In fact,the open question is to evaluate the possible presence of autoimmune pancreatitis in patients with an undefined etiology of acute pancreatitis and for this reason we carried out a search in the literature in order to explore this issue.In cases of recurrent attacks of pain in patients with "idiopathic"pancreatitis,we need to keep in mind the possibility that our patients may have autoimmune pancreatitis.Even though the frequency of this disease seems to be quite low,we believe that in the future,by increasing our knowledge on the subject,we will be able to diagnose an ever-increasing number of patients having acute recurrence of pain from autoimmune pancreatitis.

  13. Protease Activation and Inflammation in Acute Pancreatitis

    Regnér, Sara

    2008-01-01

    Approximately 10—20 % of patients with acute pancreatitis (AP) develop a severe disease with high mortality and morbidity. Activation of pancreatic proteases, the inflammatory response and impaired pancreatic circulation are pathophysiological events that are important in order for the disease to develop. There is no specific treatment for severe AP, and no useful marker for predicting the severity of the disease upon admission to the hospital. In this thesis, markers of early pathophysio...

  14. Saxagliptin-induced recurrent acute pancreatitis.

    Lee, Chien-Feng; Sun, Meng-Shun; Tai, Yen-Kuang

    2014-01-01

    Although dipeptidyl peptidase-4 (DPP-4) inhibitors have been implicated in the development of acute pancreatitis, the causality of this phenomenon is not well established. We herein report the case of an 85-year-old woman who presented with epigastric pain after taking saxagliptin for five months. A high serum lipase level with characteristic computed tomography findings confirmed the diagnosis of acute pancreatitis. The patient's symptoms rapidly resolved after admission, although they recurred when she resumed treatment with saxagliptin for 18 days after discharge. In the absence of any identifiable causes of pancreatitis and considering the temporal sequence of events, the saxagliptin therapy was highly suspected to be the triggering factor. Although drug-induced pancreatitis is rare, treatment with DPP-4 inhibitors should be included as a potential etiology of acute pancreatitis. PMID:24930656

  15. Gallium-67 scintigraphy in acute pancreatitis

    Al-Suhaili, A.R.; Bahar, R.; Nawaz, K.; Higazy, E.; Wafai, I.; Nema, T.A.; Eriksson, S.; Abdel-Dayem, H.M.

    1988-04-01

    Acute pancreatitis is a serious surgical problem with a high incidence of mortality. Both ultrasound and X-ray CT have problems in identifying the extent and severity of the disease and the response to therapy. /sup 67/Ga-citrate has been used in 21 patients with clinically diagnosed acute pancreatitis: 9 patients had X-ray CT and 15 had US examination. Gallium scans were more sensitive than X-ray CT and US in detecting the extent and severity of acute pancreatitis. In addition, gallium was helpful to monitor the response to therapy when the scan was repeated at various intervals in three patients. A subtraction technique using /sup 99m/Tc-tin colloid and /sup 67/Ga-citrate was helpful to mask the liver uptake of gallium and clearly identify the extent of acute pancreatitis.

  16. Acute pancreatitis : CT Grading and its significance

    To assess the prognostic value of computed tomography (CT) in acute pancreatitis, initial CT examinations were classified into 5 grades in terms of the degree of disease severity and CT findings were correlated with clinical course, objective prognostic signs, and complications. In 29 consecutive patients with acute pancreatitis, the CT examination and clinical course were reviewed without knowledge of each other finding. Both Ranson's prognostic signs and modified Glascow prognostic signs were used for evaluation of acute pancreatitis. Of the 29 patients, 25 patients recovered with medical treatment while 4 patients (14%) developed pseudocysts and the other 4 patients (14%) developed abscesses. CT findings of the acute pancreatitis are as follows ; 10 patients (35%) in grade A with normal pancreas, 2 patients (7%) in grade B with pancreatic enlargement, 2 patients (7%) in grade C with intrinsic pancreatic abnormalities associated with haziness, 3 patients (10%) in grade D with single, ill-defined fluid collection, and 12 patients (41%) in grade E with extensive and two or multiple fluid collections or presence of gas in or adjacent to the pancreas. Correlation co-efficient is 0.46 (p=0.012) between CT findings and Ranson's prognostic signs, 462 (p=0.0115) between CT findings and modified Glascow prognostic signs. CT grading of acute pancreatitis may be useful in predicting clinical course

  17. Detection of gall stones after acute pancreatitis.

    Goodman, A J; Neoptolemos, J. P.; Carr-Locke, D L; Finlay, D B; Fossard, D. P.

    1985-01-01

    Four methods of gall stone diagnosis after an attack of acute pancreatitis are analysed. Of 128 consecutive patients with acute pancreatitis, 99 patients were discharged from hospital without a definite aetiology. These patients had biochemical tests performed on admission and ultrasonography and oral cholecystography performed six weeks later. The sensitivity for ultrasonography was 87% and the specificity was 93%; the respective figures for oral cholecystography were 83% and 90%. The predic...

  18. Urinary trypsinogen-2 dipstick in acute pancreatitis

    Andersen, Anders Møller; Novovic, Srdan; Ersbøll, Annette Kjaer;

    2010-01-01

    In acute pancreatitis (AP), rapid diagnosis and early treatment are of importance for clinical outcome. Urinary trypsinogen-2 has been suggested as a promising diagnostic marker; however, studies using the urinary trypsinogen-2 dipstick test (UTDT) have provided varying results.......In acute pancreatitis (AP), rapid diagnosis and early treatment are of importance for clinical outcome. Urinary trypsinogen-2 has been suggested as a promising diagnostic marker; however, studies using the urinary trypsinogen-2 dipstick test (UTDT) have provided varying results....

  19. Enteral Nutrition in Severe Acute Pancreatitis

    Rudra Prasad Doley; Thakur Deen Yadav; Jai Dev Wig; Gurpreet Singh; Kishore Gurumoorthy Subramanya Bharathy; Ashwini Kudari; Rajesh Gupta; Vikas Gupta; Rakesh Kochhar; Kuchhangi Sureshchandra Poornachandra; Usha Dutta; Chetna Vaishnavi

    2009-01-01

    Context There is controversy concerning the merits of enteral and pa renteral nutrition in the manage ment of patients with severe acute pancreatitis. Objective This study was undertaken to evalua te the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis. Setting Tertiary care centre in North India. Design A prospective clinical trial. Metho...

  20. Hypertriglyceridemia-Induced Acute Pancreatitis in Pregnancy

    Mindaugas Serpytis; Jurate Dementaviciene; Kestutis Strupas; Audrius Sileikis; Vytautas Karosas; Jurate Sipylaite; Rokas Tamosauskas

    2012-01-01

    Context Hypertriglyceridemia is a well known phenomenon of pregnancy occurring due to physiologic changes in sex hormone levels. Occasionally, it could lead to development of acute pancreatitis. Gestational hypertriglyceridemia-induced acute pancreatitis occurs in pregnant women usually with preexisting abnormalities of the lipid metabolism and is associated with additional diagnostic and therapeutic challenges related to hypertriglyceridemia and pregnancy. Case report We present a case of hy...

  1. Gallium-67 scintigraphy for acute pancreatitis

    Gallium-67 citrate has been evaluated in six patients diagnosed to have acute pancreatitis based on clinical picture, urine and serum amylase level, Ultrasanography and CT scan findings. The diagnosis of acute pancreatitis was confirmed by gallium-67 scan in four patients (True positive). One of them showed evidence of acute cholecysitis and pancreatitis. No gallium uptake was detected in the region of pancreas in the other two (True negative). Repeated gallium scan in two of the true positive patients showed decreased gallium concentration in the pancreas in response to medical treatment. The scan became normal in one of these two after four weeks. We conclude that gallium-67 scintigraphy is useful to determine extent and severity of acute pancreatitis and in following the response to medical treatment. Gallium (67Ga) has been under utilised in acute pancreatitis. The aim of the present study is to find the value of gallium-67 scintigraphy in determining the extent and severity of acute pancreatitis at the initial diagnosis and for follow up of medically treated patients. (Author)

  2. Acute pancreatitis and amiodarone: A case report

    Yen-Yuan Chen; Ching-Yu Chen; Kai-Kuen Leung

    2007-01-01

    Amiodarone, a class m antiarrhythmic drug, is one of the most effective drugs used in the treatment of ventricular and paroxysmal supraventricular tachyarrhythmia. Adverse effects of amiodarone including pulmonary toxicity, hepatotoxicity, aggravation of arrhythmia, and thyroid diseases are well understood. A 66-year old woman with acute pancreatitis was admitted to our hospital with the complaint of epigastralgia radiating to both flanks for two months. Her symptoms and elevation of pancreatic enzymes did not respond to conventional medical treatment of pancreatitis for 18 d. No known causal factors for pancreatitis such as biliary tract stone, hypertriglyceridemia and alcohol consumption could be identified. Under the suspicion of amiodarone-induced acute pancreatitis, amiodarone was substituted by propafenone. Her symptoms soon alleviated and serum lipase level declined. Three months after hospital discharge, the abdominal pain did not recur. Amiodarone was approved to treat recurrent ventricular fibrillation or sustained ventricular tachyarrhythmia that has been resistant to other medications since 1986. Pancreatitis is a very rare adverse effect associated with the use of amiodarone, and only four cases of amiodarone-induced pancreatitis have been reported in literature. We report a patient who developed acute pancreatitis during amiodarone therapy.

  3. Management of Acute Pancreatitis in Critical Care Unit

    Güniz Meyancı Köksal

    2010-12-01

    Full Text Available Pancreatitis is characterized by an inflammation occuring due to digestion of pancreatic self tissues and other organs after activation of digestive enzymes which are stable under normal conditions . For all the pancreatitis cases, the mortality rate is <%15. In the acute pancreatitis cases, the monitorization of the inspiration system, cardiovascular system and the metabolic status are needed. There is no primary therapy for the pancreatitis. All the therapy protocols are support therapy. The basic support therapy methods are: Liquid replacement, respiration support, pain management, pancreas secretion inhibition, metabolic support, intra-abdominal monitoring and decompression, nutrition, antibiotherapy, immunomodulation, coagulation mechanism monitoring. In the acute pancreatitis, the causes of early deaths are pancreatic shock and acute pulmonary thrombohemorrhage, within the first 7 days the causes of the 75% deaths are pulmonary shock and congestion and after 7 days the causes of the 77% are pancreas abscess, MOF (multiple organ failure, purulent peritonitis and erosive hemorrhage. (Journal of the Turkish Society of Intensive Care 2010; 8: 85-9

  4. Acute Pancreatitis Following Doxycycline and Ornidazole Coadministration

    Serkan Ocal

    2010-11-01

    Full Text Available Context Drugs are related to the etiology of acute pancreatitis in approximately 1.4-2.0% of cases. Although antibiotics constitute a small number of the drugs suspected, tetracycline is the most encountered antibiotic among those drugs. Case report A 33-year-old woman was admitted to the emergency room complaining of nausea and abdominal pain after the use of doxycycline 500 mg and ornidazole 500 mg twice daily for three days for a vaginal infection. She experienced epigastric pain, which worsened over time and radiated to her back. After a detailed evaluation, she was diagnosed as having mild acute pancreatitis which improved with medical treatment. All other possible causes of pancreatitis were eliminated. Conclusions Antibiotic-associated pancreatitis usually has a silent and mild course. To the best of our knowledge the literature reports only two cases of doxycycline-induced acute pancreatitis reported and there are no reports of pancreatitis associated with ornidazole. Our case is the first case reported in which doxycycline and ornidazole coadministration induced acute pancreatitis.

  5. Antiproteases in the Treatment of Acute Pancreatitis

    Motoji Kitagawa

    2007-07-01

    Full Text Available The pathogenesis of acute pancreatitis relates to the inappropriate activation of trypsinogen to trypsin and a lack of the prompt elimination of the active trypsin inside the pancreas. Therefore, trypsin is believed to be the key enzyme in the initiation and exacerbation of acute pancreatitis by activating pancreatic zymogens. The activation of digestive enzymes causes pancreatic injury and results in an inflammatory response. The acute inflammatory response in the pancreas induces the systemic production of cytokines causing substantial tissue damage, and may progress beyond the pancreas to a systemic inflammatory response syndrome (SIRS, multi-organ failure (MOF or death [1]. In several studies, protease inhibitors have not been shown to be of significant value in the treatment of acute pancreatitis and are not available in the United States [2]. Several guidelines [3, 4, 5, 6, 7, 8, 9, 10, 11, 12] on the treatment of acute pancreatitis do not recommend them and the debate about the use of protease inhibitors is mentioned.

  6. Improvements in Care in Acute Pancreatitis by the Adoption of an Acute Pancreatitis Algorithm

    Jack D Bragg

    2010-03-01

    Full Text Available Dear Sir, Acute pancreatitis is a serious condition that significantly impacts both patients and the healthcare system. The incidence of acute pancreatitis in the United States has been estimated to be 33-80 per 100,000 per year [1, 2]. From 1985-2005, hospitalizations rates for acute pancreatitis have nearly doubled, although case fatality rates have declined, likely attributed to improved therapeutic options and management [2, 3]. Despite a decrease in mortality, acute pancreatitis significantly impacts healthcare cost, with an estimated cost of acute pancreatitis in 2003 being $2.2 billion, approximately $10,000 per patient [4]. Given the significant impact on patient outcomes and healthcare costs, we, at the University of Missouri Hospital and Clinics in Columbia, examined the issue further.

  7. Activation of cannabinoid receptor 2 reduces inflammation in acute experimental pancreatitis via intra-acinar activation of p38 and MK2-dependent mechanisms.

    Michler, Thomas; Storr, Martin; Kramer, Johannes; Ochs, Stefanie; Malo, Antje; Reu, Simone; Göke, Burkhard; Schäfer, Claus

    2013-01-15

    The endocannabinoid system has been shown to mediate beneficial effects on gastrointestinal inflammation via cannabinoid receptors 1 (CB(1)) and 2 (CB(2)). These receptors have also been reported to activate the MAP kinases p38 and c-Jun NH(2)-terminal kinase (JNK), which are involved in early acinar events leading to acute pancreatitis and induction of proinflammatory cytokines. Our aim was to examine the role of cannabinoid receptor activation in an experimental model of acute pancreatitis and the potential involvement of MAP kinases. Cerulein pancreatitis was induced in wild-type, CB(1)-/-, and MK2-/- mice pretreated with selective cannabinoid receptor agonists or antagonists. Severity of pancreatitis was determined by serum amylase and IL-6 levels, intracellular activation of pancreatic trypsinogen, lung myeloperoxidase activity, pancreatic edema, and histological examinations. Pancreatic lysates were investigated by Western blotting using phospho-specific antibodies against p38 and JNK. Quantitative PCR data, Western blotting experiments, and immunohistochemistry clearly show that CB(1) and CB(2) are expressed in mouse pancreatic acini. During acute pancreatitis, an upregulation especially of CB(2) on apoptotic cells occurred. The unselective CB(1)/CB(2) agonist HU210 ameliorated pancreatitis in wild-type and CB(1)-/- mice, indicating that this effect is mediated by CB(2). Furthermore, blockade of CB(2), not CB(1), with selective antagonists engraved pathology. Stimulation with a selective CB(2) agonist attenuated acute pancreatitis and an increased activation of p38 was observed in the acini. With use of MK2-/- mice, it could be demonstrated that this attenuation is dependent on MK2. Hence, using the MK2-/- mouse model we reveal a novel CB(2)-activated and MAP kinase-dependent pathway that modulates cytokine expression and reduces pancreatic injury and affiliated complications. PMID:23139224

  8. Dexamethasone mediates protection against acute pancreatitis via upregulation of pancreatitis-associated proteins

    Kandil, Emad; Lin, Yin-yao; Bluth, Martin H; Zhang, Hong; Levi, Gabriel; Zenilman, Michael E

    2006-01-01

    AIM: To examine the influence of dexamethasone on pancreatitis-associated protein (PAP) gene expression using both in vitro and in vivo models of acute pancreatitis and to study how PAP gene expression correlates with severity of pancreatitis.

  9. Clinical Practice Guidelines for Acute Pancreatitis Treatment.

    Francisco García Valdés; Jorge Luis Ulloa Capestany; Reinaldo Jiménez Prendes; Rudis Miguel Monzón Rodríguez; Carlos Jaime Geroy Gómez

    2009-01-01

    Clinical Practice Guidelines for Acute Pancreatitis Treatment. It is the acute inflammatory reaction of the pancreas, affecting a gland that was previously healthy and causes its self-digestion with variable complications of local and distal systems of organs. Its etiological agents, clinical presentation, diagnostic methods and therapy are described. It includes assessment guidelines focused on the most important aspects to be accomplished.

  10. Bortezomib-Induced Acute Pancreatitis

    Bouraoui Elouni

    2010-05-01

    Full Text Available Dear Sir, Bortezomib is the first proteasome inhibitor approved by the Food and Drug Administration (FDA and indicated for patients with multiple myeloma refractory to at least one prior therapy [1]. The most common adverse effects of bortezomib include hematological toxicities (especially transient thrombocytopenia, gastrointestinal disturbances, peripheral neuropathy, fatigue, fever, dyspnea, rash, and myalgia [2]. We herein present the first case of acute pancreatitis induced by bortezomib. A 58-year-old female was treated with vincristine, doxorubicin, and dexamethasone for a myeloma. She had no history of dyslipidemia or alcohol abuse. In relation to the relapse of the myeloma, two doses of bortezomib (1.3 mg/m2 were administered intravenously at a 4-day time interval. Concomitant medications in our patient included dexamethasone, levothyroxine for hypothyroidism, and paracetamol. Two days later, she presented because of abdominal pain of medium intensity localized in the epigastrium for which she was hospitalized. On admission, the patient had normal vital signs without fever. Abdominal examination revealed only mild epigastric tenderness. There was no rigidity or guarding. There were no palpable abdominal masses. The remainder of the examination was normal. A laboratory work-up showed a normal blood cell count and did not demonstrate hypertriglyceridemia, hypercholesterolemia or hypercalcemia. A liver test, renal function, serum electrolytes and blood sugars were all normal.

  11. Enteral versus parenteral nutrition in acute pancreatitis.

    Guillou, P J

    1999-07-01

    Conventional wisdom has previously dictated that, in order to avoid stimulation of pancreatic secretion during acute pancreatitis, and thus avoid the perpetuation of the enzymatic activation from which the pancreatitis originated, enteral feeding should be avoided. With greater understanding of the potential role of the gastrointestinal tract in the development of a systemic inflammatory response within a number of scenarios, this dogma has recently been challenged. Moreover, there is some evidence to suggest that starving the gastrointestinal tract and providing nutritional support via the parenteral route may be associated with an increased incidence of septic complications. Experimental and clinical evidence suggests that feeding the gut may diminish intestinal permeability to endotoxin and diminish bacterial translocation, thus reducing the cytokine drive to the generalized inflammatory response and preventing organ dysfunction. Preliminary experience suggests that the institution of jejunal (but not gastric or duodenal) nutrition within 48 hours of the onset of severe acute pancreatitis diminishes endotoxic exposure, diminishes the cytokine and systemic inflammatory responses, avoids antioxidant consumption and does not cause the radiological appearances of the pancreas to deteriorate. These observations are paralleled by improvements in clinical outcome measures such as intensive care unit stay, septic complications and mortality. Whist parenteral nutrition continues to have a role in the management of acute pancreatitis particularly when complicated by fistulae or prolonged ileus, the early introduction of jejunal nutrition merits further investigation in acute pancreatitis. PMID:11030611

  12. Haemolytic Uraemic Syndrome Following Acute Pancreatitis

    Sinha A

    2005-07-01

    Full Text Available CONTEXT: Haemolytic uraemic syndrome is a common cause of renal failure in children but it is a rare condition in adults. Acute pancreatitis in adult as a cause of haemolytic uraemic syndrome is very rare. CASE REPORT: A 19-year-old male presented with symptom and signs suggestive of acute pancreatitis which was confirmed as his serum amylase was significantly raised. Within three days of admission he developed acute renal failure with evidence of haemolytic anaemia and thrombocytopenia. A clinical diagnosis of haemolytic uraemic syndrome was made and he was treated with plasma exchange. He made a complete recovery. CONCLUSION: Renal failure in a patient with acute pancreatitis is rarely due to haemolytic uraemic syndrome. But it is important to consider this differential diagnosis so that early treatment can be instituted to prevent mortality.

  13. RISK FACTORS FOR PANCREATIC CANCER: UNDERLYING MECHANISMS AND POTENTIAL TARGETS

    EdwinCharlesThrower

    2014-01-01

    Full Text Available Purpose of the review:Pancreatic cancer is extremely aggressive, forming highly chemo-resistant tumors, and has one of the worst prognoses. The evolution of this cancer is multi-factorial. Repeated acute pancreatic injury and inflammation are important contributing factors in the development of pancreatic cancer. This article attempts to understand the common pathways linking pancreatitis to pancreatic cancer.Recent Findings:Intracellular activation of both pancreatic enzymes and the transcription factor NF-kB are important mechanisms that induce acute pancreatitis. Recurrent pancreatic injury due to genetic susceptibility, environmental factors such as smoking, alcohol intake, and conditions such as obesity lead to increases in oxidative stress, impaired autophagy and constitutive activation of inflammatory pathways. These processes can stimulate pancreatic stellate cells, thereby increasing fibrosis and encouraging chronic disease development. Activation of oncogneic Kras mutations through inflammation, coupled with altered levels of tumor suppressor proteins (p53 and p16 can ultimately lead to development of pancreatic cancer. Summary:Although our understanding of pancreatitis and pancreatic cancer has tremendously increased over many years, much remains to be elucidated in terms of common pathways linking these conditions.

  14. Biliary scintigraphy in acute pancreatitis

    A prospective study was carried out in 60 patients to determine the efficacy of 99/sup m/Tc-PIPIDA scintigraphy in differentiating biliary pancreatitis from nonbiliary pancreatitis. Forty patients were classified as having biliary pancreatitis and 20 patients as having the nonbiliary type. Scintigraphic scans were divided into five main types according to the time to visualization of the gallbladder and the time to excretion of 99/sup m/Tc-PIPIDA into the intestinal tract. Normal scans were obtained in 95% of patients (19/20) with nonbiliary pancreatitis; 22.5% of patients (9/40) with biliary pancreatitis had normal scans. It is concluded that elevated amylase levels together with an abnormal biliary scan, as defined by the criteria presented here, indicate biliary pancreatitis, while a normal scan largely excludes such diagnosis

  15. Biliary scintigraphy in acute pancreatitis

    A prospective study was carried out in 60 patients to determine the efficacy of /sup 99m/Tc-PIPIDA scintigraphy in differentiating biliary pancreatitis from nonbiliary pancreatitis. Forty patients were classified as having biliary pancreatitis and 20 patients as having the nonbiliary type. Scintigraphic scans were divided into five main types according to the time to visualization of the gallbladder and the time to excretion of /sup 99m/Tc-PIPIDA into the intestinal tract. Normal scans were obtained on 95% of patients (19/20) with nonbiliary pancreatitis; 22.5% of patients (9/40) with biliary pancreatitis had normal scans. It is concluded that elevated amylase levels together with an abnormal biliary scan, as defined by the criteria presented here, indicate biliary pancreatitis, while a normal scan largely excludes such diagnosis

  16. Acute pancreatitis due to scrub typhus

    Atif Shaikh Iqbal Ahmed

    2014-01-01

    Full Text Available Scrub typhus is endemic in large parts of India and can cause multi-organ failure and death. Acute pancreatitis as a complication is very rare and is potentially fatal. This case series describes seven adult patients who presented with an acute febrile illness and were diagnosed to have scrub typhus with acute pancreatitis. The mean age of the seven patients with acute pancreatitis was 49.4 years, and mean duration of fever prior to presentation was 7.7 days. All seven patients had abdominal pain, and three had a pathognomonic eschar. The mean serum lipase level was 1,509 U/L (normal value: <190 U/L and the mean serum amylase level was 434 U/L (normal value: <200 U/L. Six patients had evidence of multi-organ dysfunction. Hematological and respiratory system dysfunction was seen in five patients, hepatic and renal dysfunction in four, and central nervous system dysfunction in three patients. Three patients who had ≥4 organs involved, died (mortality rate: 42.8%. Our case series shows that pancreatitis in scrub typhus is an extremely rare complication and when present, is associated with increased mortality (42.8%. Physicians may be familiar with the various complications of scrub typhus but less so with acute pancreatitis and hence may be underdiagnosed.

  17. Mild acute pancreatitis with vildagliptin use

    Ravikant Saraogi

    2012-01-01

    Full Text Available Vildagliptin has not been associated with the development of acute pancreatitis in postmarketing reports except one case report from Sydney, Australia. We present the case report of 42 year old male, diabetic, with no historyof alcohol use, on vildagliptin 50 mg and metformin 500 mg daily since 6 months, who presented with severe abdominal pain radiating to back, nausea and fever. On evaluation, serum pancreatic enzymes were elevated, triglycerides were not raised and ultrasound showed swollen and echogenic pancreas, loss of peripancreatic fat plane and pancreatic duct was not dilated. Vildagliptin was stopped and the pancreatits resolved. On Follow up, no secondary cause was not identified. This appears to be the first reported case of acute pancreatitis from India probably attributable to use of vildagliptin, thus raising the possibility that this rare reaction may be a class effect of the DPP-4 inhibitors.

  18. Mild acute pancreatitis with vildagliptin use

    Ravikant Saraogi; Ritwika Mallik; Sujoy Ghosh

    2012-01-01

    Vildagliptin has not been associated with the development of acute pancreatitis in postmarketing reports except one case report from Sydney, Australia. We present the case report of 42 year old male, diabetic, with no historyof alcohol use, on vildagliptin 50 mg and metformin 500 mg daily since 6 months, who presented with severe abdominal pain radiating to back, nausea and fever. On evaluation, serum pancreatic enzymes were elevated, triglycerides were not raised and ultrasound showed swolle...

  19. Dengue Fever Presenting as Acute Pancreatitis

    Prasad Seetharam; Gabriel Rodrigues

    2010-01-01

    A 56-year-old non-alcoholic male was admitted with complaints of severe abdominal pain and was diagnosed with acute pancreatitis after blood investigations and a computed tomography scan of the abdomen. He developed a high-grade fever on the third day of admission, and serology tested positive for dengue. Treatment for dengue was instituted, leading to a good response and complete resolution of pancreatitis. The patient has been doing well and has had no recurrence of pancreatitis at the end ...

  20. THE DIAGNOSIS OF ACUTE GALLSTONE PANCREATITIS

    Elena Gologan

    2009-05-01

    Full Text Available Acute gallstone pancreatitis is a severe form of pancreatitis caused by an ampullary blocked gallstone. The clinical course combines elements of severe pancreatitis and obstructive jaundice with angiocolitis. Complications are very frequent in the absence of spontaneous, interventional or surgical desobstruction. The diagnosis is based upon clinical features, biochemical paramethers with cholestasis, hyperamilasemia, hyperamilasuria, hyperlipasemia, metabolic disorders. Imagistic assay is undoubtful necessary for the diagnosis; it allows identifying most of the complications, and some of these investigations are very useful in the desobstruction procedures, done at proper moment.

  1. STUDY ANALYSIS OF ACUTE PANCREATITIS BY CT

    Bulabai

    2015-11-01

    Full Text Available AIM: Study analysis of pancreatitis by computed tomography in terms of morphology of pancreas in acute pancreatitis, complications of pancreatitis and duration of hospital stay by grading the severity of disease using Modified CT severity index. MATERIAL AND METHOD: This prospective study of 100 patients suspected of pancreatitis was evaluated with multidetector spiral CT scanner, somatom, (Spirit Siemens at Tertiary care center, for period of one year. The series consists of patients of pancreatitis which were clinically diagnosed and sent directly for CT examination and in the patients in whom abdominal ultrasound examination was suggestive of pancreatitis. Water with iodinated contrast is used as oral contrast so as to distend the stomach and small bowel followed by IV contrast study. All images were viewed at window width-300, window level-40 with a wide and narrow window setting as necessary. RESULT ANALYSIS: Acute Pancreatitis was more common in males than females with alcohol consumption was the commonest etiological factor in 79.5%. In contrary biliary pathology was the commonest factor in females of 41.6%. Among the 100 cases 41 patients (41% developed complications. CONCLUSION: We had documented a statistically significant correlation between the numeric score obtained with the Modified CT Severity index and the presence of infection, the need for surgery and percutaneous interventions, and the length of the hospital stay. Finally the modified CTSI closely indicates with patient outcome in all study parameters, especially with the length of the hospital stay and the development of organ failure.

  2. Acute pancreatitis induced by methimazole therapy.

    Abraham, Albin; Raghavan, Pooja; Patel, Rajshree; Rajan, Dhyan; Singh, Jaspreet; Mustacchia, Paul

    2012-05-01

    Among the causative factors for acute pancreatitis, adverse drug reactions are considered to be rare. The diagnosis of drug-induced pancreatitis (DIP) is challenging to establish, and is often underestimated because of the difficulties in determining the causative agent and the need for a retrospective re-evaluation of the suspected agent. We present the case of an 80-year-old woman who presented with complaints of abdominal pain. Her medications included methimazole (MMI) which she had been on for the past 3 months. Computed tomography of her abdomen showed peripancreatic fat stranding with trace amount of surrounding fluid, along with amylase and lipase levels suggestive of acute pancreatitis. In the absence of classical risk factors for acute pancreatitis, a diagnosis of DIP secondary to MMI use was made. Withdrawal of the drug from her medication regimen was accompanied by relief of symptoms and resolution of clinical evidence of pancreatitis. The aim of this paper is to report only the fourth case of MMI-induced pancreatitis in the published literature, and to illustrate the significance of an appropriate and timely diagnosis of DIP. PMID:22679409

  3. Treatment with ginkgo biloba extract protects rats against acute pancreatitis-associated lung injury by modulating alveolar macrophage

    Xu, Xiao-Wu; Yang, Xiao-Min; Bai, Yong-Heng; Zhao, Yan-Rong; SHI, GONG-SHENG; Zhang, Jian-Guo; Zheng, Yi-Hu

    2014-01-01

    Introduction Acute pancreatitis (AP) protease release induces lung parenchymal destruction via inflammatory mediators. Ginkgo biloba has been reported to have anti-inflammatory effects. Aim To evaluate the effect of ginkgo biloba extract on experimental acute pancreatitis-associated lung injury in the rat and to investigate the underlying mechanisms. Material and methods Acute pancreatitis was induced in rats by injection of 5% sodium taurocholate into the biliary pancreatic duct. Ginkgo bilo...

  4. Genetic and immunologic aspects of acute pancreatitis : An odyssey

    Nijmeijer, R.M.

    2014-01-01

    Acute pancreatitis is the leading cause of acute hospitalization for gastrointestinal diseases. The course of acute pancreatitis is often mild and self-limiting, but in 15-25% of patients, pancreatitis is severe with an increased mortality risk. Infectious complications, and especially bacterial inf

  5. Obestatin Accelerates the Recovery in the Course of Ischemia/Reperfusion-Induced Acute Pancreatitis in Rats.

    Jakub Bukowczan

    pancreatic exocrine secretion. Administration of obestatin at doses used was without significant effect with regard to daily food intake or pancreatic exocrine secretion in sham-operated rats, as well as in rats with acute pancreatitis. On the other hand, obestatin abolished a statistical significance of difference in food intake between animals with AP and control animals without pancreatic fistula and induction of AP.Treatment with the exogenous obestatin reduces severity of ischemia/reperfusion-induced acute pancreatitis and accelerates recovery in this disease. The involved mechanisms are likely to be multifactorial, and are mediated, at least in part, by anti-inflammatory properties of obestatin.

  6. Role of endoscopic retrograde cholangiopancreatography in acute pancreatitis

    Canlas, Karen R; Malcolm S. Branch

    2007-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is a useful tool in the evaluation and management of acute pancreatitis. This review will focus on the role of ERCP in specific causes of acute pancreatitis, including microlithiasis and gallstone disease, pancreas divisum, Sphincter of Oddi dysfunction, tumors of the pancreaticobiliary tract, pancreatic pseudocysts, and pancreatic duct injury. Indications for endoscopic techniques such as biliary and pancreatic sphincterotomy, stenting, s...

  7. Serine proteases mediate inflammatory pain in acute pancreatitis

    Ceppa, Eugene P; Lyo, Victoria; Grady, Eileen F.; Knecht, Wolfgang; Grahn, Sarah; Peterson, Anders; Nigel W. Bunnett; Kirkwood, Kimberly S.; Cattaruzza, Fiore

    2011-01-01

    Acute pancreatitis is a life-threatening inflammatory disease characterized by abdominal pain of unknown etiology. Trypsin, a key mediator of pancreatitis, causes inflammation and pain by activating protease-activated receptor 2 (PAR2), but the isoforms of trypsin that cause pancreatitis and pancreatic pain are unknown. We hypothesized that human trypsin IV and rat P23, which activate PAR2 and are resistant to pancreatic trypsin inhibitors, contribute to pancreatic inflammation and pain. Inje...

  8. Pathogenesis of pancreatic encephalopathy in severe acute pancreatitis

    Xi-Ping Zhang; Hua Tian

    2007-01-01

    BACKGROUND:Pancreatic encephalopathy (PE) is a serious complication of severe acute pancreatitis (SAP). In recent years, more and more PE cases have been reported worldwide, and the onset PE in the early stage was regarded as a poor prognosis sign of SAP, but the pathogenesis of PE in SAP still has not been clariifed in the past decade. The purpose of this review is to elucidate the possible pathogenesis of PE in SAP. DATA SOURCES:The English-language literature concern-ing PE in this review came from the Database of MEDLINE (period of 1991-2005), and the keywords of severe acute pancreatitis and pancreatic encephalopathy were used in the searching. RESULTS:Many factors were involved in the pathogenesis of PE in SAP. Pancreatin activation, excessive release of cytokines and oxygen free radicals, microcirculation abnormalities of hemodynamic disturbance, ET-1/NO ratio, hypoxemia, bacterial infection, water and electrolyte imbalance, and vitamin B1 deifciency participated in the development of PE in SAP. CONCLUSIONS:The pathogenesis of PE in SAP has not yet been fully understood. The development of PE in SAP may be a multi-factor process. To ifnd out the possible inducing factor is essential to the clinical management of PE in SAP.

  9. Case of severe acute pancreatitis with near total pancreatic necrosis diagnosed by dynamic CT scanning

    Takeda, Kazunori; Kakugawa, Yoichiro; Amikura, Katsumi; Miyagawa, Kikuo; Matsuno, Seiki; Sato, Toshio

    1987-09-01

    A 42 year-old woman with severe acute pancreatitis had drainage of the pancreatic bed, cholecystostomy and jejunostomy on admission, but symptoms were not improved. Fourteen days after admission, clinical sepsis and septisemia were recognized. Dynamic CT scanning of the pancreas showed near total pancreatic necrosis. Symptoms were improved after necrosectomy of the pancreas and debridement of the peripancreatic necrotic tissue were performed. Our experience suggests the usefulness of dynamic CT scanning for detection of pancreatic necrosis in severe acute pancreatitis.

  10. Acute Pancreatitis with Normal Serum Lipase: A Case Series

    Anish M Shah

    2010-07-01

    Full Text Available Context Acute pancreatitis is diagnosed on the basis of clinical features, biochemical tests and imaging studies. Normal serum amylase level has been reported in the setting of acute pancreatitis but normal serum lipase level in acute pancreatitis is extremely rare. Case report Herein, we present a case series of acute pancreatitis with normal serum lipase levels along with a review of the topic. Conclusion In appropriate clinical setting, the diagnosis of acute pancreatitis should be entertained even with normal serum amylase and lipase levels.

  11. Acute Pancreatitis Classifications: Basis and Key Goals.

    Xu, Xiao Dong; Wang, Zhe Yuan; Zhang, Ling Yi; Ni, Rui; Wei, Feng Xian; Han, Wei; Zhang, Hui Han; Zhang, Ya Wu; Wei, Zhen Gang; Guo, Xiao Hu; Guo, Liu Qiang; Ma, Jian Zhong; Zhang, You Cheng

    2015-12-01

    To explore the efficacy of the revised Atlanta classification (RACAP) and the determinant-based classification of acute pancreatitis severity (DBCAPS) on the basis of clinical data and feedback from patients with acute pancreatitis (AP). The authors retrospectively investigated a total of 573 patients with AP admitted to our hospital between December 2011 and December 2014. The definitions of severity and local complications in AP using RACAP and DBCAPS are presented and common points and mutual differences between the 2 groups are analyzed and discussed. Classification according to RACAP and DBCAPS found 86 (15%) and 178 (31.1%) mild cases (P peripancreatic fluid collection (236 patients, 75.40%), pancreatic pseudocysts (20 patients, 6.4%), acute necrotic collection (42 patients, 13.4%), and walled-off necrosis (15 patients, 4.8%) were observed. Among the 153 DBCAPS-defined cases, sterile peripancreatic necrosis (105 patients, 68.6%), sterile pancreatic necrosis (44 patients, 28.8%), infected peripancreatic necrosis (2 patients, 1.3%), and infected pancreatic necrosis (2/153 patients, 1.3%) were observed. Both classifications adopted organ failure and complications as determinants of severity. Revised Atlanta classification refined local complications and DBCAPS modified severity to include critical AP. In accordance with the demands of precision medicine, a combination of the 2 could be important for further clinical practice and scientific research. PMID:26632905

  12. Radiological appearances of acute pancreatitis in children

    15 cases of acute pancreatitis presented to the Hospital for Sick Children, Great Ormond Street, London and the Royal Liverpool Children's Hospital over a 5-year period. The aim of the study was to assess the role of radiology in the diagnosis and management of pancreatitis in children. The radiological findings are varied. Plain abdominal films may be normal or show a localised ileus arousing the suspicion of pancreatitis. Ultrasound was useful, not only in the intial diagnosis, but in the follow-up and detection of complications. CT was valuable in defining collections particularly in the retroperitoneum. ERCP is increasingly being used in both centres to exclude an underlying biliary or pancreatic abnormality. (author). 12 refs.; 8 figs.; 1 tab

  13. Genetic and immunologic aspects of acute pancreatitis : An odyssey

    Nijmeijer, R.M.

    2014-01-01

    Acute pancreatitis is the leading cause of acute hospitalization for gastrointestinal diseases. The course of acute pancreatitis is often mild and self-limiting, but in 15-25% of patients, pancreatitis is severe with an increased mortality risk. Infectious complications, and especially bacterial infection of pancreatic necrosis, are commonly accepted as the major cause of death for patients with this disease. The aim of the research described in this thesis was to gain more insight in some of...

  14. Magnetic Resonance Imaging of Acute Pancreatitis: The Pancreatogram

    Gosset J

    2004-01-01

    Full Text Available CONTEXT: Acute pancreatitis has been reported in many cases after therapeutic ERCP. CASE REPORT: We report the case of a 65 year man old who, after ERCP, manifested biologically acute pancreatitis. The patient was observed using dynamic MR pancreatography with secretin administration before and after the ERCP. The dynamic MR pancreatography prominently displays a radiological sign of early chronic pancreatitis: the pancreatogram. CONCLUSION: Our case demonstrates a new sign of biologically acute pancreatitis in dynamic MR pancreatography: the pancreatogram.

  15. Acute necrotizing pancreatitis as fi rst manifestation of primary hyperparathyroidism

    Jeroen; I; Lenz; Jimmy; M; Jacobs; Bart; Op; de; Beeck; Ivan; A; Huyghe; Paul; A; Pelckmans; Tom; G; Moreels

    2010-01-01

    We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a kno...

  16. Pancreatic Perfusion CT in Early Stage of Severe Acute Pancreatitis

    Yoshihisa Tsuji; Naoki Takahashi; Chiba Tsutomu

    2012-01-01

    Early intensive care for severe acute pancreatitis is essential for improving SAP mortality rates. However, intensive therapies for SAP are often delayed because there is no ideal way to accurately evaluate severity in the early stages. Currently, perfusion CT has been shown useful to predict prognosis of SAP in the early stage. In this presented paper, we would like to review the clinical usefulness and limitations of perfusion CT for evaluation of local and systemic complications in early s...

  17. Prognostic value of CT in acute pancreatitis

    The presence and degree of pancreatic necrosis and peripancreatic phlegmon were evaluated by dynamic, bolus-contrast-enhanced CT in 88 patients with acute pancreatitis and were correlated with clinical evaluation; morbidity (infection, pseudocyst); and mortality. Patients with necrosis had a 23% mortality and 82% morbidity, compared with 0% mortality and 6% morbidity in patients without necrosis. Patients with peripancreatic phlegmons and necrosis had a 26% mortality and 84% morbidity compared with 0% mortality and 22% morbidity in individuals with phlegmons but without necrosis. In this study, the CT severity index, which combines necrosis and peripancreatic phlegmon into a grading system at the initial CT examination, was a good prognostic indicator of severity of acute pancreatitis

  18. Development of acute pancreatitis after Nissen fundoplication.

    Inoue, Mikihiro; Uchida, Keiichi; Otake, Kohei; Okigami, Masato; Maji, Tomoaki; Kusunoki, Masato

    2015-04-01

    Acute pancreatitis subsequent to Nissen fundoplication for gastroesophageal reflux disease (GERD) is an extremely rare adverse event. We describe a pediatric case of acute pancreatitis resulting from superior mesenteric artery syndrome (SMAS) and gas bloat after fundoplication. Gas bloat is one of the known postoperative complications after Nissen fundoplication. Poor nutrition status, which is often associated with severe pediatric GERD, is a risk factor for SMAS. In this case, development of gas bloat and SMAS led to the formation of a closed loop and increased intraluminal pressure of the duodenum and pancreatic duct. Many pediatric patients who need anti-reflux surgery face the risk of developing this entity. Preventive measures, such as treatment with prokinetics and frequent small-volume meals, should be considered until improvement of nutritional status after fundoplication. PMID:25868962

  19. Impaired glucose tolerance in acute pancreatitis

    Kikuta, Kazuhiro; Masamune, Atsushi; Shimosegawa, Tooru

    2015-01-01

    Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In spite of the pivotal role of the endocrine pancreas in glucose metabolism, the impact of impaired glucose tolerance on AP has not been fully elucidated. A meta-analysis of seven observational studies showed that type 2 diabetes mellitus (DM) was associated with an increased risk of AP. The increased risk of AP shown in the meta-analysis was independent of hyperlipidemia, alcohol use and gallstones. Anti-diab...

  20. Bilateral spontaneous adrenal haemorrhage complicating acute pancreatitis

    Bilateral adrenal haemorrhage is an event that mandates prompt diagnosis and treatment to prevent primary adrenocortical insufficiency and potential death. Presentation can be non-specific and incidentally diagnosed with imaging alone, primarily CT. We present a case of acute pancreatitis with spontaneous bilateral adrenal haemorrhage and briefly discuss imaging and treatment implications

  1. Walled-off pancreatic necrosis and other current concepts in the radiological assessment of acute pancreatitis*

    Cunha, Elen Freitas de Cerqueira; Rocha, Manoel de Souza; Pereira, Fábio Payão; Blasbalg, Roberto; Baroni, Ronaldo Hueb

    2014-01-01

    Acute pancreatitis is an inflammatory condition caused by intracellular activation and extravasation of inappropriate proteolytic enzymes determining destruction of pancreatic parenchyma and peripancreatic tissues. This is a fairly common clinical condition with two main presentations, namely, endematous pancreatitis - a less severe presentation -, and necrotizing pancreatitis - the most severe presentation that affects a significant part of patients. The radiological evaluation, particularly...

  2. Intra-abdominal hypertension and acute pancreatitis.

    Mifkovic, A; Skultety, J; Sykora, P; Prochotsky, A; Okolicany, R

    2013-01-01

    Intra-abdominal hypertension (IAH) contributes to organ dysfunction and leads to the development of the abdominal compartment syndrome (ACS). IAH and ACS are relatively frequent findings in patiens with severe acute pancreatitis (SAP) and are associated with deterioration in organ functions. The most affected are cardiovascular, respiratory and renal functions. The incidence of IAH in patients with SAP is approximately 60-80%. There is an accumulating evidence in human and animal studies that changes of perfusion, particularly to the microvasculature, are crucial events in the progression of acute pancreatitis (AP). The perfusion of the small and large intestine is impaired due to reduced arterial pressure, increased vascular resistence and diminished portal blood flow. Bacterial translocation has been described in patients with ACS, and this may apply to patients with SAP. Approximately 30-40% of SAP patients develop ACS because of pancreatic (retroperitoneal) inflammation, peripancreatic tissue edema, formation of fluid collections or abdominal distension. Surgical debridement was the preferred treatment to control necrotizing pancreatitis in the past. However, the management of necrotizing pancreatitis has changed over the last decade. The main objective of this article is to describe the association between IAH and AP and to emphasize this situation in clinical praxis as well (Fig. 1, Ref. 38). PMID:23406186

  3. Crohn's Disease and Acute Pancreatitis: A Review of Literature

    Sarfaraz Jasdanwala

    2015-03-01

    Full Text Available Crohn's disease, a transmural inflammatory bowel disease, has many well-known extra-intestinal manifestations and complications. Although acute pancreatitis has a higher incidence in patients with Crohn's disease as compared to the general population, acute pancreatitis is still relatively uncommon in patients with Crohn's disease. Patients with Crohn's disease are at an approximately fourfold higher risk than the general population to develop acute pancreatitis. The risk of developing acute pancreatitis is higher in females as compared to males. Acute pancreatitis can occur at any age with higher incidence reported in patients in their 20s and between 40- 50 years of age. The severity and prognosis of acute pancreatitis in patients with Crohn's disease is the same as in general population. Acute pancreatitis can occur before onset of intestinal Crohn's disease, this presentation being more common in children than adults. It can also occur as the presenting symptom. However, most commonly it occurs after intestinal symptoms have manifest with a mean time interval between the initial presentation and development of acute pancreatitis being 2 years. There are several etiological factors contributing to acute pancreatitis in patients with crohn's disease. It is not clear whether acute pancreatitis is a direct extra-intestinal manifestation of Crohn's disease; however majority of the cases of acute pancreatitis in patients with Crohn's disease are due to GS and medications. Drugs used for the treatment of Crohn's disease that have been reported to cause acute pancreatitis include 5-ASA agents, azathioprine and 6 mercaptopurine, metornidazole and corticosteroids. Recent evidence has emerged correlating both type 1 and 2 autoimmune pancreatitis with Crohn's disease. Understanding the association between the two disease entities is key to effectively manage patients with Crohn's disease and acute pancreatitis.

  4. Improving the Outcome of Acute Pancreatitis.

    Bruno, Marco J

    2016-01-01

    Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. Contrary to earlier data from uncontrolled studies, a large multicenter randomized trial comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet after 72 h, did not show that early nasoenteric tube feeding was superior in reducing the rate of infection or death in patients with AP at high risk for complications. Although early ERCP does not have a role in the treatment of predicted mild pancreatitis, except in the case of concomitant cholangitis, it may ameliorate the disease course in patients with predicted severe pancreatitis. Currently, a large-scale randomized study is underway and results are expected in 2017. PMID:27336312

  5. Pancreatic panniculitis associated with acute pancreatitis and hemorrhagic pseudocysts: A case report

    Jang, Yong Suk; Kim, Mi Sung; Park, Chan Sub; Park, Ji Yeon; Park, Noh Hyuck [Kwandong Univ., Myongji Hospital, Goyang (Korea, Republic of)

    2012-10-15

    Pancreatic panniculitis is an inflammation and necrosis of fat at distant foci in patients with pancreatic disorders, most frequently, pancreatitis and pancreatic carcinoma. Clinically, pancreatic panniculitis is manifested by painless or painful subcutaneous nodules on the legs, buttocks, or trunk. The usual sites are the distal parts of the lower extremities. To the best of our knowledge, there have not been many reports for the radiologic findings of pancreatic panniculitis. In this article, we report a case of pancreatic panniculitis, including radiologic findings of CT and ultrasonography. The patient was presented with painful subcutaneous nodules on the trunk, and had underlying acute pancreatitis and hemorrhagic pseudocysts.

  6. Crohn's Disease and Acute Pancreatitis: A Review of Literature

    Sarfaraz Jasdanwala; Mark Babyatsky

    2015-01-01

    Crohn's disease, a transmural inflammatory bowel disease, has many well-known extra-intestinal manifestations and complications. Although acute pancreatitis has a higher incidence in patients with Crohn's disease as compared to the general population, acute pancreatitis is still relatively uncommon in patients with Crohn's disease. Patients with Crohn's disease are at an approximately fourfold higher risk than the general population to develop acute pancreatitis. The risk of developing acute ...

  7. Exocrine pancreatic function during the early recovery phase of acute pancreatitis

    Raffaele Pezzilli; Patrizia Simoni; Riccardo Casadei; Antonio M. Morselli-Labate

    2009-01-01

    BACKGROUND: Exocrine pancreatic dysfunction has been reported in humans in the convalescent period after acute pancreatitis, but the data are scarce and conlficting. This study aimed to prospectively assess the exocrine pancreatic function in patients with acute pancreatitis at the time of their refeeding. METHODS: Fecal elastase-1 was determined on the day of refeeding in all consecutive acute pancreatitis patients with their ifrst episode of the disease. They were 75 patients including 60 (80.0%) patients with mild acute pancreatitis and 15 (20.0%) patients with severe acute pancreatitis. Etiologically 61 patients (81.3%) had biliary disease, 1 (1.3%) had alcoholic disease and 3 (4.0%) had hypertriglyceridemia. No causes of acute pancreatitis were found in the remaining 10 patients (13.3%). The mean (±SD) refeeding time after the attack of acute panereatitis was 11.2±10.2 days. RESULTS: Pathological values of FE-1 were found in 9 of the 75 patients (12.0%): 7 (9.3%) patients with mild pancreatitis and 2 (2.7%) patients with severe pancreatitis (P=1.000). The frequency of the pathological values of fecal elastase-1 was signiifcantly different from that of various etiologies of the disease (P=0.030). It was signiifcantly lower in patients with biliary pancreatitis (9.8%;P=0.035) than in one patient with alcoholic pancreatitis (P=0.126), one patient with hypertriglyceridemia-induced pancreatitis (33.3%;P=0.708), and one patient with idiopathic pancreatitis (10.0%;P=0.227). Pathological fecal elastase-1 was not signiifcantly related to sex, age or day of refeeding.CONCLUSION: Exocrine pancreatic function should be routinely assessed in patients with acute pancreatitis at the time of refeeding in order to supplement their diet with pancreatic extracts.

  8. Acute pancreatitis : complication of chicken pox in an immunocompetent host.

    Roy, Pinaki; Maity, Pranab; Basu, Arindam; Dey, Somitra; Das, Biman; Ghosh, U S

    2012-12-01

    Chicken pox is a benign self limited disease. But it may rarely be complicated with acute pancreatitis in otherwise healthy patient. We present a case of varicella pancreatitis and its marked recovery with acyclovir. PMID:23781673

  9. Acute pancreatitis: diagnostic value of ultrasonography and computed tomography

    Blery, M.; Hautefeuille, P.; Jacquenod, P. and others

    1987-09-01

    The value of ultrasonography and computed tomography for the diagnosis, extension, pronostic, complications and etiology of acute pancreatitis is discussed. Ultrasonography and computed tomography guided interventional radiology techniques are valuable in the management of pancreatitis complications such as abscesses.

  10. Acute pancreatitis: diagnostic value of ultrasonography and computed tomography

    The value of ultrasonography and computed tomography for the diagnosis, extension, pronostic, complications and etiology of acute pancreatitis is discussed. Ultrasonography and computed tomography guided interventional radiology techniques are valuable in the management of pancreatitis complications such as abscesses

  11. Role of oxygen free radicals in patients with acute pancreatitis

    Park, Byung Kyu; Chung, Jae Bock; Lee, Jin Heon; Suh, Jeong Hun; Park, Seung Woo; Song, Si Young; Kim, Hyeyoung; Kim, Kyung Hwan; Kang, Jin Kyung

    2003-01-01

    AIM: The generation of oxygen free radicals has been implicated in the pathogenesis of experimental pancreatitis. The aim of this study was to determine the role of oxygen free radicals in patients with acute pancreatitis.

  12. NECESSITY TO REVIEW ATLANTA CLASSIFICATION OF ACUTE PANCREATITIS

    V. Păunescu

    2013-06-01

    Full Text Available The universal credit of the acute pancreatitis description goes to Reginald Fitz Huber, who in 1889 classified acute pancreatitis in: hemorrhagic, gangrenous and suppurative, following surgical and autopsy findings. Over time were used different criteria for classification of acute pancreatitis. Classification of acute pancreatitis in 1992 in Atlanta introduced a uniform system for assessing clinical severity and various complications of the disease, widely accepted classification. In this classification, acute pancreatitis is presented in two forms: mild and severe. Mild pancreatitis is associated with minimal dysfunction of organs and, eventually, it heals. Severe form is associated with organ failure and/or local complications, such as necrosis, abscess and pseudocyst. The increase of knowledge of pathophysiology in acute pancreatitis, the introduction of advanced diagnostic and treatment means showed that some definitions have created confusion and made absolutely necessary the revision of Atlanta classification. The review includes criteria for assessing the severity and description of local complications. The revised classification of acute pancreatitis in 2012 identifies in the dynamic evolution of the disease, early stage and late stage, and classifies severity as: mild, moderate and severe, based on the presence or absence of multiple organ failure and local complications in the two forms of acute pancreatitis: interstitial edematous pancreatitis and necrotizing pancreatitis. Local complications are: acute peripancreatic fluid complications, pancreatic pseudocyst, acute necrotic collections and wall formed necrosis. CONCLUSION: This review demonstrates that revised Atlanta classification is an useful tool for the management of acute pancreatitis and will allow to decrease the morbidity and mortality of severe pancreatitis.

  13. Panniculitis – A Rare Manifestation of Acute Pancreatitis

    Zélia Neves; Úrsula Segura; André Valente; M. Helena Pacheco; José Malhado

    2015-01-01

    Pancreatic panniculitis is a rare skin disorder that occurs in 2–3% of pancreatic diseases, mostly associated with acute or chronic pancreatitis. Its pathophysiology is still unclear, but the release of pancreatic enzymes in circulation can be responsible for this disorder. The typical histological features are adipocyte necrosis with neutrophils infiltrate and typical “ghost cells”. Its treatment, clinical course and prognosis are usually related with the pancreatic disease. We present a ...

  14. Acute pancreatitis : a newly recognised potential complication of canine babesiosis

    A.J. Möhr; Lobetti, R. G.; J.J. Van der Lugt

    2000-01-01

    This retrospective study describes 4 cases of canine babesiosis with histologically confirmed acute pancreatitis. In addition, 16 dogs with babesiosis are reported with serum amylase (>3500 U/l ) and/or lipase (>650 U/l ) activity elevations of a magnitude that would support a diagnosis of probable acute pancreatitis, although extra-pancreatic sources of the enzymes could not be excluded in these cases. Median time of pancreatitis diagnosis was 2.5 days post-admission, with primarily yo...

  15. Comparison of biohumoral and morphological parameters in acute pancreatitis

    Tasić Tomislav; Grgov Saša; Nagorni Aleksandar; Benedeto-Stojanov Danijela

    2014-01-01

    Introduction. Acute pancreatitis occurs as a result of autodigestive activation of pancreatic proenzymes, within the parenchyma of the glands. Objective. The goal of the work was to establish possible connection of etiology and severity of the acute pancreatitis and biohumoral parameters, ultrasound and CT. Methods. The study included 273 patients with pancreatitis, classified by Ranson’s score, according to degree of severity and etiology, whose biohumoral...

  16. Acute Pancreatitis Associated with Neuroendocrine Tumor of the Pancreas

    José Jukemura; André Luis Montagnini; José Luiz Jesus de Almeida; Joaquim José Gama Rodrigues; José Eduardo Monteiro da Cunha; Marcos Vinícius Perini

    2006-01-01

    Context :Endocrine tumors are a less commonly known cause of acute pancreatitis. This report presents the case of a patient who have had acute pancreatitis secondary to a pancreatic endocrine neoplasm. The majority of the cases previously reported were nonfunctioning tumors and the pancreatitis tended to be mild. Moreover, the majority of the tumors were diagnosed in advanced stages, hindering curative treatment. Case report: A 31-year-old female patient presented with epigastric pain and a ...

  17. Genetics of acute and chronic pancreatitis: An update

    VV; Ravi; Kanth; D; Nageshwar; Reddy

    2014-01-01

    Progress made in identifying the genetic susceptibility underlying acute and chronic pancreatitis has benefitted the clinicians in understanding the pathogenesis of the disease in a better way. The identification of mutations in cationic trypsinogen gene(PRSS1 gene; functional gain mutations) and serine protease inhibitor kazal type 1(SPINK1 gene; functional loss mutations) and other potential susceptibility factors in genes that play an important role in the pancreatic secretory functions or response to inflammation during pancreatic injury has changed the current concepts and understanding of a complex multifactorial disease like pancreatitis. An indi-vidual’s susceptibility to the disease is governed by ge-netic factors in combination with environmental factors. Candidate gene and genetic linkage studies have iden-tified polymorphisms in cationic trypsinogen(PRSS1), SPINK1, cystic fibrosis trans-membrane conductance regulator(CFTR), Chymotrypsinogen C(CTRC), Ca-thepsin B(CTSB) and calcium sensing receptor(CASR). Individuals with polymorphisms in the mentioned genes and other as yet identified genes are at an enhanced risk for the disease. Recently, polymorphisms in genes other than those involved in "intra-pancreatic trypsin regulatory mechanism" namely Claudin-2(CLDN2) andCarboxypeptidase A1(CPA1) gene have also been iden-tified for their association with pancreatitis. With ever growing number of studies trying to identify the genetic susceptibility in the form of single nucleotide polymor-phisms, this review is an attempt to compile the avail-able information on the topic.

  18. Hereditary Angioedema Presenting as Recurrent Acute Pancreatitis.

    Berger, Tal D; Garty, Ben-Zion

    2016-02-01

    Hereditary angioedema (HAE) may manifest with swelling of the face, extremities, and upper airways. Gastrointestinal symptoms are also common and may include abdominal pain, vomiting, and diarrhea. However, pancreatic involvement is rare and has been reported only in a few adults with previously diagnosed HAE. We describe a 6-year-old boy who presented with recurrent severe abdominal pain accompanied by an elevation in pancreatic enzyme levels, without subcutaneous or cutaneous angioedema. His symptoms had begun 18 months earlier, and he was hospitalized several times before the present admission with a diagnosis of acute pancreatitis. More comprehensive analysis yielded low levels of C2, C4, CH50, and C1 esterase inhibitor, establishing the diagnosis of HAE. One year after diagnosis, swelling of the extremities appeared for the first time. This is the first report of a child in whom pancreatic disease was the presenting symptom of HAE. HAE should be included in the differential diagnosis of recurrent pancreatitis in children. PMID:26812927

  19. Is Bortezomib a Rare Cause of Acute Pancreatitis?

    Tevfik Solakoglu

    2013-11-01

    Full Text Available Recently we have read an interesting case with bortezomib-induced pancreatitis in JOP. Journal of the Pancreas (Online by Elouni et al. [1]. To the best of our knowledge, this was the first reported case of bortezomib-induced acute pancreatitis in the English literature. We know that drug-induced pancreatitis is rare and each year the list of drugs associated with acute pancreatitis increases. Bortezomib is a new drug which is selective and reversible proteasome inhibitor used for the treatment of patients with multiple myeloma [2]. Herein we present a case of acute pancreatitis induced by bortezomib.

  20. A Case of Probable Ibuprofen-Induced Acute Pancreatitis

    Paul Magill

    2006-05-01

    Full Text Available Context :The incidence of drug-induced pancreatitis is rare. There have been no prior definite cases reported of ibuprofen-induced pancreatitis. Case report: We present a case of a young man with acute pancreatitis probably secondary to an ibuprofen overdose. Immediately preceding the onset of the attack he took a 51 mg/kg dose of ibuprofen. He had other causes of acute pancreatitis excluded by clinical history, serum toxicology and abdominal imaging. Discussion :In the absence of re-challenge we believe it is probable that ibuprofen has acausative link with acute pancreatitis.

  1. Pancreatic Perfusion CT in Early Stage of Severe Acute Pancreatitis

    Yoshihisa Tsuji

    2012-01-01

    Full Text Available Early intensive care for severe acute pancreatitis is essential for improving SAP mortality rates. However, intensive therapies for SAP are often delayed because there is no ideal way to accurately evaluate severity in the early stages. Currently, perfusion CT has been shown useful to predict prognosis of SAP in the early stage. In this presented paper, we would like to review the clinical usefulness and limitations of perfusion CT for evaluation of local and systemic complications in early stage of SAP.

  2. Diagnostic evaluation of acute pancreatitis in two patients with hypertriglyceridemia

    Yoshifumi Okura; Kozo Hayashi; Tetsuji Shingu; Goro Kajiyama; Yoshiyuki Nakashima; Keijiro Saku

    2004-01-01

    We present two diagnostically challenging cases of acute pancreatitis with hypertriglyceridemia accompanied with chylomicronemia caused with a deficiency of lipoprotein lipase and with the presence of type V hyperlipidemia.Both cases suffered from acute abdomen following the ingestion of fatty food and revealed the increase in parameters of inflammation without significant elevation of serum amylase levels. The imaging examination of ultrasonography could not detect significant findings of acute pancreatitis and a computer tomography scan eventually confirmed the findings of acute pancreatitis. Both cases responded to a low fat diet and administration of a cholecystokinin receptor antagonist, exhibiting a relief of abdominal symptoms. As in the present cases with acute abdomen following the ingestion of fatty food, the identification of serum hypertriglyceridemia and an abdominal computer tomography scan might be useful in establishing the diagnosis of acute pancreatitis and in developing the therapeutic regimen, when hypertriglyceridemia interferes with the evaluation of pancreatic enzyme activities and ultrasound examination provides poor pancreatic visualization.

  3. Effects of Local Pancreatic Renin-Angiotensin System on the Microcirculation of Rat with Severe Acute Pancreatitis.

    Pan, Zhijian; Feng, Ling; Long, Haocheng; Wang, Hui; Feng, Jiarui; Chen, Feixiang

    2015-07-01

    Severe acute pancreatitis (SAP) is normally related to multiorgan dysfunction and local complications. Studies have found that local pancreatic renin-angiotensin system (RAS) was significantly upregulated in drug-induced SAP. The present study aimed to investigate the effects of angiotensin II receptors inhibitor valsartan on dual role of RAS in SAP in a rat model and to elucidate the underlying mechanisms. 3.8% sodium taurocholate (1 ml/kg) was injected to the pancreatic capsule in order for pancreatitis induction. Rats in the sham group were injected with normal saline in identical locations. We also investigated the regulation of experimentally induced SAP on local RAS expression in the pancreas through determination of the activities of serum amylase, lipase and myeloperoxidase, histological and biochemical analysis, radioimmunoassay, fluorescence quantitative PCR and Western blot analysis. The results indicated that valsartan could effectively suppress the local RAS to protect against experimental acute pancreatitis through inhibition of microcirculation disturbances and inflammation. The results suggest that pancreatic RAS plays a critical role in the regulation of pancreatic functions and demonstrates application potential as AT1 receptor antagonists. Moreover, other RAS inhibitors could be a new therapeutic target in acute pancreatitis. PMID:26170733

  4. Isoprenylation and NET formation in acute pancreatitis

    Merza, Mohammed

    2015-01-01

    Acute Pancreatitis (AP) is an inflammation disease that characterized by activation of protease and the innate immune system, leading to infiltration of neutrophils and tissue damage in the pancreas. The aim of this thesis was to determine the role of isoprenylation (farnesyltransferase and geranylgeranyltransferase) as well as NET formation in regulating recruitment of neutrophils and tissue damage in severe AP. AP in mice was induced by retrograde infusion of Na-taurocholate into the pa...

  5. Enteral Nutrition and Acute Pancreatitis: A Review

    Spanier, B.W.M.; Bruno, M.J.; Mathus-Vliegen, E.M.H.

    2010-01-01

    textabstractIntroduction. In patients with acute pancreatitis (AP), nutritional support is required if normal food cannot be tolerated within several days. Enteral nutrition is preferred over parenteral nutrition. We reviewed the literature about enteral nutrition in AP. Methods. A MEDLINE search of the English language literature between 1999-2009. Results. Nasogastric tube feeding appears to be safe and well tolerated in the majority of patients with severe AP, rendering the concept of panc...

  6. Early Prediction of Severity in Acute Pancreatitis. Is This Possible?

    Sandberg AA; Borgstrom A

    2002-01-01

    One out of ten cases of acute pancreatitis develops into severe acute pancreatitis which is a life threatening disorder with a high mortality rate. The other nine cases are self limiting and need very little therapy. The specificity of good clinical judgement on admission, concerning the prognosis of the attack, is high (high specificity) but misses a lot of severe cases (low sensitivity). The prediction of severity in acute pancreatitis was first suggested by John HC Ranson in 1974. Much eff...

  7. Mental disorders in patients with acute necrotic pancreatitis

    Stefanović Dejan; Lekić Nebojša; Dimitrijević Ivan; Žuvela Marinko; Galun Danijel; Radovanović Nebojša; Kerkez Mirko; Kalezić Nevena

    2007-01-01

    Introduction The prognosis of patients with acute pancreatitis is still uncertain regardless of modern therapeutic procedures. It is even more emphasized if the acute pancreatitis is followed by psychic disorders. Objective The aim of the study was to provide an overview of the incidence of certain psychosomatic disorders in patients with acute pancreatitis and evaluate priority therapeutic procedures. Method In this study, we analyzed 16 patients with psychosomatic disorders followed by the ...

  8. Acute Recurrent Pancreatitis: A Possible Clinical Manifestation of Ampullary Cancer

    Athanasios Petrou; Timothy Williams; Konstantinos Bramis; Alexandros Papalambros; Eleftherios Mantonakis; Evangelos Felekouras

    2011-01-01

    Context Acute recurrent pancreatitis still poses diagnostic difficulties. The coexistence or moreover the causative relationship of carcinoma of the ampulla of Vater and acute recurrent pancreatitis is fairly rare. Case report We present a case of carcinoma of the ampulla of Vater that presented with acute recurrent necrotizing pancreatitis complicated with pseudocysts. A diagnosis of malignancy in the ampulla was only made after several ERCP attempts due to residual inflammation at the peria...

  9. Enteral nutrition and immune modulation of acute pancreatitis

    Hegazi, Refaat A.; DeWitt, Tiffany

    2014-01-01

    Enteral nutrition has been strongly recommended by major scientific societies for the nutritional management of patients with acute pancreatitis. Providing severe acute pancreatitis patients with enteral nutrition within the first 24-48 h of hospital admission can help improve outcomes compared to parenteral nutrition and no feeding. New research is focusing in on when and what to feed to best improve outcomes for acute pancreatitis patients. Early enteral nutrition have the potential to modu...

  10. Alcohol abuse-related severe acute pancreatitis with rhabdomyolysis complications

    Su, Mao-Sheng; Jiang, Ying; YAN, XIAO-YUAN HU; Zhao, Qing-hua; Liu, Zhi-Wei; Wen-zhi ZHANG; He, Lei

    2012-01-01

    Non-traumatic rhabdomyolysis is a rare complication of acute pancreatitis. One of the major risk factors of both acute pancreatitis and rhabdomyolysis is alcohol abuse. However, only a few studies have reported the prognosis and association of severe acute pancreatitis (SAP) and rhabdomyolysis in alcohol abuse patients. In the present study, we report two cases presenting with SAP complicated by rhabdomyolysis following high-dose alcohol intake. The disease onset, clinical manifestations, lab...

  11. Acute pancreatitis complicated with splenic rupture: A case report

    Hernani, Bruno L; Silva, Pedro C; Nishio, Ricardo T; Mateus, Henrique C; Assef, José C; De Campos, Tercio

    2015-01-01

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography (CT) of the abdomen, the pa...

  12. Hypertriglyceridemia-induced acute pancreatitis in pregnancy causing maternal death

    Jeon, Hae Rin; Kim, Suk Young; Cho, Yoon Jin; Chon, Seung Joo

    2016-01-01

    Acute pancreatitis in pregnancy is rare and occurs in approximately 3 in 10,000 pregnancies. It rarely complicates pregnancy, and can occur during any trimester, however over half (52%) of cases occur during the third trimester and during the post-partum period. Gallstones are the most common cause of acute pancreatitis. On the other hand, acute pancreatitis caused by hypertriglyceridemia due to increase of estrogen during the gestational period is very unusual, but complication carries a hig...

  13. Dexamethasone mediates protection against acute pancreatitis via upregulation of pancreatitis-associated proteins

    Emad Kandil; Yin-Yao Lin; Martin H Bluth; Hong Zhang; Gabriel Levi; Michael E Zenilman

    2006-01-01

    AIM:To examine the influence of dexamethasone on pancreatitis-associated protein (PAP) gene expression using both in vitro and in vivo models of acute pancreatitis and to study how PAP gene expression correlates with severity of pancreatitis.METHODS:In vifro, IL-6 stimulated pancreas acinar AR42J cells were cultured with increasing concentrations of dexamethasone and assayed for PAP expression (RT-PCR). In vivo, pancreatitis was induced in rats by retrograde injection of 40 g/L taurocholate into the pancreatic duct. Animals were pretreated with dexamethasone (2 mg/kg) daily or saline for 4 d.Pancreata and serum were harvested after 24 h and gene expression levels of PAP Ⅰ , Ⅱ and Ⅲ were measured by RT-PCR. Severity of pancreatitis was based on serum amylase, pancreatic wet weight, and histopathological score.RESULTS:In vitro, dexamethasone and IL-6 induced a marked transcription of PAP Ⅰ, Ⅱ and Ⅲ genes in AR42J cells at 24 h (P < 0.05 for all comparisons). In vivo,pancreas mRNA levels of PAP Ⅰ, Ⅱ or Ⅲ increased by 2.6-fold, 1.9-fold, and 1.3-fold respectively after dexamethasone treatment, compared with saline treated animals. Serum amylase levels and edema were significantly lower in the dexamethasone group compared with the saline group. Histopathologic evaluation revealed less inflammation and necrosis in pancreata obtained from dexamethasone treated animals (P < 0.05).CONCLUSION:Dexamethasone significantly decreases the severity of pancreatitis. The protective mechanism of dexamethasone may be via upregulating PAP gene expression during injury.

  14. Solid Pseudopapillary Tumor as a Possible Cause of Acute Pancreatitis

    Okanoue T

    2004-09-01

    Full Text Available CONTEXT: Acute pancreatitis is not commonly seen in the first presentation of pancreatic neoplasms. Solid pseudopapillary tumor as a cause of acute pancreatitis has not yet been reported. This is the first report of acute pancreatitis resulting from solid pseudopapillary tumor. CASE REPORT: We report the case of a 21-year-old female who presented with a sudden onset of severe abdominal pain associated with elevated serum pancreatic enzyme concentration. The initial diagnosis was acute pancreatitis. However, subsequent ultrasonography and computed tomography showed an abdominal mass in the tail of the pancreas, retroperitoneal fluid and left pleural effusion. There was scarce pain relief even with large doses of analgesics. A distal pancreatectomy was then performed and a final diagnosis of solid pseudopapillary tumor was made histologically. The surrounding pancreatic tissue was characterized as hemorrhagic edematous pancreatitis. CONCLUSIONS: Solid pseudopapillary tumor is generally known as a slow-growing pancreatic neoplasm with few, if any, symptoms. However, solid pseudopapillary tumors should be kept in mind as a possible cause of acute pancreatitis, especially in cases of non-alcoholic young women having an acute pancreatitis attack.

  15. Imaging lexicon for acute pancreatitis: 2012 Atlanta Classification revisited.

    Sureka, Binit; Bansal, Kalpana; Patidar, Yashwant; Arora, Ankur

    2016-02-01

    The original 1992 Atlanta Classification System for acute pancreatitis was revised in 2012 by the Atlanta Working Group, assisted by various national and international societies, through web-based consensus. This revised classification identifies two phases of acute pancreatitis: early and late. Acute pancreatitis can be either oedematous interstitial pancreatitis or necrotizing pancreatitis. Severity of the disease is categorized into three levels: mild, moderately severe and severe, depending upon organ failure and local/systemic complications. According to the type of pancreatitis, collections are further divided into acute peripancreatic fluid collection, pseudocyst, acute necrotic collection, and walled-off necrosis. Insight into the revised terminology is essential for accurate communication of imaging findings. In this review article, we will summarize the updated nomenclature and illustrate corresponding imaging findings using examples. PMID:26224684

  16. Gene expression profiling and endothelin in acute experimental pancreatitis

    Helieh S Oz; Ying Lu; Louis P Vera-Portocarrero; Pei Ge; Ada Silos-Santiago; Karin N Westlund

    2012-01-01

    AIM:To analyze gene expression profiles in an experimental pancreatitis and provide functional reversal of hypersensitivity with candidate gene endothelin-1 antagonists.METHODS:Dibutyltin dichloride (DBTC) is a chemical used as a polyvinyl carbonate stabilizer/catalyzer,biocide in agriculture,antifouling agent in paint and fabric.DBTC induces an acute pancreatitis flare through generation of reactive oxygen species.Lewis-inbred rats received a single i.v.injection with either DBTC or vehicle.Spinal cord and dorsal root ganglia (DRG) were taken at the peak of inflammation and processed for transcriptional profiling with a cDNA microarray biased for rat brain-specific genes.In a second study,groups of animals with DBTC-induced pancreatitis were treated with endothelin (ET) receptor antagonists [ET-A (BQ123) and ET-B BQ788)].Spontaneous pain related mechanical and thermal hypersensitivity were measured.Immunohistochemical analysis was performed using anti-ET-A and ET-B antibodies on sections from pancreatic tissues and DRG of the T10-12 spinal segments.RESULTS:Animals developed acute pancreatic inflammation persisting 7-10 d as confirmed by pathological studies (edema in parenchyma,loss of pancreatic architecture and islets,infiltration of inflammatory cells,neutrophil and mononuclear cells,degeneration,vacuolization and necrosis of acinar cells) and the painrelated behaviors (cutaneous secondary mechanical and thermal hypersensitivity).Gene expression profile was different in the spinal cord from animals with pancreatitis compared to the vehicle control group.Over 260 up-regulated and 60 down-regulated unique genes could be classified into 8 functional gene families:circulatory/acute phase/immunomodulatory; extracellular matrix; structural; channel/receptor/transporter; signaling transduction; transcription/translation-related; antioxidants/chaperones/heat shock; pancreatic and other enzymes.ET-1 was among the 52 candidate genes upregulated greater than 2-fold in

  17. Fluid therapy for severe acute pancreatitis in acute response stage

    MAO En-qiang; TANG Yao-qing; FEI Jian; QIN Shuai; WU Jun; LI Lei; MIN Dong; ZHANG Sheng-dao

    2009-01-01

    Background Fluid therapy for severe acute pancreatitis (SAP) should not only resolve deficiency of blood volume, but also prevent fluid sequestration in acute response stage. Up to date, there has not a strategy for fluid therapy dedicated to SAP. So, this study was aimed to investigate the effects of fluid therapy treatment on prognosis of SAP. Methods Seventy-six patients were admitted prospectively according to the criteria within 72 hours of SAP onset. They were randomly assigned to a rapid fluid expansion group (Group I, n=36) and a controlled fluid expansion group (Group Ⅱ, n=40). Hemodynamic disorders were either quickly (fluid infusion rate was 10-15 ml·kg-1·h-1, Group Ⅰ) or gradually improved (fluid infusion rate was 5-10 ml·kg-1·h-1, Group Ⅱ) through controlling the rate of fluid infusion. Parameters of fluid expansion, blood lactate concentration were obtained when meeting the criteria for fluid expansion. And APACHE Ⅱ scores were obtained serially for 72 hours. Rate of mechanical ventilation, incidence of abdominal compartment syndrome (ACS), sepsis, and survival rate were obtained. Results The two groups had statistically different (P 0.05). Total amount of fluid sequestration within 4 days was higher in Group Ⅰ ((5378±2751)ml) than in Group Ⅱ ((4215±1998)ml, P<0.05). APACHE Ⅱ scores were higher in Group Ⅰ on days 1,2, and 3 (P<0.05). Rate of mechanical ventilation was higher in group Ⅰ (94.4%) than in group Ⅱ (65%, P<0.05). The incidences of abdominal compartment syndrome (ACS) and sepsis were significantly lower in Group Ⅱ (P <0.05). Survival rate was remarkably lower in Group Ⅰ (69.4%) than in Group Ⅱ (90%, P <0.05). Conclusions Controlled fluid resuscitation offers better prognosis in patients with severe volume deficit within 72 hours of SAP onset.

  18. THE TREATMENT OF ACUTE BILIARY PANCREATITIS

    Elena Gologan

    2009-11-01

    Full Text Available Acute gallstone pancreatitis represents about half of all pancreatitis and it has still a high mortality despite the progress in the early diagnosis and proper treatment. There are certain difficulties in choosing the optimal treatment because of the polymorphism of presentations, the diversity of pathological types, the particularities of the cases and the risks that are to assume in any kind of treatment strategy the doctor choose. Another difficult factor to assume is the moment of the interventional approach, which is still controversial due to its high dependence of too many factors. The conservative treatment of acute gallstone pancreatitis is not usually followed by the remission of the inflammatory process but leads to the aggravation of the disease. The removal of the cause of the ampular obstruction (the stone can be spontaneously in some cases; however, in most cases of severe disease the removal requires surgical or endoscopic interventional approach. The most important controversy lies between these two methods, and to choose the proper moment of each intervention.

  19. Acute Pancreatitis: The Role of Imaging and Interventional Radiology

    Acute pancreatitis can manifest as a benign condition with minimal abdominal pain and hyperamylasemia or can have a fulminant course, which can be life-threatening usually due to the development of infected pancreatic necrosis, and multisystem organ failure. Fortunately, 70-80% of patients with acute pancreatitis have a benign self-limiting course. The initial 24-48 hours after the initial diagnosis is usually the period that determines the subsequent course, and for many of the 20-30% of patients who subsequently have a fulminant course, this becomes apparent within this time frame. With reference to long-term outcome following acute pancreatitis, most cases recover without long-term sequelae with only a minority of cases progressing to chronic pancreatitis. In the initial management of acute pancreatitis, assessment of metabolic disturbances and systemic organ dysfunction is critical. However, the advent and continued refinement of cross-sectional imaging modalities over the past two decades has led to a prominent role for diagnostic imaging in assessing acute pancreatitis. Furthermore, these cross-sectional imaging modalities have enabled the development of diagnostic and therapeutic interventional techniques in the hands of radiologists. In this article we review the diagnostic features of acute pancreatitis, the clinical staging systems, complications and the role of imaging. The role of interventional radiology techniques in the management of acute pancreatitis will be discussed as well as potential complications associated with these treatments

  20. Effect of copaiba oil on acute pancreatitis in mice

    Daniel L Medeiros; Thiago E. V. Lemos; Luiz H. F. Junior; Tarciso B. S. Montenegro; Paula R. S. Camara

    2014-01-01

    Objective: The anti-inflammatory activity of copaiba oil was evaluated using a cerulein-induced acute pancreatitis model in mice. Methods: Mice were pretreated with Copaiba sp oleoresin before induction of pancreatitis. Pancreatitis was induced by intraperitoneal injection (five injections at hourly intervals) of cerulein solution and, 6 h later, pancreatic and lung damage were analyzed macroscopically for the severity of necrosis, and by protein plasma extravasation and plasma amylase ac...

  1. Parathyroid Cyst Presenting as Acute Pancreatitis: Report of a Case

    Kim, Mi-Young; Chung, Cho-Yun; Kim, Jong-Sun; Myung, Dae-Seong; Cho, Sung-Bum; Park, Chang-Hwan; Kim, Young; Joo, Young-Eun

    2013-01-01

    We report the first case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid cyst in a 67-year-old man. Laboratory investigation revealed increased serum amylase and lipase, increased serum ionized calcium and parathyroid hormone (PTH) levels, and decreased serum phosphate, indicating pancreatitis and primary hyperparathyroidism (PHPT). Abdominal computed tomography (CT) revealed mild swelling of the pancreatic head with peri-pancreatic fat infiltration and fluid c...

  2. Acute Recurrent Pancreatitis: A Possible Clinical Manifestation of Ampullary Cancer

    Athanasios Petrou

    2011-11-01

    Full Text Available Context Acute recurrent pancreatitis still poses diagnostic difficulties. The coexistence or moreover the causative relationship of carcinoma of the ampulla of Vater and acute recurrent pancreatitis is fairly rare. Case report We present a case of carcinoma of the ampulla of Vater that presented with acute recurrent necrotizing pancreatitis complicated with pseudocysts. A diagnosis of malignancy in the ampulla was only made after several ERCP attempts due to residual inflammation at the periampullary area. Conclusion Malignancy at the ampulla of Vater causing recurrent episodes of pancreatitis represents a realistic risk and attempts to diagnose the underlying cause should always take into account the possibility of cancer.

  3. Acute pancreatitis : new frontiers in diagnosis and treatment

    van Santvoort, H.C.

    2010-01-01

    Acute pancreatitis is an acute inflammation of the pancreas mostly caused by gallstones and alcohol abuse. Around 15 to 20% of patients show a severe clinical course, which is characterised by multiple organ failure and necrosis of the pancreatic parenchyma and/ or peripancreatic fat tissue. In around 30% of patients with necrotising pancreatitis, secondary infection of necrosis occurs, probably due to bacterial translocation from the patient’s own gut. Infected necrosis is an indication for ...

  4. Early diagnosis and staging of acute pancreatitis on computed tomography

    In 108 patients with acute pancreatitis, the CT findings were correlated with pathological staging; in 63 the diagnosis had been confirmed at operation and in 45 it was made on clinical grounds. CT differentiation between interstitial and necrotizing pancreatitis had a sensitivity of 0.87 and specificity of 1.0. In addition, exact estimation of the extent of intrapancreatic necrosis was possible. This high accuracy makes CT the method of choice for the early diagnosis and staging of acute pancreatitis. (orig.)

  5. THERAPEUTIC APPROACH IN THE COMPLICATIONS OF ACUTE PANCREATITIS

    G. Veselu; M. Paduraru; C. Baciu; Doina Veselu

    2006-01-01

    Acute pancreatitis is a disease with severe local, regional and general complications. Material and methods: During 1999 – 2004 in our unit were treated 32 cases of acute pancreatitis. The etiology of the pancreatitis was: biliary lithiasis in 25 cases (78.12%). Only 7 cases have a severe evolution. All the cases were evaluated by abdominal ultrasound exam, computed tomography and severity scores (Ranson and Apache). Also, the patients were treated and monitored in the intensive care unit. We...

  6. Endoscopic Ultrasound Assisted Etiological Localization in Acute Pancreatitis

    Appasani, Sreekanth; Basha, Jahangeer; Singh, Kartar; Kochhar, Rakesh

    2013-01-01

    Hyperparathyroidism is an uncommon cause of pancreatitis and one should look for its telltale evidence on history (renal stone disease) and investigations (hypercalcemia). Endosonography has an upcoming role in the management of acute pancreatitis, especially in the presence of fluid collection. We report a case of parathyroid adenoma related acute pancreatitis complicated with pseudocyst, which was managed with percutaneous drainage and endosonographic localization of the adenoma to the left...

  7. Hypertriglyceridemia-induced acute pancreatitis: Yet to be explored

    Neeru Sahni; Amit Kumar Mandal; Namrata Maheshwari

    2015-01-01

    Hypertriglyceridemia is an important yet often missed cause of acute pancreatitis. The diagnostic dilemma and no specific guidelines for management of this condition further add to difficulty in treating a patient with hypertriglyceridemia induced acute pancreatitis. We present a thirty five year old, diabetic male patient with hypertriglyceridemia induced pancreatitis, enumerating the difficulties in diagnosis and treatment of our patient. A brief review of literature summariz...

  8. Acute pancreatitis : new frontiers in diagnosis and treatment

    van Santvoort, H.C.

    2010-01-01

    Acute pancreatitis is an acute inflammation of the pancreas mostly caused by gallstones and alcohol abuse. Around 15 to 20% of patients show a severe clinical course, which is characterised by multiple organ failure and necrosis of the pancreatic parenchyma and/ or peripancreatic fat tissue. In arou

  9. Activity of neutrophil elastase reflects the progression of acute pancreatitis

    Novovic, Srdan; Andersen, Anders M; Nord, Magnus;

    2013-01-01

    Abstract Objective. Neutrophil elastase (NE) concentration is associated with progression of acute pancreatitis (AP), but measuring total NE concentration includes biologically inactive NE. This study aims to investigate the relationship between NE activity and the aetiology and severity of AP and...... was associated with predicted severity of AP and AP-associated respiratory failure. Specific NE inhibitors may have therapeutic potential in acute pancreatitis....

  10. Isoniazid Induced Acute Pancreatitis in a Young Girl

    Isoniazid (INH) is the mainstay of management against Mycobacterium tuberculosis. INH-induced acute pancreatitis is an uncommon association and with dearth of literature on it. We are reporting a case of an 11 years old girl who developed acute pancreatitis after 2 weeks of antituberculous therapy. An INH free regimen was started. She was discharged and followed without complications. (author)

  11. Conservative Management of Pancreatic Pseudocysts in Children with Acute Lymphoblastic Leukemia

    Spraker, Holly L.; Spyridis, Georgios P.; Pui, Ching-Hon; Howard, Scott C.

    2009-01-01

    Treatment with asparaginase for acute lymphoblastic leukemia (ALL) can cause acute pancreatitis. Complication of pancreatitis by pancreatic pseudocyst formation can prolong the hospital stay, delay chemotherapy, and necessitate long-term parenteral nutrition. We report five children with ALL who developed acute pancreatitis complicated by pancreatic pseudocysts. They required modifications to their chemotherapy regimen and prolonged parenteral nutrition but no surgical intervention. All five ...

  12. Acute Septal Panniculitis. A Cutaneous Marker of a Very Early Stage of Pancreatic Panniculitis Indicating Acute Pancreatitis

    Surendran E; Rajendran S; Jeswanth S; Balachandar TG; Kannan DG; Johnson MA

    2005-01-01

    CONTEXT: Pancreatitis may occasionally be complicated by panniculitis as a result of the release of pancreatic enzymes. Pancreatic panniculitis is rare, occurring in 2-3% of all patients with pancreatic disorders, with a higher incidence among alcoholic males. CASE REPORT: A 29-year-old male was admitted to our Department with acute abdominal pain one day following alcohol consumption. On physical examination, tender erythematous plaques and nodules were present on the left ankle and the pret...

  13. PROSPECTIVE STUDY OF CT IN ACUTE PANCREATITIS AND ITS COMPLICATIONS

    Shivanand S .

    2015-09-01

    Full Text Available Visualization of the pancreas was far better by CT than b y ultrasound. Ultrasound had certain limitation. Due to bowel gas the pancreas may not be visualized. Extra pancreatic spread of inflammation and vascular complications was not always picked up by Ultrasonography. These limitations were overcome with the u se of CT which yielded more diagnostic information in the evaluation of acute pancreatitis. CT is a confirmative investigation in diagnosis and staging of acute pancreatitis. MCTSI is a very useful tool for the screening of patients with acute pancreatitis for the classification of severity accurately and to predict the clinical outcome. OBJECTIVES OF STUDY: To determine the value of computed tomography in evaluation of early diagnosis of acute pancreatitis. To evaluate the complications using computed tom ography severity index. MATERIAL AND METHODS: The study was conducted on 100 patients with clinical suspicion of acute pancreatitis, altered biochemical parameters (Serum amylase, Serum lipase in favor of acute pancreatitis, ultrasonography suggestive of acute pancreatitis and complications known case of chronic pancreatitis with features of acute symptoms who were referred to the department of Radiodiagnosis, Basaveshwar teaching & General Hospital, Kalaburagi. Before evaluating a patient by CT imaging, i nformed consent was obtained from the patient or guardian. The patient were informed about the radiation exposure in the examination. CT was carried out using Philips 6 slice scanner. Scan was obtained with both plain and contrast study. RESULT: 100 patien ts were included in the study. 83% patients were males and 17% patients were females. Majority of patients belonged to 31 - 40 yrs. of age group. Alcohol was the most common cause of acute pancreatitis. 73 patients had positive ultrasound finding while CT wa s positive in all cases. According to, MCTSI 63 patients had moderate, 26 patients had mild and 11 patients had severe

  14. THERAPEUTIC APPROACH IN THE COMPLICATIONS OF ACUTE PANCREATITIS

    G. Veselu

    2006-10-01

    Full Text Available Acute pancreatitis is a disease with severe local, regional and general complications. Material and methods: During 1999 – 2004 in our unit were treated 32 cases of acute pancreatitis. The etiology of the pancreatitis was: biliary lithiasis in 25 cases (78.12%. Only 7 cases have a severe evolution. All the cases were evaluated by abdominal ultrasound exam, computed tomography and severity scores (Ranson and Apache. Also, the patients were treated and monitored in the intensive care unit. We performed the antibiotic prophylaxy with tienam (500 mg x 4/ day associated with metronidazole (1 g/ day. In some cases we used another therapy: ceftazidime + amikacina + metronidazole. We also used enteral nutrition where was possible, but in some cases total parenteral nutrition was required. Results: After the diagnosis of biliary lithiasis some surgical procedures were performed: cholecystectomies ? the drainage of the main biliary duct. For the 7 cases of severe acute pancreatitis we performed necrosectomies and the drainage of the pancreatic abcesses. Two patients with severe acute pancreatitis died. No surgical interventions were performed for non-biliary acute pancreatitis with good results. Conclusions: 1 The prophylactic use of antibiotics decrease the arte of pancreatic and extrapancreatic infections. 2 We performed the exploratory laparotomy in all the cases with uncertain diagnosis. 3 Cholecystectomies ? the drainage of the main biliary duct were performed in all the cases with biliary lithiasis. 4 In the cases with acute severe pancreatitis we prefer late surgical intervention

  15. MDCT features of subperitoneal space involvement in acute pancreatitis

    Objective: To investigate the MDCT features of subperitoneal space involvement in acute pancreatitis (AP). Methods: CT features of 43 consecutive cases of acute pancreatitis confirmed by clinical and laboratory examination were retrospectively analyzed. Results: Retroperitoneal space involvement in acute pancreatitis was manifested as increased density or fluid collection in the subperitoneal space. Of 43 patients with acute pancreatitis, mesentery of small intestine was involved in 38(88%), transverse mesocolon in 23(53%), hepatoduodenal ligament in 17(40%), gastrohepatic ligament in 16(37%), gastro-splenic ligament in 21(49%) and greater omentum in 8(19%). Conclusion: MDCT can precisely depict the location and extent of the subperitoneal space involvement in acute pancreatitis. (authors)

  16. Ascaris lumbricoides-Induced Acute Pancreatitis: Diagnosis during EUS for a Suspected Small Pancreatic Tumor

    Benedetto Mangiavillano; Silvia Carrara; Maria Chiara Petrone; Paolo Giorgio Arcidiacono; Pier Alberto Testoni

    2009-01-01

    Context Ascaris lumbricoides is the second most common intestinal parasite world-wide and, although the infection can be asymptomatic, in some cases it can present with complications, such as acute pancreatitis. Case report We describe the case of a 37- year-old man, with a history of travelling in Eastern countries who presented with Ascaris lumbricoides-induced acute pancreatitis mimicking a small pancreatic cancer, diagnosed during an upper EUS. The endoscopy revealeda roundworm floating i...

  17. Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection: A Case Report and Review

    Hemanta Kumar Nayak; Nitish L Kamble; Nishant Raizada; Sandeep Garg,; Mradul Kumar Daga

    2013-01-01

    Acute pancreatitis complicating fulminant viral hepatitis has been well recognized; however, acute pancreatitis occurring in nonfulminant hepatitis is very rare. The case presented describes moderate pancreatitis in a young male, manifesting during the course of nonfulminant acute hepatitis E infection. The diagnosis of acute viral hepatitis E was confirmed by serology and reverse transcriptase polymerase chain reaction (RT-PCR) to demonstrate Hepatitis E virus (HEV) RNA in both stool and ser...

  18. Pancreatitis

    ... the hormones insulin and glucagon into the bloodstream. Pancreatitis is inflammation of the pancreas. It happens when digestive enzymes start digesting the pancreas itself. Pancreatitis can be acute or chronic. Either form is ...

  19. [Determinant-based classification of acute pancreatitis severity. International multidisciplinary classification of acute pancreatitis severity: the 2013 German edition

    Layer, P.; Dellinger, E.P.; Forsmark, C.E.; Levy, P.; Maravi-Poma, E.; Shimosegawa, T.; Siriwardena, A.K.; Uomo, G.; Whitcomb, D.C.; Windsor, J.A.; Petrov, M.S.; Geenen, E.J.M. van

    2013-01-01

    OBJECTIVE: The aim of this study was to develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. BACKGROUND: The Atlanta definitions of acute pancreatitis severity a

  20. Hydronephrosis as an Unusual Cause of Acute Pancreatitis

    Nata Pratama Hardjo Lugito

    2015-01-01

    Full Text Available Acute pancreatitis is an inflammatory disease of the pancreas. The most common cause of acute pancreatitis is gallstone impacting the distal common bile-pancreatic duct (38% and alcoholism (36%. There have been a few reports in the literature of acute pancreatitis associated with an obstructed urinary system. This case describes a 38-year-old male with acute pancreatitis occurring in the setting of hydronephrosis. A magnetic resonance cholangiopancreaticography (MRCP showed right-sided severe hydronephrosis pushing the duodenum and head of pancreas anteriorly, thus obliterating distal segment of the common bile duct. There were also multiple right renal stones causing ureteral obstruction and hydronephrosis. Right nephrostomy was performed to release bile duct obstruction. However, sepsis and disseminated intravascular coagulation developed as a complication of acute pancreatitis, and the patient passed away. Although gallstone and alcoholism are the most common causes of acute pancreatitis, other causes should always be considered. Physicians should be aware of right hydronephrosis as one of the possible causes of acute pancreatitis in their workup of patients.

  1. Activation and Regulation of Hemostasis in Acute Liver Failure and Acute Pancreatitis

    Lisman, Ton; Porte, Robert J.

    2010-01-01

    Acute liver failure and acute pancreatitis are accompanied by substantial changes in the hemostatic system. In acute liver failure, defective synthesis of coagulation factors and intravascular activation of coagulation results in thrombocytopenia and reduced levels of proteins involved in coagulatio

  2. Antibiotics in acute necrotizing pancreatitis --- perspective of a developing country

    Prophylactic antibiotics in acute necrotizing pancreatitis is controversial. The mortality of acute necrotizing pancreatitis is 8-25% in the western world. In view of the limited resources available for managing the complications of infected pancreatitis in developing countries, the use of prophylactic antibiotics may be recommended in selected cases. Various antibiotics show good penetration into the pancreatic tissue; imipenem and quinolones have better penetration. Clinical trials on the use of prophylactic antibiotics in necrotizing pancreatitis have been reviewed. Prophylactic antibiotics have been considered if greater than 30% pancreatic necrosis as documented by CT scan. Imipenem can be given for a duration of 10 to 14 days if no systemic complications are present. In a developing country where the cost of managing complications of pancreatitis can be a limiting factor for patients, the use of prophylactic antibiotics early on in the disease in selected cases can be beneficial. (author)

  3. Role of genetic disorders in acute recurrent pancreatitis

    Volker Keim

    2008-01-01

    There was remarkable progress in the understanding of the role genetic risk factors in chronic pancreatitis.These factors seem to be much more important than thought in the past.The rare autosomal-dominant mutations N29I and R122H of PRSS1(cationic trypsinogen) as well as the variant N34S of SPINK1(pancreatic secretory trypsin inhibitor) are associated to a disease onset in childhood or youth.Compared to chronic alcoholic pancreatitis the progression is slow so that for a long time only signs of acute-recurrent pancreatitis are found.Only at later time points(more than 10-15 years) there is evidence for chronic pancreatitis in the majority of patients.Acute recurrent pancreatitis may therefore be regarded as a transition state until definite signs of chronic pancreatitis are detectable.

  4. Acute Pancreatitis Following Orlistat Therapy: Report of Two Cases

    Faheem Asem Ahmad

    2010-01-01

    Full Text Available Context Orlistat is a pancreatic lipase inhibitor licensed for the treatment of obesity. As obesity rates increase and non-prescription dispensing of orlistat increases, an awareness of its adverse effects is of crucial importance as complications arise more frequently from increased use. Orlistat induced pancreatitis has been described only once previously, but without a diagnostic increase in serum amylase. Case report We report the case of two patients who developed severe acute abdominal pain and elevated pancreatic enzymes at 2 and 10 days after starting orlistat. In one case no alterative precipitant was identified. In the other, a predisposing history of pancreatic injury was present. In both cases all other contributory causes were excluded. Conclusions Our reports suggest orlistat can trigger drug induced acute pancreatitis in certain patients. For patients presenting with abdominal pain soon after commencing orlistat, a diagnosis of pancreatitis must be considered. We also recommend cautious use of orlistat in patients at risk of pancreatic injury.

  5. [Acute pancreatitis with hypertriglyceridemia--an underestimated disease?].

    Wild, Wolfgang; Tajjiou, Morad; Ferschke, Melanie; Bormann, Fabian; Dörr, Pius; Schwarzbach, Matthias

    2016-01-01

    Hypertriglyceridemia is a rare, but since a long time well known etiology for acute pancreatitis. It could occure alone or coactive with other triggers like alcohlic excess. Nevertheless it found no approach to the current classifications and parameters of prognosis of the acute pancreatitis. We refer about two patients with hypertriglyceridemia and acute pancreatitis, whose initial disease was limited on the tail of the pancreas with just a circumscripted or--in the other case--no necrosis. However, in both cases and although a consequent treatment started immediately, a serious process developed including a life-threatening acute respiratory distress syndrome in one case, which necessitated an extracorporal membrane oxygenation. PMID:26710203

  6. Role of endoscopic retrograde cholangiopancreatography in acute pancreatitis

    2007-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is a useful tool in the evaluation and management of acute pancreatitis. This review will focus on the role of ERCP in specific causes of acute pancreatitis, including microlithiasis and gallstone disease, pancreas divisum, Sphincter of Oddi dysfunction, tumors of the pancreaticobiliary tract, pancreatic pseudocysts, and pancreatic duct injury. Indications for endoscopic techniques such as biliary and pancreatic sphincterotomy, stenting, stricture dilation, treatment of duct leaks, drainage of fluid collections and stone extraction will also be discussed in this review. With the advent of less invasive and safer diagnostic modalities including endoscopic ultrasound (EUS) and magnetic retrograde cholangiopancreatography (MRCP), ERCP is appropriately becoming a therapeutic rather than diagnostic tool in the management of acute pancreatitis and its complications.

  7. Acute Pancreatitis Caused By Mushroom Poisoning

    Karahan, Samet; Erden, Abdulsamet; Cetinkaya, Ali; Avci, Deniz; Ortakoyluoglu, Adile Irfan; Karagoz, Hatice; Bulut, Kadir; Basak, Mustafa

    2016-01-01

    Of the more than 5000 species of mushrooms known, 100 types are toxic and approximately 10% of these toxic types can cause fatal toxicity. A type of mushroom called Amanita phalloides is responsible for 95% of toxic mushroom poisonings. In this article, we report 2 cases of mushroom poisonings caused by Lactarius volemus, known as Tirmit by the local people. The patient and his wife were admitted to the emergency room with abdominal pain, nausea, and vomiting 20 hours after consuming Lactarius volemus, an edible type of mushroom. The patients reported that they had been collecting this mushroom from the mountains and eating them for several years but had never developed any clinicopathology to date. Further examination of the patients revealed a very rare case of acute pancreatitis due to mushroom intoxication. The male patient was admitted to the intensive care unit while his wife was followed in the internal medicine service, because of her relative mild clinical symptoms. Both patients recovered without sequelae and were discharged. In this article, we aimed to emphasize that gastrointestinal symptoms are often observed in mushroom intoxications and can be confused with acute pancreatitis, thus leading to misdiagnosis of patients. Early diagnosis and appropriate treatment can improve patients’ prognosis and prevent the development of complications. PMID:26835473

  8. Intravenous Selenium Modulates L-Arginine-Induced Experimental Acute Pancreatitis

    Jonathan Hardman

    2005-09-01

    Full Text Available Context Oxidative stress is understood to have a critical role in the development of acinar injury in experimental acute pancreatitis. We have previously demonstrated that compound multiple antioxidant therapy ameliorates end-organ damage in the intra-peritoneal L-arginine rat model. As the principal co-factor for glutathione, selenium is a key constituent of multiple antioxidant preparations. Objective The intention of this study was to investigate the effect of selenium on pancreatic and remote organ injury in a wellvalidated experimental model of acute pancreatitis. Methods Male Sprague-Dawley rats were randomly allocated to one of 3 groups (n=5/group and sacrificed at 72 hours. Acute pancreatitis was induced by 250 mg per 100 g body weight of 20% L-arginine hydrochloride in 0.15 mol/L sodium chloride. Group allocations were: Group 1, control; Group 2, acute pancreatitis; Group 3, selenium. Main outcome measures Serum amylase, anti-oxidant levels, bronchoalveolar lavage protein, lung myeloperoxidase activity, and histological assessment of pancreatic injury. Results L-arginine induced acute pancreatitis characterised by oedema, neutrophil infiltration, acinar cell degranulation and elevated serum amylase. Selenium treatment was associated with reduced pancreatic oedema and inflammatory cell infiltration. Acinar degranulation and dilatation were completely absent. A reduction in bronchoalveolar lavage protein content was also demonstrated. Conclusion Intravenous selenium given 24 hours after induction of experimental acute pancreatitis was associated with a reduction in the histological stigmata of pancreatic injury and a dramatic reduction in broncho-alveolar lavage protein content. Serum selenium fell during the course of experimental acute pancreatitis and this effect was not reversed by exogenous selenium supplementation.

  9. Questions about the use of antibiotics in acute pancreatitis

    Assef Jose

    2006-07-01

    Full Text Available Abstract Background and objective The use of antibiotics in acute pancreatitis despite recent clinical trials remains controversial. The aim of this study is to review the latest clinical trials and guidelines about antibiotics in acute pancreatitis and determine its proper use. Methods Through a Medline search, we selected and analyzed pertinent randomized clinical trials and guidelines that evaluated the use of antibiotics in acute pancreatitis. We answered the most frequent questions about this topic. Results and conclusion Based on these clinical trials and guidelines, we conclude that the best treatment currently is the use of antibiotics in patients with severe acute pancreatitis with more than 30% of pancreatic necrosis. The best option for the treatment is Imipenem 3 × 500 mg/day i.v. for 14 days. Alternatively, Ciprofloxacin 2 × 400 mg/day i.v. associated with Metronidazole 3 × 500 mg for 14 days can also be considered as an option.

  10. Evaluation of severity by whole body CT in acute pancreatitis

    Evaluation of severity in acute pancreatitis is still controversial. We studied about thirteen cases of acute pancreatitis and calculated CT score using findings of early whole body CT scanning within forty eight hours after initial symptoms. Simultaneously we calculated clinical score too. CT score was constituted by ten points (changes limitted in pancreas itself, extension of inflammation and extrapancreatic fluid collection etc.). And clinical score was constituted by eight clinical symptoms and fourteen laboratory findings in fatal pancreatitis reported in Japan. From these studies, we conclude that early CT scanning is more useful for objective determination of severity and therapy (surgical or medical) in acute pancreatitis than clinical findings. So we made new classification of severity in acute pancreatitis by CT score as follows: severe (6=: medical therapy). (author)

  11. Pathogenesis of acute lung injury in severe acute pancreatitis

    SHI Lei; YUE Yuan; ZHANG Mei; PAN Cheng-en

    2005-01-01

    Objective:To study the pathogenesis of acute lung injury in severe acute pancreatitis (SAP). Methods:Rats were sacrificed at 1, 3, 5, 6, 9 and 12 h after establishment of inducing model. Pancreas and lung tissues were obtained for pathological study, microvascular permeability and MPO examination. Gene expressions of TNF-α and ICAM-1 in pancreas and lung tissues were detected by RT-PCR. Results:After inducing SAP model, the injury degree of the pancreas and the lung increased gradually, accompanied with gradually increased MPO activity and microvascular permeability. Gene expressions of TNF-α and ICAM-1 in pancreas rose at 1 h and reached peak at 7 h. Relatively, their gene expressions in the lungs only rose slightly at 1 h and reached peak at 9-12 h gradually. Conclusion:There is an obvious time window between SAP and lung injury, when earlier protection is beneficial to prevent development of acute lung injury.

  12. Current concept of pathogenesis of severe acute pancreatitis

    Xie Ning Wu

    2000-01-01

    @@ The pathogenesis of severe acute pancreatitis is very complicated. It is a multifactorial as well as multifaceted disease. First of all, the etiologic agents initiate the pancreatic acinar injury by release of pancreatic enzymes and overstimulation of macrophages and neutrophils, then the cytokines and inflammatory mediators are liberated. There is also interaction between neutrophils and endothelial cells producing free radicals, the cytokines cause increasing vascular permeability, activating complement component, resulting in microcirculatory impairment and imbalance of thrombo-fibrinolytic system. Many of these events occur not only in the pancreas itself, but also in the other vital organs and tissues, leading to severe acute pancreatitis and complications. The sequencial events are as follows.

  13. Minimally invasive retroperitoneal necrosectomy in management of acute necrotizing pancreatitis

    Šileikis, Audrius; Beiša, Virgilijus; Beiša, Augustas; Samuilis, Artūras; Šerpytis, Mindaugas; Strupas, Kęstutis

    2012-01-01

    Introduction One of the most important requirements in treatment of acute necrotizing pancreatitis is minimized invasion. Aim We are presenting experience in treatment of acute necrotizing pancreatitis by an original minimally invasive retroperitoneal necrosectomy technique, comparing our results to other studies, evaluating feasibility and safety, discussing advantages and disadvantages of this method. Material and methods We performed a retrospective analysis of 13 patients who had acute ne...

  14. Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection: A Case Report and Review

    Hemanta Kumar Nayak

    2013-01-01

    Full Text Available Acute pancreatitis complicating fulminant viral hepatitis has been well recognized; however, acute pancreatitis occurring in nonfulminant hepatitis is very rare. The case presented describes moderate pancreatitis in a young male, manifesting during the course of nonfulminant acute hepatitis E infection. The diagnosis of acute viral hepatitis E was confirmed by serology and reverse transcriptase polymerase chain reaction (RT-PCR to demonstrate Hepatitis E virus (HEV RNA in both stool and serum. Patients with acute viral hepatitis presenting with severe abdominal pain should have a diagnosis of acute pancreatitis suspected and appropriate investigations including serum amylase, lipase, biliary ultrasonography and/or contrast-enhanced computed tomography of the abdomen should be undertaken. The identification of this unusual complication of Hepatitis E is important; however, the prognosis for patients with Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection is good, and uncomplicated recovery with conservative treatment is expected.

  15. RISK FACTORS FOR PANCREATIC CANCER: UNDERLYING MECHANISMS AND POTENTIAL TARGETS

    EdwinCharlesThrower

    2014-01-01

    Purpose of the review:Pancreatic cancer is extremely aggressive, forming highly chemo-resistant tumors, and has one of the worst prognoses. The evolution of this cancer is multi-factorial. Repeated acute pancreatic injury and inflammation are important contributing factors in the development of pancreatic cancer. This article attempts to understand the common pathways linking pancreatitis to pancreatic cancer.Recent Findings:Intracellular activation of both pancreatic enzymes and the transcri...

  16. Risk factors for pancreatic cancer: underlying mechanisms and potential targets

    KOLODECIK, THOMAS; Shugrue, Christine; Ashat, Munish; Thrower, Edwin C.

    2014-01-01

    Purpose of the review: Pancreatic cancer is extremely aggressive, forming highly chemo-resistant tumors, and has one of the worst prognoses. The evolution of this cancer is multi-factorial. Repeated acute pancreatic injury and inflammation are important contributing factors in the development of pancreatic cancer. This article attempts to understand the common pathways linking pancreatitis to pancreatic cancer. Recent findings: Intracellular activation of both pancreatic enzymes and the tr...

  17. Risk factors for pancreatic cancer: underlying mechanisms and potential targets

    KOLODECIK, THOMAS; Shugrue, Christine; Ashat, Munish; Thrower, Edwin C.

    2014-01-01

    Purpose of the review: Pancreatic cancer is extremely aggressive, forming highly chemo-resistant tumors, and has one of the worst prognoses. The evolution of this cancer is multi-factorial. Repeated acute pancreatic injury and inflammation are important contributing factors in the development of pancreatic cancer. This article attempts to understand the common pathways linking pancreatitis to pancreatic cancer. Recent findings: Intracellular activation of both pancreatic enzymes and the trans...

  18. [Biochemical diagnostics in acute pancreatitis recognition and outcome predicition].

    Olczyk, Paweł; Kozma, Ewa M; Olczyk, Krystyna; Komosińska-Vassev, Katarzyna

    2004-01-01

    Acute pancreatitis (AP) is a common disease associated with an improper activation of pancreatic zymogens leading to autodigestion of the gland and if excessive--to multiple organ dysfunction. Acute necrotizing pancreatitis manifested by 20% of patients with acute pancreatitis is a life threatening disorder requiring subsequent management in intensive care unit. Unfortunately, none of biochemical tests presently used for laboratory assessment of acute pancreatitis at the early stage of the disease is able to estimate accurately: diagnosis, etiology and severity. At present, diagnosis of acute pancreatitis is based on evaluation of serum amylase and lipase activity due to easy availability and simplicity of these enzymatic tests. Low specificity of the mentioned enzymes resulted in studies concerning pancreatic isoamylase, elastase-1, chymotrypsine, procarboxy-peptidase B, trypsinogen-2 and immunoreactive trypsinogen usefulness in the laboratory diagnosis of AP. The prediction of severity in acute pancreatitis using multifactorial scoring systems is cumbersome especially due to their complexity. On the other hand the biochemical method of choice, estimation of serum C reactive protein, is useless in the early phase of disease. Unfortunately, the computed tomography--the most accurate method in severity assessing--is not always available. Recent studies have brought some progress in severity predicting, such as phospholipase A2, cellular immunity markers, cytokines, activation peptides of trypsinogen and carboxypeptidase B, procalcitonine, pancreatitis associated protein and serum amyloid A. All these newly introduced biochemical methods allow to look optimistically into the future of laboratory diagnostics of the acute pancreatitis believing that the problem of diagnosing and predicting the AP severity will be solved. PMID:15850341

  19. Recurrent Acute Pancreatitis Possibly Induced by Atorvastatin and Rosuvastatin. Is Statin Induced Pancreatitis a Class Effect?

    Dolan JG

    2004-11-01

    Full Text Available CONTEXT: Few data exist about the incidence of drug-induced pancreatitis in the general population. Drugs are related to the etiology of pancreatitis in about 1.4-2% of cases. While statins are generally well tolerated they have been known to be associated with pancreatitis. Acute pancreatitis has been reported in a few cases treated with atorvastatin, fluvastatin, lovastatin, simvastatin and pravastatin. CASE REPORT: We report the case of a 77-year-old patient who developed acute pancreatitis after treatment with rosuvastatin, which resolved on withdrawal of the medication. She had a similar episode of pancreatitis a year ago precipitated by atorvastatin, which resolved on withdrawal. Extensive workup on both occasions failed to reveal any other etiology for the pancreatitis. CONCLUSION: To our knowledge this is the first report of rosuvastatin-induced pancreatitis. The occurrence of pancreatitis with two different statins in our patient argues that statins induced pancreatitis may be a class-effect of statins. With statin prescriptions on the rise clinicians need to be aware of this complication of statin treatment and remember that the newest statin, rosuvastatin is not dissimilar to the other statins in causing pancreatitis.

  20. The crosstalk between gut inflammation and gastrointestinal disorders during acute pancreatitis.

    Guo, Zhen-Zhen; Wang, Pu; Yi, Zhi-Hui; Huang, Zhi-Yin; Tang, Cheng-Wei

    2014-01-01

    The intestinal inflammation caused by intestinal ischemia reperfusion during acute pancreatitis (AP) often leads to multiple organ dysfunction and aggravation of acute pancreatitis. This review concerns up-date progress of the pathophysiology and molecular mechanism of the excessive production of gut-derived cytokines. The regulation effects of immuno-neuro-endocrine network for pancreatic necrosis are the basis for pharmacological therapeutic in AP. The translation from basic research to clinical trials for the prevention or treatment of severe acute pancreatitis (SAP) is of great value. Early enteral nutrition is necessary for the restitution, proliferation, and differentiation of the intestinal epithelial cells adjacent to the wounded area. Clearance of the excess intestinal bacteria and supplement of probiotics may be helpful to prevent bacterial translocation and infection of pancreas. PMID:23782148

  1. Recurrent Episodes of Acute Pancreatitis Due to Duodenal Gangliocytic Paraganglioma: Report of a Case

    Natalia Asimakopoulou

    2014-03-01

    Full Text Available Context Gangliocytic paraganglioma is a rare tumor, almost always located in the second portion of the duodenum, andmanifested with upper gastrointestinal bleeding and abdominal pain. To date, only one case of duodenal gangliocyticparaganglioma presented with recurrent acute pancreatitis has been reported in the literature. Case report We present a72-year-old woman admitted to the hospital due to recurrent episodes of acute pancreatitis. Paraclinical examinationsshowed a polypoid mass in the second portion of duodenum which was removed surgically by local excision. Thepreoperative differential diagnosis was suggestive with gastrointestinal stromal tumor or adenoma. The histopathologyexamination revealed a duodenal gangliocytic paraganglioma. After a follow up period of seventeen months the patientremained without clinical evidence of tumor recurrence. Conclusion Our case report draws attention to the need forincluding in our differential diagnosis of recurrent acute pancreatitis the mechanical obstruction of the pancreatic duct dueto this tumor.

  2. Role of macrophages in the progression of acute pancreatitis

    Sabrina; Gea-Sorlí; Daniel; Closa

    2010-01-01

    In addition to pancreatic cells,other inflammatory cell populations contribute to the generation of inflammatory mediators during acute pancreatitis.In particular,macrophages could be activated by mediators released during pancreatitis by a damaged pancreas.It has been reported that peritoneal macrophages,alveolar macrophages and Kupffer cells become activated in different stages of severe acute pancreatitis.However,macrophages display remarkable plasticity and can change their physiology in response to environmental cues.Depending on their microenvironmental stimulation,macrophages could follow different activation pathways resulting in marked phenotypic heterogeneity.This ability has made these cells interesting therapeutical targets and several approaches have been assayed to modulate the progression of inflammatory response secondary to acute pancreatitis.However,despite the recent advances in the modulation of macrophage function in vivo,the therapeutical applications of these strategies require a better understanding of the regulation of gene expression in these cells.

  3. Comparison of biohumoral and morphological parameters in acute pancreatitis

    Tasić Tomislav

    2014-01-01

    Full Text Available Introduction. Acute pancreatitis occurs as a result of autodigestive activation of pancreatic proenzymes, within the parenchyma of the glands. Objective. The goal of the work was to establish possible connection of etiology and severity of the acute pancreatitis and biohumoral parameters, ultrasound and CT. Methods. The study included 273 patients with pancreatitis, classified by Ranson’s score, according to degree of severity and etiology, whose biohumoral parameters were correlated with each other, and with the ultrasound and CT findings. Results. The values of amylase and ALT were significantly higher in the severe form of pancreatitis and biliary etiology compared to etilic (p<0.05. The ratio of AST/ALT was significantly higher in the group of etilic compared to biliary etiology (p<0.05. LDH was significantly higher in the severe form group compared to moderate form of pancreatitis (p<0.01. Cholesterol was significantly higher in the group of biliary compared to the group of etilic pancreatitis (p<0.05. There was a negative low correlation between the value of calcium ions in the plasma and CT analysis (p=0.05. Low degree negative correlation between the value of calcium ions and ultrasound analysis was established (p=0.0001. Conclusion. There was a negative correlation between the level of ionized calcium in the blood and the degree of the acute pancreatitis by the Balthazar score. Mean value of alpha amylase, total value of cholesterol and ALT were significantly higher in the group of biliary compared to the group of etilic acute pancreatitis. The average values of the alpha amylase, LDH and ALT were significantly higher in the group of severe form of the acute pancreatitis compared to the group of moderate form. The ratio AST/ALT was significantly higher in the group of etilic than in the group of biliary pancreatitis.

  4. Tissue harmonic imaging in the evaluation of acute pancreatitis

    To evaluate the role of tissue harmonic imaging (THI) in acute pancreatitis, and to compare its findings with conventional grey-scale sonography and contrast-enhanced computed tomography (CECT) scan, we evaluated 25 patients diagnosed with acute pancreatitis on clinical examination and laboratory findings. Conventional grey-scale ultrasound followed by tissue harmonic sonography was done on the same machine followed by a CECT within 12 h of the ultrasound examination. The present study showed that sonograms obtained with THI were of much better quality than those obtained conventionally, especially for the pancreatic tail. The benefits of harmonic imaging were more apparent in obese patients and in others whose body habitus was unfavourable for sonography. In the assessment of pancreatic image quality, grey-scale imaging had an accuracy of 60, 80 and 28% in relation to the head, body and tail, respectively. In comparison, THI had a far higher accuracy of 80, 92 and 60% in relation to the head, body and tail, respectively, with the superiority being most obvious in the pancreatic tail region. There were no cases in which tissue harmonic sonography provided less information than conventional sonography. However, CECT scan remained the best modality in all patients for the evaluation of acute pancreatitis. It showed superior demonstration of all the morphological changes, ranging from minimal pancreatic oedema to extensive fluid collections, necrosis and the haemorrhage that developed in fulminant severe pancreatitis. Our experience thus suggests that THI cannot replace CT scan as the gold standard in the assessment of acute pancreatitis, as it is poor in evaluating the pancreatic tail, cannot clearly distinguish phlegmon from necrosis, and is inferior to CT in the assessment of the complications of acute pancreatitis Copyright (2004) Blackwell Publishing Asia Pty Ltd

  5. Enteral Nutrition in Severe Acute Pancreatitis

    Rudra Prasad Doley

    2009-03-01

    Full Text Available Context There is controversy concerning the merits of enteral and pa renteral nutrition in the manage ment of patients with severe acute pancreatitis. Objective This study was undertaken to evalua te the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis. Setting Tertiary care centre in North India. Design A prospective clinical trial. Methods Fifty consecutive patients with severe acute pancreatitis were randomized in a prospective trial to receive total enteral nutrition (n=25 or total parenteral nutrition (n=25. Enteral nutrition was deliver ed distal to the ligament of Treitz. Serum C-reactive protein, transferrin le vels, albumin, surgical intervention, infections, duration of h ospital stay and mortality were compared in the two groups. Results The mean age in the enteral nutrition group was 38.4±13.8 years and in the total parenteral nutrition group 41.1±11.3 years. The etiologi cal factors were alcohol (n=19, gallstones (n=23, idiopathi c (n=7 and drug-induced (n=1. There was a significant decrease in seru m C-reactive protein values in both the enteral nutrition group and the total parenteral nutrition group at one week and two weeks (P<0.001 for both. Serum albumin rose from a prenutritional val ue of 2.82±0.51 g/dL to 3.34±0.45 g/dL on day 14 of nutritional support in the enteral nutrition group (P=0.003; in the total parent eral nutrition group, the level rose from 3.10±0.59 g/dL to 3.21±0.30 g/dL (P=0.638. A signi ficant rise in transferrin value was ob served from day 0 to day 14 in enteral nutrition group (169±30 to 196±36 mg/dL; P<0.001 whereas, in the total parenteral nutrition gr oup, a less significant difference (191±41 to 201±29 mg/dL; P=0.044 was observed. There was no significant difference in surgical intervention (56.0% versus 60.0%; P=1.000, infectiv e complications (64.0% versus 60.0%; P=1.000, hospital stay (42 days

  6. Tyrosine Kinase Inhibitors and Acute Pancreatitis

    Raffaele Pezzilli

    2010-05-01

    Full Text Available In 2007, Badalov et al. [1] revised the data in the literature on drug-induced acute pancreatitis on the basis of a new classification system; they suggested the following classification: Class Ia - drugs having at least one case report with positive rechallenge, excluding all other causes, such as alcohol, hypertriglyceridemia, gallstones and other drugs; Class Ib - those drugs having at least one case report with positive rechallenge in whom other causes, such as alcohol, hypertriglyceridemia, gallstones and other drugs were not ruled out; Class II - those drugs with at least four cases in the literature and consistent latency (75% of cases or more; Class III - drugs with at least two cases in the literature, no consistent latency among cases and no rechallenge and, finally, Class IV - the drugs not fitting into the above-mentioned classes, having a single case report published in the medical literature, without rechallenge.

  7. Cytokines and Organ Failure in Acute Pancreatitis

    Malmstrøm, Marie Louise; Hansen, Mark Berner; Andersen, Anders Møller;

    2012-01-01

    Objectives: We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP). Methods: Interleukin (IL) 6, IL-8, IL-18, and tumor necrosis factor > were measured on admission and...... at days 1, 2, and 14 in 60 patients admitted with first attack of AP. The prediction of single-organ and multiorgan failure from the cytokine profiles was evaluated by receiver operating characteristic analyses. Results: Interleukin 6 and IL-8 levels were significantly higher in patients who...... developed renal, respiratory, and circulatory failure, as was the case for patients with multiorgan failure. Interleukin 18 levels were significantly elevated in renal and respiratory failure only. Tumor necrosis factor > was significantly elevated in all types of organ failures, except for intestinal...

  8. Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay.

    Foster, Bryan R; Jensen, Kyle K; Bakis, Gene; Shaaban, Akram M; Coakley, Fergus V

    2016-01-01

    The 2012 revised Atlanta classification is an update of the original 1992 Atlanta classification, a standardized clinical and radiologic nomenclature for acute pancreatitis and associated complications based on research advances made over the past 2 decades. Acute pancreatitis is now divided into two distinct subtypes, necrotizing pancreatitis and interstitial edematous pancreatitis (IEP), based on the presence or absence of necrosis, respectively. The revised classification system also updates confusing and sometimes inaccurate terminology that was previously used to describe pancreatic and peripancreatic collections. As such, use of the terms acute pseudocyst and pancreatic abscess is now discouraged. Instead, four distinct collection subtypes are identified on the basis of the presence of pancreatic necrosis and time elapsed since the onset of pancreatitis. Acute peripancreatic fluid collections (APFCs) and pseudocysts occur in IEP and contain fluid only. Acute necrotic collections (ANCs) and walled-off necrosis (WON) occur only in patients with necrotizing pancreatitis and contain variable amounts of fluid and necrotic debris. APFCs and ANCs occur within 4 weeks of disease onset. After this time, APFCs or ANCs may either resolve or persist, developing a mature wall to become a pseudocyst or a WON, respectively. Any collection subtype may become infected and manifest as internal gas, though this occurs most commonly in necrotic collections. In this review, the authors present a practical image-rich guide to the revised Atlanta classification system, with the goal of fostering implementation of the revised system into radiology practice, thereby facilitating accurate communication among clinicians and reinforcing the radiologist's role as a key member of a multidisciplinary team in treating patients with acute pancreatitis. (©)RSNA, 2016. PMID:27163588

  9. Chronic pancreatitis

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be ...

  10. Procalcitonin Strip Test as an Independent Predictor in Acute Pancreatitis.

    Dias, Brendan Hermenigildo; Rozario, Anthony Prakash; Olakkengil, Santosh Antony; V, Anirudh

    2015-12-01

    Plasma procalcitonin (PCT) is a highly specific marker for the diagnosis of bacterial infection and sepsis. Studies have demonstrated its role in the setting of sepsis and acute pancreatitis. This study aims to analyze and compare the prognostic efficacy of plasma procalcitonin strip test in acute pancreatitis. A prospective study was conducted in the department of general surgery from June 2012 to June 2013. Plasma procalcitonin was estimated by the semiquantitative strip test. The study included a total of 50 patients diagnosed to have acute pancreatitis. Data was collected and statistically analyzed using SPSS version 17. Thirty-nine out of the 50 patients (78 %) were males with a mean age of 46.8 years (range, 25-78 years) and 25 patients (50 %) had ethanol-induced pancreatitis, while 13 patients (26 %) had gall stone pancreatitis. Plasma PCT values were found to correlate better than CRP levels and total leukocyte count with the total duration of hospitalization, ITU, and ICU stay, as well as with the progression to severe acute pancreatitis. A cut off for plasma PCT of >2 ng/mL was found to be 100 % sensitive and 100 % specific and a cut off for CRP of >19 mg/dL was 70 % sensitive and 65 % specific for predicting the progression to severe acute pancreatitis. Plasma PCT also correlated well with antibiotic requirement. A cut off value of >0.5 ng/mL for plasma PCT was 100 % sensitive and 80 % specific and a cut off value of >18 mg/dL for CRP was 86 % sensitive and 63 % specific for predicting antibiotic requirement. Plasma procalcitonin is an early and reliable prognostic indicator in acute pancreatitis. The procalcitonin strip test is a rapid test which is useful in analyzing prognosis in patients with acute pancreatitis. PMID:27011501

  11. A Case of Acute Pancreatitis Possibly Associated with Combined Salicylate and Simvastatin Treatment

    Giannoulis G

    2005-05-01

    Full Text Available CONTEXT: Drug-induced acute pancreatitis is a rather rare clinical entity. From time to time, several cases have been reported in which statins or salicylates have been associated with the development of acute pancreatitis. There is only one report which implies the involvement of both drugs in pancreatic inflammation. CASE REPORT: A 58-year-old Caucasian male with a history of coronary heart disease and hypercholesterolemia, under treatment with acetyl-salicylate for 6 years and simvastatin for 2 months, presented to the Emergency Department of our hospital with epigastric pain and vomiting of 24-hour duration. The clinical and laboratory investigation led to the diagnosis of acute pancreatitis. Conservative and rich-in-fluid treatment resulted in clinical and laboratory amelioration, and the patient was discharged on day 15, after full restoration of his health. In our patient, all possible common causes of acute pancreatitis were excluded. CONCLUSION: Conclusion It is a rational assumption to connect this case to the co-administration of simvastatin and acetyl-salicylate. However, the pathophysiological mechanism behind the onset of acute pancreatitis due to a statin, or, even more, due to its combination with salicylate, remains vague.

  12. A transatlantic survey of nutrition practice in acute pancreatitis.

    Duggan, SN

    2012-08-01

    Many guidelines exist for the nutritional management of acute pancreatitis; however, little is known regarding current practice. We aimed to investigate feeding practices, including the use of parenteral\\/enteral nutrition.

  13. Wernicke Encephalopathy Presenting in a Patient with Severe Acute Pancreatitis

    Ana Cecilia Arana-Guajardo

    2012-01-01

    Full Text Available Context Acute pancreatitis can lead to prolonged fasting and malnutrition. Many metabolic changes, including thiamine deficiency, may lead to the well know pancreatic encephalopathy. In this condition however the thiamine deficiency is rarely suspected. Case report We report the case of a 17-year-old woman with severe acute pancreatitis who developed mental status changes and ophthalmoplegia. A magnetic resonance image showed hyperintensive signals in periventricular areas, medial thalamus, and mammillary bodies, findings consistent with the diagnosis of Wernicke encephalopathy. Thiamine treatment reversed neurological complications. Conclusion Wernicke encephalopathy secondary to thiamine deficiency should be considered as a possible cause of acute mental status changes in patients with acute pancreatitis and malnutrition. Prophylactic doses of thiamine could be considered in susceptible patients.

  14. Hedgehog信号在胰腺炎症损伤中的作用机制%Mechanisms of the Hedgehog signaling pathway in acute and chronic pancreatitis

    郑英强; 周翔宇; 李园

    2014-01-01

    Aberrant activation of Hedgehog signaling plays multiple roles in acute and chronic inflammatory injury,cell regeneration and tissue self-repair.In acute and chronic pancreatitis,cell regeneration and tissue repair are triggered simultaneously.The hedgehog family is a group of secreted molecules that are essential for cell fate and patterning during the development.Studies have revealed that hedgehog signaling cross-talks with others signaling pathways in regulating inflammation,cell regeneration and fibrosis.Inhibition of hedgehog signal obviously influenced pancreatic inflammation and regeneration.%Hedgehog信号通路广泛参与多种器官急慢性炎症损伤、细胞再生和组织修复.尽管急性胰腺炎和慢性胰腺炎发病机制各异,在炎症损伤的同时,组织的自身修复和再生机制必然启动.国内外的研究已经证实,Hedgehog信号通路与其他信号通路发生交联反应,参与调节胰腺炎症程度、细胞再生以及纤维化,干预Hedgehog信号通路明显影响胰腺炎症进程和纤维化的程度.

  15. CLINICAL STUDY OF ACUTE PANCREATITIS AND ITS COMPLICATIONS

    Raj Siddharth; Anil; Sindhu; Satish

    2016-01-01

    BACKGROUND More than a century after its comprehensive description, acute pancreatitis remains a common disorder with devastating consequences. The presentation of wide spectrum of symptoms gives the clinician a heart breaking exercise to bring back the patient from the clutches of the disease process. Pancreatitis by itself is a disease which is unique, protean and extrudes into the diagnostic arena. It cannot be too strongly emphasized that the primary treatment of acute pan...

  16. Skin signs in acute pancreatitis: a case report

    Marco Bassi; Gelorma Belmonte; Paola Billi; Angelo Pasquale; Massimo Reta; Paolo Leandri; Francesco Ferrara; Stefania Ghersi; Nicola D’Imperio; Roberto Nardi

    2013-01-01

    Introduction: Subcutaneous manifestations of severe acute pancreatitis (Cullen’s sign, Gray- Turner’s sign, Fox’s sign, and Bryant’s sign) are often discussed in journals and textbooks, but seldom observed. Although historically associated with acute pancreatitis, these clinical signs have been described in various other conditions associated with retroperitoneal hemorrhage. Case report: We describe the case of a 61-year-old male with no history of alcohol intake, who was admitted for epigast...

  17. The Significance of Mean Platelet Volume in Acute Pancreatitis

    Keziban Ucar Karabulut

    2016-01-01

    Aim: Acute pancreatitis is a high-mortality disease carrying significant risk of complications and characterized by intra-acinar cell activation of digestive enzymes, followed by a subsequent response via the release of proinflammatory cytokines. Here, we aimed to investigate the development of mean platelet volume in patients diagnosed with acute pancreatitis. Material and Method: The study was performed in patients admitted to the emergency room with the complaint of abdominal pain and dia...

  18. PROSPECTIVE STUDY OF CT IN ACUTE PANCREATITIS AND ITS COMPLICATIONS

    Shivanand S; Shrishail; Mahesh; Govinda Raju

    2015-01-01

    Visualization of the pancreas was far better by CT than b y ultrasound. Ultrasound had certain limitation. Due to bowel gas the pancreas may not be visualized. Extra pancreatic spread of inflammation and vascular complications was not always picked up by Ultrasonography. These limitations were overcome with the u se of CT which yielded more diagnostic information in the evaluation of acute pancreatitis. CT is a confirmative investigation in diagnosis and staging of acute ...

  19. Clinical Study on Acute Pancreatitis in Pregnancy in 26 Cases

    Cheng Qihui; Zhang Xiping; Ding Xianfeng

    2012-01-01

    Aim. This paper investigated the pathogenesis and treatment strategies of acute pancreatitis (AP) in pregnancy. Methods. We analyzed retrospectively the characteristics, auxiliary diagnosis, treatment strategies, and clinical outcomes of 26 cases of patients with AP in pregnancy. Results. All patients were cured finally. (1) Nine cases of 22 mild acute pancreatitis (MAP) patients selected automatic termination of pregnancy because of the unsatisfied therapeutic efficacy or those patients' req...

  20. Low intracellular magnesium in patients with acute pancreatitis and hypocalcemia.

    Ryzen, E; Rude, R K

    1990-01-01

    To determine the role of magnesium deficiency in the pathogenesis of hypocalcemia in acute pancreatitis, we measured magnesium levels in serum and in peripheral blood mononuclear cells in 29 patients with acute pancreatitis, 14 of whom had hypocalcemia and 15 of whom had normal calcium levels. Only six patients had overt hypomagnesemia (serum magnesium less than 0.70 mmol per liter [1.7 mg per dl]). The mean serum magnesium concentration in hypocalcemic patients was not significantly lower th...

  1. Acute pancreatitis in association with small cell lung carcinoma: potential pitfall in diagnosis and management.

    Allan, S. G.; Bundred, N; Eremin, O; Leonard, R. C.

    1985-01-01

    Tumour metastases to the pancreas are a rare but recognized cause of acute pancreatitis, there is a 24-40% incidence of pancreatic involvement from small cell lung cancer in autopsy series but only a very few cases of tumour-induced acute pancreatitis have been described. Chemotherapy has been advocated as the primary therapy in patients with known oat cell carcinoma who develop acute pancreatitis. We describe 2 patients with acute haemorrhagic pancreatitis in association with disseminated sm...

  2. Mental disorders in patients with acute necrotic pancreatitis

    Stefanović Dejan

    2007-01-01

    Full Text Available Introduction The prognosis of patients with acute pancreatitis is still uncertain regardless of modern therapeutic procedures. It is even more emphasized if the acute pancreatitis is followed by psychic disorders. Objective The aim of the study was to provide an overview of the incidence of certain psychosomatic disorders in patients with acute pancreatitis and evaluate priority therapeutic procedures. Method In this study, we analyzed 16 patients with psychosomatic disorders followed by the episode of acute pancreatitis among 202 patients that were hospitalized in the period from 1993 until 2000. The diagnosis was based on anamnesis, clinical and laboratory findings and diagnostic procedures such as X-ray, US, CT and MRI. Results Among 16 patients with psychosomatic disorders followed by acute pancreatitis, 13 (81.25% patients were operated on and 3 (18.75% patients were medically treated. 6 patients experienced hallucinations, 5 memory deficiency, 16 disorientation and 14 confabulation. Conclusion Psychosomatic disorders in patients with acute pancreatitis require complex medical treatment. Due to the already mentioned complications, the management of these conditions is very difficult and with uncertain.

  3. Potential effects of PKC or protease inhibitors on acute pancreatitis-induced tissue injury in rats.

    Shi, Changbin; Zhao, Xia; Wang, Xiangdong; Zhao, Liming; Andersson, Roland

    2007-01-01

    Background: Acute pancreatitis (AP) is still one of the severe diseases, that cause the development of multiple organ dysfunction with a high mortality. Effective therapies for AP are still limited, mainly due to unclear mechanisms by which A-P initiates both pancreatic and extrapancreatic organ injury. Methods: Protease inhibitors (aprotinin, pefabloc, trypsin inhibitor) and PKC inhibitors (polymyxin B, staurosporine) were administrated 30 min before 'induction of AP in rats. To investig...

  4. Acute pancreatitis and acute respiratory distress syndrome complicating dengue haemorrhagic fever

    Agrawal, Avinash; Jain, Nirdesh; Gutch, Manish; Shankar, Amit

    2011-01-01

    Dengue infection is now known to present with wide spectrum of complications. Isolated cases of acute pancreatitis complicating dengue haemorrhagic fever have been reported in literature. Here the authors report a case of dengue haemorrhagic fever that develops acute pancreatitis and presented with acute onset of breathlessness, which then progressed to full-blown acute respiratory distress syndrome. To our knowledge, this is the first reported case of dengue haemorrhagic fever complicated wi...

  5. Can Roxithromycin and Betamethasone Induce Acute Pancreatitis? A Case Report

    Renkes P

    2003-09-01

    Full Text Available CONTEXT: Acute pancreatitis has been reported in a few cases treated with macrolides or glucocorticoids. CASE REPORT: We report the case of a 58 year old patient who, after 2 days of treatment with roxithromycin and betamethasone, manifested acute pancreatitis. Other causes of the disease were ruled out. No re-occurrence of pancreatitis was observed in a 16 month follow-up. CONCLUSION: Our case sheds new light on glucocorticoid pancreatotoxicity and confirms the role of macrolides as potential pancreatotoxic drugs

  6. CLINICAL STUDY OF ACUTE PANCREATITIS AND ITS COMPLICATIONS

    Raj Siddharth

    2016-03-01

    Full Text Available BACKGROUND More than a century after its comprehensive description, acute pancreatitis remains a common disorder with devastating consequences. The presentation of wide spectrum of symptoms gives the clinician a heart breaking exercise to bring back the patient from the clutches of the disease process. Pancreatitis by itself is a disease which is unique, protean and extrudes into the diagnostic arena. It cannot be too strongly emphasized that the primary treatment of acute pancreatitis is conservative only, but it is the Pandora’s box of manifestation with its inherent complications from surgery comes into play as diagnostic, prognostic and therapeutic endeavour. To study age and sex incidence of acute pancreatitis, to study and analyse the etiopathological factors associated with acute pancreatitis, especially alcohol aetiology in our study. To analyse the prognosis of acute pancreatitis using CT scan abdomen. To analyse the complications, to analyse the role of surgery in acute pancreatitis. METHODS This study was carried out on patients admitted in the General Surgery Department, MGM Hospital, from December 2013 to June 2015. RESULTS The incidence of acute pancreatitis was found to be in a younger age group in our study. Serum amylase and lipase both (80% sensitivity should be used for diagnosis wherever possible. Ideally, all cases should be stratified during the first 48 hours according to one of the scoring systems (Balthazar’s. Scoring systems help to identify patients who are more likely to have a severe attack and they should be referred to higher centres if adequate facilities are not available.

  7. The role of MRI in evaluation of acute pancreatitis

    The purpose of this study is to assess the role of MRI in acute pancreatitis. The findings of MPD (main pancreatic duct) and CBD (common bile duct) on MR cholangiopancreatography (MRCP) images were retrospectively reviewed in 60 patients with acute pancreatitis. The patients were divided into two groups; severe and mild pancreatitis, according to the criteria of Japanese group of investigation for pancreatic diseases. T2 weighed MR images were compared with contrast-enhanced CT images for evaluation of severity of the disease. MRCP images were also compared with endoscopic retrograde cholangiopancreatography (ERCP) images for evaluation of MPD and CBD. CBD was more clearly demonstrated by MRCP than MPD. Both MPD and CBD were more clearly seen in the mild group than in the severe group. A few false-negative cases were seen in MRCP. T2 weighed MR images were almost the same as contrast-enhanced CT images in diagnosis of acute pancreatitis. MRCP is useful for evaluation of CBD in severe cases and for evaluation of both CBD and MPD in mild cases of acute pancreatitis. The severity of disease can be evaluated by combination of T2 weighted MR images and MRCP alternative to contrast-enhanced CT. (author)

  8. Lupeol Protects Against Cerulein-Induced Acute Pancreatitis in Mice.

    Kim, Min-Jun; Bae, Gi-Sang; Choi, Sun Bok; Jo, Il-Joo; Kim, Dong-Goo; Shin, Joon-Yeon; Lee, Sung-Kon; Kim, Myoung-Jin; Song, Ho-Joon; Park, Sung-Joo

    2015-10-01

    Lupeol is a triterpenoid commonly found in fruits and vegetables and is known to exhibit a wide range of biological activities, including antiinflammatory and anti-cancer effects. However, the effects of lupeol on acute pancreatitis specifically have not been well characterized. Here, we investigated the effects of lupeol on cerulein-induced acute pancreatitis in mice. Acute pancreatitis was induced via an intraperitoneal injection of cerulein (50 µg/kg). In the lupeol treatment group, lupeol was administered intraperitoneally (10, 25, or 50 mg/kg) 1 h before the first cerulein injection. Blood samples were taken to determine serum cytokine and amylase levels. The pancreas was rapidly removed for morphological examination and used in the myeloperoxidase assay, trypsin activity assay, and real-time reverse transcription polymerase chain reaction. In addition, we isolated pancreatic acinar cells using a collagenase method to examine the acinar cell viability. Lupeol administration significantly attenuated the severity of pancreatitis, as was shown by reduced pancreatic edema, and neutrophil infiltration. In addition, lupeol inhibited elevation of digestive enzymes and cytokine levels, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and interleukin (IL)-6. Furthermore, lupeol inhibited the cerulein-induced acinar cell death. In conclusion, these results suggest that lupeol exhibits protective effects on cerulein-induced acute pancreatitis. PMID:26179197

  9. Pancreatic Rest or Not? The Debate on the Nutrition in Acute Pancreatitis Continues...

    Generoso Uomo

    2013-03-01

    Full Text Available Acute pancreatitis creates a catabolic stress state promoting a systemic inflammatory response and nutritional deterioration; as a consequence, adequate supply of nutrients plays an important role in recovery [1]. Up to the 1990s, total parenteral nutrition and gastrointestinal tract rest have been comprehensively recommended in acute pancreatitis, which make pancreas at rest to reduce pancreatic exocrine secretion and also meet nutritional need [2, 3, 4]. Afterwards, several studies showed that intestinal mucosa undergoes atrophy during oral fasting, which would induce bacteria translocation in gastrointestinal tract and cause pancreatic necrotic tissue infection [5, 6]. According to this, animal experiments and human studies have shown that enteral nutrition is safe and can preserve the integrity of intestinal mucosa to decrease the incidence of infectious complications and other severe complications, such as multiple organ deficiency syndrome [4]. Furthermore, enteral nutrition does not stimulate pancreatic exocrine secretion, if the feeding tube is positioned in the jejunum by nasojejunal or jejunostomy routes.

  10. Tyropanoate cholecystography early in the course of acute pancreatitis.

    Longstreth, G F; Slivka, J

    1981-01-01

    Oral cholecystography (OCG) has traditionally been delayed until several weeks after hospitalization for pancreatitis because of the putative frequent poor visualization during the acute episode. Recently, OCG with iopanoic acid was reported successful in most patients with acute pancreatitis soon after resumption of a solid diet. We evaluated OCG with sodium tyropanoate, a pharmacokinetically different contrast material, in 30 hospitalized patients with pancreatitis before resumption of solid food. It accurately evaluated the gallbladder in 24 cases (80%). Abnormal liver function tests, including mild hyperbilirubinemia, did not interfere with the examination. Consequently, 1) tyropanoate OCG adequately opacifies the gallbladder in most patients with acute pancreatitis who are fasting or taking liquids only; 2) allows gallbladder evaluation earlier than with iopanoic acid OCG; 3) is less affected by hepatic dysfunction; and 4) provides an alternative to ultrasonography. PMID:7328298

  11. Endoscopic retrograde pancreatography (ERP) in acute alcoholic and biliary pancreatitis

    An analysis of the ERP findings in 31 patients with acute pancreatitis enable us to define the terminology of the pancreatogram in these diseases. Irregularities of the ducts indicate previous damage to the organ. A frequent phenomenon is thinning of lateral branches, which can be explained by compression due to oedema. Early parenchymal staining indicates abnormal permeability of the duct epithelium. Cavities are an expression of acute pseudo-cysts. A sign characteristic of alcoholic pancreatitis is the presence of contrast defects due to protein plugs and due to increased viscosity of pancreatic secretions. These observations confirm the theory that protein precipitates due to abnormal secretions play an important role in acute pancreatitis. (orig.)

  12. Secondary acute pancreatitis to hypertriglyceridemia: presentation of two clinical cases

    The acute pancreatitis is a reversible inflammatory process. Hypertriglyceridemia as etiology of the acute pancreatitis reaches frequencies between 1,3 to 11% according to literature when the triglycerides levels of reach values over 1000 mg/dl nevertheless hypertriglyceridemia is observed in 12 to 39% of the acute pancreatitis like factor associate. The objective of the medical treatment is to increase the activity of lipoproteinlipasa and to increase the degradation of vhylomicrones; diminishing therefore the serum triglycerides values of a levels smaller to 500 even to less of 200 mg/dl if is possible with different strategies among of them the insulin. In the present article, we presented two clinical cases of severe pancreatitis induced by hypertriglyceridemia, handled with therapy of insulin infusion with suitable evolution and clinical answer given by significant diminution of the levels of triglycerides, 48 hours post treatment

  13. Activity of "nonspecific pancreatic carboxylesterase" in rat serum in experimentally induced acute pancreatitis (preliminary results).

    Kálmán, A; Kálmán, Z; Velösy, G; Vargha, G; Vargha, G; Papp, M

    1989-01-01

    The aim of this study was to obtain more information on the serum level of "nonspecific pancreatic carboxylesterase" (PCE) in experimentally induced acute pancreatitis in rats. The effects of caerulein stimulation, hepatic duct ligation, bile-pancreatic duct ligation or the effect of retrograde injection of saline, 5% taurocholate and sunflower oil were investigated. The activity of PCE and amylase was measured in the serum, pancreatic tissue, pancreatic juice and ascitic fluid. The changes in PCE activity were greater (both in directions to increase or decrease) than that of amylase, produced by different experimental procedures. The results confirm the thesis that the serum activity of PCE is a more sensitive diagnostic method than that of amylase to detect the inflammatory process in the pancreas or the effect of obstruction of the pancreatic duct. PMID:2480696

  14. Hyperlipidemia intensifies cerulein-induced acute pancreatitis associated with activation of protein kinase C in rats

    Ya-Jun Wang; Jia-Bang Sun; Fei Li; Shu-Wen Zhang

    2006-01-01

    AIM: To investigate the effects of hyperlipidemia on acute pancreatitis (AP) and the possible mechanisms.METHODS: Rat models of hyperlipidemia and AP were established by Triton WR1339 and cerulein respectively.Human albumin was used to treat AP complicated by hyperlipidemia. In each group, we compared the histological score, volume of ascites, ratio of pancreatic wet/dry weight, serum amylase (AMY) and pancreatic acinar cell apoptosis. The level of protein kinase C (PKC) membrane translocation in pancreatic tissue was detected by Western blot.RESULTS: In the hyperlipidemia model established by Triton WR1339, triglyceride (TG) increased remarkably and reached its peak 6 h after injection, and most rats developed mild acute pancreatitis. Histological score, volume of ascites, ratio of wet/dry weight and serum AMY in AP animals with hyperlipidemia were obviously higher than those in AP animals (P <0.05) and decreased after albumin therapy but not significantly (P > 0.05). Apoptotic cells detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) increased in AP animals with hyperlipidemia and did not change distinctly after albumin therapy. PKC membrane translocation level increased in AP animals with hyperlipidemia and decreased remarkably after albumin therapy (P < 0.05).CONCLUSION: Hyperlipidemia may induce AP or intensify pancreatic injury. Albumin therapy can not alleviate pancreatic lesion effectively. PKC activation may be one mechanism by which AP is intensified by hyperlipidemia.

  15. Peripancreatic fat necrosis worsens acute pancreatitis independent of pancreatic necrosis via unsaturated fatty acids increased in human pancreatic necrosis collections

    Noel, Pawan; Patel, Krutika; Durgampudi, Chandra; Trivedi, Ram N; de Oliveira, Cristiane; Crowell, Michael D; Pannala, Rahul; Lee, Kenneth; Brand, Randall; Chennat, Jennifer; Slivka, Adam; Papachristou, Georgios I; Khalid, Asif; Whitcomb, David C; DeLany, James P; Cline, Rachel A; Acharya, Chathur; Jaligama, Deepthi; Murad, Faris M; Yadav, Dhiraj; Navina, Sarah; Singh, Vijay P

    2016-01-01

    Background and aims Peripancreatic fat necrosis occurs frequently in necrotising pancreatitis. Distinguishing markers from mediators of severe acute pancreatitis (SAP) is important since targeting mediators may improve outcomes. We evaluated potential agents in human pancreatic necrotic collections (NCs), pseudocysts (PCs) and pancreatic cystic neoplasms and used pancreatic acini, peripheral blood mononuclear cells (PBMC) and an acute pancreatitis (AP) model to determine SAP mediators. Methods We measured acinar and PBMC injury induced by agents increased in NCs and PCs. Outcomes of caerulein pancreatitis were studied in lean rats coadministered interleukin (IL)-1β and keratinocyte chemoattractant/growth-regulated oncogene, triolein alone or with the lipase inhibitor orlistat. Results NCs had higher fatty acids, IL-8 and IL-1β versus other fluids. Lipolysis of unsaturated triglyceride and resulting unsaturated fatty acids (UFA) oleic and linoleic acids induced necro-apoptosis at less than half the concentration in NCs but other agents did not do so at more than two times these concentrations. Cytokine coadministration resulted in higher pancreatic and lung inflammation than caerulein alone, but only triolein coadministration caused peripancreatic fat stranding, higher cytokines, UFAs, multisystem organ failure (MSOF) and mortality in 97% animals, which were prevented by orlistat. Conclusions UFAs, IL-1β and IL-8 are elevated in NCs. However, UFAs generated via peripancreatic fat lipolysis causes worse inflammation and MSOF, converting mild AP to SAP. PMID:25500204

  16. Effect of copaiba oil on acute pancreatitis in mice

    Daniel L. Medeiros

    2014-06-01

    Full Text Available Objective: The anti-inflammatory activity of copaiba oil was evaluated using a cerulein-induced acute pancreatitis model in mice. Methods: Mice were pretreated with Copaiba sp oleoresin before induction of pancreatitis. Pancreatitis was induced by intraperitoneal injection (five injections at hourly intervals of cerulein solution and, 6 h later, pancreatic and lung damage were analyzed macroscopically for the severity of necrosis, and by protein plasma extravasation and plasma amylase activity (a biomarker of acute pancreatic damage; myeloperoxidase activity (MPO; a neutrophil marker and thiobarbituric reactive species (TBARS; a lipid peroxidation index were determined in the pancreas and lung. Results: A significant reduction in protein plasma extravasation of damaged pancreatic tissue was observed in mice that received copaiba oil. This effect was confirmed biochemically by reduction of protein plasma extravasation, and associated with reduced plasma amylase and MPO activity. Conclusion: These findings indicate the anti-inflammatory effect of copaiba oil on experimental acute pancreatitis induced by cerulein in mice. [J Exp Integr Med 2014; 4(2.000: 107-114

  17. Reproducibility in the assessment of acute pancreatitis with computed tomography

    Freire Filho, Edison de Oliveira; Vieira, Renata La Rocca; Yamada, Andre Fukunishi; Shigueoka, David Carlos; Bekhor, Daniel; Freire, Maxime Figueiredo de Oliveira; Ajzen, Sergio; D' Ippolito, Giuseppe [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. of Imaging Diagnosis]. E-mail: eofilho@ig.com.br; eoffilho@uol.com.br

    2007-11-15

    Objective: To evaluate the reproducibility of unenhanced and contrast-enhanced computed tomography in the assessment of patients with acute pancreatitis. Materials and methods: Fifty-one unenhanced and contrast-enhanced abdominal computed tomography studies of patients with acute pancreatitis were blindly reviewed by two radiologists (observers 1 and 2). The morphological index was separately calculated for unenhanced and contrast-enhanced computed tomography and the disease severity index was established. Intraobserver and interobserver reproducibility of computed tomography was measured by means of the kappa index ({kappa}). Results: Interobserver agreement was {kappa} 0.666, 0.705, 0.648, 0.547 and 0.631, respectively for unenhanced and contrast-enhanced morphological index, presence of pancreatic necrosis, pancreatic necrosis extension, and disease severity index. Intraobserver agreement (observers 1 and 2, respectively) was {kappa} = 0.796 and 0.732 for unenhanced morphological index; {kappa} 0.725 and 0.802 for contrast- enhanced morphological index; {kappa} = 0.674 and 0.849 for presence of pancreatic necrosis; {kappa} = 0.606 and 0.770 for pancreatic necrosis extension; and {kappa} = 0.801 and 0.687 for disease severity index at computed tomography. Conclusion: Computed tomography for determination of morphological index and disease severity index in the staging of acute pancreatitis is a quite reproducible method. The absence of contrast- enhancement does not affect the computed tomography morphological index reproducibility. (author)

  18. Reproducibility in the assessment of acute pancreatitis with computed tomography

    Objective: To evaluate the reproducibility of unenhanced and contrast-enhanced computed tomography in the assessment of patients with acute pancreatitis. Materials and methods: Fifty-one unenhanced and contrast-enhanced abdominal computed tomography studies of patients with acute pancreatitis were blindly reviewed by two radiologists (observers 1 and 2). The morphological index was separately calculated for unenhanced and contrast-enhanced computed tomography and the disease severity index was established. Intraobserver and interobserver reproducibility of computed tomography was measured by means of the kappa index (κ). Results: Interobserver agreement was κ 0.666, 0.705, 0.648, 0.547 and 0.631, respectively for unenhanced and contrast-enhanced morphological index, presence of pancreatic necrosis, pancreatic necrosis extension, and disease severity index. Intraobserver agreement (observers 1 and 2, respectively) was κ = 0.796 and 0.732 for unenhanced morphological index; κ 0.725 and 0.802 for contrast- enhanced morphological index; κ = 0.674 and 0.849 for presence of pancreatic necrosis; κ = 0.606 and 0.770 for pancreatic necrosis extension; and κ = 0.801 and 0.687 for disease severity index at computed tomography. Conclusion: Computed tomography for determination of morphological index and disease severity index in the staging of acute pancreatitis is a quite reproducible method. The absence of contrast- enhancement does not affect the computed tomography morphological index reproducibility. (author)

  19. VALIDITY OF CONTRAST ENHANCED CT IN THE ASSESSMENT OF ACUTE PANCREATITIS AND ITS RELATED COMPLICATIONS

    Mannivanan; Vallepu Ramaiah Shiva; Shankar

    2016-01-01

    BACKGROUND In the earlier days, ultrasonogram was considered as one of the most important investigation for pancreatitis, later the clinicians started using cholangiography in acute pancreatitis, but today CT is considered as a gold standard test in the diagnosis of acute pancreatitis. Though the sensitivity of CT in diagnosing acute pancreatitis was not studied much particularly in a mild case, but a good-quality contrast enhanced CT demonstrates distinct pancreatic and peri-p...

  20. Effects of urtica dioica extract on experimental acute pancreatitis model in rats

    Yilmaz, Baris; Basar, Ömer; Aktas, Bora; Altinbas, Akif; Ekiz, Fuat; Büyükcam, Fatih; Albayrak, Aynur; Ginis, Zeynep; Öztürk, Gülfer; Coban, Sahin; Ucar, Engin; Kaya, Oskay; Yüksel, Osman; Caner, Sedat; Delibasi, Tuncay

    2014-01-01

    Acute pancreatitis is the acute inflammation of pancreas and peripancreatic tissues, and distant organs are also affected. The aim of this study was to investigate the effect of Urtica dioica extract (UDE) treatment on cerulein induced acute pancreatitis in rats. Twenty-one Wistar Albino rats were divided into three groups: Control, Pancreatitis, and UDE treatment group. In the control group no procedures were performed. In the pancreatitis and treatment groups, pancreatitis was induced with ...

  1. Acute and chronic pancreatitis: epidemiology and clinical aspects

    B.W.M. Spanier

    2011-01-01

    In Nederland zijn de afgelopen jaren de incidentiecijfers en de ziekenhuisopnamen voor acute en chronische alvleesklierontsteking (pancreatitis) gestegen. De verwachting is dat deze blijven toenemen bij een vergrijzende samenleving. Uit de EARL-studie van Marcel Spanier komt naar voren dat bij acute

  2. An experimental model of hemolysis-induced acute pancreatitis

    Saruc M.

    2003-01-01

    Full Text Available The literature indicates that acute pancreatitis is a complication of massive hemolysis with a prevalence of about 20%. We describe an experimental model of hemolysis-induced acute pancreatitis. Hemolytic anemia was induced in rats by a single ip injection of 60 mg/kg of 20 mg/ml acetylphenylhydrazine (APH in 20% (v/v ethanol on the first experimental day (day 0. One hundred and fifty Wistar albino rats weighing 180-200 g were divided into three groups of 50 animals each: groups 1, 2 and 3 were injected ip with APH, 20% ethanol, and physiological saline, respectively. Ten rats from each group were sacrificed on study days 1, 2, 3, 4 and 5. Serum amylase, lipase levels and pancreatic tissue tumor necrosis factor-alpha (TNF-alpha and platelet-activating factor (PAF contents were determined and a histological examination of the pancreas was performed. No hemolysis or pancreatitis was observed in any of the rats in groups 2 and 3. In group 1, massive hemolysis was observed in 35 (70% of 50 rats, moderate hemolysis in seven (14%, and no hemolysis in eight (16%. Thirty-three of 35 (94.2% rats with massive hemolysis had hyperamylasemia, and 29 of these rats (82.8% had histologically proven pancreatitis. The most severe pancreatitis occurred on day 3, as demonstrated by histology. Tissue TNF-alpha and PAF levels were statistically higher in group 1 than in groups 2 and 3. Acute massive hemolysis induced acute pancreatitis, as indicated by histology, in almost 80% of cases. Hemolysis may induce acute pancreatitis by triggering the release of proinflammatory and immunoregulatory cytokines.

  3. Acute pancreatitis caused by leptospirosis: Report of two cases

    Ekrem Kaya; Adem Dervisoglu; Cafer Eroglu; Cafer Polat; Mustafa Sunbul; Kayhan Ozkan

    2005-01-01

    Two cases of acute pancreatitis with leptospirosis are reported in this article. Case 1: A 68-year-old woman,presented initially with abdominal pain, nausea, vomiting,and jaundice. She was in poor general condition, and had acute abdominal signs and symptoms on physical examination. Emergency laparotomy was performed, acute pancreatitis and leptospirosis were diagnosed on the basis of surgical findings and serological tests. The patient died on postoperative d 6. Case 2: A 62-year-old man, presented with fever, jaundice, nausea, vomiting, and malaise. Acute pancreatitis associated with leptospirosis was diagnosed,according to abdominal CT scanning and serological tests.The patient recovered fully with antibiotic treatment and nutritional support within 19 d.

  4. Walled-off pancreatic necrosis and other current concepts in the radiological assessment of acute pancreatitis

    Acute pancreatitis is an inflammatory condition caused by intracellular activation and extravasation of inappropriate proteolytic enzymes determining destruction of pancreatic parenchyma and peripancreatic tissues. This is a fairly common clinical condition with two main presentations, namely, endematous pancreatitis - a less severe presentation - and necrotizing pancreatitis - the most severe presentation that affects a significant part of patients. The radiological evaluation, particularly by computed tomography, plays a fundamental role in the definition of the management of severe cases, especially regarding the characterization of local complications with implications in the prognosis and in the definition of the therapeutic approach. New concepts include the subdivision of necrotizing pancreatitis into the following presentations: pancreatic parenchymal necrosis with concomitant peripancreatic tissue necrosis, and necrosis restricted to peripancreatic tissues. Moreover, there was a systematization of the terms acute peripancreatic fluid collection, pseudocyst, post-necrotic pancreatic/peripancreatic fluid collections and walled-off pancreatic necrosis. The knowledge about such terms is extremely relevant to standardize the terminology utilized by specialists involved in the diagnosis and treatment of these patients. (author)

  5. Walled-off pancreatic necrosis and other current concepts in the radiological assessment of acute pancreatitis

    Cunha, Elen Freitas de Cerqueira [Image Memorial/DASA and Diagnoson Medicina Diagnostica, Salvador, BA (Brazil); Rocha, Manoel de Souza; Pereira, Fabio Payao; Blasbalg, Roberto; Baroni, Ronaldo Hueb [Universidade de Sao Paulo (FM/USPU), Sao Paulo, SP (Brazil). Faculdade de Medicina

    2014-05-15

    Acute pancreatitis is an inflammatory condition caused by intracellular activation and extravasation of inappropriate proteolytic enzymes determining destruction of pancreatic parenchyma and peripancreatic tissues. This is a fairly common clinical condition with two main presentations, namely, endematous pancreatitis - a less severe presentation - and necrotizing pancreatitis - the most severe presentation that affects a significant part of patients. The radiological evaluation, particularly by computed tomography, plays a fundamental role in the definition of the management of severe cases, especially regarding the characterization of local complications with implications in the prognosis and in the definition of the therapeutic approach. New concepts include the subdivision of necrotizing pancreatitis into the following presentations: pancreatic parenchymal necrosis with concomitant peripancreatic tissue necrosis, and necrosis restricted to peripancreatic tissues. Moreover, there was a systematization of the terms acute peripancreatic fluid collection, pseudocyst, post-necrotic pancreatic/peripancreatic fluid collections and walled-off pancreatic necrosis. The knowledge about such terms is extremely relevant to standardize the terminology utilized by specialists involved in the diagnosis and treatment of these patients. (author)

  6. Treatment of acute pancreatitis with mexidol and low-intensity laser radiation

    Parzyan, G. R.; Geinits, A. V.

    2001-04-01

    This article presents the results of treatment of 54 patients with acute pancreatitis. The patients were divided into two groups according to the method of treatment. The control group (26 patients) received a conventional therapy, whereas the experimental group (28 patients) received mexidol in combination with the intravenous laser irradiation of blood. Clinical and laboratory tests confirmed a high efficiency of the combined therapy based on the administration of mexidol antioxidant and low-intensity (lambda) equals 0.63 micrometers diode laser irradiation of blood. This therapeutic technique produced an influence on the basic pathogenetic mechanisms of acute pancreatitis. The application of this method of treatment improved the course and prognosis of acute pancreatitis.

  7. Methomyl-Induced Severe Acute Pancreatitis: Possible Etiological Association

    Ioannides M

    2005-03-01

    Full Text Available CONTEXT: N-methyl carbamate insecticides are widely used in homes, gardens and agriculture. They share the capacity to inhibit cholinesterase enzymes with organophosphates and therefore share similar symptomatology during acute and chronic exposures. One of the serious effects of organophosphate and carbamate intoxication is the development of acute pancreatitis and subsequent intrapancreatic fluid formation. CASE REPORT: An 18-year old Caucasian man was admitted to our Intensive Care Unit with cholinergic crisis symptomatology, after the ingestion of an unknown amount of a carbamate insecticide (methomyl. Pseudocholinesterase levels were 2 kU/L on the day of admission (reference range: 5.4-13.2 kU/L. Two days after admission, an abdominal CT scan revealed blurring of the peripancreatic fat planes, inflammation and swelling of the pancreas, and a substantial amount of ascitic fluid in the left anterior pararenal space and pelvis. Paracentesis and analysis of the ascitic fluid demonstrated findings diagnostic of pancreatic ascites. There had been no other evident predisposing factors for acute pancreatitis, other than methomyl intoxication. Eleven days after admission, pseudocholinesterase levels returned to normal, while a new abdominal CT scan revealed the formation of intrapancreatic fluid collection. The patient was discharged in good physical condition two weeks after admission. A follow up abdominal CT scan performed one month later showed a significant reduction in the size of the intrapancreatic fluid. DISCUSSION: Acute pancreatitis is not uncommon after organophosphate intoxication and carbamates share the same risk as organophosphorus pesticides. The development of acute pancreatitis and subsequent intrapancreatic fluid collection after methomyl intoxication has not previously been reported. This is the first case reported of acute pancreatitis and pancreatic ascite formation after anticholinesterase insecticide ingestion.

  8. Prognostic criteria in acute pancreatitis: importance of assessment of pancreatic necrosis by contrast-enhanced CT

    To compare the value of the clinical criteria of Ranson, the classical tomographic criteria of Balthzar and the severity of illness index according to CT in predicting the development of complications of acute pancreatitis. A retrospective study was performed in 100 patients with clinical and analytical evidence of acute pancreatitis. All patients were assessed according to Ranson score at admission and 48 hours later, and contrast-enhanced abdominal CT was carried out. The tomographic images were analyzed on the basis of the classical criteria of Balthazar and the new CT severity of illness index, which includes the assessment of pancreatic necrosis, identified as the areas of the pancreas that are not enhanced by the administration of the contrast material. These three criteria were then correlated with onset of medical and surgical implications. Our findings show that, of the three criteria analyzed, the CT severity of illness index presents the greatest specificity, sensitivity and positive and negative predictive values in the prediction of complications of acute pancreatitis. We conclude that the inclusion of pancreatic necrosis in the tomographic study improves the early assessment of the prognosis of acute pancreatitis. (Author) 20 refs

  9. Necroptosis: a potential, promising target and switch in acute pancreatitis.

    Wang, Gang; Qu, Feng-Zhi; Li, Le; Lv, Jia-Chen; Sun, Bei

    2016-02-01

    Pancreatic acinar cell death is the major pathophysiological change in early acute pancreatitis (AP), and the death modalities are important factors determining its progression and prognosis. During AP, acinar cells undergo two major modes of death, including necrosis and apoptosis. Acinar necrosis can lead to intensely local and systemic inflammatory responses, which both induce and aggravate the lesion. Necrosis has long been considered an unregulated, and passive cell death process. Since the effective interventions of necrosis are difficult to perform, its relevant studies have not received adequate attention. Necroptosis is a newly discovered cell death modality characterized by both necrosis and apoptosis, i.e., it is actively regulated by special genes, while has the typical morphological features of necrosis. Currently, necroptosis is gradually becoming an important topic in the fields of inflammatory diseases. The preliminary results from necroptosis in AP have confirmed the existence of acinar cell necroptosis, which may be a potential target for effectively regulating inflammatory injuries and improving its outcomes; however, the functional changes and mechanisms of necroptosis still require further investigation. This article reviewed the progress of necroptosis in AP to provide a reference for deeply understanding the pathogenic mechanisms of AP and identifying new therapeutic targets. PMID:26514558

  10. Protective effects of rhubarb on experimental severe acute pancreatitis

    Yu-Qing Zhao; Xiao-Hong Liu; Tetsuhide Ito; Jia-Ming Qian

    2004-01-01

    AIM: To investigate the effects of rhubarb on severe acute pancreatitis (SAP) in rats.METHODS: Severe acute pancreatitis was induced by two intraperitoneal injections of cerulein (40 μg/kg body weight) plus 5-h restraint water-immersion stress. Rhubarb (75-150 mg/kg) was orally fed before the first cerulein injection.The degree of pancreatic edema, serum amylase level,local pancreatic blood flow (PBF), and histological alterations were investigated. The effects of rhubarb on pancreatic exocrine secretion in this model were evaluated by comparing with those of somatostatin.RESULTS: In the Cerulein+Stress group, severe edema and diffuse hemorrhage in the pancreas were observed,the pancreatic wet weight (11.60±0.61 g/Kg) and serum amylase (458 490±43 100 U/L) were markedly increased (P<0.01 vs control). In the rhubarb (150 mg/kg) treated rats, necrosis and polymorphonuclear neutrophil (PMN) infiltration in the pancreas were significantly reduced (P<0.01), and a marked decrease (50%) in serum amylase levels was also observed (P<0.01). PBF dropped to 38%(93±5 Ml/min per 100 g) of the control in the Cerulein+Stressgroup and partly recovered in the Cerulein+Stress+Rhubarb 150 mg group (135±12 Ml/min per 100 g) (P<0.01). The pancreatic exocrine function was impaired in the SAP rats.The amylase levels of pancreatic juice were reduced in the rats treated with rhubarb or somatostatin, comparing with that of untreated SAP group. The bicarbonate concentration of pancreatic juice was markedly elevated only in the rhubarb treated group (P<0.01).CONCLUSION: Rhubarb can exert protective effects on SAP, probably by inhibiting the inflammation of pancreas,improving pancreatic microcirculation, and altering exocrine secretion.

  11. Experimental Models in Syrian Golden Hamster Replicate Human Acute Pancreatitis

    Yunan Wang; Abudurexiti Kayoumu; Guotao Lu; Pengfei Xu; Xu Qiu; Liye Chen; Rong Qi; Shouxiong Huang; Weiqin Li; Yuhui Wang; George Liu

    2016-01-01

    The hamster has been shown to share a variety of metabolic similarities with humans. To replicate human acute pancreatitis with hamsters, we comparatively studied the efficacy of common methods, such as the peritoneal injections of caerulein, L-arginine, the retrograde infusion of sodium taurocholate, and another novel model with concomitant administration of ethanol and fatty acid. The severity of pancreatitis was evaluated by serum amylase activity, pathological scores, myeloperoxidase acti...

  12. Endoscopic Fenestration of Pseudo Cyst in Acute Pancreatitis

    Fuminori Yamagishi; Mistuyosi Shimoda; Takashi Sakamoto; Kastunori Tauchi; Kastuo Shimada; Takeichi Goka; Tadashi Bandou; Masao Fujimaki; Ademar Yamanaka

    1998-01-01

    We report a case of pseudo cyst accompanied by acute pancreatitis which was successfully treated by endoscopic cyst-gastrostomy. It had been enlarged recurrently after twice simple needle aspiration under ultrasonic monitoring. Because of the infection of the cyst, rapid and complete drainage was needed. Upper gastro-intestinal endoscopy showed a large bulge of the stomach which was compressed by paragastric pancreatic cyst. Endoscopic ultrasonography revealed that the cyst wall was attached ...

  13. Scrotal Swelling as a Complication of Hydrochlorothiazide Induced Acute Pancreatitis

    Ivan Nikiforov; Qurat Mansoora; Hassan Al-Khalisy; Sarah Joseph; Pramil Cheriyath

    2015-01-01

    Background. Scrotal swelling is a rare complication of acute pancreatitis with few reported cases in the literature. In this case report, we present a 59-year-old male with hydrochlorothiazide induced pancreatitis who developed scrotal swelling. Case Presentation. A 59-year-old male presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest. On physical examination, he had abdominal tenderness and distention with hypoactive bowel sounds. Com...

  14. Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia

    Ercan Gündüz; Recep Dursun; Mustafa İçer; Yılmaz Zengin; Cahfer Güloğlu

    2015-01-01

    Acute pancreatitis (AP) is a condition characterised by the activation of the normally inactive digestive enzymes due to an etiological factor and digestion of the pancreatic tissues, resulting in extensive inflammation and leading to local, regional, and systemic complications in the organism. It may vary from the mild edematous to the hemorrhagic and severely necrotising form. The most common causes are biliary stones and alcohol abuse. In this case study, we would like to present a patient...

  15. Pediatric Burkitt lymphoma presenting as acute pancreatitis: MRI characteristics

    Amodio, John; Brodsky, Jennie E. [SUNY Downstate Medical Center, Department of Radiology, Brooklyn, NY (United States)

    2010-05-15

    Acute pancreatitis is a rare initial presentation of non-Hodgkin lymphoma with few reported cases described in older adults and even fewer in children. MRI features of Burkitt lymphoma of the pancreas are sparse in the radiologic literature. We present a 6-year-old boy who presented with pancreatitis and obstructive jaundice, which was the result of Burkitt lymphoma of the pancreas. The imaging findings of pancreatic involvement of Burkitt lymphoma on MRI are discussed and the contributory role of the radiologist in guiding the appropriate clinical work-up of this disease is highlighted. (orig.)

  16. Pediatric Burkitt lymphoma presenting as acute pancreatitis: MRI characteristics

    Acute pancreatitis is a rare initial presentation of non-Hodgkin lymphoma with few reported cases described in older adults and even fewer in children. MRI features of Burkitt lymphoma of the pancreas are sparse in the radiologic literature. We present a 6-year-old boy who presented with pancreatitis and obstructive jaundice, which was the result of Burkitt lymphoma of the pancreas. The imaging findings of pancreatic involvement of Burkitt lymphoma on MRI are discussed and the contributory role of the radiologist in guiding the appropriate clinical work-up of this disease is highlighted. (orig.)

  17. Inferior phrenic artery pseudoaneurysm complicating drug-induced acute pancreatitis.

    Salem, Jean F; Haydar, Ali; Hallal, Ali

    2014-01-01

    Inferior phrenic artery (IPA) pseudoaneurysm is an extremely rare complication of chronic pancreatitis with only three cases reported in the literature so far. It is a serious condition that can be life-threatening if not diagnosed promptly. Recent advances in endovascular interventions made angiography with embolisation the modality of choice for diagnosis and treatment. We presented the first report of a case of ruptured IPA pseudoaneurysm complicating a drug-induced acute pancreatitis that was successfully treated by transcatheter arterial embolisation. Despite its rarity, rupture of pseudoaneurysm due to drug-induced pancreatitis should be suspected and included in the differential diagnosis when associated with haemodynamic instability. PMID:24385392

  18. The value of immunoreactive lipase in acute pancreatitis.

    1988-01-01

    We have evaluated a new agglutination test for serum immunoreactive lipase in 24 patients with abdominal pain and hyperamylasaemia. On admission all 20 patients with acute pancreatitis had a positive lipase test, 3 of the 4 patients who did not have pancreatitis had a negative lipase test. The sensitivity of the lipase test on day 1 is 100%, the specificity 96% and predictive value of a positive test is 95.2% compared to 83% for amylase. A negative test excludes pancreatitis. In addition, the...

  19. Is leptin related to systemic inflammatory response in acute pancreatitis?

    Andrés Duarte-Rojo; Ana Lezama-Barreda; Mar(i)a Teresa Ram(i)rez-lglesias; Mario Peláez Luna; Guillermo Robles-Diaz

    2006-01-01

    AIM: To evaluate the relationship between leptin and systemic inflammation in acute pancreatitis.METHODS: Consecutive patients with acute pancreatitis were included. Body mass index and serum samples were obtained at admission. Leptin, TNF-α, IL-6, -8and -10 levels were determined by ELISA. Severity was defined according to Atlanta criteria.RESULTS: Fifty-two (29 females) patients were studied.Overall body mass index was similar between mild and severe cases, although women with severe pancreatitis had lower body mass index (P = 0.04) and men showed higher body mass index (P = 0.05). No difference was found in leptin levels regarding the severity of pancreatitis, but higher levels tended to appear in male patients with increased body mass index and severe pancreatitis (P = 0.1). A multivariate analysis showed no association between leptin levels and severity. The strongest cytokine associated with severity was IL-6.Correlations of leptin with another cytokines only showed a trend for IL-8 (P = 0.058).CONCLUSION: High body mass index was associated with severity only in males, which may be related to android fat distribution. Serum leptin seems not to play a role on the systemic inflammatory response in acute pancreatitis and its association with severe outcome in males might represent a marker of increased adiposity.

  20. Significance of CT severity index in acute pancreatitis

    Hwang, Ho; Ahn, In Oak; Kim, Young Mi; Na, Jae Boem; Chung, Sung Hoon; You, Jin Jong [Gyeongsang National Univ. College of Medicine, Chinju (Korea, Republic of); Jun, Se June [Inchon Christian Hospital, Inchon (Korea, Republic of); Song, Ik Hoon [Masan Samsung Hospital, Masan (Korea, Republic of)

    1997-02-01

    To assess the usefulness of a CT severity index(CTSI) for the evaluation of acute pancreatitis and to correlate it with clinical findings. We retrospectively evaluated contrast enhanced CT in 34 patients with acute pancreatitis. They were categorized into low-score(0-2), middle-socre(3-6), and high-score(7-10) groups according to CTSI points, and those groups were correlated with duration of fasting period, days in hospital morbidity and mortality. We attempted to determine the differences in CTSI between pancreatitis caused by alcohol and by biliary tract disease. Of 34 patients, 11 were placed in the low-score group, 19 in the middle-score group, and 4 in the high-score group. The patients in the middle-score group experienced longer fasting period and stayed longer in hospital than those in the low-score group(p < .05 and p= .08, respectively). Morbidity was 0% in the low-score group, 37% in the middle-score group and 50% in the high-score group. Mortality occurred in two patients in high-score group, only. Alcohol-induced pancreatitis generally showed a higher CTSI and more severe clinical course than pancreatitis caused by biliary tract disease. In the evaluation of acute pancreatitis, CTSI can be a useful predictor of its prognosis.

  1. Establishment of a better pig model of severe acute pancreatitis

    Objective: To establish a new severe acute pancreatitis (SAP) pig model for evaluating enteral administration therapy. Methods: Eight tai-lake plum-mountain pigs were randomized into the SAP group(n=4) and the control group(n=4). In anaesthetised eight pigs were orthophoric inserted a nasojejunal catheter. In the SAP group the pancreatic duct was cannulated and taurocholic acid was infused to induce severe acute pancreatitis. Pigs in the control group were cannulated alone and served as the controls. Temperature, bowel sounds, serum amylase, computed tomography (CT) scores and histologic examination were compared between the two groups, to confirm that whether pancreatitis model was established or catheter was inserted. Results: Compared with the control group, SAP group serum amylase was obviously increased (P<0.05). Both CT and histologic examination demonstrated that severe acute pancreatitis model was established and nasojejunal catheter was inserted successfully. Conclusion: It is a simple, noninvasive, repeatable model of enteral nutrition and administration through intestinum in pancreatitis treatment. (authors)

  2. Significance of CT severity index in acute pancreatitis

    To assess the usefulness of a CT severity index(CTSI) for the evaluation of acute pancreatitis and to correlate it with clinical findings. We retrospectively evaluated contrast enhanced CT in 34 patients with acute pancreatitis. They were categorized into low-score(0-2), middle-socre(3-6), and high-score(7-10) groups according to CTSI points, and those groups were correlated with duration of fasting period, days in hospital morbidity and mortality. We attempted to determine the differences in CTSI between pancreatitis caused by alcohol and by biliary tract disease. Of 34 patients, 11 were placed in the low-score group, 19 in the middle-score group, and 4 in the high-score group. The patients in the middle-score group experienced longer fasting period and stayed longer in hospital than those in the low-score group(p < .05 and p= .08, respectively). Morbidity was 0% in the low-score group, 37% in the middle-score group and 50% in the high-score group. Mortality occurred in two patients in high-score group, only. Alcohol-induced pancreatitis generally showed a higher CTSI and more severe clinical course than pancreatitis caused by biliary tract disease. In the evaluation of acute pancreatitis, CTSI can be a useful predictor of its prognosis

  3. Pancreaticobronchial Fistula: A Complication of Acute Pancreatitis

    Dorota Overbeck-Zubrzycka

    2011-01-01

    Full Text Available Context Pancreaticobronchial fistula is a rare complication of severe pancreatitis. Various diagnostic methods have been described previously. Case report The presentation, diagnostic methods, management and 5-year follow-up of a 40-year-old woman with severe gallstone induced pancreatitis complicated by a pancreaticobronchial fistula were reviewed. Diagnosis was made on the endotracheal intubation when amylase rich-fluid was drained via the tube and confirmed by CT scanning. Successful management was achieved by an open pancreatic necrosectomy, during which air bubbles were seen emerging from the pancreatic collection which supported the diagnosis of the fistula. Five-year follow-up did not reveal any complications. Conclusions Pancreaticobronchial fistulas have the potential to cause severe respiratory complications and mortality. Awareness of this condition is important in the treatment of complicated cases of pancreatitis.

  4. The Effect of an Intraperitoneal Injection of Melatonin on Serum Amylase Levels in Acute Pancreatitis

    Cavit Çöl

    2009-05-01

    Full Text Available Context Several experimental studies have been carried out to explain the ph ysiopathological mechan isms and to introduce endocrinological, enzymatic, biochemical and histopathol ogical changes in organism s during acute pancreatitis. Objective To evaluate the effect of an intraperitoneal injection of melatonin on serum amylase levels. Design Experimental acut e pancreatitis was experimentally caused through panc reatic duct ligation in 20 Winstar Albino rats . The rats were then divided into two groups: control and melatonin groups. Intervention The serum amylase level was measured on the 7 th day after acute pancreatitis had developed. In the melatonin group, an intraperitoneal injecti on of melatonin (20 mg/kg/day was performed starting from the 2 nd day after pancreatic duct ligation. Main outcome measure The levels of serum amylase were measured with an auto analyzer. Results It was found that the mean (±SD level of serum amylase in th e control group was 947±182 IU/mL wh ile it was 358±177 IU/mL in the experimental group (P<0.001. Conclusions The 20 mg/kg/day intraperitoneal injection of melatonin which was carried out for one week attenuated the serum amylase levels to a statistically si gnificant degree. The researchers believe that intraperitoneal in jections of melatonin decrease the severity of acute pancreatitis.

  5. Effects of Montelukast in an Experimental Model of Acute Pancreatitis.

    Angı, Serkan; Eken, Hüseyin; Kılıc, Erol; Karaköse, Oktay; Balci, Gürhan; Somuncu, Erkan

    2016-01-01

    BACKGROUND We evaluated the hematological, biochemical, and histopathological effects of Montelukast on pancreatic damage in an experimental acute pancreatitis model created by cerulein in rats before and after the induction of pancreatitis. MATERIAL AND METHODS Forty rats were divided into 4 groups with 10 rats each. The study groups were: the Cerulein (C) group, the Cerulein + early Montelukast (CMe) group, the Cerulein + late Montelukast (CMl) group, and the Control group. The pH, pO2, pCO2, HCO3, leukocyte, hematocrit, pancreatic amylase, and lipase values were measured in the arterial blood samples taken immediately before rats were killed. RESULTS There were statistically significant differences between the C group and the Control group in the values of pancreatic amylase, lipase, blood leukocyte, hematocrit, pH, pO2, pCO2, HCO3, and pancreatic water content, and also in each of the values of edema, inflammation, vacuolization, necrosis, and total histopathological score (Ppancreatic amylase, lipase, pH, PO2, pCO2, HCO3, pancreatic water content, histopathological edema, inflammation, and total histopathological score values were significantly different between the groups (Ppancreatitis might not result in any benefit; however, when they are given in the early phases or prophylactically, they may decrease pancreatic damage. PMID:27479458

  6. Skin signs in acute pancreatitis: a case report

    Marco Bassi

    2013-04-01

    Full Text Available Introduction: Subcutaneous manifestations of severe acute pancreatitis (Cullen’s sign, Gray- Turner’s sign, Fox’s sign, and Bryant’s sign are often discussed in journals and textbooks, but seldom observed. Although historically associated with acute pancreatitis, these clinical signs have been described in various other conditions associated with retroperitoneal hemorrhage. Case report: We describe the case of a 61-year-old male with no history of alcohol intake, who was admitted for epigastric pain, vomiting, and increasing serum amylase and lipase levels. Five days after admission, ecchymotic skin discoloration was noted over both flanks (Gray-Turner’s sign and the upper third of the thighs (Fox’s sign. Ten days later, he developed multiorgan failure and was transferred to the ICU for 5 days. Computed tomography revealed a large pancreatic fluid collection, which was subjected to EUS-guided drainage. Cholecystectomy was later performed for persistent obstructive jaundice. After more than 4 months of hospitalization, he died as a result of severe gastrointestinal bleeding. Discussion and conclusions: Skin manifestations of retroperitoneal hemorrhage in a patient with acute pancreatitis indicate a stormy disease course and poor prognosis. The severity of acute pancreatitis is currently estimated with validated scoring systems based on clinical, laboratory, and imaging findings. However, skin signs like the ones discussed above can represent a simple and inexpensive parameter for evaluating the severity and prognosis of this disease.

  7. A Case of Recurrent Acute Pancreatitis Due to Intra-Articular Corticosteroid Injection

    Patompong Ungprasert

    2014-03-01

    Full Text Available Context Corticosteroid is a well-established cause of drug-induced pancreatitis. However, acute pancreatitis from intraarticularinjection of corticosteroid has never been described. Case report A 69-year-old male presented with acuteabdominal pain and was diagnosed with acute pancreatitis. The patient had one episode of acute pancreatitis two yearearlier. Both episodes occurred after intra-articular cortisone injection. Investigations for other causes of pancreatitis werenegative. Conclusion We report the first case of acute pancreatitis from intra-articular corticosteroid injection. Physiciansshould be aware of this adverse reaction of corticosteroid that can even occur with local administration.

  8. Long-term recurrence and death rates after acute pancreatitis

    Lund, Helle; Tønnesen, Hanne; Tønnesen, Maja Hanne;

    2006-01-01

    The aim of this study was to compare long-term recurrence and death rates after a first episode of acute pancreatitis in patients with and without gallstones. Additionally, it was of interest to find out if there were factors predictive of readmission or death.......The aim of this study was to compare long-term recurrence and death rates after a first episode of acute pancreatitis in patients with and without gallstones. Additionally, it was of interest to find out if there were factors predictive of readmission or death....

  9. Secondary pancreatic involvement by a diffuse large B-cell lymphoma presenting as acute pancreatitis

    M Wasif Saif; Sapna Khubchandani; Marek Walczak

    2007-01-01

    Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma. More than 50% of patients have some site of extra-nodal involvement at diagnosis,including the gastrointestinal tract and bone marrow.However, a diffuse large B-cell lymphoma presenting as acute pancreatitis is rare. A 57-year-old female presented with abdominal pain and matted lymph nodes in her axilla. She was admitted with a diagnosis of acute pancreatitis. Abdominal computed tomography (CT) scan showed diffusely enlarged pancreas due to infiltrative neoplasm and peripancreatic lymphadenopathy. Biopsy of the axillary mass revealed a large B-cell lymphoma.The patient was classified as stage Ⅳ, based on the Ann Arbor Classification, and as having a high-risk lymphoma,based on the International Prognostic Index. She was started on chemotherapy with CHOP (cyclophosphamide,doxorubicin, vincristine and prednisone). Within a week after chemotherapy, the patient's abdominal pain resolved. Follow-up CT scan of the abdomen revealed a marked decrease in the size of the pancreas and peripancreatic lymphadenopathy. A literature search revealed only seven cases of primary involvement of the pancreas in B-cell lymphoma presenting as acute pancreatitis. However, only one case of secondary pancreatic involvement by B-cell lymphoma presenting as acute pancreatitis has been published. Our case appears to be the second report of such a manifestation.Both cases responded well to chemotherapy.

  10. Infarto esplénico secundario a pancreatitis aguda Splenic infarction secondary to acute pancreatitis

    J. J. Arenal Vera

    2008-05-01

    Full Text Available Fundamento y objetivo: la estrecha relación anatómica del páncreas con los vasos esplénicos y el bazo es responsable de complicaciones esplénicas en el curso de la pancreatitis aguda. El objetivo es presentar dos casos clínicos de pancreatitis aguda grave que sufrieron infarto esplénico como complicación de la enfermedad pancreática. Pacientes, participantes: en un periodo de tres meses, dos pacientes fueron diagnosticados de infarto esplénico secundario a pancreatitis aguda. En ambos casos el diagnóstico y seguimiento evolutivo del infarto esplénico se hizo a través de tomografía axial computerizada. Resultados: en el primer paciente, las imágenes muestran de forma inequívoca la afectación de la arteria esplénica por el proceso inflamatorio pancreático. En el segundo, no se pudo demostrar afectación de los vasos esplénicos, por lo que la única posible explicación etiológica es un incremento de coagulabilidad intravascular. Conclusiones: sería recomendable añadir las complicaciones esplénicas al conjunto de complicaciones graves extrapancreáticas de la pancreatitis aguda. La tomografía axial computerizada es de gran utilidad para la detección y seguimiento de las complicaciones esplénicas de la pancreatitis aguda.Background and objective: the close anatomic relationship of the pancreas with the splenic vessels and the spleen is responsible for splenic complications in the course of acute pancreatitis. Our objective was to report two cases of severe acute pancreatitis complicated by splenic infarction. Patients: in a three-month period of time two patients were diagnosed with splenic infarction secondary to acute pancreatitis. In both cases splenic infarction diagnosis and follow-up were carried out using computed tomography. Results: in the first case images clearly showed a narrowing of the splenic artery due to the inflammatory pancreatic condition. In the second case no involvement of the splenic vessels could

  11. Src kinases play a novel dual role in acute pancreatitis affecting severity but no role in stimulated enzyme secretion.

    Nuche-Berenguer, Bernardo; Ramos-Álvarez, Irene; Jensen, R T

    2016-06-01

    In pancreatic acinar cells, the Src family of kinases (SFK) is involved in the activation of several signaling cascades that are implicated in mediating cellular processes (growth, cytoskeletal changes, apoptosis). However, the role of SFKs in various physiological responses such as enzyme secretion or in pathophysiological processes such as acute pancreatitis is either controversial, unknown, or incompletely understood. To address this, in this study, we investigated the role/mechanisms of SFKs in acute pancreatitis and enzyme release. Enzyme secretion was studied in rat dispersed pancreatic acini, in vitro acute-pancreatitis-like changes induced by supramaximal COOH-terminal octapeptide of cholecystokinin (CCK). SFK involvement assessed using the chemical SFK inhibitor (PP2) with its inactive control, 4-amino-7-phenylpyrazol[3,4-d]pyrimidine (PP3), under experimental conditions, markedly inhibiting SFK activation. In CCK-stimulated pancreatic acinar cells, activation occurred of trypsinogen, various MAP kinases (p42/44, JNK), transcription factors (signal transducer and activator of transcription-3, nuclear factor-κB, activator protein-1), caspases (3, 8, and 9) inducing apoptosis, LDH release reflective of necrosis, and various chemokines secreted (monocyte chemotactic protein-1, macrophage inflammatory protein-1α, regulated on activation, normal T cell expressed and secreted). All were inhibited by PP2, not by PP3, except caspase activation leading to apoptosis, which was increased, and trypsin activation, which was unaffected, as was CCK-induced amylase release. These results demonstrate SFK activation is playing a dual role in acute pancreatitis, inhibiting apoptosis and promoting necrosis as well as chemokine/cytokine release inducing inflammation, leading to more severe disease, as well as not affecting secretion. Thus, our studies indicate that SFK is a key mediator of inflammation and pancreatic acinar cell death in acute pancreatitis, suggesting it

  12. Soluble CD40 ligand in prediction of acute severe pancreatitis

    Jean Louis Frossard; Philippe Morel; Brenda Kwak; Catherine Pastor; Thierry Berney; Léo Buhler; Alain Von Laufen; Sandrine Demulder; Fran(c)ois Mach

    2006-01-01

    AIM: To assess the early predictability of the soluble CD40L (sCD40L) in pancreatitis severity.METHODS: Between February 2000 and February 2003,279 consecutive patients with acute pancreatitis were prospectively enrolled in our study. In this report, 40 patients with mild and 40 patients with severe pancreatitis were randomly studied. sCD40L concentrations were measured 48 hours after admission.RESULTS: sCD40L levels were significantly higher 48 hours after admission in severe pancreatitis than in mild pancreatitis. Using a cutoff of 1000 pg/L, the sensitivity and specificity of sCD40L to detect a severe course of the disease were 78% and 62% respectively compared to 72% and 81% for CRP. Logistic regression analysis found that CRP was the only statistically significant marker able to detect a severe course of the disease.CONCLUSION: These findings indicate that CRP remains a valuable marker to determine the severity and prognosis of acute pancreatitis whereas sCD40L levels should be assessed in further studies.

  13. Diagnosis on multi-slice spiral CT in acute pancreatitis and complications

    Objective: To analyze multi-slice CT features and to assess the diagnostic value of CT in acute pancreatitis. Methods: CT was performed on 21 patients with acute pancreatitis in the unenhanced, arterial (28 seconds after intravenous contrast injection), venous (60 seconds) phases. The morphology and contrast enhancement enhancement patterns were analyzed. Results: Of 21 patients, pancreatic necrosis was found in 9 and acute edematous pancreatitis in 12. Associated findings included bile duct stones or cholecystitis (13), liver abscess (1), systemic lupus erythematosis (1), abdominal trauma (2), and pancreatic divisum (1). Complications included pseudoaneurysm (1), venous thrombosis (1), ascites (7), pleural effusion (4) and right lower lobe lung atelectasis (1). Conclusion: Tri-phasic multi-slice spiral CT can accurately distinguish acute edematous pancreatitis from acute hemorrhagic necrotic pancreatitis. CT allows comprehensive evaluation of the cause and complication of acute pancreatitis. (authors)

  14. Acute pancreatitis with saw palmetto use: a case report

    Amankona Raymond

    2011-08-01

    Full Text Available Abstract Introduction Saw palmetto is a phytotherapeutic agent commercially marketed for the treatment of benign prostatic hyperplasia. Evidence suggests that saw palmetto is a safe product, and mild gastrointestinal adverse effects have been reported with its use. We report a case of acute pancreatitis, possibly secondary to the use of saw palmetto. Case presentation A 61-year-old Caucasian man with a history of benign prostatic hyperplasia and gastroesophageal reflux disease developed epigastric pain associated with nausea 36 hours prior to presentation. He denied drinking alcohol prior to the development of his symptoms. His home medications included saw palmetto, lansoprazole and multivitamins. Laboratory results revealed elevated lipase and amylase levels. An abdominal ultrasound demonstrated a nondilated common bile duct, without choledocholithiasis. Computed tomography of his abdomen showed the pancreatic tail with peripancreatic inflammatory changes, consistent with acute pancreatitis. Our patient's condition improved with intravenous fluids and pain management. On the fourth day of hospitalization his pancreatic enzymes were within normal limits: he was discharged home and advised to avoid taking saw palmetto. Conclusion It is our opinion that a relationship between saw palmetto and the onset of acute pancreatitis is plausible, and prescribers and users of saw palmetto should be alert to the possibility of such adverse reactions.

  15. Ischemic penumbra in early stage of severe acute pancreatitis

    We investigated the existence of an ischemic penumbra, which indicates ischemic but still viable lesion, in the early stage of severe acute pancreatitis (SAP). Seventy-one consecutive patients with SAP were enrolled. We divided the pancreas into three regions, the head, body and tail, and measured pancreatic blood flow (FV) and volume (VD) in each region by perfusion CT with one compartment method within three days after the onset of symptoms. Three weeks later, all patients underwent contrast-enhanced CT to diagnose each region for the development of pancreatic necrosis. Of the 227 pancreatic regions from 71 SAP patients, 30 regions were diagnosed as positive for pancreatic necrosis. FV and VD in regions that developed pancreatic necrosis were significantly lower than those in regions without necrosis (35.7±50.7 vs. 197.0±227.6 ml/min, pVDV≥37.5 ml/min and VDVD≥3.4%, 4 (11.7%) developed necrosis. None of 141 regions with FV≥37.5 ml/min and VD≥3.4% developed necrosis. If FV or VD was low, not all regions developed pancreatic necrosis; therefore, we considered that these regions could include zones of ischemic penumbra. (author)

  16. Perfusion CT is superior to angiography in predicting pancreatic necrosis in patients with severe acute pancreatitis

    We performed perfusion computed tomography (P-CT) and angiography of the pancreas in patients with severe acute pancreatitis (SAP) and compared the usefulness of these two methods in predicting the development of pancreatic necrosis. We compared P-CT and angiography results taken within 3 days after symptom onset in 21 SAP patients. We divided the pancreas into three areas, the head, body, and tail, and examined each area for perfusion defects (via P-CT) and arterial vasospasms (by angiography). Three weeks later, all patients underwent contrast-enhanced CT to determine whether pancreatic necrosis had developed. Of the 21 SAP patients, 16 exhibited perfusion defects, while 17 proved positive for vasospasms in at least one area. Fourteen patients developed pancreatic necrosis. Of the 63 pancreatic areas from the 21 SAP patients, perfusion defects appeared in 25 areas (39.7%), 24 of which showed vasospasms (96.0%). Angiography showed 33 areas with vasospasms (52.4%), of which 24 showed perfusion defects (72.7%). Of the 25 areas with perfusion defects, 21 developed pancreatic necrosis (84.0%). Of the 33 areas with vasospasms, 21 developed necrosis (63.6%). Pancreatic necrosis developed only in the areas positive both for perfusion defects and for vasospasms. No areas without perfusion defect or vasospasms developed pancreatic necrosis. P-CT predicted the development of pancreatic necrosis with significantly higher accuracy than angiography. While both P-CT and angiography are useful in predicting the development of pancreatic necrosis in patients with SAP, P-CT appears to be more accurate for this purpose. (author)

  17. Mobilization of xanthine oxidase from the gastrointestinal tract in acute pancreatitis

    Closa Daniel

    2004-01-01

    intestine. Conclusions During the early stages of acute pancreatitis, α-amylase absorbed from AF through the gastrointestinal tract could interfere with the binding of XDH/XOD attached to glycoproteins of the endothelial cells. Proteolytic enzymes convert XDH into its oxidase form promoting an increase in circulating XOD that has been reported to be one of the mechanisms involved in the triggering of the systemic inflammatory process.

  18. Early Prognostic Evaluation of Acute Pancreatitis: An On-Going Challenge

    Karan Kapoor; Banks, Peter A.

    2013-01-01

    Acute pancreatitis remains a serious disease. In 2009, acute pancreatitis accounted for more than 274,000 hospital discharges, (ranking first among all gastrointestinal discharge diagnoses), with an aggregate cost of more than $2,500,000 (the costliest of all gastrointestinal disorders). It also ranked 14th among causes of death from gastrointestinal and liver diseases [1]. Mortality from acute pancreatitis is approximately 3% for interstitial pancreatitis [2], and 15% for necrotizing pancrea...

  19. Clinical significance of computed tomography on management for severe acute pancreatitis

    We studied whether CT findings would be useful for the judgement of severity and treatment of acute pancreatitis in eight patients who had been diagnosed as having acute severe pancreatitis CT findings objectively revealed where and to what extent such inflammatory reactions of acute pancreatitis as massive retroperitoneal fluid collection and ascites appeared. Those results agreed to abdominal physical findings including Blumberg's sign, muscular defense, paralytic ileus and ascites. When pancreatic fluid collection is prominent, early surgical therapy was effective. (author)

  20. Hypertriglyceridemia-induced recurrent acute pancreatitis: A case-based review

    Kota, Sunil K; Kota, Siva K.; Sruti Jammula; S.V.S. Krishna; Modi, Kirtikumar D.

    2012-01-01

    Hypertriglyceridemia is a rare, but well-known cause of acute pancreatitis. A serum triglyceride level of more than 1000 to 2000 mg / dl is the identifiable risk factor. It typically presents as an episode of acute pancreatitis or recurrent acute pancreatitis. The clinical course and routine management of Hypertriglyceridemia-induced pancreatitis is similar to other causes. A thorough family history is important, as is the identification of secondary causes of hypertriglyceridemia. The mainst...

  1. Duodenal foreign body mimicking acute pancreatitis

    Objective: To determine the specificity and sensitivity of plasma and urinary trypsinogen activation peptide (TAP) concentrat. Design: Retrospective analysis of clinical cases. Procedure: Dogs were classified into three groups: healthy animals, dogs with confirmed pancreatitis and dogs with nonpancreatic disease, which clinically or biochemically resembled pancreatitis. This last group was further subdivided into dogs with renal and those with nonrenal disease. The plasma and urinary TAP concentration was determined by a competitive enzyme immunoassay. Clinical cases additionally had serum trypsin-like immunoreactivity concentration measured, as well as radiography and ultrasound of the abdomen and further diagnostic procedures. Nonparametric analysis of variance (Kruskal-Wallis test) was performed using Statistix 4.0 program. Results: There was a wide range of urinary TAP concentration in healthy dogs (mean 52.30 nmol/L, standard deviation 55.25) that made interpretation of urinary TAP concentrations difficult in the other groups. There was a narrow reference range for plasma TAP (mean 2.67 nmol/L, standard deviation 0.93). Plasma and urinary TAP concentrations, as well as urinary TAP to creatinine ratio, were all increased in dogs that died with necrotising pancreatitis. Values were not increased in mild, interstitial pancreatitis. Increased plasma TAP concentrations were also present in dogs with severe renal disease. Conclusion: Plasma TAP concentration isa good prognostic indicator in naturally occurring pancreatitis in dogs. The failure of TAP to increase in mild pancreatitis, and the increase present in severe renal disease, suggests its measurement has limited application as a sole diagnostic tool for canine pancreatitis. Further investigations are required in order to explain the large variability of urinary TAP concentration and the presence of circulating TAP in healthy dogs

  2. Acute pancreatitis; correlation between clinical course and CT grading

    Chung, Suk Jin; Shin, Seung Joon; Kang, Sung Gwon; Kim, Jeong; Kim, Eun Gyung; Kim, Young Sook; Byun, Joo Nam; Oh, Jae Hee; Kim, Young Chul [College of Medicine, Chosun University, Kwangju (Korea, Republic of)

    1994-04-15

    The purpose is to correlate computed tomographic findings classified according to the degree of disease severity(grading A-E) with clinical course of acute pancreatitis. In a retrospective review of 42 patients with acute pancreatitis, computed tomographic scans were classified according to the degree of disease severity, and were correlated with the clinical course. Pancreatic abscesses were seen in 14.3% and occurred in 35.7% of grade D and E patients. Three patients with abscess died. Fatty infiltration of the liver was noted in 16.7%, pleural effusion in 21.4%. Gallstones and thickened wall of the gallbladder were present in 7.1% and in 9.5%, respectively. Our data indicate that phlegmonous extrapancreatic spread on initial CT scan had a high predictive value of the patients, prognosis.

  3. The dependablitiy between CT grade of the acute pancreatitis and CT depiction of the liver parenchymatous abnormal density of the complication of the acute pancreatitis

    Objective: To investigate the dependablitiy between CT grade of the acute pancreatitis and CT depiction of the liver parenchymatous abnormal density in complication of the acute pancreatitis. Methods: Sixty patients with the acute pancreatitis were undergone abdominal helical CT scanning. Result: Two cases with liver abnormal density were in grade A, 9 were in grade B, 13 were in grade C, 18 in grade D and E, accounting for 30.0%. Conclusion: The rate and the descriptions of the liver abnormal density are higher and more distinct when the CT grade of the acute pancreatitis is in more serious category. (authors)

  4. Prevention of bacterial infection and sepsis in acute severe pancreatitis.

    McClelland, P.; Murray, A; Yaqoob, M.; Van Saene, H. K.; Bone, J M; Mostafa, S. M.

    1992-01-01

    Between 1984 and 1986 six patients with acute respiratory failure (requiring ventilation for at least 3 days) complicating acute pancreatitis were managed on the intensive care unit (median ventilation period 6 days; range 3-41 days). Between 1987 and 1989 nine similar patients were managed (median ventilation period 35 days, range 4-69 days), and a regimen of enteral tobramycin, polymyxin and amphotericin to selectively decontaminate the digestive tract (SDD) was introduced. Five of six pati...

  5. Diagnostic evaluation of acute pancreatitis in two patients with hypertriglyceridemia

    Okura, Yoshifumi; Hayashi, Kozo; Shingu, Tetsuji; Kajiyama, Goro; Nakashima, Yoshiyuki; Saku, Keijiro

    2004-01-01

    We present two diagnostically challenging cases of acute pancreatitis with hypertriglyceridemia accompanied with chylomicronemia caused with a deficiency of lipoprotein lipase and with the presence of type V hyperlipidemia. Both cases suffered from acute abdomen following the ingestion of fatty food and revealed the increase in parameters of inflammation without significant elevation of serum amylase levels. The imaging examination of ultrasonography could not detect significant findings of a...

  6. Role of endoscopic ultrasound during hospitalization for acute pancreatitis

    Kotwal, Vikram; Talukdar, Rupjyoti; Levy, Michael; Vege, Santhi Swaroop

    2010-01-01

    Endoscopic ultrasound (EUS) is often used to detect the cause of acute pancreatitis (AP) after the acute attack has subsided. The limited data on its role during hospitalization for AP are reviewed here. The ability of EUS to visualize the pancreas and bile duct, the sonographic appearance of the pancreas, correlation of such appearance to clinical outcomes and the impact on AP management are analyzed from studies. The most important indication for EUS appears to be for detection of suspected...

  7. Recurrent Acute Pancreatitis and Wirsungocele. A Case Report and Review of Literature

    Rajesh Gupta

    2008-07-01

    Full Text Available Context The association of Santorinicele with pancreas divisum has been well described. There is an increased risk of recurrent acute pancreatitis in patients with pancreas divisum who also have Santorinicele. Focal saccular dilation of the terminal part of the main pancreatic duct has been described as an incidental finding and termed, ‘Wirsungocele’. Case report We report a case of a 39-yearold male who had recurrent episodes of acute pancreatitis. Laboratory tests, US of the abdomen and CECT of the abdomen confirmed acute pancreatitis. MRCP showed focal saccular dilation of the terminal part of the main pancreatic duct suggestive of Wirsungocele. An ERCP confirmed MRCP findings. An endoscopic pancreatic sphincterotomy was performed and a 5 Fr single pigtail pancreatic stent was placed. The pancreatic stent was removed after 4 weeks. At the 12-week follow-up, the patient was asymptomatic. Conclusion This case report describes the association of Wirsungocele with recurrent acute pancreatitis.

  8. Non-traumatic abdominal emergencies: imaging and intervention in acute pancreatic conditions

    Procacci, Carlo; Mansueto, Giancarlo; D' Onofrio, Mirko; Gasparini, Anna; Ferrara, Rosa Maria [Department of Radiology, University Hospital ' ' G.B. Rossi' ' , Piazza L.A. Scuro 10, 37134 Verona (Italy); Falconi, Massimo [Department of Surgery, University Hospital ' ' G.B. Rossi' ' , Piazza L.A. Scuro 10, 37134 Verona (Italy)

    2002-10-01

    Pancreatic emergency, unrelated to traumatic events, can occur as a consequence of the more significant pancreatic pathologies (acute and chronic pancreatitis, tumors) or of the interventional or surgical treatment carried out as therapy for the above-mentioned lesions. Acute pancreatic conditions are represented by pancreatic infections, the involvement of organs, structures, and adjacent spaces within the pancreatic disease, and, lastly, vascular complications. Acute pancreatic conditions are common in pancreatic diseases and can be catastrophic; even if there is a gamut in the severity of clinical presentation, each can be potentially life threatening. Immediate radiological detection of the lesions together with a correct therapeutic percutaneous radiological approach whenever an interventional procedure is preferable to surgery or, when performed before surgery, whenever it can optimize its results, is of fundamental importance in the management of these patients. This article focuses on the essential role of radiology and the integration of imaging and intervention in acute pancreatic conditions. (orig.)

  9. Non-traumatic abdominal emergencies: imaging and intervention in acute pancreatic conditions

    Pancreatic emergency, unrelated to traumatic events, can occur as a consequence of the more significant pancreatic pathologies (acute and chronic pancreatitis, tumors) or of the interventional or surgical treatment carried out as therapy for the above-mentioned lesions. Acute pancreatic conditions are represented by pancreatic infections, the involvement of organs, structures, and adjacent spaces within the pancreatic disease, and, lastly, vascular complications. Acute pancreatic conditions are common in pancreatic diseases and can be catastrophic; even if there is a gamut in the severity of clinical presentation, each can be potentially life threatening. Immediate radiological detection of the lesions together with a correct therapeutic percutaneous radiological approach whenever an interventional procedure is preferable to surgery or, when performed before surgery, whenever it can optimize its results, is of fundamental importance in the management of these patients. This article focuses on the essential role of radiology and the integration of imaging and intervention in acute pancreatic conditions. (orig.)

  10. Paeoniflorin ameliorates acute necrotizing pancreatitis and pancreatitis‑induced acute renal injury.

    Wang, Peng; Wang, Weixing; Shi, Qiao; Zhao, Liang; Mei, Fangchao; Li, Chen; Zuo, Teng; He, Xiaobo

    2016-08-01

    Acute renal injury caused by acute necrotizing pancreatitis (ANP) is a common complication that is associated with a high rate of mortality. Paeoniflorin is the active ingredient of paeonia radix and exhibits a number of pharmacological effects, such as anti‑inflammatory, anticancer, analgesic and immunomodulatory effects. The present study detected the potential treatment effects of paeoniflorin on acute renal injury induced by ANP in a rat model. The optimal dose of paeoniflorin for preventing acute renal injury induced by ANP was determined. Then, the possible protective mechanism of paeoniflorin was investigated. The serum levels of tumor necrosis factor (TNF)‑α, interleukin (IL)‑1β and IL‑6 were measured with enzyme‑linked immunosorbent assay kits. Renal inflammation and apoptosis were measured by immunohistochemistry and terminal deoxynucleotidyl transferase‑mediated dUTP nick end labeling assay. The expression of nitric oxide in kidney tissues was also evaluated. The p38 mitogen‑activated protein kinases (MAPKs) were measured by western blotting. The results shown that paeoniflorin may ameliorate acute renal injury following ANP in rats by inhibiting inflammatory responses and renal cell apoptosis. These effects may be associated with the p38MAPK and nuclear factor‑κB signal pathway. PMID:27279569

  11. Factors associated with long-term mortality in acute pancreatitis

    Nøjgaard, Camilla; Matzen, Peter; Bendtsen, Flemming;

    2011-01-01

    Knowledge of the long-term prognosis of acute pancreatitis (AP) is limited. The aims were to investigate: (1) prognostic factors associated with long-term mortality in patients with AP; (2) whether or not the level of serum (S-)amylase at admission had an impact on the prognosis; (3) causes of...

  12. Metastasis-Induced Acute Pancreatitis in a Patient with Small Cell Carcinoma of the Lungs

    Hajime Tanaka

    2009-09-01

    Full Text Available Context Pancreatic metastases are relatively common in advanced lung cancers (both small cell lung carcinoma and non-small cell lung carcinoma, but metastasis-induced acute pancreatitis is very unusual. Case report A 51-year-old woman with small cell carcinoma of the lung developed acute pancreatitis as the initial manifestation. Abdominal ultrasonography revealed multiple pancreatic metastases which were confirmed by magnetic resonance imaging. Conventional treatment did not improve her condition. However, aggressive chemotherapy resulted in a dramatic recovery from the acute pancreatitis and significant improvement in her general condition. Conclusion When cases of acute pancreatitis in patients with small cell lung carcinoma are encountered, we must consider the possibility of metastasis-induced acute pancreatitis and that, should pancreatic metastases be found in these patients, chemotherapy may provide substantial benefit.

  13. Acute fatty liver of pregnancy associated with severe acute pancreatitis: A case report

    Cássio; Vieira; de; Oliveira; Alecsro; Moreira; Julio; P; Baima; Leticia; de; C; Franzoni; Talles; B; Lima; Fabio; da; S; Yamashiro; Kunie; Yabuki; Rabelo; Coelho; Ligia; Y; Sassaki; Carlos; Antonio; Caramori; Ferno; G; Romeiro; Giovanni; F; Silva

    2014-01-01

    Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed.

  14. Early Prediction of Severity in Acute Pancreatitis. Is This Possible?

    Sandberg AA

    2002-09-01

    Full Text Available One out of ten cases of acute pancreatitis develops into severe acute pancreatitis which is a life threatening disorder with a high mortality rate. The other nine cases are self limiting and need very little therapy. The specificity of good clinical judgement on admission, concerning the prognosis of the attack, is high (high specificity but misses a lot of severe cases (low sensitivity. The prediction of severity in acute pancreatitis was first suggested by John HC Ranson in 1974. Much effort has been put into finding a simple scoring system or a good biochemical marker for selecting the severe cases of acute pancreatitis immediately on admission. Today C-reactive protein is the method of choice although this marker is not valid until 48-72 hours after the onset of pain. Inflammatory mediators upstream from CRP like interleukin-6 and other cytokines are likely to react faster and preliminary results for some of these mediators look promising. Another successful approach has been to study markers for the activation of trypsinogen such as TAP and CAPAP. This is based on studies showing that active trypsin is the initial motor of the inflammatory process in acute pancreatitis. In the near future a combined clinical and laboratory approach for early severity prediction will be the most reliable. Clinical judgement predicts 1/3 of the severe cases on admission and early markers for either inflammation or trypsinogen activation should accurately identify 50-60% of the mild cases among the rest, thus missing only 2-4% of the remaining severe cases. One problem is that there is no simple and fast method to analyze any of these parameters.

  15. CD14 promoter polymorphism in Chinese alcoholic patients with cirrhosis of liver and acute pancreatitis

    You-Chen Chao; Heng-Cheng Chu; Wei-Kuo Chang; Hsin-Hung Huang; Tsai-Yuan Hsieh

    2005-01-01

    AIM: To investigate the relationship between genetic polymorphism of the CD14 promoter and the occurrence of alcoholic cirrhosis and alcoholic pancreatitis, and to challenge the conclusion made earlier that the patients with acute alcoholic pancreatitis and patients with alcoholic cirrhosis of liver are two different subpopulations.METHODS: Using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, we determined the polymorphism of CD14 gene and aldehyde dehydrogenase gene 2 (ALDH 2) in 335 alcoholic patients with different organ complications i.e., cirrhosis of liver (n = 100), acute pancreatitis (n = 100), esophageal cancer (n = 82) and avascular necrosis of hip joint (AVN) (n = 53)and 194 non-alcoholic controls in a Chinese group.RESULTS: The results showed that the carriage of T allele was not different among alcoholic patients with cirrhosis of liver, alcoholic patients with other complication and non-alcoholic controls. On the other hand, the carriage of the C allele was significantly more prevalent for alcoholic pancreatitis than for esophageal cancer (0.79 vs 0.60,P<0.001), alcoholic AVN (0.79 vs 0.65, P<0.025) and nonalcoholic controls (0.79 vs 0.68, P<0.025). Furthermore,when only subjects with ALDH2 1-1 genotype were examined, the C allele frequency was significantly more prevalent for alcoholic pancreatitis than for alcoholic liver cirrhosis (0.82 vs 0.69, P<0.025), esophageal cancer (0.82 vs 0.61, P<0.01), alcoholic AVN (0.82 vs 0.64,P<0.01) and non-alcoholic controls (0.82 vs 0.69, P<0.05).CONCLUSION: The C allele may be associated with some mechanism, which is important in the pathogenesis of alcoholic pancreatitis, and that alcoholic patients with acute pancreatitis and cirrhosis of liver are probably two different subpopulations.

  16. The Proteome of Mesenteric Lymph During Acute Pancreatitis and Implications for Treatment

    Anubhav Mittal

    2009-03-01

    Full Text Available The protein fraction of mesenteric lymph during acute pancreatitis and other critical illness is thought to contain toxic factors. However, we do not have a complete description of the mesenteric lymph proteome during acute pancreatitis. Objective The aim of this study was to define the proteomic changes in mesenteric lymph during acute pancreatitis. Setting Animal Laboratory, University of Auckland, New Zealand. Design Mesenteric lymph was collected from sixteen male Wistar rats randomised to Group 1 (n=8 with taurocholate induced acute pancreatitis and Group 2 (n=8 sham control. The lymph was subjected to proteomic analysis using iTRAQTM (Applied Biosystems, Foster City, CA, USA and liquid chromatography-tandem mass spectrometry. Results Two hundred and forty-five proteins including 35 hypothetical proteins were identified in mesenteric lymph. Eight of the 245 proteins had a significant increase in their relative abundance in acute pancreatitis conditioned mesenteric lymph, and 7 of these were pancreatic catabolic enzymes (pancreatic amylase 2, pancreatic lipase, carboxypeptidase A2, chymotrypsinogen B, carboxypeptidase B1, cationic trypsinogen, ribonuclease 1. Conclusions This is the first comprehensive description of the proteome of mesenteric lymph during acute pancreatitis and has demonstrated a significantly increased relative abundance of 7 secreted pancreatic catabolic enzymes in acute pancreatitis conditioned mesenteric lymph. This study provides a clear rationale for further research to investigate the efficacy of enteral protease inhibitors in the treatment of acute pancreatitis.

  17. Acute pancreatitis and type 2 diabetes mellitus: who is guilty?

    Ferit Kerim Kucukler

    2015-07-01

    Full Text Available Many factors play a role in the etiology of acute pancreatitis and its pathogenesis is not fully understood. Dipeptidyl peptidase 4 (DPP-4 inhibitors are a new group of agents for the treatment of Diabetes Mellitus (DM. There are some controversies about specific adverse events such as pancreatitis and hypersensitivity reactions. A 50-year-old morbid obese woman presented with upper abdomen pain after the eating food, nausea and vomiting. She was diagnosed with type 2 diabetes mellitus 7 years ago. Vildagliptin had been added to her treatment six months ago. Abdominal examination revealed epigastric tenderness with guarding. Laboratory data revealed elevated pancreatic enzymes. Abdominal computed tomography (CT showed features of pancreatitis. Vildagliptin was stopped and patient's symptoms had diminished in parallel with normalization of pancreatic enzymes; and at the 5th day patient was discharged with healthy condition. She was free of symptoms and all laboratory data were normal at the 30th day after discharge. It is important to keep in mind that diabetic patients have an increased risk of pancreatitis which may be related to obesity, hyperlipidemia and/or drugs.

  18. Acute pancreatitis; Value of CT as a predictor of outcome

    Perez, C.; Llauger, J.; Andreu, J.; Palmer, J.; Puig, J. (Autonomous University of Barcelona (Spain). Hospital de la Santa Creu i Sant Pau, Department of Diagnostic Radiology)

    A prospective study was performed on the relationship of CT findings to the clinical course of 148 patients with acute pancreatitis. The type of pancreatic inflammation seen on CT was classified into six categories based on an overall assessment of size, contour and density of the gland, and peripancreatic abnormalities. The majority (94%) of patients in whom CT showed mild pancreatic changes (grades A, B and C) had two or less positive clinical indicaters of severe pancreatitis (Ranson's signs). In contrast, 92% of patients in whom CT showed more severe changes of pancreatitis (grades D, E or F) had three or more positive signs. The nine patients who died with pancreatitis-related complications were in grades D, E or F. We wish to draw attention to a CT appearance which we have called 'fat islets' (low density intrapancreatic or peripancreatic areas, the contents of which approach fat in attenuation values); there was a strong correlation between this appearance and subsequent infection. (author). 24 refs.; 7 figs.; 4 tabs.

  19. The aetiology of acute and chronic pancreatitis over time in a hospital in Copenhagen

    Nøjgaard, Camilla; Bendtsen, Flemming; Matzen, Peter;

    2010-01-01

    INTRODUCTION: The change in aetiology over time of acute and chronic pancreatitis has been sparsely described, as has also the validity of the diagnostic codes. The aim of the study was 1) to clarify whether the aetiology of acute and chronic pancreatitis changed during the period 1983-2005, and 2......) to validate the diagnostic codes over time for acute and chronic pancreatitis registered in the Danish National Patient Registry (NPR) in the same period. MATERIAL AND METHODS: All admissions at Hvidovre Hospital coded in the NPR in 1983, 1994 and 2005 with a diagnosis of either acute or chronic......: Gallstone disease significantly (p = 0.04) increased as the cause of acute pancreatitis over the 22-year period, while alcohol remained the major cause of chronic pancreatitis. The validity of the diagnoses for patients with acute pancreatitis varied between 51% and 73%, and for chronic pancreatitis between...

  20. The aetiology of acute and chronic pancreatitis over time in a hospital in Copenhagen

    Nøjgaard, Camilla; Bendtsen, Flemming; Matzen, Peter;

    2010-01-01

    : Gallstone disease significantly (p = 0.04) increased as the cause of acute pancreatitis over the 22-year period, while alcohol remained the major cause of chronic pancreatitis. The validity of the diagnoses for patients with acute pancreatitis varied between 51% and 73%, and for chronic pancreatitis between......INTRODUCTION: The change in aetiology over time of acute and chronic pancreatitis has been sparsely described, as has also the validity of the diagnostic codes. The aim of the study was 1) to clarify whether the aetiology of acute and chronic pancreatitis changed during the period 1983-2005, and 2......) to validate the diagnostic codes over time for acute and chronic pancreatitis registered in the Danish National Patient Registry (NPR) in the same period. MATERIAL AND METHODS: All admissions at Hvidovre Hospital coded in the NPR in 1983, 1994 and 2005 with a diagnosis of either acute or chronic...

  1. Posterior Reversible Encephalopathy Syndrome (PRES After Acute Pancreatitis

    Tara Murphy

    2015-12-01

    Full Text Available Posterior reversible encephalopathy syndrome (PRES is an unusual condition typified by acute visual impairment caused by sudden, marked parieto-occipital vasogenic edema. Thought to be inflammatory in origin, it has been described in patients undergoing chemotherapy, with autoimmune disease, and in some infections. We report a case of PRES that occurred one week after an episode of acute pancreatitis in an otherwise healthy 40-year-old female. There was progressive visual impairment over a 24-hour period with almost complete visual loss, with characteristic findings on magnetic resonance imaging. After treatment with steroids, the visual loss recovered. Clinicians should retain an index of suspicion of this rare condition in patients with visual impairment after acute pancreatitis.

  2. Acute Pancreatitis as the First Presentation of Wegener's Granulomatosis

    Mohammed Abu-Hilal

    2008-05-01

    Full Text Available Context Wegener’s granulomatosis is a systemic vasculitis with prominent involvement of the respiratory tract and kidney. An association between acute pancreatitis and Wegener's granulomatosis is rarely reported and is even rarer as the first presentation. This can result in diagnostic difficulty and may allow severe pancreatitis to develop with potentially poor outcome. Case report We report a rare case with fatal outcome of vasculitis consistent with Wegener’s granulomatosis presenting as acute pancreatitis in a 20-year-old female. The patient was admitted with worsening abdominal pain associated with nausea and loss of appetite. Accepted causes of acute pancreatitis were excluded and granulomatous vasculitis of the pancreas was confirmed from immunological profile, computed tomography and histology. As the disease progressed the patient experienced cutaneous, pulmonary, renal and severe gut involvement. Thirteen months from diagnosis the patient died of multi-organ failure despite appropriate surgical and immunosuppressive therapy. Conclusion Vasculitic disease of the pancreas is rare but should be considered when other causes have been appropriately ruled out. Careful radiological, immunological and histological diagnosis is necessary and early immunosuppressant therapy in conjunction with advice from immunologists is essential to avoid the poor outcome reported in this and other case reports.

  3. Acute pancreatitis complicated with splenic rupture: A case report

    Bruno; L; Hernani; Pedro; C; Silva; Ricardo; T; Nishio; Henrique; C; Mateus; José; C; Assef; Tercio; De; Campos

    2015-01-01

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography(CT) of the abdomen, the pancreatitis was scored as Balthazar C grade, and a suspicious area of necrosis affecting 30% of the pancreas with splenic vein thrombosis was revealed. Seventytwo hours after admission, the patient had significant improvement in symptoms. However, he showed clinical worsening on the sixth day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma and contrast extravasation along the spleen artery. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was then performed, followed by ultrasound-guided percutaneous drainage.

  4. Scrotal Swelling as a Complication of Hydrochlorothiazide Induced Acute Pancreatitis

    Ivan Nikiforov

    2015-01-01

    Full Text Available Background. Scrotal swelling is a rare complication of acute pancreatitis with few reported cases in the literature. In this case report, we present a 59-year-old male with hydrochlorothiazide induced pancreatitis who developed scrotal swelling. Case Presentation. A 59-year-old male presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest. On physical examination, he had abdominal tenderness and distention with hypoactive bowel sounds. Computed tomography (CT scan of the abdomen showed acute pancreatitis. The patient’s condition deteriorated and he was admitted to the intensive care unit (ICU. After he improved and was transferred out of the ICU, the patient developed swelling of the scrotum and penis. Ultrasound (US of the scrotum showed large hydrocele bilaterally with no varicoceles or testicular masses. Good blood flow was observed for both testicles. The swelling diminished over the next eight days with the addition of Lasix and the patient was discharged home in stable condition. Conclusion. Scrotal swelling is a rare complication of acute pancreatitis. It usually resolves spontaneously with conservative medical management such as diuretics and elevation of the legs.

  5. Acute pancreatitis: reflections through the history of the Atlanta Consensus

    Torres López, Ana María

    2014-10-01

    Full Text Available Acute pancreatitis is an inflammatory process with systemic and local repercussions. Most cases are mild with low mortality rate, but 20% of the patients have severe pancreatitis with a mortality rate up to 30%. Through the years the medical community has tried to reach consensus about this disease in order to better understand, classify and treat it. The most important of these has been known as the Atlanta Consensus 1992, in use for many years. However, it has been recently the subject of various proposals for changes and updates, which are discussed in this review article.

  6. Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection?

    Yan Luo; Chao Xin Yuan; Yu Lan Peng; Pei Lin Wei; Zhao Da Zhang; Jun Ming Jiang; Lin Dai; Yun Kai Hu

    2001-01-01

    @@INTRODUCTION The spectrum of acute pancreatitis (AP) ranges from a mild spontaneously resolved disorder to severe disease with mortality up to 20%-48.4%[1-3]. sAP is defined as the AP with organ failure and /or local complications which developed form acute fluid collection (AFC) including necrosis ,abscess , pseudocyst formation into or around the pancreas [4].

  7. Early Antibiotic Treatment in Acute Pancreatitis: More News

    Jan J De Waele

    2006-07-01

    Full Text Available Early antibiotic treatment still remains a therapeutic challenge in the clinical management of acute pancreatitis and several papers have been published in this field [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]. In particular, the antibiotic of choice in preventing the infection of pancreatic necrosis seems to be imipenem [4, 9, 10, 11, 13]. Subsequently, Manes et al. [15] have reported that meropenem, an antibiotic of the same family as imipenem having considerable stability in the presence of renal dehydropeptidase-I and enhanced activity against gram-negative bacteria including Pseudomonas aeruginosa, has an efficacy similar to imipenem in terms of the incidence of pancreatic infection and extrapancreatic infections. We have previously emphasized that further studies should be carried out to specifically decide on the optimal doses of meropenem in patients with acute pancreatitis and that there is a need for studies which answer the following questions. What should the timing of early antibiotic treatment be?. What are the resistant strains selected by meropenem?. Which are the nosocomial infections and fungal superinfections resulting from this new treatment? [16, 17]. These questions are still open and the study from Manes et al. is welcome to attempt to answer some of the aforementioned questions [18]. In this study, the authors compared antibiotic prophylaxis with early antibiotic treatment started after the demonstration of pancreatic necrosis. They studied 215 consecutive patients with acute pancreatitis who were randomized to either Group A (n=108, who started antibiotic therapy (meropenem 500 mg tid at admission, or Group B (n=107, who received antibiotics after computed tomography showed necrosis. C-reactive protein was determined in all patients within 48 hours from the onset of symptoms and computed tomography was performed in both groups after at least 48 h of hospitalization; the clinical course of disease was also compared

  8. Acute kidney injury in severe acute pancreatitis: An experience from a tertiary care center

    Ravindra Kumar; Naresh Pahwa; Neeraj Jain

    2015-01-01

    Acute kidney injury (AKI) is an important cause of morbidity and mortality in severe acute pancreatitis (SAP). We aimed in our study to explore the risk factors of AKI in patients with SAP and assess the prognosis of patients with SAP and AKI. This is a retrospective study consisting of analysis of outcome and complications encountered in 72 severe acute pancreatitis patients admitted to a tertiary care center at Indore, India, from May 2011 to April 2012. We encountered 14 AKI cases in the S...

  9. Atypical presentation of acute pancreatitis in a man with pancreatic insufficiency and cystic fibrosis: a case report

    Turner Malcolm

    2010-08-01

    Full Text Available Abstract Introduction Whether acute pancreatitis can occur in pancreatically insufficient individuals with cystic fibrosis remains a matter of debate. Case presentation We describe a case of acute pancreatitis occurring in a 52-year-old Caucasian Australian man with moderately severe cystic fibrosis lung disease and pancreatic insufficiency. An inflammatory mass within the head of his pancreas was confirmed using computed tomography, magnetic resonance imaging and pancreatic biopsy, but serum amylase and lipase remained normal throughout the acute phase of his illness. His symptoms and the pancreatic mass resolved following the insertion of a biliary stent and the introduction of ursodeoxycholic acid. Conclusion Our case report highlights the potential for acute pancreatitis to occur in patients with pancreatic insufficiency and cystic fibrosis. We further demonstrate that conventional biochemical markers that are normally assessed to confirm the diagnosis may not be of particular use. As patients with cystic fibrosis survive into their fourth and fifth decades of life, atypical presentations of acute pancreatitis may become more common.

  10. X-CT evaluation of the severity of acute pancreatitis

    In some patients with acute pancreatitis, some experience life-threatening complications. Although there are reports of the assessment of the severity of the disease, mainly based on clinical signs and laboratory findings, pertinent criteria remain elusive. As little information is available concerning the degree or extent of pancreatic lesions; it is difficult to predict the severity and outcome. I examined 74 patients with acute pancreatitis, using computed tomography (CT). The severity was evaluated by means of a CT-score consisting of ten points on the CT findings, in the early stage of the acute pancreatitis. The following results were obtained. 1) Infiltration into the retroperitoneal space such as anterior pararenal space was observed by CT earlier and more frequently than were changes within the pancreas parenchyma. 2) Heterogeneous density of the pancreas and involvement of the posterior pararenal space were more significant and frequently in the severe group than in the moderate or mild group. 3) CT observations made 48 hours after the onset were the most adequate for evaluating the severity in case of acute pancreatitis. 4) After evaluating the severity by the CT-score, the 74 patients were grouped into 3: mild in 46, moderate in 22 and severe in 6 patients. The CT-score revealed a significantly greater specifity and accuracy than did the clinical score, Forell's, Ranson's, or the criteria submitted by a committee for the study of this disease appointed by the Japanese Ministry of Health and Welfare. I propose that an evaluation of the severity by CT-score obtained about 48 hours after the onset of symptoms is useful for predicting the prognosis and for designing proper treatment. (author)

  11. Pancreatic Protein Tyrosine Phosphatase 1B Deficiency Exacerbates Acute Pancreatitis in Mice.

    Bettaieb, Ahmed; Koike, Shinichiro; Chahed, Samah; Bachaalany, Santana; Griffey, Stephen; Sastre, Juan; Haj, Fawaz G

    2016-08-01

    Acute pancreatitis (AP) is a common and devastating gastrointestinal disorder that causes significant morbidity. The disease starts as local inflammation in the pancreas that may progress to systemic inflammation and complications. Protein tyrosine phosphatase 1B (PTP1B) is implicated in inflammatory signaling, but its significance in AP remains unclear. To investigate whether PTP1B may have a role in AP, we used pancreas PTP1B knockout (panc-PTP1B KO) mice and determined the effects of pancreatic PTP1B deficiency on cerulein- and arginine-induced acute pancreatitis. We report that PTP1B protein expression was increased in the early phase of AP in mice and rats. In addition, histological analyses of pancreas samples revealed enhanced features of AP in cerulein-treated panc-PTP1B KO mice compared with controls. Moreover, cerulein- and arginine-induced serum amylase and lipase were significantly higher in panc-PTP1B KO mice compared with controls. Similarly, pancreatic mRNA and serum concentrations of the inflammatory cytokines IL-1B, IL-6, and tumor necrosis factor-α were increased in panc-PTP1B KO mice compared with controls. Furthermore, panc-PTP1B KO mice exhibited enhanced cerulein- and arginine-induced NF-κB inflammatory response accompanied with increased mitogen-activated protein kinases activation and elevated endoplasmic reticulum stress. Notably, these effects were recapitulated in acinar cells treated with a pharmacological inhibitor of PTP1B. These findings reveal a novel role for pancreatic PTP1B in cerulein- and arginine-induced acute pancreatitis. PMID:27461362

  12. VALIDITY OF CONTRAST ENHANCED CT IN THE ASSESSMENT OF ACUTE PANCREATITIS AND ITS RELATED COMPLICATIONS

    Mannivanan

    2016-03-01

    Full Text Available BACKGROUND In the earlier days, ultrasonogram was considered as one of the most important investigation for pancreatitis, later the clinicians started using cholangiography in acute pancreatitis, but today CT is considered as a gold standard test in the diagnosis of acute pancreatitis. Though the sensitivity of CT in diagnosing acute pancreatitis was not studied much particularly in a mild case, but a good-quality contrast enhanced CT demonstrates distinct pancreatic and peri-pancreatic abnormalities. AIM To assess the importance of computed tomography in diagnosing acute pancreatitis and its related complications. MATERIALS AND METHODS A prospective study was conducted on 150 patients with clinically suspected pancreatitis. CT was performed on all the patients with Siemens Spiral CT scanner Sensation 16 slice. Oral contrast of was 1000 mL given one hour prior to the scan in the form of taking 250 mL every 15 mins. The CT severity index (CTSI and the necrosis point scoring was used to assess the severity of acute pancreatitis. All the complications related to acute pancreatitis were also assessed. RESULTS The CT analysis in the detection of acute pancreatitis showed the sensitivity of 100% and the positive predictive value of 97.3%. The severity index of acute pancreatitis based on the CT imaging had shown that majority of the patients are with moderate (60.6% level of acute pancreatitis. The necrosis point scoring showed that 54.6% of the patients had necrosis involving less than 30% of the pancreas. Among the various complications detected by CECT the commonest were pleural effusion and ascites. CONCLUSION CECT is the most important gold standard technique both for diagnosis as well as for predicting the prognosis in acute pancreatitis. The clinicians should routinely send the patient for the CT imaging whenever there is a suspicion of pancreatitis clinically.

  13. A large volume of visceral adipose tissue leads to severe acute pancreatitis

    Obesity plays an important role in acute pancreatitis. Assuming that the volume of visceral adipose tissue (VAT) directly influences the severity of acute pancreatitis, we investigated the relationship between VAT and acute pancreatitis. Data were collected consecutively from 124 patients who were diagnosed with acute pancreatitis. Body mass index (BMI) was calculated from the database. Computed tomography was performed in all patients, and VAT, subcutaneous adipose tissue (SAT), and waist circumference (WC) were measured at the level of the intervertebral disk between L2 and L3. Atlanta criteria were adopted to define severe acute pancreatitis. Clinical courses were investigated, and the Ranson and acute physiology and chronic health evaluation II (APACHE II) scores were calculated for all patients. Forty-eight patients had severe acute pancreatitis (38.7%), and 76 were mild cases. BMI, VAT, SAT, and WC were correlated with the severity of acute pancreatitis in a univariate analysis, but only VAT had a strong correlation with severe acute pancreatitis in the multivariate analysis. In a trend analysis, not only severity but also the presence of pseudocysts (local complication) and prognostic factors (Ranson and APACHE II scores) were significantly related to VAT volume. In particular, the presence of a pancreatic pseudocyst was strongly related to VAT volume (p<0.001). In acute pancreatitis, peripancreatic VAT has a stronger correlation with severe acute pancreatitis than BMI or WC. VAT volume is strongly correlated with the formation of a pseudocyst and with systemic inflammatory response syndrome in patients with acute pancreatitis and high VAT volume may lead to severe acute pancreatitis. (author)

  14. Berberine inhibits inflammatory mediators and attenuates acute pancreatitis through deactivation of JNK signaling pathways.

    Choi, Sun-Bok; Bae, Gi-Sang; Jo, Il-Joo; Wang, Shaofan; Song, Ho-Joon; Park, Sung-Joo

    2016-06-01

    Acute pancreatitis (AP) is a life-threatening disease. Berberine (BBR), a well-known plant alkaloid, is reported to have anti-inflammatory activity in many diseases. However, the effects of BBR on AP have not been clearly elucidated. Therefore, the present study aimed to investigate the effects of BBR on cerulein-induced AP in mice. AP was induced by either cerulein or l-arginine. In the BBR treated group, BBR was administered intraperitoneally 1h before the first cerulein or l-arginine injection. Blood samples were obtained to determine serum amylase and lipase activities and nitric oxide production. The pancreas and lung were rapidly removed for examination of histologic changes, myeloperoxidase (MPO) activity, and real-time reverse transcription-polymerase chain reaction. Furthermore, the regulating mechanisms of BBR were evaluated. Treatment of mice with BBR reduced pancreatic injury and activities of amylase, lipase, and pancreatitis-associated lung injury, as well as inhibited several inflammatory parameters such as the expression of pro-inflammatory cytokines and inducible nitric oxide synthesis (iNOS). Furthermore, BBR administration significantly inhibited c-Jun N-terminal kinase (JNK) activation in the cerulein-induced AP. Deactivation of JNK resulted in amelioration of pancreatitis and the inhibition of inflammatory mediators. These results suggest that BBR exerts anti-inflammatory effects on AP via JNK deactivation on mild and severe acute pancreatitis model, and could be a beneficial target in the management of AP. PMID:27148818

  15. Experimental and clinical evidence of antioxidant therapy in acute pancreatitis

    Mukaddes Esrefoglu

    2012-01-01

    Oxidative stress has been shown to play an important role in the pathogenesis of acute pancreatitis (AP).Antioxidants,alone or in combination with conventional therapy,should improve oxidative-stress-induced organ damage and therefore accelerate the rate of recovery.In recent years,substantial amounts of data about the efficiency of antioxidants against oxidative damage have been obtained from experiments with rodents.Some of these antioxidants have been found beneficial in the treatment of AP in humans; however,at present there is insufficient clinical data to support the benefits of antioxidants,alone or in combination with conventional therapy,in the management of AP in humans.Conflicting results obtained from experimental animals and humans may represent distinct pathophysiological mechanisms mediating tissue injury in different species.Further detailed studies should be done to clarify the exact mechanisms of tissue injury in human AP.Herein I tried to review the existing experimental and clinical studies on AP in order to determine the efficiency of antioxidants.The use of antioxidant enriched nutrition is a potential direction of clinical research in AP given the lack of clues about the efficiency and safety of antioxidant usage in patients with AP.

  16. Effects of diclofenac sodium and octreotide on treatment of caerulein-induced acute pancreatitis in mice

    Ozer Cakir, Ozlem; Esen, Hasan; Toker, Aysun; Ataseven, Huseyin; Demir, Ali; Polat, Hakki

    2015-01-01

    Background: Research continues to develop novel therapeutic modalities that particularly focus on the pathogenesis of acute pancreatitis. This study aimed to assess the effects of diclofenac sodium and octreotide, alone or in combination, on pancreatic enzymes, pancreatic myeloperoxidase activity, histopathology and apoptosis of pancreas cells, using a model of experimentally induced acute pancreatitis. Objectives: We aimed to demonstrate effects of diclofenac sodium, octreotide and their com...

  17. Hemoconcentration is a poor predictor of severity in acute pancreatitis

    José M. Remes-Troche; Andrés Duarte-Rojo; Gustavo Morales; Guillermo Robles-Díaz

    2005-01-01

    AIM: To determine whether the hematocrit (Hct) at admission or at 24 h after admission was associated with severe acute pancreatitis (AP), organ failure (OF), and pancreatic necrosis.METHODS: A total of 336 consecutive patients with a first AP episode were studied. Etiology, Hct values at admission and at 24 h, development of severe AP according to Atlanta's criteria, pancreatic necrosis, OF and mortality were recorded. Hemoconcentration was defined as Hct level >44% for males and >40% for females. The t-test and χ2 test were used to assess the association of hemoconcentration to the severity, necrosis and OF.Diagnostic accuracy was also determined.RESULTS: Biliary disease was the most frequent etiology(n = 148). Mean Hct levels at admission were 41±6%for females and 46±7% for males (P<0.01). Seventyeight (23%) patients had severe AP, and OF developed in 45 (13%) patients. According to contrast-enhanced computed tomography scan, 36% (54/150) patients showed pancreatic necrosis. Hct levels were elevated in58% (55/96) and 61% (33/54) patients with interstitial and necrotizing pancreatitis, respectively. Neither Hct levels at admission nor hemoconcentration at 24 h were associated with the severity, necrosis or OF. Sensitivity,specificity and positive predictive values for both determinations were very low; and negative predictive values were between 61% and 86%, being the highest value for OF.CONCLUSION: Hct is not a useful marker to predict a worse outcome in acute pancreatitis. In spite of the high negative predictive value of hemoconcentration, the prognosis gain is limited due to an already high incidence of mild disease.

  18. Tissue Pharmacology of Da-Cheng-Qi Decoction in Experimental Acute Pancreatitis in Rats

    Xianlin Zhao

    2015-01-01

    Full Text Available Objectives. The Chinese herbal medicine Da-Cheng-Qi Decoction (DCQD can ameliorate the severity of acute pancreatitis (AP. However, the potential pharmacological mechanism remains unclear. This study explored the potential effective components and the pharmacokinetic characteristics of DCQD in target tissue in experimental acute pancreatitis in rats. Methods. Acute pancreatitis-like symptoms were first induced in rats and then they were given different doses of DCQD (6 g/kg, 12 g/kg, and 24 g/kg body weight orally. Tissue drug concentration, tissue pathological score, and inflammatory mediators in pancreas, intestine, and lung tissues of rats were examined after 24 hours, respectively. Results. Major components of DCQD could be found in target tissues and their concentrations increased in conjunction with the intake dose of DCQD. The high-dose compounds showed maximal effect on altering levels of anti-inflammatory (interleukin-4 and interleukin-10 and proinflammatory markers (tumor necrosis factor α and interleukin-6 and ameliorating the pathological damage in target tissues P<0.05. Conclusions. DCQD could alleviate pancreatic, intestinal, and lung injury by altering levels of inflammatory cytokines in AP rats with tissue distribution of its components.

  19. The role of Card9 overexpression in peripheral blood mononuclear cells from patients with aseptic acute pancreatitis

    Yang, Zhi‐wen; Weng, Cheng‐zhao; Jing WANG; Xu, Ping

    2015-01-01

    Abstract Activated mononuclear cells are an early event in the course of severe acute pancreatitis (SAP). To date, the molecular mechanism triggering peripheral blood mononuclear cells (PBMCs) is poorly understood. The aim of this paper was to determine the potential role of Card9 in SAP. We collected data from 72 subjects between January 2013 and June 2014. Subsequently, PBMCs were isolated on day 1, 3 and 5 of pancreatitis. Immunofluorescence staining, quantitative real‐time PCR, Western bl...

  20. Successful transgastric cytogastrostomy in a dog with acute pancreatitis and pancreatic pseudocyst complications

    A five-year-old, spayed female mixed breed dog was presented after four weeks of vomiting and anorexia, and was diagnosed with acute pancreatitis. A large, anechoic mass having no blood flow organization was seen adjoining the stomach in an ultrasonic examination of the abdomen. A large ball-like mass protruded from the stomach pylorus under mucous membrane causing stricture of the stomach, and obstructing the transit. A low-density mass of consistent texture extending from the left limb of the main mass was confirmed by CT. A celiotomy was performed and a pancreatic cyst was confirmed. A transgastric cytogastrostomy was performed to treat the pancreatic pseudocyst. Clinical signs resolved following surgery, and 16 months after surgery there have been no complications

  1. Inflammatory role of the acinar cells during acute pancreatitis

    Isabel; De; Dios

    2010-01-01

    Pancreatic acinar cells are secretory cells whose main function is to synthesize, store and f inally release digestive enzymes into the duodenum. However, in response to noxious stimuli, acinar cells behave like real inflammatory cells because of their ability to activate signalling transduction pathways involved in the expression of inflammatory mediators. Mediated by the kinase cascade, activation of Nuclear factor-κB, Activating factor-1 and Signal transducers and activators of transcription transcription factors has been demonstrated in acinar cells, resulting in overexpression of inflammatory genes. In turn, kinase activity is down-regulated by protein phosphatases and the f inal balance between kinase and phosphatase activity will determine the capability of the acinar cells to produce inflammatory factors. The kinase/ phosphatase pair is a redox-sensitive system in which kinase activation overwhelms phosphatase activity under oxidant conditions. Thus, the oxidative stress developed within acinar cells at early stages of acute pancreatitis triggers the activation of signalling pathways involved in the up-regulation of cytokines, chemokines and adhesion molecules. In this way, acinar cells trigger the release of the f irst inflammatory signals which can mediate the activation and recruitment of circulating inflammatorycells into the injured pancreas. Accordingly, the role of acinar cells as promoters of the inflammatory response in acute pancreatitis may be considered. This concept leads to amplifying the focus from leukocyte to acinar cells themselves, to explain the local inflammation in early pancreatitis.

  2. Statins and the risk of acute pancreatitis: A population-based case-control study

    Thisted, Henriette; Jacobsen, Jacob; Munk, Estrid Muff;

    2006-01-01

    BACKGROUND: Case reports have suggested that statins may cause acute pancreatitis. AIM: To examine if statins are associated with risk of acute pancreatitis. METHODS: We identified 2576 first-time admitted cases of acute pancreatitis from hospital discharge registers in three Danish counties, and...... 25 817 age- and gender-matched controls from the general population. Prescriptions for statins prior to admission with acute pancreatitis or index date among controls were retrieved from prescription databases. We used conditional logistic regression analysis to estimate odds ratios for acute...... pancreatitis among ever (ever before), current (0-90 days before), new (first prescription in 0-90 days before) and former (>90 days, but not 0-90 days before) users of statins. RESULTS: Adjusted odds ratios for acute pancreatitis among ever, current, new and former users of statins were 1.44 (95% confidence...

  3. Acute pancreatitis: The role of imaging in diagnosis and management

    Bharwani, Nishat, E-mail: nishat.bharwani@nhs.ne [Imaging Department, Barts and The London NHS Trust, St Bartholomew' s Hospital, Ground Floor, King George V Wing, London EC1A 7BE (United Kingdom); Patel, Shilpa; Prabhudesai, Shirish; Fotheringham, Tim; Power, Niall [Imaging Department, Barts and The London NHS Trust, St Bartholomew' s Hospital, Ground Floor, King George V Wing, London EC1A 7BE (United Kingdom)

    2011-02-15

    Acute pancreatitis is one of the more commonly encountered aetiologies in the emergency setting and its incidence is rising. Presentations range from a mild-self limiting condition which usually responds to conservative management to one with significant morbidity and mortality in its most severe forms. While clinical criteria are necessary to make the initial diagnosis, contrast-enhanced CT is the mainstay of imaging and has a vital role in assessing the extent and evolution of the disease and its associated complications. The purpose of this article is to summarise the natural course of acute severe pancreatitis, clarify confusing nomenclature, demonstrate the morphological stages in conjunction with radiological scoring systems and illustrate the complications. We will review and illustrate the increasing and significant role interventional radiology has in the management of these patients, which are often life-saving and surgery-sparing.

  4. Burkitt's lymphoma causing acute pancreatitis in a child

    Muhammed Akl; Avni Kaya; MSeluk Bekta; Fesih Aktar; Sinan Akbayram; Salim Bilici; Mehmet Beyazal

    2013-01-01

    A8-year-old boy admitted with abdominal pain, fever and vomiting for the previous10 days. Sensitivity was detected in the epigastric area.There was not defense and rebond.Aspartate aminotransferase was106U/L, alanine aminotransferase25U/L, alkaline phosphatase311U/L, blood amylase level748U/L, blood lipase level391U/L.In thoracicCT, soft tissue with smooth contours measuring32 mmí28 mm was identified in the posterior mediastinum.Bone marrow aspiration biopsy was normal.A mass specimen obtained from the duodenum endoscopic biopsy. This specimen was diffuse staining by leukocyte common antigen,CD10 andCD20.The patient was diagnosed with acute pancreatitis associated with stage3 duodenalBurkitt's lymphoma. ModifiedLMB-98 was initiated.Burkitt's lymphoma may rarely cause acute pancreatitis.

  5. Drug-associated acute pancreatitis : twenty-one years of spontaneous reporting in The Netherlands

    Eland, I A; van Puijenbroek, E P; Sturkenboom, M J; Wilson, J H; Stricker, B H

    1999-01-01

    OBJECTIVE: Drugs are considered a rare cause of acute pancreatitis. We conducted a descriptive study to assess which drugs have been associated with acute pancreatitis in spontaneous adverse drug reaction reports in The Netherlands. METHODS: Our study is based on reports of drug-associated acute pan

  6. Citrobacter freundii infection after acute necrotizing pancreatitis in a patient with a pancreatic pseudocyst: a case report

    Larino-Noia Jose

    2011-02-01

    Full Text Available Abstract Introduction Infections are the most frequent and severe complications of acute necrotizing pancreatitis with a mortality rate of up to 80 percent. Although experimental and clinical studies suggest that the microbiologic source of pancreatic infection could be enteric, information in this regard is controversial. Case presentation We describe a Citrobacter freundii isolation by endoscopy ultrasound fine needle aspiration in a 80-year-old Caucasian man with pancreatic pseudocyst after acute necrotizing pancreatitis. Conclusion Our case report confirms that this organism can be recovered in patients with a pancreatic pseudocyst. On-site cytology feedback was crucial to the successful outcome of this case as immediate interpretation of the fine needle aspiration sample directed the appropriate cultures and, ultimately, the curative therapy. To the best of our knowledge, this is the first reported case of isolated pancreatic C. freundii diagnosed by endoscopy ultrasound fine needle aspiration.

  7. Efficacy of glucocorticoids in rodents of severe acute pancreatitis: a meta-analysis

    Yu, Min; Yang, Zhen; Zhu, Yin; Lu, Nonghua

    2014-01-01

    Background: The use of corticosteroid in the management of severe acute pancreatitis (SAP) remains contentious and is still being debated despite many pre-clinical studies demonstrating benefits. The limitations of clinical research on corticosteroid in SAP are disparities with regard to benefit, a lack of adequate safety data and insufficient understanding of its mechanisms of action. Thus, we performed a meta-analysis to assess the effectiveness of corticosteroid in experimental SAP and tak...

  8. Criteria for the diagnosis and severity stratification of acute pancreatitis

    Otsuki, Makoto; Takeda, Kazunori; Matsuno, Seiki; Kihara, Yasuyuki; Koizumi, Masaru; Hirota, Masahiko; Ito, Tetsuhide; Kataoka, Keisho; Kitagawa, Motoji; Inui, Kazuo; TAKEYAMA, YOSHIFUMI

    2013-01-01

    Recent diagnostic and therapeutic progress for severe acute pancreatitis (SAP) remarkably decreased the case-mortality rate. To further decrease the mortality rate of SAP, it is important to precisely evaluate the severity at an early stage, and initiate appropriate treatment as early as possible. Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs. Severity can be evaluated by laboratory examina...

  9. Acute ethanol administration induces oxidative changes in rat pancreatic tissue.

    Altomare, E; Grattagliano, I; Vendemiale, G.; V. Palmieri; Palasciano, G

    1996-01-01

    BACKGROUND--There is mounting clinical evidence that ethanol toxicity to the pancreas is linked with glutathione depletion from oxidative stress but there is not experimental proof that this occurs. AIMS AND METHODS--The effect of acute ethanol ingestion (4 g/kg) on the pancreatic content of reduced (GSH) and oxidised (GSSG) glutathione, malondialdehyde (MDA), and carbonyl proteins were therefore studied in the rat. RESULTS--Ethanol caused a significant reduction in GSH (p < 0.02) and an incr...

  10. MODIFIED COMPUTED TOMOGRAPHY SEVERITY INDEX IN ACUTE PANCREATITIS

    Shivanand

    2014-12-01

    Full Text Available : 100 cases of acute pancreatitis patients were studied to evaluate the complications using MCTSI and its comparison with CTSI. Age distribution of patients varied from 11 to 79 years. Maximum patients were male. The CTSI grades are classified into mild (0-3, moderate (4-6 and severe (7-10 and MCTSI grades are classified into mild (0-2, moderate (4-6 and severe (8-10

  11. Probing the urinary proteome of severe acute pancreatitis

    Flint, Richard S.; Phillips, Anthony R.J.; Farrant, Glenn J.; Mckay, Duncan; Buchanan, Christina M.; Cooper, Garth S.J.; Windsor, John A.

    2007-01-01

    Background. Proteinuria is a characteristic feature of severe acute pancreatitis (SAP) that may allow unique insights into AP pathophysiology. This study used a proteomic approach to differentiate the abundant urinary proteins in AP patients. Materials and methods. Urine samples were prospectively collected from 4 groups (5 SAP, 10 mild gallstone AP, 7 mild alcohol AP, 7 controls). Reverse-phase high-performance liquid chromatography (RP-HPLC) and matrix-assisted laser desorption/ionization t...

  12. Acute Pancreatitis Secondary to a Perivaterian Duodenal Diverticular Abscess

    Pastides, P.; Bertaud, S.; Sarker, S. K.; S. Dindyal

    2010-01-01

    A 46-year-old previously fit lady was admitted with acute pancreatitis. She had no history of gallstones. She was not on any medications and consumed minimal amounts of alcohol. On subsequent investigations as to the causative factor, she was found at ultrasound to have an air-fluid filled cystic structure posterior to the head of pancreas which was compressing the common bile duct. Further magnetic resonance imaging and computer tomography scans showed that this cystic lesion was located aro...

  13. Early plasmapheresis in patients with severe hypertriglyceridemia induced acute pancreatitis

    Prashant Nasa; George Alexander; Amitabh Kulkarni; Deven Juneja; Sudhish Sehra; Rajesh Agarwal; Kandy Koul

    2015-01-01

    Hypertriglyceridemia can cause severe diseases such as acute pancreatitis (AP) and coronary artery disease. The routine management of hypertriglyceridemia is dietary restriction of fat and lipid-lowering medications to manage the secondary or precipitating causes of hypertriglyceridemia. However, in cases of AP with severe hypertriglyceridemia (SHTG) (triglycerides [TG] >1000 mg/dl) rapid reduction of TG levels to well below 1000 mg/dl can improve outcome and prevent further episodes of pancr...

  14. The aetiology of acute and chronic pancreatitis over time in a hospital in Copenhagen

    Nøjgaard, Camilla; Bendtsen, Flemming; Matzen, Peter;

    2010-01-01

    The change in aetiology over time of acute and chronic pancreatitis has been sparsely described, as has also the validity of the diagnostic codes. The aim of the study was 1) to clarify whether the aetiology of acute and chronic pancreatitis changed during the period 1983-2005, and 2) to validate...... the diagnostic codes over time for acute and chronic pancreatitis registered in the Danish National Patient Registry (NPR) in the same period....

  15. Metastasis-induced acute pancreatitis in a patient with small cell carcinoma of the lung.

    Kim, K. H.; Kim, C D; Lee, S. J.; Lee, G.; Jeen, Y T; Lee, H.S.; Chun, H J; Song, C. W.; Um, S. H.; Lee, S. W.; Choi, J. H.; Ryu, H. S.; Hyun, J. H.

    1999-01-01

    Acute pancreatitis in cancer patients can be secondary to the malignant process itself or a complication of antineoplastic agent administration. However, acute pancreatitis caused by metastatic carcinoma of the pancreas is an uncommon condition with a poor prognosis. We report a case of a 63-year-old man with small cell carcinoma of the lung, who developed acute pancreatitis lately. Thirteen months earlier, he developed small cell carcinoma of the lung and received 6 cycles of chemotherapy. A...

  16. COMPARING TRADITIONAL SERUM AMYLASE WITH RELATIVELY NEW LIPASE IN ACUTE PANCREATITIS

    Roopa Murgod; Gladys Soans; Bindu CM

    2014-01-01

    Acute pancreatitis is most often diagnosed clinically and by blood tests rather than expensive radiological methods. Among the blood tests, amylase and lipase are frequently used to diagnose acute pancreatitis. In this retrospective study, we compare amylase versus lipase in terms of sensitivity and specificity with ROC curve analysis.40 established cases of acute pancreatitis were chosen. Day 1 measurements of serum amylase and lipase were noted. Values ≥3 times the upper limit of normal wer...

  17. Epstein-Barr Virus Infection with Acute Pancreatitis Associated with Cholestatic Hepatitis

    Kang, Seok-Jin; Yoon, Ka-Hyun; Hwang, Jin-Bok

    2013-01-01

    Infection-induced acute hepatitis complicated with acute pancreatitis is associated with hepatitis A virus, hepatitis B virus or hepatitis E virus. Although rare, Epstein-Barr virus (EBV) infection should be considered also in the differential diagnosis if the patient has acute hepatitis combined with pancreatitis. We report a case of EBV infection with cholestatic hepatitis and pancreatitis with review of literature. An 11-year-old female was admitted due to 1-day history of abdominal pain a...

  18. Enteral nutrition in acute pancreatitis: A review of the current evidence

    Oláh, Attila; Romics Jr, Laszlo

    2014-01-01

    The use of enteral feeding as part of the management of acute pancreatitis dates back almost two decades. This review describes the indications for and limitations of enteral feeding for the treatment of acute pancreatitis using up-to-date evidence-based data. A systematic review was carried out to analyse current data on the use of enteral nutrition in the management of acute pancreatitis. Relevant literature was analysed from the viewpoints of enteral vs parenteral feeding, early vs delayed...

  19. Magnetic resonance imaging for local complications of acute pancreatitis: A pictorial review

    2010-01-01

    Acute pancreatitis is a common disease characterized by sudden upper abdominal pain and vomiting. Alcoholism and choledocholithiasis are the most common factors for this disease. The choice of treatment for acute pancreatitis might be affected by local complications, such as local hemorrhage in or around the pancreas, and peripancreatic infection or pseudoaneurysm. Diagnostic imaging modalities for acute pancreatitis have a significant role in confirming the diagnosis of the disease, helping detect the exte...

  20. An assessment of clinical guidelines for the management of acute pancreatitis.

    S. A. Norton; Cheruvu, C. V.; Collins, J.; Dix, F. P.; Eyre-Brook, I. A.

    2001-01-01

    BACKGROUND: Recent guidelines have been issued for the management of acute pancreatitis. The aim of this study was to audit the management of acute pancreatitis in one district general hospital, to determine the problems and benefits associated with the implementation of such guidelines. METHODS: Data were collected over the period 1991-1995 for all patients diagnosed as having acute pancreatitis who were admitted to one district general hospital. Data regarding severity grading, determinatio...

  1. An Acute Edematous Pancreatitis Case caused by Probably Hypertriglyceridemia: Case Report

    Ayse Demir; Ruhusen Kutlu; Ertugrul Kayacetin

    2010-01-01

    Hypertriglyceridemia is one of the non-biliary, eluding important causes of acute pancreatitis. Currently, there is no standardized protocol to treat these patients. We presented a case with acute edematous pancreatitis caused by hypertriglyceridemia in this case report. The patient, then, complicated with a pseudocyst in the pancreas and bilateral pleural effusion. We aimed to present this case with acute pancreatitis due to the probable hypertriglyceridemia and to show how one can handle th...

  2. Effects of somatestatin analogues on pancreatic tissue TGF-β1 expression in acute pancreatitis in rats and its mechanisms%生长抑素类似物对急性胰腺炎胰腺组织转化生长因子β1基因改变的研究

    袁耀宗; 楼恺娴; 龚自华; 涂水平; 翟祖康; 徐家裕

    2001-01-01

    目的 观察比较生长抑素类似物治疗大鼠急性胰腺炎前后胰腺组织转化生长因子β1(trans-forminggrowthfactorβ1,TGF-β1)的表达、DNA合成及总蛋白含量,并探讨其作用机制。方法 以雨蛙肽腹腔注射诱导大鼠急性胰腺炎模型,并于生长抑素类似物治疗前后6、24、48、72、96 h处死大鼠。同时应用逆转录多聚酶链反应(RT-PCR)技术检测治疗前后胰腺组织TGF-β1mRNA表达,核素体外掺入法测定胰腺组织DNA合成及Lowry法测定胰腺组织总蛋白含量。结果 胰腺炎诱导后血清淀粉酶上升,生长抑素类似物治疗后显著下降。正常胰腺组织、胰腺炎诱导后6 h,未见TGF-β1mRNA表达。TGF-β124 h后出现表达,72 h时达高峰。生长抑素类似物治疗后6 h即可检测到TGF-β1表达,且24 h、48 h时表达均较非治疗组显著增强,并于24 h时达最大值。同时胰腺炎诱导后72 h,DNA合成显著下降,治疗后96 h DNA合成明显增加。胰腺炎诱导后48 h总蛋白含量下降,治疗后48 h总蛋白含量有明显增高,至96 h达高峰。结论 生长抑素类似物治疗急性胰腺炎促进胰腺再生,可能是通过诱导TGF-β1基因表达增强,促进多种细胞外基质成分的合成,增加胰腺DNA合成和蛋白含量,从而加速胰腺组织的再生和修复。%Objective To determine the effects and mechanisms of somatostatin analogues (sandostatin) on pancreatic repair and regeneration in caerulein-induced pancreatitis. Methods Acute pancreatitis was induced by intra-abdominal infusion of caerulein in rats, sandostatin was administered intra-abdominally at the time of induction of pancreatitis and 24, 48 and 72 hours after. Rats were sacrificed at 6, 24, 48, 72 and 96 hours after the operation. The mRNA expression for Transforming growth factor β1 (TGF-β1) was evaluated by reverse transcription-polymerase chain reaction, pancreatic tissue DNA synthesis was measured

  3. Percutaneous necrosectomy in patients with acute, necrotizing pancreatitis

    Bruennler, T.; Langgartner, J.; Lang, S.; Salzberger, B.; Schoelmerich, J. [University Hospital of Regensburg, Department of Internal Medicine 1, Regensburg (Germany); Zorger, N.; Herold, T.; Feuerbach, S.; Hamer, O.W. [University Hospital of Regensburg, Department of Radiology, Regensburg (Germany)

    2008-08-15

    The objective of this retrospective study was to evaluate the outcome of patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy. By searching the radiological, surgical and internal medicine databases, all patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy between 1992 and 2004 were identified. Demographic, laboratory, and clinical data, and details about invasive procedures were collected by reviewing patient charts, radiological and surgical reports. The computed tomography severity index (CTSI) scores were determined by reviewing CT images. Eighteen patients were identified. Median Ranson score on admission was 2. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was median 22. Median CTSI score was 7. Initially all patients were treated with CT-guided drainage placement. Because passive drainage proved not to be effective, subsequent minimally invasive, percutaneous necrosectomy was performed. Eight out of 18 patients recovered fully without the need for surgery. Ten of 18 patients required additional surgical necrosectomy. For one of ten patients, percutaneous necrosectomy allowed postponing surgery by 39 days. Four of ten surgically treated patients died: three from septic multiorgan failure, one from pulmonary embolism. Percutaneous minimally invasive necrosectomy can be regarded as a safe and effective complementary treatment modality in patients with necrotizing pancreatitis. It is suitable for a subset of patients to avoid or delay surgery. (orig.)

  4. A case of thrombotic thrombocytopenic purpura induced by acute pancreatitis

    Arimoto M

    2012-03-01

    Full Text Available Miyoko Arimoto1, Yutaka Komiyama2, Fumiko Okamae1, Akemi Ichibe1, Setsuko Teranishi1, Hirohiko Tokunaga1, Keiko Nakaya3, Michie Fujiwara3, Manabu Yamaoka4, Shuji Onishi4, Rie Miyamoto5, Naoto Nakamichi5, Shosaku Nomura51Blood Transfusion Unit, Kansai Medical University Takii Hospital, 2Department of Clinical Sciences and Laboratory Medicine, Kansai Medical University, 3Clinical Medical Technology Unit, Kansai Medical University Takii Hospital, 4Blood Transfusion Unit, Kansai Medical University Hirakata Hospital, 5First Department of Internal Medicine, Kansai Medical University, Moriguchi, JapanAbstract: Thrombotic thrombocytopenic purpura (TTP is a multisystemic microvascular disorder that may be caused by an imbalance between unusually large von Willebrand factor multimers and the cleaving protease ADAMTS13. In acquired TTP, especially in secondary TTP with various underlying diseases, the diagnosis is difficult because there are many cases that do not exhibit severe deficiency of ADAMTS13 or raised levels of ADAMST13 inhibitors. It is well known that collagen disease, malignancy, and hematopoietic stem cell transplantation can be underlying conditions that induce TTP. However, TTP induced by acute pancreatitis, as experienced by our patient, has rarely been reported. Our patient completely recovered with treatments using steroids and plasma exchange (PE only. In cases where patients develop acute pancreatitis with no apparent causes for hemolytic anemia and thrombocytopenia, the possibility of TTP should be considered. Treatments for TTP including PE should be evaluated as soon as a diagnosis is made.Keywords: thrombotic thrombocytopenic purpura, ADAMTS13, acute pancreatitis, plasma exchange

  5. Percutaneous necrosectomy in patients with acute, necrotizing pancreatitis

    The objective of this retrospective study was to evaluate the outcome of patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy. By searching the radiological, surgical and internal medicine databases, all patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy between 1992 and 2004 were identified. Demographic, laboratory, and clinical data, and details about invasive procedures were collected by reviewing patient charts, radiological and surgical reports. The computed tomography severity index (CTSI) scores were determined by reviewing CT images. Eighteen patients were identified. Median Ranson score on admission was 2. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was median 22. Median CTSI score was 7. Initially all patients were treated with CT-guided drainage placement. Because passive drainage proved not to be effective, subsequent minimally invasive, percutaneous necrosectomy was performed. Eight out of 18 patients recovered fully without the need for surgery. Ten of 18 patients required additional surgical necrosectomy. For one of ten patients, percutaneous necrosectomy allowed postponing surgery by 39 days. Four of ten surgically treated patients died: three from septic multiorgan failure, one from pulmonary embolism. Percutaneous minimally invasive necrosectomy can be regarded as a safe and effective complementary treatment modality in patients with necrotizing pancreatitis. It is suitable for a subset of patients to avoid or delay surgery. (orig.)

  6. Citrobacter freundii infection after acute necrotizing pancreatitis in a patient with a pancreatic pseudocyst: a case report

    Larino-Noia Jose; Iglesias-Garcia Julio; Iglesias-Canle Jose; Lozano-Leon Antonio; Dominguez-Muñoz Enrique

    2011-01-01

    Abstract Introduction Infections are the most frequent and severe complications of acute necrotizing pancreatitis with a mortality rate of up to 80 percent. Although experimental and clinical studies suggest that the microbiologic source of pancreatic infection could be enteric, information in this regard is controversial. Case presentation We describe a Citrobacter freundii isolation by endoscopy ultrasound fine needle aspiration in a 80-year-old Caucasian man with pancreatic pseudocyst afte...

  7. Radiological evaluation about the effects of acute and chronic pancreatitis on the stomach patterns

    The present study was intended to examine the spectrum of radiographic patterns of the stomach associated with acute and chronic pancreatitis and their complications. Subjects served for the study consisted of 70 cases of pancreatitis (36 cases in acute stage and 34 cases in chronic stage). Intramural and perigastric permeation of extravasated pancreatic enzymes and secondary inflammatory reaction that follows are responsible for the radiographic change observed. 1. Generalized rugal thickening and particularly selective mucosal prominences in greater curvature of body and antrum are characteristically seen in acute (14 of 36 cases- 39%) and chronic pancreatitis (11 of 34 cases- 32%) 2. The only finding of the chronic pancreatitis includes patterns mimicking limits plastica, indurated and nondistensible rugae induced by perigastric adhesion (11 of 34 cases- 32%) Familiarization with these patterns of involvement contributes to the radiographic diagnosis of acute pancreatitis and avoides serious diagnostic errors in case of chronic pancreatitis

  8. Pancreatic Exocrine Enzymes and Intrapancreatic Protein Synthesis in Acute Oedematous Pancreatitis

    Yoshio Kinami; Ichiro Kita; Yasuhiko Kojima; Shigeki Takashima

    1994-01-01

    Changes in serum and intrapancreatic enzyme content and protein synthesis in pancreas were studied in acute oedematous pancreatitis (AOP). Male Wistar rats (n = 111) were divided into 2 groups, controls with a sham operation and those with AOP. Serum amylase levels rose immediately after the procedure causing AOP and then fell gradually, while serum lipase and ribonuclease levels remained higher than control values over 48h. (p < 0.05, 0.01). Serum deoxyribonuclease (DNase) II levels were unc...

  9. Possible mechanisms of normal amylase activity in hyperlipemic pancreatitis.

    Mishkin, S.; Bates, J.; O'Hashi, J.; Schneider, P.; Sniderman, A. D.; Wolf, R. O.

    1976-01-01

    Lipemic serum from three patients with acute pancreatitis and type IV hyperlipemia was fractionated into very-low-density lipoproteins and clear serum. Amylase activity (determined by the Phadebas method) in the component fractions did not exceed that in the original lipemic serum. Addition of these fractions or VLDL and chylomicrons from asymptomatic patients with hyperlipemia to nonlipemic serum from patients with "routine acute pancreatitis" did not inhibit amylase activity or alter the electrophoretic mobility of amylase isoenzymes. Therefore the normal amylase activity often observed in hyperlipemic pancreatitis does not result from an inhibition of amylase activity by serum lipoproteins. Images FIG. 4 FIG. 5 PMID:206333

  10. Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis

    Muller, C.; Uhl, W.; Printzen, G; Gloor, B; Bischofberger, H; Tcholakov, O; Buchler, M.

    2000-01-01

    BACKGROUND—Infected pancreatic necrosis (IPN) is the main cause of death in patients with severe acute pancreatitis. Therefore an early prediction of IPN is of utmost importance.
AIM—Analysis of new blood variables as potential early predictors to differentiate between IPN and sterile pancreatic necrosis (SPN).
PATIENTS—64 consecutive patients with acute pancreatitis were enrolled in this prospective study; 29 were suffering from acute oedematous pancreatitis (AIP), and 35 from necrotising di...

  11. Increased activity of group II phospholipase A2 in plasma in rat sodium deoxycholate induced acute pancreatitis

    Furue, S.; Hori, Y.(University of Tokyo, Tokyo, Japan); KUWABARA, K.; IKEUCHI, J; ONOYAMA, H; Yamamoto, M.; Tanaka, K.

    1997-01-01

    Background—Two different types of secretory phospholipase A2 (PLA2), pancreatic group I (PLA2-I) and non-pancreatic group II (PLA2-II), have been identified and postulated to be associated with the pathogenesis of various diseases, such as acute pancreatitis, septic shock, and multiple organ failure. 
Aims—To investigate the type of secretory PLA2 responsible for its catalytic activity found in plasma and ascites of experimental acute pancreatitis. 
Methods—Acute pancreat...

  12. Effects of sulfhydryl compounds on pancreatic cytoprotection in acute necrotic pancreatitis

    崔培林; 杨昭徐; 张磊; 孙异临

    2003-01-01

    Objective To observe sulfhydryl compound variation in the injury of pancreatic cells and the effects of external sulfhydryl compounds on cytoprotection.Methods Male Wistar mice were divided randomly into three groups: groups A and B served as animal models (retrograde duct infusion with 5% sodium taurocholate), in group A, 45 animals were treated with normal saline therapy, in group B, 45 aminals were treated with Tiopronin therapy; and group C, 15 animals, were designated as normal control. Animals were killed at 2, 4, 6, 12 and 24 h, and pancreatic tissue was analyzed for total sulfhydryl (TSH), nonprotein sulfhydryl (NPSH) and malondialdehyde (MDA). Histopathology, serum amylase (Sam) and C reactive protein (CRP) were assessed as well.Results Levels of Sam and CRP increased in both group A and group B, with corresponding pathological changes of acute nerotic pancreatitis (ANP). Levels of TSH, NPSH and protein sulfhydryl (PSH) in group A decreased markedly during pancreatitis (P<0.01), but MDA increased significantly (P<0.01). The depletion of NPSH in group B was markedly ameliorated at 4 h or 6 h, when Tiopronin was prophylactically administered (P<0.05), after which the level of MDA showed very little increase when compared to group A (P<0.01). Histopathological damage was attenuated to a certain extent, in regards to serum amylase and CRP.Conclusions All sulfhydryl compounds decreased significantly during ANP; external sulfhydryl compound could protect the pancreatic cells most likely as a type of scavengers of oxygen free radicals, which are critically involved in the pathophysiology of ANP. Sulfhydryl plays an important role in the action of pancreatic cytoprotection.

  13. Epidural anaesthesia restores pancreatic microcirculation and decreases the severity of acute pancreatitis

    Alp Demirag; Leo H Bühler; Catherine M Pastor; Philippe Morel; Copin Jean-Christophe; Andreas W Sielenk(a)mper; Nilgun Güvener; Gang Mai; Thierry Berney; Jean-Louis Frossard

    2006-01-01

    AIM: To investigate the effect of epidural anaesthesia (EA) on pancreatic microcirculation during acute pancreatitis (AP).METHODS: AP was induced by injection of sodium taurocholate into the pancreatic duct of Sprague-Dawley rats. To realize EA, a catheter was introduced into the epidural space between T7 and T9 and bupivacaine was injected. Microcirculatory flow was measured by laser Doppler flowmetry. Arterial blood gas analyses were performed. At the end of the experiment (≤ 5 h), pancreas was removed for histology. The animals were divided into three groups: Group 1 (n = 9), AP without EA; Group 2 (n = 4), EA without AP; and Group 3 (n = 6), AP treated by EA.RESULTS: In Group 1, pancreatic microcirculatory flow prior to AP was 141± 39 perfusion units (PU). After AP,microcirculatory flow obviously decreased to 9±6 PU (P<0.05). Metabolic acidosis developed with base excess (BE) of - 14±3 mmol/L. Histology revealed extensive edema and tissue necrosis. In Group 2, EA did not significantly modify microcirculatory flow. BE remained unchanged and histological analysis showed normal pancreatic tissue. In Group 3, AP initially caused a significant decrease in microcirculatory flow from 155±25 to 11±7PU (P< 0.05). After initiation of EA, microcirculatory flow obviously increased again to 81±31 PU (P<0.05).BE was -6 ±4 mmol/L, which was significantly different compared to Group 1 (P<0.05). Furthermore, histology revealed less extensive edema and necrosis in pancreatic tissue in Group 3 than that in Group 1.CONCLUSION: AP caused dramatic microcirculatory changes within the pancreas, with development of metabolic acidosis and tissue necrosis. EA allowed partial restoration of microcirculatory flow and prevented development of tissue necrosis and systemic complications.Therefore, EA should be considered as therapeutic op-.tion to prevent evolution from edematous to necrotic AP.

  14. The Effects of Total Colectomy on Bacterial Translocation in a Model of Acute Pancreatitis.

    Şenocak, Rahman; Yigit, Taner; Kılbaş, Zafer; Coşkun, Ali Kağan; Harlak, Ali; Menteş, Mustafa Öner; Kılıç, Abdullah; Günal, Armağan; Kozak, Orhan

    2015-12-01

    Prevention of secondary infection is currently the main goal of treatment for acute necrotizing pancreatitis. Colon was considered as the main origin of secondary infection. Our aim was to investigate whether prophylactic total colectomy would reduce the rate of bacterial translocation and infection of pancreatic necrosis. Forty-two Sprague-Dawley rats were used. Pancreatitis was created by ductal infusion of sodium taurocholate. Rats were divided into four groups: group-1, laparotomy + pancreatic ductal infusion of saline; group-2, laparotomy + pancreatic ductal infusion of sodium taurocholate; group-3, total colectomy + pancreatic ductal infusion of saline; and group-4, total colectomy + pancreatic ductal infusion of sodium taurocholate. Forty-eight hours later, tissue and blood samples were collected for microbiological and histopathological analysis. Total colectomy caused small bowel bacterial overgrowth with gram-negative and gram-positive microorganisms. Bacterial count of gram-negative rods in the small intestine and pancreatic tissue in rats with colectomy and acute pancreatitis were significantly higher than in rats with acute pancreatitis only (group-2 versus group-4; small bowel, p = bacterial overgrowth and pancreatic infection (r = 0,836, p = 0.001). In acute pancreatitis, prophylactic total colectomy (which can mimic colonic cleansing and reduction of colonic flora) induces small bowel bacterial overgrowth, which is associated with increased bacterial translocation to the pancreas. PMID:26730036

  15. Screening of Natural Antioxidants by using L-Arginine induced acute Pancreatitis Model

    Sandeep Biradar

    2012-12-01

    Full Text Available Medicinal plants and their active constituents are traditionally used for herbal preparations and were proposed for their interesting antioxidant activities. Nearly all the medicinal plants are used for the therapeutic action and some of them are used in the investigation. Inflammation of pancreas of the exocrine part is called as acute pancreatitis. Inflammatory mediators and oxidative mediators are major factors for development of acute pancreatitis (AP. In the present study the protective effects of lawsone, myrcene, limonene, "-pinene and the underlying mechanisms in an experimental pancreatitis model. AP was induced in eleven groups of rats (n =6 by Larginine (2x2.5 g/kg, intraperitoneal, 1 h apart and 1 h later, they received a single oral dose of lawsone, myrcene, limonene, "- pinene, (100 and 200 mg/kg respectively, vehicle (3% Tween 80 and methylprednisolone (30 mg/kg. A saline (0.9% NaCl treated group served as a normal control. The efficacy was determined at 24 h by determination of serum levels of amylase, lipase and proinflammatory cytokines [tumor necrosis factor (TNF-a, C-reactive proteins and interleukin (IL], nitrate/nitrite levels, and the wet weight/body weight ratio. Lawsone, myrcene, limonene, "-pinene and methylprednisolone treatments significantly (P < 0.05 attenuated the L-arginine induced increases in pancreatic wet weight/body weight ratio, decreased the serum levels of amylase and lipase, TNF-a, IL-6 and significantly lowered pancreatic levels of TBARS, and nitrate/nitrite. The histoimmunological findings further proved the amelioration of pancreatic injury by lawsone, myrcene, limonene and "-pinene. Hence it proved anti-inflammatory and antioxidant agent property of lawsone, myrcene, limonene and "-pinene.

  16. Ansa Pancreatica: A Case Report of a Type of Ductal Variation in a Patient with Idiopathic Acute Recurrent Pancreatitis

    Kim, Hye Mi; Park, Jung Yup; Kim, Myeong Jin [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    Ansa pancreatica is a rare type of pancreatic ductal variation. Recently, ansa pancreatic has been considered as a predisposing factor in patients with idiopathic acute pancreatitis. To the best of our knowledge, no previously published report in Korea has described ansa pancreatica. We report a case of acute recurrent pancreatitis with ansa pancreatica, which was revealed on magnetic resonance cholangiopancreatography (MRCP)

  17. Pancreatic regenerating protein (reg I) and reg I receptor mRNA are upregulated in rat pancreas after induction of acute pancreatitis

    Bluth, Martin H; Patel, Sameer A; Dieckgraefe, Brian K.; Okamoto, Hiroshi; Zenilman, Michael E

    2006-01-01

    AIM: Pancreatic regenerating protein (regI) stimulates pancreatic regeneration after pancreatectomy and is mitogenic to ductal and β-cells. This suggests that regIand its receptor may play a role in recovery after pancreatic injury. We hypothesized that regIand its receptor are induced in acute pancreatitis.

  18. Tamoxifen-induced acute pancreatitis – a case report

    Rafał Czyżykowski

    2014-03-01

    Full Text Available Tamoxifen is a selective estrogen receptor modulator used for the treatment of oestrogen/progesterone receptor positive breast cancer. It has antagonistic or agonistic activity depending on the tissue location. Generally it causes mild and reversible side effects, however more serious ones including cardiovascular and thromboembolic adverse events, uterine cancer or acute pancreatitis can also occur. Tamoxifen, like oestrogens, increases the plasma level of TG and liver secretion of VLDL. Moreover, it inhibits the key enzymes of triglyceride metabolism. In this report we present a case of a 55-year-old woman with a history of a poorly controlled hypertriglyceridaemia diagnosed with breast cancer. She was treated with surgery and adjuvant chemotherapy, radiotherapy and hormonotherapy with tamoxifen. About three months after hormonal treatment, her triglyceride level increased. Five months later she developed an acute necrotic pancreatitis that required hospitalization. Her serum samples on admission were highly lipemic. An abdominal ultrasound showed no evidence of gallstones or dilation of the bile ducts. There was no history of alcohol abuse or abdominal trauma. Tamoxifen was suspected as a trigger factor for pancreatitis. After the drug withdrawal and administration of the conservative management the patient’s medical condition improved. Due to a postmenopausal status of the patient and no harmful effect on serum lipids, an adjuvant hormonotherapy with aromatase inhibitor was started.

  19. Colonic Necrosis in a 4-Year-Old with Hyperlipidemic Acute Pancreatitis

    Tiffany J. Patton

    2016-01-01

    Full Text Available Here we report the case of a 4-year-old male with severe acute pancreatitis due to hyperlipidemia, who presented with abdominal pain, metabolic abnormalities, and colonic necrosis. This colonic complication was secondary to the extension of a large peripancreatic fluid collection causing direct serosal autodigestion by pancreatic enzymes. Two weeks following the initial presentation, the peripancreatic fluid collection developed into a mature pancreatic pseudocyst, which was percutaneously drained. To our knowledge, this is the youngest documented pediatric case of colonic necrosis due to severe pancreatitis and the first descriptive pediatric case of a colonic complication due to hyperlipidemia-induced acute pancreatitis.

  20. Colonic Necrosis in a 4-Year-Old with Hyperlipidemic Acute Pancreatitis.

    Patton, Tiffany J; Sentongo, Timothy A; Mak, Grace Z; Kahn, Stacy A

    2016-01-01

    Here we report the case of a 4-year-old male with severe acute pancreatitis due to hyperlipidemia, who presented with abdominal pain, metabolic abnormalities, and colonic necrosis. This colonic complication was secondary to the extension of a large peripancreatic fluid collection causing direct serosal autodigestion by pancreatic enzymes. Two weeks following the initial presentation, the peripancreatic fluid collection developed into a mature pancreatic pseudocyst, which was percutaneously drained. To our knowledge, this is the youngest documented pediatric case of colonic necrosis due to severe pancreatitis and the first descriptive pediatric case of a colonic complication due to hyperlipidemia-induced acute pancreatitis. PMID:26925282

  1. Severe Acute Pancreatitis Due to Tamoxifen-Induced Hypertriglyceridemia with Positive Rechallenge

    Jaballah Sakhri

    2010-07-01

    Full Text Available Context Pancreatitis is a very rare adverse effect of tamoxifen with only six cases of tamoxifen-associated pancreatitis reported in the English literature until now. In these cases, rechallenge with tamoxifen was not carried out. Case report We report a case of recurrent severe acute pancreatitis in a 44-year-old female induced by tamoxifen therapy and review the literature with regards to tamoxifen-associated pancreatitis. Conclusion Clinicians should be aware of the risks of developing severe acute pancreatitis when using tamoxifen therapy. If tamoxifen is suspected as the probable causative agent, rechallenge with this drug should be prohibited.

  2. Hepatic damage during acute pancreatitis in the rat

    A.M.M. Coelho

    1997-08-01

    Full Text Available We studied the alterations in the metabolism of liver mitochondria in rats with acute pancreatitis. Male Wistar rats were allocated to a control group (group I and to five other groups corresponding to 2, 4, 12, 24 and 48 h after the induction of acute pancreatitis by the injection of 5% sodium taurocholate into the pancreatic duct. Sham-operated animals were submitted to the same surgical steps except for the induction of acute pancreatitis. Mitochondrial oxidation and phosphorylation were measured polarographically by determining oxygen consumption without ADP (basal respiration, state 4 and in the presence of ADP (activated respiration, state 3. Serum amylase, transaminases (ALT and AST and protein were also determined. Ascitic fluid, contents of amylase, trypsin and total protein were also determined and arterial blood pressure was measured in all groups. In ascitic fluid, trypsin and amylase increased reaching a maximum at 2 and 4 h, respectively. Serum amylase increased at 2 h reaching a maximum at 4 h. Serum transaminase levels increased at 12 and 24 h. After 2 h (and also 4 h there was an increase in state 4 respiration (45.65 ± 1.79 vs 28.96 ± 1.50 and a decrease in respiration control rate (3.53 ± 0.09 vs 4.45 ± 0.08 and in the ADP/O ratio (1.77 ± 0.02 vs 1.91 ± 0.01 compared to controls (P<0.05. These results indicate a disruption of mitochondrial function, which recovered after 12 h. In the 48-h groups there was mitochondrial damage similar to that occurring in ischemic lesion. Beat-to-beat analysis (30 min showed that arterial blood pressure remained normal up to 24 h (111 ± 3 mmHg while a significant decrease occurred in the 48-h group (91 ± 4 mmHg. These data suggest biphasic damage in mitochondrial function in acute pancreatitis: an initial uncoupled phase, possibly secondary to enzyme activity, followed by a temporary recovery and then a late and final dysfunction, associated with arterial hypotension, possibly related

  3. CT findings and CT score in acute pancreatitis compared with severity

    CT findings in 28 patients with acute pancreatitis were compared with severity of the disease. The pancreatic image, which demonstrates the pancreatic lesion, was studied with respect to 9 items, and fluid collection showing the peripancreatic status with respect to 13 items. 1) According to Forell's classification, the lesion was minor in 8 patients, moderate in 11, and severe in 9. 2) The detection rates of abnormal pancreatic images and fluid collection increased with the advance in the severity of the disease. 3) The mean CT score by severity was 0.88 ± 0.64 for minor pancreatitis, 7.18 ± 4.51 for moderate pancreatitis, and 13.44 ± 4.22 for severe pancreatitis. Significant differences were observed among the groups, suggesting the usefulness of the CT score in evaluating the severity of acute pancreatitis. (author)

  4. THE CHANGES OF PANCREATIC ACINAR CELL FUNCTION IN ACUTE NECROTIZING PANCREATITIS OF RATS

    余枭; 韩天权; 汤耀卿; 雷若庆; 夏宗勤

    2000-01-01

    Objective To evaluate the changes of pancreatic acinar cell functions in the rats with acute necrotizing pancreatitis (ANP). Methods Seventy SD rats were randomized into two groups: experimental group (n=35) and control group (n=35). To prepare the experimental model, the retrograde injection of 5% sodium taurocholate into the pancreatic duct was used for inducing ANP. Radioactive tracing by L- 3H-phenylalanine and autoradiography were performed for scoring the differences of changes of amino acid uptake, enzyme-protein synthesis and output from acinar cells in rats between both groups. Results No changes were observed in amino acid uptake and enzyme-protein synthesis in rats with dotted and haemorrhagic necrotizing foci as compared with control group. However, accumulated zymogen granules in the interstitial of acinar cells were seen in the experimental group. Conclusion It indicates that in experimental ANP rats, the functions of acinar cells in both amino acid uptake and protein synthesis were essentially normal, but the pathway of enzyme output was affected into ectopic secretion through the bottom or lateral cellular membrane of pancreatic acinar cell.

  5. Recognition and Importance of New Definitions of Peripancreatic Fluid Collections in Managing Patients with Acute Pancreatitis.

    Ahmed, Akram; Gibreel, Waleed; Sarr, Michael G

    2016-01-01

    Our understanding of the etiopathogenesis of acute pancreatitis has matured tremendously in the last 3 decades. Advanced cross-sectional imaging with 3-dimensional techniques along with use of intravenous contrast to image the presence or absence of organ tissue perfusion has allowed early recognition of necrotizing pancreatitis. With this knowledge, the old terms to describe what used to be called 'peri-pancreatic fluid collections' we now recognize are no longer accurate nor appropriate. The 2013 revised Atlanta Classification has introduced a new, accurate, objective classification of acute pancreatitis and terminology for the natural history of all forms of acute pancreatitis that is easy to use and will help in both the description of the disease and its appropriate treatment. This review will describe these pancreatic and peri-pancreatic collections with added insight into their natural history. PMID:27216496

  6. Acute pancreatitis due to ascariasis: a sonographic pictorial essay on four cases.

    Lynser, Donboklang; Thangkhiew, R S; Laloo, Demitrost; Hek, M D; Marbaniang, Evarisalin; Tariang, Satisfy

    2016-06-01

    Ascariasis is the commonest helminthic disease to infect humans. Due to their wandering nature, the roundworms from the second part of the duodenum migrate through the biliary opening into the hepatobiliary and pancreatic ducts. Ascariasis is the most common parasitic cause of pancreatitis in endemic region. Pancreatitis can result due to pancreatic ascariasis, biliary ascariasis or both. Pancreatitis due to ascariasis can be severe and life-threatening. We present a pictorial essay of acute pancreatitis due to ascariasis on four cases. PMID:27059341

  7. An autopsy case of acute pancreatitis with a high serum IgG4 complicated by amyloidosis and rheumatoid arthritis

    Tatsuki Ichikawa; Kazuhiko Nakao; Keisuke Hamasaki; Kazuaki Ohkubo; Kan Toriyama; Katsumi Eguchi

    2005-01-01

    We report an autopsy case of acute pancreatitis with a high serum IgG4 concentration complicated by systemic amyloid A amyloidosis and rheumatoid arthritis (RA). The patient was a 42-year-old Japanese female with a 22-year history of rheumatoid arthritis. She was diagnosed with myasthenia gravis when she was 31-year old. At the onset of pancreatitis, the patient was anti-nuclear antibody-positive,and had high serum gamma globulin and IgG4 levels.Dexamethasone and conventional therapy induced clinical remission and significantly decreased the serum IgG4 and gamma globulin. However, despite the decreased disease parameters, the patient developed a bleeding pseudocyst and died of cardiac failure. In the autopsy examination, it was determined that pancreatitis was probably caused by ischemia due to vascular obstruction caused by amyloid deposition in the pancreas. Even though acute pancreatitis is a rare complication in RA patients, we speculate that an autoimmune pancreatitis-related mechanism and ischemia due to vascular obstruction by amyloid deposition might be attributable to a single source that leads to acute pancreatitis in our particular case.

  8. Posterior reversible encephalopathy syndrome following acute pancreatitis during chemotherapy for acute monocytic leukemia.

    Nishimoto, Mitsutaka; Koh, Hideo; Bingo, Masato; Yoshida, Masahiro; Nanno, Satoru; Hayashi, Yoshiki; Nakane, Takahiko; Nakamae, Hirohisa; Shimono, Taro; Hino, Masayuki

    2014-05-01

    We describe an 18-year-old man with acute leukemia who presented with posterior reversible encephalopathy syndrome (PRES) shortly after developing acute pancreatitis. On day 15 after the third consolidation course with high-dose cytarabine, treatment with broad-spectrum antibiotics was initiated for febrile neutropenia. On day 16, he developed septic shock, and subsequently, acute respiratory distress syndrome (ARDS). After adding vancomycin, micafungin and high-dose methylprednisolone (mPSL) to his treatment regimen, these manifestations subsided. On day 22, he received hemodialysis for drug-induced acute renal failure. On day 24, he developed acute pancreatitis possibly due to mPSL; the following day he had generalized seizures, and was intubated. Cerebrospinal fluid findings were normal. Brain MRI revealed hyperintense signals on FLAIR images and increased apparent diffusion coefficient values in the sub-cortical and deep white matter areas of the bilateral temporal and occipital lobes, indicative of vasogenic edema. Thus, we diagnosed PRES. Blood pressure, seizures and volume status were controlled, with MRI findings showing improvement by day 42. He was extubated on day 32 and discharged on day 49 without complications. Although little is known about PRES following acute pancreatitis, clinicians should be aware that this condition may develop. PMID:24881921

  9. Imaging of the pancreas. Acute and chronic pancreatitis

    Balthazar, Emil J.; Megibow, Alec J. [NYU-Langone Medical Center, New York, NY (United States). Dept. of Radiology; Pozzi Mucelli, Roberto (eds.) [Policlinico ' ' GB Rossi' ' Verona Univ. (Italy). Dept. of Radiology

    2009-07-01

    With the aid of numerous high-quality illustrations, this volume explains the strengths and limitations of the different techniques employed in the imaging of pancreatitis. Ultrasound, computed tomography, magnetic resonance imaging and interventional imaging are each considered separately in the settings of acute and chronic pancreatitis. A further section is devoted to imaging of the complications of these conditions. Throughout, care has been taken to ensure that the reader will achieve a sound understanding of how the imaging findings derive from the pathophysiology of the disease processes. The significance of the imaging findings for clinical and therapeutic decision making is clearly explained, and protocols are provided that will assist in obtaining the best possible images. (orig.)

  10. Hepatic infarction complicating acute pancreatitis: a case report

    Kim, Hyun Suk; Hong, Sung Hwan; Park, Hong Suk; Lee, Eil Seong; Kang, Ik Won [College of Medicine, Hallym University, Seoul (Korea, Republic of)

    2000-07-01

    Hepatic infarction is relatively uncommon and is usually related to surgery or interventional procedures. Pancreatitis-associated hepatic infarction has not been reported in the literature, and we now describe a case of hepatic infarction in a 31-year-old man with acute pancreatitis. Initial CT scanning demonstrated an enlarged pancreas with multifocal fluid collection, and a large wedge-shaped low attenuation lesion was seen in the right lobe of the liver along with thrombi in the posteroinferior branch of the right portal vein. Hepatic arteriography and SMA portography revealed a pseudoaneurysm in the right hepatic artery, thrombi in the main portal vein and its posteroinferior branch, and perfusion defects confined to S6 of the liver. (author)

  11. Interventional Radiology in Acute Pancreatitis: Friend or Foe?

    Maziar Khorsandi

    2012-01-01

    Full Text Available Context Peripancreatic fluid collections are known complications of pancreatitis. The majority of fluid collections can be drained percutaneously under radiological guidance. Although radiological percutaneous drainage is regarded as safe, here it resulted in catastrophic haemorrhage from the colon due to an iatrogenic injury. Case report We present a case of a 70-year-old man who presented with acute alcohol-related severe necrotizing pancreatitis and an associated massive peripancreatic fluid collection. The drainage of this collection was attempted under computed tomography (CT scan guidance. During the procedure the splenic artery and the splenic flexure of the colon were inadvertently damaged leading to life threatening per rectal bleeding requiring emergency angiographic embolisation of the splenic artery. Conclusion Radiological drainage of peripancreatic fluid collections is generally regarded as having lower rates of complications compared to surgical necrosectomy. However, in this case it leads to a life threatening per rectal bleed requiring emergency splenic artery embolisation.

  12. Contemporary management of infected necrosis complicating severe acute pancreatitis

    Jamdar, Saurabh; Siriwardena, Ajith K

    2006-01-01

    Pancreatic necrosis complicating severe acute pancreatitis is a challenging scenario in contemporary critical care practice; it requires multidisciplinary care in a setting where there is a relatively limited evidence base to support decision making. This commentary provides a concise overview of current management of patients with infected necrosis, focusing on detection, the role of pharmacologic intervention, and the timing and nature of surgical interventions. Fine-needle aspiration of necrosis remains the mainstay for establishment of infection. Pharmacological intervention includes antibiotic therapy as an adjunct to surgical debridement/drainage and, more recently, drotrecogin alfa. Specific concerns remain regarding the suitability of drotrecogin alfa in this setting. Early surgical intervention is unhelpful; surgery is indicated when there is strong evidence for infection of necrotic tissue, with the current trend being toward 'less drastic' surgical interventions. PMID:16356213

  13. Treatment of severe acute pancreatitis through retroperitoneal laparoscopic drainage

    Chun Tang; Baolin Wang; Bing Xie; Hongming Liu; Ping Chen

    2011-01-01

    A treatment method based on drainage via retroperitoneal laparoscopy was adopted for 15 severe acute pancreatitis (SAP) patients to investigate the feasibility of the method.Ten patients received only drainage via retroperitoneai laparoscopy,four patients received drainage via both retroperitoneal and preperitoneal laparoscopy,and one patient received drainage via conversion to laparotomy.Thirteen patients exhibited a good drainage effect and were successfully cured without any other surgical treatment.Two patients had encapsulated effusions or pancreatic pseudocysts after surgery,but were successfully cured after lavage and B ultrasound-guided percutaneous catheter drainage.SAP treatment via retroperitoneal laparoscopic drainage is an effective surgical method,resulting in minor injury.

  14. Laparoscopic Partial Pancreatectomy in a Patient with Pancreas Trifurcation and Recurrent Acute Pancreatitis

    Marcel Autran Machado

    2016-02-01

    Full Text Available Introduction Embryologically the pancreas develops by the fusion of dorsal and ventral pancreatic elements. The ventral pancreatic bud gives rise to part of the head and uncinate process, while the remainder of the head, body, and tail of the pancreas develops from the dorsal pancreatic bud. Failure in this process may result in pancreatic duct variation. Several types have been described, including bifid pancreatic duct, ectopic pancreas and duplication anomaly. To our knowledge, pancreatic trifurcation has never been described so far. Aim To present a video of a laparoscopic partial pancreatectomy resection in a patient with trifurcation of pancreas and intermittent acute pancreatitis. Methods A forty-year-old woman suffering from intermittent episodes of acute pancreatitis with first onset at 2-years of age with multiple surgical interventions for abdominal abscess drainage until puberty when severity and number of episodes decreased. Three years ago, she experimented a new episode of severe acute pancreatitis with prolonged hospitalization and since then intermittent episodes. MRI revealed an anomalous pancreas with three pancreatic ducts. One of them with signs of obstruction and pancreatitis. Laparoscopic resection of the diseased pancreas was proposed. Results Operative time was 150 minutes. Blood loss was minimum. Recovery was uneventful and patient was discharged on the 4th postoperative day. Final pathology showed no signs of malignancy. Patient is well with no sign of the disease 12 months after operation. Conclusion Although anomaly of the pancreatic duct is extremely rare, this case should alert clinicians to be aware of such an anatomical variant that may alter the flow characteristics in the pancreatic ductal system resulting in an increased risk of relapsing episodes of acute pancreatitis. Our patient received the correct diagnosis only 38 years after the first episode of acute pancreatitis.

  15. Severe Acute Pancreatitis Due to Tamoxifen-Induced Hypertriglyceridemia with Positive Rechallenge

    Jaballah Sakhri; Houssem Harbi; Rached Ltaief; Chaker Ben Salem; Neila Fathallah

    2010-01-01

    Context Pancreatitis is a very rare adverse effect of tamoxifen with only six cases of tamoxifen-associated pancreatitis reported in the English literature until now. In these cases, rechallenge with tamoxifen was not carried out. Case report We report a case of recurrent severe acute pancreatitis in a 44-year-old female induced by tamoxifen therapy and review the literature with regards to tamoxifen-associated pancreatitis. Conclusion Clinicians should be aware of the risks of developing sev...

  16. Recurrent Acute Pancreatitis and Cholangitis in a Patient with Autosomal Dominant Polycystic Kidney Disease

    Kambiz Yazdanpanah; Navid Manouchehri; Elinaz Hosseinzadeh; Mohammad Hassan Emami; Mehdi Karami; Amir Hossein Sarrami

    2013-01-01

    Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder associated with multiple cyst formation in the different organs. Development of pancreatic cyst in ADPKD is often asymptomatic and is associated with no complication. A 38-year-old man with ADPKD was presented with six episodes of acute pancreatitis and two episodes of cholangitis in a period of 12 months. Various imaging studies revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct,...

  17. Nitric Oxide Pathways and Evidence-Based Perturbations in Acute Pancreatitis

    DiMagno, Matthew J.

    2007-01-01

    Nitric oxide (NO) is a gaseous neurotransmitter, a vasodilator and paracrine regulator. In the pancreas, NO regulates normal pancreatic exocrine secretion, endocrine pancreatic insulin secretion and pancreatic microvascular blood flow. NO has multiple species and is produced de novo by 3 NO synthase enzymes. Endothelial NO synthase reduces the severity of the initial phase of experimental acute pancreatitis (AP). Cigarette smoking and chronic alcohol use disrupt normal NO pathways and are ass...

  18. Acute pancreatitis at the beginning of the 21st century: The state of the art

    Alfredo F Tonsi; Matilde Bacchion; Stefano Crippa; Giuseppe Malleo; Claudio Bassi

    2009-01-01

    Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consumption are the most frequent causes of pancreatitis in adults. The treatment of mild acute pancreatitis is conservative and supportive; however severe episodes characterized by necrosis of the pancreatic tissue may require surgical intervention. Advanced understanding of the pathology, and increased interest in assessment of disease severity are the cornerstones of future management strategies of this complex and heterogeneous disease in the 21st century.

  19. Cannabinoid HU210 Protects Isolated Rat Stomach against Impairment Caused by Serum of Rats with Experimental Acute Pancreatitis

    Cao, Ming-hua; Li, Yong-yu; Xu, Jing; Feng, Ya-jing; Lin, Xu-hong; Li, Kun; HAN Tong; Chen, Chang-Jie

    2012-01-01

    Acute pancreatitis (AP), especially severe acute pancreatitis often causes extra-pancreatic complications, such as acute gastrointestinal mucosal lesion (AGML) which is accompanied by a considerably high mortality, yet the pathogenesis of AP-induced AGML is still not fully understood. In this report, we investigated the alterations of serum components and gastric endocrine and exocrine functions in rats with experimental acute pancreatitis, and studied the possible contributions of these alte...

  20. C - REACTIVE PROTEIN LEVELS IN ACUTE PANCREATITIS AND ITS PROGNOSTIC SIGNIFICANCE

    Mohan; Aditya A.; Avantee; Priyadarshini; Minakshi,; Mansha B.

    2013-01-01

    ABSTRA CT: AIM: To measure C - reactive protein (CRP) levels in patients of acute pancreatitis and evaluate if CRP levels predict the severity of pancreatitis by correlating these levels with - 1. C T Severity Index (CTSI). 2. Presence of complications. 3. Time take n for recovery. METHOD: Between the years 2007 and 2009 fifty patients diagnosed to have acute pancreatitis were included in this study. Their CRP levels were sent on second day of admission ...

  1. Effect of drugs on the pulmonary changes in experimental acute pancreatitis in the rat.

    Berry, A R; Taylor, T V

    1982-01-01

    Respiratory complications of acute pancreatitis are well recognised and are closely related to a poor prognosis. Using an experimental model in the rat, a decrease in lung compliance and an increase in lung weight were produced in acute pancreatitis. The effects of dexamethasone, heparin, and aspirin on these changes were studied. The mean specific lung compliance was reduced by 16% in the pancreatitis group compared with the control group (p less than 0.05) and this change was abolished by d...

  2. Preventive Effect of Cichorium Intybus L. Two Extracts on Cerulein-induced Acute Pancreatitis in Mice

    Mohsen Minaiyan; Ali-Reza Ghannadi; Parvin Mahzouni; Ali-Reza Abed

    2012-01-01

    Objectives: Acute pancreatitis is an inflammatory condition of pancreas with sudden onset, high mortality rate and multiple organ failure characteristics. It has been shown that oxygen free radicals have an important role in development of pancreatitis and its complications. Antioxidant, anti-inflammatory, anti-hepatotoxicity and gastroprotective properties of Cichorium intybus L. suggest that this plant may have beneficial effects in the management of acute pancreatitis. Methods: Five in...

  3. Experimental evidence of obesity as a risk factor for severe acute pancreatitis

    Frossard, Jean-Louis; Lescuyer, Pierre; Pastor, Catherine M

    2009-01-01

    The incidence of acute pancreatitis, an inflammation of the pancreas, is increasing worldwide. Pancreatic injury is mild in 80%-90% of patients who recover without complications. The remaining patients may develop a severe disease with local complications such as acinar cell necrosis, abscess and remote organ injury including lung injury. The early prediction of the severity of the disease is an important goal for physicians in management of patients with acute pancreatitis in order to optimi...

  4. Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging.

    Block, S; Maier, W.; Bittner, R.; Büchler, M; Malfertheiner, P; Beger, H G

    1986-01-01

    One hundred and five of 395 patients with acute pancreatitis were surgically treated in our clinic from 1981 to 1984. Ninety three of these patients were examined with contrast enhanced computed tomography and/or ultrasound and were clinically assessed according to Ranson's objective criteria before operation. At operation, 77 patients showed necrotising pancreatitis and 16 showed biliary acute interstitial pancreatitis. Ninety per cent of the cases with extensive and 79% of those with minor ...

  5. Comparing the Roles of EUS, ERCP and MRCP in Idiopathic Acute Recurrent Pancreatitis

    Safari, Mohammad Taghi; Miri, Mohammad Bager; Ebadi, Shahram; Shahrokh, Shabnam; Alizadeh, Amir Houshang Mohammad

    2016-01-01

    Acute recurrent pancreatitis (ARP) is defined as more than two attacks of acute pancreatitis with complete or almost complete resolution of symptoms and signs of pancreatitis between episodes. The initial evaluation fails to detect the cause of ARP in 10%–30% of patients, whose condition is classified as idiopathic ARP. Endoscopic ultrasound (EUS) has gained increasing attention as a useful imaging modality for the pancreas and the extrahepatic biliary tree. The close proximity of the pancrea...

  6. Nifuroxazide-induced acute pancreatitis: a new side-effect for an old drug?

    Shindano, Akilimali; Marot, Liliane; Geubel, André P

    2007-01-01

    We report the case of a middle-aged woman who developed a typical picture of acute pancreatitis together with systemic features of immunoallergy after the intake of two capsules (200 mg) of nifuroxazide. Even if acute pancreatitis is a rare adverse event of nitrofuran derivative therapy, nifuroxazide-induced pancreatitis as not been previously described. As suggested by associated systemic features, the disease is likely of immunoallergic origin. PMID:17619536

  7. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    Smit, M.; Buddingh, K. T.; Bosma, B; Nieuwenhuijs, V B; Hofker, H.S.; Zijlstra, J.G.

    2016-01-01

    INTRODUCTION: Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS

  8. Is the SPINK1 variant p.N34S overrepresented in patients with acute pancreatitis?

    Jøergensen, Maiken Thyregod; Brusgaard, Klaus; Novovic, Srdan;

    2012-01-01

    Serine Protease Inhibitor Kazal type 1 (SPINK1) protects against premature intracellular activation of trypsinogen and development of acute pancreatitis. Our aim was to determine the prevalence of SPINK1 mutations (a) in unselected patients with first-time acute pancreatitis and (b) in the Danish...

  9. Heparin improves organ microcirculatory disturbances in caerulein-induced acute pancreatitis in rats

    Dobosz, Marek; Mionskowska, Lucjanna; Hać, Stanislaw; Dobrowolski, Sebastian; Dymecki, Dariusz; Wajda, Zdzislaw

    2004-01-01

    AIM: Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis. The aim of the study was to evaluate changes in microperfusion of the pancreas, liver, kidney, stomach, colon, skeletal muscle, and to investigate the influence of heparin on the organ microcirculation in caerulein-induced experimental acute pancreatitis.

  10. A Rare and Unexpected Side-Effect of Cannabis Use: Abdominal Pain due to Acute Pancreatitis

    Mehmet Husamettin Akkucuk; Mustafa Erbayrak

    2015-01-01

    Acute pancreatitis is a frequently encountered disorder in patients presenting to emergency units. Biliary system disorders, alcohol consumption, infections, and drugs are among the causes of acute pancreatitis. However, it is sometimes difficult to determine the etiology of this disorder, particularly if the patient does not wish to disclose his consumption of cannabis, the use of which is illegal.

  11. Use of methimazole and risk of acute pancreatitis: A case–control study in Taiwan

    Shih-Wei Lai

    2016-01-01

    Conclusions: Our study does not detect a substantial association between the use of methimazole and risk of acute pancreatitis on the basis of systematic analysis. There appears to be a discrepancy between case reports and our systematic analysis about the association between the use of methimazole and risk of acute pancreatitis.

  12. Effects of abdominal fat distribution parameters on severity of acute pancreatitis.

    O'Leary, D P

    2012-07-01

    Obesity is a well-established risk factor for acute pancreatitis. Increased visceral fat has been shown to exacerbate the pro-inflammatory milieu experienced by patients. This study aimed to investigate the relationship between the severity of acute pancreatitis and abdominal fat distribution parameters measured on computed tomography (CT) scan.

  13. Traditional Chinese medicine, Qing Ying Tang, ameliorates the severity of acute lung injury induced by severe acute pancreatitis in rats via the upregulation of aquaporin-1

    GAO, ZHENMING; Xu, Junfeng; Sun, Deguang; ZHANG, Rixin; LIANG, RUI; Wang, Liming; Fan, Rong

    2014-01-01

    Aquaporin-1 (AQP-1) is expressed in lung endothelial cells and regulates water transport; thus, AQP-1 plays an important role in a number of edema-associated lung diseases. Qing Yin Tang (QYT), a traditional Chinese medicine, has been shown to effectively reduce the mortality rate of acute lung injury (ALI) induced by severe acute pancreatitis (SAP). The current study aimed to investigate the detailed mechanisms underlying the effects of QYT on ALI induced by SAP, particularly the effects on ...

  14. Acute kidney injury in severe acute pancreatitis: An experience from a tertiary care center

    Ravindra Kumar

    2015-01-01

    Full Text Available Acute kidney injury (AKI is an important cause of morbidity and mortality in severe acute pancreatitis (SAP. We aimed in our study to explore the risk factors of AKI in patients with SAP and assess the prognosis of patients with SAP and AKI. This is a retrospective study consisting of analysis of outcome and complications encountered in 72 severe acute pancreatitis patients admitted to a tertiary care center at Indore, India, from May 2011 to April 2012. We encountered 14 AKI cases in the SAP study patients. There was a significant association of diabetes and alcohol with AKI in patients with SAP. Alcohol was found to be an independent significant risk factor for AKI in SAP. All the eight patients with SAP who expired had AKI. None of the patients of SAP without AKI expired during the study. We conclude that the patients with SAP with AKI have a greater mortality rate as compared with the SAP patients without AKI.

  15. Severe acute pancreatitis due to tamoxifen-induced hypertriglyceridemia with diabetes mellitus

    Kim, Young Ae; Lee, Sol; Jung, Ji Woong; Kwon, Yu Jin; Lee, Gyeong Bok; Shin, Dong Gue; Park, Sang Su; Yun, Jin; Jang, Yong-Seog

    2014-01-01

    The side effects of tamoxifen are generally mild, including the effect on lipoprotein metabolism. However, there are few cases of severe tamoxifen induced hypertriglyceridemia. Hypertriglyceridemia is a marked risk factor for acute pancreatitis and approximately 2% to 5% of cases of acute pancreatitis are related to drugs. We report on tamoxifen-induced hypertriglyceridemia and acute pancreatitis in a 40 years old woman with type 2 diabetes mellitus occurred by dexamethasone. She was treated with insulin infusion and fenofibrate, and goserelin acetate was started instead of tamoxifen after discharge from the hospital. Also, probable pathogenic hypotheses about the correlation between tamoxifen and dexamethasone induced type 2 diabetes mellitus on severe acute pancreatitis are provided. Clinicians should take care of risks of severe acute pancreatitis on using tamoxifen, especially for patients with dexamethasone induced diabetes mellitus. These individuals should undergo pre-post tamoxifen lipid screening and careful history taking of drugs, including dexamethasone. PMID:25035662

  16. Imaging and Percutaneous Management of Acute Complicated Pancreatitis

    Acute pancreatitis varies from a mild, self-limited disease to one with significant morbidity and mortality in its most severe forms. While clinical criteria abound, imaging has become indispensable to diagnose the extent of the disease and its complications, as well as to guide and monitor therapy. Percutaneous interventional techniques offer options that can be life-saving, surgery-sparing or important adjuncts to operation. Close cooperation and communication between the surgeon, gastroenterologist and interventional radiologist enhance the likelihood of successful patient care

  17. Complement activation and complement control proteins in acute pancreatitis.

    Whicher, J T; Barnes, M. P.; Brown, A; Cooper, M J; Read, R; Walters, G; Williamson, R C

    1982-01-01

    Serum levels of the complement proteins C3, C4, C1 inhibitor (C1 INH), factor I (C3b inactivator) and factor H (BIH) and plasma levels of cleavage products of C3 (C3c) and factor B were measured in 26 patients with acute pancreatitis. Breakdown of C3 occurred in 19 patients, as shown by a reduction in C3 level and the presence of C3c. C4 levels, however, did not fall and factor B breakdown products were not detected, thus suggesting that enzymatic cleavage of C3 occurred without significant i...

  18. [Immune and enzyme disorders in patients with acute pancreatitis].

    Briskin, B S; Iarovaia, G A; Savchenko, Z I; Rybakov, G S; Khalidov, O Kh; Mkhitarova, L A; Suplotova, A A

    2001-01-01

    Analysis of immune and enzyme disorders in 85 patients with acute pancreatitis shows that persistent imbalance of immunoregulatory T-lymphocytes with suppression predominance; reduction of all immunoglobulines number, imbalance in phagocytic immunity with height of absorbing activity of neutropils and stimultaneous decrease of their digestive capacity are prognostically unfavourable for high risk of pyonecrotic complications and lethal outcome. It is necessary to include immunocorrectors in combined therapy. Direct assessment of leukocytic elastase activity and alpha-IP level in blood plasma permits to evaluate spreading of inflammatory process and it severity, efficacy and prognosis of treatment. PMID:11521303

  19. Reverse-migrated neutrophils regulated by JAM-C are involved in acute pancreatitis-associated lung injury

    Deqing Wu; Yue Zeng; Yuting Fan; Jianghong Wu; Tunike Mulatibieke; Jianbo Ni; Ge Yu; Rong Wan; Xingpeng Wang; Guoyong Hu

    2016-01-01

    Junctional adhesion molecule-C (JAM-C) plays a key role in the promotion of the reverse transendothelial migration (rTEM) of neutrophils, which contributes to the dissemination of systemic inflammation and to secondary organ damage. During acute pancreatitis (AP), systemic inflammatory responses lead to distant organ damage and typically result in acute lung injury (ALI). Here, we investigated the role of rTEM neutrophils in AP-associated ALI and the molecular mechanisms by which JAM-C regula...

  20. Effect of the acute postoperative pancreatitis at the postoperative period in the abdominal surgery

    Kotenko К.V.

    2013-12-01

    Full Text Available The study aims the influence of development of the acute postoperative pancreatitis at the early postoperative period; determine its influence at the frequency and spectrum of complications after abdominal surgery. Material and methods. The work is based on the results of the complex examination and surgical treatment of 1934 patients with various disorders of the digestive system (complicated duodenal ulcer and gastric ulcer, gastric cancer, the proximal and distal pancreatic cancer, colon cancer and postgastrectomy syndromes. The dependence of the overall incidence of postoperative complications, the number of complications per patient, and the number of infectious and inflammatory complications per patient, hospital mortality and length of postoperative hospital days for the development of acute postoperative pancreatitis were studied. Results. Acute postoperative pancreatitis is a leading cause of morbidity postoperative intra-abdominal operations. 97,8% of the cases of complicated early postoperative period of the operations on the organs of the abdominal cavity caused by the development of acute postoperative pancreatitis. Specific complications for the acute postoperative pancreatitis (satellite complications were identified. Satellite complication had a clearly defined correlation with the development of the acute postoperative pancreatitis. The negative effect of acute postoperative pancreatitis on the severity of the postoperative period, on the morbidity, on the number of complications per patient, on the number of the infectious and inflammatory complications per patient, hospital mortality and on the duration of the postoperative hospital stay were found.

  1. Relaxin prevents the development of severe acute pancreatitis

    Laura Iris Cosen-Binker; Marcelo Gustavo Binker; Rodica Cosen; Gustavo Negri; Osvaldo Tiscornia

    2006-01-01

    AIM: To investigate the severity of acute pancreatitis (AP) is associated to the intensity of leukocyte activation,inflammatory up-regulation and microcirculatory disruption associated to ischemia-reperfusion injury.Microvascular integrity and inhibition of pro-inflammatory mediators are key-factors in the evolution of AP. Relaxin is an insulin-like hormone that has been attributed vasorelaxant properties via the nitric oxide pathway while behaving as a glucocorticoid receptor agonist.METHODS: AP was induced by the bilio-pancreatic duct-outlet-exclusion closed-duodenal-loops model.Treatment with relaxin was done at different timepoints. Nitric oxide synthase inhibition by L-NAME and glucocorticoid receptor (GR) blockage by mifepristone was considered. AP severity was assessed by biochemical and histopathological analyses.RESULTS: Treatment with relaxin reduced serum amylase, lipase, C-reactive protein, IL-6, IL-10, hsp72,LDH and 8-isoprostane as well as pancreatic and lung myeloperoxidase. Acinar and fat necrosis, hemorrhage and neutrophil infiltrate were also decreased. ATP depletion and ADP/ATP ratio were reduced while caspases 2-3-8 and 9 activities were increased. L-NAME and mifepristone decreased the efficiency of relaxin.CONCLUSION: Relaxin resulted beneficial in the treatment of AP combining the properties of a GR agonist while preserving the microcirculation and favoring apoptosis over necrosis.

  2. Ischemic Acute Necrotizing Pancreatitis in a Marathon Runner. Comment

    Johannes Matthias Löhr

    2009-03-01

    Full Text Available Dear Sir we read the contribution by Mast et al. with great interest [1]. They report on this unfortunate gentleman who developed acute pancreatitis after running marathon and taking a sauna. Although this combination of physical activities is not so uncommon in the Nordic countries, particularly during winter time, no such experience or reports exist on pancreatitis. Morbidity and mortality of sauna bathing is rather low [2], despite the fact that there is a readiness to combine sauna with alcohol intake. The more this case report appears worth publishing, even though we should have appreciated some more data on the level of hemoconcentration in this runner and sauna bather Furthermore, as it is routine in our pancreas clinic these days, we would have searched also for one of the known genetic factors contributing to the development of pancreatitis such as mutations in PRSS1, SPINK1, CFTR and CTRC genes [3]. Even more though in a patient who does not have one of the known or obvious causes such as alcohol, gallstones or hyperlipidemia. Further, despite his obvious physical condition, the presence of atherosclerotic microangiopathy would be worth knowing in a 57-year-old man, since most of the ischemic etiologies are thought to be associated with atherosclerotic disease [4].

  3. Dynamic high-field MR imaging in experimental porcine acute pancreatitis

    The effects of acute pancreatitis on MR imaging signal intensities (SIs) were determined in an experimental study at 1.0 T. Oedematous pancreatitis was induced in 9 piglets and haemorrhagic pancreatitis in 11 piglets. Each animal served as its own control for MR imaging before and after induction of pancreatitis. T1-weighted spin echo (450/15 ms) and dynamic turbo FLASH (flip angle 8 ) sequences were used without contrast medium in testing the stability of the SI measurements. There was no significant difference in the SI-versus-time curves of the pancreas in piglets with oedematous and haemorrhagic pancreatitis. However, the difference in mean SIs between healthy and diseased piglets was significant. Thus, although non-contrast MR may be useful in the diagnosis of acute pancreatitis, it does not distinguish between oedematous and haemorrhagic pancreatitis. (orig.)

  4. High risk of acute pancreatitis after endoscopic ultrasound-guided fine needle aspiration of side branch intraductal papillary mucinous neoplasms

    Siddiqui, Ali A.; Shahid, Haroon; Shah, Apeksha; Khurana, Tanvi; Huntington, William; Ghumman, Saad S.; Loren, David E; Kowalski, Thomas E; Laique, Sobia; Hayat, Umar; Eloubeidi, Mohamad A

    2015-01-01

    Background and Objectives: Data on the risk of acute pancreatitis following endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions are limited. The aim of our study was to evaluate the frequency of acute pancreatitis after EUS-FNA of pancreatic cysts and solid lesions, and determine whether there was a difference in pancreatitis risk in patients with side branch intraductal papillary mucinous neoplasms (SB-IPMN). Patients and Methods: A retrospective review...

  5. Protective Effects of Hydrogen Gas on Experimental Acute Pancreatitis

    Zhou, Hao-xin; Han, Bing; Hou, Li-Min; An, Ting-Ting; Jia, Guang; Cheng, Zhuo-Xin; Ma, Yong; Zhou, Yi-Nan; Kong, Rui; Wang, Shuang-Jia; Wang, Yong-Wei; Sun, Xue-Jun; Pan, Shang-Ha; Sun, Bei

    2016-01-01

    Acute pancreatitis (AP) is an inflammatory disease mediated by damage to acinar cells and pancreatic inflammation. In patients with AP, subsequent systemic inflammatory responses and multiple organs dysfunction commonly occur. Interactions between cytokines and oxidative stress greatly contribute to the amplification of uncontrolled inflammatory responses. Molecular hydrogen (H2) is a potent free radical scavenger that not only ameliorates oxidative stress but also lowers cytokine levels. The aim of the present study was to investigate the protective effects of H2 gas on AP both in vitro and in vivo. For the in vitro assessment, AR42J cells were treated with cerulein and then incubated in H2-rich or normal medium for 24 h, and for the in vivo experiment, AP was induced through a retrograde infusion of 5% sodium taurocholate into the pancreatobiliary duct (0.1 mL/100 g body weight). Wistar rats were treated with inhaled air or 2% H2 gas and sacrificed 12 h following the induction of pancreatitis. Specimens were collected and processed to measure the amylase and lipase activity levels; the myeloperoxidase activity and production levels; the cytokine mRNA expression levels; the 8-hydroxydeoxyguanosine, malondialdehyde, and glutathione levels; and the cell survival rate. Histological examinations and immunohistochemical analyses were then conducted. The results revealed significant reductions in inflammation and oxidative stress both in vitro and in vivo. Furthermore, the beneficial effects of H2 gas were associated with reductions in AR42J cell and pancreatic tissue damage. In conclusion, our results suggest that H2 gas is capable of ameliorating damage to the pancreas and AR42J cells and that H2 exerts protective effects both in vitro and in vivo on subjects with AP. Thus, the results obtained indicate that this gas may represent a novel therapy agent in the management of AP. PMID:27115738

  6. [Acute necrotizing pancreatitis--diagnostic and treatment strategy].

    Madzhov, R; Georgiev, K; Arnaudov, P; Radev, R; Bankov, P

    2003-01-01

    Despite of the current achievements of medicine, the mortality of necrotizing pancreatitis (NP) is still too high--up to 35-40% and stands as a serious diagnostic and treatment problem. The results of treatment of 148 patients, admitted in the clinic with diagnosis NP, 95 males and 53 females, are discussed. The ratio between patients with acute oedematic and acute NP is 81.1% to 18.9%. According to the hystopatology findings, the results are as follows: pancreatic necrosis--128 patients, peripancreatic necrosis--42 patients, retropancreatic necrosis--29 patients, phlegmonous cholecystitis--31 patients. For the exact diagnostic estimation of the development and prognosis of NP, we are based on: Clinic symptomatology, biochemical constellations (the prognostic scale of Ranson), ultrasonography, CT, ERCP, ES, laparoscopy (48 pts), and laparoscopic drainage (34 pts) of the abdominal cavity with one or two drains, in order to decrease the intoxication and manage intraperitoneal irrigation with antibiotics and enzymes. The operative intervations consists of a thorough exploration, broad necrectomy combined with lavage and large drainage. COLD (controlled open lesser sac drainage) has been performed at 34 cases. In 31 pts cholecystectomy and choledochotomy with T-tube drainage of d. choledochus (Kehr drainage) was performed. Reoperations have been made at 34 pts (22.9%); in 11 of them--2 operative revisions have been carried out, in 3 cases--three, and in 3 cases--4 operative revisions were performed. The total postoperative death rate was 21.6% (32 patients). The most common postoperative complications were as follows: pulmonary complications at 11 cases, pleural effusions--9 pts, intraabdominal abscesses--6 patients, postnecrotic pseudocysts--9 cases, pancreatic fistulas--6 cases, fistulas of the colon--2 pts, bleeding--4 patients. PMID:15584453

  7. Local Renin-Angiotensin System in the Pancreas: The Significance of Changes by Chronic Hypoxia and Acute Pancreatitis

    Leung PS

    2001-01-01

    Full Text Available The circulating renin-angiotensin system (RAS plays an important role in the maintenance of blood pressure and fluid homeostasis. Recently, there has been a shift of emphasis from the circulating RAS to the local RAS in the regulation of individual tissue functions via a paracrine and/or autocrine mechanism. In fact, a local RAS has been proposed to be present in an array of tissues including the brain, heart, kidney and gonads. Our previous studies have provided solid evidence that several key elements of the RAS, notably angiotensinogen and renin, are present in the rat pancreas. The data support the existence of an intrinsic RAS in the pancreas and this local RAS may be important for the exocrine/endocrine functions of the pancreas. Interestingly, such a pancreatic RAS has been demonstrated to be markedly activated by experimental rat models of chronic hypoxia and acute pancreatitis. The activation of the pancreatic RAS by chronic hypoxia and experimental pancreatitis could play a role in the physiology and pathophysiology of the pancreas. The significant changes of pancreatic RAS may have clinical relevance to acute pancreatitis and hypoxia-induced injury in the pancreas.

  8. A murine model of obesity implicates the adipokine milieu in the pathogenesis of severe acute pancreatitis.

    Zyromski, Nicholas J; Mathur, Abhishek; Pitt, Henry A; Lu, Debao; Gripe, John T; Walker, Julia J; Yancey, Kyle; Wade, Terence E; Swartz-Basile, Deborah A

    2008-09-01

    Obesity is clearly an independent risk factor for increased severity of acute pancreatitis (AP), although the mechanisms underlying this association are unknown. Adipokines (including leptin and adiponectin) are pleiotropic molecules produced by adipocytes that are important regulators of the inflammatory response. We hypothesized that the altered adipokine milieu observed in obesity contributes to the increased severity of pancreatitis. Lean (C57BL/6J), obese leptin-deficient (LepOb), and obese hyperleptinemic (LepDb) mice were subjected to AP by six hourly intraperitoneal injections of cerulein (50 microg/kg). Severity of AP was assessed by histology and by measuring pancreatic concentration of the proinflammatory cytokines IL-1beta and IL-6, the chemokine MCP-1, and the marker of neutrophil activation MPO. Both congenitally obese strains of mice developed significantly more severe AP than wild-type lean animals. Severity of AP was not solely related to adipose tissue volume: LepOb mice were heaviest; however, LepDb mice developed the most severe AP both histologically and biochemically. Circulating adiponectin concentrations inversely mirrored the severity of pancreatitis. These data demonstrate that congenitally obese mice develop more severe AP than lean animals when challenged by cerulein hyperstimulation and suggest that alteration of the adipokine milieu exacerbates the severity of AP in obesity. PMID:18583460

  9. The Imaging Assessment of the Severity of Acute Pancreatitis May Change in the Near Future

    Raffaele Pezzilli

    2005-09-01

    Full Text Available The diagnosis and the assessment of the severity of acute pancreatitis has been completely revolutionized by the routine use of dynamic contrast-enhanced computed tomography (CT in clinical practice. Furthermore, objective CT assessment of the disease has made the various diagnostic and therapeutic studies on acute pancreatitis comparable for the first time [1, 2, 3, 4]. CT has two major roles for patients with suspected acute pancreatitis: to evaluate the severity of the inflammatory process and to detect the complications of the disease , such as the identification and quantification of parenchymal necrosis early. The CT severity index proposed by Balthazar et al. [5] is at present largely applied in all pancreatological centers in the world in order to assess and to stratify the severity of acute pancreatitis. Because the CT findings of necrosis may be equivocal during the first 24-48 hours, it has been suggested that the initial CT scan obtained in patients with clinically severe acute pancreatitis should be done after this period [6, 7]. CT is also largely used to obtain pancreatic specimens for microbiological examination in order to detect the presence of bacterial contamination in pancreatic necrosis [8]; using this imaging technique, we are also able to treat some of the complications of acute pancreatitis such as infected fluid collections and pseudocysts [9, 10].

  10. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis

    En-Qiang Mao; Yao-Qing Tang; Sheng-Dao Zhang

    2003-01-01

    AIM: To investigate a formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis (HL-SAP).METHODS: Thirty-two consecutive patients with severe acute pancreatitis were included in the clinical trial. All of them met the following five criteria for admission to the study, namely the Atlanta classification and stratification system for the clinical diagnosis of SAP, APACHEII score more than 8, time interval for therapeutic intervention less than 72 hours after onset of the disease, serum triglyceride (TG) level 6.8 mmol/l or over, and exdusion of other etiologies.They were divided into severe acute pancreatitis group (SAP,22 patients) and fulminant severe acute pancreatitis group (FSAP, 10 patients). Besides the conventional therapeutic measures, Penta-association therapywas also applied in the two groups, which consisted of blood purification (adsorption of triglyceride and hemofiltration), antihyperlipidemic agents (fluvastatin or lipanthyl), low molecular weight heparin (fragmin), insulin, topical application of Pixiao (a traditional Chinese medicine) over the whole abdomen, serum triglyceride,pro-inflammatory cytokines and anti-inflammatory cytokines were determined before blood purification (PF), at the end of blood purification (AFE) and on the 7th day after onset of the disease (AF7) respectively. Simultaneously, severity of the diseases was assessed by the APACHE Ⅱ system.Prognosis was evaluated by non-operation cure rate,absorption rate of pseudocyst, time interval pseudocyst absorption, hospital stay and survival rate.RESULTS: Serum triglyceride level (mmol/L), TNFα (U/mi) concentration and APACHE Ⅱ score were significantly decreased (P<0.05) at AFE and AF7, as compared with PF.However, serum IL-10 concentration (pg/ml) was increased significantly (P<0.001) at AFE, and decreased significantly (P<0.05) at AF7 when compared with PF. Operations: The First surgical intervention time was 55.8±42.6 days in SAP group (5 patients) and

  11. Replacement Gastrostomy Tube Causing Acute Pancreatitis: Case Series with Review of Literature

    Anish M Shah

    2012-01-01

    Full Text Available Context Percutaneous endoscopic gastrostomy (PEG feedings are generally considered safe with few serious complications. Acute pancreatitis is a rare complication associated with replacement percutaneous endoscopic gastrostomy tubes. Case report We report two cases of acute pancreatitis induced by migrated replacement percutaneous endoscopic gastrostomy tubes. Conclusions Migration of a balloon into the duodenum can result in external manipulation of the ampulla of Vater thereby disturbing the flow of pancreatic secretions leading to acute pancreatitis. Recognition of this complication is important and should be included as potential etiology of acute pancreatitis in patients receiving percutaneous endoscopic gastrostomy feedings. Periodic examination and documentation of the distance of the balloon from the skin should be performed to document the position of the tubes or any inadvertent migration of the tubes. The use of Foley catheters as permanent replacement tubes should be considered medically inappropriate.

  12. Meandering Main Pancreatic Duct in a Case of Recurrent Acute Pancreatitis

    Mahesh Prakash

    2016-03-01

    Full Text Available Meandering main pancreatic duct is an anatomical variant of main pancreatic duct, characterized by abnormal configuration of the duct in pancreatic head region. Meandering pancreatic duct can be underlying cause for recurrent pancreatitis. This less common variant can be easily diagnosed on imaging, particularly magnetic resonance cholangiopancreatography.

  13. The effects of 2-aminoethyl diphenylborinate on L-Arginine induced acute pancreatitis in the rats

    Yildar, Murat; Basbug, Murat; Ozkan, Omer Faruk; Cavdar, Faruk; YAMAN, Ismail; Aksit, Hasan; Ozyigit, Musa Ozgür; ASLAN, Figen; Derici, Hayrullah

    2015-01-01

    Intraduction: The aim of the study is to investigate the protective effect of 2-aminoethyl diphenylborinate  on an acute pancreatitis model through an experimental study.Materials and Methods: 30 Spraque-Dawley male rats were randomly divided into three groups:  Sham ,  Pancreatitis and  Pancreatitis + 2-APB. Pancreatitis was induced by L-arginine administration. The therapeutic agent 2-APB was performed i.v. at a dose of 2 mg/kg 10 min before pancreatitis induction. From blood samples, super...

  14. Asparaginase-associated pancreatitis in children with acute lymphoblastic leukaemia in the NOPHO ALL2008 protocol

    Raja, Raheel A; Schmiegelow, Kjeld; Albertsen, BK;

    2014-01-01

    L-asparaginase is an important drug in the treatment of childhood acute lymphoblastic leukaemia (ALL). Treatment is associated with several toxicities, including acute pancreatitis. Clinical course, presentation, re-exposure to L-asparginase after pancreatitis and risk of recurrent pancreatitis...... within an asparaginase-intensive protocol has been poorly reported. Children (1-17 years) on the ongoing Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL2008 protocol with asparaginase-associated pancreatitis (AAP) diagnosed between 2008 and 2012 were identified through the online NOPHO...

  15. Acute Pancreatitis with Rapid Clinical Improvement in a Child with Isovaleric Acidemia

    Elpis Mantadakis

    2013-01-01

    Full Text Available Isovaleric acidemia is a rare branched-chain organic acidemia. The authors describe a 3.5-year-old girl with isovaleric acidemia and acute abdominal pain associated with bilious emesis. Elevated serum amylase and abdominal ultrasonography demonstrating an enlarged and edematous pancreas, along with the presence of peripancreatic exudates, confirmed the presence of acute pancreatitis. The patient recovered quickly with intravenous hydration, pancreatic rest, and administration of intravenous L-carnitine. Pancreatitis should be ruled out in the context of vomiting in any patient with isovaleric acidemia. Conversely, branched-chain organic acidemias should be included in the differential diagnosis of any child with pancreatitis of unknown origin.

  16. Significance of extrapancreatic findings in computed tomography (CT) of acute pancreatitis

    Computed tomography (CT) has proven reliable in the early detection of acute haemorrhagic pancreatitis. In the present study the extrapancreatic changes at CT were studied in 60 patients with acute pancreatitis. The CT findings were correlated to the early 'prognostic signs' by Ranson and the clinical course of the disease. All the patients with minor extrapancreatic changes recovered without complications. When moderate to severe extrapancreatic changes were seen the incidence of haemorrhagic pancreatitis and the risk of development of pseudocyst or abscess was high. In these patients a dynamic contrast enhanced CT should be done in order to select the patients with haemorrhagic pancreatitis. (orig.)

  17. Effect of somatostatin on the sphincter of Oddi in patients with acute non-biliary pancreatitis

    Lai, K.; Lo, G.; Cheng, J; Fu, M; Wang, E; Chan, H.; Wang, Y.; P. Hsu; Lin, C.

    2001-01-01

    BACKGROUND—Somatostatin has been used to prevent pancreatitis after endoscopic retrograde cholangiopancreatography but its effect on acute non-biliary pancreatitis is still unclear.
AIM—The purpose of this study was to evaluate the function of the sphincter of Oddi (SO) and the effect of somatostatin on patients with non-biliary pancreatitis.
METHODS—Twenty patients (18 males, two females) with acute pancreatitis (alcoholic 18, idiopathic two) received SO manometry within one week after admis...

  18. Clinical Implications and Risk Factors of Acute Pancreatitis after Cardiac Valve Surgery

    Chung, Joo Won; Ryu, Sung Ho; Jo, Jung Hyun; Park, Jeong Youp; Lee, Sak; Park, Seung Woo; Song, Si Young; Chung, Jae Bock

    2012-01-01

    Purpose Acute pancreatitis is one of the potentially lethal complications that occurs after cardiac surgery. We tried to identify risk factors for and the prognosis of acute pancreatitis after cardiac valve surgery with cardiopulmonary bypass. Materials and Methods We retrospectively analyzed a database of consecutive patients who underwent cardiac valve surgery with cardiopulmonary bypass between January 2005 and April 2010 at our institution. Patients were classified as having acute pancrea...

  19. A clinical study of complications of acute pancreatitis and their outcome

    Sajjad Hussain; Rakesh Saraf

    2015-01-01

    Aim: The aim was to study the complications of acute pancreatitis, the outcome of complications, and to find out methods of improving the outcome. Materials and Methods: This is a descriptive study of patients admitted with acute pancreatitis. The management and outcome of the complications were recorded in detail. For determining the severity and predicting the course of acute pan- creatitis, a multiple organ system failure (MOSF) scoring system was utilized. Results: 104 patients were...

  20. Inflammatory response in the early prediction of severity in human acute pancreatitis.

    Viedma, J A; M. Pérez-Mateo; Agulló, J.; Domínguez, J E; F. Carballo

    1994-01-01

    The role of the inflammatory response in acute pancreatitis and its relation with the clinical course was examined. This study examined if the serial measurement of polymorphonuclear granulocyte (PMN) elastase/A1PI complex, phospholipase A catalytic activity, C reactive protein, and other acute phase proteins, and the protease inhibitor alpha 2-macroglobulin, provides meaningful information for prognosis. Eighty non-consecutive patients with acute pancreatitis, classified according to their c...

  1. Adenomyomatous hyperplasia of the ampulla of Vater presenting as acute pancreatitis

    Rafiullah,; Tanimu, Sabo

    2014-01-01

    We report an interesting and rare case of a man with adenomyomatous hyperplasia of the ampulla of Vater presenting as acute pancreatitis, which to our knowledge, is only the second reported case in the English literature. The patient presented with an acute onset of abdominal pain, nausea and vomiting, without fever, chills or rigours. CT of the abdomen revealed changes of acute pancreatitis with a peripancreatic adenopathy, and abdominal ultrasound revealed a slightly hyperechoic and oedemat...

  2. A mouse model of severe acute pancreatitis induced with caerulein and lipopolysaccharide

    Shi-Ping Ding; Ji-Cheng Li; Chang Jin

    2003-01-01

    cells was seriously damaged in the Cn+LPS group. Chromatin margination of nuclei was present, the number and volume of vacuoles greatly increased. Zymogen granules (ZGs) were greatly decreased in number and endoplasmic reticulum exhibited whorls. The swollen mitochondria appeared, the crista of which was decreased in number or disappeared.(3) Pancreatic weight and serum amylase levels in the Cn +LPS was significantly higher than those of the NS group and the LPS group respectively (P<0.01 or P<0.05).However, the pancreatic wet weight and serum amylase concentration showed no significant difference between the Cn+LPS group and the Cn group. (4) NO concentration in the Cn+LPS group was significantly higher than that of NS group, LPS group and Cn group(P<0.05 or P<0.01). 5) The SOD and MDA concentration of the pancreas in the Cn+LPS group were significantly higher than those of NS, LPS and Cn groups (P<0.05 or P<0.01).CONCLUSION: The mouse model of severe acute pancreatitis could be induced with caerulein and LPS, which could be non-traumatic and easy to induce, reproducible with the same pathological characteristics as those of SAP in human, and could be used in the research on the mechanism of human SAP.

  3. Acute Pancreatitis from Mumps Re-infection in Adulthood. A Case Report

    Atsuko Taii

    2008-05-01

    Full Text Available Context Acute pancreatitis is a complication of mumps which mainly affects children who then usually acquire permanent immunity. We present the case of a woman with acute pancreatitis caused by mumps re-infection in adulthood. Case report A 34-year-old woman developed mild acute pancreatitis caused by re-infection with mumps, as confirmed serologically by enzyme-linked immunosorbent assays mumps -specific IgM and IgG. Acute pancreatitis was indicated by the elevation of amylase and other pancreatic enzymes such as lipase and elastase-1 as well as by swelling of the pancreatic head visualized by abdominal computed tomography. The abdominal symptoms were resolved soon after the administration of a pancreatic enzyme inhibitor. As the swelling of the right and left parotids decreased, serum amylase levels also gradually normalized. Conclusion We believe that this is the first reported case of acute pancreatitis caused by mumps re-infection in an adult. Such reinfection should be considered a possible though rare

  4. Protective effect of Mimosa pudica L. in an L-arginine model of acute necrotising pancreatitis in rats.

    Kaur, Jagdeep; Sidhu, Shabir; Chopra, Kanwaljit; Khan, M U

    2016-07-01

    Mimosa pudica is used in traditional medicine for treating various disorders such as inflammatory conditions, diarrhoea, insomnia, alopecia, urogenital infections and wounds. The present study investigated the effect of M. pudica extract (MPE) on L-arginine-induced acute necrotising pancreatitis in rats. The ethanolic extract of M. pudica leaves was studied for the presence of quercetin and gallic acid using high-performance liquid chromatography. Four groups were employed-normal control rats, L-arginine control rats (two intraperitoneal [i.p.] injections of 2 g/kg at an interval of 1 h), MPE-treated rats (400 mg/kg orally) and melatonin-treated rats (positive control 10 mg/kg i.p.), which were further divided into subgroups according to time points (24 h, 3 days and 14 days). Serum amylase, lipase, tumour necrosis factor-α (TNF-α), pancreatic amylase, nucleic acid content, protein, transforming growth factor-β1 (TGF-β1), thiobarbituric reactive substances, glutathione, nitrite/nitrate, collagen content and histopathological examination were carried out. MPE significantly improved acute necrotising pancreatitis by modulating diagnostic markers of pancreatitis such as serum lipase and pancreatic amylase, inflammation (TNF-α), and oxidative and nitrosative stress. Moreover, MPE administration induced regenerative changes in the pancreas evidenced by increased levels of pancreatic proteins, nucleic acid content and histopathology report. In addition, MPE improved TGF-β1 and collagen levels thereby preventing fibrosis. The current investigation indicates the novel role of MPE in reducing the severity of acute necrotising pancreatitis by plausible mechanisms such as anti-inflammatory and anti-fibrotic activity and by promoting repair and regeneration of the pancreas. PMID:27164910

  5. Serum interleukin 10 and interleukin 11 in patients with acute pancreatitis

    Chen, C.; Wang, S.; Lu, R; Chang, F.; Lee, S.

    1999-01-01

    BACKGROUND—Proinflammatory and anti-inflammatory cytokines are involved in the pathogenesis of acute pancreatitis.
AIMS—To measure the serial serum levels of interleukin 10 and interleukin 11 in patients with acute pancreatitis and analyse the relation of these anti-inflammatory cytokines to disease severity.
METHODS—In 50 patients with acute pancreatitis, the serum concentrations of interleukin 10 and interleukin 11 were determined on days one, two, three, four, and seven after admission. Se...

  6. Acute pancreatitis with eclampsia-preeclampsia syndrome and poor maternal outcome: two case reports and review of literature.

    Gainder, Shalini; Arora, Parul; Saha, S C; Kaman, Lileswar

    2015-09-01

    Acute pancreatitis in pregnancy is a rare entity and has been reported to be associated with preeclampsia in the literature. Fulminant pancreatitis may have a guarded prognosis despite intensive multidisciplinary management. Two cases of maternal mortality in women with acute pancreatitis noted in the setting of preeclampsia-eclampsia syndrome are reported here. PMID:27512470

  7. Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

    Ming-Jun Xin; Hong Chen; Bin Luo; Jia-Bang Sun

    2008-01-01

    AIM: To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (≥60 years of age).METHODS: We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007.RESULTS: In 169 patients with SAP, 94 were elderly and 16 died.Biliary and idiopathic etiologies were the first two causes that accounted for over 90% of SAP in the elderly.Biliary, hyperlipemic and alcoholic etiologies were the first three causes in the young.The proportion of comorbidity of cholelithiasis, biliary infection, hypertension and coronary heart disease in the aged was significantly higher than that in their young partners.The scores of APACHE Ⅱ and Ranson were also significantly higher in the elderly except the CT score.Organ failures were more common in the elderly, but the local pancreatic complications were not different between the two groups.Mortality of the aged was correlated with the severity of SAP, multiple co-morbidity and incidence of multiple organ dysfunction syndrome (NODS).NODS was the main cause of death.CONCLUSION: The etiology of SAP in the elderly is quite different from that in the young.Biliary and unknown factors are main causes in the aged.The elderly are subject to major organ failures but there is no difference in the occurrence of local pancreatic complications between the elderly and the young.It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with SAP.

  8. Small Cell Carcinoma of the Lung Presented as Acute Pancreatitis. Case Report and Review of the Literature

    Abdulzahra Hussain

    2012-11-01

    Full Text Available Context Small cell carcinoma of the lung is an aggressive cancer with gloomy prognosis. Links to acute pancreatitis is extremely rare. Case report We are reporting a 53-year-old patient who was admitted because of acute pancreatitis. She had no history of gallstones, alcohol abuse, medications or any other predisposition for acute pancreatitis. Further investigations of blood, CT of chest abdomen and neck and ultrasound scan of abdomen, bone marrow and neck lymph node biopsies confirmed advanced small cell carcinoma of the lung with hypercalcemia, which was the only definite cause of acute pancreatitis. The patient made good recovery from pancreatitis after controlling the hypercalcemia. She was referred to respiratory team for further management of lung cancer. Conclusion Acute pancreatitis due to hypercalcemia of advanced small cell carcinoma of the lung is an extremely rare condition. Acute pancreatitis due to hypercalcemia should be thoroughly investigated to exclude serious pathology as in our case.

  9. Splenic artery pseudoaneurysm due to acute pancreatitis in a 6-year-old boy with acute lymphoblastic leukaemia treated with L-aspariginase

    Larsen, Cæcilie Crawley; Laursen, Christian B; Dalby, Kasper;

    2014-01-01

    Acute pancreatitis is a rare phenomenon in children but its incidence seems to be increasing. In children, it is generally caused due to systemic illness, biliary disease, trauma, idiopathy and side effects of medicines like L-aspariginase. Acute pancreatitis is difficult to diagnose in children...... pseudoaneurysm due to acute pancreatitis in a 6-year-old boy with acute lymphoblastic leukaemia treated with L-aspariginase. He presented with fever, irritability and pain in his left groin region....

  10. Early Treatment of Acute Pancreatitis: Do Not Forget the Need for Water

    Raffaele Pezzilli

    2011-09-01

    Full Text Available FV: fluid volume; FV48: fluid volume administered during the initial 48 h; FVH: fluid volume during hospitalization; FVR: FV ratio as FV48/FVH An Italian survey on the treatment of acute pancreatitis published in 2007 [1] assessed the compliance of 56 medical and surgical centers equally distributed throughout Italy to the Italian guidelines on acute pancreatitis [2]. The severity of the disease was clinically assessed according to the Atlanta criteria [3] and the majority of patients were observed and treated early after the onset of acute pancreatitis; in fact, the mean interval between the onset of pain and hospital admission was 14.9±37.2 hours (mean±SD in patients with mild acute pancreatitis and 17.8±39.1 hours (mean±SD in those with severe pancreatitis. One of the results of this study was that the amount of fluids administered to acute pancreatitis patients was significantly higher in patients with severe acute pancreatitis than in those with the mild form. The appropriate fluid replacement may be one of reasons for the low mortality (3.1% observed in the patients with acute pancreatitis enrolled in this study. Low mortality due to early fluid administration is now supported by the findings of three recent studies coming from Japan and the United States [4, 5, 6]. In the first study we examined [4], the authors revised the data of 9,489 acute pancreatitis patients 18 years of age or older who were categorized into four study groups: ventilation, hemodialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. They analyzed the fluid volume (FV administered during the initial 48 h (FV48 and during hospitalization (FVH, and calculated the FV ratio (FVR as FV48/FVH. The authors found that FV48 and FVR were higher in patients requiring ventilation as compared to those not requiring ventilation.

  11. CLINICAL STUDY OF ACUTE PANCREATITIS WITH SPECIAL REFERENCE TO RANSONS PROGNOSTIC CRITERIA

    Sudhir

    2016-02-01

    Full Text Available INTRODUCTION The pancreas is perhaps the most unforgiving organ in the human body and with its critical endocrine functions and its exocrine portion is a major source of extremely potent digestive enzymes Pancreatic diseases are very complex and acute pancreatitis is associated with high morbidity and mortality rates. Early diagnosis of pancreatitis, its severity evaluation and adequate intensive care are highly essential for the reduction in morbidity and mortality. There are various criteria to assess the severity of acute pancreatitis like Ranson’s criteria, The Acute Physiology and Chronic Health Evaluation II (APACHE II score, Glasgow score etc. Ranson’s criteria is most frequently and accurate method to assess the severity and mortality associated with acute pancreatitis because of its relative easy tabulation and resulting scores well correlated with morbidity and mortality. OBJECTIVES To study the clinical presentation, complications and prognosis of patients with acute pancreatitis during the study period. To study the correlation of Ranson’s criteria in acute pancreatitis with prognosis of the patient. METHODS Prospective study conducted in period ranging from November 2012 to October 2014 who admitted in JSS Hospital, Mysore in the Department of surgery satisfying inclusion criteria were taken into study. RESULTS Patients with low Ranson’s score had shorter hospital duration and majority recovered by the time of discharge. High Ranson’s score predicts long hospital stay and increased morbidity and mortality. In our study it predicted long hospital study but could not predict significant morbidity or mortality. CONCLUSION Ranson’s criteria is the best prognostic tool in assessing the severity of the acute pancreatitis and also defines the need for early aggressive management in acute severe pancreatitis to reduce morbidity and mortality.

  12. Clinical significance of serum triglyceride elevation at early stage of acute biliary pancreatitis

    Cheng, Long; Luo, Zhulin; Xiang, Ke; Ren, Jiandong; Huang, Zhu; Tang, Lijun; Tian, Fuzhou

    2015-01-01

    Background Pancreatitis induced by hypertriglyceridemia (HTG) has gained much attention. However, very limited numbers of studies have focused on the clinical significance of TG elevation in non-HTG induced pancreatitis, such as acute biliary pancreatitis (ABP). This study aimed to study the clinical significances of triglyceride (TG) elevation in patients with ABP. Methods We retrospectively analyzed a total of 426 ABP cases in our research center. According to the highest TG level within 72...

  13. CLINICAL STUDY OF ACUTE PANCREATITIS WITH SPECIAL REFERENCE TO RANSONS PROGNOSTIC CRITERIA

    Sudhir; Venkatesh,

    2016-01-01

    INTRODUCTION The pancreas is perhaps the most unforgiving organ in the human body and with its critical endocrine functions and its exocrine portion is a major source of extremely potent digestive enzymes Pancreatic diseases are very complex and acute pancreatitis is associated with high morbidity and mortality rates. Early diagnosis of pancreatitis, its severity evaluation and adequate intensive care are highly essential for the reduction in morbidity and mortality. There are...

  14. Acute pancreatitis in pregnancy: A treatment paradigm based on our hospital experience

    Juneja, Sunil Kumar; Gupta, Shweta; Virk, Satpal Sing; Tandon, Pooja; Bindal, Vidushi

    2013-01-01

    Background: Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 pregnancies. The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts, and multiple organ dysfunction syndromes. As in any other disease associated with pregnancy, AP is associated with greater concerns as it deals with two lives rather than just one as in the nonpregnant population. AP is most often associated w...

  15. Prognosis of acute and chronic pancreatitis - a 30-year follow-up of a Danish cohort

    Nøjgaard, Camilla

    2010-01-01

    SUMMARY Acute and chronic pancreatitis are most frequently caused by a high consumption of alcohol and tobacco but often the aetiology is unknown. The diseases have a high risk of complications, but the long-term prognosis and the natural course of the diseases are only sparsely described. The aims...... of the study were to investigate the long-term prognosis of acute pancreatitis (AP) and chronic pancreatitis (CP), the risk of progression to CP, and the natural course of progressive acute pancreatitis. Hereby, describe the prognostic factors associated with mortality and the causes of death in...... these patients. The study was based on the large prospective cohort study - Copenhagen Pancreatitis Study - of patients in the Copenhagen Municipality admitted with either AP or CP fulfilling specific diagnostic criteria and enrolled in the study during 1977 to 1982 and in 2008 followed up by linkage to...

  16. CRP: AN AID TO ASSESS THE SEVERITY, COMPLICATIONS AND PROGNOSIS OF ACUTE PANCREATITIS

    Manoranjan Ujjaini

    2016-05-01

    Full Text Available BACKGROUND - AIMS Acute pancreatitis, a routine surgical emergency encountered, intensity of treatment depends on proper prognostic indicators to assess the severity of the disease. The present study investigated the use of C-reactive protein (CRP as prognosticator of the severity of the disease. METHODS Fifty-eight patients with acute pancreatitis were studied. Serum samples for measurement of CRP were collected on the day of admission and additionally on the 5 th day, CT Balthazar scoring was done in each of the cases and severity assessed. RESULTS The mean serum CRP in people with mild pancreatitis was 39 U/L and that in those suffering with severe pancreatitis was 127.93, this difference was statistically significant (p<0.001. CONCLUSIONS Measurement of CRP levels seem to be an accurate method in order to assess the extent and persistence of the inflammatory process and progression of acute pancreatitis to severity and complications.

  17. The Role of Eugenol in the Prevention of Acute Pancreatitis-Induced Acute Kidney Injury: Experimental Study

    Charalampos Markakis; Alexandra Tsaroucha; Papalois, Apostolos E.; Maria Lambropoulou; Eleftherios Spartalis; Christina Tsigalou; Konstantinos Romanidis; Constantinos Simopoulos

    2016-01-01

    Aim. Acute pancreatitis is an inflammatory intra-abdominal disease, which takes a severe form in 15–20% of patients and can result in high mortality especially when complicated by acute renal failure. The aim of this study is to assess the possible reduction in the extent of acute kidney injury after administration of eugenol in an experimental model of acute pancreatitis. Materials and Methods. 106 male Wistar rats weighing 220–350 g were divided into 3 groups: (1) Sham, with sham surgery; (...

  18. Effect of Vagotomy on Acute Pancreatitis in Rats

    2000-01-01

    One hundred and eighty-two SD rats were randomly divided into the normal control group, fast operating group and food-intake operating group. The experimental model of acute pancreatitis (AP) in rats was established by injecting 5 % sodium taurocholate into the pancreatic duct of rat according to Aho's method. The sandostatin was used for positive contrast. The concentrations of serum amylase, calcium, C reaction protein (CRP) and interleukin-6 (IL-6) were assayed respectively at different time points. The pathological sections were observed. Each operating group contained 10 rats. The mortality of the operating groups was observed during the 24 h. The serum amylase level in the AP rats was reduced after receiving vagotomy (VG, P<0.05). Although the serum calcium level in most groups was decreased, the reduction in the group with VG plus sandostatin was not obvious (P>0.05). The increase of CRP and IL-6 was not obvious after VG (P>0.05). The change of mortality was not significant (P>0.05). The pathological sections showed that the AP pathological change was mild after VG. The disease condition of food-intake operating group was more serious than that of fast operating group. It was suggested that VG had some influence on the prognosis of AP in rats.

  19. Soluble epoxide hydrolase deficiency ameliorates acute pancreatitis in mice.

    Bettaieb, Ahmed; Morisseau, Christophe; Hammock, Bruce; Haj, Fawaz

    2014-10-01

    Acute pancreatitis (AP) is a frequent gastrointestinal disorder that causes significant morbidity and its incidence has been progressively increasing. AP starts as a local inflammation in the pancreas that often leads to systemic inflammatory response and complications. Soluble epoxide hydrolase (sEH) is a cytosolic enzyme whose inhibition in murine models has beneficial effects in inflammatory diseases, but its significance in AP remains unexplored. To investigate whether sEH may have a causal role in AP we utilized sEH knockout (KO) mice to determine the effects of sEH deficiency on ceruelin- and arginine-induced AP. sEH expression increased at the protein and messenger RNA levels, as well as sEH activity in the early phase of cerulein- and arginine-induced AP in mice. In addition, amylase and lipase levels were lower in cerulein-treated sEH KO mice compared with non-treated controls. Moreover, pancreatic mRNA and serum concentrations of the inflammatory cytokines IL-1ß and IL-6 were lower in sEH KO mice compared with controls. Further, sEH KO mice exhibited decreased cerulein- and arginine-induced NF-?B inflammatory response, MAPKs activation and decreased cell death. These findings demonstrate a novel role for sEH in the progression of cerulein- and arginine-induced AP. PMID:26461340

  20. Inlfammatory mediators and microcirculatory disturbance in acute pancreatitis

    Xi-Ping Zhang; Zhi-Jun Li; Jie Zhang

    2009-01-01

    BACKGROUND: Inlfammatory mediators are not only initiation factors of acute pancreatitis (AP) but also key factors causing pancreatic hemorrhage and necrosis, which damage important organs such as the heart, brain, liver, kidney and lung. Microcirculatory disturbance in AP has attracted widespread attention. In order to provide a theoretical basis for clinical therapy of AP, it is very important to explore the effect of inlfammatory mediators on microcirculatory disturbance in this disease. DATA SOURCES: In this review, the impact of inlfammatory mediators on microcirculatory disturbance in AP was reviewed according to the literature, especially the articles indexed in PubMed and books published in China and reports from websites. RESULTS: At present, inlfammatory mediation and micro-circulatory disturbance are the two major hypotheses to explain the development of AP. Although experimental studies have shown that inlfammatory mediators induce or aggravate microcirculatory disturbance, the clinical application of these ifndings is still dififcult because the inlfammatory mediators are diverse and their research is not comprehensive and thorough. CONCLUSION: It is very important to explore the inlfuence of inlfammatory mediators on microcirculatory disturbance in AP.