WorldWideScience

Sample records for acute pancreatitis due

  1. Acute chylous peritonitis due to acute pancreatitis.

    Science.gov (United States)

    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.

  2. Acute chylous peritonitis due to acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia.

    Science.gov (United States)

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

    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 with AP due to hypertriglyceridemia (HPTG), which is a rare cause of pancreatitis, and splenic vein thrombosis, which is a rare complication of pancreatitis.

  4. Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia

    Directory of Open Access Journals (Sweden)

    Ercan Gündüz

    2015-01-01

    Full Text Available 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 with AP due to hypertriglyceridemia (HPTG, which is a rare cause of pancreatitis, and splenic vein thrombosis, which is a rare complication of pancreatitis.

  5. Acute pancreatitis

    Science.gov (United States)

    ... its blood vessels. This problem is called acute pancreatitis. Acute pancreatitis affects men more often than women. Certain ... pancreatitis; Pancreas - inflammation Images Digestive system Endocrine glands Pancreatitis, acute - CT scan Pancreatitis - series References Forsmark CE. Pancreatitis. ...

  6. Acute pancreatitis due to ascariasis: a sonographic pictorial essay on four cases.

    Science.gov (United States)

    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.

  7. Acute pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  8. Acute pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  9. Acute Pancreatitis and Pregnancy

    Science.gov (United States)

    ... Pancreatitis Acute Pancreatitis and Pregnancy Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as ... pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for almost 1 ...

  10. [Chronic pancreatitis, acute pancreatitis].

    Science.gov (United States)

    Mabuchi, T; Katada, N; Nishimura, D; Hoshino, H; Shimizu, F; Suzuki, R; Sano, H; Kato, K

    1998-11-01

    MRCP has been recognized as a safe and noninvasive diagnostic method. In the present study we evaluated the usefulness of MRCP in diagnosis of chronic and acute pancreatitis. Two-dimensional fast asymmetric spin-echo (FASE) MRCP was performed in 40 patients with chronic pancreatitis and 13 with acute pancreatitis. In 29 patients (72.5%) with chronic pancreatitis and 9 (66.7%) with acute pancreatitis, main pancreatic duct (MPD) was visualized entirely. MRCP could demonstrate the characteristic findings of chronic pancreatitis such as dilatation and irregularity of MPD in most cases. In acute pancreatitis, MRCP indicated that MPD was normal in diameter, but irregular in configuration compared with that of the control group. MRCP may facilitate the diagnosis of chronic and acute pancreatitis.

  11. ERCP in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  12. Pancreatic Juice Culture in Acute Pancreatitis and Other Pancreatic Disorders

    Directory of Open Access Journals (Sweden)

    Masataka Kikuyama

    2016-09-01

    Full Text Available We retrospectively evaluated the results of pancreatic juice cultures of patients with acute pancreatitis and other pancreatic disorders. Methods Twenty patients who underwent pancreatic juice culture were studied. Nine had acute pancreatitis due to alcohol (n=5, idiopathic causes (n=2, drugs (n=1, or gallstones (n=1, and remaining 11 had other pancreatic disorders such as an intraductal papillary mucin-producing neoplasm (n=3 and main pancreatic duct dilatation with a stricture due to a tumorous lesion suspected of pancreatic cancer (n=7 or chronic pancreatitis (n=1 without symptoms. Nasopancreatic drainage tubes were placed for pancreatic duct drainage in acute pancreatitis and for pancreatic juice cytology in other disorders. Pancreatic juice was obtained through the drainage tube and cultured. Results Pancreatic juice cultures were positive in all patients with acute pancreatitis for Staphylococcus epidermidis, Streptococcus species, and others. Six among 11 patients (54.5% with other disorders showed positive results for Escherichia coli, Streptococcus salivarius, and others. The rate of positive pancreatic juice cultures was significantly higher in acute pancreatitis (p=0.038. Seven of the 9 patients with acute pancreatitis were classified as having severe acute pancreatitis, and all survived treatment. Conclusions Pancreatic juice culture was highly positive in acute pancreatitis. Further study is needed to confirm the relationship between orally indigenous bacteria identified in the pancreatic juice and acute pancreatitis.

  13. Splenic artery pseudoaneurysm due to acute pancreatitis in a 6-year-old boy with acute lymphoblastic leukaemia treated with L-aspariginase

    DEFF Research Database (Denmark)

    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....

  14. Acute Pancreatitis due to Rupture of the Hydatid Cyst into the Biliary Tract: A Case Report

    Directory of Open Access Journals (Sweden)

    Zulfu Bayhan

    2014-02-01

    Full Text Available Hydatid disease is still endemic in our country and in many parts of the world. Liver is the most common site of hydatid disease. Rupture of hydatid cysts of liver into the biliary ducts can be seen as a complication. Obstructive jaundice, acute cholangitis and much more rarely acute pancreatitis may occur due to rupture of hydatid cysts into the biliary ducts. In this case report, a 38-year-old male patient with findings of acute pancreatitis and obstructive jaundice due to rupture of hydatid cyst into the biliary tract were presented . In our case, Endoscopic retrograde cholangiopancreatography (ERCP was performed to the patient with diagnostic and therapeutic purposes. Parts of germinative membrane located within the common bile duct and causing the obstruction of papillary orifice was seen in ERCP. Germinative membrane components were removed during the process. Endoscopic sphincterotomy was performed to the patient. After the procedure, the clinical findings and laboratory findings of the patient returned to normal rapidly. As a result, it should be noted that rupture of hepatic hydatid cysts into the bile ducts might be a rare cause of biliary pancreatitis. It must be kept in mind that endoscopic sphincterotomy and endoscopic removal of cyst membranes is a very important method for the diagnosis and treatment of the acute pancreatitis and obstructive jaundice due to rupture of hydatid cyst into the biliary tract. [Natl J Med Res 2014; 4(1.000: 92-94

  15. Pentoxifylline Treatment in Acute Pancreatitis (AP)

    Science.gov (United States)

    2016-09-14

    Acute Pancreatitis (AP); Gallstone Pancreatitis; Alcoholic Pancreatitis; Post-ERCP/Post-procedural Pancreatitis; Trauma Acute Pancreatitis; Hypertriglyceridemia Acute Pancreatitis; Idiopathic (Unknown) Acute Pancreatitis; Medication Induced Acute Pancreatitis; Cancer Acute Pancreatitis; Miscellaneous (i.e. Acute on Chronic Pancreatitis)

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Loperamide-Induced Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Halla Vidarsdottir

    2013-01-01

    Full Text Available 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.

  18. Severe Acute Pancreatitis Due to Tamoxifen-Induced Hypertriglyceridemia with Positive Rechallenge

    Directory of Open Access Journals (Sweden)

    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.

  19. A Rare and Unexpected Side-Effect of Cannabis Use: Abdominal Pain due to Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Mehmet Husamettin Akkucuk

    2015-01-01

    Full Text Available 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.

  20. Readmissions due to acute biliary edematous pancreatitis in patients without cholecystectomy

    Directory of Open Access Journals (Sweden)

    Eva Barreiro-Alonso

    Full Text Available Objectives: Analyzing the readmission of patients with acute biliary edematous pancreatitis (ABEP without cholecystectomy despite a previous episode of mild acute gallstone pancreatitis or lithiasic cholecystitis. Calculating the health costs associated with the non-performance of cholecystectomy. Materials and methods: Prospective observational study conducted at a tertiary hospital (Hospital de Cabueñes. Gijón, Asturias. Spain from July to November 2014. The study has consecutively included inpatients suffering from ABEP who: a had suffered a previous episode of mild acute gallstone pancreatitis or cholecystitis at least 2 weeks before readmission; and b had not undergone cholecystectomy despite the lack of contraindications. Results: During the research period, 9 patients (7 females and 2 males with a mean age of 65.3 years (standard deviation [SD] 19.2 were readmitted. The median number of days between the previous episode of ABEP or cholecystitis and the readmission was 114 days (interquartile range [IQR] 111.0. Reported median overall length of hospital stay was 10 days (IQR = 2.0. Patients underwent a mean of 2.8 (SD = 1.2 ultrasound scans, 1.3 (SD = 0.9 abdominal and pelvic CT, 0.8 (SD = 1.0 MRCP and 0.2 (SD = 0.4 ERCP. The mean cost per patient for each readmission, including hospital stay (143.0 €/day, Emergency Service (332.31 € and tests performed was 2,381.70 €/patient. Conclusions: Not performing a cholecystectomy within two weeks after a first episode of mild ABEP or cholecystitis contributes to patient readmission due to recurrent pancreatitis, resulting in avoidable treatment costs.

  1. Acute portal vein thrombosis due to chronic relapsing pancreatitis: a fistula between a pancreatic pseudocyst and the splenic vein.

    Science.gov (United States)

    Kikuchi, Masahiro; Nishizaki, Yasuhiro; Tsuruya, Kota; Hamada, Ikuko; Higashi, Toru; Sakuma, Keiko; Shiozawa, Hirokazu; Aoki, Jun; Nagashima, Rena; Koizumi, Jun; Arase, Yoshitaka; Shiraishi, Koichi; Matsushima, Masashi; Mine, Tetsuya

    2014-02-01

    Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but several other causes might play an important role in PVT pathogenesis. We present a case of alcoholic chronic pancreatitis complicated by acute extensive PVT. The patient was managed conservatively with danaparoid sodium at first, but the thrombosis gradually extended. We then tried radiological intervention using the direct transhepatic and transjugular intrahepatic postsystemic shunt approaches. Although we were able to successfully catheterize the percutaneous transhepatic portal vein (PTP), we could not achieve recanalization of the portal vein. Therefore, PTP catheterization and systemic intravenous infusion of urokinase and heparin was performed to prevent further progression of the thrombosis and cavernous transformation was finally achieved. Computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a pancreatic stone which had possibly induced dilatation of the tail duct and formation of a pancreatic pseudocyst and caused intractable pancreatitis. We performed endoscopic retrograde cholangiopancreatography and placed a stent in the pancreatic duct, which completely cured the pancreatitis. Retrospectively, the previous CT with curved multi-planar reconstruction was reviewed and a fistula was detected between the pancreatic pseudocyst and splenic vein. We concluded that the etiology of the PVT was not only inflammatory extension from pancreatitis but also a fistula between the pancreatic duct and the splenic vein.

  2. Acute pancreatitis in children

    Directory of Open Access Journals (Sweden)

    Jokić Radoica

    2012-01-01

    Full Text Available Introduction. Acute pancreatitis in children is mostly due to abdominal trauma, diseases or congenital anomalies of the biliary-pancreatic tree. Both exogenous and endogenous functions of the gland could be disturbed by various levels of damage. Clinical Finding and Diagnostics. Acute abdominal pain, gastrointestinal signs and general deterioration are the main clinical findings. The examination can be completed by blood and urine tests of amylase, electrolytes level, and the C-reactive protein. In addition to these tests, ultrasound, computed tomography and endoscopy are required as well. Therapeutic Methods. The therapy of choice is non-operative treatment using medicaments to control the pain, decrease the pancreatic activity and prevent further complications. If the conservative treatment fails, the surgical approach is necessary: drainage, resections, by-pass procedures, etc. Conclusion. Acute pancreatitis is a very serious disease in childhood. Clinical experience and rational approach are very important in the diagnostic and therapeutic methods.

  3. Point-of-Care Ultrasound in Necrotizing Acute Pancreatitis Complicated by Perforated Ileum Due to Nonocclusive Mesenteric Ischemia

    Directory of Open Access Journals (Sweden)

    Sonia López-Cuenca

    2016-09-01

    Full Text Available Necrotizing acute pancreatitis is the most severe form of pancreatitis, and it is a potentially life-threatening condition. Its diagnosis and severity are based on radiological signs. Although computed tomography is the most used imaging tool, ultrasound can be a quick and useful technique in emergency and intensive care scenarios. The use of abdominal ultrasound is generally limited to ruling out cholecystitis. Bowel gas can limit the accuracy of pancreatic imaging. When the pancreas is visualized, ultrasound can reveal pancreatic enlargement, echotextural changes, and peripancreatic fluid. We present a patient with necrotizing pancreatitis who developed peritonitis due to ileal perforation, where the use of ultrasound as a bedside imaging technique was very useful.

  4. Imaging of Acute Pancreatitis.

    Science.gov (United States)

    Thoeni, Ruedi F

    2015-11-01

    Acute pancreatitis is an acute inflammation of the pancreas. Several classification systems have been used in the past but were considered unsatisfactory. A revised Atlanta classification of acute pancreatitis was published that assessed the clinical course and severity of disease; divided acute pancreatitis into interstitial edematous pancreatitis and necrotizing pancreatitis; discerned an early phase (first week) from a late phase (after the first week); and focused on systemic inflammatory response syndrome and organ failure. This article focuses on the revised classification of acute pancreatitis, with emphasis on imaging features, particularly on newly-termed fluid collections and implications for the radiologist.

  5. [Etiological factors of acute pancreatitis].

    Science.gov (United States)

    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

  6. Pancreatic pseudocyst after acute organophosphate poisoning.

    Science.gov (United States)

    Kawabe, Ken; Ito, Tetsuhide; Arita, Yoshiyuki; Sadamoto, Yojiro; Harada, Naohiko; Yamaguchi, Koji; Tanaka, Masao; Nakano, Itsuro; Nawata, Hajime; Takayanagi, Ryoichi

    2006-04-01

    Acute organophosphate poisoning (OP) shows several severe clinical symptoms due to its strong blocking effect on cholinesterase. Acute pancreatitis is one of the complications associated with acute OP, but this association still may not be widely recognized. We report here the case of a 73-year-old man who had repeated abdominal pain during and after the treatment of acute OP. Hyperamylasemia and a 7-cm pseudocyst in the pancreatic tail were noted on investigations. We diagnosed pancreatic pseudocyst that likely was secondary to an episode of acute pancreatitis following acute OP. He was initially treated with a long-term intravenous hyperalimentation, protease inhibitors and octerotide, but eventually required surgical intervention, a cystgastrostomy. Acute pancreatitis and hyperamylasemia are known to be possible complications of acute OP. It is necessary to examine and assess pancreatic damage in patients with acute OP.

  7. Pancreatic Pseudocyst after Acute Organophosphate Poisoning

    OpenAIRE

    Kawabe, Ken; Ito, Tetsuhide; Arita, Yoshiyuki; Sadamoto, Yojiro; Harada, Naohiko; Yamaguchi, Koji; Tanaka, Masao; Nakano, Itsuro; Nawata, Hajime; Takayanagi, Ryoichi

    2006-01-01

    Acute organophosphate poisoning(OP) shows several severe clinical symptoms due to its strong blocking effect on cholinesterase. Acute pancreatitis is one of the complications associated with acute OP, but this association still may not be widely recognized. We report here the case of a 73-year-old man who had repeated abdominal pain during and after the treatment of acute OP. Hyperamylasemia and a 7-cm pseudocyst in the pancreatic tail were noted on investigations. We diagnosed pancreatic pse...

  8. Acute Pancreatitis Secondary to Pancreatic Neuroendocrine Tumours

    Directory of Open Access Journals (Sweden)

    Grinó P

    2003-03-01

    Full Text Available CONTEXT: Pancreatic neoplasms are an uncommon aetiology of acute pancreatitis. Pancreatic neuroendocrine tumours are a rare subgroup of pancreatic neoplasms. CASE REPORT: We report on three patients having acute pancreatitis secondary to pancreatic neuroendocrine tumours, one of them with severe pancreatitis, and review the published cases up to now. Only 22 patients with acute pancreatitis secondary to pancreatic neuroendocrine tumours have been reported (including the present cases. Most of these cases were of non-functioning neoplasms and the course of the pancreatitis tended to be mild. In the most recent reports and in the present cases, the initial diagnostic method was CT scan. Less than half had metastases when the tumour was diagnosed and mortality from these neoplasms reached approximately 50%. CONCLUSIONS: Pancreatic neuroendocrine tumours can cause acute pancreatitis even in patients under 50 years of age. On many occasions, the tumours are non-functioning; therefore, acute pancreatitis may be the first clinical symptom. Consequently, faced with acute pancreatitis of unknown origin, a non-functioning neuroendocrine tumour should be ruled out.

  9. Treatment of acute pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  10. [Acute hypertrygliceridemic pancreatitis].

    Science.gov (United States)

    Senosiain Lalastra, Carla; Tavío Hernández, Eduardo; Moreira Vicente, Victor; Maroto Castellanos, Maite; García Sánchez, Maria Concepción; Aicart Ramos, Marta; Téllez Vivajos, Luis; Cuño Roldán, José Luis

    2013-04-01

    Acute hypertriglyceridemic pancreatitis is the third cause of acute pancreatitis in the Western population. There is usually an underlying alteration in lipid metabolism and a secondary factor. Clinical presentation is similar to that of pancreatitis of other etiologies, but the course of acute hypertriglyceridemic pancreatitis seems to be worse and more recurrent. Some laboratory data can be artefacts, leading to diagnostic errors. This is the case of amylase, which can show false low levels. Treatment is based on intense fluidotherapy and analgesia. When there is no response to conservative management, other methods to lower triglyceride levels should be used. Several options are available, such as plasmapheresis, insulin, and heparin. The present article provides a review of the current literature on this entity.

  11. Acute Recurrent Pancreatitis

    Directory of Open Access Journals (Sweden)

    Glen A Lehman

    2003-01-01

    Full Text Available History, physical examination, simple laboratory and radiological tests, and endoscopic retrograde cholangiopancreatography (ERCP are able to establish the cause of recurrent acute pancreatitis in 70% to 90% of patients. Dysfunction of the biliary and/or pancreatic sphincter, as identified by sphincter of Oddi manometry, accounts for the majority of the remaining cases. The diagnosis may be missed if the pancreatic sphincter is not evaluated. Pancreas divisum is a prevalent congenital abnormality that is usually innocuous but can lead to recurrent attacks of acute pancreatitis or abdominal pain. In select cases, endoscopic sphincterotomy of the minor papilla can provide relief of symptoms and prevent further attacks. A small proportion of patients with idiopathic pancreatitis have tiny stones in the common bile duct (microlithiasis. Crystals can be visualized during microscopic analysis of bile that is aspirated at the time of ERCP. Neoplasia is a rare cause of pancreatitis, and the diagnosis can usually be established by computerized tomography or ERCP. A wide variety of medications can also cause recurrent pancreatitis. ERCP, sphincter of Oddi manometry, and microscopy of aspirated bile should be undertaken in patients with recurrent pancreatitis in whom the diagnosis is not obvious.

  12. Drug-induced acute pancreatitis

    NARCIS (Netherlands)

    I.A. Eland (Ingo)

    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

  13. Prevention and Intervention Strategies in Acute Pancreatitis

    NARCIS (Netherlands)

    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

  14. Ischemic Acute Necrotizing Pancreatitis in a Marathon Runner

    Directory of Open Access Journals (Sweden)

    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

  15. Orlistat-induced acute pancreatitis

    OpenAIRE

    2012-01-01

    Drug-induced pancreatitis is a rare but important cause of pancreatic injury. Orlistat is a pancreatic lipase inhibitor licensed for the treatment of obesity. We present a case of orlistat- induced mild acute pancreatitis that developed 8 days after starting treatment.

  16. CLINICAL STUDY ON ACUTE PANCREATITIS

    Directory of Open Access Journals (Sweden)

    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

  17. Acute Pancreatitis and Ileus Postcolonoscopy

    Directory of Open Access Journals (Sweden)

    Hin Hin Ko

    2009-01-01

    Full Text Available Postpolypectomy bleeding and perforation are the most common complications of colonoscopy. A case of acute pancreatitis and ileus after colonoscopy is described. A 60-year-old woman underwent a gastroscopy and colonoscopy for investigation of iron deficiency anemia. Gastroscopy was normal; however, the colonoscope could not be advanced beyond the splenic flexure due to a tight angulation. Two polypectomies were performed in the descending colon. After the procedure, the patient developed a distended, tender abdomen. Bloodwork was remarkable for an elevated amylase level. An abdominal x-ray and computed tomography scan showed pancreatitis (particularly of the tail, a dilated cecum and a few air-fluid levels. The patient improved within 24 h of a repeat colonoscopy and decompression tube placement. The patient had no risk factors for pancreatitis. The causal mechanism of pancreatitis was uncertain but likely involved trauma to the tail of the pancreas during the procedure. Our patient developed ileus, likely secondary to pancreatitis. The present case is the first report of clinical pancreatitis and ileus associated with colonoscopy.

  18. [Acute pancreatitis and pregnancy].

    Science.gov (United States)

    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.

  19. Acute Pancreatitis Associated with Brucellosis

    Directory of Open Access Journals (Sweden)

    Demetrios Papaioannides

    2006-01-01

    Full Text Available Context :Acute pancreatitis can be caused by a variety of infectious agents but it is regarded as an extremely rare complication of brucellosis. Case report: We briefly describe a 56-yearold man who presented with acute pancreatitis, fever, myalgia, and other clinical symptoms. Brucella melitensis was cultured from his blood. All clinical manifestations gradually resolved with the institution of intramuscular streptomycin and oral doxycycline therapy. Conclusion :Acute pancreatitis may rarely be a complication of infection with B. melitensis. In areas where brucellosis is endemic, it should be kept in mind that acute pancreatitis may result from infection with brucella organisms..

  20. Acute Pancreatitis Concomitant Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Okay Abacı

    2013-03-01

    Full Text Available Acute pancreatitis is an inflammatory syndrome with unpredictable progression to systemic inflammation and multi-organ dysfunction. As in our case rarely, acute pancreatitis can be presented with the coexistance of acute coronary syndrome. To prevent a misdiagnosis of acute situation presented with chest or abdominal pain, physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations.

  1. Severe Acute Pancreatitis in Pregnancy

    Directory of Open Access Journals (Sweden)

    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.

  2. Juxta-Ampullary Intraluminal Diverticulum and Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Echenique-Elizondo M

    2004-05-01

    Full Text Available CONTEXT: Acute pancreatitis is usually due to well-known causes, such as biliary lithiasis and alcohol consumption. Anatomic abnormalities may represent a less frequent but important etiological factor. CASE REPORT: The case of a 27 year old women complaining of acute pancreatitis associated with a large duodenal juxta-papillary diverticulum is presented. CONCLUSIONS: Anatomic causes of pancreatitis must be considered in the diagnosis of the etiology of acute pancreatitis.

  3. Early management of acute pancreatitis.

    Science.gov (United States)

    Schepers, Nicolien J; Besselink, Marc G H; van Santvoort, Hjalmar C; Bakker, Olaf J; Bruno, Marco J

    2013-10-01

    Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis.

  4. Canagliflozin-Associated Acute Pancreatitis.

    Science.gov (United States)

    Verma, Rajanshu

    2016-01-01

    Canagliflozin is a new drug in class of sodium-glucose cotransporter 2 inhibitors used for treatment of type 2 diabetes mellitus. We describe a patient who developed moderately severe acute pancreatitis as an untoward consequence after being initiated on this drug. To the best of our knowledge, this is the first reported case of canagliflozin-associated acute pancreatitis in clinical literature.

  5. Acute pancreatitis-induced thrombotic thrombocytopenic purpura with recurrent acute pancreatitis.

    Science.gov (United States)

    Fujino, Yasuhisa; Inoue, Yoshihiro; Onodera, Makoto; Kikuchi, Satoshi; Sato, Masayuki; Kojika, Masahiro; Sato, Hisaho; Suzuki, Keijiro; Matsumoto, Masanori

    2016-04-01

    Recent successive reports on acute pancreatitis-induced thrombotic thrombocytopenic purpura (TTP) have revealed that TTP-related microvascular damage is an aggravating factor of acute pancreatitis. Here, we report the case of a 26-year-old man diagnosed with acute pancreatitis due to high alcohol consumption. The patient was unconscious as he had taken an overdose of medication, and presented with fever and renal failure due to acute pancreatitis on admission. Although the pancreatitis subsequently improved, the symptoms were still observed; on the next day, he exhibited hemoglobinuria, anemia, and thrombocytopenia. Moreover, general blood examinations indicated the presence of schistocytes and reduced activity of ADAMTS13 (a disintegrin-like metalloproteinase with thrombospondin type 1 motif 13) to 47 %. Thus, the patient was diagnosed with TTP, and plasma exchange was performed. After the development of TTP, the acute pancreatitis recurred, but a severe pathogenesis was prevented by plasma exchange. Thus, ADAMTS13 activity may be useful for predicting a severe pathogenesis of acute pancreatitis. In ADAMTS13-deficient cases, plasma exchange may be an effective technique for preventing aggravation of acute pancreatitis.

  6. Acute Pancreatitis: Surgery, Pathophysiology and Probiotic Prophylaxis

    NARCIS (Netherlands)

    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

  7. Acute pancreatitis in acute viral hepatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  8. Acute pancreatitis: Etiology and common pathogenesis

    Institute of Scientific and Technical Information of China (English)

    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.

  9. Pancreatic Panniculitis: A rare manifestation of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  10. Nutrition Support in Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    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].

  11. Carbofuran-Induced Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  12. Acute pancreatitis: clinical vs. CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Hill, M.C. (Univ. of Miami, FL); Barkin, J.; Isikoff, M.B.; Silver stein, W.; Kalser, M.

    1982-08-01

    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.

  13. Crohn's disease and acute pancreatitis. A review of literature.

    Science.gov (United States)

    Jasdanwala, Sarfaraz; Babyatsky, Mark

    2015-03-01

    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 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Keishoku; Kim, Jong-hyo; Nakasaku, Osamu

    1987-12-01

    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.

  15. Haemolytic Uraemic Syndrome Following Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  16. Redox signaling in acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Salvador Pérez

    2015-08-01

    Full Text Available Acute pancreatitis is an inflammatory process of the pancreatic gland that eventually may lead to a severe systemic inflammatory response. A key event in pancreatic damage is the intracellular activation of NF-κB and zymogens, involving also calcium, cathepsins, pH disorders, autophagy, and cell death, particularly necrosis. This review focuses on the new role of redox signaling in acute pancreatitis. Oxidative stress and redox status are involved in the onset of acute pancreatitis and also in the development of the systemic inflammatory response, being glutathione depletion, xanthine oxidase activation, and thiol oxidation in proteins critical features of the disease in the pancreas. On the other hand, the release of extracellular hemoglobin into the circulation from the ascitic fluid in severe necrotizing pancreatitis enhances lipid peroxidation in plasma and the inflammatory infiltrate into the lung and up-regulates the HIF–VEGF pathway, contributing to the systemic inflammatory response. Therefore, redox signaling and oxidative stress contribute to the local and systemic inflammatory response during acute pancreatitis.

  17. Redox signaling in acute pancreatitis.

    Science.gov (United States)

    Pérez, Salvador; Pereda, Javier; Sabater, Luis; Sastre, Juan

    2015-08-01

    Acute pancreatitis is an inflammatory process of the pancreatic gland that eventually may lead to a severe systemic inflammatory response. A key event in pancreatic damage is the intracellular activation of NF-κB and zymogens, involving also calcium, cathepsins, pH disorders, autophagy, and cell death, particularly necrosis. This review focuses on the new role of redox signaling in acute pancreatitis. Oxidative stress and redox status are involved in the onset of acute pancreatitis and also in the development of the systemic inflammatory response, being glutathione depletion, xanthine oxidase activation, and thiol oxidation in proteins critical features of the disease in the pancreas. On the other hand, the release of extracellular hemoglobin into the circulation from the ascitic fluid in severe necrotizing pancreatitis enhances lipid peroxidation in plasma and the inflammatory infiltrate into the lung and up-regulates the HIF-VEGF pathway, contributing to the systemic inflammatory response. Therefore, redox signaling and oxidative stress contribute to the local and systemic inflammatory response during acute pancreatitis.

  18. Acute pancreatitis and fibromyalgia: Cytokine link

    Directory of Open Access Journals (Sweden)

    Sadat Muzammil

    2011-01-01

    Full Text Available Context: Fibromyalgia is a widespread musculoskeletal pain disorder found in 2% of the general population and with a preponderance of 85% in females, and has both genetic and environmental contribution. Acute pancreatitis is a severe condition and in most cases gallstones disease represents approximately half of the cases of acute pancreatitis, and 20-25% are related to alcohol abuse. Small numbers of cases are caused by a variety of other reasons but a few cases have no obvious cause, referred to as ′idiopathic′. Here we present a case where fibromyalgia might be linked to acute pancreatitis. We believe this has not been reported in this context in literature. Case Report: Fibromyalgia is a widespread musculoskeletal pain disorder found in 2% of the general population and with a preponderance of 85% in females, and has both genetic and environmental contribution. Patient had a cholecystectomy eight years previously. Patient feels tired almost all the time due to her fibromyalgia and requires family support for daily routine. Patient′s blood results showed alanine transaminase 527 IU/L, alkaline phosphatase 604 IU/L, bilirubin 34 μmol/L, amylase 2257 IU/L, C-reactive protein 19 mg/L, Gamma-Glutamyl transpeptidase 851 IU/L, renal function and electrolytes were within normal limits. The patient was admitted to the high dependency unit with a diagnosis of acute pancreatitis. Conclusion: There is a known increase in levels of cytokines in patients with fibromyalgia. Part of the pathophysiology of acute pancreatitis is related to raised cytokines and immune deregulations. We hypothesize that elevated levels of cytokines in fibromyalgia has led to acute pancreatitis in our patient. Further epidemiological research on the incidence of pancreatitis in cytokine mediated conditions such as fibromyalgia is required.

  19. Is acute recurrent pancreatitis a chronic disease?

    OpenAIRE

    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...

  20. Pharmacological approach to acute pancreatitis

    DEFF Research Database (Denmark)

    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...... 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...

  1. Pancreatic and pulmonary mast cells activation during experimental acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Inmaculada; Lopez-Font; Sabrina; Gea-Sorlí; Enrique; de-Madaria; Luis; M; Gutiérrez; Miguel; Pérez-Mateo; Daniel; Closa

    2010-01-01

    AIM:To study the activation of pancreatic and pulmonary mast cells and the effect of mast cell inhibition on the activation of peritoneal and alveolar macrophages during acute pancreatitis.METHODS:Pancreatitis was induced by intraductal infusion of 5% sodium taurodeoxycholate in rats.The mast cell inhibitor cromolyn was administered intraperitoneally(i.p.) 30 min before pancreatitis induction.The pancreatic and pulmonary tissue damage was evaluated histologically and mast cells and their state of activation...

  2. Biliary acute pancreatitis: a review

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Is acute recurrent pancreatitis a chronic disease?

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  7. Diabetes due to recurrent pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Sumit Kumar Chakrabarti

    2013-01-01

    Full Text Available Acute pancreatitis due to hypercalcemia associated with hyperparathyroidism (HPT is not very common. We herein report a case of a 21-year-old woman, who presented with acute pancreatitis. She had a past history of recurrent nephrolithiasis. Subsequent evaluation revealed hypercalcemia (serum calcium: 12.6 mg/dL; low phosphate (2.9 mg/dL with elevated parathyroid hormone (PTH, 156.7 pg/mL and HbA1c (6.9%. Diagnosis of primary HPT (PHPT was made. Recurrent pancreatitis due to hypercalcemia may have resulted in diabetes mellitus.

  8. Pancreatic ductal system obstruction and acute recurrent pancreatitis

    Institute of Scientific and Technical Information of China (English)

    M Delhaye; C Matos; M Arvanitakis; J Devière

    2008-01-01

    Acute recurrent pancreatitis is a clinical entity largely associated with pancreatic ductal obstruction.This latter includes congenital variants,of which pancreas divisum is the most frequent but also controversial,chronic pancreatitis,tumors of the pancreaticobiliary junction and sphincter of Oddi dysfunction.This review summarizes current knowledge about diagnostic work-up and therapy of these conditions.

  9. Recurrent acute pancreatitis and its relative factors

    Institute of Scientific and Technical Information of China (English)

    Wei Zhang; Hong-Chao Shan; Yan Gu

    2005-01-01

    AIM: To evaluate the causes and the relative factors of recurrent acute pancreatitis.METHODS: From 1997 to 2000, acute pancreatitis relapsed in 77 of 245 acute pancreatitis patients. By reviewing the clinical treatment results and the follow-up data, we analyzed the recurrent factors of acute pancreatitis using univariate analysis and multivariate analysis.RESULTS: Of the 245 acute pancreatitis patients, 77 were patients with recurrent acute pancreatitis. Of them, 56 patients relapsed two times, 19 relapsed three times, each patient relapsed three and four times. Forty-seven patients relapsed in hospital and the other 30 patients relapsed after discharge. Eighteen patients relapsed in 1 year, eight relapsed in 1-3 years, and four relapsed after 3 years. There were 48 cases of biliary pancreatitis, 3 of alcohol pancreatitis, 5 of hyperlipidemia pancreatitis, 21 of idiopathic pancreatitis. Univariate analysis showed that the patients with local complications of pancreas, obstructive jaundice and hepatic function injury were easy to recur during the treatment period of acute pancreatitis (P = 0.022<0.05, P = 0.012<0.05 and P = 0.002<0.05, respectively). Multivariate analysis showed that there was no single factor related to recurrence. Of the 47 patients who had recurrence in hospital, 16 had recurrence in a fast period, 31 after refeeding. CONCLUSION: Acute pancreatitis is easy to recur even during treatment. The factors such as changes of pancreas structure and uncontrolled systemic inflammatory reaction are responsible for the recurrence of acute pancreatitis. Early refeeding increases the recurrence of acute pancreatitis. Defining the etiology is essential for reducing the recurrence of acute pancreatitis.

  10. Energetic etiologies of acute pancreatitis: A report of five cases

    Institute of Scientific and Technical Information of China (English)

    Artem; Shmelev; Alain; Abdo; Sarina; Sachdev; Urvi; Shah; Gopal; C; Kowdley; Steven; C; Cunningham

    2015-01-01

    There are several common causes of acute pancreatitis, principally excessive alcohol intake and gallstones, and there are many rare causes. However, cases of pancreatitis still occur in the absence of any recognizable factors, and these cases of idiopathic pancreatitis suggest the presence of unrecognized etiologies. Five cases of acute pancreatitis in four patients came to attention due to a strong temporal association with exposure to nerve stimulators and energy drinks. Given that these cases of pancreatitis were otherwise unexplained, and given that these exposures were not clearly known to be associated with pancreatitis, we performed a search for precedent cases and for mechanistic bases. No clear precedent cases were found in Pub Med and only scant, weak precedent cases were found in public-health databases. However, there was a coherent body of intriguing literature in support of a mechanistic basis for these exposures playing a role in the etiology of pancreatitis.

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

    Directory of Open Access Journals (Sweden)

    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

  12. Managing acute and chronic pancreatitis.

    Science.gov (United States)

    Skipworth, James R A; Shankar, Arjun; Pereira, Stephen P

    2010-10-01

    Pancreatitis may be acute or chronic. Although both can be caused by similar aetiologies, they tend to follow distinct natural histories. Around 80% of acute pancreatitis (AP) diagnoses occur secondary to gallstone disease and alcohol misuse. AP is commonly associated with sudden onset of upper abdominal pain radiating to the back that is usually severe enough to warrant the patient seeking urgent medical attention. Onset of pain may be related to a recent alcohol binge or rich, fatty meal. The patient may appear unwell, be tachycardic and have exquisite tenderness in the upper abdomen. Overall, 10-25% of AP episodes are classified as severe, leading to an associated mortality rate of 7.5%. Disease severity is best predicted from a number of clinical scoring systems which can be applied at diagnosis in association with repeated clinical assessment, measurement of acute inflammatory markers, and CT. All patients with suspected AP should be referred urgently. Chronic pancreatitis (CP) follows continued, repetitive or sustained injury to the pancreas and 70% of diagnoses occur secondary to alcohol abuse. The characteristic presenting feature of CP is insidious progression of chronic, severe, upper abdominal pain, radiating to the back, caused by a combination of progressive pancreatic destruction, inflammation and duct obstruction. Signs and symptoms include weight loss and steatorrhoea and later on diabetes. CP patients may also present with recurrent episodes mimicking AP, both symptomatically and metabolically. Diagnosis of CP should be based on symptom profile, imaging and assessment of exocrine and endocrine pancreatic function. CT should be the first-line imaging investigation.

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

    OpenAIRE

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

    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...

  14. Acute and chronic pancreatitis: surgical management.

    Science.gov (United States)

    Dzakovic, Alexander; Superina, Riccardo

    2012-08-01

    Pancreatitis is becoming increasingly prevalent in children, posing new challenges to pediatric health care providers. Although some general adult treatment paradigms are applicable in the pediatric population, diagnostic workup and surgical management of acute and chronic pancreatitis have to be tailored to anatomic and pathophysiological entities peculiar to children. Nonbiliary causes of acute pancreatitis in children are generally managed nonoperatively with hydration, close biochemical and clinical observation, and early initiation of enteral feeds. Surgical intervention including cholecystectomy or endoscopic retrograde cholangiopancreatography is often required in acute biliary pancreatitis, whereas infected pancreatic necrosis remains a rare absolute indication for pancreatic debridement and drainage via open, laparoscopic, or interventional radiologic procedure. Chronic pancreatitis is characterized by painful irreversible changes of the parenchyma and ducts, which may result in or be caused by inadequate ductal drainage. A variety of surgical procedures providing drainage, denervation, resection, or a combination thereof are well established to relieve pain and preserve pancreatic function.

  15. Multiple intrahepatic pseudocysts in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    David Casado; Luis Sabater; Julio Calvete; Empar Mayordomo; Luis Aparisi; Juan Sastre; Salvador Lledo

    2007-01-01

    Liver pseudocysts are a very rare complication in acute pancreatitis with only a few cases previously described. The lack of experience and literature on this condition leads to difficulties in the differential diagnosis and management. We report herein a case of acute pancreatitis who developed multiple intrahepatic pseudocysts. After complete imaging evaluation, the diagnosis was still unclear and the patient was operated on. The presence of liver lesions in patients with acute pancreatitis should raise the possibility of intrahepatic pseudocysts.

  16. Pharm GKB: Acute necrotizing pancreatitis [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available A165108252 External Vocabularies MeSH: Pancreatitis, Acute Necrotizing (D019283) SnoMedCT: Acute necrotizing... pancreatitis (7881005) UMLS: C0267941 (C0267941) MedDRA: Necrotising pancreatitis (10056219) NDFRT: Pancreatitis, Acute... Necrotizing [Disease/Finding] (N0000003910) Common Searches Search Medline Plus Search CTD Pharm GKB: Acute necrotizing pancreatitis ...

  17. [Correlation between hyperamylasemia and acute pancreatitis].

    Science.gov (United States)

    Monaco, R; Durante, E; Pampolini, M; Tioli, P

    1981-05-31

    It is often difficult to differentiate acute pancreatitis (A.P.) from some other acute abdominal diseases, when there is an elevated serum amylase. In contrast, the renal clearance of amylase, expressed as a percentage of creatinine clearance, can separate patients with A.P. from patients with acute colecistitis, common duct stone without pancreatitis, hyperamylasemia after biliary surgery, acute peptic ulcer and acute salivary diseases.

  18. Acute pancreatitis in children and adolescents

    Institute of Scientific and Technical Information of China (English)

    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.

  19. Contemporary Management of Acute Biliary Pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2016-03-01

    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 higher risk of morbidity and mortality for both the mother and the fetus. We experienced a case of pregnant woman who died of acute exacerbation of hypertriglyceridemia-induced acute pancreatitis at 23 weeks of gestation. We report on progress and management of this case along with literature reviews.

  1. Acute pancreatitis in patients with pancreatic cancer

    Science.gov (United States)

    Li, Shaojun; Tian, Bole

    2017-01-01

    Abstract Acute pancreatitis (AP) is a rare manifestation of pancreatic cancer (PC). The relationship between AP and PC remains less distinct. From January 2009 to November 2015, 47consecutive patients with PC who presented with AP were reviewed for this study. Clinical features, clinicopathologic variables, postoperative complications, and follow-up evaluations of patients were documented in detail from our database. In order to identify cutoff threshold time for surgery, receiver operating curve (ROC) was built according to patients with or without postoperative complications. Cumulative rate of survival was calculated by using the Kaplan–Meier method. The study was conducted in accordance with the principles of the Declaration of Helsinki and the guidelines of West China Hospital. This study included 35 men (74.5%) and 12 women (25.5%) (mean age: 52 years), with a median follow-up of 40 months. AP was clinically mild in 45 (95.7%) and severe in 2 (4.3%). The diagnosis of PC was delayed by 2 to 660 days (median 101 days). Thirty-nine (83.0%) cases underwent surgery. Eight (17.0%) cases performed biopsies only. Of 39 patients, radical surgery was performed in 32 (82.1%) cases and palliative in 7 (19.9%) cases. Two (8.0%) patients were needed for vascular resection and reconstruction. Postoperative complications occurred in 12 (30.8%) patients. About 24.5 days was the best cutoff point, with an area under curve (AUC) of 0.727 (P = 0.025, 95% confidence interval: 0.555–0.8999). The survival rate of patients at 1 year was 23.4%. The median survival in patients with vascular resection and reconstruction was 18 months, compared with 10 months in patients without vascular resection (P = 0.042). For the primary stage (T), Tix was identified in 3 patients, the survival of whom were 5, 28, 50 months, respectively. And 2 of them were still alive at the follow-up period. The severity of AP was mainly mild. Surgical intervention after 24.5 days may benefit for

  2. Acute pancreatitis in pregnancy:An unresolved issue

    Institute of Scientific and Technical Information of China (English)

    Pankaj; Jain

    2010-01-01

    Management of acute pancreatitis in pregnancy is based on expert opinion only,due to geographic and ethic variations.Nonbiliary causes should be sought as they are associated with worse outcomes.Alcohol as a cause of acute pancreatitis is not rare.Hemoconcentration as a marker of fluid def icit and severity should be predicted with caution and fluid resuscitation should be done carefully by closely monitoring the central venous pressure,cardiac and respiratory system.Hypercalcemia of hyperparathyroidism may...

  3. Chylous ascites caused by acute pancreatitis with portal vein thrombosis

    OpenAIRE

    Park, Dong Eun; Chae, Kwon Mook

    2011-01-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also rev...

  4. Computerized tomography in acute and chronic pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Kalmar, J.A.; Matthews, C.C.; Bishop, L.A.

    1984-11-01

    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.

  5. Severe Vascular Complications Of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Głuszek Stanisław

    2015-10-01

    Full Text Available Acute pancreatitis (AP develops as a result of the imbalance of the mechanisms inhibiting the activity of enzymes in the pancreatic cells, which causes their autoactivation in the pancreas. The incidence of AP ranges from 10 up to 100 cases per 100,000 population per year in different parts of the world. The overall mortality rate for acute pancreatitis is 10-15%. The mortality rate in patients diagnosed with the severe form of acute pancreatitis is up to 30-40%.

  6. An unreported complication of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    G Muthukumarasamy; V Shanmugam; SR Yule; R Ravindran

    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.This case is reported for its unusual and unreported spinal complications after acute pancreatitis.

  7. Approach to acute, recurrent, and chronic pancreatitis.

    Science.gov (United States)

    Kinney, Timothy P; Freeman, Martin L

    2008-06-01

    Pancreatitis can manifest as a one-time episode, recurring attacks, or chronic pain. It is caused by numerous factors ranging from alcohol consumption to gallstones to subtle obstructive causes and occult autoimmune disorders. As a result, determining the etiology and effectively treating the causes and consequences of pancreatitis can be challenging. This article reviews the diagnosis and management of acute, acute recurrent, and chronic pancreatitis, focusing on more challenging scenarios.

  8. Cytokines and organ failure in acute pancreatitis

    DEFF Research Database (Denmark)

    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)....

  9. Pharmacological approach to acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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. Severe Hypophosphatemia in a Patient with Acute Pancreatitis.

    Directory of Open Access Journals (Sweden)

    Rizos E

    2000-11-01

    Full Text Available CONTEXT: We describe a patient with alcohol-induced pancreatitis who developed severe life-threatening hypophosphatemia of multifactorial origin during hospitalization. CASE REPORT: Decreased phosphate levels along with urine phosphate wasting were already noticed on the patient's admission due to underlying chronic alcoholism. However, a further deterioration of hypophosphatemia appeared on the second day of hospitalization presumably resulting from an increased transfer of phosphate from extracellular to intracellular fluid. CONCLUSIONS: Phosphate deficiency is often overlooked in patients with acute pancreatitis. Our case emphasizes that serum phosphate levels should be checked along with serum calcium levels in patients with acute pancreatitis, especially in alcoholic patients.

  11. Drug-Induced Acute Pancreatitis and Pseudoaneurysms: An Ominous Combination

    Directory of Open Access Journals (Sweden)

    Diogo Branquinho

    2016-11-01

    Full Text Available Rupture of pseudoaneurysms is rare but can be life-threatening complications of acute or chronic pancreatitis, usually due to enzymatic digestion of vessel walls crossing peripancreatic fluid collections. We report the case of a 40 year-old female, with multisystemic lupus and anticoagulated for prior thrombotic events, admitted for probable cyclosporine-induced acute pancreatitis. Hemodynamic instability occurred due to abdominal hemorrhage from two pseudoaneurysms inside an acute peri-pancreatic collection. Selective angiography successfully embolized the gastroduodenal and pancreatoduodenal arteries. The hemorrhage recurred two weeks later and another successful embolization was performed and the patient remains well to date. The decision to restart anticoagulants and to suspend cyclosporine was challenging and required a multidisciplinary approach. Despite rare, bleeding from a pseudoaneurysm should be considered when facing a patient with pancreatitis and sudden signs of hemodynamic instability.

  12. Pancreatite aguda devida a hematoma intramural do duodeno por uso de anticoagulante Acute pancreatitis due to intramural hematoma of the duodenum by use of anticoagulant therapy

    Directory of Open Access Journals (Sweden)

    Samer FARHOUD

    2001-01-01

    Full Text Available Racional - A hemorragia intramural espontânea do duodeno causada por complicações da terapêutica anticoagulante é rara e seu tratamento controverso. Objetivo -- Apresentar a experiência advinda do tratamento de doente com essa condição clínica. Relato do caso - Expõe-se o caso de uma mulher de 71 anos de idade, que há 3 meses fazia uso de anticoagulante oral para tratamento de trombose venosa profunda dos membros inferiores. Apresentou-se com cefaléia e dores abdominais intensas no andar superior do abdome, associadas a náuseas e vômitos. Os exames laboratoriais e de imagem comprovaram o diagnóstico de surto agudo de pancreatite, decorrente de hematoma intramural de duodeno. Os valores de protrombina (49,7 s e o sangramento de tecidos moles cervicais e urinário, sugeriam complicação da terapêutica anticoagulante. Resultados - A terapêutica conservadora foi efetiva, tendo a doente recebido alta, assintomática, no 10º dia de internação. Conclusão - É recomendado o emprego do anticoagulante em doses menores nos doentes de risco e adequado controle dos parâmetros da coagulação. Acredita-se ser ideal a conduta conservadora e recomenda-se a cirurgia somente nos casos que evoluem com complicações.Background - Spontaneous intramural hemorrhage of the duodenum due to anticoagulant therapy is rare and the treatment is controversial. Objective - To present the acquired knowledge with the treatment of these disease. Case report - A 71-year-old women receiving for a 3 month period an anticoagulant therapy presented cervical bleeding of soft tissues and symptoms of acute pancreatitis and high small bowel obstruction. Early noninvasive diagnosis by computed tomographic scan was possible and conservative therapy proved successful in complete resolution of the pancreatitis and obstructive symptoms, with resumption of oral intake in the fourth day of treatment. The frequency of bleeding in high risk patients during warfarin therapy

  13. Recurrent acute pancreatitis in a Saudi child with isovaleric acidemia

    Directory of Open Access Journals (Sweden)

    Satti Abdelrahim Satti

    2016-01-01

    Full Text Available Isovaleric acidemia (IVA, also known as the sweaty foot syndrome, is an autosomal recessive organic acid disorder due to a defect in the mitochondrial Flavin Adenine Dinucleotide (FAD-dependent enzyme isovaleryl CoA dehydrogenase. Acute pancreatitis as a complication has been reported. We are presenting a rare case of recurrent acute pancreatitis complicating a 9-year-old girl with IVA. She presented with repeated attacks of vomiting, severe abdominal pain, and fever since the age of 18 months. These were diagnosed as attacks of pancreatitis with high serum amylase presenting clinically as diabetic ketoacidosis. Later, she developed chronic pancreatitis which is proved by lapratomy. In the last attack, she was comatosed with fulminant sepsis and sooner the patient died. Blood sample taken during this last attack confirmed the diagnosis of IVA. An inborn error of organic acid metabolism should be considered in children with pancreatitis of unknown origin.

  14. Imaging of acute pancreatitis and its complications. Part 1: acute pancreatitis.

    Science.gov (United States)

    Türkvatan, A; Erden, A; Türkoğlu, M A; Seçil, M; Yener, Ö

    2015-02-01

    Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical setting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.

  15. Pancreatic microcirculatory impairment in experimental acute pancreatitis in rats

    Institute of Scientific and Technical Information of China (English)

    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.

  16. Acute recurrent pancreatitis: An autoimmune disease?

    Institute of Scientific and Technical Information of China (English)

    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.

  17. Primary hyperparathyroidism presenting as acute gallstone pancreatitis

    Institute of Scientific and Technical Information of China (English)

    HE Jian-hong; ZHANG Quan-bao; LI Yu-min; ZHU You-quan; LI Xun; SHI Bin

    2010-01-01

    @@ Primary hyperparathyroidism (PHPT) is a generalized disorder of calcium metabolism resulting from an abnormally high level of serum calcium and an increased level of parathormone (PTH).1,2 Traditionally, symptomatic PHPT patients present with a variety of disorders including fatigue, amyotrophy, memory impairment, emotional instability, hallucination, irritation, loss of consciousness, abdominal distention, nausea, vomiting, constipation, acute pancreatitis, refractory peptic ulcer, osteopenia, hypertension, etc.3-5 Acute pancreatitis (AP) is an uncommon presentation of PHPT.6-8 We report a typical case of primary hyperparathyroidism with hypercalcemic crisis presenting as acute gallstone pancreatitis.

  18. Advances in Management of Acute Pancreatitis.

    Science.gov (United States)

    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.

  19. Morbimortality Indicators in Severe Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Tercio De Campos

    2008-11-01

    Full Text Available Objective The aim of this study was to determine the factors related to the development of systemic complications, mortality and pancreatic necrosis in patients with severe acute pancreatitis. Patients Thirty-nine patients (22.3% out of 175 patients with acute pancreatitis who were admitted to our center, had an APACHE II score greater than 8; they were classified as having severe acute pancreatitis and were evaluated in the study. Main outcome measures Sepsis-related Organ Failure Assessment (SOFA and Marshall scores were obtained. The variables analyzed were age, sex, etiology, hematocrit, leukocyte count, CRP level, CT findings and length of hospital stay. These variables were related to the development of systemic complications, mortality and necrotizing pancreatitis. Results The mean APACHE II value of the patients included was 11.6±3.1, the mean SOFA score was 3.2±2.0 and the Marshall score was 1.5±1.9. Eleven patients developed necrotizing pancreatitis. The mortality rate among severe acute pancreatitis patients was 3 out of 39 (7.7%. Variables found to be related to systemic complications were the APACHE II score as well as SOFA and Marshall scores greater than 3. The variables related to mortality were SOFA score greater than 3 and leukocytosis greater than 19,000 mm-3. CRP greater than 19.5 mg/dL and length of hospital stay were related to necrotizing pancreatitis. Conclusions The scoring systems, especially the SOFA score, were related to the development of systemic complications and mortality. CRP showed a relationship to necrotizing pancreatitis. There was no relationship between the evaluated scoring systems and necrotizing pancreatitis in patients with severe acute pancreatitis.

  20. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis

    NARCIS (Netherlands)

    Ahmed Ali, Usama; Issa, Yama; Hagenaars, Julia C.; Bakker, Olaf J.; van Goor, Harry; Nieuwenhuijs, Vincent B.; Bollen, Thomas L.; van Ramshorst, Bert; Witteman, Ben J.; Brink, Menno A.; Schaapherder, Alexander F.; Dejong, Cornelis H.; Spanier, B. W Marcel; Heisterkamp, Joos; van der Harst, Erwin; van Eijck, Casper H.; Besselink, Marc G.; Gooszen, Hein G.; van Santvoort, Hjalmar C.; Boermeester, Marja A.

    2016-01-01

    Background & Aims: Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events. Methods: We performed a cross-sectional study of 669 patients with a first episode of acute pancre

  1. Recurrent acute pancreatitis: From the editor

    Institute of Scientific and Technical Information of China (English)

    Pier Alberto Testoni

    2008-01-01

    @@ This special issue of World Journal of Gastroenterology contains a number of articles focusing on acute recurrent pancreatitis,a clinical entity that still remains a complex diagnostic and therapeutic challenge in clinical practice.

  2. Stress kinase inhibition modulates acute experimental pancreatitis

    Institute of Scientific and Technical Information of China (English)

    F. Fleischer; R. Dabew; B. Goke; ACC Wagner

    2001-01-01

    AIM To examine the role of p38 during acute experimental cerulein pancreatitis.METHODS Rats were treated with cerulein with or without a specific JNK inhibitor (CEP1347)andy or a specific p38 inhbitor (SB203380) and pancreatic stress kinase activity wasdetermined. Parameters to assess pancreatitis included trypsin, amylase, lipase, pancreatic weight and histology.RESULTS JNK inhibition with CEP1347ameliorated pancreatitis, reducing pancreatic edema. In contrast, p38 inhibition with SB203580aggravated pancreatitis with higher trypsinlevels and, with induction of acinar necrosis not normally found after cerulein hyperstimulation.Simultaneous treatment with both CEP1347 and SB203580 mutually abolished the effects of either compound on cerulein pancreatitis.CONCLUSION Stress kinases modulatepancreatitis differentially. JNK seems to promote pancreatitis development, possibly by supporting inflammatory reactions such as edema formation while its inhibition ameliorates pancreatitis. In contrast, p38 may help reduce organ destruction while inhibition of p38 during induction of cerulein pancreatitis leads to the occurrence of acinar necrosis.

  3. Urinary trypsinogen-2 dipstick in acute pancreatitis

    DEFF Research Database (Denmark)

    Novovic, Srdan; Ersbøll, Annette Kjaer; Jørgensen, Lars Nannestad

    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....

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Management of Acute Pancreatitis in Critical Care Unit

    Directory of Open Access Journals (Sweden)

    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

  6. Acute pancreatitis and amiodarone: A case report

    Institute of Scientific and Technical Information of China (English)

    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.

  7. Pancreaticoatmospheric fistula following severe acute necrotising pancreatitis.

    Science.gov (United States)

    Simoneau, Eve; Chughtai, Talat; Razek, Tarek; Deckelbaum, Dan L

    2014-12-17

    Severe acute necrotising pancreatitis is associated with numerous local and systemic complications. Abdominal compartment syndrome requiring urgent decompressive laparotomy is a potential complication of this disease process and is associated with increased morbidity and mortality. We describe the case of a pancreaticoatmospheric fistula following decompressive laparotomy in a patient with severe acute necrotising pancreatitis. While this fistula was managed successfully using the current standard of care for pancreatic fistulas, the wound care for in this patient with drainage of the fistula through an open abdomen, is a significant challenge.

  8. Models of acute and chronic pancreatitis.

    Science.gov (United States)

    Lerch, Markus M; Gorelick, Fred S

    2013-06-01

    Animal models of acute and chronic pancreatitis have been created to examine mechanisms of pathogenesis, test therapeutic interventions, and study the influence of inflammation on the development of pancreatic cancer. In vitro models can be used to study early stage, short-term processes that involve acinar cell responses. Rodent models reproducibly develop mild or severe disease. One of the most commonly used pancreatitis models is created by administration of supraphysiologic concentrations of caerulein, an ortholog of cholecystokinin. Induction of chronic pancreatitis with factors thought to have a role in human disease, such as combinations of lipopolysaccharide and chronic ethanol feeding, might be relevant to human disease. Models of autoimmune chronic pancreatitis have also been developed. Most models, particularly of chronic pancreatitis, require further characterization to determine which features of human disease they include.

  9. Acute Pancreatitis Caused By Mushroom Poisoning

    Directory of Open Access Journals (Sweden)

    Samet Karahan Research Fellow

    2016-01-01

    Full Text Available 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.

  10. Controversies in the Etiologies of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Ali Safdar Khan

    2010-11-01

    Full Text Available Acute pancreatitis is a potentially life threatening acute inflammatory condition of the pancreas with an annual incidence in the United States estimated to be 40 cases per 100,000 adults [1] which is one of the highest in the world [2]. There is also a rising trend in the incidence of acute pancreatitis in the United States which has been observed over the past several decades [3]. Though most cases are mild with mortality below 1%, there is a subset classified as severe pancreatitis in which the mortality can reach as high as 30% [4]. The direct medical cost of hospitalization for acute pancreatitis is estimated to be $2.2 billion at a mean cost per hospital day of $1,670 [5] which is likely an underestimation. To determine the etiology of the acute pancreatitis is crucial to the management of this potentially fatal condition. Even though a wide variety of etiologies have been proposed, the exact role of the some of these still remains controversial and in some cases ill-defined. A cause is not clinically determined in up to 30% of cases which are labeled idiopathic pancreatitis [6]. This review attempts to re-visit some of the controversies surrounding these etiologies, discuss the current understanding of the mechanisms that underlie them and to identify areas requiring further research.

  11. Antiproteases in the Treatment of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  12. Alcohol consumption in patients with acute or chronic pancreatitis.

    Science.gov (United States)

    Sand, J; Lankisch, P G; Nordback, I

    2007-01-01

    Understanding of the relation between the alcoholic consumption and the development of pancreatitis should help in defining the alcoholic etiology of pancreatitis. Although the association between alcohol consumption and pancreatitis has been recognized for over 100 years, it remains still unclear why some alcoholics develop pancreatitis and some do not. Surprisingly little data are available about alcohol amounts, drinking patterns, type of alcohol consumed and other habits such as dietary habits or smoking in respect to pancreatitis preceding the attack of acute pancreatitis or the time of the diagnosis of chronic pancreatitis. This review summarizes the current knowledge. Epidemiological studies clearly show connection between the alcohol consumption in population and the development of acute and chronic pancreatitis. In the individual level the risk to develop either acute or chronic pancreatitis increases along with the alcohol consumption. Moreover, the risk for recurrent acute pancreatitis after the first acute pancreatitis episode seems also to be highly dependent on the level of alcohol consumption. Abstaining from alcohol may prohibit recurrent acute pancreatitis and reduce pain in chronic pancreatitis. Therefore, all the attempts to decrease alcohol consumption after acute pancreatitis and even after the diagnosis of chronic pancreatitis should be encouraged. Smoking seems to be a remarkable co-factor together with alcohol in the development of chronic pancreatitis, whereas no hard data are available for this association in acute pancreatitis. Setting the limits for accepting the alcohol as the etiology cannot currently be based on published data, but rather on the 'political' agreement.

  13. Antiproteases in Preventing Post-ERCP Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Takeshi Tsujino

    2007-07-01

    Full Text Available Pancreatitis remains the most common and potentially fatal complication following ERCP. Various pharmacological agents have been used in an attempt to prevent post-ERCP pancreatitis, but most randomized controlled trials have failed to demonstrate their efficacy. Antiproteases, which have been clinically used to manage acute pancreatitis, would theoretically reduce pancreatic injury after ERCP because activation of proteolytic enzymes is considered to play an important role in the pathogenesis of post-ERCP pancreatitis. Gabexate and ulinastatin have recently been evaluated regarding their efficacy in preventing post-ERCP pancreatitis. Long-term (12 hours infusion of gabexate significantly decreased the incidence of post-ERCP pancreatitis; however, no prophylactic effect was observed for shortterm infusion (2.5 and 6.5 hours. These results may be due to the short-life of gabexate (55 seconds. Since long-term infusion requires additional hospitalization, the use of gabexate in all patients at average risk of developing post-ERCP pancreatitis is an expensive strategy. Ulinastatin has a halflife of 35 minutes and can be given as a bolus infusion. Short-term (10 minutes administration of ulinastatin showed a significant reduction in the incidence of post- ERCP pancreatitis in one randomized controlled trial. Ulinastatin is superior to gabexate in terms of cost because it does not require additional hospitalization. At present, there is no other randomized, placebocontrolled trial on ulinastatin under way. Large scale randomized controlled trials revealed that both the long-term infusion of gabexate and the short-term administration of ulinastatin may reduce pancreatic injury, but these studies involve patients at average risk of developing post-ERCP pancreatitis. Additional research is needed to confirm the preventive efficacy of these antiproteases in patients at a high risk of developing post- ERCP pancreatitis.

  14. Statin Pretreatment in Experimental Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    José Luiz Jesus de Almeida

    2008-07-01

    Full Text Available Context Some authors have found beneficial effect of statins in certain inflammatory conditions, but the effect of statins on acute pancreatitis is not yet defined. Objective The aim of this study was to evaluate the effect of simvastatin on an experimental model of mild and severe acute pancreatitis. Animals One hundred and one Wistar rats with cerulein or taurocholate-induced acute pancreatitis were used in this study. Design The rats were divided into two groups: Group I (n=51 received two previously i.p. injections (18±2 and 3±1 hours of simvastatin (200 μg/kg and Group II (n=50 received two previously i.p. injections of saline. Both groups were subdivided into two subgroups: mild pancreatitis (cerulein-induced; IA, n=10; IIA, n=10 and severe pancreatitis (taurocholateinduced; IB, n=41; IIB, n=40. Main outcome measures The parameters evaluated were: pancreatic vascular permeability, tissue water content, histologic lesion, amylase serum levels in rats with mild pancreatitis (subgroups A; mortality rate, serum levels of IL-6, IL-10, amylase, pulmonary myeloperoxidase activity and ascitic levels of TNF-alpha in rats with severe pancreatitis (subgroups B. Results Serum levels of IL-10 were significantly lower in the simvastatin-treated group as well as the myeloperoxidase activity. There was no significant difference in any of other studied parameters. Conclusion Simvastatin appears to reduce inflammatory cytokines and pulmonary neutrophilic activation in the severe acute pancreatitis model, but there is no significant effect on survival curve, in spite of a clear trend towards a better survival in the simvastatin group.

  15. Pathophysiology of pulmonary complications of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    George W Browne; CS Pitchurnoni

    2006-01-01

    Acute pancreatitis in its severe form is complicated by multiple organ system dysfunction, most importantly by pulmonary complications which include hypoxia,acute respiratory distress syndrome, atelectasis, and pleural effusion. The pathogenesis of some of the above complications is attributed to the production of noxious cytokines. Clinically significant is the early onset of pleural effusion, which heralds a poor outcome of acute pancreatitis. The role of circulating trypsin, phospholipase A2, platelet activating factor, release of free fatty acids,chemoattractants such as tumor necrsosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, IL-8, fMet-leu-phe (a bacterial wall product), nitric oxide, substance P, and macrophage inhibitor factor is currently studied. The hope is that future management of acute pancreatitis with a better understanding of the pathogenesis of lung injury will be directed against the production of noxious cytokines.

  16. Chylous ascites caused by acute pancreatitis with portal vein thrombosis.

    Science.gov (United States)

    Park, Dong Eun; Chae, Kwon Mook

    2011-12-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.

  17. Mediastinal Pseudocyst in Acute on Chronic Pancreatitis.

    Science.gov (United States)

    Mishra, Sushil Kumar; Jain, Pawan Kumar; Gupta, Sukhdev

    2016-03-01

    Pseudocyst is a common complication of Acute and chronic pancreatitis. However, its extension into the mediastinum is a rare entity. We present a case of 52 years male with acute on chronic pancreatitis (alcohol related) who presented with dysphagia and dyspnoea and was found to have a pancreatic pseudocyst extending upto the neck. Ultrasound fails to pick up mediastinal pseudocysts and requires additional imaging modalities - CT and MRI. Management of Mediastinal pseudocyst depends upon underlying etiology, ductal anatomy, size of the pseudocyst, and availability of expertise. Small pseudocysts in asymptomatic patients may resolve spontaneously, but requires prolonged conservative therapy with somatostatin or its analogue and Total Parenteral Nutrition. Ruptured pseudocyst in a symptomatic unstable patient requires surgical resection. Endoscopic ultrasound guided drainage (transmural or transpapillary) and Main Pancreatic Duct stenting are safe and effective treatment modality.

  18. Nutritional support in acute and chronic pancreatitis.

    Science.gov (United States)

    Grant, John P

    2011-08-01

    Nutritional support can have a significant beneficial impact on the course of moderate to severe acute pancreatitis. Enteral nutrition is preferred, with emphasis on establishment of jejunal access; however, parenteral nutrition can also be of value if intestinal failure is present. Early initiation of nutritional support is critical, with benefits decreasing rapidly if begun after 48 hours from admission. Severe malnutrition in chronic pancreatitis can be avoided or treated with dietary modifications or enteral nutrition.

  19. STUDY ANALYSIS OF ACUTE PANCREATITIS BY CT

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    Ruchir Patel; Nirav Pipaliya; Prateik Poddar; Vikas Pandey; Meghraj Ingle; Prabha Sawant

    2016-01-01

    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 abdomina...

  1. Risk Factors For Development Of Acute Necrotizing Pancreatitis

    Directory of Open Access Journals (Sweden)

    Stojanovic Bojan

    2015-06-01

    Full Text Available Acute necrotizing pancreatitis (ANP is a severe form of acute pancreatitis that is associated with high morbidity and mortality. Thus, an adequate initial treatment of patients who present with acute pancreatitis (AP based on correct interpretation of early detected laboratory and clinical abnormalities may have a significant positive impact on the disease course.

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

    NARCIS (Netherlands)

    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

  3. Hyperamylasaemia and acute pancreatitis in paracetamol poisoning

    DEFF Research Database (Denmark)

    Schmidt, L E; Dalhoff, K

    2004-01-01

    BACKGROUND: Hyperamylasaemia and even acute pancreatitis have been reported in patients with paracetamol poisoning. AIMS: To describe the incidence, clinical characteristics, and prognostic implications of hyperamylasaemia in paracetamol poisoning. PATIENTS: Six hundred and two patients transferred...... in 28 of the unselected patients (13%), in 218 of the transferred patients (36%), and in 118 of 148 patients (80%) with fulminant hepatic failure. Only 33 cases of paracetamol-associated acute pancreatitis were diagnosed. A threshold serum amylase of 150 U/L to discriminate non-survivors had sensitivity......, whereas clinical acute pancreatitis occurs rarely. The incidence of hyperamylasaemia increases with the degree of hepatic dysfunction. A serum amylase exceeding 1.5 times the upper normal limit indicates a poor prognosis....

  4. Acute pancreatitis, acute hepatitis and acute renal failure favourably resolved in two renal transplant recipients.

    Science.gov (United States)

    Voiculescu, Mihai; Ionescu, Camelia; Ismail, Gener; Mandache, Eugen; Hortopan, Monica; Constantinescu, Ileana; Iliescu, Olguta

    2003-03-01

    Renal transplantation is often associated with severe complications. Except for acute rejection, infections and toxicity of immunosuppressive treatment are the most frequent problems observed after transplantation. Infections with hepatic viruses (HBV, HDV, HCV, HGV) and cytomegalic virus (CMV) are the main infectious complications after renal transplantation. Cyclosporine toxicity is not unusual for a patient with renal transplantation and is even more frequent for patients with hepatic impairment due to viral infections. The subjects of this report are two renal transplant recipients with acute pancreatitis, severe hepatitis and acute renal failure on graft, receiving immunosuppressive therapy for maintaining renal graft function

  5. Fungal infections in severe acute pancreatitis.

    Science.gov (United States)

    Kochhar, Rakesh; Noor, Mohd Talha; Wig, Jaidev

    2011-06-01

    Severe acute pancreatitis (SAP) is associated with significant morbidity and mortality. The majority of deaths related to SAP are the result of infectious complications. Although bacterial infections are most commonly encountered, fungal infections are increasingly being recognized. Candida is the most common fungal infection. The occurrence of fungal infection in patients with acute pancreatitis adversely affects the clinical course, leading to a higher incidence of systemic complications, and possibly mortality as well. Important risk factors for fungal infection in patients with acute pancreatitis include broad-spectrum antibiotics, prolonged hospitalization and surgical/endoscopic interventions, use of total parenteral nutrition, and mechanical ventilation. Patients with higher severity of pancreatitis are at a greater risk. The pathogenesis of fungal infection in patients with acute pancreatitis is multifactorial. Translocation of microorganisms across the gut epithelium, lymphocyte dysfunction, and the virulence of the invading microorganisms play important roles. Histological demonstration of fungi remains the gold standard of diagnosis, but a positive biopsy is rarely obtained. The role of biomarkers in the diagnosis is being investigated. As early diagnosis and treatment can lead to improved outcome, a high index of suspicion is required for prompt diagnosis. Limiting the use of broad-spectrum antibiotics, early introduction of enteral nutrition, and timely change of vascular catheters are important preventive strategies. The role of antifungal prophylaxis remains controversial. Surgical necrosectomy with antifungal therapy is the most widely used treatment approach. Clinical trials on antifungal prophylaxis are needed, and indications for surgical intervention need to be clearly defined.

  6. ICAM-1 and Acute Pancreatitis Complicated by Acute Lung Injury

    Directory of Open Access Journals (Sweden)

    XiPing Zhang

    2009-01-01

    Full Text Available One of the most common complications of acute pancreatitis is acute lung injury, during which intercellular adhesion molecule-1 (ICAM-1 plays an important role by participating in leukocyte adhesion and activation as well as by inducing the “cascade effect” of inflammatory mediators, pulmonary microcirculation dysfunction and even acute respiratory distress syndrome, multiple organ failure or death. Although it is generally believed that the modulatory mechanism of ICAM-1 during this process is associated with the activation of nuclear transcription factor kappa B which is mediated by IL-1, IL-6, IL-18 and oxygen free radical, etc., further studies are still required to clarify it. Since the upregulation of ICAM-1 expression in the lung during acute lung injury is one of main pathogeneses, the early detection of the ICAM-1 expression level may contribute to the prevention and treatment of acute lung injury. Moreover, reducing pulmonary ICAM-1 expression levels through treatment with anti-ICAM-1 monoclonal antibody (aICAM-1 and antagonists of the neurokinin 1 receptor, etc., should have a positive effect on protecting the lungs during acute pancreatitis. This review aims to further clarify the relationship between ICAM-1 and acute pancreatitis complicated by acute lung injury, and therefore provides a theoretical basis for the formulation of corresponding therapeutic measures in clinical practice for acute pancreatitis.

  7. Pancreatic ascites hemoglobin contributes to the systemic response in acute pancreatitis.

    Science.gov (United States)

    Pérez, Salvador; Pereda, Javier; Sabater, Luis; Sastre, Juan

    2015-04-01

    Upon hemolysis extracellular hemoglobin causes oxidative stress and cytotoxicity due to its peroxidase activity. Extracellular hemoglobin may release free hemin, which increases vascular permeability, leukocyte recruitment, and adhesion molecule expression. Pancreatitis-associated ascitic fluid is reddish and may contain extracellular hemoglobin. Our aim has been to determine the role of extracellular hemoglobin in the local and systemic inflammatory response during severe acute pancreatitis in rats. To this end we studied taurocholate-induced necrotizing pancreatitis in rats. First, extracellular hemoglobin in ascites and plasma was quantified and the hemolytic action of ascitic fluid was tested. Second, we assessed whether peritoneal lavage prevented the increase in extracellular hemoglobin in plasma during pancreatitis. Third, hemoglobin was purified from rat erythrocytes and administered intraperitoneally to assess the local and systemic effects of ascitic-associated extracellular hemoglobin during acute pancreatitis. Extracellular hemoglobin and hemin levels markedly increased in ascitic fluid and plasma during necrotizing pancreatitis. Peroxidase activity was very high in ascites. The peritoneal lavage abrogated the increase in extracellular hemoglobin in plasma. The administration of extracellular hemoglobin enhanced ascites; dramatically increased abdominal fat necrosis; upregulated tumor necrosis factor-α, interleukin-1β, and interleukin-6 gene expression; and decreased expression of interleukin-10 in abdominal adipose tissue during pancreatitis. Extracellular hemoglobin enhanced the gene expression and protein levels of vascular endothelial growth factor (VEGF) and other hypoxia-inducible factor-related genes in the lung. Extracellular hemoglobin also increased myeloperoxidase activity in the lung. In conclusion, extracellular hemoglobin contributes to the inflammatory response in severe acute pancreatitis through abdominal fat necrosis and inflammation

  8. Refractory thrombotic thrombocytopenic purpura following acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ebisa Bekele; Bethel Shiferaw; Alexandra Sokolova; Arpan Shah; Phillip Saunders; Alida Podrumar; Javed Iqbal

    2016-01-01

    Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder with an estimated incidence of 4–5 cases per million people per year. It is characterized by small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia and organ damage. There are reports in literature that TTP and acute pancreatitis are associated, indicating each can be the cause of the other. However, acute pancreatitis triggering TTP is very rare. A 71 years old female presented with abdominal pain of 3 days, followed by dark urine. She had icteric sclera, petechial rash and mild epigastric tenderness. Lab findings were significant for hemolytic anemia, thrombocytopenia and elevated lipase. CT of abdomen showed evidence of pancreatitis and cholelithiasis. After admission, patient developed symptoms of stroke. Further investigation showed elevated lactate dehydrogenase and normal coagulation studied with peripheral blood smear showed 5–6 schistocytes/high power field. Disintegrin and metalloproteinase with thrombospondin motifs-13 (ADAMTS13) activity showed less than 3% with high ADAMTS13 inhibitor 2.2. Patient required 6–7 weeks of daily plasmapheresis until she showed complete response. Our patient presented with clinical features of pancreatitis prior to having dark urine and petechial rash. Therefore, we strongly believe that our patient had pancreatitis which was followed by TTP. Patient's ADMTS13 activity was 6%after 10 plasma exchanges, signifying refractory TTP and higher risk for morbidity and mortality. There are limited data and consensus on the management of refractory TTP. TTP and acute pancreatitis are associated. However, refractory TTP following acute pancreatitis is rarely mentioned in the literature. We would like to emphasize the importance of having higher clinical suspicion of the association of both disease entities.

  9. Pathogenesis of pancreatic encephalopathy in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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. A CLINICAL STUDY ON ACUTE PANCREATITIS AND ITS DIFFERENT ETIOLOGIES IN BOWRING & LADY CURZON HOSPITALS, BENGALURU

    Directory of Open Access Journals (Sweden)

    Harindranath

    2016-01-01

    Full Text Available There are various etiological factors causing acute pancreatitis; of them to identify the most common etiological factor affecting the severity of symptoms, complications and mortality in acute pancreatitis. Acute pancreatitis is one of the commonest medical emergencies encountered in Tertiary Care Center. Different etiologies have been proposed in its causation in different parts of the world, i.e. alcohol, gallstones, viruses, certain drugs; however, there are no much studies conducted in India to assess the incidence of acute pancreatitis and the role of different etiological agents. METHODS This study was conducted in Bowring and Lady Curzon hospital, Bengaluru. A total of 40 patients admitted between January 2015 to November 2015 with symptoms of acute pancreatitis were analysed retrospectively to study the etiology in each case and findings were tabulated. RESULTS AND CONCLUSION The highest incidence of acute pancreatitis was found in the age group of 30 to 50 years followed by the age group of 20 to 30 years. Acute pancreatitis was found more commonly in males compared to females. This may be due to effect of alcohol addiction in males. Surgeries not much useful except in cases of gallstone and necrotizing pancreatitis. In acute pancreatitis, serum lipase level may be elevated more consistently and for longer half-life than serum amylase. Octreotide used in all patients, found helpful in producing symptomatic relief and promoting recovery in mild to moderate cases.

  12. Acute pancreatitis and acute renal failure following multiple hornet stings

    Directory of Open Access Journals (Sweden)

    N. Sharma

    2006-04-01

    Full Text Available Hymenoptera is a class of insects that sting in order to subdue their prey. Humans coming into accidental contact with these insects results in stings that may cause from mild local reaction like weal formation around the sting site to severe systemic reactions such as intravascular hemolysis, acute renal failure, pulmonary edema, cerebral edema, and rarely pancreatitis. We report here the clinical course of a patient who developed concurrent acute pancreatitis and pigment-induced acute renal failure after multiple hornet stings.

  13. Cardiac tamponade, an unusual complication of acute pancreatitis.

    Science.gov (United States)

    Veron Esquivel, Daniel; Aello, Gerardo; Batiz, Fernando; Fernandez Barrera, Alejandro

    2016-03-11

    A 41-year-old Hispanic man was admitted to our hospital with the diagnosis of acute pancreatitis due to hypertriglyceridemia. During his stay, he developed sudden haemodynamic instability and clinical presentation suggestive of cardiac tamponade. A transthoracic echocardiogram confirmed the diagnosis. Echocardiography-guided pericardiocentesis was performed with immediate haemodynamic improvement. The patient's condition underwent favourable evolution. The pancreatitis was resolved and a control transthoracic echocardiography was performed showing no pericardial effusion. The pathophysiology of this rare entity is unknown. Early diagnosis and treatment are crucial. Although pericardiocentesis is the treatment of choice, there have been a few reports of medical treatment with encouraging results. Although the association of acute pancreatitis and tamponade are anecdotal in literature, medics should be aware of this association in order to perform prompt diagnosis.

  14. Endoscopic therapy in acute recurrent pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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).

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

    Institute of Scientific and Technical Information of China (English)

    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. Cytokines and Organ Failure in Acute Pancreatitis

    DEFF Research Database (Denmark)

    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...

  17. Enteral Nutrition and Acute Pancreatitis: A Review

    NARCIS (Netherlands)

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

    2011-01-01

    Introduction. 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

  18. Enteral nutrition and acute pancreatitis: A review

    NARCIS (Netherlands)

    B.W.M. Spanier (Marcel); M.J. Bruno (Marco); E.M.H. Mathus-Vliegen (Elisabeth)

    2011-01-01

    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

  19. Acute pancreatitis and acute renal failure complicating doxylamine succinate intoxication.

    Science.gov (United States)

    Lee, Yang Deok; Lee, Soo Teik

    2002-06-01

    Doxylamine succinate is an antihistaminic drugwith additional hypnotic, anticholinergic and local anesthetic effects first described in 1948. In Korea and many other countries, it is a common-over-the counter medication frequently involved in overdoses. Clinical symtomatology of doxylamine succinate overdose includes somnolence, coma, seizures, mydriasis, tachycardia, psychosis, and rhabdomyolysis. A serious complication may be rhabdomyolysis with subsequent impairment of renal function and acute renal failure. We report a case of acute renal failure and acute pancreatitis complicating a doxylamine succinate intoxication.

  20. Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Emily K Smith; Edmund Ek; Daniel Croagh; Lavinia A Spain; Stephen Farrell

    2009-01-01

    We report a case of acute chylous peritonitis mimicking acute appendicitis in a man with acute on chronic pancreatitis. Pancreatitis, both acute and chronic, causing the development of acute chylous ascites and peritonitis has rarely been reported in the English literature. This is the fourth published case of acute chylous ascites mimicking acute appendicitis in the literature.

  1. Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Yeon Hwa Yu; Joo Hyun Sohn; Tae Yeob Kim; Jae Yoon Jeong; Dong Soo Han; Yong Cheol Jeon; Min Young Kim

    2012-01-01

    Hepatic artery pseudoaneurysm (HAP) is a very rare disease but in cases of complication,there is a very high mortality.The most common cause of HAP is iatrogenic trauma such as liver biopsy,transhepatic biliary drainage,cholecystectomy and hepatectomy.HAP may also occur with complications such as infections or inflammation associated with septic emboli.HAP has been reported rarely in patients with acute pancreatitis.As far as we are aware,there is no report of a case caused by acute idiopathic pancreatitis,particularly.We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman.The woman initially presented with acute pancreatitis due to unknown cause.After conservative management,her symptoms seemed to have improved.But eight days after admission,abdominal pain abruptly became worse again.Abdominal computed tomography (CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT.Endoscopic retrograde cholangiopancreatography (ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain.ERCP confirmed hemobilia by observing fresh blood clots at the opening of the ampulla and several filling defects in the distal common bile duct on cholangiogram.Without any particular treatment such as embolization or surgical ligation,HAP thrombosed spontaneously.Three months after discharge,abdominal CT demonstrated that HAP in the left lateral segment had disappeared.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. Therapeutic proteasome inhibition in experimental acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Tamás Letoha; Tamás Takács; Liliána Z Fehér; László Pecze; Csaba Somlai; Ilona Varga; József Kaszaki; Gábor Tóth; Csaba Vizier; László Tiszlavicz

    2007-01-01

    AIM: To establish the therapeutic potential of proteasome inhibition, we examined the therapeutic effects of MG132 (Z-Leu-Leu-Leu-aldehyde) in an experimental model of acute pancreatitis.METHODS: Pancreatitis was induced in rats by two hourly intraperitoneal (ip) injections of cholecystokinin octapeptide (CCK; 2 × 100 μg/kg) and the proteasome inhibitor MG132 (10 mg/kg ip) was administered 30 min after the second CCK injection. Animals were sacrificed 4 h after the first injection of CCK.RESULTS: Administering the proteasome inhibitor MG132 (at a dose of 10 mg/kg, ip) 90 min after the onset of pancreatic inflammation induced the expression of cell-protective 72 kDa heat shock protein (HSP72) and decreased DNA-binding of nuclear factor-κB (NF-κB).Furthermore MG132 treatment resulted in milder inflammatory response and cellular damage, as revealed by improved laboratory and histological parameters of pancreatitis and associated oxidative stress.CONCLUSION: Our findings suggest that proteasome inhibition might be beneficial not only for the prevention,but also for the therapy of acute pancreatitis.

  4. Improving the Outcome of Acute Pancreatitis.

    Science.gov (United States)

    Bruno, Marco J

    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.

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

    Directory of Open Access Journals (Sweden)

    Surendran E

    2005-07-01

    Full Text Available 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 pretibial regions of both lower legs, a clinical sign of panniculitis indicating acute pancreatitis common in alcoholic patients. Abdominal ultrasonography showed a diffusely edematous pancreas suggestive of acute pancreatitis. Abdominal contrast enhanced computerized tomography revealed features suggestive of severe acute pancreatitis with pancreatic necrosis. A skin biopsy confirmed the diagnosis of septal panniculitis without vasculitis or fat necrosis, which is indicative of a very early stage of pancreatic panniculitis suggesting acute alcoholic pancreatitis. CONCLUSION: Septal panniculitis without vasculitis or fat necrosis is a cutaneous clinical marker which denotes a very early stage of pancreatic panniculitis associated with acute alcoholic pancreatitis. The treatment of pancreatic panniculitis is primarily supportive and depends on the underlying pancreatic pathology which may include surgery or endoscopic management.

  6. Severe acute pancreatitis: Clinical course and management

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically.Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the SepsisRelated Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions.Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.

  7. Cardiocirculatory pathophysiological mechanisms in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  8. Tamoxifen-induced hypertriglyceridemia causing acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Hemant Kumar Singh

    2016-01-01

    Full Text Available 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 on tamoxifen (20mg/day hormonal therapy for breast cancer. Within 3 months of starting therapy, she developed hypertriglyceridemia and acute pancreatitis. Laboratory values include: Serum amylase 778 IU/L, total cholesterol 785 mg/dL, triglycerides 4568 mg/dL and high-density lipoproteins (HDL 12 mg/dL. Tamoxifen was substituted with letrozole and atorvastatin started. There was a prompt reversal of the adverse effects. Effects on lipid profile must be considered while initiating tamoxifen in predisposed individuals as the consequences are life threatening.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  10. Hiatus Hernia: A Rare Cause of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Shruti Patel

    2016-01-01

    Full Text Available Hiatal hernia (HH is the herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm. A giant HH with pancreatic prolapse is very rare and its causing pancreatitis is an even more extraordinary condition. We describe a case of a 65-year-old man diagnosed with acute pancreatitis secondary to pancreatic herniation. In these cases, acute pancreatitis may be caused by the diaphragmatic crura impinging upon the pancreas and leading to repetitive trauma as it crosses the hernia; intermittent folding of the main pancreatic duct; ischemia associated with stretching at its vascular pedicle; or total pancreatic incarceration. Asymptomatic hernia may not require any treatment, while multiple studies have supported the recommendation of early elective repair as a safer route in symptomatic patients. In summary, though rare, pancreatic herniation should be considered as a cause of acute pancreatitis. A high index of suspicion for complications is warranted in cases like these.

  11. Pravastatin: A potential cause for acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Constantine Tsigrelis; CS Pitchumoni

    2006-01-01

    Acute pancreatitis (AP) secondary to drugs is uncommon, with an incidence ranging from 0.3% to 2.0%of AP cases. Drug-induced AP due to statins is rare, and only 12 cases have thus far been reported. In this case report, we report a case of a 50-year-old female on pravastatin therapy for 3 d prior to developing symptoms of AP. The common etiological factors for AP were all excluded. The patient was admitted to the intensive care unit secondary to respiratory distress, though she subsequently improved and was discharged 14 d after admission. Although the incidence of drug-induced AP is low, clinicians should have a high index of suspicionfor it in patients with AP due to an unknown etiology.Clinicians should be aware of the association of statins with AP. If a patient taking a statin develops abdominal pain, clinicians should consider the diagnosis of AP and conduct the appropriate laboratory and diagnostic evaluation if indicated.

  12. Infected pancreatic necrosis: Not necessarily a late event in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    MaximSPetrov; Vincent Chong; John A Windsor

    2011-01-01

    It is widely believed that infection of pancreatic necrosis is a late event in the natural course of acute pancreatitis. This paper discusses the available data on the timing of pancreatic infection. It appears that infected pancreatic necrosis occurs early in almost a quarter of patients. This has practical implications for the type, timing and duration of preventive strategies used in these patients. There are also implications for the classification of severity in patients with acute pancreatitis. Given that the main determinants of severity are both local and systemic complications and that they can occur both early and late in the course of acute pancreatitis, the classification of severity should be based on their presence or absence rather than on when they occur. To do otherwise, and in particular overlook early infected pancreatic necrosis, may lead to a misclassification error and fallacies of clinical studies in patients with acute pancreatitis.

  13. Extraperitoneal Fluid Collection due to Chronic Pancreatitis.

    Science.gov (United States)

    Yasuda, Takeo; Kamei, Keiko; Araki, Mariko; Nakata, Yasuyuki; Ishikawa, Hajime; Yamazaki, Mitsuo; Sakamoto, Hiroki; Kitano, Masayuki; Nakai, Takuya; Takeyama, Yoshifumi

    2013-01-01

    A 39-year-old man was referred to our hospital for the investigation of abdominal fluid collection. He was pointed out to have alcoholic chronic pancreatitis. Laboratory data showed inflammation and slightly elevated serum direct bilirubin and amylase. An abdominal computed tomography demonstrated huge fluid collection, multiple pancreatic pseudocysts and pancreatic calcification. The fluid showed a high level of amylase at 4,490 IU/l. Under the diagnosis of pancreatic ascites, endoscopic pancreatic stent insertion was attempted but was unsuccessful, so surgical treatment (Frey procedure and cystojejunostomy) was performed. During the operation, a huge amount of fluid containing bile acid (amylase at 1,474 IU/l and bilirubin at 13.5 mg/dl) was found to exist in the extraperitoneal space (over the peritoneum), but no ascites was found. His postoperative course was uneventful and he shows no recurrence of the fluid. Pancreatic ascites is thought to result from the disruption of the main pancreatic duct, the rupture of a pancreatic pseudocyst, or possibly leakage from an unknown site. In our extremely rare case, the pancreatic pseudocyst penetrated into the hepatoduodenal ligament with communication to the common bile duct, and the fluid flowed into the round ligament of the liver and next into the extraperitoneal space.

  14. Extraperitoneal Fluid Collection due to Chronic Pancreatitis

    Directory of Open Access Journals (Sweden)

    Takeo Yasuda

    2013-08-01

    Full Text Available A 39-year-old man was referred to our hospital for the investigation of abdominal fluid collection. He was pointed out to have alcoholic chronic pancreatitis. Laboratory data showed inflammation and slightly elevated serum direct bilirubin and amylase. An abdominal computed tomography demonstrated huge fluid collection, multiple pancreatic pseudocysts and pancreatic calcification. The fluid showed a high level of amylase at 4,490 IU/l. Under the diagnosis of pancreatic ascites, endoscopic pancreatic stent insertion was attempted but was unsuccessful, so surgical treatment (Frey procedure and cystojejunostomy was performed. During the operation, a huge amount of fluid containing bile acid (amylase at 1,474 IU/l and bilirubin at 13.5 mg/dl was found to exist in the extraperitoneal space (over the peritoneum, but no ascites was found. His postoperative course was uneventful and he shows no recurrence of the fluid. Pancreatic ascites is thought to result from the disruption of the main pancreatic duct, the rupture of a pancreatic pseudocyst, or possibly leakage from an unknown site. In our extremely rare case, the pancreatic pseudocyst penetrated into the hepatoduodenal ligament with communication to the common bile duct, and the fluid flowed into the round ligament of the liver and next into the extraperitoneal space.

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Science.gov (United States)

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

    2015-09-27

    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. Seventy-two 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Pathogenic role of myeloperoxidase in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Serge Chooklin; Andriy Pereyaslov; Ihor Bihalskyy

    2009-01-01

    BACKGROUND: Myeloperoxidase (MPO) has been implicated in promoting tissue damage in various inlfammatory diseases. However, MPO blood levels in relation to the severity of acute pancreatitis (AP) and its time-course have not been studied. The present study aimed to determine the role of MPO in AP. METHODS: We studied 86 patients with AP (48 patients with mild and 38 with severe pancreatitis) and 18 controls (volunteers). The relations of serum MPO levels to cytokine level, severity, and time-course of pancreatitis were studied. The serum level of MPO and cytokines were measured by MPO-EIA and cytokines ELISA, respectively. RESULTS: The highest level of MPO was noted at the ifrst day in patients with severe AP. A decrease of MPO blood level occurred during the ifrst three days in all patients with necrotizing pancreatitis. The development of pancreatitis-associated lung injury and purulent complications was accompanied by increased MPO levels. Administration of pentoxifylline signiifcantly reduced the MPO blood level, which was clearly correlated with the levels of proinlfammatory cytokines in the two groups of patients. CONCLUSIONS: The results of the present study showed the MPO blood level is dependent on the severity of AP and on cytokine blood levels. Pentoxifylline in the complex management of severe AP may improve the results of treatment.

  19. Is Bortezomib a Rare Cause of Acute Pancreatitis?

    Directory of Open Access Journals (Sweden)

    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. Diagnostic evaluation of acute pancreatitis in two patients with hypertriglyceridemia

    Institute of Scientific and Technical Information of China (English)

    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.

  1. Luminal lactate in acute pancreatitis - validation and relation to disease severity

    DEFF Research Database (Denmark)

    Pynnönen, Lauri; Minkkinen, Minna; Räty, Sari;

    2012-01-01

    the physiological validity of the method. Rectal luminal lactate at the hospital admission was not associated with the first day or the highest SOFA score, CRP level, hospital length of stay, length of stay in intensive care or mortality. In this cohort of unselected consecutive patients with acute pancreatitis we...... patients admitted to hospital due to acute pancreatitis to test the hypothesis that a single measurement of rectal luminal lactate predicts the severity of acute pancreatitis, the length of hospital stay, the need of intensive care and ultimately, mortality. We also tested the physiological validity...... and systemic inflammation. In acute pancreatitis (AP) bacterial translocation is considered as the key event leading to infection of necrotic pancreatic tissue and high severity of illness. METHODS: We used rectal luminal equilibration dialysis for the measurement of gut luminal lactate in 30 consecutive...

  2. Acute pancreatitis | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available lot Trial of Indomethacin in Acute Pancreatitis Ensayo piloto controlado y aleatorizado con indometacina en ....1 Medical condition or disease under investigation E.1.1Medical condition(s) being investigated Acute...n criteria Patients ages 18 or above admitted to hospital with a diagnosis of Acute pancreatitis (AP) based

  3. A rare disease in the differential diagnosis of acute pancreatitis: acute brucellosis.

    Science.gov (United States)

    Berber, Ilhami; Erkurt, Mehmet Ali; Yetkin, Funda; Unlu, Serkan; Yilmaz, Sami; Bentli, Recep; Bazna, Sezai

    2014-01-01

    Some infectious organisms may give rise to acute pancreatitis; brucellosis, however, extremely rarely leads to acute pancreatitis. A 40-year-old man was diagnosed with acute pancreatitis, the etiology of which was determined to be acute brucellosis. The patient was discharged without complications approximately 15 days after the initiation of trimethoprim-sulfamethoxazole and doxycycline treatment. Brucella infections may rarely be complicated by acute pancreatitis. Thus, brucellosis should be remembered in the etiology of acute pancreatitis in regions such as Turkey, where Brucella infections are endemic.

  4. An Unusual Case of Colon Perforation Complicating Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Anthony A. Aghenta

    2009-08-01

    Full Text Available Colonic complications of severe acute pancreatitis occur rarely. Although there have been several theories on how pancreatic pseudocysts rupture into the colon, the exact pathogenesis remains unknown. We report an unusual case of pseudocysts complicating severe acute pancreatitis presenting with colonic perforation in a 71-year-old man with a history of chronic mesenteric ischemia. Pressure effects from a giant pseudocyst and intravascular volume depletion with acute insult on chronic mesenteric ischemia are highlighted as possible etiologic factors.

  5. Trypsin-Based Laboratory Methods and Carboxypeptidase Activation Peptide in Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Kylanpaa-Back ML

    2002-03-01

    Full Text Available Acute pancreatitis is a common disease varying widely in severity. At present, there is no "gold standard" for the diagnosis of acute pancreatitis. Currently, the diagnosis of acute pancreatitis is based on measurements of serum amylase and/or lipase activity, which are considered unsatisfactory due to their low level of accuracy. Early identification of acute pancreatitis and especially detection of patients with a severe form of the disease is of utmost importance. Premature intrapancreatic activation of trypsinogen is a crucial early event in the pathophysiology of acute pancreatitis. The conversion of trypsinogen to active trypsin is mediated by the release of its activation peptide (TAP. The active trypsin is then able to activate other pancreatic zymogens (i.e. procarboxypeptidase leading to tissue damage and eventually to autodigestion of the pancreas. To improve the laboratory diagnostics of AP, new methods have been developed to measure this primary pancreatic proteolytic insult. Here we review the current knowledge and clinical implications of trypsin based laboratory methods and carboxypeptidase activation peptide (CAPAP in the diagnosis and severity assessment of acute pancreatitis.

  6. Nutrición en pancreatitis aguda Nutrition acute pancreatitis

    Directory of Open Access Journals (Sweden)

    F. J. García-Alonso

    2012-04-01

    Full Text Available La pancreatitis aguda es una patología frecuente y potencialmente grave en la que el manejo nutricional influye de manera importante en su desarrollo, de tal forma que se puede considerar un tratamiento específico en los casos graves. Éstos suponen aproximadamente el 20% de los pacientes y presentan una mortalidad entre el 8-39%. En los casos leves se suele proceder a un ingreso en dieta absoluta y posterior reintroducción progresiva de la dieta. Aunque se ha demostrado que una reintroducción temprana acorta la duración del ingreso, existe incertidumbre acerca del momento y del tipo de dieta idóneos. Las pancreatitis graves son estados hipercatabólicos que se presentan en pacientes que frecuentemente presentan déficits nutricionales basales. El soporte nutricional iniciado precozmente por vía enteral ha demostrado un beneficio significativo respecto a la vía parenteral en cuanto a tasa de infección, control de glucemia y mortalidad. Este beneficio puede relacionarse con una disminución de la traslocación bacteriana. Si bien tradicionalmente se ha empleado la vía nasoyeyunal, existen estudios que apoyan la vía nasogástrica, mucho más accesible. En el siguiente texto ofrecemos una revisión actualizada del manejo nutricional en la pancreatitis aguda, intentando responder de manera clara y con un enfoque práctico a las preguntas que más frecuentemente se presentan en el manejo de esta patología.Acute pancreatitis is a common and potentially severe disease where nutritional support does affect its development in a way it may be considered a treatment in severe cases. These include around 20% of patients and present mortality rates of 8%-39%. In mild acute pancreatitis patients are prescribed nil per os at admission and advance diet in a progressive manner the following days. Although early introduction of diet has proven to shorten the length of stay, it is still not clear when and how to introduce diet. Severe disease is a

  7. [Acute respiratory distress caused by a mediastinal pancreatic pseudocyst].

    Science.gov (United States)

    Guillaume, A; Desport, J C; Dolan, P; Fressard, D; Feiss, P

    1993-01-01

    The pseudocyst of the pancreas is a frequent complication of acute pancreatitis. However to intrathoracic localization remains exceptional. A case of acute respiratory insufficiency in a 66-year-old man in whom artificial ventilation was required for such a complication is reported. This case stresses the difficulty often encountered for the differential diagnosis of these liquid tumors. The clinical signs are variable and non specific, especially in case of absence of any history of pancreatitis. The radiographic studies, in particular ultrasonography and CT-scanner defines its liquid nature and its connections. Endoscopy examination confirms its retro-oesophageal extension due to the migration through the oesophageal hiatus. Only the percutaneous needle aspiration of a collection or an associated pleural effusion confirms the diagnosis by the high content of amylases. The treatment of this type of localisation is surgical and essentially consists of an internal derivation.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  9. Acute Obstructive Suppurative Pancreatic Ductitis in an Asymptomatic Patient

    Directory of Open Access Journals (Sweden)

    Eisha Wali

    2015-01-01

    Full Text Available Acute obstructive suppurative pancreatic ductitis (AOSPD, defined as suppuration from the pancreatic duct without associated pseudocyst, abscess, or necrosis, is a rare complication of chronic pancreatitis. We present the first case of AOSPD in an asymptomatic patient with a polymicrobial infection and review the literature on this rare clinical entity.

  10. BISAP: A NOVEL METHOD FOR ASSESSING SEVERITY OF ACUTE PANCREATITIS

    Directory of Open Access Journals (Sweden)

    Ramalingeshwara

    2014-09-01

    Full Text Available BACKGROUND: There are many multifactorial scoring systems, radiological scores, and biochemical markers are available for early prediction of severity, and mortality in patients with acute pancreatitis (AP. The bedside index for severity in acute pancreatitis (BISAP has been considered as an accurate method for risk stratification in patients with acute pancreatitis. OBJECTIVE: This study aimed to evaluate the usefulness of the BISAP as a predictor for severe pancreatitis. METHODS AND MATERIAL: We analyzed 100 patients diagnosed with acute pancreatitis at our hospital between October 2012 and April 2013. We used BISAP score in all such patients within 24 hours of admission. Patient were assessed for organ failure and followed throughout the period of hospitalization for complications. Statistical analysis was made using the student t test and chi-square test and statistical significance was analyzed. RESULTS: Out of 100 patients, 20% had severe pancreatitis. Acute Pancreatitis was seen male (87%, in 4th decade (70%, alcohol was the most common etiology (60%, biliary pancreatitis (25%, remaining idiopathic (15%. Patients with BISAP >= 3 was associated with transient or persistent organ failure and pancreatic necrosis. CONCLUSION: BISAP scoring is a simple clinical method to identify patients at risk of increased mortality within 24 hours of presentation in patients with acute pancreatitis.

  11. Acute pancreatitis with gliptins: Is it a clinical reality?

    Directory of Open Access Journals (Sweden)

    Muthukrishnan Jayaraman

    2013-01-01

    Full Text Available There are reports of acute pancreatitis with the use of dipeptidyl peptidase-4 inhibitors (gliptins. This class of drugs is widely being prescribed for type 2 diabetes mellitus (DM in our country. We evaluated the incidence of acute pancreatitis with the use of gliptins during the period January 2012-June 2013. Patients of type 2 DM on treatment with any of the gliptins (Sitagliptin, vildagliptin, or saxagliptin for at least 1 month duration were included. A total of 185 patients were included (205.3 patient years of follow-up. Five of them had history of acute pancreatitis (all mild >6 months prior to inclusion with complete resolution and no chronic pancreatitis. One patient (0.48 per 100 patient years presented with mild acute pancreatitis which resolved in 8 days. Asymptomatic elevation of serum amylase > 3× upper limit of normal was noted in five patients (2.4 per 100 patient years, without any sonological evidence of pancreatitis, which resolved on withdrawal of gliptins. None of the patients with previous history of pancreatitis had a recurrence of pancreatitis. In a group at low risk of acute pancreatitis, incidence of acute pancreatitis is low with the use of gliptins.

  12. Pancreatitis

    Science.gov (United States)

    ... 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 ...

  13. Hepatobiliary and pancreatic ascariasis-sonographic pictorial essay on four pediatric cases with acute biliary colic.

    Science.gov (United States)

    Lynser, Donboklang; Marbaniang, Evarisalin

    2016-04-01

    Hepatobiliary and pancreatic ascariasis occur due to migration of the round worm ascaris lumbricoides through the bile duct orifice finally reaching the common bile duct, main pancreatic duct, intrahepatic ducts or gallbladder. These resulted in acute epigastric and right hypochondriac region colicky pain. Ultrasound is the investigation of choice in hepatobiliary ascariasis. We present here sonographic images on four pediatric patients with acute biliary colic.

  14. The complex treatment of acute pancreatitis using miniinvasive surgical treatment

    Directory of Open Access Journals (Sweden)

    G. I. Ohrimenko

    2015-06-01

    Full Text Available Nowadays methods used in acute pancreatitis diagnostic do not allow to find the most optimal indications, terms of surgical drainage approaches in surgical treatment of acute pancreatitis. Aim. In order to develop optimal diagnostic and treatment algorithm 316 patients took part in the study. Methods and results. Surgery outcomes were assessed by the next methods: ultrasound, computed tomography. We determined that destructive changes in pancreas in group of sterile pancreatic necrosis were limited. In cases of infected pancreatic necrosis the damage was spread and the disease course was septic. That’s why the operative treatment in cases of sterile pancreatitis has to be used with strict indications such as fermentative peritonitis, acute liquid formations, acute pseudocysts. Conclusion. In such cases miniinvasive surgery is mainly used while in the cases of infected pancreatic necrosis we ought to choose open surgery treatment.

  15. Consensus of primary care in acute pancreatitis in Japan

    Institute of Scientific and Technical Information of China (English)

    Makoto Otsuki; Tetsuhide Ito; Kazuo Inui; Tooru Shimosegawa; Shigeki Tanaka; Keisho Kataoka; Hiromitsu Saisho; Kazuichi Okazaki; Yosikazu Kuroda; Norio Sawabu; Yoshifumi Takeyama; Masahiko Hirota; Shinju Arata; Masaru Koizumi; Shigeyuki Kawa; Terumi Kamisawa; Kazunori Takeda; Toshihiko Mayumi; Motoji Kitagawa

    2006-01-01

    The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis.The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital.Monitoring of blood pressure, pulse and respiratory rate,body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as thediagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases.

  16. Impact of global Fxr deficiency on experimental acute pancreatitis and genetic variation in the FXR locus in human acute pancreatitis.

    Directory of Open Access Journals (Sweden)

    Rian M Nijmeijer

    Full Text Available Infectious complications often occur in acute pancreatitis, related to impaired intestinal barrier function, with prolonged disease course and even mortality as a result. The bile salt nuclear receptor farnesoid X receptor (FXR, which is expressed in the ileum, liver and other organs including the pancreas, exhibits anti-inflammatory effects by inhibiting NF-κB activation and is implicated in maintaining intestinal barrier integrity and preventing bacterial overgrowth and translocation. Here we explore, with the aid of complementary animal and human experiments, the potential role of FXR in acute pancreatitis.Experimental acute pancreatitis was induced using the CCK-analogue cerulein in wild-type and Fxr-/- mice. Severity of acute pancreatitis was assessed using histology and a semi-quantitative scoring system. Ileal permeability was analyzed in vitro by Ussing chambers and an in vivo permeability assay. Gene expression of Fxr and Fxr target genes was studied by quantitative RT-PCR. Serum FGF19 levels were determined by ELISA in acute pancreatitis patients and healthy volunteers. A genetic association study in 387 acute pancreatitis patients and 853 controls was performed using 9 tagging single nucleotide polymorphisms (SNPs covering the complete FXR gene and two additional functional SNPs.In wild-type mice with acute pancreatitis, ileal transepithelial resistance was reduced and ileal mRNA expression of Fxr target genes Fgf15, SHP, and IBABP was decreased. Nevertheless, Fxr-/- mice did not exhibit a more severe acute pancreatitis than wild-type mice. In patients with acute pancreatitis, FGF19 levels were lower than in controls. However, there were no associations of FXR SNPs or haplotypes with susceptibility to acute pancreatitis, or its course, outcome or etiology.We found no evidence for a major role of FXR in acute human or murine pancreatitis. The observed altered Fxr activity during the course of disease may be a secondary phenomenon.

  17. Effects of ORP150 on appearance and function of pancreatic beta cells following acute necrotizing pancreatitis.

    Science.gov (United States)

    Deng, Wen-Hong; Chen, Chen; Wang, Wei-Xing; Yu, Jia; Li, Jin-You; Liu, Lei

    2011-06-15

    Pancreatic beta cells produce and release insulin, which decreases the blood glucose level. Endoplasmic reticulum stress caused pancreatic beta cell dysfunction and death in acute necrotizing pancreatitis (ANP). The 150kD oxygen-regulated protein (ORP150) took part in the process of endoplasmic reticulum stress. This study investigated the effect of ORP150 on appearance and function of pancreatic beta cells in ANP. Acute necrotizing pancreatitis relied on retrograde infusion of 5% sodium taurocholate into the bile-pancreatic duct. The severity of ANP was estimated by serum amylase, secretory phospholipase A(2,) and pancreatic histopathology. The changes in appearance and function of pancreatic beta cells were detected by light and electron microscopy and the levels of serum glucose, insulin, and C-peptide. ORP150 expression was studied using western blot and immunohistochemisty assay. The expression of ORP150 mainly appeared on pancreatic beta cells and decreased gradually during the pathogenesis of ANP. The results of light and electron microscopy indicated pancreatic beta cell dysfunction and death, concomitant with elevation of serum glucose, insulin, and C-peptide in ANP. These results imply a probable role of ORP150 in the changes in appearance and function of pancreatic beta cells following acute necrotizing pancreatitis, through the pathway of endoplasmic reticulum stress.

  18. Acute pancreatitis: etiology, clinical presentation, diagnosis, and therapy.

    Science.gov (United States)

    Cappell, Mitchell S

    2008-07-01

    Acute pancreatitis is a relatively common disease that affects about 300,000 patients per annum in America with a mortality of about 7%. About 75% of pancreatitis is caused by gallstones or alcohol. Other important causes include hypertriglyceridemia, medication toxicity, trauma from endoscopic retrograde cholangiopancreatography, hypercalcemia, abdominal trauma, various infections, autoimmune, ischemia, and hereditary causes. In about 15% of cases the cause remains unknown after thorough investigation. This article discusses the causes, diagnosis, imaging findings, therapy, and complications of acute pancreatitis.

  19. Acute Pancreatitis as the Initial Presentation of Systematic Lupus Erythematosus

    OpenAIRE

    Yi Jia; Arleen Ortiz; Richard Mccallum; Hasan Salameh; Pedro Serrato

    2014-01-01

    Systematic lupus erythematosus (SLE) is a multisystem disease, including the gastrointestinal system in about half of SLE patients. As a rare complication of SLE, acute pancreatitis presents as generalized flare-ups in most cases of patients previously diagnosed with SLE. Here we report a rare case of acute pancreatitis as the initial presentation with later diagnosis of SLE.

  20. Acute Pancreatitis as the Initial Presentation of Systematic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Yi Jia

    2014-01-01

    Full Text Available Systematic lupus erythematosus (SLE is a multisystem disease, including the gastrointestinal system in about half of SLE patients. As a rare complication of SLE, acute pancreatitis presents as generalized flare-ups in most cases of patients previously diagnosed with SLE. Here we report a rare case of acute pancreatitis as the initial presentation with later diagnosis of SLE.

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

    DEFF Research Database (Denmark)

    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...... was associated with predicted severity of AP and AP-associated respiratory failure. Specific NE inhibitors may have therapeutic potential in acute pancreatitis....

  2. Acute pancreatitis : new frontiers in diagnosis and treatment

    NARCIS (Netherlands)

    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

  3. Association between acute pancreatitis and peptic ulcer disease

    Institute of Scientific and Technical Information of China (English)

    Kang-Moon Lee; Chang-Nyol Paik; Woo Chul Chung; Jin Mo Yang

    2011-01-01

    AIM:To evaluate the relationship between peptic ulcer disease (PUD) and acute pancreatitis.METHODS:A cohort of 78 patients with acute pancreatitis were included in this study.The presence of PUD and the Helicobacter pylori (H.pylori ) status were assessed by an endoscopic method.The severity of acute pancreatitis was assessed using Ranson's score, the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score,computed tomography severity index and the clinical data during hospitalization,all of which were compared between the patients with and without PUD.The risk factors for PUD were also evaluated. RESULTS:Among 78 patients,41 patients (52.6%) with acute pancreatitis suffered from PUD,but only 13 (31.7%) patients with PUD were infected by H.pylori .On univariate analysis,male gender,an etiology of alcohol-induced pancreatitis,a history of smoking or alcohol consumption, elevated triglyceride and C-reactive protein levels, and high APACHE Ⅱ score were significantly associated with PUD.However,on multivariate logistic regression analysis,the APACHE Ⅱ score (odds ratio:7.69; 95% confidence interval:1.78-33.33; P < 0.01) was found to be the only independent risk factor for PUD.CONCLUSION:Patients with acute pancreatitis are liable to suffer from PUD.PUD is associated with severe acute pancreatitis according to the APACHE Ⅱ score, and treatment for PUD should be considered for patients with severe acute pancreatitis.

  4. Timing and impact of infections in acute pancreatitis

    NARCIS (Netherlands)

    Besselink, M. G.; van Santvoort, H. C.; Boermeester, M. A.; Nieuwenhuijs, V. B.; van Goor, Harry; Dejong, C. H. C.; Schaapherder, A. F.; Gooszen, H. G.

    2009-01-01

    Background: Although infected necrosis is an established cause of death in acute pancreatitis, the impact of bacteraemia and pneumonia is less certain. Methods: This was a cohort study of 731 patients with a primary episode of acute pancreatitis in 2004-2007, including 296 patients involved in a ran

  5. Abdominal compartment syndrome in acute pancreatitis: a systematic review

    NARCIS (Netherlands)

    Brunschot, S. van; Schut, A.J.; Bouwense, S.A.W.; Besselink, M.G.; Bakker, O.J.; Goor, H. van; Hofker, S.; Gooszen, H.G.; Boermeester, M.A.; Santvoort, H.C. van

    2014-01-01

    Abdominal compartment syndrome (ACS) is a lethal complication of acute pancreatitis. We performed a systematic review to assess the treatment and outcome of these patients.A systematic literature search for cohorts of patients with acute pancreatitis and ACS was performed. The main outcomes were num

  6. Abdominal Compartment Syndrome in Acute Pancreatitis : A Systematic Review

    NARCIS (Netherlands)

    van Brunschot, Sandra; Schut, Anne Julia; Bouwense, Stefan A.; Besselink, Marc G.; Bakker, Olaf J.; van Goor, Harry; Hofker, Hendrik; Gooszen, Hein G.; Boermeester, Marja A.; van Santvoort, Hjalmar C.

    2014-01-01

    Abdominal compartment syndrome (ACS) is a lethal complication of acute pancreatitis. We performed a systematic review to assess the treatment and outcome of these patients. A systematic literature search for cohorts of patients with acute pancreatitis and ACS was performed. The main outcomes were nu

  7. Acute pancreatitis as the initial presentation of systematic lupus erythematosus.

    Science.gov (United States)

    Jia, Yi; Ortiz, Arleen; Mccallum, Richard; Salameh, Hasan; Serrato, Pedro

    2014-01-01

    Systematic lupus erythematosus (SLE) is a multisystem disease, including the gastrointestinal system in about half of SLE patients. As a rare complication of SLE, acute pancreatitis presents as generalized flare-ups in most cases of patients previously diagnosed with SLE. Here we report a rare case of acute pancreatitis as the initial presentation with later diagnosis of SLE.

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

    OpenAIRE

    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...

  9. [The glutathione system in the blood of rats and morphological changes of the pancreas under experimental acute and chronic pancreatitis].

    Science.gov (United States)

    Makarchuk, V A; Ushakova, H O; Krylova, O O

    2013-01-01

    In experiment on laboratory rats the models of acute and chronic pancreatitis were developed to study the changes of lipoperoxidation-antioxidant protection system depending on morphological changes of the pancreas. The acute and chronic pancreatitis is accompanied with intensification of lipoperoxidation and gradual inhibition of antioxidant system due to development of subsequent chronization of the pathological process.

  10. SCORING IN ACUTE PANCREATITIS: WHEN IMAGING IS APPROPRIATE?.

    Science.gov (United States)

    Cucuteanu, B; Prelipcean, Cristina Cijevschi; Mihai, Cătălina; Dranga, Mihaela; Negru, D

    2016-01-01

    Acute pancreatitis (AP) is a frequent presentation to the emergency departments with a rising incidence and a great variability in clinical severity and outcome. The aim of this review is to offer a succinct presentation on acute pancreatitis scoring systems and the use of different imaging methods in severity prediction: Ranson criteria, Glasgow criteria, Hong Kong Score, Acute Physiology and Chronic Health Evaluation II (APACHE II), computed tomography scoring systems, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Panc 3, Japanese Severity Score (JSS), Harmless Acute Pancreatitis Score (HAPS), Pancreatitis Outcome Prediction (POP), Sequential Organ Failure Assessment (SOFA). This article also describes the Revised Atlanta Classification of AP (2012) and the correlation with computed tomography.

  11. [Diagnosis and treatment of acute pancreatitis].

    Science.gov (United States)

    Dalgat, D M; Magomaev, M Sh; Medzhidov, R T; Kurbanov, K M

    1986-04-01

    In diagnosis of acute pancreatitis of special importance is determination of the activity of transamidinase, phospholipase A, lipase, concentration of copper, calcium and triglycerides in blood serum as well as laparoscopy with biopsy and local thermometry of the pancreas. The dosage of 5-fluoruracil in the complex treatment of patients should be differentiated corresponding to the form of the disease: 3 mg/kg in the endomatous form, 5 mg/kg in the destructive form. The general lethality was 1.4%. In conservative treatment there were no lethal outcomes.

  12. Resveratrol: A medical drug for acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Zhen-Hua Ma; Qing-Yong Ma

    2005-01-01

    Accumulating evidence demonstrates that resveratrol, a natural polyphenolic compound exracted from plants, inhibit inflammation when administered. It has direct effects on suppression of platelet coagulation and cytokines production in many experimental models. Because microcirculation occlusion and cytokines over-production is involved in many diseases such as acute pancreatitis (AP), the discovery of resveratrol as platelet and cytokines inhibitors has shed light on the treatment of AP, which still has significant mortality and morbidity. It is anticipated that this natural polyphenol could serve as a therapeutic compound in managing AP through different pathways.

  13. Acute necrotizing pancreatitis: a multicenter study.

    Science.gov (United States)

    Fernández-Cruz, L; Navarro, S; Valderrama, R; Sáenz, A; Guarner, L; Aparisi, L; Espi, A; Jaurietta, E; Marruecos, L; Gener, J

    1994-04-01

    A multicenter study of acute necrotizing pancreatitis (ANP) classified in accordance with the Balthazar criteria (grades D and E), has been performed in 12 teaching hospitals. A total of 233 patients were reviewed, and the mortality rate was 26.6%. The most common etiology was biliary pancreatitis (45.5%). Among the complications, shock, renal insufficiency, pulmonary insufficiency and hemorrhagic gastritis were associated with a mortality rate of 51-66%. Diffuse fluid collections were associated with a higher mortality rate (26.8%) than localized fluid collections (14.5%). In 106 patients with gallstone pancreatitis, early surgery was performed in 17, and 5 patients (29.4%) died. No mortality was observed in 32 patients with delayed surgery. Sphincterotomy was performed in 13 patients, and 4 (30.7%) died. Early surgery (necrosectomy and closed peritoneal lavage) was undertaken in 75 patients, with a mortality rate of 39%. In conclusion, the morbidity and mortality rates of ANP can be improved with proper monitoring, adequate supportive care and the judicious use of surgery based on clinical and morphological findings.

  14. Hydronephrosis as an Unusual Cause of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  15. Role of genetic disorders in acute recurrent pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Successful Management of Gastrointestinal Haemorrhage Associated with Ischaemic Colonic Ulceration in Acute Pancreatitis with Video Assisted Retroperitoneal Debridement

    Directory of Open Access Journals (Sweden)

    Yogesh Puri

    2011-05-01

    Full Text Available Context Colonic involvement is an uncommon but potentially lethal complication of severe acute pancreatitis and has received little attention in the surgical literature. Such complications can range from localized colonic pathology to widespread ischaemic pancolitis. Treatment options have historically been limited to resection of the affected segment. Case report We describe the successful role of video assisted retroperitoneal pancreatic debridement in the management of two cases presenting with major gastrointestinal haemorrhage due to localised colonic ulceration on the background of acute necrotising pancreatitis. Conclusion Video assisted retroperitoneal debridement should be considered early in the management of local colonic complications associated with severe acute necrotising pancreatitis.

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

    NARCIS (Netherlands)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Current concept of pathogenesis of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  2. Acute pancreatitis with pancreatic abscess secondary to sealed jejunal diverticular perforation

    OpenAIRE

    King, Angela; Peters, Christopher John; Shorvon, Philip

    2012-01-01

    Although most cases of acute pancreatitis are attributed to gallstones or alcohol, many remain idiopathic. The authors describe a case of acute pancreatitis in a 75-year-old gentleman who presented with acute epigastric pain, fevers and shortness of breath. Serum amylase was 2164. CT showed free mesenteric air, and a partly cystic/partly gas-containing mass in the uncinate lobe of the pancreas. Gastrograffin meal revealed duodenal and jejunal diverticular disease, but no contrast leak. Furthe...

  3. Pathogenesis of acute lung injury in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  4. Acute Pancreatitis in the Course of Meprobamate Poisoning

    Directory of Open Access Journals (Sweden)

    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.

  5. Pancreatitis

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    950347 Pancreatic endorcine response to parenteralnutrition in experimental acute pancreatitis.SUN Xi-aoguang(孙晓光),et al.Dept Nucl Med,ZhongshanHosp,Shanghai Med Univ,Shanghai.Shanghai Med J1995;18(2),74-70.In order to study the pancreatic endocrine responseto parenteral nutrition (PN) in acute pancreatitis,thedisease was induced in dogs by injecting 4% tauro-cholate sodium 0.5ml/kg plus trypsin 0.5mg/kg into the pancreatic duct.Intravenous infusion of PN wasinitiated one hour after the establishment of the dis-

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Acetaminophen-Induced Acute Pancreatitis. A Case Report

    Directory of Open Access Journals (Sweden)

    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.

  8. Effects of octreotide on acute necrotizing pancreatitis in rabbits

    Institute of Scientific and Technical Information of China (English)

    László Czakó; Péter Hegyi; Tamás Takács; Csaba Góg; András Farkas; Yvette Mándy; Ilona Sz. Varga; László Tiszlavicz; János Lonovics

    2004-01-01

    AIM: To assess the role of oxygen-derived free radicals and cytokines in the pathogenesis of taurocholic acid-induced acute pancreatitiS, and to evaluate the preventive effects of octreotide towards the development of acute pancreatitis.METHODS: Acute pancreatitis was induced in male New Zealand 50 g/L sodium taurocholate (NaTC) in the pancreatic duct. Shamwas administered subcutaneously before the induction of pancreatitis. Blood was taken from the jugular vein before and at 1, 3, 6, 12 and 24 h after pancreatitis induction.Serum activities of amylase, IL-6 and TNF-α and levels of malonyl dialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GPx), catalase and superoxide dismutase (Mn-,Cu-, and Zn-SOD) in pancreatic tissue were measured.RESULTS: Serum TNF-α and IL-6 levels increased significantly 3 h after the onset of pancreatitis, and then returned to control level. The tissue concentration of MDA was significantly elevated at 24 h, while the GSH level and GP-x, catalase, Mn-SOD, Cu-, Zn-SOD activities were all significantly decreased in animals with pancreatitis as compared to the control. Octreotide pretreatment significantly reversed the changes in cytokines and reactive oxygen metabolites. Octreotide treatment did not alter the serum amylase activity and did not have any beneficial effects on the development of histopathological changes.CONCLUSION: Oxygen-derived free radicals and proinflammatory cytokines are generated at an early stage of NaTc-induced acute pancreatitis in rabbits. Prophylactic octreotide treatment can prevent release of cytokines and generation of reactive oxygen metabolites, but does not have any beneficial effects on the development of necrotizing pancreatitis.

  9. The Outcomes in Patients with Acute Idiopathic Pancreatitis: The Lost Tribe of Pancreatitis

    Directory of Open Access Journals (Sweden)

    Anwar Ahmad

    2016-05-01

    Full Text Available Introduction Acute idiopathic pancreatitis remains a challenge with no available strong recommendations. Its impact on patient outcome is not clear. This study compared the outcomes between patients with idiopathic pancreatitis and acute non-idiopathic pancreatitis. Methods A retrospective analysis of electronic prospectively maintained database of all episodes of acute pancreatitis over a 4-year study period. Patients’ clinicopathological data for hospital admissions were collected. Primary end points were organ failure, intensive care unit admission, pancreatic necrosis and mortality. Data analysis using SPSS version 19.0 with Chi-square test and unpaired Student t-test comparing the outcomes between idiopathic pancreatitis and non-idiopathic pancreatitis with p-value <0.05 set as statistically significance. Results 569 episodes of acute pancreatitis were recorded in 446 patients during the study period. The median age for all episodes was 62 (13-100 years with 264 males and 305 females. 142/569 (25% and 427/569 (75% were idiopathic pancreatitis and non-idiopathic pancreatitis respectively. Both groups were similar in their pre-admission co-morbidities (p=0.77 and demographics except for a preponderance of female patients in the idiopathic pancreatitis (63% compared to the idiopathic pancreatitis (51% (p=0.012. 21/142 (15% patients with IP had overall poor outcomes compared with 30/427 (7% in the non-idiopathic pancreatitis group (odds ratio 2.29; 95% confidence interval 1.27-4.16; P=0.006. Significantly poor outcomes noted in idiopathic pancreatitis compared with non-idiopathic pancreatitis for pancreatitis specific mortality (odds ratio 3.17; confidence interval 1.408-7.180; P=0.004, intensive care unit admission (odds ratio 2.73; confidence interval 1.36-5.46; P=0.003 and multi-organ failure (odds ratio 2.97; confidence interval 1.36-6.49; P=0.004. Conclusions Outcomes is significantly poor in idiopathic pancreatitis and this reflects our

  10. Role of macrophages in the progression of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  11. Comparison of biohumoral and morphological parameters in acute pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

  12. Organ failure associated with severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ai-Jun Zhu; Jing-Sen Shi; Xue-Jun Sun

    2003-01-01

    AIM: To investigate the relationship between severe acute pancreatitis (SAP) and organ failure.METHODS: Clinical data of 74 cases of SAP from Jan. 1993 to Dec. 2002 were retrospectively reviewed, and the relationship between organ failure and age, gender, etiology,extent of necrosis, infection of necrosis and mortality was analyzed.RESULTS: A total of 47 patients (63.5 %) showed organ failure, 20 patients (27.0 %) multiple organ failure, whereas 27 patients (36.5 %) with dysfunction of a single organ system. Pulmonary failure was the most common organ dysfunction (23.0 %) among single organ failures. There were no significant differences in age, gender and gallstone pancreatitis among patients with or without organ failure (P>0.05). The incidence of organ failure in infected necrosis was not higher compared with sterile necrosis, and patients with increased amount of necrosis did not have an increased prevalence of organ failure (P>0.05). Patients with organ failure had a higher mortality rate compared with those without organ failure (P<0.05). The death of SAP was associated with multiple organ failure (P<0.005), pulmonary failure (P<0.005), cardiovascular dysfunction (P<0.05) and gastrointestinal dysfunction (P<0.05).CONCLUSION: Organ failure is common in patients with SAP, and patients with multiple organ failure and pulmonary failure have a higher mortality rate. Prevention and active treatment of organ failure can improve the outcome of patients with SAP.

  13. The mechanism of increased renal clearance of amylase in acute pancreatitis.

    Science.gov (United States)

    Warshaw, A L; Lee, K H

    1976-09-01

    Amylase isoenzymes, separated by polyacrylamide gel electrophoresis, were measures in 25 normal persons (mean amylase to creatinine clearance ratio 3.0%), 15 patients with acute pancreatitis (mean clearance ratio 9.5%, P less than 0.0001), and 6 patients with hyperamylasemia due to common duct stones (mean clearance ratio 4.1%). Two isoamylases (P1, P2) resembling pancreatic isoenzymes and three isoamylases (S1, S2, S3) resembling salivary isoenzymes appeared regularly in normal serum and urine. Salivary amylases predominated in serum, but pancreatic amylases predominated in urine. This finding is consistent with renal clearance of pancreatic amylases exceeding that of salivary amylases under normal conditions. In patients with pancreatitis or common duct stones, essentially all of the increased amylase activity in serum and urine was due to pancreatic isoamylases (P1 and P2) in their normal proportions. No new or altered amylase isoenzymes were detected. The fraction of pancreatic amylases in the serum or urine was identical for the two diseases. Whereas the difference in amylase to creatinine clearance ratios observed between the two groups of patients is not a function of different amylase isoenzymes presented to the kidney, we conclude that the increased amylase clearance in acute pancreatitis is caused by an alteration of renal transfer of amylase, either at the glomerulus or tubule.

  14. Optimizing the Treatment of Acute Duct-Destructive Pancreatitis

    Science.gov (United States)

    Zhakiev, Bazylbek S.; Karsakbayev, Uteugali G.; Kelimberdiev, Mersaid S.; ?uhamedgalieva, Bodagoz M.; K?nonenko, Aleksander F.

    2016-01-01

    The search for new methods for treating duct-destructive pancreatitis is a relevant problem. Endogenous intoxication and oxidative stress that accompany acute pancreatitis often progress even after surgery, which forces one to search for additional possibilities of preventing these severe consequences. This research studied the effect of small…

  15. Histopathological Sequential Changes in Sodium Taurocholate-Induced Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Ashwinikumar Kudari

    2007-09-01

    Full Text Available Context Experimental models of acute pancreatitis have been developed in order to understand its pathophysiology and extrapancreatic manifestations. Objective The objective of our study was to study sequential changes in the pancreas and distant organs in sodium taurocholate-induced acute pancreatitis in a rat model. Animals Sixteen male Wistar rats weighing 250-300 g. Design The rats were distributed into two groups: induced acute pancreatitis (study group: 8 rats and a control group (8 rats. Within each group, the animals were divided into subgroups: those who were sacrificed early (24 h and 72 h; two each and those who were sacrificed late (120 h and 240 h; two each. Intervention Acute pancreatitis was induced in the rats by multiple intraparenchymal injections of 10% sodium taurocholate solution. In the controls, the same amount of normal saline was injected into the pancreatic parenchyma. Main outcome measures Pathological examination of the pancreas, lungs, kidneys, intestine and liver was done. Results In this model of taurocholate-induced acute pancreatitis, the early changes observed in the pancreas were focal hemorrhages, parenchymal necrosis and neutrophil infiltration. At 72 hours, the changes observed were acinar necrosis, edema, fibrin deposition and inflammatory cell infiltration. Late changes were fibrinoid necrosis and fibroblast proliferation. In the acute phase, the histological changes in the lungs were congestion, focal pulmonary edema and intraalveolar hemorrhages while, in the late stage, there was persistence of vascular congestion. The changes observed in the kidneys were vacuolization of tubular epithelium in the subcapsular region and areas of hemorrhage in the interstitium. Intestinal changes included degenerative changes in the villous epithelium in the acute phase with normalization of the histology in the late phase. Conclusion Our findings correlate with the clinical observation of multisystem organ failure in

  16. UNDERSTANDING THE INTERNATIONAL CONSENSUS FOR ACUTE PANCREATITIS: CLASSIFICATION OF ATLANTA 2012

    Science.gov (United States)

    de SOUZA, Gleim Dias; SOUZA, Luciana Rodrigues Queiroz; CUENCA, Ronaldo Máfia; JERÔNIMO, Bárbara Stephane de Medeiros; de SOUZA, Guilherme Medeiros; VILELA, Vinícius Martins

    2016-01-01

    ABSTRACT Introduction: Contrast computed tomography and magnetic resonance imaging are widely used due to its image quality and ability to study pancreatic and peripancreatic morphology. The understanding of the various subtypes of the disease and identification of possible complications requires a familiarity with the terminology, which allows effective communication between the different members of the multidisciplinary team. Aim: Demonstrate the terminology and parameters to identify the different classifications and findings of the disease based on the international consensus for acute pancreatitis ( Atlanta Classification 2012). Methods: Search and analysis of articles in the "CAPES Portal de Periódicos with headings "acute pancreatitis" and "Atlanta Review". Results: Were selected 23 articles containing radiological descriptions, management or statistical data related to pathology. Additional statistical data were obtained from Datasus and Population Census 2010. The radiological diagnostic criterion adopted was the Radiology American College system. The "acute pancreatitis - 2012 Rating: Review Atlanta classification and definitions for international consensus" tries to eliminate inconsistency and divergence from the determination of uniformity to the radiological findings, especially the terminology related to fluid collections. More broadly as "pancreatic abscess" and "phlegmon" went into disuse and the evolution of the collection of patient fluids can be described as "acute peripancreatic collections", "acute necrotic collections", "pseudocyst" and "necrosis pancreatic walled or isolated". Conclusion: Computed tomography and magnetic resonance represent the best techniques with sequential images available for diagnosis. Standardization of the terminology is critical and should improve the management of patients with multiple professionals care, risk stratification and adequate treatment. PMID:27759788

  17. Should anticoagulants be administered for portal vein thrombosis associated with acute pancreatitis?

    Institute of Scientific and Technical Information of China (English)

    Won-Seok Park; Hyeong-Il Kim; Byung-Jun Jeon; Seong-Hun Kim; Seung-Ok Lee

    2012-01-01

    Venous complications in patients with acute pancreatitis typically occur as a form of splenic,portal,or superior mesenteric vein thrombosis and have been detected more frequently in recent reports.Although a well-organized protocol for the treatment of venous thrombosis has not been established,anticoagulation therapy is commonly recommended.A 73-year-old man was diagnosed with acute progressive portal vein thrombosis associated with acute pancreatitis.After one month of anticoagulation therapy,the patient developed severe hematemesis.With endoscopy and an abdominal computed tomography scan,hemorrhages in the pancreatic pseudocyst,which was ruptured into the duodenal bulb,were confirmed.After conservative treatment,the patient was stabilized.While the rupture of a pseudocyst into the surrounding viscera is a well-known phenomenon,spontaneous rupture into the duodenum is rare.Moreover,no reports of upper gastrointestinal bleeding caused by pseudocyst rupture in patients under anticoagulation therapy for venous thrombosis associated with acute pancreatitis have been published.Herein,we report a unique case of massive upper gastrointestinal bleeding due to pancreatic pseudocyst rupture into the duodenum,which developed during anticoagulation therapy for portal vein thrombosis associated with acute pancreatitis.

  18. [Acute pancreatitis. Evidence-based practice guidelines, prepared by the Hungarian Pancreatic Study Group].

    Science.gov (United States)

    Hritz, István; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Szücs, Ákos; Takács, Tamás; Tiszlavicz, László; Hegyi, Péter

    2015-02-15

    Acute pancreatitis is one of the most common diseases of the gastrointestinal tract associated with significant morbidity and mortality that requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare evidence based guideline for the medical and surgical management of acute pancreatitis based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and, if it was necessary, complemented and/or modified the international guidelines. All together 42 relevant clinical questions were defined in 11 topics (Diagnosis and etiology, Prognosis, Imaging, Fluid therapy, Intensive care management, Prevention of infectious complications, Nutrition, Biliary interventions, Post-endoscopic retrograde cholangio-pancreatography pancreatitis, Indication, timing and strategy for intervention in necrotizing pancreatitis, Timing of cholecystectomy [or endoscopic sphincterotomy]). Evidence was classified according to the UpToDate® grading system. The draft of the guideline was presented and discussed at the consensus meeting on September 12, 2014. 25 clinical questions with almost total (more than 95%) and 17 clinical questions with strong (more than 70%) agreement were accepted. The present guideline is the first evidence based acute pancreatitis guideline in Hungary. The guideline may provide important help for tuition, everyday practice and for establishment of proper finance of acute pancreatitis. Therefore, the authors believe that these guidelines will widely become as basic reference in Hungary.

  19. An Unexpected Result of Obesity Treatment: Orlistat-Related Acute Pancreatitis.

    Science.gov (United States)

    Kose, Murat; Emet, Samim; Akpinar, Timur Selcuk; Ilhan, Mehmet; Gok, Ali Fuat Kaan; Dadashov, Mubariz; Tukek, Tufan

    2015-01-01

    Orlistat is a pancreatic lipase inhibitor which is used to treat obesity. Due to the increasing prevalence of obesity, orlistat use is thought to rise progressively. We report an interesting case caused by orlistat use caught in the early stages of acute pancreatitis through imaging; in addition, the case had significantly elevated serum amylase levels. A 54-year-old male who had a history of orlistat treatment started 7 days before was admitted to the emergency department with complaints of abdominal pain, nausea and vomiting lasting for 24 h. Abdominal computed tomography revealed peripancreatic fat tissue edema and a heterogeneous appearance of the pancreas. Based on these findings, it was concluded that edematous pancreatitis was in its initial stage. Orlistat is a drug that is increasingly widespread use due to obesity. More attention must be paid when planning to prescribe orlistat to patients if there are risk factors for acute pancreatitis (alcohol use, height, serum calcium and lipid levels).

  20. An Unexpected Result of Obesity Treatment: Orlistat-Related Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Murat Kose

    2015-05-01

    Full Text Available Orlistat is a pancreatic lipase inhibitor which is used to treat obesity. Due to the increasing prevalence of obesity, orlistat use is thought to rise progressively. We report an interesting case caused by orlistat use caught in the early stages of acute pancreatitis through imaging; in addition, the case had significantly elevated serum amylase levels. A 54-year-old male who had a history of orlistat treatment started 7 days before was admitted to the emergency department with complaints of abdominal pain, nausea and vomiting lasting for 24 h. Abdominal computed tomography revealed peripancreatic fat tissue edema and a heterogeneous appearance of the pancreas. Based on these findings, it was concluded that edematous pancreatitis was in its initial stage. Orlistat is a drug that is increasingly widespread use due to obesity. More attention must be paid when planning to prescribe orlistat to patients if there are risk factors for acute pancreatitis (alcohol use, height, serum calcium and lipid levels.

  1. Wegener's granulomatosis--an etiology of acute pancreatitis.

    Science.gov (United States)

    Joshipura, Vismit P; Haribhakti, Sanjiv P; Pandya, Sapan C; Soni, Harshad N; Patel, Nitin R

    2007-01-01

    Wegener's granulomatosis is a systemic disease that usually involves the upper respiratory tract and kidneys. We report a 47-year-old man with Wegener's granulomatosis that presented as acute pancreatitis.

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

    LENUS (Irish Health Repository)

    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.

  3. Acute pancreatitis in early postpartum period: A case report

    Directory of Open Access Journals (Sweden)

    Arun Sharma

    2013-01-01

    Full Text Available Acute pancreatitis (AP during peripartum is a rare life-threatening condition which poses as a real challenge for clinician to diagnose it early. Here, we present a case of severe AP occurring in early postpartum period.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Amylase, lipase, pancreatic isoamylase, and phospholipase A in diagnosis of acute pancreatitis.

    Science.gov (United States)

    Clavé, P; Guillaumes, S; Blanco, I; Nabau, N; Mercé, J; Farré, A; Marruecos, L; Lluís, F

    1995-08-01

    To determine the utility of serum amylase (AMY), lipase (Lp), pancreatic isoamylase (isoA), phospholipase A (PLA), and urine AMY in the diagnosis of acute pancreatitis, samples of serum and urine were obtained on admission and every day thereafter for 5 days from 384 patients with acute abdominal pain. Diagnostic accuracy, determined as the area under the receiver operating characteristic curve, was > 0.975 for serum AMY, Lp, isoA, and urine AMY. For each of these enzymes, a threshold value (twice to sixfold the upper limit of the reference values) offering diagnostic efficiency > 95% could be determined. In contrast, accuracy and efficiency of serum PLA were low. The profiles of these enzymes in acute pancreatitis decreased in a parallel fashion over 5 days except for PLA. We conclude that diagnostic utilities are similar for serum AMY, Lp, isoA, and urine AMY for acute pancreatitis, provided that an appropriate threshold is established.

  6. Effect of resveratrol on pancreatic oxygen free radicals in rats with severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Zhen-Dong Li; Qing-Yong Ma; Chang-An Wang

    2006-01-01

    AIM: To investigate the therapeutic effects of resveratrol (RESV) as a free radical scavenger on experimental severe acute pancreatitis (SAP).METHODS: Seventy-two male Sprague-Dawley rats were divided randomly into sham operation group, SAP group, and resveratrol-treated group. Pancreatitis was induced by intraductal administration of 0.1 mL/kg 4%sodium taurocholate. RESV was given intravenously at a dose of 20 mg/kg body weight. All animals were killed at 3, 6, 12 h after induction of the model. Serum amylase, pancreatic superoxide dismutase (SOD),malondialdehyde (MDA), and myeloperoxidase (MPO)were determined. Pathologic changes of the pancreas were observed under optical microscope.RESULTS: The serum amylase, pancreatic MPO and the score of pathologic damage increased after the induction of pancreatitis, early (3, 6 h) SAP samples were characterized by decreased pancreatic SOD and increased pancreatic MDA. Resveratrol exhibited a protective effect against lipid peroxidation in cell membrane caused by oxygen free radicals in the early stage of SAP. This attenuation of the redox state impairment reduced cellular oxidative damage, as reflected by lower serum amylase, less severe pancreatic lesions, normal pancreatic MDA levels, as well as diminished neutrophil infiltration in pancreas.CONCLUSION: RESV may exert its therapeutic effect on SAP by lowering pancreatic oxidative free radicals and reducing pancreatic tissue infiltration of neutrophils.

  7. Ansa Pancreatica Type of Ductal Anatomy in a Patient with Idiopathic Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Deepak K Bhasin

    2006-05-01

    Full Text Available Context :Ansa pancreatica is a type of pancreatic ductal variation. The exact clinical significance of this ductal variation is not clear. Case report :We report the case of a 21-yearold male with acute idiopathic severe pancreatitis and extensive parenchymal necrosis who later developed a large pancreatic abscess. Subsequently, transpapillary drainage of the pancreatic abscess was attempted and on endoscopic retrograde pancreatography, disruption in the mid-body of the pancreas and the ansa pancreatica type of ductal anatomy was noted. A 7 Fr nasopancreatic catheter was placed across the disruption. However, due to the development of a new abscess, surgical drainage was performed. The patient has since been asymptomatic over a one-year follow up period. Conclusion :A pancreatic ductal variation such as ansa pancreatica may be a finding in severe acute pancreatitis; it is not clear if the presence of these two conditions is coincidental or if ansa pancreatica causes acute pancreatitis. Further studies are needed to clarify these points.

  8. Pancreatic Ketoacidosis (Kabadi Syndrome: Ketoacidosis Induced by High Circulating Lipase in Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Udaya M Kabadi

    2016-09-01

    Full Text Available Ketoacidosis is well established as a metabolic complication of both type 1 and type 2 diabetes Mellitus (Diabetic Ketoacidosis. It is often an initial presentation of type 1 diabetes in children and adolescents and occasionally in adults. Alternatively, it is induced of an onset of an acute disorder, e. g, sepsis, myocardial infarction, stroke, pregnancy etc. in subjects with type 1 and 2 diabetes. Ketoacidosis is also known to occur following an ethanol binge (Alcoholic Ketoacidosis. Finally, ketonemia with a rare progression to Ketoacidosis is documented to ensue following prolonged starvation. Methods The review of English literature for over 35 years from 01/1980 till 12/2015 for terms, 'ketonemia, ketonuria and ketoacidosis' 'pancreatic lipase' and 'acute pancreatitis'. Results 1 Description of individual patients presented as case reports, 2 Documentation of a series of consecutive subjects hospitalized for management of acute pancreatitis with special attention to establishing the prevalence of the disorder as well as examining the relationship between the severity of the disorder and occurrence of Ketoacidosis, 3 Studies demonstrating the relationship between progressively rising circulating pancreatic lipase concentrations with ketonuria, ketonemia and Ketoacidosis in subjects presenting with acute pancreatitis irrespective of the etiology and documenting resolution of ketonuria, ketonemia and ketoacidosis following the declining serum lipase levels on remission of acute pancreatitis with prompt appropriate therapeutic management thus confirming the pathophysiologic role of elevated circulating pancreatic lipase in this disorder. Conclusion Therefore, it is evident that the disorder ' Pancreatic Ketoacidosis ' (Kabadi Syndrome is a definite serious complication of acute pancreatitis deserving prompt attention and appropriate management.

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

    Science.gov (United States)

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

    2016-06-15

    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 activity, and the expression of inflammation factors in pancreas. The results support that the severity of pathological injury is consistent with the pancreatitis induced in mice and rat using the same methods. Specifically, caerulein induced mild edematous pancreatitis accompanied by minimal lung injury, while L-arginine induced extremely severe pancreatic injury including necrosis and neutrophil infiltration. Infusion of Na-taurocholate into the pancreatic duct induced necrotizing pancreatitis in the head of pancreas and lighter inflammation in the distal region. The severity of acute pancreatitis induced by combination of ethanol and fatty acids was between the extent of caerulein and L-arginine induction, with obvious inflammatory cells infiltration. In view of the advantages in lipid metabolism features, hamster models are ideally suited for the studies of pancreatitis associated with altered metabolism in humans.

  10. Angiographic Features in Acute Pancreatitis: The Severity of Abdominal Vessel Ischemic Change Reflects the Severity of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Inoue K

    2003-11-01

    Full Text Available CONTEXT: Assessment of tissue microcirculation is one of the important aspects of pathological evaluation in acute pancreatitis. Severe ischemic change sometimes leads to the development of organ dysfunction and/or infectious complications. OBJECTIVE: To evaluate the angiographic features of acute pancreatitis and correlate them with the severity of the disease. DESIGN: Retrospective study. PATIENTS: Twenty-seven consecutive patients with acute pancreatitis who had undergone angiography were retrospectively investigated. MAIN OUTCOME MEASURES: Vascular findings and Ranson score. RESULTS: Ischemic changes were found in 18 patients (66.7%; 11 (40.7% were severe changes. Pseudoaneurysm, bleeding, and staining were seen in 4 (14.8%, 2 (7.4% and 5 (18.5% patients, respectively. The rate of severe ischemic changes was significantly correlated with the Ranson score (P=0.012. Conclusions Angiographic findings are useful for the evaluation of severe acute pancreatitis.

  11. A Rare Cause of Acute Pancreatitis: Intramural Duodenal Hematoma

    Directory of Open Access Journals (Sweden)

    Hemant Goyal

    2012-01-01

    Full Text Available We describe an interesting case of intramural duodenal hematoma in an otherwise healthy male who presented to emergency room with gradually progressive abdominal pain, nausea, and vomiting. This condition was missed on initial evaluation and patient was discharged from emergency room with diagnosis of acute gastritis. After 3 days, patient came back to emergency room and abdominal imaging studies were conducted which showed that patient had intramural duodenal hematoma associated with gastric outlet obstruction and pancreatitis. Hematoma was the cause of acute pancreatitis as pancreatic enzymes levels were normal at the time of first presentation, but later as the hematoma grew in size, it caused compression of pancreas and subsequent elevation of pancreatic enzymes. We experienced a case of pancreatitis which was caused by intramural duodenal hematoma. This case was missed on initial evaluation. We suggest that physicians should be more vigilant about this condition.

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

    LENUS (Irish Health Repository)

    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. The Outcome of a Long-Term Follow-up of Pancreatic Function after Recovery from Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Tomas Symersky

    2006-09-01

    Full Text Available Context: It is generally assumed that pancreatic function recovers completely after mild but not after severe acute pancreatitis. Objective :To evaluate both pancreatic function and quality of life in patients who had recovered from acute pancreatitis in a long-term follow-up study. Participants :Thirty-four patients (mean age: 56 years who had recovered from biliary (n=26 or post ERCP (n=8 acute pancreatitis. The mean time after the event was 4.6 years. Main outcome measures :Pancreatic function was evaluated by fecal fat excretion, urinary 4-aminobenzoic acid (PABA recovery, oral glucose tolerance test and pancreatic polypeptide (PP secretion. In addition, the quality of life was measured by the gastrointestinal quality of life index (GIQLI. Results :Of the 34 patients, 22 (65% had mild and 12 (35% had severe acute pancreatitis. Exocrine insufficiency (fecal fat greater than 7 g/24h and/or urinary PABA recovery less than 50% was present in 22 (65% patients: in 10 (83% after severe and in 12 (55% after mild acute pancreatitis, respectively (P=0.140. Endocrine insufficiency was present in 12 patients (35%: 7 (32% mild versus 5 (42% severe acute pancreatitis; P=0.711. the quality of life was significantly impaired after acute pancreatitis, (P=0.024. No significant relationship was found between the severity of the pancreatitis and impairment of the quality of life (P=0.604. Conclusion :In a significant proportion of patients who had recovered from acute pancreatitis, exocrine and endocrine functional impairment was found. This finding is not confined only to patients after severe acute pancreatitis. Routine evaluation of pancreatic function after acute pancreatitis should be considered.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Cheng Qihui

    2012-01-01

    Full Text Available 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’ requirements. (2 Four cases of all patients were complicated with severe acute pancreatitis (SAP; 2 cases underwent uterine incision delivery while one of them also received cholecystectomy, debridement and drainage of pancreatic necrosis, and percutaneous jejunostomy. One case had a fetal death when complicated with SAP; she had to receive extraction of bile duct stones and drainage of abdominal cavity after induced abortion. The other one case with hyperlipidemic pancreatitis was given induced abortion and hemofiltration. Conclusions. The first choice of MAP in pregnancy is the conventional therapy. Apart from the conventional therapy, we need to terminate pregnancy as early as possible for patients with SAP. Removing biliary calculi and drainage is supposed to be considered for acute biliary pancreatitis. Lowering blood lipids treatment should be applied to hyperlipidemic pancreatitis or given to hemofiltration when necessary.

  17. Antiproteases in the Treatment of Acute Necrotizing Pancreatitis: Continuous Regional Arterial Infusion

    Directory of Open Access Journals (Sweden)

    Kazunori Takeda

    2007-07-01

    Full Text Available Acute necrotizing pancreatitis is still a fatal disease. Pancreatic necrosis might be, in part, a result of infarction due to ischemia with vasospasm and an increase in intravascular coagulability. Synthetic antiproteases have a broad inhibitory action on pancreatic enzymes, the coagulation system, the complement system and the production of proinflammatory cytokines. Therefore, antiproteases have been expected to prevent necrotic changes in the pancreas and to reduce the mortality rate. However, the clinical efficacy of antiproteases is still a matter of controversy. Unfortunately, an antiprotease cannot easily reach the pancreas when administered intravenously because of its pharmacokinetic characteristics and impaired microcirculation. Administration through a catheter placed in one of the arteries which supplies the inflamed area of the pancreas, dramatically increases the concentration of the antiprotease in the pancreas. Clinical studies of continuous regional arterial infusion of a protease inhibitor have been conducted in Japan and have demonstrated the possible therapeutic efficacy of the new treatment in severe acute pancreatitis.

  18. Imaging tests for accurate diagnosis of acute biliary pancreatitis.

    Science.gov (United States)

    Şurlin, Valeriu; Săftoiu, Adrian; Dumitrescu, Daniela

    2014-11-28

    Gallstones represent the most frequent aetiology of acute pancreatitis in many statistics all over the world, estimated between 40%-60%. Accurate diagnosis of acute biliary pancreatitis (ABP) is of outmost importance because clearance of lithiasis [gallbladder and common bile duct (CBD)] rules out recurrences. Confirmation of biliary lithiasis is done by imaging. The sensitivity of the ultrasonography (US) in the detection of gallstones is over 95% in uncomplicated cases, but in ABP, sensitivity for gallstone detection is lower, being less than 80% due to the ileus and bowel distension. Sensitivity of transabdominal ultrasonography (TUS) for choledocolithiasis varies between 50%-80%, but the specificity is high, reaching 95%. Diameter of the bile duct may be orientative for diagnosis. Endoscopic ultrasonography (EUS) seems to be a more effective tool to diagnose ABP rather than endoscopic retrograde cholangiopancreatography (ERCP), which should be performed only for therapeutic purposes. As the sensitivity and specificity of computerized tomography are lower as compared to state-of-the-art magnetic resonance cholangiopancreatography (MRCP) or EUS, especially for small stones and small diameter of CBD, the later techniques are nowadays preferred for the evaluation of ABP patients. ERCP has the highest accuracy for the diagnosis of choledocholithiasis and is used as a reference standard in many studies, especially after sphincterotomy and balloon extraction of CBD stones. Laparoscopic ultrasonography is a useful tool for the intraoperative diagnosis of choledocholithiasis. Routine exploration of the CBD in cases of patients scheduled for cholecystectomy after an attack of ABP was not proven useful. A significant rate of the so-called idiopathic pancreatitis is actually caused by microlithiasis and/or biliary sludge. In conclusion, the general algorithm for CBD stone detection starts with anamnesis, serum biochemistry and then TUS, followed by EUS or MRCP. In the end

  19. Emodin promoted pancreatic claudin-5 and occludin expression in experimental acute pancreatitis rats

    Institute of Scientific and Technical Information of China (English)

    Xian-Ming Xia; Bang-Ku Li; Shi-Mei Xing; Hai-Ling Ruan

    2012-01-01

    AIM:To investigate the effect of emodin on pancreatic claudin-5 and occludin expression,and pancreatic paracellular permeability in acute pancreatitis (AP).METHODS:Experimental pancreatitis was induced by retrograde injection of 5% sodium taurocholate into the biliopancreatic duct.Emodin was injected via the external jugular vein 0 or 6 h after induction of AP.Rats from sham operation and AP groups were injected with normal saline at the same time.Samples of pancreas were obtained 6 or 12 h after drug administration.Pancreatic morphology was examined with hematoxylin and eosin staining.Pancreatic edema was estimated by measuring tissue water content.Tumor necrosis factor (TNF)-α and interleukin (IL)-6 level were measured by enzyme-linked immunosorbent assay.Pancreatic paracellular permeability was assessed by tissue dye extravasation.Expression of pancreatic claudin-5 and occludin was examined by immunohistology,quantitative real-time reverse transcriptase polymerase chain reaction and western blotting.RESULTS:Pancreatic TNF-α and IL-6 levels,wet/dry ratio,dye extravasation,and histological score were significantly elevated at 3,6 and 12 h following sodium taurocholate infusion; treatment with emodin prevented these changes at all time points.Immunostaining of claudin-5 and occludin was detected in rat pancreas,which was distributed in pancreatic acinar cells,ductal cells and vascular endothelial cells,respectively.Sodium taurocholate infusion significantly decreased pancreatic claudin-5 and occludin mRNA and protein levels at 3,6 and 12 h,and that could be promoted by intravenous administration of emodin at all time points.CONCLUSION:These results demonstrate that emodin could promote pancreatic claudin-5 and occludin expression,and reduce pancreatic paracellular permeability.

  20. Chronic pancreatitis

    OpenAIRE

    Kocher, Hemant M.; Kadaba, Raghu

    2011-01-01

    Chronic pancreatitis is characterised by long-standing inflammation of the pancreas due to a wide variety of causes, including recurrent acute attacks of pancreatitis. Chronic pancreatitis affects between 3 and 9 people in 100,000; 70% of cases are alcohol-induced.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  2. The amylase creatinine clearance ratio in acute pancreatitis.

    Science.gov (United States)

    Murray, W R; Mackay, C

    1977-03-01

    One hundred and twenty-two patients have been studied in order to evaluate the usefulness of the amylase creatinine clearance ratio (ACCR) as a simple diagnostic test for acute pancreatitis. Sixteen out of 17 patients with acute pancreatitis had significant elevations in ACCR; in only 10 of these 17 cases was the serum amylase greater than 1200iu/l. The mean ACCR was within the normal range in control patients, in patients with chronic gastro-intestinal disease and in patients with acute abdominal conditions excluding pancreatitis; however, the mean serum amylase was significantly greater in patients with acute abdominal conditions than in the control group (P less than 0-05). The ACCR remained significantly elevated in patients with acute pancreatitis for longer than either serum or urine amylase values. The findings of the study suggest that the amylase creatinine clearance ratio is a simple yet reliable diagnostic test which could be used when screening patients suspected of having acute pancreatitis.

  3. Local Renin-Angiotensin System in the Pancreas: The Significance in Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Lai PBS

    2001-01-01

    Full Text Available Acute pancreatitis is a complex disease entity of which the pathogenesis is still not completely known. Research into the initiation and propagation of the diseases would hopefully help to design new treatment strategies for patients, especially those with severe acute pancreatitis. The novel observation of the activation of the local pancreatic renin-angiotensin system in experimental pancreatitis opens up new horizons for research regarding the pathogenesis of acute pancreatitis.

  4. N-acetylcysteine in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Laura; Ramudo; Manuel; A; Manso

    2010-01-01

    Premature trypsinogen activation and production of oxygen free radicals (OFR) are early pathogenic events which occur within acinar cells and trigger acute pancreatitis (AP). OFR exert their harmful effects on various cell components causing lipid peroxidation, disturbances in calcium homeostasis and DNA damage, which lead to increased cell injury and eventually cell death. This review presents the most recent data concerning the effects of N-Acetylcysteine (NAC), in the treatment of AP. NAC is an antioxidant capable of restoring the levels of Glutathione, the most important cellular antioxidant. Studies show the benef icial effects of NAC treatment in preventing OFR production and therefore attenuating oxidative damage. Additionally, NAC treatment has been shown to prevent the increase in cytosolic Ca2+ concentration and reduce the accumulation of enzymes in acinar cells during AP. The prevention, by NAC, of these pathological events occurring within acinar would contribute to reducing the severity of AP. NAC is also capable of reducing the activation of transcription factors especially sensitive to the cellular redox state, such as Nuclear factor-κB, signal transducer and activator of transcription-3 and mitogenactivated protein kinase. This leads to a down-regulation of cytokines, adhesion molecules and chemokine expression in various cell types during AP. These f indingspoint to NAC as a powerful therapeutic treatment, attenuating oxidative-stress-induced cell injury and other pathological events at early stages of AP, and potentially contributing to reducion in the severity of disease.

  5. Acute and chronic pancreatitis: epidemiology and clinical aspects

    NARCIS (Netherlands)

    Spanier, B.W.M.

    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

  6. Role of endoscopic ultrasonography in the diagnosis of acute and chronic pancreatitis.

    Science.gov (United States)

    Stevens, Tyler

    2013-10-01

    Endoscopic ultrasonography (EUS) can be a useful tool for detecting underlying causes of acute pancreatitis and establishing the severity of fibrosis in chronic pancreatitis. Ancillary techniques include fine needle aspiration and core biopsy, bile collection for crystal analysis, pancreatic function testing, and celiac plexus block. This review focuses on the role of EUS in the diagnosis of acute and chronic pancreatitis.

  7. Malignant lymphoma of spleen presenting as acute pancreatitis: A case report

    Institute of Scientific and Technical Information of China (English)

    Chao-Ming Wu; Lung-Chih Cheng; Gin-Ho Lo; Kwok-Hung Lai; Chia-Ling Cheng; Wen-Cheng Pan

    2007-01-01

    This is a case report of a patient who presented with acute pancreatitis without the common causes. A pancreatic biopsy revealed large B cell lymphoma. Spleen lymphoma with pancreatic involvement inducing acute pancreatitis, which is a rare disorder, was diagnosed.Here we also review the few similar cases reported in the literature.

  8. Ductal branch-oriented pancreatic resection for an intraductal papillary mucinous neoplasm in the uncinate process that caused recurrent acute pancreatitis: a case report of successful treatment.

    Science.gov (United States)

    Natsume, Toshiyuki; Maruyama, Takashi; Kobayashi, Akitoshi; Shimizu, Shinichiro; Tanaka, Hajime; Matsuzaki, Hiroshi; Miyazaki, Akinari; Ohta, Takumi; Sato, Yayoi; Yamamoto, Yuji; Aikawa, Mizuho; Otsuka, Ryota; Yanagihara, Akitoshi

    2013-12-01

    Acute pancreatitis reportedly occurs in about 15 % of cases of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs), with two-thirds of BD-IPMNs being located in the head or uncinate process of the pancreas. However, the surgical indications and optimal treatment methods for BD-IPMNs have not been established. A 59-year-old Japanese male with epigastralgia was admitted to our hospital. A multidetector row computed tomography (MDCT) scan disclosed grade I acute pancreatitis. Magnetic resonance cholangiopancreatography disclosed a 1.5-cm BD-IPMN in the uncinate process. Two months after discharge, the epigastralgia recurred, and MDCT again revealed grade I pancreatitis. Due to the repeated episodes of pancreatitis, we performed ductal branch-oriented pancreatic resection. To detect the inferior branch of the Wirsung duct and avoid the development of a pancreatic fistula, we injected indigo carmine into the tumor which confirmed ligation of the inferior branch. Histopathologically, the tumor proved to be an adenoma. The postoperative course was uneventful in both the short- and long-term follow-up and, to date, there has been no recurrence of pancreatitis, or diabetes mellitus during the 6 years since pancreatectomy. This procedure is one of the methods that can be used for the successful resection of a BD-IPMN in the uncinate process that caused recurrent acute pancreatitis.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  10. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient

    Institute of Scientific and Technical Information of China (English)

    Michael J Forster; Jacob A Akoh

    2008-01-01

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

  11. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient.

    Science.gov (United States)

    Forster, Michael-J; Akoh, Jacob-A

    2008-03-21

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

  12. Amylase/creatinine clearance ratio and tubular proteinuria in acute pancreatitis.

    Science.gov (United States)

    Lankisch, P G; Wolfrum, D I; Koop, H; Winckler, K

    1979-01-01

    Amylase/creatinine clearance ratio (CAm/CCr), urinary protein concentration and urinary protein pattern were studied in 102 samples from 27 patients with acute pancreatitis and in 46 controls. Raised CAm/CCr, proteinuria and a tubular protein pattern were present in 74, 56 and 96% of the patients, respectively. However, CAm/CCr and proteinuria and CAm/CCr and tubular protein pattern were not correlated. These results do not support the suggestion that an elevated CAm/CCr in acute pancreatitis is due to generalized tubular protein reabsorption failure presenting with tubular proteinuria.

  13. Endoscopic retrograde pancreatography (ERP) in acute alcoholic and biliary pancreatitis. Endoskopische retrograde Pankreatographie (ERP) bei akuter alkoholischer und biliaerer Pankreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Brambs, H.J. (Heidelberg Univ. (Germany, F.R.). Radiologische Klinik)

    1991-05-01

    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.).

  14. Chronic pancreatitis

    Science.gov (United States)

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... alcohol abuse over many years. Repeated episodes of acute ... chronic pancreatitis. Genetics may be a factor in some cases. ...

  15. Hereditary Pancreatitis

    Science.gov (United States)

    ... alcohol is a known risk factor for both acute and chronic pancreatitis. Therefore it is recommended that all HP patients ... Pancreatitis Patient Info Animated Pancreas Patient Pancreatic Cancer Chronic Pancreatitis Acute Pancreatitis Research Research Grant Application Research History Grant ...

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Trypsinogen activation in acute and chronic pancreatitis: Is it a prerequisite?

    OpenAIRE

    Sah, Raghuwansh P.; Saluja, Ashok K.

    2011-01-01

    Trypsinogen activation is sufficient to induce acute pancreatitis in an experimental model. However, whether it is a requirement for the pathogenesis of acute and chronic pancreatitis remains to be explored.

  18. Probioticaprofylaxe bij voorspeld ernstige acute pancreatitis : een gerandomiseerde, dubbelblinde, placebogecontroleerde trial

    NARCIS (Netherlands)

    Besselink, M.G.H.; Santvoort, H.C.; Buskens, E.; Boermeester, M.A.; van Goor, Harry; Timmerman, H.M.; Nieuwenhuijs, V.B.; Bollen, T.L.; Ramshorst, B.van

    2008-01-01

    OBJECTIVE: To evaluate whether enteral prophylaxis with probiotics in patients with predicted severe acute pancreatitis prevents infectious complications. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. METHOD: A total of 296 patients with predicted severe acute pancreatitis

  19. An impacted pancreatic stone in the papilla induced acute obstructive cholangitis in a patient with chronic pancreatitis.

    Science.gov (United States)

    Yoo, Kwang-Ho; Kwon, Chang-Il; Yoon, Sang-Wook; Kim, Won Hee; Lee, Jung Min; Ko, Kwang Hyun; Hong, Sung Pyo; Park, Pil Won

    2012-03-01

    Obstructive jaundice is very rarely caused by impaction of a pancreatic stone in the papilla. We report here on a case of obstructive jaundice with acute cholangitis that was caused by an impacted pancreatic stone in the papilla in a patient with chronic pancreatitis. A 48-year-old man presented with acute obstructive cholangitis. Abdominal computed tomography with the reconstructed image revealed distal biliary obstruction that was caused by a pancreatic stone in the pancreatic head, and there was also pancreatic ductal dilatation and parenchymal atrophy of the pancreatic body and tail with multiple calcifications. Emergency duodenoscopy revealed an impacted pancreatic stone in the papilla. Precut papillotomy using a needle knife was performed, followed by removal of the pancreatic stone using grasping forceps. After additional sphincterotomy, a large amount of dark-greenish bile juice gushed out. The patient rapidly improved and he has remained well.

  20. Protective effects of rhubarb on experimental severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  1. Genetics of acute and chronic pancreatitis: An update

    OpenAIRE

    Ravi Kanth, VV; Nageshwar Reddy, D

    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 ...

  2. Relationship Between Acute Benzodiazepine Poisoning and Acute Pancreatitis Risk: A Population-Based Cohort Study.

    Science.gov (United States)

    Liaw, Geng-Wang; Hung, Dong-Zong; Chen, Wei-Kung; Lin, Cheng-Li; Lin, I-Ching; Kao, Chia-Hung

    2015-12-01

    We designed a population-based retrospective cohort study to investigate the association between the event of benzodiazepine (BZD) poisoning and the risk of acute pancreatitis.In the present study, 12,893 patients with BZD poisoning during 2000 to 2011 were enrolled and matched with 4 comparison patients according to mean age and sex. We determined the cumulative incidences and adjusted hazard ratios of acute pancreatitis.A significant association was observed between BZD poisoning and acute pancreatitis. After adjustment for potential risk factors, the patients with BZD poisoning had a 5.33-fold increased risk of acute pancreatitis compared with the controls without BZD poisoning (HR = 5.33, 95% CI = 2.26-12.60). The results revealed that acute pancreatitis in patients with BZD poisoning occurred in a follow-up time of ≤1 month (HR = 50.0, P risk of acute pancreatitis was no different between the patients with and without BZD poisoning when the follow-up time was >1 month (HR = 1.07, P > .05).This population-based study revealed the positive correlation between the event of BZD poisoning and an increased risk of acute pancreatitis. The findings warrant further large-scale and in-depth investigation.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    DEFF Research Database (Denmark)

    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......: Our findings speak against a strong causative effect of statins on the risk of acute pancreatitis, and may even indicate a mild protective effect....

  5. Gastrointestinal Fistulas in Acute Pancreatitis With Infected Pancreatic or Peripancreatic Necrosis

    OpenAIRE

    Wei JIANG; Tong, Zhihui; YANG, DONGLIANG; Ke, Lu; Shen, Xiao; Zhou, Jing; Li, Gang; Li, Weiqin; Li, Jieshou

    2016-01-01

    Abstract Gastrointestinal (GI) fistula is a well-recognized complication of acute pancreatitis (AP). However, it has been reported in limited literature. This study aimed to evaluate the incidence and outcome of GI fistulas in AP patients complicated with infected pancreatic or peripancreatic necrosis (IPN). Between 2010 and 2013 AP patients with IPN who diagnosed with GI fistula in our center were analyzed in this retrospective study. And we also conducted a comparison between patients with ...

  6. Nutritional support in patients with severe acute pancreatitis Soporte nutricional en pacientes con pancreatitis aguda grave

    Directory of Open Access Journals (Sweden)

    Mónica Marcela Peláez Hernández

    2007-04-01

    Full Text Available Severe acute pancreatitis is associated with a systemic inflammatory response leading to a hypermetabolic, hypercatabolic condition; for those reasons, patients suffering from this disease require an excellent artificial nutritional support in order to maintain the structural integrity and the function of vital organs with minimal pancreatic secretion. Total parenteral nutrition has been the standard practice in the treatment of patients with severe acute pancreatitis because of the favorable outcomes of early nutritional support while avoiding pancreatic stimulation; however, recent evidence suggests there are potentially greater benefits with enteral as compared with parenteral nutrition, including fewer septic and metabolic complications and lesser costs. That is why present guidelines for the management of acute pancreatitis recommend that enteral instead of parenteral nutrition be used in patients with severe acute pancreatitis. La pancreatitis aguda, especialmente en su forma grave, está asociada con una respuesta inflamatoria sistémica que lleva a un estado de hipermetabolismo e hipercatabolismo, en el que se requiere un excelente soporte nutricional que permita mantener la integridad estructural y la función de los órganos vitales con un estímulo mínimo de la secreción pancreática. La nutrición parenteral total era el soporte de elección, que permitía obtener todos los beneficios de la nutrición temprana sin estimular la secreción pancreática; pero la evidencia actual muestra mayores beneficios con la nutrición enteral, porque se asocia con menos complicaciones infecciosas y metabólicas y con disminución en los costos. Por ello las guías actuales de tratamiento de la pancreatitis aguda grave recomiendan como primera elección el soporte nutricional enteral.

  7. Pancreaticobronchial Fistula: A Complication of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  9. Hemodiafiltration combined with resin-mediated absorption as a therapy for hyperlipidemic acute pancreatitis.

    Science.gov (United States)

    Li, Mao-qin; Shi, Zai-xiang; Xu, Ji-yuan; Lu, Bo; Li, Jia-qiong; Xu, Yan-jun; Wang, Xiao-Meng; Li, Song-mei; Mo, Xun

    2014-07-01

    The aim of this study is to investigate whether hemodiafiltration combined with resin-mediated absorption is a better therapy for hyperlipidemic acute pancreatitis. Patients (n = 67) with acute pancreatitis treated in ICU from January 2009 to December 2012 were included in this study. Seven of these 67 cases were diagnosed hyperlipidemic acute pancreatitis (HLAP). All the 7 HLAP patients went through fast, gastrointestinal decompression, anti-shock treatment, inhibition of pancreatic secretion, antiseptic treatments, and hemoperfusion (HP) combined with continuous veno venous hemodiafiltration (CVVHDF). After one round of treatment by resin adsorption, there was a significant decrease in serum triglycerides (TG) (29.78 %) and total cholesterol (TC) (24.02 %) levels (p < 0.01). TG and TC levels dropped by 49.02 and 37.66 %, respectively, after 1-day treatment of HP + CVVHDF; by 62.81 and 47.37 % on day 2 post-treatment; and by 69.57 and 49.47 % on day 3 post-treatment. All the 7 patients survived. The average time spent in the ICU was 7 ± 3.8 days, and the average duration of hospitalization was 19 ± 15.1 days. Our results show that hemoperfusion combined with hemodiafiltration is an efficient treatment as this approach can reduce plasma lipid levels effectively and reduce the risk of acute pancreatitis due to hyperlipidemia.

  10. Acute pancreatitis associated with acute viral hepatitis A (HAV) - a case report.

    Science.gov (United States)

    Arafat, S M; Azad, A K; Basher, A; Ananna, M A; Islam, M S; Abdullah, S; Abdullah, A M; Islam, M A

    2013-01-01

    In this case report, a young woman had acute viral hepatitis (HAV) and acute pancreatitis together. She was admitted to our hospital with fever, jaundice and abdominal pain. Hepatic and pancreatic enzymes were elevated. Her serum alanine aminotransferase (ALT) level was high. An initial abdominal ultrasound was per-formed at hospital and revealed features of acute viral hepatitis. Spiral computed imaging revealed imaging features of an acute stage of pancreatitis and gallbladder wall thickness. HAV infection was diagnosed by the detection of immunoglobulin M (IgM) against HAV in the serum. She was closely monitored and treated conservatively. On 10th day of hospital admission she was discharge after an uneventful recovery. In the current literature HAV infections have rarely been reported as a cause of acute pancreatitis.

  11. Hemorrhagic Fever with Renal Syndrome Associated with Acute Pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Edmond Puca; Arben Pilaca; Pellumb Pipero; Dhimiter Kraja; Entela Y Puca

    2012-01-01

    Hemorrhagic fever with renal syndrome (HFRS) is a systemic infectious disease caused by Hantaviruses and characterized by fevers,bleeding tendencies,gastrointestinal symptoms and renal failure.It encompasses a broad spectrum of clinical presentations,ranging from unapparent or mild illnesses to fulminant hemorrhagic processes.Among the various complications of HFRS,acute pancreatitis is a rare find.In this report,based on clinical data,laboratory and radiologic examination findings,we describe a clinical case,with HFRS from Dobrava virus,associated with acute pancreatitis.The patient was successfully treated by supportive management.Clinicians should be alert to the possibility of HFRS when examining patients with epidemiological data and symptoms of acute pancreatitis.

  12. Hypertriglyceridemic acute pancreatitis in a patient with Sheehan's syndrome

    Institute of Scientific and Technical Information of China (English)

    Wei-Zhong Zhang; Jue-Xing Xie; Jie Shen; Feng Lin

    2006-01-01

    BACKGROUND:There is no report on case of severe acute hyperlipidemic pancreatitis after treatment of Sheehan's syndrome. METHODS: A 32-year-old female patient was diagnosed as having acute hyperlipidemic pancreatitis after treatment of Sheehan's syndrome, and treated with diet and lipid-lowering agents in early stage. RESULTS: Abdominal pain and fever of the patient resolved within a few days. She was subjected to diet and oral lipid-lowering therapy on the 4th day after admission. The disease did not recur during the follow-up for more than one year. CONCLUSIONS: Estrogen replacement therapy should be prescribed for Sheehan's syndrome. The serum level of triglyceride should be monitored and treatment should be given to prevent severe acute pancreatitis. Lipid-lowering therapy in early stage is the key step towards a complete recovery.

  13. Acute pancreatitis in pregnancy: a challenge for the clinician

    Directory of Open Access Journals (Sweden)

    Urvashi Miglani

    2016-07-01

    Full Text Available Acute pancreatitis is one of the very rare events in pregnancy associated with high maternal and fetal morbidity and mortality. We are presenting a case of acute pancreatitis in a 25 year old G2P1L1 at 33 weeks of gestation with previous LSCS who presented to us with hypertension, epigastric pain, vomiting. Investigations revealed hyperamylysemia, hypertriglyceridemia and deranged liver enzymes. After examination and investigations, diagnosis of acute pancreatitis with pregnancy was made. She underwent caesarean section for obstetric hemorrhage and was put in intensive care for 3 days. She was discharged after. 1 week and is under regular follow up for past 6 months. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2448-2449

  14. Skin signs in acute pancreatitis: a case report

    Directory of Open Access Journals (Sweden)

    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.

  15. Splenic hematoma in acute pancreatitis. Role of coagulation disorders.

    Science.gov (United States)

    Clavé, P; Guillaumes, S; Blanco, I; Martínez de Hurtado, J; Esquius, J; Marruecos, L; Fontcuberta, J; Pérez, C; Farré, A; Lluís, F

    1992-08-01

    Splenic hematomas are infrequent complications of acute pancreatitis. In some cases, local factors that may play a role in the pathogenesis of the hematoma (thrombosis of the splenic artery or veins, intrasplenic pseudocysts, perisplenic adhesions, enzymatic digestion) are found. In the absence of local factors, the etiology of splenic hemorrhage remains unknown. We report two cases of splenic hematoma occurring during an acute necro-hemorrhagic pancreatitis associated with renal failure that required renal replacement therapy (hemodialysis and continuous arteriovenous hemodialysis). In both cases, more than half of splenic parenchyma was affected by multiple infarctions. No local factors responsible for the splenic abnormalities were detected in either case. Thrombosis of the splenic arterial microcirculation and a coagulation disorder consistent with disseminated intravascular coagulation was detected in one patient. In the second patient, coagulation disorders secondary to either liver disease, pancreatitis and its septic complications, or extracorporeal circuit heparinization for renal replacement therapy were present. Coagulation disorders should be considered whenever a splenic hematoma is found in a patient with acute pancreatitis. Disseminated intravascular coagulation may be the etiology of a splenic hematoma in acute pancreatitis.

  16. Meandering main pancreatic duct as a relevant factor to the onset of idiopathic recurrent acute pancreatitis.

    Directory of Open Access Journals (Sweden)

    Wataru Gonoi

    Full Text Available BACKGROUND: Meandering main pancreatic duct (MMPD, which comprises loop type and reverse-Z type main pancreatic duct (MPD, has long been discussed its relation to pancreatitis. However, no previous study has investigated its clinical significance. We aimed to determine the non-biased prevalence and the effect of MMPD on idiopathic pancreatitis using non-invasive magnetic resonance (MR technique. METHODS AND FINDINGS: A cross-sectional study performed in a tertiary referral center. The study enrolled 504 subjects from the community and 30 patients with idiopathic pancreatitis (7 acute, 13 chronic, and 10 recurrent acute. All subjects underwent MR scanning and medical examination. MMPD was diagnosed when the MPD in the head of pancreas formed two or more extrema in the horizontal direction on coronal images of MR cholangiopancreatography, making a loop or a reverse-Z shaped hairpin curves and not accompanied by other pancreatic ductal anomaly. Statistical comparison was made among groups on the rate of MMPD including loop and reverse-Z subtypes, MR findings, and clinical features. The rate of MMPD was significantly higher for all idiopathic pancreatitis/idiopathic recurrent acute pancreatitis (RAP (20%/40%; P<0.001/0.0001; odds ratio (OR, 11.1/29.0 than in the community (2.2% but was not higher for acute/chronic pancreatitis (14%/8%; P = 0.154/0.266. Multiple logistic regression analysis revealed MMPD to be a significant factor that induces pancreatitis/RAP (P<0.0001/0.0001; OR, 4.01/26.2. Loop/reverse-Z subtypes were found more frequently in idiopathic RAP subgroup (20%/20%; P = 0.009/0.007; OR, 20.2/24.2 than in the community (1.2%/1.0%. The other clinical and radiographic features were shown not associated with the onset of pancreatitis. CONCLUSIONS: MMPD is a common anatomical variant and might be a relevant factor to the onset of idiopathic RAP.

  17. Pretreatment with low doses of acenocoumarol inhibits the development of acute ischemia/reperfusion-induced pancreatitis.

    Science.gov (United States)

    Warzecha, Z; Sendur, P; Ceranowicz, P; Dembinski, M; Cieszkowski, J; Kusnierz-Cabala, B; Tomaszewska, R; Dembinski, A

    2015-10-01

    Coagulative disorders are known to occur in acute pancreatitis and are related to the severity of this disease. Various experimental and clinical studies have shown protective and therapeutic effect of heparin in acute pancreatitis. Aim of the present study was to determine the influence of acenocoumarol, a vitamin K antagonist, on the development of acute pancreatitis. Studies were performed on male Wistar rats weighing 250 - 270 g. Acenocoumarol at the dose of 50, 100 or 150 μg/kg/dose or vehicle were administered once a day for 7 days before induction of acute pancreatitis. Acute pancreatitis was induced in rats by pancreatic ischemia followed by reperfusion. The severity of acute pancreatitis was assessed after 5-h reperfusion. Pretreatment with acenocoumarol given at the dose of 50 or 100 μg/kg/dose reduced morphological signs of acute pancreatitis. These effects were accompanied with a decrease in the pancreatitis-evoked increase in serum activity of lipase and serum concentration of pro-inflammatory interleukin-1β. Moreover, the pancreatitis-evoked reductions in pancreatic DNA synthesis and pancreatic blood flow were partially reversed by pretreatment with acenocoumarol given at the dose of 50 and 100 μg/kg/dose. Administration of acenocoumarol at the dose of 150 μg/kg/dose did not exhibit any protective effect against ischemia/reperfusion-induced pancreatitis. We concluded that pretreatment with low doses of acenocoumarol reduces the severity of ischemia/reperfusion-induced acute pancreatitis.

  18. Eruptive xanthomas and acute pancreatitis in a patient with hypertriglyceridemia.

    Science.gov (United States)

    Martínez, Desirée Pérez; Díaz, Juan Oscar Fernández; Bobes, Carmen Maciá

    2008-05-12

    Acute pancreatitis and eruptive xanthomas are the only recognised direct complications of severe hypertriglyceridaemia. We present the case of a 33-years old male patient in whom the onset of a type 2 diabetes, added to an unknown familial hyperlipidemia, precipitated a dramatic raise of serum triglyceride levels, that cause in turn an acute pancreatitis and the appearance of dermic eruptive xanthomas. TRANSLATION: This article is translated from Spanish, originally published in Archivos de Medicina. The original work is at doi:10.3823/001.

  19. Pancreatitis with Electrocardiographic Changes Mimicking Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Paul Khairy

    2001-01-01

    Full Text Available A 64-year-old woman with mild acute pancreatitis presented with epigastric pain, nausea and vomiting while undergoing hemodialysis for chronic renal insufficiency. Serial electrocardiograms revealed new onset ST segment elevations in leads V2 to V4 mimicking an anterior myocardial infarction, followed by diffusely inverted deep T waves. No cardiac pathology was demonstrated by echocardiography or coronary angiography. A review of the literature and possible pathophysiological mechanisms of electrocardiographic changes in acute pancreatitis, such as metabolic abnormalities, hemodynamic instability, vasopressors, pericarditis, myocarditis, a cardiobiliary reflex, exacerbation of underlying cardiac pathology, coagulopathy and coronary vasospasm, are discussed.

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

    DEFF Research Database (Denmark)

    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....

  1. Severity assessment of acute pancreatitis: applying Marshall scoring system

    Directory of Open Access Journals (Sweden)

    André Lanza Carioca

    2015-10-01

    Full Text Available Objective: To analyze the effectiveness of the Marshall scoring system to evaluate the severity of acute pancreatitis (AP. Methods : We performed a prospective, observational study in 39 patients with AP evaluated by the Marshall scoring system and the Ranson criteria (admission and 48 hours. We assessed the progression of the disease for seven days and compared the data of the two criteria. Results : Seven patients died during the observation period and one died afterwards. All deaths had shown failure of at least one system by the Marshall method. Conclusion : The Marshall scoring system may be used as an effective and simplified application method to assess the severity of acute pancreatitis.

  2. TO EVALUATE THE EFFICACY OF URINARY TRYPSINOGEN 2 DIPSTICK TEST IN DIAGNOSING ACUTE PANCREATITIS

    Directory of Open Access Journals (Sweden)

    Prem Anandh

    2016-08-01

    Full Text Available BACKGROUND Pancreatitis is a common cause of abdominal pain in the emergency room. Serum amylase and lipase are the initial screening investigations. A rapid urine analysis by a dipstick to detect urinary trypsinogen is a good screening test. MATERIALS AND METHODOLOGY This study was conducted after obtaining the Institutional Ethics Committee (IEC clearance, Reference No.: CSP - MED/14/FEB12/50. Informed consent was obtained from all study participants and ICH/GCP guidelines were followed. The present prospective study was done during the period of June 2013 to October 2015, which involved a group of 98 patients with upper abdominal pain (Reporting within 36 hours of onset of pain who came to the Department of Surgery of Sri Ramachandra Medical College and Research Institute. RESULTS A total of 98 consecutive patients with upper abdominal pain who fulfilled the inclusion criteria and exclusion criteria were enrolled in the study during the period of June 2013 - October 2015. When we analysed the patients with upper abdominal pain we found that in the age group 21-30, there were 22 patients (22.9%; in 31-40 years, there were 28 patients (29.2%; in 41-50 years, there were 17 patients (17.7%; in 51-60 years, there were 18 patients (18.8%; and in between 61-70 years, there were 11 patients (11.5% of study group (1, 2. CONCLUSIONS The analysis of the demographics of our study showed that 40.8% of acute upper abdominal pains were due to acute pancreatitis and 59.2% were non-pancreatic in origin. Male Patients accounted for 75.0% and 65.5% respectively in the acute pancreatitis and non-pancreatic groups. In both acute pancreatitis and non-pancreatic groups, major clustering of patients was seen in the age group of 31-40 yrs.

  3. Seasonal variation in the onset of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Massimo Gallerani; Benedetta Boari; Raffaella Salmi; Roberto Manfredini

    2004-01-01

    AIM: A circannual variation in the onset of several acute diseases,mostly dealing with cardiovascular system, has been reported.The present study was to verify the possible existence of a seasonal variability in the onset of acute pancreatitis.METHODS: All patients consecutively admitted to the Hospital of Ferrara, Italy, between January 1998 to December 2002,whose discharge diagnosis was acute pancreatitis, were considered. According to the time of admission, cases were categorized into twelve 1-mo intervals and in four periods by season. x2 test for goodness of fit and partial Fourier series were used for statistical analysis.RESULTS: During the study period, 549 cases of acute pancreatitis were observed. A significant peak of higher incidence was found in March-May, both for total population,males and subgroups with and without cholelithiasis or alcoholism. Fourier analysis showed the existence of a circannual rhythmic pattern with its main peak in March (95%C.L.: February-April, P = 0.005), and a secondary one in September. Death occurred more frequently in DecemberFebruary, compared to the other periods (P = 0.029), and chronobiologic analysis yielded a seasonal peak in NovemberDecember (P<0.001).CONCLUSION: This study shows the existence of a circannual variation in the onset of acute pancreatitis, with a significanty higher frequency of events in the spring, especially for patients with cholelithiasis or alcoholism. Moreover, events occurring during the colder months seem to be characterized by a higher mortality rate.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  5. Clinical characteristics and prognostic factors of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Lei Kong; Nn Santiago; Tian-Quan Han; Sheng-Dao Zhang

    2004-01-01

    AIM: To investigate the clinical characteristics and prognostic factors of a consecutive series of patients with severe acute pancreatitis (SAP).METHODS: Clinical data of SAP patients admitted to our hospital from January 2003 to January 2004 were retrospectively reviewed. Collected data included the age, gender, etiology,length of hospitalization, APACHE Ⅱ score at admission,local and organ/systemic complications of the patients.RESULTS: Of the 268 acute pancreatitis patients, 94 developed SAP. The mean age of SAP patients was 52 years, the commonest etiology was cholelithiasis (45.7%), the mean length of hospitalization was 70 d, the mean score of APACHE Ⅱ was 7.7. Fifty-four percent of the patients developed necrosis, 25% abscess, 58% organ/systemic failure. A total of 23.4% (22/94) of the SAP patients died. Respiratory failure was the most common organ clysfunction (90.9%) in deceased SAP patients, followed by cardiovascular failure (86.4%),renal failure (50.0%). In the SAP patients, 90.9% (20/22)developed multiple organ/systemic failures. There were significant differences in age, length of hospitalization,APACHE Ⅱ score and incidences of respiratory failure, renal failure, cardiovascular failure and hematological failure between deceased SAP patients and survived SAP patients.By multivariate logistic regression analysis, independent prognostic factors for mortality were respiratory failure,cardiovascular failure and renal failure.CONCLUSION: SAP patients are characterized by advanced age, high APACHE Ⅱ score, organ failure and their death is mainly due to multiple organ/systemic failures. In patients with SAP, respiratory, cardiovascular and renal failures can predict the fatal outcome and more attention should be paid to their clinical evaluation.

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

    DEFF Research Database (Denmark)

    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 pancreatitis......: 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...

  7. Case of acute pancreatitis associated with Campylobacter enteritis.

    Science.gov (United States)

    Kobayashi, Rumiko; Matsumoto, Satohiro; Yoshida, Yukio

    2014-06-21

    A 25-year-old man was admitted with the chief complaints of right flank pain, watery diarrhea, and fever. Blood tests revealed high levels of inflammatory markers, and infectious enteritis was diagnosed. A stool culture obtained on admission revealed no growth of any significant pathogens. Conservative therapy was undertaken with fasting and fluid replacement. On day 2 of admission, the fever resolved, the frequency of defecation reduced, the right flank pain began to subside, and the white blood cell count started to decrease. On hospital day 4, the frequency of diarrhea decreased to approximately 5 times per day, and the right flank pain resolved. However, the patient developed epigastric pain and increased blood levels of the pancreatic enzymes. Abdominal computed tomography revealed mild pancreatic enlargement. Acute pancreatitis was diagnosed, and conservative therapy with fasting and fluid replacement was continued. A day later, the blood levels of the pancreatic enzymes peaked out. On hospital day 7, the patient passed stools with fresh blood, and Campylobacter jejuni/coli was detected by culture. Lower gastrointestinal endoscopy performed on hospital day 8 revealed diffuse aphthae extending from the terminal ileum to the entire colon. Based on the findings, pancreatitis associated with Campylobacter enteritis was diagnosed. In the present case, a possible mechanism of onset of pancreatitis was invasion of the pancreatic duct by Campylobacter and the host immune responses to Campylobacter.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. [Efficacy of selective digestive decontamination (SDD) for severe acute pancreatitis].

    Science.gov (United States)

    Kitamura, Nobuya; Hirano, Takeshi; Moriguchi, Takeshi; Hirasawa, Hiroyuki; Ohtani, Shunsuke

    2004-11-01

    Bacterial translocation (BT) is involved in the development of pancreatic infection in severe acute pancreatitis (SAP) and influences the prognosis. We should suppress BT to prevent pancreatic infection and improve survival rate. Selective digestive decontamination (SDD) is rational treatment. We should aim at effective SDD, ensuring the following 4 points: (1) enteral antimicrobials, in combination with, (2) parenteral antibiotics given immediately on admission, (3) hand hygiene, (4) surveillance cultures of throat and rectum. Starting enteral feeding as soon as possible and avoiding long-term SDD is useful for maintaining the defenses of the intestinal mucosa and preventing emergence of resistant bacteria. We used glutamine and dietary fiber besides SDD and were able to reduce pancreatic infection.

  10. A rare entity of acute bilateral cortical renal necrosis following acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Kruti D Dave

    2015-01-01

    Full Text Available Acute bilateral renal cortical necrosis following acute pancreatitis is extremely rare condition. Among all cases of acute renal failure, the incidence of renal cortical necrosis was 3.8% in one of the study in North India. Till date, only eight cases of bilateral cortical necrosis following acute pancreatitis were reported in the literature. We report a case of a 27-year-old male patient with abdominal pain, nausea and vomiting since 2 days duration and anuria since 24 h. Serum amylase and lipase were raised, and elevated serum creatinine was noted on admission. Contrast-enhanced computed tomography scan of the abdomen revealed changes of acute pancreatitis with hypoenhancement of renal cortex compared to medulla on both sides (reverse rim sign-stronger enhancement of the renal medulla compared to cortex, suggest an acute renal cortical necrosis.

  11. Epidemiology, aetiology and outcome of acute and chronic pancreatitis: An update.

    Science.gov (United States)

    Spanier, B W M; Dijkgraaf, M G W; Bruno, M J

    2008-01-01

    Over the past decades several epidemiological studies have been published reporting on incidence trends, hospital admissions, etiological factors and outcome of both acute and chronic pancreatitis. Over time, the incidence of acute pancreatitis has increased in the Western countries. Also, the number of hospital admissions for both acute and chronic pancreatitis have increased. These upward time trends possibly reflect a change in the prevalence of main etiological factors (e.g. gallstones and alcohol consumption) and cofactors such as obesity and genetic susceptibility. Acute and chronic pancreatitis are associated with significant morbidity and mortality and a substantial use of health care resources. Although the case-fatality rate of acute pancreatitis decreased over time, the overall population mortality did not change for both acute and chronic pancreatitis. This chapter will focus on recent developments in the epidemiology, aetiology, natural course and outcome of both acute and chronic pancreatitis.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    OpenAIRE

    Ioannides M; Christodoulides P; Symeonides M; Vounou E; Tsikkos S; Achillews G; Koukouvas M; Makrides C

    2005-01-01

    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 wi...

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

    DEFF Research Database (Denmark)

    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...

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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. Genetics of acute and chronic pancreatitis: An update.

    Science.gov (United States)

    Ravi Kanth, Vv; Nageshwar Reddy, D

    2014-11-15

    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 individual's susceptibility to the disease is governed by genetic factors in combination with environmental factors. Candidate gene and genetic linkage studies have identified polymorphisms in cationic trypsinogen (PRSS1), SPINK1, cystic fibrosis trans-membrane conductance regulator (CFTR), Chymotrypsinogen C (CTRC), Cathepsin 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) and Carboxypeptidase A1 (CPA1) gene have also been identified for their association with pancreatitis. With ever growing number of studies trying to identify the genetic susceptibility in the form of single nucleotide polymorphisms, this review is an attempt to compile the available information on the topic.

  18. Genetics of acute and chronic pancreatitis: An update

    Institute of Scientific and Technical Information of China (English)

    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.

  19. Inhibitory effect of Patrinia scabiosaefolia on acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Sang-Wan Seo; Hyung-Min Kim; Sung-Joo Park; Cheung-Seog Park; Seung-Heon Hong; Kang-Beom Kwon; Hyoung-Chul Moon; Bong-keun Song; Kyung-Yo Kim; Young-Min Park; Ho-Joon Song

    2006-01-01

    AIM: To investigate the effect of Patrinia scabiosaefolia (PS) on the cholecystokinin (CCK) octapeptide- induced acute pancreatitis (AP) in rats.METHODS: Wistar rats weighing 240-260 g were divided into three groups: (1) Normal saline-treated group;(2) treatment with PS at 100 mg/kg group, in which PS was administered orally, followed by subcutaneous administration of 75 μg/kg CCK octapeptide three times after 1, 3 and 5 h, and this whole procedure was repeated for 5 d; (3) treatment with saline group,in which the protocols were the same as in treatment group with PS. We determined the pancreatic weight/body weight ratio, the levels of pancreatic HSP60,HSP72 and the secretion of pro-inflammatory cytokines.Repeated CCK octapeptide treatment resulted in the typical laboratory findings of experimentally induced pancreatitis.RESULTS: PS reduced the pancreatic weight/body weight ratio, the levels of serum amylase and lipase,and inhibited expressions of pro-inflammatory cytokines in the CCK octapeptide-induced AP. Furthermore, PS pretreatment increased the pancreatic levels of HSP60and HSP72.CONCLUSION: Pretreatment with PS has an antiinflammatory effect on CCK octapeptide-induced AP.

  20. Impact of Global Fxr Deficiency on Experimental Acute Pancreatitis and Genetic Variation in the FXR Locus in Human Acute Pancreatitis

    NARCIS (Netherlands)

    Nijmeijer, Rian M; Schaap, Frank G; Smits, Alexander J J; Kremer, Andreas E; Akkermans, Louis M A; Kroese, A.B.; Rijkers, Ger T; Schipper, Marguerite E I; Verheem, André; Wijmenga, Cisca; Gooszen, Hein G; van Erpecum, Karel J

    2014-01-01

    BACKGROUND: Infectious complications often occur in acute pancreatitis, related to impaired intestinal barrier function, with prolonged disease course and even mortality as a result. The bile salt nuclear receptor farnesoid X receptor (FXR), which is expressed in the ileum, liver and other organs in

  1. Impact of Global Fxr Deficiency on Experimental Acute Pancreatitis and Genetic Variation in the FXR Locus in Human Acute Pancreatitis

    NARCIS (Netherlands)

    Nijmeijer, Rian M.; Schaap, Frank G.; Smits, Alexander J. J.; Kremer, Andreas E.; Akkermans, Louis M. A.; Kroese, Alfons B. A.; Rijkers, Ger. T.; Schipper, Marguerite E. I.; Verheem, Andre; Wijmenga, Cisca; Gooszen, Hein G.; van Erpecum, Karel J.

    2014-01-01

    Background: Infectious complications often occur in acute pancreatitis, related to impaired intestinal barrier function, with prolonged disease course and even mortality as a result. The bile salt nuclear receptor farnesoid X receptor (FXR), which is expressed in the ileum, liver and other organs in

  2. Systematic Biliary Sphincterotomy in Acute Gallstone Pancreatitis without Cholangitis?

    Directory of Open Access Journals (Sweden)

    Manley C Uy

    2009-11-01

    Full Text Available Drs. Shrode and Kahaleh [1] noted correctly that two out of the three mortalities in the early ERCP group of the Oria study [3] were not reported to be directly due to ERCP. However, it is worthwhile to take into consideration that one mortality was attributed to progressive respiratory failure despite early ERCP and sphincterotomy. Taking note that the incidence of severe and mild pancreatitis and other demographic and clinical characteristics were grossly the same in both groups, only one patient died in the early conservative group. Furthermore, both groups had the same number of patients undergoing surgery (45 early ERCP vs. 47 early conservative, respectively but nobody in the early conservative group died from biliary surgery as compared to the mortality in the early ERCP group which was attributed to elective biliary surgery. it was interesting that there was the absence of mortality in the early conservative group despite more complicated surgeries due to the larger number of patients necessitating transcystic ductal stone clearance and/or laparoscopic/open choledochotomy for main bile duct stones (one in the early ERCP vs. 19 in the early conservative management group. The large number of early conservative management patients with positive intraoperative cholangiography (40%, meaning persistent common bile duct stone, also raises doubts as to the need for early ERCP with sphincterotomy [3]. As to the study of Folsch et al. [4], although Drs. Shrode and Kahaleh [1] correctly noted that 22 patients in the early conservative management group required ERCP and that four patients died from cholecystitis and/or jaundice, they failed to note that there were fewer patients who died from respiratory and renal failure than in the early ERCP group. The two aforementioned organ failures are both possible complications of acute pancreatitis. This was in a background of the same demographic characteristics (including severity of pancreatitis [4

  3. Perfusion-CT--Can We Predict Acute Pancreatitis Outcome within the First 24 Hours from the Onset of Symptoms?

    Directory of Open Access Journals (Sweden)

    Joanna Pieńkowska

    Full Text Available Severe acute pancreatitis (AP is still a significant clinical problem which is associated with a highly mortality. The aim of this study was the evaluation of prognostic value of CT regional perfusion measurement performed on the first day of onset of symptoms of AP, in assessing the risk of developing severe form of acute pancreatitis.79 patients with clinical symptoms and biochemical criteria indicative of acute pancreatitis (acute upper abdominal pain, elevated levels of serum amylase and lipase underwent perfusion CT within 24 hours after onset of symptoms. The follow-up examinations were performed after 4-6 days to detect progression of the disease. Perfusion parameters were compared in 41 people who developed severe form of AP (pancreatic and/or peripancreatic tissue necrosis with parameters in 38 consecutive patients in whom course of AP was mild. Blood flow, blood volume, mean transit time and permeability surface area product were calculated in the three anatomic pancreatic subdivisions (head, body and tail. At the same time the patient's clinical status was assessed by APACHE II score and laboratory parameters such as CRP, serum lipase and amylase, AST, ALT, GGT, ALP and bilirubin were compared.Statistical differences in the perfusion parameters between the group of patients with mild and severe AP were shown. Blood flow, blood volume and mean transit time were significantly lower and permeability surface area product was significantly higher in patients who develop severe acute pancreatitis and presence of pancreatic and/or peripancreatic necrosis due to pancreatic ischemia. There were no statistically significant differences between the two groups in terms of evaluated on admission severity of pancreatitis assessed using APACHE II score and laboratory tests.CT perfusion is a very useful indicator for prediction and selection patients in early stages of acute pancreatitis who are at risk of developing pancreatic and/or peripancreatic

  4. Reduced Pancreatic Exocrine Function and Organellar Disarray in a Canine Model of Acute Pancreatitis.

    Directory of Open Access Journals (Sweden)

    Yuepeng Jin

    Full Text Available The aim of the present study was to investigate the pancreatic exocrine function in a canine model and to analyze the changes in organelles of pancreatic acinar cells during the early stage of acute pancreatitis (AP. AP was induced by retrograde injection of 5% sodium taurocholate (0.5 ml/kg into the main pancreatic duct of dogs. The induction of AP resulted in serum hyperamylasemia and a marked reduction of amylase activity in the pancreatic fluid (PF. The pancreatic exocrine function was markedly decreased in subjects with AP compared with the control group. After the induction of AP, histological examination showed acinar cell edema, cytoplasmic vacuolization, fibroblasts infiltration, and inflammatory cell infiltration in the interstitium. Electron micrographs after the induction of AP revealed that most of the rough endoplasmic reticulum (RER were dilated and that some of the ribosomes were no longer located on the RER. The mitochondria were swollen, with shortened and broken cristae. The present study demonstrated, in a canine model, a reduced volume of PF secretion with decreased enzyme secretion during the early stage of AP. Injury of mitochondria and dilatation and degranulation of RER may be responsible for the reduced exocrine function in AP. Furthermore, the present model and results may be useful for researching novel therapeutic measures in AP.

  5. Enterococcus hirae Bacteremia Associated with Acute Pancreatitis and Septic Shock

    Science.gov (United States)

    Dicpinigaitis, Peter V.; De Aguirre, Manuel; Divito, Joseph

    2015-01-01

    Infection with Enterococcus hirae has rarely been reported in humans but is not uncommon in mammals and birds. We describe a case of Enterococcus hirae bacteremia associated with acute pancreatitis, acute cholecystitis, and septic shock responsive to antibiotic therapy and supportive critical care management. Unique aspects of this case of Enterococcus hirae bacteremia are its association with acute pancreatitis and its geographical origin. To our knowledge, this is the first report of Enterococcus hirae bacteremia occurring in a patient in the United States. Although human infection with this organism appears to be rare, all cases reported to date describe bacteremia associated with severe and life-threatening illness. Thus, physicians need to be cognizant of the clinical significance of this heretofore little recognized pathogen. PMID:26417465

  6. Enterococcus hirae Bacteremia Associated with Acute Pancreatitis and Septic Shock

    Directory of Open Access Journals (Sweden)

    Peter V. Dicpinigaitis

    2015-01-01

    Full Text Available Infection with Enterococcus hirae has rarely been reported in humans but is not uncommon in mammals and birds. We describe a case of Enterococcus hirae bacteremia associated with acute pancreatitis, acute cholecystitis, and septic shock responsive to antibiotic therapy and supportive critical care management. Unique aspects of this case of Enterococcus hirae bacteremia are its association with acute pancreatitis and its geographical origin. To our knowledge, this is the first report of Enterococcus hirae bacteremia occurring in a patient in the United States. Although human infection with this organism appears to be rare, all cases reported to date describe bacteremia associated with severe and life-threatening illness. Thus, physicians need to be cognizant of the clinical significance of this heretofore little recognized pathogen.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Early Cytokine Profile Changes In Interstitial And Necrotic Forms Of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Kostic Irena

    2015-03-01

    Full Text Available Acute pancreatitis (AP is a common, potentially lethal, acute inflammatory process with a highly variable clinical course. The aim of this study was to analyse early changes in the serum concentrations of pro- and anti-inflammatory cytokines in the peripheral blood of patients with the interstitial form of acute pancreatitis (IAP and necrotic acute pancreatitis (NAP, especially in those patients who had lethal outcomes.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  12. Early Antibiotic Treatment in Acute Pancreatitis: More News

    Directory of Open Access Journals (Sweden)

    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

  13. Pancreatitis - discharge

    Science.gov (United States)

    Chronic pancreatitis - discharge; Pancreatitis - chronic - discharge; Pancreatic insufficiency - discharge; Acute pancreatitis - discharge ... You were in the hospital because you have pancreatitis. This is a swelling of the pancreas. You ...

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

    Directory of Open Access Journals (Sweden)

    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.

  15. [Defense mechanism to prevent ectopic activation of pancreatic digestive enzymes under physiological conditions and its breakdown in acute pancreatitis].

    Science.gov (United States)

    Kaku, Midori; Otsuko, Makoto

    2004-11-01

    Independent of the etiology, acute pancreatitis is associated with significant morbidity and the potential for mortality. In most patients, acute pancreatitis follows an uncomplicated or mild course. Recent studies in hereditary pancreatitis have clearly revealed that trypsin is the key enzyme at the onset of pancreatitis. However, there are several defense mechanisms to prevent ectopic activation of trypsin under physiological conditions. If the defense mechanisms failed or activation of trypsin occurred over defense ability, trypsin would activate other digestive enzymes and self-digestion of the pancreas would occur.

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

    Institute of Scientific and Technical Information of China (English)

    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].

  17. Amylase: creatinine clearance ratio and urinary excretion of lysozyme in acute pancreatitis and acute duodenal perforation.

    Science.gov (United States)

    Berger, G M; Cowlin, J; Turner, T J

    1976-09-18

    The amylase:creatinine clearance ratio in patients suffering from acute pancreatitis or acute duodenal perforation was higher than normal in both groups of patients. These findings cast doubt on the value of this parameter as a specific index of acute pancreatitis. The mechanism or mechanisms underlying the increased amylase excretion have not been determined. However, the markedly elevated urinary excretion of lysozyme observed in some patients suggests, by analogy, that diminished tubular reabsorption of amylase may contribute towards the elevated amylase:creatinine ratio.

  18. Acute Pancreatitis and Diabetic Ketoacidosis following L-Asparaginase/Prednisone Therapy in Acute Lymphoblastic Leukemia

    Directory of Open Access Journals (Sweden)

    Dania Lizet Quintanilla-Flores

    2014-01-01

    Full Text Available Acute pancreatitis and diabetic ketoacidosis are unusual adverse events following chemotherapy based on L-asparaginase and prednisone as support treatment for acute lymphoblastic leukemia. We present the case of a 16-year-old Hispanic male patient, in remission induction therapy for acute lymphoblastic leukemia on treatment with mitoxantrone, vincristine, prednisone, and L-asparaginase. He was hospitalized complaining of abdominal pain, nausea, and vomiting. Hyperglycemia, acidosis, ketonuria, low bicarbonate levels, hyperamylasemia, and hyperlipasemia were documented, and the diagnosis of diabetic ketoacidosis was made. Because of uncertainty of the additional diagnosis of acute pancreatitis as the cause of abdominal pain, a contrast-enhanced computed tomography was performed resulting in a Balthazar C pancreatitis classification.

  19. The screening value of the amylase-creatinine clearance ratio in acute pancreatitis.

    Science.gov (United States)

    Van Hee, R; Hubens, A

    1979-01-01

    The screening value of the amylase creatinine clearance ratio in acute pancreatitis is studied. A series of 28 patients with pancreatic disease is compared with 80 controls and 82 patients with other intra-abdominal disease. The greatest specificity of the amylase creatinine clearance ratio value is reached at the 3.5 level. The amylase creatinine clearance ratio value proves to be of interest, not only in the diagnosis of acute pancreatitis but also in differentiating mild and heavy forms of pancreatitis.

  20. Lipasuria in acute pancreatitis: result of tubular dysfunction?

    Science.gov (United States)

    Muench, R; Buehler, H; Kehl, O; Ammann, R

    1987-01-01

    Lipase, in contrast to amylase, is completely reabsorbed by the proximal tubules after glomerular filtration. Therefore, no lipase is detectable in the unconcentrated urine according to the current opinion. The handling of lipase (detected with an enzyme-immunoassay) by the kidney was investigated in comparison with creatinine, amylase, and beta-2-microglobulin by clearance studies in acute pancreatitis (n = 10), burn injury (n = 4), glomerular proteinuria (n = 8), and controls without evidence of pancreatic or renal diseases (n = 5). In initial stages of acute pancreatitis a measurable clearance of lipase (mean: 49.6 microliters/min, range: 0.5-234) was found in association with corresponding increased clearances of beta-2-microglobulin (mean: 10.5 ml/min, range: 0.02-58.9) and of amylase (mean: 8.9 ml/min, range: 2.4-22.6) in nine of ten patients. This finding is consistent with a defect of tubular function. However, regression analysis failed to show a significant correlation between lipase and beta-2-microglobulin clearance. Repeated measurements during the course of pancreatitis in seven patients showed reversibility of tubular dysfunction. In patients with burn injury a similar elevation of clearances of beta-2-microglobulin and of amylase was found, but tubular dysfunction in this condition was not associated with lipasuria. In glomerular proteinuria a lipase clearance was found in two of five cases with moderate, and in the other three cases with severe impairment of creatinine clearance. beta-2-microglobulin clearance was normal in the former and only slightly elevated in the latter group. In conclusion lipase is measurable in the urine of most patients with acute pancreatitis as a result of a reversible tubular dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Acute pancreatitis associated with hypercalcemia: A report of two cases Pancreatitis aguda asociada a hipercalcemia: Presentación de dos casos

    Directory of Open Access Journals (Sweden)

    J. Egea Valenzuela

    2009-01-01

    Full Text Available Hypercalcemia due to hyperparathyroidism is a rare etiology for acute pancreatitis, oscillating between 1.5 and 7% in the different series. Although the cause-effect relationship and the pathophysiology of the condition are not clear, it seems that the association among them is not incidental, and serum calcium could be a major risk factor, so that pancreatitis would come to occur during severe hypercalcemia attacks. Mutations in different genes have been proposed as well to justify why only some patients with primary hyperparathyroidism and hypercalcemia develop acute pancreatitis. References to cases like these ones are rare in the literature. We report two patients with acute pancreatitis associated with hyperparathyroidism and hypercalcemia, one of them with a fatal outcome.La hipercalcemia secundaria a hiperparatiroidismo es una causa rara de pancreatitis aguda, variando entre el 1,5-7% según las series consultadas. Aunque la relación causal y la fisiopatología del proceso no están totalmente aclaradas, parece claro que la asociación no es incidental y que los niveles de calcio sérico serían un factor de riesgo mayor, desencadenándose los cuadros de pancreatitis durante las crisis de hipercalcemia. También se han descrito alteraciones en diversos genes que podrían estar implicados, justificando por qué sólo unos pocos pacientes con hiperparatiroidismo primario e hipercalcemia sufren pancreatitis aguda. Existen muy pocas referencias en la literatura a casos como los que nos ocupan. Presentamos a continuación dos pacientes con cuadros de pancreatitis aguda asociados a hiperparatiroidismo e hipercalcemia, uno de ellos con desenlace fatal.

  2. Inflammatory role of the acinar cells during acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Therapeutic effect of ghrelin in the course of cerulein-induced acute pancreatitis in rats.

    Science.gov (United States)

    Warzecha, Z; Ceranowicz, P; Dembinski, A; Cieszkowski, J; Kusnierz-Cabala, B; Tomaszewska, R; Kuwahara, A; Kato, I

    2010-08-01

    Recent studies have shown that pretreatment with ghrelin exhibits protective effect in the gut. Administration of ghrelin reduces gastric mucosal damage, as well as inhibits the development of experimental pancreatitis. However, this protective effect requires administration of ghrelin before gastric or pancreatic damage and thus has a limited clinical value. The aim of present study was to assess the influence of ghrelin administered after development of acute pancreatitis on the course of this disease. Acute pancreatitis was induced by cerulein. Ghrelin was administered twice a day for 1, 2, 4, 6 or 9 days at the dose of 4, 8 or 16 nmol/kg/dose. The first dose of ghrelin was given 24 hours after last injection of cerulein. The severity of acute pancreatitis was assessed between 0 h and 10 days after cessation of cerulein administration. Administration of caerulein led to the development of acute edematous pancreatitis and maximal severity of this disease was observed 24 hours after induction of pancreatitis. Treatment with ghrelin reduced morphological signs of pancreatic damage such as pancreatic edema, leukocyte infiltration and vacuolization of acinar cells, and led to earlier regeneration of the pancreas. Also biochemical indexes of the severity of acute pancreatitis, serum activity of lipase and amylase were significantly reduced in animals treated with ghrelin. These effects were accompanied by an increase in the pancreatic DNA synthesis and a decrease in serum level of pro-inflammatory interleukin-1b. Administration of ghrelin improved pancreatic blood flow in rats with acute pancreatitis. We conclude that: (1) treatment with ghrelin exhibits therapeutic effect in caerulein-induced experimental acute pancreatitis; (2) this effect is related, at least in part, to the improvement of pancreatic blood flow, reduction in proinflammatory interleukin-1beta and stimulation of pancreatic cell proliferation.

  4. Studies on porcine pancreatic elastase activity. II. Immunoreactive elastase level during acute hemorrhagic pancreatitis in pigs.

    Science.gov (United States)

    Nakajima, Y; Matsuno, S; Noto, N; Saitoh, Y; Sato, T

    1980-06-01

    Acute hemorrhagic pancreatitis was produced in pig to study serum concentration of elastase and its physiological role. Pancreatitis was induced in two groups of young pigs by the injection of autologous bile. One group was injected with autologous bile (0.5 ml/kg) at high pressure, and the second group was injected as low pressure (100 cm H2O). Then femoral blood, portal blood and thoracic lymph were sampled at scheduled time intervals. The control level of immunoreactive elastase was around 90 ng/ml in each site, which significantly increased beginning 15 min after bile injection; the level of immunoreactive elastase was higher in the thoracic lymph duct than in the femoral and portal vein. The total and free elastase of both groups in pancreatic tissue were significantly decreased in pancreatitis, and an abundance of immunoreactive elastase was found in the ascites. The increasing pattern of immunoreactive elastase and amylase after bile injection was very similar. Therefore, the level of immunoreactive elastase was considered to be inadequate to determine the grade of severity of pancreatitis as well as the level of amylase which is already known.

  5. Gene expression profiling and endothelin in acute experimental pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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

  6. Acute lung injury and ARDS in acute pancreatitis: Mechanisms and potential intervention

    Institute of Scientific and Technical Information of China (English)

    Roland; Andersson

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in acute pancreatitis still represents a substantial problem,with a mortality rate in the range of 30%-40%.The present review evaluates underlying pathophysiological mechanisms in both ALI and ARDS and potential clinical implications.Several mediators and pathophysiological pathways are involved during the different phases of ALI and ARDS.The initial exudative phase is characterized by diffuse alveolar damage,microvascular injury and inf...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  8. To Study the Clinical, Biochemical and Radiological Features of Acute Pancreatitis in HIV and AIDS

    Science.gov (United States)

    Raza, Shahzad; Chaudhry, Naueen A.; Brown, Jordan D.; Aghaie, Sina; Rezai, Damoun; Khan, Areej; Tan, Paul De Leon; Berger, Barbara J.

    2013-01-01

    Background Pancreatitis complicating HIV infection, even in the Highly Active Antiretroviral Therapy (HAART) era, remains a management challenge. We felt there is a need to discern patterns in the biochemical markers, radiological studies, co-infections, length of stay (LOS) in patients with HIV or AIDS AND pancreatitis. Methods This is a retrospective study conducted from June, 2008 to August, 2010 on patients admitted with acute pancreatitis to our hospital. We extracted and compared the following parameters: biochemical markers, HBV markers (surface antigen, core antibody and surface antibody), HCV antibody, radiological studies, and length of stay (LOS). The Balthazar Grade score was used to assess radiological severity of disease. We stratified the cohort into comparison subsets according to CD4 count. Results Ninety-four admissions met the criteria for HIV or AIDS AND pancreatitis; 67 unique patients comprised the cohort. Median age was 48 years (range, 23 to 60 years). Thirty seven (55%) were male, 30 (45%), female. Two third (n = 51) (76%) were African American. Known risk factors included a history of pancreatitis, 17 (25%); cholecystitis, 13 (19%); alcohol abuse, 25 (37%); Intravenous drug abuse, 18 (27%). Only 36 (38%) admissions were on HAART regimen. Biochemical features on admission were: WBC, 6,100/mm3 (900 - 25,700); amylase, 152 U/L (30 - 1,344); lipase, 702.5 U/L (30 - 5,766), triglyceride, 65 mg/dL (57 - 400); glucose, 94 mg/dL (60 - 1,670); lactate, 2.3 mmol/L (1.09 - 5.49); AST, 61.5 U/L (9 - 1,950); LDH, 762 U/L (394 - 5,500); bicarbonate 19.5 mEq/L (3.3 - 82.7). Interestingly, 62% patients had normal pancreas on CT scan on admission. Of 67 individuals, hepatitis profile was available in 43, 21 (49%) were positive for HCV, 11 (26%) had markers for HBV. Four of 11 patients (36) with CD4 200. P = 0.03 via t-test comparison. One patient with CD4 < 50 died due to acute pancreatitis. Conclusion Pancreatitis remains a major cause of morbidity in HIV

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

    NARCIS (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

  10. A Case of Chronic Pancreatic Insufficiency Due to Valproic Acid in a Child

    Directory of Open Access Journals (Sweden)

    Mary Anne Cooper

    2001-01-01

    Full Text Available A 14-year-old child treated with valproic acid over several years for a seizure disorder developed abdominal pain with radiological evidence of acute pancreatitis. The association with valproic acid was not recognized, and the child continued to take the drug. The patient eventually developed steatorrhea and weight loss that improved with pancreatic enzyme replacement. Radiological evaluation showed an atrophic pancreas. Without evidence of other etiological factors, valproic acid by itself appeared to be the cause of chronic pancreatitis with exocrine pancreatic insufficiency in this patient.

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

    DEFF Research Database (Denmark)

    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....

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

    Institute of Scientific and Technical Information of China (English)

    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...

  13. Organ dysfunction as a risk factor for early severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jan De Waele; S.Blot; Francis Colardyn

    2004-01-01

    @@ To the Editor: We read with interest the review paper by Tao et al.[1] on the topic of early severe acute pancreatitis (EASP, defined as severe acute pancreatitis according to the Altanta criteria[2], with organ dysfunction within 72 h after the start of symptoms) in a recent issue of the World Journal of Gastroenterology. It addresses an important problem in patients with severe acute pancreatitis,namely early organ dysfunction and its effect on outcomes.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    Jakub Bukowczan

    Full Text Available Several previous studies have shown that obestatin exhibits protective and regenerative effects in some organs including the stomach, kidney, and the brain. In the pancreas, pretreatment with obestatin inhibits the development of cerulein-induced acute pancreatitis, and promotes survival of pancreatic beta cells and human islets. However, no studies investigated the effect of obestatin administration following the onset of experimental acute pancreatitis.The aim of this study was to evaluate the impact of obestatin therapy in the course of ischemia/reperfusion-induced pancreatitis. Moreover, we tested the influence of ischemia/reperfusion-induced acute pancreatitis and administration of obestatin on daily food intake and pancreatic exocrine secretion.Acute pancreatitis was induced by pancreatic ischemia followed by reperfusion of the pancreas. Obestatin (8 nmol/kg/dose was administered intraperitoneally twice a day, starting 24 hours after the beginning of reperfusion. The effect of obestatin in the course of necrotizing pancreatitis was assessed between 2 and 14 days, and included histological, functional, and biochemical analyses. Secretory studies were performed on the third day after sham-operation or induction of acute pancreatitis in conscious rats equipped with chronic pancreatic fistula.Treatment with obestatin ameliorated morphological signs of pancreatic damage including edema, vacuolization of acinar cells, hemorrhages, acinar necrosis, and leukocyte infiltration of the gland, and led to earlier pancreatic regeneration. Structural changes were accompanied by biochemical and functional improvements manifested by accelerated normalization of interleukin-1β level and activity of myeloperoxidase and lipase, attenuation of the decrease in pancreatic DNA synthesis, and by an improvement of pancreatic blood flow. Induction of acute pancreatitis by pancreatic ischemia followed by reperfusion significantly decreased daily food intake and

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

    Energy Technology Data Exchange (ETDEWEB)

    Jaun, Woo Ki; Han, Chang Yul [In Je Medical College, Paik Hospital, Seoul (Korea, Republic of); Park, Soo Sung [Chung Ang University College of Medicine, Seoul (Korea, Republic of)

    1983-06-15

    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.

  17. Pancreatitis

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009216 Relation of inositol 1,4,5-trisphosphate with calcium metabolism in rats with severe acute pancreatitis.SHI Chengxian(石承先),et al.Dept Live Bili Pancre Surg,Guizhou Prov Hosp,Guiyang 550002.World Chin J Digestol,2009;17(6):598-601.

  18. An autopsy case of acute pancreatitis with a high serum IgG4 complicated by amyloidosis and rheumatoid arthritis

    Institute of Scientific and Technical Information of China (English)

    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.

  19. Acute pancreatitis related to therapeutic dosing with colchicine: a case report

    Directory of Open Access Journals (Sweden)

    Ting Joseph

    2007-08-01

    Full Text Available Abstract Background Colchicine is used in the treatment and prophylaxis of gout. It possesses a narrow therapeutic window, frequently resulting in dose-limiting gastrointestinal side-effects such as diarrhoea and emesis. As colchicine is a cellular anti-mitotic agent, the most serious effects include myelosuppression, myoneuropathy and multiple organ failure. This occurs with intentional overdose or with therapeutic dosing in patients with reduced clearance of colchicine due to pre-existing renal or hepatic impairment. Acute pancreatitis has rarely been reported, and only in association with severe colchicine overdose accompanied by multi-organ failure. Case presentation We report a case of acute pancreatitis without other organ toxicity related to recent commencement of colchicine for acute gout, occurring in an elderly male with pre-existing renal impairment. Conclusion 1 Colchicine should be used with care in elderly patients or patients with impaired renal function. 2 Aside from myelosuppression, myoneuropathy and multiple organ failure, colchicine may now be associated with acute pancreatitis even with therapeutic dosing; this has not previously being reported.

  20. Multiple Ascending Aortic Mural Thrombi and Acute Necrotizing Mediastinitis Secondary to Acute Pancreatitis

    Science.gov (United States)

    Chong, Byung Kwon; Yun, Jae Kwang; Kim, Joon Bum; Park, Do Hyun

    2016-01-01

    The formation of aortic thrombi is an extremely rare complication of acute pancreatitis. Here we report a case of acute pancreatitis complicated by a paraesophageal pseudocyst, necrotizing mediastinitis, and the formation of multiple thrombi in the ascending aorta. The patient was successfully treated by surgical therapy, which included extensive debridement of the mediastinum and removal of the aortic thrombi under cardiopulmonary bypass. Although esophageal resection was not carried out concomitantly, the lesions were resolved and the patient remained free of complications over 2 years of follow-up care. PMID:27734004

  1. Acute pancreatitis-induced enzyme release and necrosis are attenuated by IL-1 antagonism through an indirect mechanism.

    Science.gov (United States)

    Fink, G; Yang, J; Carter, G; Norman, J

    1997-01-01

    Interleukin-1 beta (IL-1) is a proinflammatory cytokine which is produced within the pancreas during acute pancreatitis reaching levels which are toxic to many cell types. Since antagonism of this cytokine provides dramatic survival benefits during lethal pancreatitis, we hypothesized that IL-1 had direct secretagogue and cytolytic effects within the pancreas. The effect of IL-1 on pancreatic exocrine function and tissue viability was assessed in vivo by blockade of IL-1 with varying doses of IL-1 receptor antagonist (IL-1ra) prior to the induction of either moderate (caerulein-induced) or severe (choline deficient diet-induced) necrotizing pancreatitis. Subsequent in vitro studies were conducted to determine the direct effect of IL-1 on dispersed rat acini prepared through collagenase digestion. Amylase release was measured after a 30-min incubation with varying doses of recombinant IL-1 beta. Viability was determined in the presence of IL-1 via trypan blue exclusion at multiple time points. Blockade of the IL-1 receptor decreased pancreatic amylase release and tissue necrosis in both models of pancreatitis in a dose-dependent fashion (1.0 mg/kg, P = NS; 10 mg/kg, P amylase release and tissue necrosis are significantly attenuated during experimental pancreatitis by IL-1 antagonism. These changes do not appear to be due to the direct action of IL-1 on pancreatic acini and are likely due to more complex interactions between acini and cytokine-producing leukocytes.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Acute pancreatitis induced by paclitaxel and carboplatin therapy in an ovarian cancer patient.

    Science.gov (United States)

    Shintani, D; Yoshida, H; Imai, Y; Fujiwara, K

    2016-01-01

    A 46-year-old female was treated with a regimen of paclitaxel and carboplatin (TC therapy) as adjuvant chemotherapy for Stage IC ovarian adenocarcinoma. There was no severe toxicity except for grade 3 neutropenia during the first four cycles of TC therapy. However, she developed acute pancreatitis at 14 days after fifth cycle. TC therapy is commonly associated with adverse effects such as myelosuppression, hypersensitivity, alopecia, and peripheral neuropathy, but acute pancreatitis has rarely been reported. Ovarian cancer patients often present with nausea and abdominal pain, which are the same symptoms of pancreatitis. It is very important to keep in mind that acute pancreatitis may be concealed in these common symptoms of ovarian cancer during and after TC therapy. Because acute pancreatitis is fatal complication and quitting the drug usually leads to complete cure. The authors report an uncommon case in which TC therapy may have caused acute pancreatitis.

  4. The role of neopterine in the diagnosis of patients with acute pancreatitis on admission to the emergency department

    Directory of Open Access Journals (Sweden)

    Keziban Ucar Karabulut

    2016-03-01

    Full Text Available Purpose: There are difficulties observed in the diagnosis of acute pancreatitis in emergency departments due to its different clinical properties and the insufficiencies in the methods of diagnosis. Since there is no specific biochemical indicator, the diagnosis is made usually late or with difficulty. Neopterine is an enzyme secreted from the macrophages and is an indicator of cellular immunity activation. The aim of this study was to determine the role of neopterine in the early diagnosis of acute pancreatitis . Material and Methods: 39 patients, who had been hospitalized with the complaints of abdominal pain and diagnosed as acute pancreatitis via laboratory and screening methods, and 30 healthy controls were included in the study. Amylase, lipase, cholesterol and neopterine were measured in the patients' samples. The diagnoses were confirmed with abdominal ultrasound and computed tomography. Results: The neopterine values in patients with acute pancreatitis were significantly higher than those of the control group. Conclusion: Neopterine is an indicator which is elevated in certain inflammatory and autoimmune situations. We believe that it is important in the early diagnosis of acute pancreatitis. Further experimental and clinical studies should be conducted on the subject. [Cukurova Med J 2016; 41(1.000: 51-54

  5. Effects of subtotal colectomy on bacterial translocation during experimental acute pancreatitis

    NARCIS (Netherlands)

    van Minnen, LP; Nieuwenhuijs, VB; de Bruijn, MT; Verheem, A; Visser, MR; van Dijk, JE; Akkermans, LMA; Gooszen, HG

    2006-01-01

    Objectives: The colon is considered a major source of bacteria causing infection of pancreatic necrosis in acute pancreatitis (AP). Subtotal colectomy before AP in rats reduces mortality, but its role in affecting small bowel flora, bacterial translocation, and infection of pancreatic necrosis is un

  6. Timing of mortality in severe acute pancreatitis: Experience from 643 patients

    Institute of Scientific and Technical Information of China (English)

    Chih-Yuan Fu; Chun-Nan Yeh; Jun-Te Hsu; Yi-Yin Jan; Tsann-Long Hwang

    2007-01-01

    AIM: To determine the timing of mortality after onset of severe acute pancreatitis (SAP) and the course of the disease in a large series of patients.METHODS: From July 1996 to June 2005, all patients diagnosed with acute pancreatitis at Chang Gung Memorial Hospital, Taipei, Taiwan were retrospectively studied. Three thousand two hundred and fifty episodes of acute pancreatitis were recorded in 2248 patients (1431 males and 817 females; median age, 55.6 years; range,18-97 years). Mortality was divided into two groups:early death (≤ 14 d after admission), and late death (>14 d after admission). The clinical features of patients in these two groups were compared.RESULTS: Although the overall mortality rate of acute pancreatitis was 3.8% (123/3250), mortality rate of SAP was as high as 16.3% (105/643). Of those 105 SAP mortalities, 44 (41.9%) deaths occurred within the first 14 d after admission and 61 (58.1%) occurred after14 d.Incidence of early death did not significantly differ from that of late death. The co-morbidities did not contribute to the timing of death. Early deaths mainly resulted from multiple organ failure. Late deaths were mainly caused by secondary complication of infected necrosis. Intraabdominal bleeding significantly caused higher mortality in late death.CONCLUSION: Approximately half (42%) of SAP deaths occur within 14 d and most were due to multiple organ failure. The late deaths of SAP were mostly due to infected necrosis.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  8. Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

    Science.gov (United States)

    Ohyama, Hiroshi; Mikata, Rintaro; Ishihara, Takeshi; Sakai, Yuji; Sugiyama, Harutoshi; Yasui, Shin; Tsuyuguchi, Toshio

    2017-01-01

    AIM To investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors. METHODS Ten consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared. RESULTS Endoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 ± 1.8 mm vs 13.7 ± 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo. CONCLUSION Sequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy. PMID:28101303

  9. THE CHANGES OF PANCREATIC ACINAR CELL FUNCTION IN ACUTE NECROTIZING PANCREATITIS OF RATS

    Institute of Scientific and Technical Information of China (English)

    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.

  10. Severe acute pancreatitis:Pathogenetic aspects and prognostic factors

    Institute of Scientific and Technical Information of China (English)

    Ibrahim A Al Mofleh

    2008-01-01

    Approximately 20% of patients with acute pancreatitis develop a severe disease associated with complications and high risk of mortality.The purpose of this study is to review pathogenesis and prognostic factors of severe acute pancreatitis (SAP).An extensive medline search was undertaken with focusing on pathogenesis,complications and prognostic evaluation of SAP.Cytokines and other inflammatory markers play a major role in the pathogenesis and course of SAP and can be used as prognostic markers in its early phase.Other markers such as simple prognostic scores have been found to be as effective as multifactorial scoring systems (MFSS) at 48 h with the advantage of simplicity,efficacy,low cost,accuracy and early prediction of SAP.Recently,several laboratory markers including hematocrit,blood urea nitrogen (BUN),creatinine,matrix metalloproteinase-9 (MMP-9) and serum amyloid A (SAA)have been used as early predictors of severity within the first 24 h.The last few years have witnessed a tremendous progress in understanding the pathogenesis and predicting the outcome of SAP.In this review we classified the prognostic markers into predictors of severity,pancreatic necrosis (PN),infected PN (IPN) and mortality.

  11. Hepatic damage during acute pancreatitis in the rat

    Directory of Open Access Journals (Sweden)

    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

  12. Pancreatitis

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008318 Proteomics of hyperlipidemia-associated pancreatitis using differential gel electrophoresis and tandem mass spectrometry: experiment with rats. ZHANG Wei(张伟), et al. Dept Gastroenterol, Shanghai 1st Hosp, Shanghai Jiaotong Univ, Shanghai 200080. Natl Med J China 2008;88(16):1132-1131.Objective To analyze the injury mechanismof hyperlipidemia-associated acute pancreatitis utilizing pro-teomics.Methods Ten SD rats were fed with high fat feed to establish hyperlipidemic models,and 10 SD rats were fed with normal feed to be used as control group.

  13. Atorvastatin Use Associated With Acute Pancreatitis: A Case-Control Study in Taiwan.

    Science.gov (United States)

    Lai, Shih-Wei; Lin, Cheng-Li; Liao, Kuan-Fu

    2016-02-01

    Few data are present in the literature on the relationship between atorvastatin use and acute pancreatitis. The aim of this study was to explore this issue in Taiwan. Using representative claims data established from the Taiwan National Health Insurance Program, this case-control study consisted of 5810 cases aged 20 to 84 years with a first-time diagnosis of acute pancreatitis during the period 1998 to 2011and 5733 randomly selected controls without acute pancreatitis. Both cases and controls were matched by sex, age, comorbidities, and index year of diagnosing acute pancreatitis. Subjects who at least received 1 prescription for other statins or nonstatin lipid-lowering drugs were excluded from the study. If subjects never had 1 prescription for atorvastatin, they were defined as never use of atorvastatin. Current use of atorvastatin was defined as subjects whose last remaining 1 tablet of atorvastatin was noted ≤7 days before the date of diagnosing acute pancreatitis. Late use of atorvastatin was defined as subjects whose last remaining 1 tablet of atorvastatin was noted >7 days before the date of diagnosing acute pancreatitis. The odds ratio with 95% confidence interval of acute pancreatitis associated with atorvastatin use was calculated by using the logistic regression analysis. The logistic regression analysis revealed that the odds ratio of acute pancreatitis was 1.67 for subjects with current use of atorvastatin (95% confidence interval 1.18, 2.38), when compared with subjects with never use of atorvastatin. The odds ratio decreased to 1.15 for those with late use of atorvastatin (95% confidence interval 0.87, 1.52), but without statistical significance. Current use of atorvastatin is associated with the diagnosis of acute pancreatitis. Clinically, clinicians should consider the possibility of atorvastatin-associated acute pancreatitis when patients present with a diagnosis of acute pancreatitis without a definite etiology but are taking atorvastatin.

  14. [Probiotic prophylaxis in patients with predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial

    NARCIS (Netherlands)

    Besselink, M.G.; Santvoort, H.C. van; Buskens, E.; Boermeester, M.A.; Goor, H. van; Timmerman, H.M.; Nieuwenhuijs, V.B.; Bollen, T.L.; Ramshorst, B. van; Witteman, B.J.M.; Rosman, C.; Ploeg, R.J.; Brink, M.; Schaapherder, A.F.; Dejong, C.H.; Wahab, P.J.; Laarhoven, C.J.H.M. van; Harst, E. van der; Eijck, C.H. van; Cuesta, M.A.; Akkermans, L.M.; Gooszen, H.G.

    2008-01-01

    OBJECTIVE: To evaluate whether enteral prophylaxis with probiotics in patients with predicted severe acute pancreatitis prevents infectious complications. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. METHOD: A total of 296 patients with predicted severe acute pancreatitis

  15. Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Raiz A Misgar

    2011-01-01

    Full Text Available The association between pancreatitis and primary hyperparathyroidism (PHPT is controversial. We report a 32-year-old man who presented with recurrent episodes of acute pancreatitis. Primary hyperparathyroidism was diagnosed after the fourth episode of pancreatitis. He had no additional risk factors for pancreatitis. Eighteen months after successful parathyroid surgery, there has been no recurrence of abdominal pain and his serum calcium is within the normal range.

  16. Imaging of the pancreas. Acute and chronic pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  17. Treatment of severe acute pancreatitis through retroperitoneal laparoscopic drainage

    Institute of Scientific and Technical Information of China (English)

    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.

  18. ANALYSIS OF DEATH FACTORS FOR ACUTE HEMORRHAGIC NECROTIZING PANCREATITIS

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Objective:To analyse the factors affecting the mortality of acute hemorrhagic necrotizing pancreatitis (AHNP). Methods:One hundred and twelve patients with AHNP were retrospectively divided into two groups--the dead and survivors. Some parameters were analysed statistically.Results:The average age,sex ratio and onset of illness were similar between two groups. The difference of early shock, early ARDS, high body temperature, leukocytosis and high blood glucose between two groups were not significant. The important factors affecting the mortality were: severe pancreatic necrosis; incorrect therapeutic surgery;improper surgical methods.Conclusion: The patients with mild or moderate AHNP should mainly receive conservative treatment for 48~72 hours. The early shock and ARDS should be corrected before surgical intervention, the swelling pancreas should be dissected fully and duodenostomy should be performed in operation.

  19. Acute flaccid paralysis due to rabies

    Directory of Open Access Journals (Sweden)

    J B Ghosh

    2009-01-01

    Full Text Available Two clinical forms of rabies are recognize: i a furious form associated with classical signs of excitation or phobic symptoms, ii Dumb rabies (paralytic rabies characterized by progressive paralysis without an initial furious phase wherein distinction from Guillain-Barrι Syndrome may be difficult. Paralytic rabies is more common in persons who have received postexposure vaccination. We report here the diagnostic dilemma of two cases of acute flaccid paralysis due to rabies.

  20. Efficacy analysis of Dahuang Fuzi Decotion on treating severe acute pancreatitis in patients with ARDS

    Institute of Scientific and Technical Information of China (English)

    吕春雨

    2013-01-01

    Objective To observe the the therapeutic efficacy of Dahuang Fuzi Decoction in patients with acute respiratory distress syndrome(ARDS)and severe acute pancreatitis(SAP).Methods A prospective,multi-center,randomized

  1. Prognosis of acute and chronic pancreatitis - a 30-year follow-up of a Danish cohort

    DEFF Research Database (Denmark)

    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...

  2. Acute pancreatitis at the beginning of the 21st century: The state of the art

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Pioglitazone, a specific ligand of peroxisome proliferator-activated receptor-gamma, protects pancreas against acute cerulein-induced pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Peter C Konturek; Artur Dembinski; Zygmunt Warzecha; Grzegorz Burnat; Piotr Ceranowicz; Eckhart G Hahn; Marcin Dembinski; Romana Tomaszewska; Stanislaw J Konturek

    2005-01-01

    AIM: To determine the effect of pioglitazone, a specific peroxisome proliferator-activated receptor-γ (PPARγ)ligand, on the development of acute pancreatitis (AP) and on the expression of heat shock protein 70 (HSP70) in the pancreas.METHODS: AP was induced in rats by subcutaneous infusion of cerulein for 5 h. Pancreatic blood flow was measured by laser Doppler flowmetry. Plasma lipase activity, interleukin-1β (IL-1β) and IL-10 were determined.Pancreatic weight and histology were evaluated and pancreatic DNA synthesis and blood flow as well as pancreatic mRNA for IL-1β and HSP70 were assessed in rats treated with pioglitazone alone or in combination with cerulein.RESULTS: Pioglitazone administered (10-100 mg/kg I.g.)30 min before cerulein, attenuated dose-dependently the pancreatic tissue damage in cerulein-induced pancreatitis (CIP) as demonstrated by the improvement of pancreatic histology, reduction in plasma lipase activity,plasma concentration of pro-inflammatory IL-1β and its gene expression in the pancreas and attenuation of the pancreatitis-evoked fall in pancreatic blood flow. CIP increased pancreatic HSP70 mRNA and protein expression in the pancreas and this effect was enhanced by pioglitazone treatment.CONCLUSION: Pioglitazone attenuates CIP and the beneficial effect of this pioglitazone is multifactorial probably due to its anti-inflammatory activities, to the suppression of IL-1β and to the overexpression of HSP70.PPARγ ligands could represent a new therapeutic option in the treatment of AP.

  4. Pioglitazone, a specific ligand of peroxisome proliferator-activated receptor-gamma, protects pancreas against acute cerulein-induced pancreatitis

    Science.gov (United States)

    Konturek, Peter C; Dembinski, Artur; Warzecha, Zygmunt; Burnat, Grzegorz; Ceranowicz, Piotr; Hahn, Eckhart G; Dembinski, Marcin; Tomaszewska, Romana; Konturek, Stanislaw J

    2005-01-01

    AIM: To determine the effect of pioglitazone, a specific peroxisome proliferator-activated receptor-γ (PPARγ) ligand, on the development of acute pancreatitis (AP) and on the expression of heat shock protein 70 (HSP70) in the pancreas. METHODS: AP was induced in rats by subcutaneous infusion of cerulein for 5 h. Pancreatic blood flow was measured by laser Doppler flowmetry. Plasma lipase activity, interleukin-1β (IL-1β) and IL-10 were determined. Pancreatic weight and histology were evaluated and pancreatic DNA synthesis and blood flow as well as pancreatic mRNA for IL-1β and HSP70 were assessed in rats treated with pioglitazone alone or in combination with cerulein. RESULTS: Pioglitazone administered (10-100 mg/kg i.g.) 30 min before cerulein, attenuated dose-dependently the pancreatic tissue damage in cerulein-induced pancreatitis (CIP) as demonstrated by the improvement of pancreatic histology, reduction in plasma lipase activity, plasma concentration of pro-inflammatory IL-1β and its gene expression in the pancreas and attenuation of the pancreatitis-evoked fall in pancreatic blood flow. CIP increased pancreatic HSP70 mRNA and protein expression in the pancreas and this effect was enhanced by pioglitazone treatment. CONCLUSION: Pioglitazone attenuates CIP and the beneficial effect of this pioglitazone is multifactorial probably due to its anti-inflammatory activities, to the suppression of IL-1β and to the overexpression of HSP70. PPARγ ligands could represent a new therapeutic option in the treatment of AP. PMID:16419161

  5. Pancreatic encephalopathy and Wernicke encephalopathy in association with acute pancreatitis: A clinical study

    Institute of Scientific and Technical Information of China (English)

    Guo-Hui Sun; Yun-Sheng Yang; Qing-Sen Liu; Liu-Fang Cheng; Xu-Sheng Huang

    2006-01-01

    AIM: To investigate clinical characteristics and therapy of pancreatic encephalopathy (PE) and Wernicke encephalopathy (WE).METHODS: In a retrospective study of 596 patients with acute pancreatitis (AP), patients with PE were compared to those with WE in regards to history, clinical manifestation, diagnosis, treatment and outcome.RESULTS: There were 93 patients with severe acute pancreatitis (SAP). Encephalopathies were discovered in 10 patients (1.7%). Six patients with PE all developed in SAP (6.5%), and three of them died (3% of SAP, 50% of PE). Four patients with WE developed in AP (0.7%),and two of them died (0.3% of AP, 50% of WE). Two patients with WE were treated with parenteral thiamine and survived. Global confusions were seen in all patients with encephalopathy. Ocular abnormalities were found.Conjugate gaze palsies were seen in 1 of 6 (16.7%)patients with PE. Of 4 patients with WE, one (25%)had conjugate gaze palsies, two (50%) had horizontal nystagmus, three (75%) had diplopia, and one (25%)had myosis. Ataxia was not seen in all patients. None of patients with WE presented with the classic clinical triad.CSF examinations for 2 patients with WE showed lightlyincreased proteins and glucose. CT and MRI of the brain had no evidence of characteristic abnormalities.CONCLUSION: PE occurs in early or reiteration stage of SAP, and WE in restoration stage of SAP/AR Ocular abnormalities are the hallmarks of WE, and horizontal nystagmus is common. It is difficult to diagnose earlier an encephalopathy as PE or WE, as well as differentiate one from the other. Long fasting, hyperemesis and total parenteral nutrition (TPN) without thiamine are main causes of thiamine deficiency in the course of pancreatitis.

  6. Is there correlation between pancreatic enzyme and radiological severity in acute pancreatitis?

    Institute of Scientific and Technical Information of China (English)

    Yeon Sop Kim; Byung Seok Lee; Seok Hyun Kim; Jae Kyu Seong; Hyun Yong Jeong; Heon Young Lee

    2008-01-01

    AIM: To investigate the correlation between the changes of pancreatic enzyme, the biochemical markers and the clinical results according to the Balthazar computer tomography (CT) grade.METHODS: Between July 2004 and July 2005, we reviewed the charts of 119 patients who were admitted to our hospital with acute pancreatitis.RESULTS: Eighty-three patients (69.7%) were male,and the mean age of the patients was 57 ± 15.7 years.The biliary pancreatitis patients had an older mean age.Forty-nine patients (41.1%) had biliary pancreatitis and forty-six (38.6%) had alcoholic pancreatitis. Group 3patients had a longer duration of pain (2.51 ± 1.16 vs 3.17 ± 1.30 vs 6.56 ± 6.13, P < 0.001), a longer period of fasting (7.49 ± 4.65 vs 10.65 4- 5.54 vs 21.88 4±13.81, P < 0.001) and a longer hospital stay (9.17 ± 5.34vs 14.63 4± 8.65 vs 24.47 ± 15.52, P < 0.001) than the other groups. On the univariate analysis, the factors that affected the radiological grade were the leukocyte count at admission (P = 0.048), the hemoglobin (P = 0.016)and total bilirubin concentrations (P = 0.023), serum lipase (P = 0.009), the APACH Ⅱ scores at admission (P = 0.017), the APACH Ⅱ scores after 24 h (P = 0.031),the C-reactive protein (CRP) titer (P = 0.0001) and the follow up CRP titer (P = 0.003). But the CRP level (P = 0.001) and follow up CRP titer (P = 0.004)were only correlated with the radiological grade on multivariate analysis. According to the ROC curve, when we set the CRP cut off value at 83 mg/L, the likelihood ratio for a positive test was 3.84 and the likelihood ratio for a negative test was 0.26 in group 3.CONCLUSION: In conclusion, our study suggests that the CRP with the radiological severity may be used to estimate the severity of acute pancreatitis.

  7. Nifuroxazide-induced acute pancreatitis: a new side-effect for an old drug?

    Science.gov (United States)

    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.

  8. Use of pre-, pro- and synbiotics in patients with acute pancreatitis:A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM: To assess the clinical outcomes of pre-, pro-and synbiotics therapy in patients with acute pancreatitis. METHODS: The databases including Medline, Embase, the Cochrane Library, Web of Science and Chinese Biomedicine Database were searched for all relevant randomized controlled trials that studied the effects of pre-, pro- or synbiotics in patients with acute pancreatitis. Main outcome measures were postoperative infections, pancreatic infections, multiple organ failure (MOF), systemic inflammatory resp...

  9. Use of methimazole and risk of acute pancreatitis: A case–control study in Taiwan

    Directory of Open Access Journals (Sweden)

    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.

  10. Effects of abdominal fat distribution parameters on severity of acute pancreatitis.

    LENUS (Irish Health Repository)

    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.

  11. Acute pancreatitis as an adverse event in patients with the duodenal-jejunal bypass liner

    NARCIS (Netherlands)

    Betzel, B; Homan, J.; Aarts, E.; Janssen, I.; Spanier, M.; Wahab, P.J.; Groenen, M.; Berends, F.

    2015-01-01

    Placement of the duodenal-jejunal bypass liner (DJBL) is a minimally invasive technique for the management of patients with type 2 diabetes mellitus and obesity. Acute pancreatitis was seen in 5 of 167 patients (3 %) in our series. It is suggested that acute pancreatitis in patients with the DJBL re

  12. Actively using clopidogrel correlates with an increased risk of acute pancreatitis in Taiwan.

    Science.gov (United States)

    Lai, Shih-Wei; Lin, Cheng-Li; Liao, Kuan-Fu

    2015-03-15

    The aim of this study is to assess whether there is an association between clopidogrel use and risk of acute pancreatitis in Taiwan. We conducted a case-control study using the database of the Taiwan National Health Insurance Program from 2000 to 2011. There were 5644 subjects aged 20-84 years with a first-time attack of acute pancreatitis as the case group and 22,576 randomly selected sex-matched and age-matched subjects without acute pancreatitis as the control group. We defined clopidogrel use as "actively using" if the final clopidogrel prescription was filled between 0 and 7 days before the date of diagnosing acute pancreatitis, or "not actively using" if the final clopidogrel prescription was filled ≧ 8 days before the date of diagnosing acute pancreatitis. Subjects who never used clopidogrel were defined as never used. The multivariable logistic regression model was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of acute pancreatitis associated with clopidogrel use. Comparing the subjects actively using clopidogrel to those who never used clopidogrel, the adjusted OR of acute pancreatitis was 8.46 (95%CI 5.25, 13.7). The adjusted OR decreased to 1.16 among subjects not actively using clopidogrel (95%CI 0.95, 1.43). Persons actively using clopidogrel are at an increased risk of acute pancreatitis. Further studies are necessary to prove the causal relationship.

  13. Specificity of increased amylase to creatinine clearance ratio in acute pancreatitis.

    Science.gov (United States)

    Lankisch, P G; Koop, H; Otto, J; Oberdieck, U; Winckler, K; Wolfrum, D I

    1977-01-01

    The amylase to creatinine clearance ratio was found to be normal in 11 of 33 patients with acute pancreatitis. The ratio was elevated in 10 of 19 patients with renal insufficiency. Thus, it does not seem to be a specific index in the diagnosis of acute pancreatitis.

  14. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    NARCIS (Netherlands)

    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

  15. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    NARCIS (Netherlands)

    Smit, M.; Buddingh, K. T.; Bosma, B.; Nieuwenhuijs, V. B.; Hofker, H. S.; Zijlstra, J. G.

    2016-01-01

    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, in particula

  16. Is the SPINK1 variant p.N34S overrepresented in patients with acute pancreatitis?

    DEFF Research Database (Denmark)

    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...

  17. The Role of Endoscopic Ultrasound in Primary Pancreatic Lymphoma Presented with Acute Pancreatitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Seyed Hassan Abedi

    2014-09-01

    Full Text Available Context Primary pancreatic lymphoma (PPL is rare but manageable malignant tumor of the pancreas which may be confused with pancreatic adenocarcinoma. Case report We report a 38 year-old smoker man with IVDA and history of B (inactive carrier, C (Ia genotype hepatitis and negative for HIV admitted to our hospital because of nausea, vomiting, epigastric and RUQ pain as a result of long period of alcohol consumption. Due to high amount of amylase (480 U/L and lipase (326 U/L Pancreatitis was diagnosed. Four days after admission CT was done that showed enhancement a large tumor of the head of the pancreas. Endoscopic ultrasound (EU revealed diffusely enlarged of pancreas. There was a mixed echoic mass lesion 37-50 mm at the head of pancreas (R/O walled off necrosis with adhesion to portal vein and SMV. On the other hand the CBD was 9 mm. Abdominal MRI and MRCP for patient was done. The intra-hepatic bile ducts, main hepatic ducts, CHD and CBD were mildly dilated and displaced to the right side by a large lobulated mass (160×112×130 mm of pancreatic head with low signal intensity on T1W images and high intensity on T2W images. We did EUS-FNA and there was a mixed echoic lesion (38-40mm adhered to head of pancreas with invasion to portal vein, SMA and SMV. The diagnosis of pancreatic lymphoma was established by immunohistochemical study and the assessment of the neoplastic cells revealed B cell lymphoma phenotypes. Conclusion Herein we present an interesting 38 year- old man with pancreas head tumor. Primary pancreatic lymphoma is almost never suspected clinically. It is usually diagnosed by imaging and histological methods.

  18. Acute pancreatitis associated with pegylated interferon-alpha-2a therapy in chronic hepatitis C.

    Science.gov (United States)

    Choi, Jong Wook; Lee, June Sung; Paik, Woo Hyun; Song, Tae Jun; Kim, Jung Wook; Bae, Won Ki; Kim, Kyung-Ah; Kim, Jung Gon

    2016-03-01

    Chronic hepatitis C virus (HCV) infection is a major cause of liver cirrhosis and hepatocellular carcinoma. Combination therapy of pegylated interferon-alpha (PEG-IFN-α) and ribavirin (RBV) is a current standard treatment for chronic HCV infection in Korea, which has considerable adverse effects. Acute pancreatitis is a rare complication of PEG-IFN-α administration. We report a case of a 62-year-old female who experienced acute pancreatitis after 4 weeks of PEG-IFN-α-2a and RBV combination therapy for chronic HCV infection. The main cause of the acute pancreatitis in this case was probably PEG-IFN-α rather than RBV for several reasons. A few cases have been reported in which acute pancreatitis occurred during treatment with PEG-IFN-α-2b. This is the first report of acute pancreatitis associated with PEG-IFN-α-2a in Korea.

  19. Nasogastric or nasointestinal feeding in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Matteo; Piciucchi; Elettra; Merola; Massimo; Marignani; Mari-anna; Signoretti; Roberto; Valente; Lucia; Cocomello; Flavia; Baccini; Francesco; Panzuto; Gabriele; Capurso; Gianfranco; Delle; Fave

    2010-01-01

    AIM:To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and nasointestinal(NI)(beyond the ligament of Treitz) feeding in severe acute pancreatitis(SAP).METHODS:After bedside intragastric insertion,tube position was assessed,and enteral nutrition(EN) started at day 4,irrespective of tube localization.Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric(NG) or NI tube.RESULTS:Spontaneous tube ...

  20. Acute renal failure due to rhabdomyolyisis

    Directory of Open Access Journals (Sweden)

    Nieto-Ríos, John Fredy

    2016-04-01

    Full Text Available Acute renal failure is a frequent cause of morbidity and mortality in emergency, hospitalization and critical care services. In 15 % of cases it is due to rhabdomyolysis, in which there is breakdown of skeletal muscle with massive necrosis and leakage of muscle cell contents into the circulation. It has many different etiologies. The rhabdomyolysis-induced acute kidney injury results from the combination of several mechanisms, including tubular obstruction, vasoconstriction and oxidative stress. The most important therapeutic measures are: Aggressive repletion of fluids, forced diuresis and avoidance of exposure to nephrotoxic substances. In cases of severe uremia, metabolic acidosis, hiperkalemia or fluid overload it is necessary to start renal replacement therapy. As a rule, kidney function is completely recovered, but these patients have higher risk of future chronic kidney disease.

  1. Factors predisposing to severe acute pancreatitis: evaluation and prevention

    Institute of Scientific and Technical Information of China (English)

    Bei Sun; Ha-Li Li; Yue Gao; Jun Xu; Hong-Chi liang

    2003-01-01

    AIM: To analyze factors predisposing to the infections associated with severe acute pancreatitis (SAP) and to work out ways for its prevention.METHODS: Total 208 cases of SAP treated in this hospital from Jan. 1980 to Dec. 2001 were retrospectively analyzed.RESULTS: Statistical difference in the incidence of the aforementioned infections was found between the following pairs: between the groups of bloody or non-bloody ascites,paralytic ileus lasting shorter or longer than 5 days, Ranson scores lower or higher than 5, hematocrit lower or higher than 45 %, CT Balthazar scores lower or higher than 7 and between 1980.1-1992.6 or 1992.7-2001.12 admissions (χ2>3.84, P<0.05), while no statistical difference was established between the groups of biliogenic and nonbiliogenic pancreatitis, serum amylase <200 U/L and ≥200U/L, serum calcium <2 mmol/L and ≥ 2 mmol/L or groups of total parenteral nutrition shorter or longer than 7 days (χ2<3.84, P>0.05).CONCLUSION: Occurrence of infection in patients with SAP is closely related with bloody ascites, paralytic ileus ≥5 days, Ranson scores ≥5, hematocrit ≥45 % and CT Balthazar Scores ≥7, but not with pathogens, serum calcium and total parenteral nutrition (TPN). Comprehensive prevention of pancreatic infection and practice of individualized therapy contribute to reducing the incidence of infection.

  2. Relaxin prevents the development of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Ischemic Acute Necrotizing Pancreatitis in a Marathon Runner. Comment

    Directory of Open Access Journals (Sweden)

    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].

  4. Anterior abdominal wall abscess with epididymo-orchitis: An unusual presentation of acute pancreatitis

    Directory of Open Access Journals (Sweden)

    P M Kamble

    2011-01-01

    Full Text Available Pancreatitis indicates inflammation of the pancreas. Clinically acute pancreatitis typically presents as upper abdominal pain mostly in epigastric region, nausea, vomiting and elevated levels of amylase and lipase. Depending upon severity of acute pancreatitis patient may presents with minimal symptoms to more severe signs of acute abdomen like generalized guarding and rigidity. Inspite of absence of disease-specific signs and symptoms for acute pancreatitis, diagnosis is usually not difficult using a combination of clinical, laboratory and radiological findings. Sometimes pancreatitis may presents atypically, which may be misleading in the management especially when typical presentation of pancreatitis as described above is absent. We have described a case of pancreatitis where patient presented with anterior abdominal wall abscess with epididymo-orchitis because of tracking of pancreatic fluid into the retroperitoneum till scrotum. Patients presentation may be different depending upon complication occurred during the course of pancreatitis. After reviewing the literature we found very few cases in which you may not get a clue to diagnose pancreatitis because of atypical presentation. In the described case, patient managed conservatively with percutaneous drainage of the abscess by pigtail catheter placement and scrotal support for epididymoorchitis. This avoided unnecessary exploration in above patient.

  5. Protective Effects of Hydrogen Gas on Experimental Acute Pancreatitis.

    Directory of Open Access Journals (Sweden)

    Hao-Xin Zhou

    Full Text Available 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.

  6. Use of endoscopic naso-pancreatic drainage in the treatment of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Zhu-Fu Quan; Zhi-Ming Wang; Wei-Qin Li; Jie-Shou Li

    2003-01-01

    AIM: To review the experience on the use of endoscopic nasopancreatic drainage (ENPD) in the treatment of severe acute pancreatitis (SAP).METHODS: Since March 1998, under the regular management of SAP with non-operative method, ENPD has been randomly used in 14 patients. The average age of the patients was 41.3±15.9 (years), with 8 males and 6 females.The time from onset to admission was 32.9±22.8 (hours). 8cases were found to have gallbladder stone. The daily output of pancreatic fluid was measured. The body temperature,heart rate, WBC count, blood glucose, blood calcium, PaO2,blood and urine levels of amylase were detected on the fifth day and compared with their respective data on the first day.Therapeutic results and hospitalization times were recorded.RESULTS: The time of drainage was 7.3±4.0 days. The daily drainage outputs of the first five days were 236.4±176.6,287.1±164.7, 284.6±216.4, 435.0±357.8 and 377.8±223.8 ml,respectively. The decreases in body temperature, heart rate,WBC counts, blood and urine levels of amylase and the increase in PaO2 were significant on the fifth day when compared with those on the first day. Infection of pancreatic necrosis was found in one patient and controlled by antiinfectives. 6 out of 8 patients with gallbladder stone were operated during hospital stay. All patients were cured and diischarged and the average hospital stay was 28.1±11.6 days.CONCLUSION: ENPD is an effective method for the drainage of pancreatic fluid and might have an important role in the treatment of SAP. Further observation, comparison and summary by this method are worthy to be considered.

  7. Strongyloidiasis: a case with acute pancreatitis and a literature review.

    Science.gov (United States)

    Makker, Jasbir; Balar, Bhavna; Niazi, Masooma; Daniel, Myrta

    2015-03-21

    Strongyloides stercoralis, a soil transmitted helminth infection, affects millions with varying prevalence worldwide. A large number of affected hosts are asymptomatic. Symptoms pertaining to pulmonary and gastrointestinal involvement may be present. Manifestations of involvement beyond lung and intestine can be seen with dissemination of infection and lethal hyperinfection. Immunosuppression secondary to use of steroids or other immunosuppressants and coexistence of human T-lymphotropic virus type-1 are the known risk factors for dissemination and hyperinfection. Diagnostic modalities comprise stool examination, serology and molecular testing. Stool tests are inexpensive but are limited by low sensitivity, whereas serologic and molecular tests are more precise but at the expense of higher cost. Treatment with Ivermectin or Albendazole as an alternative is safe and efficacious. We present a rare case of acute pancreatitis secondary to Strongyloides. High index of suspicion in patients specifically from endemic countries of origin and lack of other common etiologies of acute pancreatitis may help in early diagnosis and prompt treatment of this potentially fatal infection.

  8. The clinical analysis of acute pancreatitis in colorectal cancer patients undergoing chemotherapy after operation

    Directory of Open Access Journals (Sweden)

    Ji YL

    2015-09-01

    Full Text Available Yanlei Ji,1 Zhen Han,2 Limei Shao,1 Yunling Li,1 Long Zhao,1 Yuehuan Zhao1 1Department of Special Diagnosis, Shandong Cancer Hospital and Institute, Jinan, People’s Republic of China; 2Department of Internal Medicine, Jinan Second People’s Hospital, Jinan, People’s Republic of China Abstract: Acute pancreatitis is a rare complication in postoperative colorectal cancer patients after FOLFOX6 (oxaliplatin + calcium folinate +5-FU [5-fluorouracil] chemotherapy. In this paper, a total of 62 patients with gastrointestinal cancer were observed after the burst of acute pancreatitis. Surgery of the 62 cases of colorectal cancer patients was completed successfully. But when they underwent FOLFOX6 chemotherapy, five patients got acute pancreatitis (8.06%, four (6.45% had mild acute pancreatitis, and one (1.61% had severe acute pancreatitis, of which two were males (3.23% and three females (4.84%. No patients (0.00% had acute pancreatitis on the 1st day after chemotherapy; one patient (1.61% got it in the first 2 and 3 days after chemotherapy; and three others (4.83% got it in the first 4 days after chemotherapy. In the 62 patients with malignant tumors, the body mass index (BMI was less than 18 (underweight in six of them, with two cases of acute pancreatitis (33.33%; the BMI was 18–25 (normal weight in 34 cases, with one case (2.94% of acute pancreatitis; the BMI was 25–30 (overweight in 13 cases, with 0 cases (0.00% of acute pancreatitis; and the BMI was ≥30 (obese in nine patients, with two cases of acute pancreatitis (22.22%. After symptomatic treatment, four patients were cured and one died; the mortality rate was 1.61%. Most of them appeared in the first 4 days after chemotherapy; the probability of this complication is significantly higher in slim and obese patients than in normal weight patients. Postoperative colorectal cancer patients after FOLFOX6 chemotherapy have a sudden onset of acute pancreatitis occult, especially in

  9. Dipeptidyl Peptidase-4 Inhibitor Use Is Not Associated With Acute Pancreatitis in High-Risk Type 2 Diabetic Patients: A Nationwide Cohort Study.

    Science.gov (United States)

    Chang, Chia-Hsuin; Lin, Jou-Wei; Chen, Shu-Ting; Lai, Mei-Shu; Chuang, Lee-Ming; Chang, Yi-Cheng

    2016-02-01

    To analyze the association between use of DPP-4 inhibitors and acute pancreatitis in high-risk type 2 diabetic patients. A retrospective nationwide cohort study was conducted using the Taiwan National Health Insurance claim database. The risk associated with sitagliptin was compared to that with acarbose, a second-line antidiabetic drug prescribed for patients with similar diabetes severity and with a known neutral effect on pancreatitis. Between January 1, 2009 and December 31, 2010, a total of 8526 sitagliptin initiators and 8055 acarbose initiators who had hypertriglyceridemia or prior hospitalization history for acute pancreatitis were analyzed for the risk of hospitalization due to acute pancreatitis stratified for baseline propensity score. In the crude analysis, sitagliptin was associated with a decreased risk of acute pancreatitis (hazard ratio [HR] 0.74; 95% confidence interval [CI]: 0.62-0.88) compared to acarbose in diabetic patients with prior history of hospitalization for pancreatitis or hypertriglyceridemia. The association was abolished after stratification for propensity score quintiles (adjusted HR 0.95; 95% CI: 0.79-1.16). Similar results were found separately in both patients' histories of prior hospitalization of acute pancreatitis (adjusted HR 0.97; 95% CI: 0.76-1.24) and those with hypertriglyceridemia (adjusted HR 0.86; 95% CI: 0.65-1.13). No significant association was found for different durations or accumulative doses of sitagliptin. In the stratified analysis, no significant effect modification was found in relation to patients' characteristics. Use of sitagliptin was not associated with an increased risk of acute pancreatitis in high-risk diabetic patients with hypertriglyceridemia or with history of acute pancreatitis.

  10. Ritonavir and Disulfiram May Be Synergistic in Lowering Active Interleukin-18 Levels in Acute Pancreatitis, and thereby Hasten Recovery

    Directory of Open Access Journals (Sweden)

    Richard Eric Kast

    2008-05-01

    Full Text Available This short note reviews the role of interleukin-18 (IL-18 in acute pancreatitis. IL-18 is a narrow yet important aspect of acute pancreatitis. Narrow because many other inflammatory mediators are active in acute pancreatitis, but important because: a many of the other inflammatory mediators arise secondary to IL-18; and B we happen to have several medicines, in use for other purposes for decades, that pre-clinical and murine studies have indicated happily have ability to lower active IL-18 formation. Also giving IL-18 particular importance is: c the cause of early mortality in acute pancreatitis is mostly due to systemic inflammation, for which IL-18 is an important driving force [1, 2, 3]. Alcohol abuse and cholelithiasis account for 90% of acute pancreatitis, with autoimmune, genetic, hyperlipidemia, obesity and other factors as less common predisposing factors [1, 2, 3]. Diverse secondary morbidity is seen, with chronic pain as a common sequela. Mortality rate is not trivial by multiorgan dysfunction that in extreme forms leads to multiorgan failure[1, 2, 3]. The clinical picture is dominated by fierce pain, hypotension, and susceptibility to secondary infection. Hepatitis and pneumonia are common. Endoscopic or surgical decompression procedures, necrotic tissue removal can help. Medical interventions seem limited to supportive measures, antibiotics for secondary infection, etc. and have not changed much in the last 50 years [1, 2, 3]. This short note presents data indicating that three old drugs, ritonavir, disulfiram, and captopril, have potential to lower IL-18 and may therefore be of benefit in treating pancreatitis.

  11. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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

  12. Tumor necrosis factor α antibody prevents brain damage of rats with acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Yan-Ling Yang; Ji-Peng Li; Kai-Zong Li; Ke-Feng Dou

    2004-01-01

    AIM: To study the protective effects of tumor necrosis factor á (TNFα) antibody on pancreatic encephalopathy in rats.METHODS:One hundred and twenty SD rats were randomly divided into normal control group,acute necrotizing pancreatitis group and TNFα antibody treated group.Acute hemorrhage necrotizing pancreatitis model in rats was induced by retrograde injection of 50 g/L sodium taurocholate into the pancreatobiliary duct.Serum TNFα was detected and animals were killed 12 h after drug administration.Changes in content of brain water,MDA and SOD as well as leucocyte adhesion of brain microvessels were measured.RESULTS:In TNFα antibody treated group,serum TNFálevel was decreased.Content of brain water,MDA and SOD as well as leucocyte adhesion were decreased significantly in comparison with those of acute necrotizing pancreatitis group (P<0.05).CONCLUSION:TNFα antibody can alleviate the brain damage of rats with acute hemorrhage necrotizing pancreatitis.

  13. [PECULIARITIES OF DIAGNOSIS AND TREATMENT OF AN ACUTE PANCREATITIS IN ELDERLY AND SENILE PATIENTS].

    Science.gov (United States)

    Osadchuk, D V; Chornomydz, A V

    2016-04-01

    Peculiarities of clinical course, diagnosis and treatment of elderly patients for an acute pancreatitis were analyzed. There was established, that the clinical course of an acute pancreatitis is atypical with obscure symptoms. Late admittance to hospital, presence of concomitant diseases, low reactivity of the organism defense systems, morpho-functional changes in pancreatic gland complicate the early diagnosis. While the abdominal pain occurrence in the patient it is necessary always to keep in mind the diagnosis of an acute pancreatitis and not to rely on the diagnosis with which the patient was delivered to hospital. Because of presence of several concomitant diseases in a patient with an acute pancreatitis the treatment must be multimodal with multidisciplinary approach, including surgeon, anesthesiologist and therapeutist. Operative intervention is mandatory only in presence of a life-threatening complications and in insufficiency of conservative therapy. Miniinvasive technologies constitute the first-line procedures.

  14. Replacement Gastrostomy Tube Causing Acute Pancreatitis: Case Series with Review of Literature

    Directory of Open Access Journals (Sweden)

    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.

  15. A RETROSPECTIVE STUDY OF MANAGEMENT OF ACUTE PANCREATITIS IN A PERIPHERAL TERTIARY HOSPITAL

    Directory of Open Access Journals (Sweden)

    Thomas Karunahara

    2016-06-01

    Full Text Available BACKGROUND & OBJECTIVES Acute pancreatitis (AP is one of the most common diseases in gastroenterology. Two percent of all patients admitted to hospital are diagnosed with AP. During the last decade, an increasing incidence was observed, mostly because of a higher sensitivity of diagnostic tests. Treatment of Acute Pancreatitis is still symptomatic and no specific medication is available today. As a result of popular belief that the pancreas should be put to rest during acute pancreatitis, the parenteral route for nutrition is still predominantly used in Acute Pancreatitis. There has been increasing evidence; however, about gut being main source of microorganisms causing infectious pancreatic complications and multiorgan failure. In patients with severe pancreatitis, oral intake is inhibited by nausea and subileus. Although some reports show that enteral feeding is possible in acute pancreatitis and associated with fewer septic complications. Although the evidence is inconclusive to support enteral nutrition in all patients with severe acute pancreatitis, the enteral route may be used if tolerated. Supportive treatment is the most important line of management in acute pancreatitis. The aim is to study the management of acute pancreatitis in a peripheral tertiary hospital and to assess the outcome of the management. METHODS & MATERIALS Data Collection: Patients with acute abdominal pain are admitted in hospital and diagnosed as acute pancreatitis based on blood investigations and radiological findings. Patients categorised- Revised Atlanta Classification. Different medical management modes followed and outcomes recorded, tabulated and analysed. Research Design: Retrospective study. Research Settings: Mahatma Gandhi Memorial Government Hospital, Trichy, Tamilnadu. Duration: 5 yrs. (2010-2015 Sample Size: 186. Inclusion Criteria: Patients between 12 and 75 yrs. of age, patients admitted to the hospital as a case of acute pancreatitis, both sexes

  16. Do We Really Need a New Category of Severity for Patients with Acute Pancreatitis?

    Directory of Open Access Journals (Sweden)

    Generoso Uomo

    2009-09-01

    Full Text Available In the last few years several international surveys have confirmed that approximately 15-20% of patients suffering from acute pancreatitis have a severe outcome [1, 2, 3, 4, 5, 6, 7, 8]. The most widely used system for defining an episode of acute pancreatitis as severe derives from the Symposium on classifying acute pancreatitis held in Atlanta, GA, U.S.A. in 1992 [9]. This innovative classification system pays specific attention to the morphological data, the complications of acute pancreatitis and the terminology. In a short period of time, the Atlanta criteria enjoyed worldwide diffusion and wide international agreement. Its clinical and scientific relevance is witnessed by the fact that, since 1994, virtually every paper published in any journal having a high impact factor and which deals with acute pancreatitis from a clinical point of view refers to the Atlanta criteria for patient stratification. Acute pancreatitis is categorized as either “mild” or “severe”, severe being defined as the presence of any one of the following: a failure of one or more organ systems (respiratory, renal, gastrointestinal or circulatory at any time during the course of the disease; b occurrence of one or more local complications (pancreatic necrosis, pseudocyst or abscess. In short, acute pancreatitis is classified as severe in the presence of any organ failure and/or the presence of any local complication. As a consequence, all patients having any type of organ dysfunction after a single examination were described as severe acute pancreatitis without any distinction between minimal or multi-organ failure, and transient or persistent organ dysfunction. At the same time, all patients showing evidence of pancreatic necrosis were described as severe, independently of the entity of the necrotic process.

  17. Clinical results of the complex prevention of the acute postoperative pancreatitis at the surgical gastroenterology

    Directory of Open Access Journals (Sweden)

    Kotenko К.V.

    2013-12-01

    Full Text Available The article aims to study the results of the complex prevention of the acute postoperative pancreatitis in the surgical gastroenterology. Material and methods. 2968 patients with various disorders of the digestive system were operated. Empirical preventing of the acute postoperative pancreatitis was used in the control group. Complex prevention of the acute postoperative pancreatitis in the main group of patients included the use of Dalargin, intravenous infusion of Octreotide, duodenal trypsin enzyme inhibition; intraduodenal reversal of pancreatic secret; intraductal injection of Lidocaine and external transnasal drainage of the pancreatic and biliary ducts. Results. The frequency of acute postoperative pancreatitis was 12.2% in the main group. The frequency of acute postoperative pancreatitis was 36.9% in the control group. Increased frequency of a mild form of the acute postoperative pancreatitis observed in the main group compared with the control. At the same time reducing the frequency of the moderate severity and severity forms of the acute postoperative pancreatitis observed in the main group compared with the control. Reduction of the morbidity (13.6% vs. 25.1%, hospital mortality (1.6% vs. 3.5%, the duration of the postoperative hospital bed-day (12.1±0.4 vs. 16.7±0.6 were identified in the main group patients compared with the control group. Conclusion. The use of the given scheme for the complex prevention of the acute postoperative pancreatitis allowed significantly reduce the frequency and severity of illness, morbidity, reduce the duration of postoperative hospital bed-day and hospital mortality, as well as the frequency of both mild and severity, and fatal postoperative complications in all investigated groups of patients.

  18. Soporte nutricional en la pancreatitis aguda Artificial nutrition in acute pancreatitis

    Directory of Open Access Journals (Sweden)

    J. Garnacho Montero

    2005-06-01

    Full Text Available Los cambios metabólicos que tienen lugar en la pancreatitis aguda originan, como en otros pacientes graves, una situación de estrés metabólico que, en muchas ocasiones, requiere la aplicación de soporte nutricional especializado. Los pacientes que presentan mayores niveles de gravedad (definida como un índice de Ranson = 3 o un APACHE II = 10 son los candidatos a recibir apoyo nutricional. La nutrición enteral debe ser la primera vía de aporte de nutrientes a considerar y debe mantenerse salvo que los pacientes presenten intolerancia o desarrollen dolor, ascitis, o incremento de las cifras de amilasa sérica. La nutrición enteral transpilórica, a través de una sonda naso-yeyunal o mediante yeyunostomía por catéter, es una vía de acceso segura en la pancreatitis aguda grave e incluso puede acompañarse de ventajas evolutivas para los pacientes en comparación con la nutrición parenteral. La indicación de nutrición parenteral estaría condicionada por la imposibilidad de obtener un abordaje enteral adecuado (yeyunal, la intolerancia a la nutrición enteral o la reagudización del proceso tras el inicio del soporte nutricional enteral. Con los datos actuales, no pueden establecerse recomendaciones acerca de las características idóneas que debe reunir la composición de nutrientes que deben recibir los pacientes con pancreatitis aguda.Metabolic changes that occur in acute pancreatitis result, as with other critically ill patients, in a metabolic stress situation that many times requires the application of a specialized nutritional support. Patients presenting the highest severity indexes (defined as Ranson's index = 3 or an APACHE II = 10 are candidates to receive nutritional support. Enteral nutrition must be the first route to consider for nutrients supply and must be maintained except for patients that have intolerance or develop pain, ascites, or increased serum amylase levels. Transpyloric enteral nutrition, through a naso

  19. Biliopancreatic duct injection of ethanol as an experimental model of acute and chronic pancreatitis in rats.

    Science.gov (United States)

    Unal, Ethem; Atalay, Suleyman; Tolan, Huseyin Kerem; Yuksekdag, Sema; Yucel, Metin; Acar, Aylin; Basak, Fatih; Gunes, Pembegul; Bas, Gurhan

    2015-01-01

    In the present study, we described an easily reproducable experimental pancreatits model induced by biliopancreatic duct injection of ethyl alcohol. Seventy Wistar albino rats were divided equally into seven groups randomly: the control group (group 1), acute pancreatitis groups; induced by 20% ethanol (group 2), 48% ethanol (group 3), 80% ethanol (group 4), chronic pancreatitis groups; induced by 20% ethanol (group 5), 48% ethanol (group 6) and by 80% ethanol (group 7). Acute pancreatitis groups were sacrified on postoperative day 3, while the control group and chronic pancreatitis groups were killed on postoperative day 7. Histopathologic evaluation was done, and P acute pancreatitis (100%). Inflammatory infiltration of neutrophils and mononuclear cells, interstitial edema, and focal necrotic areas were seen in the pancreatic tissues. Similarly, all rats in group 6 developed chronic pancreatitis (100%). Interstitial fibrosis, lymphotic infiltration, ductal dilatation, acinar cell atrophy, periductal hyperplasia were seen in the pancreatic tissues. Mortality was seen only in group 7. The biliopancreatic ductal injection of 48% ethanol induced acute and chronic pancreatitis has 100% success rate.

  20. Clinical value of rapid urine trypsinogen-2 test strip, urinary trypsinogen activation peptide, and serum and urinary activation peptide of carboxypeptidase B in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jesús Sáez; Juan Martínez; Celia Trigo; José Sánchez-Payá; Luis Compa(n)y; Raquel Laveda; Pilar Gri(n)ó; Cristina García; Miguel Pérez-Mateo

    2005-01-01

    AIM: To assess the usefulness of urinary trypsinogen-2 test strip, urinary trypsinogen activation peptide (TAP),and serum and urine concentrations of the activation peptide of carboxypeptidase B (CAPAP) in the diagnosisof acute pancreatitis.METHODS: Patients with acute abdominal pain and hospitalized within 24 h after the onset of symptoms were prospectively studied. Urinary trypsinogen-2 was considered positive when a clear blue line was observed (detection limit 50 μg/L). Urinary TAP was measured using a quantitative solid-phase ELISA, and serum and urinary CAPAP by a radioimmunoassay method.RESULTS: Acute abdominal pain was due to acute pancreatitis in 50 patients and turned out to be extrapancreatic in origin in 22 patients. Patients with acute pancreatitis showed significantly higher median levels of serum and urinary CAPAP levels, as well as amylase and lipase than extrapancreatic controls. Median TAP levels were similar in both groups. The urinary trypsinogen-2 test strip was positive in 68% of patients with acute pancreatitis and 13.6% in extrapancreatic controls (P<0.01). Urinary CAPAP was the most reliable test for the diagnosis of acute pancreatitis (sensitivity 66.7%, specificity 95.5%, positive and negative predictive values 96.6% and 56.7%, respectively), with a 14.6 positive likelihood ratio for a cut-off value of 2.32 nmol/L.CONCLUSION: In patients with acute abdominal pain,hospitalized within 24 h of symptom onset, CAPAP in serum and urine was a reliable diagnostic marker of acute pancreatitis. Urinary trypsinogen-2 test strip showed a clinical value similar to amylase and lipase.Urinary TAP was not a useful screening test for the diagnosis of acute pancreatitis.

  1. Idiopathic cystic ar ter y aneur ysm complicated with hemobilia and acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Subhi J. Al'Aref; Husham Abdel-Rahman; Nasir Hussain

    2008-01-01

    BACKGROUND:  Aneurysm of the cystic artery is not common, and it is a rare cause of hemobilia. Most of reported cases are pseudoaneurysms resulting from either an inlfammatory process in the abdomen or abdominal trauma. METHOD: We report a healthy individual who developed hemobilia and acute pancreatitis associated with cystic artery aneurysm. RESULT: The patient was managed with angio-embolization with an uneventful post-embolization course. CONCLUSIONS: Visceral artery aneurysms are rare and can rupture with potentially grave outcome due to excessive bleeding. Angiographic embolization as a common method of treatment for visceral artery aneurysms was used in our patient with good outcome.

  2. Acute hepatitis due to brucellosis: case report

    Directory of Open Access Journals (Sweden)

    Nevil AYKIN

    2009-06-01

    Full Text Available Brucella infection is a systemic disease. It rarely causes local infections like hepatitis in gastrointestinal system. In this article we would like to present an acute hepatitis case related to brucella infection that followed up in our clinic. A male, 30 year-old patient hospitalized due to common muscle pain, high fever and vomiting. During the physical examination the patient’s skin, scleras and mucosal membranes were icteric, the liver was 2-3 cm palpable and tender. Laboratory findings were as follows: AST:1190 U/L; ALT:715 U/L; GGT:961 U/L; ALP:369 U/L; total bilirubin:4.6 mg/dL; direct bilirubin:2.1 mg/dL. Viral markers were found to be negative. We started treatment with streptomicine and doxicycline since, the patient’s standard brucella tube agglutination test was positive (1/60 and brucella spp produced in his blood culture. From the second day of the treatment, we started to get clinical response. On the 17th day of the treatment, he discharged from the hospital because ALT, AST and bilirubine level were found normal and his treatment was completed to the 8 weeks. Brucella is continuing to be an important health problem especially who live in surrounding countryside and have to keep in mind in the differential diagnosis of the acute hepatitis.

  3. Acute Pancreatitis from Mumps Re-infection in Adulthood. A Case Report

    Directory of Open Access Journals (Sweden)

    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. A new pathological scoring method for adrenal injury in rats with severe acute pancreatitis.

    Science.gov (United States)

    Deng, Wenhong; Hui, Yuanjian; Yu, Jia; Wang, Weixing; Xu, Sheng; Chen, Chen; Xiong, Xincheng

    2014-12-01

    These studies investigated the appearance and function of adrenal glands in rats with severe acute pancreatitis (SAP) and established a new histopathological score to evaluate adrenal histopathological changes. Severe acute pancreatitis relied on retrograde infusion of 5% sodium taurocholate into the bile-pancreatic duct. The damage of SAP was estimated by serum amylase, secretory phospholipase A2 and pancreatic histopathology. Light and electron microscopy of adrenal gland, and the levels of serum corticosterone were investigated. These results showed that the generally ascending trend of adrenal pathological score was inversely proportional to the generally descending trend of serum corticosterone levels, but parallel with the changes of pancreatic histopathology. Herein, the new adrenal histopathological score was effective in the evaluation of adrenal injury following SAP. It may indirectly reflect the variation of serum cortisol levels and the severity of pancreatitis to a certain extent.

  5. Transient reduction of spleen density in acute pancreatitis: case reports and literature review.

    Science.gov (United States)

    Jiang, Xing Yue; Bian, Jia; Zhang, Cheng Zhou; Wang, Shan Shan; Nie, Tai Ming; Zhang, Lin

    2014-01-01

    A healthy spleen has density stable on computed tomographic (CT) scan; in some patients, spleen infarction can be associated with acute pancreatitis. Here, we report 2 patients with acute pancreatitis associated with transient reduction of spleen density that were confirmed in our hospital. The clinical data of the 2 patients were retrospectively analyzed, and the relevant literature was reviewed. Acute pancreatitis with transient reduction of splenic density has certain characteristics in clinical and radiological aspects. After clinical treatment, the spleen density can be restored. Its mechanism may be related to glucose and lipid metabolism, transient thrombosis formation in splenic vessels, and so on.

  6. Immune-Manipulation of the Inflammatory Response in Acute Pancreatitis. What Can Be Expected?

    Directory of Open Access Journals (Sweden)

    Corinaldesi R

    2004-05-01

    Full Text Available Severe acute pancreatitis still has a high mortality rate and multiple organ failure is considered to be a severe complication of the disease. Activated polymorphonuclear leukocytes have an important role in the development of multiple organ failure which may result from acute pancreatitis and they are an important pathogenetic factor in the severity of this disease. Therefore, a logical therapeutic approach is to limit the organ damage by selective suppression of inflammatory mediators involved in the systemic inflammatory response syndrome and protect against systemic complication. In this paper, we review the recent literature data on the possible manipulation of the immune response in acute pancreatitis.

  7. Smoking and risk of acute and chronic pancreatitis among women and men: a population-based cohort study

    DEFF Research Database (Denmark)

    Tolstrup, Janne Schurmann; Kristiansen, Louise; Becker, Ulrik;

    2009-01-01

    . Information on incident cases of acute and chronic pancreatitis were obtained by record linkage with the Danish national registries. RESULTS: A total of 235 cases of pancreatitis occurred during follow-up. A dose-response association between smoking and risk of acute and chronic pancreatitis was observed...

  8. Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

    Institute of Scientific and Technical Information of China (English)

    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.

  9. Aggravation of Hypertriglyceridemia and Acute Pancreatitis in a Bipolar Patient Treated with Quetiapine

    OpenAIRE

    Liou, Li-Syue; Hung, Yi-Jen; Hsieh, Chang-Hsun; Hsiao, Fone-Ching

    2014-01-01

    Pancreatitis is a very rare adverse effect of quetiapine treatment, with only 5 cases of quetiapine-associated pancreatitis reported in the English literature to date. Herein, we report one patient who developed severe hypertriglyceridemia (>1000 mg/dL) after quetiapine administration, resulting in acute pancreatitis. An analysis of the underlying pathogenic mechanisms and a review of relevant literature are also presented. Clinicians should be aware of the potentially life-threatening metabo...

  10. CLINICAL STUDY OF ACUTE PANCREATITIS WITH SPECIAL REFERENCE TO RANSONS PROGNOSTIC CRITERIA

    Directory of Open Access Journals (Sweden)

    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.

  11. The Perfect Way to Predict the Severity of Acute Pancreatitis: The Search Continues

    Directory of Open Access Journals (Sweden)

    Daniel C Sadowski

    2004-01-01

    Full Text Available This study was designed to determine the clinical utility of three rating scales (Ranson's, Acute Physiology And Chronic Health Evaluation [APACHE] II and Glasgow in predicting the severity of acute pancreatitis experienced by patients known to have human immunodeficiency virus (HIV or acquired immunodeficiency syndrome (AIDS. A retrospective analysis identified 73 patients with both acute pancreatitis and HIV who had been admitted to two Canadian hospitals between 1989 and 1999. Of those 73, 11 (15% went on to have a clinical course consistent with a diagnosis of severe pancreatitis. For the purposes of the study, severe pancreatitis was defined by the occurrence of death, intensive care unit admission, surgical intervention or significant symptomatic local complications (necrosis, abscess or pseudocyst. The authors found that the APACHE II and Ranson's scores had a sensitivity of 100% and specificities of 70% and 33% for severe pancreatitis, respectively. The Glasgow score had a statistically poorer diagnostic performance.

  12. Inlfammatory mediators and microcirculatory disturbance in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    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.

  13. Effect of Vagotomy on Acute Pancreatitis in Rats

    Institute of Scientific and Technical Information of China (English)

    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.

  14. The revised Atlanta criteria 2012 altered the classiifcation, severity assessment and management of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jie Huang; Hong-Ping Qu; Yun-Feng Zheng; Xu-Wei Song; Lei Li; Zhi-Wei Xu; En-Qiang Mao; Er-Zhen Chen

    2015-01-01

    BACKGROUND: The Atlanta criteria for acute pancreatitis (AP) has been revised recently. This study was to evaluate its practical value in classiifcation of AP, the severity assessment and management. METHODS: The clinical features, severity classiifcation, out-come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria (RAC) and the original Atlanta criteria (OAC). RESULTS: Compared to the OAC group, the incidence of se-vere acute pancreatitis (SAP) was decreased by approximately one half (13.9% vs 28.2%) in the RAC group. The RAC present-ed a lower sensitivity but higher speciifcity, and its predictive value for severity and poor outcome was higher than those of the OAC. The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was signiifcantly lower than that in the OAC group (P CONCLUSIONS: The RAC showed a higher predictive value for severity and poorer outcome than the OAC. However, the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP. Among SAP cases, older age, high CTSI, renal and cardiovascular failure, com-plications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.

  15. The revised Atlanta criteria 2012 altered the classiifcation, severity assessment and management of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jie Huang; Hong-Ping Qu; Yun-Feng Zheng; Xu-Wei Song; Lei Li; Zhi-Wei Xu; En-Qiang Mao; Er-Zhen Chen

    2016-01-01

    BACKGROUND: The Atlanta criteria for acute pancreatitis (AP) has been revised recently. This study was to evaluate its practical value in classiifcation of AP, the severity assessment and management. METHODS: The clinical features, severity classiifcation, out-come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria (RAC) and the original Atlanta criteria (OAC). RESULTS: Compared to the OAC group, the incidence of se-vere acute pancreatitis (SAP) was decreased by approximately one half (13.9% vs 28.2%) in the RAC group. The RAC present-ed a lower sensitivity but higher speciifcity, and its predictive value for severity and poor outcome was higher than those of the OAC. The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was signiifcantly lower than that in the OAC group (P CONCLUSIONS: The RAC showed a higher predictive value for severity and poorer outcome than the OAC. However, the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP. Among SAP cases, older age, high CTSI, renal and cardiovascular failure, com-plications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.

  16. Early phase of acute pancreatitis: Assessment and management

    Institute of Scientific and Technical Information of China (English)

    Veit; Phillip; Jrg; M; Steiner; Hana; Algül

    2014-01-01

    Acute pancreatitis(AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis.

  17. How We Predict the Etiology of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Miguel Pérez-Mateo

    2006-05-01

    Full Text Available Acute pancreatitis (AP is a frequent disease which represents 0.15-1.5% of all diagnoses in the emergency room. Although its prevalence varies in different countries and even in different areas of a given country, it is likely that its real prevalence ranges from 200-300 cases per million inhabitants a year [1, 2, 3]. The list of etiologic factors related to its development is shown in Table 1. However, a biliary origin is by far the most frequent cause, followed by an alcoholic origin. Together these etiologies are responsible for 80% of all episodes of AP [4]. In a published series, each one of the remaining possible etiologic causes affected a reduced number of patients with AP.

  18. Pioglitazone attenuates the severity of sodium taurocholate-induced severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ping Xu; Xiao-Jiang Zhou; Ling-Quan Chen; Jiang Chen; Yong Xie; Long-Hua Lv; Xiao-Hua Hou

    2007-01-01

    AIM: To determine the effect of pioglitazone, a specific peroxisome proliferator-activated receptor-γ (PPARγ)ligand, on development of severe acute pancreatitis (SAP) and expression of nuclear factor-kappa B (NF-κB)and intercellular adhesion molecule-1 (ICAM-1) in the pancreas.METHODS: Male Sprague-Dawley (SD) rats (160-200 g)were randomly allocated into three groups (n = 18in each group): severe acute pancreatitis group,pioglitazone group, sham group. SAP was induced by retrograde infusion of 1 mL/kg body weight 5% sodium taurocholate (STC) into the biliopancreatic duct of male SD rats. Pioglitazone was injected intraperitoneally two hours piror to STC infusion. Blood and ascites were obtained for detecting amylase and ascitic capacity. Pancreatic wet/dry weight ratio, expression of NF-κB and ICAM-1 in pancreatic tissues were detected by immunohistochemical staining. Pancreatic tissue samples were stained with hematoxylin and eosin (HE)for routine optic microscopy.RESULTS: Sham group displayed normal pancreatic structure. SAP group showed diffuse hemorrhage,necrosis and severe edema in focal areas of pancreas.There was obvious adipo-saponification in abdominal cavity. Characteristics such as pancreatic hemorrhage,necrosis, severe edema and adipo-saponification were found in pioglitazone group, but the levels of those injuries were lower in pioglitazone group than those in SAP group. The wet/dry pancreatic weight ratio,ascetic capacity, serum and ascitic activities of anylase in the SAP group were significantly higher than those in the sham group and pioglitazone group respectively (6969.50 ± 1368.99 vs 2104.67 ± 377.16, 3.99 ± 1.22 vs 2.48 ± 0.74, P < 0.01 or P < 0.05). According to Kusske criteria, the pancreatic histologic score showed that interstitial edema, inflammatory infiltration,parenchyma necrosis and parenchyma hommorrhage in SAP group significantly differed from those in the sham group and pioglitazone group (7.17 ± 1.83 vs 0.50 ±0.55, 7

  19. Proteasome inhibitor ameliorates severe acute pancreatitis and associated lung injury of rats

    Institute of Scientific and Technical Information of China (English)

    Xi Chen; Shun-Le Li; Tao Wu; Ji-Dong Liu

    2008-01-01

    AIM:To observe the effect of proteasome inhibitor MG-132 on severe acute pancreatitis (SAP) and associated lung injury of rats.METHODS:Male adult SD rats were randomly divided into SAP group,sham-operation group,and MG-132 treatment group.A model of SAP was established by injection of 5% sodium taurocholate into the biliarypancreatic duct of rats.The MG-132 group was pretreated with 10 mg/kg MG-132 intraperitoneally (ip) 30 rnin before the induction of pancreatitis.The changes in serum amylase,myeloperoxidase (MPO) activity of pancreatic and pulmonary tissue were measured.The TNF-α level in pancreatic cytosolic fractions was assayed with an enzyme-linked immunosorbent assay (ELISA) kit.Meanwhile,the pathological changes in both pancreatic and pulmonary tissues were also observed.RESULTS:MG-132 significantly decreased serum amylase,pancreatic weight/body ratio,pancreatic TNF-α level,pancreatic and pulmonary MPO activity (P < 0.05).Histopathological examinations revealed that pancreatic and pulmonary samples from rats pretreated with MG-132 demonstrated milder edema,cellular damage,and inflammatory activity (P < 0.05).CONCLUSION:The proteasome inhibitor MG-132shows a protective effect on severe acute pancreatitis and associated lung injury of rats.

  20. A nuclear import inhibitory peptide ameliorates the severity of Cholecystokinin-induced acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Tamás Letoha; István Krizbai; Imre Boros; Ern(o) Duda; Erzsébet Kusz; Botond Penke; Csaba Somlai; Tamás Takács; Annamária Szabolcs; Katalin Jármay; Zoltán Rakonczay Jr; Péter Hegyi; Ilona Varga; József Kaszaki

    2005-01-01

    AIM: To assess the effect of our novel cell-permeable nuclear factor-kappaB (NF-κB) inhibitor peptide PN50 in an experimental model of acute pancreatitis. PN50 was produced by conjugating the cell-penetrating penetratin peptide with the nuclear localization signal of the NF-κB p50 subunit.METHODS: Pancreatitis was induced in male Wistar rats by administering 2×100 μg/kg body weight of cholecystokininoctapeptide (CCK) intraperitoneally (IP) at an interval of 1 h. PN50-treated animals received 1 mg/kg of PN50 IP 30 min before or after the CCK injections. The animals were sacrificed 4 h after the first injection of CCK.RESULTS: All the examined laboratory (the pancreatic weight/body weight ratio, serum amylase activity,pancreatic levels of TNF-α and IL-6, degree of lipid peroxidation, reduced glutathione levels, NF-κB binding activity, pancreatic and lung myeloperoxidase activity) and morphological parameters of the disease were improved before and after treatment with the PN50 peptide.According to the histological findings, PN50 protected the animals against acute pancreatitis by favoring the induction of apoptotic, as opposed to necrotic acinar cell death associated with severe acute pancreatitis.CONCLUSION: Our study implies that reversible inhibitors of stress-responsive transcription factors like NF-κB might be clinically useful for the suppression of the severity of acute pancreatitis.

  1. [Pathophysiology of hormonal, immune, metabolic changes in acute and chronic pancreatitis. Experimental and clinical studies].

    Science.gov (United States)

    Trubitsyna, I E; Chikunova, B Z; Tkachenko, E V; Tsaregorodtseva, T M; Vinokurova, L V; Varvanina, G G

    2008-01-01

    There is literature review of the acute and chronic pancreatitis experimental models. Patogenetic necrosis mechanisms with fibrosis progress in pancreas were revealed. The stimulation of the proteolytic enzymes synthesis and secretion, that was examined in experiments were compared with clinical examinations. The patients with chronic pancreatitis were investigated in the Central Research Institute of Gastroenterology.

  2. Acute Pancreatitis Occurring after Pamidronate Infusions in Two Patients with Spondyloarthritis

    Directory of Open Access Journals (Sweden)

    Éric Toussirot

    2013-01-01

    Full Text Available We report two cases of acute pancreatitis following the administration of pamidronate given as an anti-inflammatory agent for spondyloarthritis with a recurrence in one patient when the drug was reintroduced. The upper gastrointestinal toxicity of aminobisphosphonates is well known and this drug class could be added to the list of medications that are associated with the development of pancreatitis.

  3. Progression from acute to chronic pancreatitis: prognostic factors, mortality, and natural course

    DEFF Research Database (Denmark)

    Nøjgaard, Camilla; Becker, Ulrik; Matzen, Peter

    2011-01-01

    Knowledge of the natural course of acute pancreatitis (AP) and risk of progression to chronic pancreatitis (CP) is limited. The aims were to describe: (1) the incidence of progression from AP to CP, (2) prognostic factors for progression, and (3) the natural course and mortality of progressive AP....

  4. Progression From Acute to Chronic Pancreatitis Prognostic Factors, Mortality, and Natural Course

    DEFF Research Database (Denmark)

    Nojgaard, C.; Becker, U.; Matzen, Peter

    2011-01-01

    Objectives: Knowledge of the natural course of acute pancreatitis (AP) and risk of progression to chronic pancreatitis (CP) is limited. The aims were to describe: (1) the incidence of progression from AP to CP, (2) prognostic factors for progression, and (3) the natural course and mortality...

  5. The effects of probiotic supplementation on experimental acute pancreatitis: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Hooijmans, C.R.; Vries, R.B.M. de; Rovers, M.M.; Gooszen, H.G.; Ritskes-Hoitinga, M.

    2012-01-01

    BACKGROUND: In February 2008, the results of the PRObiotics in PAncreatitis TRIAl (PROPATRIA) were published. This study investigated the use of probiotics in patients suffering from severe acute pancreatitis. No differences between the groups were found for any of the primary endpoints. However, mo

  6. Dihydro-Resveratrol Ameliorates Lung Injury in Rats with Cerulein-Induced Acute Pancreatitis.

    Science.gov (United States)

    Lin, Ze-Si; Ku, Chuen Fai; Guan, Yi-Fu; Xiao, Hai-Tao; Shi, Xiao-Ke; Wang, Hong-Qi; Bian, Zhao-Xiang; Tsang, Siu Wai; Zhang, Hong-Jie

    2016-04-01

    Acute pancreatitis is an inflammatory process originated in the pancreas; however, it often leads to systemic complications that affect distant organs. Acute respiratory distress syndrome is indeed the predominant cause of death in patients with severe acute pancreatitis. In this study, we aimed to delineate the ameliorative effect of dihydro-resveratrol, a prominent analog of trans-resveratrol, against acute pancreatitis-associated lung injury and the underlying molecular actions. Acute pancreatitis was induced in rats with repetitive injections of cerulein (50 µg/kg/h) and a shot of lipopolysaccharide (7.5 mg/kg). By means of histological examination and biochemical assays, the severity of lung injury was assessed in the aspects of tissue damages, myeloperoxidase activity, and levels of pro-inflammatory cytokines. When treated with dihydro-resveratrol, pulmonary architectural distortion, hemorrhage, interstitial edema, and alveolar thickening were significantly reduced in rats with acute pancreatitis. In addition, the production of pro-inflammatory cytokines and the activity of myeloperoxidase in pulmonary tissues were notably repressed. Importantly, nuclear factor-kappaB (NF-κB) activation was attenuated. This study is the first to report the oral administration of dihydro-resveratrol ameliorated acute pancreatitis-associated lung injury via an inhibitory modulation of pro-inflammatory response, which was associated with a suppression of the NF-κB signaling pathway.

  7. Acute Pancreatitis in Association with Campylobacter jejuni- Associated Diarrhea in a 15-Year-Old with CFTR Mutations: Is There a Link?

    OpenAIRE

    Leena Kandula; Lowe, Mark E.; Seema Khan; Whitcomb, David C.

    2006-01-01

    Context: Acute pancreatitis has occasionally been reported in association with Campylobacter jejuni infection in humans. However, the mechanism linking Campylobacter jejuni infection and pancreatitis isunclear. Acute pancreatitis in association with an infectious illness may be related to underlying genetic mutations. For instance, studies show that mutations in the cystic fibrosis transmembrane conductance regulator gene increase the susceptibility for acute and chronic pancreatitis. Case re...

  8. [Acute pancreatitis and acalculous cholecystitis associated with viral hepatitis A].

    Science.gov (United States)

    Arcana, Ronald; Frisancho, Oscar

    2011-01-01

    We report the case of a 14 year-old male from Lima. He is a student with a history of bronchial asthma since age 4 receives conditional salbutamol, corticosteroids used for asthma attacks (a crisis in 2010, 1 month ago) Refuses surgery or transfusions. He presented with a two weeks for abdominal pain, nausea, fever, and jaundice. Epigastric pain is colicky and radiated back to righ upper quadrant, refers in addition to nausea and fever, for ten days notice jaundice of skin and sclera. On examen he was lucid, with jaundice of skin and mucous membranes. There was no palpable lymph nodes, abdomen with bowel sounds, soft, depressible, liver span of 15cm, positive Murphy, no peritonitis. The laboratory findings showed hemoglobin 13gr, MCV 90, platelets 461.000/mm3, WBC 4320/mm, lymphocytes 1700 (39%). total bilirubin: 8.8, B Direct: 7.6, ALT (alanine aminotransferase): 3016, AST (aspartate aminotransferase): 984, alkaline phosphatase: 250, albumin: 3.34gr%, globulin: 2.8, amylase: 589 (high serum amylase), TP: 17, INR: 1.6, VHA IgM positive. 89 mg glucose, urea 19 mg%, creatinine 0.5 mg Hemoglobin 13gr, MCV 90 Platelet 461000/mm3, WBC 4320/mm, Lymphocytes 1700 (39%). The nuclear magnetic resonance showed hepatomegaly associated with thickening of gallbladder wall without stones up to 11mm inside. No bile duct dilatation, bile duct 4mm, pancreas increased prevalence of body size. Mild splenomegaly and free fluid in the space of Morrison and right flank. Abdominal ultrasound revealed a gallbladder wall thickness (11mm), without stones in his light. Pancreas to increase volume with peripancreatic fluid free perivesicular with a volume of 430 cc. Findings consistent with acute acalculous cholecystitis and acute pancreatitis. CT-scan showed enlarged pancreas with predominance of body and tail with peripancreatic edema; the gallbladder was thickening. We report this case because the extrahepatic manifestations of viral hepatitis A infection are uncommon, specially the

  9. Analysis of Treatment-Related Factors Affecting Mortality in Patients with Severe Necrotizing Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Praznik Ivan

    2016-09-01

    Full Text Available The aim of the paper was to determine the factors related to the initial therapy that may contribute to death from severe necrotizing acute pancreatitis and to analyze their clinical importance as well as possible additive effects.

  10. Nonfasting Mild-to-Moderate Hypertriglyceridemia and Risk of Acute Pancreatitis

    DEFF Research Database (Denmark)

    Pedersen, Simon B; Langsted, Anne; Nordestgaard, Børge G

    2016-01-01

    Importance: Severe hypertriglyceridemia is associated with increased risk of acute pancreatitis. However, the threshold above which triglycerides are associated with acute pancreatitis is unclear. Objective: To test the hypothesis that nonfasting mild-to-moderate hypertriglyceridemia (177-885 mg....../dL; 2-10 mmol/L) is also associated with acute pancreatitis. Design, Setting, and Participants: This prospective cohort study examines individuals from the Copenhagen General Population Study in 2003 to 2015 and the Copenhagen City Heart Study initiated in 1976 to 1978 with follow-up examinations...... individuals were followed until the occurrence of an event, death, emigration, or end of follow-up (November 2014), whichever came first. Exposures: Plasma levels of nonfasting triglycerides. Main Outcomes and Measures: Hazard ratios (HRs) for acute pancreatitis (n = 434) and myocardial infarction (n = 3942...

  11. Probiotic prophylaxis in predicted severe acute pancreatitis : a randomised, double-blind, placebo-controlled trial

    NARCIS (Netherlands)

    Besselink, M.G.; Santvoort, H.C. van; Buskens, E.; Boermeester, M.A.; Goor, H. van; Timmerman, H.M.; Nieuwenhuijs, V.B.; Bollen, T.L.; Ramshorst, B. van; Witteman, B.J.; Rosman, C.; Ploeg, R.J.; Brink, M.A.; Schaapherder, A.F.; Dejong, C.H.; Wahab, P.J.; Laarhoven, C.J.H.M. van; Harst, E. van der; Eijck, C.H. van; Cuesta, M.A.; Akkermans, L.M.; Gooszen, H.G.

    2008-01-01

    BACKGROUND: Infectious complications and associated mortality are a major concern in acute pancreatitis. Enteral administration of probiotics could prevent infectious complications, but convincing evidence is scarce. Our aim was to assess the effects of probiotic prophylaxis in patients with predict

  12. Probiotic prophylaxis in predicted severe acute pancreatitis : a randomised, double-blind, placebo-controlled trial

    NARCIS (Netherlands)

    Besselink, Marc G. H.; van Santvoort, Hjalmar C.; Buskens, Erik; Boermeester, Marja A.; van Goor, Harry; Timmerman, Harro M.; Nieuwenhuijs, Vincent B.; Bollen, Thomas L.; van Ramshorst, Bert; Witteman, Ben J. M.; Rosman, Camiel; Ploeg, Rutger J.; Brink, Menno A.; Schaapherder, Alexander F. M.; Dejong, Cornelis H. C.; Wahab, Peter J.; van Laarhoven, Cees J. H. M.; van der Harst, Erwin; van Eijck, Casper H. J.; Cuesta, Miguel A.; Akkermans, Louis M. A.; Gooszen, Hein G.

    2008-01-01

    Background Infectious complications and associated mortality are a major concern in acute pancreatitis. Enteral administration of probiotics could prevent infectious complications, but convincing evidence is scarce. Our aim was to assess the effects of probiotic prophylaxis in patients with predicte

  13. Angiopoietin-2 Is an Early Indicator of Acute Pancreatic-Renal Syndrome in Patients with Acute Pancreatitis.

    Science.gov (United States)

    Sporek, Mateusz; Dumnicka, Paulina; Gala-Bladzinska, Agnieszka; Ceranowicz, Piotr; Warzecha, Zygmunt; Dembinski, Artur; Stepien, Ewa; Walocha, Jerzy; Drozdz, Ryszard; Kuzniewski, Marek; Kusnierz-Cabala, Beata

    2016-01-01

    Within the first week of the disease, acute kidney injury (AKI) is among the most common causes of mortality in acute pancreatitis (AP). Recently, serum angiopoietin-2 (Ang-2) has been associated with hyperdynamic state of the systemic circulation. The aim of this study was to examine the associations between Ang-2 and the clinical AP severity during the first 72 hours of the disease, and organ disfunction, including AKI. Methods. Study included patients admitted to the surgery ward, diagnosed with AP. AKI was diagnosed according to KDIGO guidelines and renal failure according to modified Marshall scoring system. Ang-2 was determined in serum with ELISA. Results. AP was classified as mild (MAP) in 71% of patients, moderately severe (MSAP) in 22%, and severe (SAP) in 8%. During the first 72 hours of AP, 11 patients developed AKI and 6 developed renal failure. Ang-2 at 24, 48, and 72 hours following the onset of AP symptoms significantly predicted SAP and MSAP, as well as AKI and renal failure. Also, Ang-2 significantly correlated with acute phase proteins as well as with the indicators of renal disfunction. Conclusions. Serum Ang-2 may be a relevant predictor of AP severity, in particular of the development of AP-renal syndrome.

  14. Angiopoietin-2 Is an Early Indicator of Acute Pancreatic-Renal Syndrome in Patients with Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Mateusz Sporek

    2016-01-01

    Full Text Available Within the first week of the disease, acute kidney injury (AKI is among the most common causes of mortality in acute pancreatitis (AP. Recently, serum angiopoietin-2 (Ang-2 has been associated with hyperdynamic state of the systemic circulation. The aim of this study was to examine the associations between Ang-2 and the clinical AP severity during the first 72 hours of the disease, and organ disfunction, including AKI. Methods. Study included patients admitted to the surgery ward, diagnosed with AP. AKI was diagnosed according to KDIGO guidelines and renal failure according to modified Marshall scoring system. Ang-2 was determined in serum with ELISA. Results. AP was classified as mild (MAP in 71% of patients, moderately severe (MSAP in 22%, and severe (SAP in 8%. During the first 72 hours of AP, 11 patients developed AKI and 6 developed renal failure. Ang-2 at 24, 48, and 72 hours following the onset of AP symptoms significantly predicted SAP and MSAP, as well as AKI and renal failure. Also, Ang-2 significantly correlated with acute phase proteins as well as with the indicators of renal disfunction. Conclusions. Serum Ang-2 may be a relevant predictor of AP severity, in particular of the development of AP-renal syndrome.

  15. Neonatal diabetes mellitus due to pancreatic agenesis and pervasive developmental disorder

    Directory of Open Access Journals (Sweden)

    Giannattasio Alessandro

    2009-07-01

    Full Text Available Abstract Recent studies suggested a link between type 1 diabetes mellitus and pervasive developmental disorder. Moreover, permanent neonatal diabetes mellitus due to pancreatic agenesis can be associated with neurological deficit involving cerebellar functions, but no association with pervasive developmental disorder has been described so far. Clinical and neuropsychological evaluation of a child with pancreatic agenesis, mental retardation and pervasive developmental disorder is reported.

  16. Acute pancreatitis induced by transarterial chemoembolization:a single-center experience of over 1500 cases

    Institute of Scientific and Technical Information of China (English)

    Wong Hoi She; Albert CY Chan; Tan To Cheung; Kenneth SH Chok; See Ching Chan; Ronnie TP Poon; Chung Mau Lo

    2016-01-01

    BACKGROUND: Acute pancreatitis is a relatively rare but po-tentially lethal complication after transarterial chemotherapy. This study aimed to review the complications such as acute pancreatitis after transarterial chemotherapy with or without embolization for hepatocellular carcinoma. METHODS: A total of 1632 patients with hepatocellular car-cinoma who had undergone transarterial chemoembolization from January 2000 to February 2014 in a single-center were reviewed retrospectively. We investigated the potential com-plications of transarterial chemoembolization, such as acute pancreatitis and acute pancreatitis-related complications. RESULTS: Of the 1632 patients with hepatocellular carcinoma who had undergone 5434 transarterial chemoembolizations, 1328 were male and 304 female. The median age of these pa-tients was 61 years. Most (79.6%) of the patients suffered from HBV-related hepatocellular carcinoma. The median tumor size was 5.2 cm. Of the 1632 patients, 145 patients underwent transarterial chemoembolization with doxorubicin elut-ing bead, making up a total of 538 episodes. The remaining patients underwent transarterial chemoembolization with cisplatin. Seven (0.4%) patients suffered from acute pancre-atitis post-chemoembolization. Six patients had chemoembo-lization with doxorubicin and one had chemoembolization with cisplatin. Patients who received doxorubicin eluting bead had a higher risk of acute pancreatitis [6/145 (4.1%) vs 1/1487 (0.1%), P CONCLUSIONS: Acute pancreatitis after transarterial chemo-embolization could result in serious complications, especially after treatment with doxorubicin eluting bead. Continuation of current treatment with transarterial chemoembolization after acute pancreatitis is feasible providing the initial attack is completely resolved.

  17. In vitro, but not in vivo, reversibility of peritoneal macrophages activation during experimental acute pancreatitis

    OpenAIRE

    Closa Daniel; Gea-Sorlí Sabrina

    2009-01-01

    Abstract Background Systemic inflammatory response syndrome is one of the major pathobiologic processes underlying severe acute pancreatitis and the degree of macrophage activation could be one of the factors that finally determine the severity of the disease. We evaluated the activation phenotype in peritoneal macrophages during the progression of an experimental model of acute pancreatitis induced in rats by intraductal administration of 5% sodium taurocholate and the effect of IL-4 and IL-...

  18. The value of the amylase/creatinine clearance ratio in the diagnosis of acute pancreatitis.

    Science.gov (United States)

    Solomon, A R

    1978-01-01

    Acute pancreatitis usually confronts the clinician with a difficult diagnostic task. For years, the primary laboratory diagnostic tests were the serum and urine amylase and the serum lipase determinations. Recent studies have introduced the concept of the amylase/creatinine clearance ratio as a means of increasing the specificity of the laboratory diagnosis. This paper reviews the laboratory evaluation of acute pancreatitis with emphasis on the rationale, derivation, and specificity of the amylase/creatinine clearance ratio.

  19. Proinflammatory cytokines in alcohol or gallstone induced acute pancreatitis. A prospective study

    DEFF Research Database (Denmark)

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

    2009-01-01

    OBJECTIVES: If differences of inflammatory pathways in acute pancreatitis exist for various etiologies, selective and specific antiinflammatory and other modulatory treatment regimens might be indicated. Circulating levels of prominent proinflammatory cytokines IL-6, 8, 18, and TNF-alpha were mea...... and clinical outcome is independent of the underlying etiology. Revealing the complex spatial and temporal profile of proinflammatory cytokine expression in acute pancreatitis is necessary and important for the development of a more targeted rational therapy....

  20. Low-dose dopamine reduces inlfammatory factors of acute pancreatitis in rats

    Institute of Scientific and Technical Information of China (English)

    Shun Zhang; Xin-Gang Peng; Chang-Chang Liu; Hong Liu; Yun Lu

    2007-01-01

    BACKGROUND:Acute pancreatitis, especially acute necrotizing pancreatitis (ANP), is a serious disease with a high morbidity because of multiorgan dysfunction. Recent studies have indicated that during the pathogenesis of ANP, changes of the microcirculation play an important role in the worsening of the disease. This study based on a model of acute pancreatitis in Wistar rats was to determine the effect of treatment with low-dose dopamine on acute pancreatitis by the dynamic measurement of serum levels of inlfammatory factors IL-6 and TNF-α. METHODS:Fifty Wistar rats were randomly divided into two groups, and a model of ANP was set up by injecting sodium taurocholate into the pancreatic duct. Rats in the dopamine group (treatment group) were given dopamine by vein and those in the acute pancreatitis group (control group) were given normal saline. To assess the effect of low-dose dopamine (5 μg·kg-1·min-1) on induced acute pancreatitis, the antibody sandwich ELISA method was used to measure the serum levels of IL-6 and TNF-α at different times before and after the induction of ANP. RESULTS:The serum levels of IL-6 and TNF-α in the treatment and control groups before and after ANP induction were signiifcantly different. There was a markedly signiifcant difference in the comparison of the two groups after ANP induction (P0.05). Postoperative pancreatic histopathologic changes in the treatment group were more marked than those in the control group. CONCLUSIONS:Low-dose dopamine is effective in treating ANP by alleviating inlfammatory reactions. This effect may be related to the fact that low-dose dopamine not only can increase the blood lfow of the pancreatic microcirculation but also reduce its permeability.

  1. Mortality in Acute Pancreatitis: Is It an Early or a Late Event?

    Directory of Open Access Journals (Sweden)

    Antonio Carnovale

    2005-09-01

    Full Text Available Context Many prior studies have suggested that the majority of deaths in severe acute pancreatitis occur late in the course of the disease as a result of pancreatic sepsis or pancreatic septic-like syndrome. Other have observed that at least half of the deaths occur early as a result of multisystem organ failure. Objective The aim of the present study was to determine the timing of mortality of severe acute pancreatitis and to analyze the course of the disease in a large series of patients. Patients All consecutive patients with a diagnosis of acute pancreatitis admitted to our Centre from October 1984 to December 2000 were retrospectively studied. One thousand one hundred and fifty episodes of acute pancreatitis occurred in 1,135 patients. Main outcome measures Total mortality and frequency of early deaths (less than or equal to 14 days after admission. The clinical features of patients who died were also compared in the early and late mortality groups. Results The overall mortality rate of acute pancreatitis was 4.8% (55 deaths out of 1,135 cases and when considering the severe forms only, it was13.5% (55 deaths out of 408 cases; 28 deaths (50.9% occurred within the first two weeks of hospitalization (median day 8, range 2-14 whereas 27 cases (49.1% occurred after two weeks (median day 28, range 15-56. Early deaths resulted primarily from multisystem organ failure; late deaths occurred mainly from complications in patients having infected necrosis. Conclusion Early deaths in severe acute pancreatitis occur in the half of patients within the first 14 days owing to multi-organ system failure. The remainder of deaths occur later from complications secondary to the infection of pancreatic necrosis; in this subgroup of patients, the association of infected necrosis with organ failure is found frequently.

  2. Soluble E-Cadherin: An Early Marker of Severity in Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    A. Sewpaul

    2009-01-01

    Full Text Available Background/Aims. At present, there is no simple test for predicting severity in acute pancreatitis. We investigated the use of an assay of soluble E-cadherin (sE-cadherin. Methods. Concentrations of sE-cadherin, from 19 patients with mild acute pancreatitis, 7 patients with severe acute pancreatitis, 11 patients with other acute gastrointestinal pathologies, and 12 healthy subjects were measured using a commercially available sandwich ELISA kit based on two monoclonal antibodies specific to the extracellular fragment of human E-cadherin. Measurements were made at 12 hours or less from onset of pain and also at 24 and 48 hours after onset of pain. Results. Mean (standard deviation concentration of sE-cadherin in patients with severe acute pancreatitis at <12 hours was 17780 ng/mL (7853, significantly higher than that of healthy volunteers 5180 ng/mL (1350, =.0039, patients with other gastrointestinal pathologies 7358 ng/mL (6655, =.0073, and also significantly higher than that of patients with mild pancreatitis, 7332 ng/mL (2843, =.0019. Discussion. Serum sE-cadherin could be an early (within 12 hours objective marker of severity in acute pancreatitis. This molecule warrants further investigation in the form of a large multicentre trial.

  3. Acute pancreatitis induced by mycophenolate mofetil in a kidney transplant patient

    Directory of Open Access Journals (Sweden)

    Einollahi Behzad

    2015-04-01

    Full Text Available Acute pancreatitis is a rare life-threatening complication in patients after kidney transplantation. Here we described a 56-year-old man who had received a living related kidney transplant for an end-stage renal disease. In his regular follow-up, his serum creatinine was gradually increased and he underwent an allograft biopsy, which revealed an interstitial nephritis/tubular atrophy grade II. Mycophenolate mofetil (MMF was prescribed to control chronic allograft nephropathy. He presented with complaints of severe abdominal pain, vomiting, loss of appetite and fever requiring hospital admission twelve days later. Acute pancreatitis was diagnosed on the basis of laboratory data and imaging findings during hospital admission. There was no history of alcohol consumption in our patient. Unfortunately he died one week later and autopsy findings demonstrated acute necrotizing pancreatitis. The bladder drainage of this patients was normal. Laboratory findings in this patient did not endorse infections and other possibilities regarding the etiology of acute pancreatitis in this patient. Therefore, we concluded that acute pancreatitis in near the patient was induced by drugs and basis on our evidence, MMF is the most important suspect. This study suggests that acute pancreatitis can be considered as a side effect of MMF.

  4. Prediction of severe acute pancreatitis: Current knowledge and novel insights

    Institute of Scientific and Technical Information of China (English)

    Georgios I Papachristou

    2008-01-01

    Acute pancreatitis (AP) is a common and potentially lethal acute inflammatory process with a highly variable clinical course. It is still unclear why some patients progress to organ failure and others do not. Physicians, ability to predict which patients will develop severe disease is limited. Routine clinical and laboratory data and multi-factorial clinical scores measured on admission and during the first 48 h of hospitalization are currently the standards of care used to estimate the magnitude of the inflammatory response to injury. Current literature highlights several common environmental, metabolic and genetic factors that increase the risk of AP development and subsequent adverse sequelae. Several cytokines have been found to play a critical role in the pathogenesis of AP by driving the subsequent inflammatory response, to include tumor necrosis factor-α (TNF-α), Interleukin-1 (IL-1), IL-6 and monocyte chemotactic protein-1 (HCP-1). Large, prospective studies are still needed to address these questions by identifying AP risk factors and serum biomarkers of severe disease.

  5. Non-ketotic hyperosmolar diabetic pre-coma due to pancreatitis in a boy on continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Emder, P J; Howard, N J; Rosenberg, A R

    1986-01-01

    An unusual case of diabetes secondary to acute pancreatitis in a boy with end-stage renal failure receiving continuous ambulatory peritoneal dialysis (CAPD) is described. A hyperglycaemic, hyperosmolar pre-coma developed, aggravated by associated hypercalcaemia. The glucose content of the dialysis fluid contributed to the hyperglycaemia, which settled as the pancreatitis resolved and lower glucose concentration dialysis fluid was used. Our experience suggests that pancreatic dysfunction should be considered where significant hyperglycaemia occurs during peritoneal dialysis.

  6. Taraxacum officinale protects against cholecystokinin-induced acute pancreatitis in rats

    Institute of Scientific and Technical Information of China (English)

    Sang-Wan Seo; Hyung-Min Kim; Seung-Heon Hong; Hyun-Na Koo; Hyo-Jin An; Kang-Beom Kwon; Byung-Cheal Lim; Eun-A Seo; Do-Gon Ryu; Goo Moon; Hong-Yeoul Kim

    2005-01-01

    AIM: Taraxacum officinale (TO) has been frequently used as a remedy for inflammatory diseases. The aim of this study was to investigate the effect of TO on cholecystokinin (CCK)-octapeptide-induced acute pancreatitis in rats.METHODS: TO at 10 mg/kg was orally administered, followed by 75 μg/kg CCK octapeptide injected subcutaneously three times after 1, 3 and 5 h. This whole procedure was repeated for 5 d. We determined the pancreatic weight/body weight ratio, the levels of pancreatic HSP60 and HSP72, and the secretion of pro-inflammatory cytokines. Repeated CCK octapeptide treatment resulted in typical laboratory and morphological changes of experimentally-induced pancreatitis.RESULTS: TO significantly decreased the pancreatic weight/body weight ratio in CCK octapeptide-induced acute pancreatitis. TO also increased the pancreatic levels of HSP60 and HSP72. Additionally, the secretion of IL-6 and TNF-α decreased in the animals treated with TO.CONCLUSION: TO may have a protective effect against CCK octapeptide-induced acute pancreatitis.

  7. Amylase clearance in differentiating acute pancreatitis from peptic ulcer with hyperamylasemia.

    Science.gov (United States)

    Warshaw, A L; Lesser, P B

    1975-03-01

    Thirty-four patients with abdominal pain, tenderness, and hyperamylasemia suggesting acute pancreatitis were studied prospectively to elucidate the relationship between peptic ulcer disease and pancreatitis. Confirming evidence of pancreatitis and/or ulcer was obtained either at laparotomy of by upper gastrointestinal roentgenograms. The presence or absence of pancreatitis was substantiated by measurement of the amylase/creatinine clearance ratio, which is significantly higher (p less than 0.001) in patients with acute pancreatitis (9.3 plus or minus 0.9), than in patients without pancreatitis (3.1 plus or minus 0.2). Nine of the 34 patients were found to have gastric or duodenal ulcers. However, seven of the nine, despite an elevated serum amylase, had no sign of pancreatitis at surgery, on radiological examination, or by elevation of the amylase/creatinine clearance ratio (3.1 plus or minus 0.4). It is suggested that hyperamylasemia associated with peptic ulcer disease is most often not indicative of acute pancreatitis and that treatment is most appropriately directed at the ulcer.

  8. Recurrent acute pancreatitis and cholangitis in a patient with autosomal dominant polycystic kidney disease

    Directory of Open Access Journals (Sweden)

    Kambiz Yazdanpanah

    2013-01-01

    Full Text Available 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, dilation of biliary system and absence of biliary stone. He was managed with conservative treatment for each attack. ADPKD should be considered as a potential risk factor for recurrent acute and/or chronic pancreatitis and cholangitis.

  9. A Case of Idiopathic Acute Pancreatitis in the First Trimester of Pregnancy

    Directory of Open Access Journals (Sweden)

    Tomomi Hara

    2015-01-01

    Full Text Available Acute pancreatitis is rare in pregnancy, with an estimated incidence of approximately 1 in 1000 to 1 in 10,000 pregnancies. Acute pancreatitis in pregnancy usually occurs in the third trimester. Here, we report a case of acute pancreatitis in the first trimester. A 36-year-old primigravida at 11 weeks of gestation complained of severe lower abdominal pain. The pain gradually worsened and migrated toward the epigastric region. She had no history of chronic alcoholism. Blood investigations showed elevated level of C-reactive protein (9.58 mg/dL, pancreatic amylase (170 IU/L, and lipase (332 IU/L. There was no gallstone and no abnormality in the pancreatic and biliary ducts on ultrasonography. Antinuclear antibody and IgG4 were negative and no evidence of hyperlipidemia or diabetes was found. There was also no evidence of viral infection. On the third day of hospitalization, she was diagnosed with severe acute pancreatitis on magnetic resonance imaging. Medical interventions were initiated with nafamostat mesilate and ulinastatin, and parenteral nutrition was administered through a central venous catheter. On the eighth day of hospitalization, her condition gradually improved with a decreased level of pancreatic amylase and the pain subsided. After conservative management, she did not have any recurrence during her pregnancy.

  10. ACUTE-PANCREATITIS IN A PATIENT WITH FAMILIAL BENIGN HYPERCALCEMIA

    NARCIS (Netherlands)

    VANHAEFTEN, TW; HOOGENBERG, K; VANESSEN, LH

    1994-01-01

    A patient with familial benign hypercalcaemia (FBH) who developed relapsing pancreatitis is presented. She underwent distal partial pancreas resection with surgical removal of pancreatic duct stones, and a pancreaticojejunostomy. No further causes for the pancreatitis were found. The present case is

  11. From Acute to Chronic Pancreatitis: The Role of Mutations in the Pancreatic Secretory Trypsin Inhibitor Gene

    OpenAIRE

    Hirota M; Kuwata K; Ohmuraya M; Ogawa M

    2003-01-01

    Pancreatic secretory trypsin inhibitor (PSTI) is a potent natural inhibitor of trypsin. We proposed the hypothesis that, if the function of the PSTI is impaired by its genetic mutation, trypsin may easily promote autodigestion causing pancreatitis and we performed a mutational analysis of the PSTI gene in patients with pancreatitis. Two exonic mutations (N34S and R67C) were thought to be associated with a predisposition to pancreatitis. The N34S mutation was co-segregated with two intronic mu...

  12. Effects of Baicalin on inflammatory mediators and pancreatic acinar cell apoptosis in rats with sever acute pancreatitis

    Directory of Open Access Journals (Sweden)

    zhang xiping

    2009-02-01

    Full Text Available

    • BACKGROUND: To investigate the effects of Baicalin and Octreotide on inflammatory mediators and pancreatic acinar cells apoptosis of rats with severe acute pancreatitis (SAP.
    • METHODS: SD rats were randomly divided into sham operated group (I group, model control group (II group, Baicalin treated group (III group and Octreotide treated group (IV group. Each group was also divided into subgroup of 3, 6 and 12 h (n = 15. The mortality rate, ascites/body weight ratio as well as the level of endotoxin, NO and ET-1 in blood were measured. The pathological severity score of pancreas, apoptotic indexes, and expression levels of Bax and Bcl-2 proteins in each group were investigated.
    • RESULTS: The survival rate of III and IV group has a significant difference compared with II group (P12 h < 0.05. The ascites volume, contents of inflammatory mediators in blood and pathological severity score of pancreas of III and IV group declined at different degrees compared to II group (P < 0.05, P < 0.01 or P < 0.001. Apoptotic index in III group was significantly higher than that in II group at 3 and 6 h (P3, 6 h < 0.05. Apoptotic index in IV group was significantly higher than that in II group at pancreatic tail at 6 h (P6 h < 0.05. Expression level of Bax in III group was significantly higher than that in II group (pancreatic head P3 h,6 h < 0.01, pancreatic tail P3 h < 0.001.
    • CONCLUSIONS: Compared with Octreotide in the treatment of SAP, the protective mechanisms of Baicalin include reducing the excessive inflammatory mediators’ release, inducing the pancreatic acinar cells apoptosis.
    • KEY WORDS: Severe acute pancreatitis, baicalin, octreotide, inflammatory mediators, apoptosis, tissue microarrays.

  13. Obese rats exhibit high levels of fat necrosis and isoprostanes in taurocholate-induced acute pancreatitis.

    Directory of Open Access Journals (Sweden)

    Javier Pereda

    Full Text Available BACKGROUND: Obesity is a prognostic factor for severity in acute pancreatitis in humans. Our aim was to assess the role of oxidative stress and abdominal fat in the increased severity of acute pancreatitis in obese rats. METHODOLOGY: Taurocholate-induced acute pancreatitis was performed in lean and obese Zucker rats. Levels of reduced glutathione, oxidized glutathione, L-cysteine, cystine, and S-adenosylmethionine were measured in pancreas as well as the activities of serine/threonine protein phosphatases PP1 and PP2A and tyrosin phosphatases. Isoprostane, malondialdehyde, triglyceride, and free fatty acid levels and lipase activity were measured in plasma and ascites. Lipase activity was measured in white adipose tissue with and without necrosis and confirmed by western blotting. FINDINGS: Under basal conditions obese rats exhibited lower reduced glutathione levels in pancreas and higher triglyceride and free fatty acid levels in plasma than lean rats. S-adenosyl methionine levels were markedly increased in pancreas of obese rats. Acute pancreatitis in obese rats led to glutathione oxidation and lower reduced glutathione levels in pancreas together with decreased activities of redox-sensitive phosphatases PP1, and PP2A. S-adenosyl methionine levels decreased but cystine levels increased markedly in pancreas upon pancreatitis. Acute pancreatitis triggered an increase in isoprostane levels in plasma and ascites in obese rats. Free fatty acid levels were extremely high in pancreatitis-associated ascitic fluid from obese rats and lipase was bound with great affinity to white adipose tissue, especially to areas of necrosis. CONCLUSIONS: Our results show that oxidative stress occurs locally and systemically in obese rats with pancreatitis favouring inactivation of protein phosphatases in pancreas, which would promote up-regulation of pro-inflammatory cytokines, and the increase of isoprostanes which might cause powerful pulmonary and renal

  14. Hydrogen-rich saline ameliorates the severity of L-arginine-induced acute pancreatitis in rats

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Han; Sun, Yan Ping; Li, Yang [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China); Liu, Wen Wu [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China); Xiang, Hong Gang [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China); Fan, Lie Ying [Department of Clinical Laboratory, Shanghai East Hospital, Tong Ji University, Shanghai 200120 (China); Sun, Qiang [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China); Xu, Xin Yun [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China); Cai, Jian Mei [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China); Ruan, Can Ping; Su, Ning; Yan, Rong Lin [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China); Sun, Xue Jun, E-mail: sunxjk@hotmail.com [Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433 (China); Wang, Qiang, E-mail: wang2929@hotmail.com [Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai 200003 (China)

    2010-03-05

    Molecular hydrogen, which reacts with the hydroxyl radical, has been considered as a novel antioxidant. Here, we evaluated the protective effects of hydrogen-rich saline on the L-arginine (L-Arg)-induced acute pancreatitis (AP). AP was induced in Sprague-Dawley rats by giving two intraperitoneal injections of L-Arg, each at concentrations of 250 mg/100 g body weight, with an interval of 1 h. Hydrogen-rich saline (>0.6 mM, 6 ml/kg) or saline (6 ml/kg) was administered, respectively, via tail vein 15 min after each L-Arg administration. Severity of AP was assessed by analysis of serum amylase activity, pancreatic water content and histology. Samples of pancreas were taken for measuring malondialdehyde and myeloperoxidase. Apoptosis in pancreatic acinar cell was determined with terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling technique (TUNEL). Expression of proliferating cell nuclear antigen (PCNA) and nuclear factor kappa B (NF-{kappa}B) were detected with immunohistochemistry. Hydrogen-rich saline treatment significantly attenuated the severity of L-Arg-induced AP by ameliorating the increased serum amylase activity, inhibiting neutrophil infiltration, lipid oxidation and pancreatic tissue edema. Moreover, hydrogen-rich saline treatment could promote acinar cell proliferation, inhibit apoptosis and NF-{kappa}B activation. These results indicate that hydrogen treatment has a protective effect against AP, and the effect is possibly due to its ability to inhibit oxidative stress, apoptosis, NF-{kappa}B activation and to promote acinar cell proliferation.

  15. Comparison of BISAP, Ranson, MCTSI, and APACHE II in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients

    OpenAIRE

    Lixin Yang; Jing Liu; Yun Xing; Lichuan Du; Jing Chen; Xin Liu; Jianyu Hao

    2016-01-01

    In recent years, with the developing of living standard, hyperlipidemia becomes the second major reason of acute pancreatitis. It is important to predict the severity and prognosis at early stage of hyperlipidemic acute pancreatitis (HLAP). We compared the BISAP, Ranson, MCTSI, and APACHE II scoring system in predicting MSAP and SAP, local complications, and mortality of HLAP. A total of 326 diagnosed hyperlipidemic acute pancreatitis patients from August 2006 to July 2015 were studied retros...

  16. [Effect of somatostatin on the hemodynamic changes induced by acute experimental pancreatitis in the conscious rat].

    Science.gov (United States)

    Ais, G; Novo, C; Ortega, M; González, A; Jiménez, I; López, J; Romeo, J M

    1994-03-01

    The aim of this study was to determine the hemodynamic effect of somatostatin, either prophylactically or therapeutically, in shock caused by acute necrohemorragic pancreatitis in conscious rats. For this purpose, radioactive microspheres were used in 3 groups (control pancreatitis, therapeutic somatostatin and prophylactic somatostatin), performing a basal and final hemodynamic study. In the control group, acute necrohemorragic pancreatitis resulted in overwhelming shock with decrease of 55% in cardiac output, 58% in renal blood flow, increase in total peripheral resistances of 342%, and death after 70 min. Therapeutic somatostatin decreased cardiac output by 42%, renal blood flow by 47%, and increased total peripheral resistances by 153%. Prophylactic somatostatin decreased cardiac output by 24%, and renal blooded flow by 28%; it increased peripheral resistances by 146%, and improved survival up to 97 min. In conclusion, therapeutic somatostatin, and particularly prophylactic somatostatin, improved hemodynamic shock after acute necrohemorragic pancreatitis in conscious rats.

  17. Valproic Acid-Induced Severe Acute Pancreatitis with Pseudocyst Formation: Report of a Case.

    Science.gov (United States)

    Ray, Sukanta; Khamrui, Sujan; Kataria, Mohnish; Biswas, Jayanta; Saha, Suman

    2015-08-01

    Valproic acid is the most widely used anti-epilep-tic drug in children, and it is probably the most frequent cause of drug-induced acute pancreatitis. Outcomes for patients with valproic acid-associated pancreatitis vary from full recovery after discontinuation of the drug to severe acute pancreatitis and death. Here, we present a case of valproic acid-induced severe acute pancreatitis with pseudocyst formation in a 10-year-old girl with cerebral palsy and generalized tonic-clonic seizure. There was no resolution of the pseudocyst after discontinuation of valproic acid. The patient became symptomatic with a progressive increase in the size of the pseudocyst. She was successfully treated with cystogastrostomy and was well at 12-month follow-up.

  18. Acute fulminant drug induced necrotizing pancreatitis in a patient with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Pablo Miramontes

    2015-03-01

    Full Text Available Drug-induced acute necrotizing pancreatitis is a rare adverse event, although it has been reported in association with different drugs, including non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and analgesic agents commonly used in rheumatology. In different reviews of the pancreotoxicity of drugs, infliximab and etanercept are mentioned among all medications implicated in drug-induced pancreatitis, but clinical cases of acute pancreatitis complicating treatment with these anti-TNF-α agents have been exceptionally reported. We describe a patient with ankylosing spondylitis treated with etanercept, who developed an acute fulminant necrotizing pancreatitis that resulted in death. Doctors should pay close attention to patients taking biologic drugs in which a complaint of abdominal pain lasting for several days with no apparent cause may require a prompt referral for medical consultation.

  19. Disseminate Fungal Infection after Acute Pancreatitis in a Simultaneous Pancreas-Kidney Recipient

    Directory of Open Access Journals (Sweden)

    Anna Rossetto

    2010-01-01

    Full Text Available Fungal infections after kidney transplantation are a major cause of morbidity and mortality, and Candida infection of the pancreas is considered an infrequent but important agent in necrotizing pancreatitis. We report the case of a 43-year-old Caucasian patient who underwent simultaneous pancreas-kidney transplantation because of diabetes type I, and chronic renal failure with peritoneal dialysis. The postoperative course was complicated by acute pancreatitis due to the thrombosis of the splenic artery of the graft, the subsequent acute rupture of the external iliac artery caused by fungal arteritis (Candida glabrata, and peritonitis a few days later caused by sigmoid perforation with detection of Candida glabrata infection of the resected intestinal tract. The present case remarks that awareness and prevention of fungal infection are major issues in the transplant field. Important information can be added by systematic culture of conservation perfusates but, probably, the best way for early recognition of a critical level of infectious risk remains the routine application of the colonization index screening. In cases of positive results, preemptive antifungal therapy could be warranted.

  20. Lethal post-endoscopic retrograde cholangiopancreatography pancreatitis following fully covered metal stent placement in distal biliary obstruction due to unresectable cholangiocarcinoma.

    Science.gov (United States)

    Itoi, Takao; Tsuchiya, Takayoshi; Tanaka, Reina; Ikeuchi, Nobuhito; Sofuni, Atsushi

    2013-05-01

    Biliary self-expandable metallic stent (SEMS) is the preferred and first-line therapy for unresectable malignant biliary obstruction. To date, several reports have revealed the relatively high incidence of acute complications such as pancreatitis and cholecystitis due to mechanical stent compression. In the present case, we encountered fatal pancreatitis following fully covered metal stent placement. An 85-year-old man had middle bile duct strictures due to cholangiocarcinoma. A 10-mm diameter fully covered SEMS was placed across the papilla for biliary decompression. Laboratory data and physical evidence the following day revealed acute pancreatitis. Therefore, antibiotics and protein degeneration enzyme inhibitors were given. However, his condition did not improve. Two days after the procedure, we removed the stent and returned him to his original hospital. Serum amylase level decreased below 400 mg/dL 6 h after the procedure. However, the acute pancreatitis worsened. Although we treated the patient in the intensive care unit, he died 32 days after the second admission.

  1. Pathogenic aspects of pulmonary complications in acute pancreatitis patients

    Institute of Scientific and Technical Information of China (English)

    Serge Chooklin

    2009-01-01

    BACKGROUND: Experimental and clinical observations show that proinlfammatory cytokines and oxidative stress are involved in the development of local and particularly systemic complications in acute pancreatitis (AP) patients. There are often pulmonary complications in such patients. The mechanisms through which lung injury is induced in AP are not fully clear. METHODS: In order to assess the role of activated neutrophils, pro- and anti-inlfammatory cytokines and adhesion molecules at the onset and development of respiratory complications and respiratory failure, we measured the serum levels of pro-inlfammatory (IL-1β, IL-6, IL-8, IL-18, TNF-α) and anti-inlfammatory (IL-1ra, IL-10) cytokines in 51 AP patients who had been diagnosed with pancreatitis-associated lung injury with and without the development of organ dysfunction. RESULTS: When admitted to the hospital, severe AP patients had increased concentrations of IL-1β, IL-6, IL-8, IL-18, and TNF-α. The concentration of IL-18 alone was considerably increased in the patients who later developed respiratory failure. The onset of acute respiratory distress syndrome in the AP patients was accompanied by an increase in the level of anti-inlfammatory cytokines, especially IL-10. It was noted that in severe lung injury, myeloperoxidase activity in the blood increased signiifcantly, but still relfected the processes taking place in the lung parenchyma. Increase in the concentrations of adhesion molecules preceded the development of pulmonary inifltration with respiratory failure symptoms, which provoked endothelial dysfunction and determined the capillary surface permeability for neutrophils and monocytes.CONCLUSIONS: In the pathogenesis of respiratory complications in AP cytokines, chemokines and adhesion molecules, in particular IL-1β, IL-6, IL-8, IL-18, TNF-α, ICAM-1, and E-selectin play major roles. At IL-18 concentrations >650 pg/ml, AP patients are likely to develop pulmonary dysfunction (sensitivity

  2. Acute biliary pancreatitis and cholecystolithiasis in a child:one time treatment with laparoendoscopic "Rendez-vous" procedure

    Institute of Scientific and Technical Information of China (English)

    Gaetano La Greca; Michele Di Blasi; Francesco Barbagallo; Manuela Di Stefano; Saverio Latteri; Domenico Russello

    2006-01-01

    Acute biliary pancreatitis (ABP) is rare in childhood and endoscopic sphincterotomy should be avoided in the child due to the risk of both early and late complications but, when necessary, the optimal timing between endoscopic procedure and cholecystectomy is still uncertain.A nine years old child with acute biliary pancreatitis underwent successfull laparo-endoscopic "Rendez-Vous" procedure in which endoscopic drainage of the common bile duct and laparoscopic cholecystectomy were performed simultaneously. This is the first case reported of laparo-endoscopic Rendez-Vous in a child. The excellent outcome of this patient and the review of the literature concerning other available options for the treatment of such cases suggest that this procedure offers great advantages, especially in children, of reducing the required number of treatments, the risk of ineffectiveness, the number of anaesthesia, the length of hospital stay and the risk of iatrogenic morbidity.

  3. Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Mortele, Koenraad J. E-mail: kmortele@partners.org; Mergo, Patricia J.; Taylor, Helena M.; Wiesner, Walter; Cantisani, Vito; Ernst, Michael D.; Kalantari, Babak N.; Ros, Pablo R

    2004-10-01

    Objective: To determine the prevalence and morphologic helical computed tomography (CT) features of peripancreatic vascular abnormalities in patients with acute pancreatic inflammatory disease in correlation with the severity of the pancreatitis. Materials and methods: One hundred and fifty-nine contrast-enhanced helical CT scans of 100 consecutive patients with acute pancreatitis were retrospectively and independently reviewed by three observers. CT scans were scored using the CT severity index (CTSI): pancreatitis was graded as mild (0-2 points), moderate (3-6 points), and severe (7-10 points). Interobserver agreement for both the CT severity index and the presence of peripancreatic vascular abnormalities was calculated (K-statistic). Correlation between the prevalence of complications and the degree of pancreatitis was estimated using Fisher's exact test. Results: The severity of pancreatitis was graded as mild (n=59 scans), moderate (n=82 scans), and severe (n=18 scans). Venous abnormalities detected included splenic vein (SV) thrombosis (31 scans, 19 patients), superior mesenteric vein (SMV) thrombosis (20 scans, 14 patients), and portal vein (PV) thrombosis (17 scans, 13 patients). Arterial hemorrhage occurred in five patients (6 scans). In our series, no cases of arterial pseudoaneurysm formation were detected. The interobserver agreement range for scoring the degree of pancreatitis and the overall presence of major vascular abnormalities was 75.5-79.2 and 86.2-98.8%, respectively. The presence of the vascular abnormalities in correlation with the severity of pancreatitis was variable. Conclusion: Vascular abnormalities are relatively common CT findings in association with acute pancreatitis. The CT severity index is insufficiently accurate in predicting some of these complications since no statistically significant correlation between their prevalence and the severity of pancreatitis could be established.

  4. Role of Biomarkers in Diagnosis and Prognostic Evaluation of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Susanta Meher

    2015-01-01

    Full Text Available Acute pancreatitis is a potentially life threatening disease. The spectrum of severity of the illness ranges from mild self-limiting disease to a highly fatal severe necrotizing pancreatitis. Despite intensive research and improved patient care, overall mortality still remains high, reaching up to 30–40% in cases with infected pancreatic necrosis. Although little is known about the exact pathogenesis, it has been widely accepted that premature activation of digestive enzymes within the pancreatic acinar cell is the trigger that leads to autodigestion of pancreatic tissue which is followed by infiltration and activation of leukocytes. Extensive research has been done over the past few decades regarding their role in diagnosis and prognostic evaluation of severe acute pancreatitis. Although many standalone biochemical markers have been studied for early assessment of severity, C-reactive protein still remains the most frequently used along with Interleukin-6. In this review we have discussed briefly the pathogenesis and the role of different biochemical markers in the diagnosis and severity evaluation in acute pancreatitis.

  5. Ligustrazine alleviates acute renal injury in a rat model of acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jian-Xin Zhang; Sheng-Chun Dang; Jian-Guo Qu; Xue-Qing Wang

    2006-01-01

    AIM: To evaluate the effect of ligustrazine, a traditional Chinese medicine, on renal injury in a rat model of acute necrotizing pancreatitis (ANP).METHODS: A total of 192 rats were randomly divided into three groups: control (C group), ANP without treatment (P group), and ANP treated with ligustrazine (T group). Each group was further divided into 0.5,2, 6, 12 h subgroups. All rats were anesthetized with an intraperitoneal injection of sodium pentobarbital.Sodium taurocholate was infused through the pancreatic membrane to induce ANP. T group was infused sodium taurocholate as above, and 0.6% ligustrazine was then administered via the femoral vein. Serum urea nitrogen (BUN) and creatinine (Cr) concentrations were measured for the evaluation of renal function. The effects of ligustrazine on the severity of renal injury were assessed by renal function, TXA2/PGI2 and histopathological changes. Renal blood flow was determined by the radioactive microsphere technique (RMT).RESULTS: Compared with control group, the renal blood flow in P group was decreased significantly. Serious renal and pancreatic damages were found in P group, the BUN and Cr levels were elevated significantly, and the ratio of TXA2 to PGI2 was increased at 2, 6 and 12 h. Compared with P group, the blood flow of kidney was elevated significantly at 6 and 12 h after induction of ANP, the renal and pancreatic damages were attenuated, and the BUN and Cr levels were decreased significantly, and the ratio of TXA2 to PGI2 was decreased at 6 and 12 h in T group.CONCLUSION: Microcirculatory disorder (MCD) is an important factor for renal injury in ANP. Ligustrazine can ameliorate the condition of MCD and the damage of pancreas and kidney.

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

    Science.gov (United States)

    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.

  7. The potential role of kinesin and dynein in Golgi scattering and cytoplasmic vacuole formation during acute experimental pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ina A Weber; Igor Buchwalow; Daniela Hahn; Wolfram Domschke; Markus M Lerch; Jürgen Schnekenburger

    2010-01-01

    @@ Dear Editor, Acute pancreatitis is initiated in pancreatic acinar cells and characterized by a profound disturbance in intracel-lular vesicle transport. Moreover, secretion of pancreatic zymogens is blocked, paralleled by the formation of cytoplasmic vacuoles with premature protease activation that precedes cellular necrosis and organ damage.

  8. Gardenia jasminoides protects against cerulein-induced acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Won-Seok Jung; Rae-Kil Park; Jong-Suk Kim; Eun-Cheol Kim; Sung-Yeon Hwang; Sung-Joo Park; Ho-Joon Song; Young-Seok Chae; Do-Yun Kim; Sang-Wan Seo; Hee-Je Park; Gi-Sang Bae; Tae-Hyeon Kim; Hyo-Jeong Oh; Ki-Jung Yun

    2008-01-01

    AIM: To investigate the effect of Gardenia jasminoides (G3) on cerulein-induced acute pancreatitis (AP) in mice. METHODS: C57BL/6 mice weighing 18-20 g were divided into three groups. (1) Normal saline-treated group, (2) treatment with GJ at a dose of 0.1 g/kg, (3) treatment with GJ at a dose of 1 g/kg. GJ was administered orally (η = 6 per group) for 1 wk. Three hours later, the mice were given an intraperitoneal injection of cerulein (50 ug/kg), a stable cholecystokinin (CCK) analogue, every hour for a total of 6h as described previously. The mice were sacrificed at 6 h after completion of cerulein injections. Blood samples were obtained to determine serum amylase, lipase and cytokine levels. The pancreas was rapidly removed for morphologic examination and scoring. A portion of pancreas was stored at -70℃ and prepared for the measurement of tissue myeloperoxidase (MPO) activity, an indicator of neutrophil sequestration, and for reverse-transcriptase PCR (RT-PCR) and real-time PCR measurements. RESULTS: Treatment with GJ decreased significantly.

  9. Alteration of peripheral blood lymphocyte subsets in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Miroslawa Pietruczuk; Milena I Dabrowska; Urszula Wereszczynska-Siemiatkowska; Andrzej Dabrowski

    2006-01-01

    AIM: To evaluate peripheral blood lymphocyte subsets in patients with acute pancreatitis (AP).METHODS: Twenty patients with mild AP (M-AP) and 15 with severe AP (S-AP) were included in our study. Peripheral blood lymphocytes were examined at d 1-3, 5,10 and 30 by means of flow cytometry.RESULTS: A significant depletion of circulating lymphocytes was found in AP. In the early AP, the magnitude of depletion was similar for T- and B- lymphocytes. In the late course of S-AP, B-lymphocytes were much more depleted than T-lymphocytes. At d 10, strong shift in the CD7+/CD19+ ratio implicating predominance of Tover B-lymphocytes in S-AP was found. Among T-lymphocytes, the significant depletion of the CD4+ population was observed in M-AP and S-AP, while CD8+ cells were in the normal range. Lymphocytes were found to strongly express activation markers: CD69, CD25, CD28,CD38 and CD122. Serum interleukin-2 (IL-2), IL-4, IL-5,IL-10, interferon-γ (IFN-γ) and tumor necrosis factor-α(TNF-α) levels were significantly increased in both forms of AP. The magnitude of elevation of cytokines known to be produced by Th2 was much higher than cytokines produced by Th1 cells.CONCLUSION: AP in humans is characterized by significant reduction of peripheral blood T- and B-lymphocytes.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  11. Present and future of prophylactic antibiotics for severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Kun Jiang; Wei Huang; Xiao-Nan Yang; Qing Xia

    2012-01-01

    AIM: To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and meta-analyses.METHODS: An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT. RESULTS: Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR) = 1.01, P = 0.98]. Funnel plot indicated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P < 0.05). However, the number needed to treat having a minor lower limit of the range (7-5096 patients) implied that certain SAP patients could still potentially prevent death by antibiotic prophylaxis.CONCLUSION: Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations.

  12. Early preventive treatment for severe acute pancreatitis combined with lung injury

    Institute of Scientific and Technical Information of China (English)

    刘学民; 刘青光; 潘承恩

    2002-01-01

    @@ Severe acute pancreatitis (SAP) can cause systematic inflammatory response syndrome (SIRS),which leads to injury or failure of the internal organs and systems.1 Among them,acute respiratory distress syndrome(ARDS)is a severe or fatal complication.In this article,the early preventive treatment for SAP combined with lung injure is studied.

  13. Rapid detection of sepsis complicating acute necrotizing pancreatitis using polymerase chain reaction

    Institute of Scientific and Technical Information of China (English)

    Wei Zhong Zhang; Tian Quan Han; Yao Qing Tang; Sheng Dao Zhang

    2001-01-01

    @@INTRODUCTION Acute narcotizing pancreatitis usually takes a severe clinical course and is associated with multiple organ dysfunction .With the further understanding of pathophysiological events of acute pancreatisis and the therapeutic measuses taken by the clinicians ,the patients can pass through the critical carry stages ,and then the septic complication caused by rtanslocated bacteria, mostly gram-negative microbes from the intestines ensues[1].

  14. Risk of acute pancreatitis in patients with cronic inflammatory bowel disease

    DEFF Research Database (Denmark)

    Rasmussen, Henrik Højgaard; Fonager, Kirsten; Sørensen, Henrik Toft;

    1999-01-01

    of patients with acute pancreatitis was compared with expected numbers on the basis of age, sex, and calendar-specific incidence rates in the general population. RESULTS: Overall, 15,526 patients were discharged and followed up for 112,824 person-years. The standardized incidence ratio (SIR) for acute...

  15. Retrospective Analyses Of The Acute Pancreatitis With Patients In The West Black Sea

    Directory of Open Access Journals (Sweden)

    Mehmet YAŞAR, Ali Kemal TAŞKIN, İsmet ÖZAYDIN, Yavuz DEMİRARAN

    2010-11-01

    Full Text Available Introduction: In these study patients who were our clinic with an etiology, diagnosis andtreatment methods, morbidity, mortality and effect of Ranson criteria to prognosis wereexamined retrospectively. Material and Method: In the study 44 mild and 18 severe total 62 AP cases among 2003-2008at the General Surgery of Duzce University were analyzed retrospectively. Results: A etiologic factor was 40 (66,7 %, gallstone 11 (17, 7% idiopathic, 4 (6,4 %hyperlipidemia, 3 (4,8% alchol-hyperlipidemia, 2 (3,2 % alcohol, 2 (3,2 % after ERCPcomplications. Patients were followed up with a diagnosis of acute pancreatitis, the average ageof 59.6 (18 - 84 and 23 (37% were man, 39 (63% were woman. ERCP were performed to 14patients with billiary pancreatitis 2 patients for the persistent billiary pancreatitis and for the 6patients cholecystitis accompanied pancreatitis in the first 48 hours period, 23 patients followingthe acute pancreatitis attack were performed cholecystectomy. Acute pancreatitis patients first6 cases of biliary 3 reputations have been switched to laparoscopic open cholecystectomy isbeing performed. 3 patients peritoneal lavage under local anesthesia, 4 patients’ diagnosticlaparoscopy and 2 patients nerosectomy were performed. Mean hospitalization times were 9.8days for mild and 11.2 days severe. In the severe group idiopathic a etiology 3 (4.8 % patientswere exitus. Conclusion: Acute pancreatitis is a disease that can watch a high mortality rate. Biliary factorswere the most common etiological factor. Idiopathic AP played a role in second place and wehave observed that the effect of alcohol is quite low. In biliary acute pancreatitis ERCP is auseful method in the first stage. Overall mortality in severe AP, as observed in patients with thediagnosis, treatment and follow-up was important in these patients.

  16. Lesson from Acute Experimental Pancreatitis: Multidrug Strategies Is Effective than Single-Target Therapy

    Directory of Open Access Journals (Sweden)

    Generoso Uomo

    2012-09-01

    Full Text Available Current strategy of treatment in acute pancreatitis is mainly based on supportive measures, adequate analgesia, elimination (if possible of any underlying cause, and prevention of complications. Many “specific” therapies able to interrupt one key step in the pathogenesis of local and systemic injury have been proposed but no single therapy has been shown to significantly decrease acute pancreatitis mortality. Over the last few years, lessons from experimental animal models helped us to better understand many important pathways involved in the pathogenesis of necrotizing acute pancreatitis and associated systemic complications. In this setting, multiple mediators of the inflammatory cascade, including oxygen-free radicals, vasoactive mediators, cytokines, leukocyte and endothelial activation, and pancreatic ischemia have been identified. In experimental studies (mainly in animal models but also in humans, several drugs that specifically inhibit each of those pathogenetic steps (e.g., protease inhibitors, oxygen-free radical scavengers, cytokine antagonists, nitric oxide (NO agonists, and inhibitors of adhesion molecules attenuated biochemical and histological changes; however, neither the inhibition of pancreatic autodigestion nor the inhibition of any other single pathogenetic factor has decreased mortality in cases of severe acute pancreatitis.

  17. Acute oral poisoning due to chloracetanilide herbicides.

    Science.gov (United States)

    Seok, Su-Jin; Choi, Sang-Cheon; Gil, Hyo-Wook; Yang, Jong-Oh; Lee, Eun-Young; Song, Ho-Yeon; Hong, Sae-Yong

    2012-02-01

    Chloracetanilide herbicides (alachlor, butachlor, metachlor) are used widely. Although there are much data about chronic low dose exposure to chloracetanilide in humans and animals, there are few data about acute chloracetanilide poisoning in humans. This study investigated the clinical feature of patients following acute oral exposure to chloracetanilide. We retrospectively reviewed the data on the patients who were admitted to two university hospitals from January 2006 to December 2010. Thirty-five patients were enrolled. Among them, 28, 5, and 2 cases of acute alachlor, metachlor, butachlor poisoning were included. The mean age was 49.8 ± 15.4 yr. The poison severity score (PSS) was 17 (48.6%), 10 (28.6%), 5 (14.3%), 2 (5.7%), and 1 (2.9%) patients with a PSS of 0, 1, 2, 3, and 4, respectively. The age was higher for the symptomatic patients (1-4 PSS) than that for the asymptomatic patients (0 PSS) (43.6 ± 15.2 vs 55.7 ± 13.5). The arterial blood HCO₃⁻ was lower in the symptomatic patients (1-4 PSS) than that in the asymptomatic patients (0 PSS). Three patients were a comatous. One patient died 24 hr after the exposure. In conclusion, although chloracetanilide poisoning is usually of low toxicity, elder patients with central nervous system symptoms should be closely monitored and cared after oral exposure.

  18. Fatal acute pancreatitis in a patient with visceral leishmaniasis during miltefosine treatment

    Directory of Open Access Journals (Sweden)

    K Pandey

    2013-01-01

    Full Text Available Pancreatitis is a known side effect of the once commonly used drug, sodium stibogluconate, for treatment of visceral leishmaniasis (VL. In India, miltefosine has recently been introduced as the first-line drug. Its side effects include loose motions, vomiting, and teratogenicity. We report here a case of a 41-year-old parasitologically confirmed male case of VL, who developed acute pancreatitis during treatment with miltefosine. On the 13 th day of treatment, he presented with abdominal pain and vomiting. The biochemical, hematological, and radiological features were suggestive of acute pancreatitis. The patient was put on conservative treatment for pancreatitis at the specialized center but succumbed to renal failure and septicaemia.

  19. Acute pancreatitis and development of pancreatic pseudo cyst after extra corporeal shock wave lithotripsy to a left renal calculus: A rare case with review of literature

    Directory of Open Access Journals (Sweden)

    Prasad Mylarappa

    2014-01-01

    Full Text Available Extracorporeal shock wave lithotripsy (SWL is considered the standard of care for the treatment of small upper ureteric and renal calculi. A few centers have extended its use to the treatment of bile duct calculi and pancreatic calculi. The complication rates with SWL are low, resulting in its wide spread acceptance and usage. However, some of the serious complications reported in 1% of patients include acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, rupture of aortic aneurysm and intracranial hemorrhage. To our knowledge, only six cases of acute pancreatitis or necrotizing pancreatitis following SWL have been documented in the literature. Herein, we report a rare case of acute pancreatitis and formation of a pseudo cyst following SWL for left renal pelvic calculus.

  20. Heparin improves organ microcirculatory disturbances in caerulein-induced acute pancreatitis in rats

    Institute of Scientific and Technical Information of China (English)

    Marek Dobosz; Lucjanna Mionskowska; Stanislaw Ha(a); Sebastian Dobrowolski; Dariusz Dymecki; Zdzislaw Wajda

    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.METHODS: Acute pancreatitis was induced by 4 intraperitoneal injections of caerulein (Cn) (15 μg/kg). The organ microcirculation was measured by laser Doppler flowmetry. Serum interleukin 6 and hematocrit levels were analysed.RESULTS: Acute pancreatitis resulted in a significant drop of microperfusion in all examined organs. Heparin administration (2×2.5 mg/kg) improved the microcirculation in pancreas (36.9±4% vs 75.9±10%), liver (56.6±6% vs 75.2±16%), kidney (45.1±6% vs 79.3±5%), stomach (65.2±8% vs78.1±19%), colon (69.8±6% vs102.5±19%),and skeletal muscle (59.2±6% vs 77.9±13%). Heparin treatment lowered IL-6 (359.0±66 U/mL vs288.5±58 U/mL)and hematocrit level (53±4% vs 46±3%).CONCLUSION: Heparin administration has a positive influence on organ microcirculatory disturbances accompanying experimental Ch-induced acute pancreatitis.

  1. Nutritional advice for prevention of acute pancreatitis: review of current opinion

    Directory of Open Access Journals (Sweden)

    Lowe ME

    2012-12-01

    Full Text Available Mark E Lowe, Wednesday A SevillaDivision of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USAAbstract: Pancreatitis is inflammation of the pancreas that can be acute and self-limiting or, in a small percentage of patients, recurrent. Patients with recurrent episodes of acute pancreatitis (RAP often progress to chronic pancreatitis. Pancreatitis in all forms causes significant economic and social burdens. Prevention of RAP may decrease those burdens and halt progression to chronic disease. Unfortunately, no therapy has proven effective at altering the course of RAP. While enteral nutritional therapy plays an important role in the treatment of acute pancreatitis during episodes, nutritional advice provided to patients in an attempt to prevent recurrent episodes has not proven effective in most cases. Discontinuing alcohol consumption and treating dyslipidemia with diet and medication can help patients with these issues. In patients whose pancreatitis is associated with celiac disease or eosinophilic gastroenteritis, a gluten-free diet and avoidance of food allergens can be effective in stopping RAP. Advice to take pancreatic enzyme replacement therapy, lose weight, control diabetes, decrease dietary sucrose, decrease dietary fat or avoid monosodium glutamate has little to no evidence of efficacy. Some studies suggest that an antioxidant cocktail may decrease the frequency of RAP and the intensity of chronic pain, but the evidence is weak. Nutritional therapy may have a role in the treatment of patients with RAP. At present, there are no clear guidelines for nutritional advice to give these patients. More studies are needed to identify nutritional interventions that will benefit patients with RAP.Keywords: pancreatitis, nutrition, pancreatic enzyme replacement therapy, antioxidants, herbal supplements

  2. Acute Pancreatitis with Normal Serum Lipase and Amylase: A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Arvind K Mathur

    2016-08-01

    Full Text Available Acute pancreatitis presenting with normal serum amylase and lipase levels is a rare phenomenon. It is thought that typically, acute inflammation and auto-digestion of the pancreas leads to the release of both amylase and lipase, leading to elevated levels in the blood. For this reason, normal serum amylase and lipase levels in a patient with acute abdominal pain would typically rule out acute pancreatitis in favor of another diagnosis. Here we present two cases of acutely ill patients that were confirmed to have acute pancreatitis radiologically but with serum amylase and lipase levels that remained within the normal range throughout their illnesses for both patients. These cases suggest that while an important diagnostic tool, serum amylase and lipase should not be used as the sole factor to either diagnose or rule out acute pancreatitis. Instead, these laboratory markers should be viewed in the context of the patient’s overall presentation, weighted equally with the presenting signs, symptoms, and imaging studies to help guide toward a diagnosis.

  3. Activity of cathepsins in rat's spleen due to experimentally induced pancreatitis.

    Science.gov (United States)

    Maciejewski, R; Burdan, F; Madej, B; Kiś, G; Szkodziak, P; Burski, K

    The aim of this study was to establish and quantify the changes of the level of cathepsin B, D and L in the spleen during experimental pancreatitis. The experiment was carried out in 115 male Wistar rats, randomly divided into three groups: intact (n = 15), injected with 0.9% NaCl solution into the common bile pancreatic duct (n = 50) and injected with 5% sodium taurocholate into this duct to induce acute pancreatitis (n = 50). After 2, 6, 12, 24 and 48 hours rats were anaesthetised, and blood was taken for amylase determination from the heart, and the spleen was removed. Alpha-amylase level in the blood serum samples was measured by enzymatic method. Cathepsin activity was established by spectrophotometric methods using substrates which form coloured complexes when they react with these proteases. The specific free fraction activity of cathepsin B, D and L in the spleen changed during the course of experiment, but there was no correlation between their activity and the intensity of pancreatitis established by serum amylase level.

  4. Acute pancreatitis in pregnancy: a 6-year single center clinical experience

    Institute of Scientific and Technical Information of China (English)

    LI Hua-ping; HUANG Ya-juan; CHEN Xuan

    2011-01-01

    Background The acute abdomen remains a challenge for all obstetricians and physicians who take part in the care of women in pregnancy.To add substantially to our understanding of acute pancreatitis (AP) in pregnancy,in particular affirming the increased risks for mother and fetus associated with AP,we explored features of clinical manifestation and the strategy of management of this disease during pregnancy,and its effects on maternal and fetal outcomes.Methods A retrospective review of medical records of all pregnant patients diagnosed with AP admitted to the Department of Obstetrics and Gynecology,Sixth People's Hospital Affiliated to Shanghai Jiao Tong University between 2005 and 2010 was performed.Information was collected from presentation,management,and outcome from medical records.Results There were 11 cases in 2010,accounting for 44% of 25 cases.Among these cases,mild AP (MAP) occurred in 15 cases (60%),while the rest cases were severe AP (SAP) (40%).The major etiology of AP in pregnancy was due to gallstone and cholecystitis.Clinical features together with elevation of the plasma concentrations of pancreatic enzymes were the cornerstones of diagnosis.Positive conservative treatment was taken in most of the cases (21 cases,84%) with a favorable outcome.Seven cases of critically ill patients were monitored in intensive care unit,and 4 patients underwent surgical interventions.As a result,all of 25 patients had better prognosis,no maternal death was observed.There were 8 preterm labors and 2 fetal losses,accounting for the perinatal mortality of 8%.Fetal malformation was not observed.Conclusions While a pregnant woman suffers acute abdominal pain,early diagnosis and severity assessment of AP are very important.Conservative comprehensive treatment with intensive care is recommended.Surgical intervention should be performed as late as possible.

  5. Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism.

    Science.gov (United States)

    Agito, Katrina; Manni, Andrea

    2015-01-01

    We report here a unique case of methimazole (MMI)-induced pancreatitis. To our knowledge, this is the sixth case reported in the literature and the first diagnosed in a patient with toxic multinodular goiter. A 51-year-old Caucasian female with a history of benign multinodular goiter and subclinical hyperthyroidism was started on MMI 10 mg orally daily. Three weeks later, she developed sharp epigastric pain, diarrhea, lack of appetite, and fever. Her lipase was elevated 5 times the upper limit of normal, consistent with acute pancreatitis. There was no history of hypertriglyceridemia, or alcohol abuse. Abdominal computed tomography was consistent with acute uncomplicated pancreatitis, without evidence of gallstones or tumors. MMI was discontinued, and her hyperthyroid symptoms were managed with propranolol. Her acute episode of pancreatitis quickly resolved clinically and biochemically. One year later, she redeveloped mild clinical symptoms of hyperthyroidism with biochemical evidence of subclinical hyperthyroidism. MMI 10 mg orally daily was restarted. Five days later, she experienced progressive abdominal discomfort. Her lipase was elevated 12 times the upper limit of normal, and the abdominal computed tomography was again compatible with acute uncomplicated pancreatitis. MMI was again discontinued, which was followed by rapid resolution of her pancreatitis. The patient is currently considering undergoing definitive therapy with radioactive iodine ablation. Our case as well as previous case reports in the literature should raise awareness about the possibility of pancreatitis in subjects treated with MMI in the presence of suggestive symptoms. If the diagnosis is confirmed by elevated pancreatic enzymes, the drug should be discontinued.

  6. Kaempferol, a dietary flavonoid, ameliorates acute inflammatory and nociceptive symptoms in gastritis, pancreatitis, and abdominal pain.

    Science.gov (United States)

    Kim, Shi Hyoung; Park, Jae Gwang; Sung, Gi-Ho; Yang, Sungjae; Yang, Woo Seok; Kim, Eunji; Kim, Jun Ho; Ha, Van Thai; Kim, Han Gyung; Yi, Young-Su; Kim, Ji Hye; Baek, Kwang-Soo; Sung, Nak Yoon; Lee, Mi-nam; Kim, Jong-Hoon; Cho, Jae Youl

    2015-07-01

    Kaempferol (KF) is the most abundant polyphenol in tea, fruits, vegetables, and beans. However, little is known about its in vivo anti-inflammatory efficacy and mechanisms of action. To study these, several acute mouse inflammatory and nociceptive models, including gastritis, pancreatitis, and abdominal pain were employed. Kaempferol was shown to attenuate the expansion of inflammatory lesions seen in ethanol (EtOH)/HCl- and aspirin-induced gastritis, LPS/caerulein (CA) triggered pancreatitis, and acetic acid-induced writhing.

  7. Effect of 5-FU on modulation of disarrangement of immuneassociated cytokines in experimental acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Xiao-Li Chen; Sang-Zhu Ciren; Hui Zhang; Li-Geng Duan; Alexander J Wesley

    2009-01-01

    AIM: To investigate the effects of 5-Fluorouracil (5-FU)on modulation of pro-inflammatory and anti-inflammatory cytokines in acute pancreatitis and the mechanism of it in the treatment of acute pancreatitis.METHODS: Male Sprague Dawley rats were assigned to 3 Groups: Group A, sham operated rats as controls ( n = 7); Group B, acute pancreatitis induced by ductal injection with 5% sodium cholate at a volume of 1.0 mL/kg without any other treatment; Group C, after the pancreatitis was induced as in Group B, the rats were injected intravenously with 5-FU 40 mg/kg. The animals in Groups B and C were killed at 2, 6 and 24 h after operation ( n = 7), and blood samples were taken for measurement of tumor necrosis factor-α (TNF-α),interleukin-1 (IL-1), interleukin-6 (IL-6) (by bioassay),and interleukin-10 (IL-10), transforming growth factor-β (TGF-β) (by ELISA). The wet weight of pancreatic tissue, serum amylase levels and white blood cells were also measured.RESULTS: Four rats in Group B and one in Group C died after pancreatitis was induced. Both pro-inflammatory cytokines (TNF-α, IL-1, IL-6) at the 2 and 6 h period and the anti-inflammatory cytokines (IL-10,TGF-β) at 24 h increased significantly ( P < 0.05) in rats of Group B. After treatment with 5-FU, TNF-α, IL-1, and IL-6 in serum of rats of Group C were inhibited at 2 and 6 h after operation ( P < 0.05), and IL-10, TGF-β were inhibited at 24 h compared to Group B ( P < 0.05). Obvious improvements in the severity of the acute pancreatitis,including the amylase levels, wet weight of pancreatic tissue and neutrophil counts, were also observed after treatment with 5-FU.

  8. Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Katrina Agito MD

    2015-06-01

    Full Text Available We report here a unique case of methimazole (MMI-induced pancreatitis. To our knowledge, this is the sixth case reported in the literature and the first diagnosed in a patient with toxic multinodular goiter. A 51-year-old Caucasian female with a history of benign multinodular goiter and subclinical hyperthyroidism was started on MMI 10 mg orally daily. Three weeks later, she developed sharp epigastric pain, diarrhea, lack of appetite, and fever. Her lipase was elevated 5 times the upper limit of normal, consistent with acute pancreatitis. There was no history of hypertriglyceridemia, or alcohol abuse. Abdominal computed tomography was consistent with acute uncomplicated pancreatitis, without evidence of gallstones or tumors. MMI was discontinued, and her hyperthyroid symptoms were managed with propranolol. Her acute episode of pancreatitis quickly resolved clinically and biochemically. One year later, she redeveloped mild clinical symptoms of hyperthyroidism with biochemical evidence of subclinical hyperthyroidism. MMI 10 mg orally daily was restarted. Five days later, she experienced progressive abdominal discomfort. Her lipase was elevated 12 times the upper limit of normal, and the abdominal computed tomography was again compatible with acute uncomplicated pancreatitis. MMI was again discontinued, which was followed by rapid resolution of her pancreatitis. The patient is currently considering undergoing definitive therapy with radioactive iodine ablation. Our case as well as previous case reports in the literature should raise awareness about the possibility of pancreatitis in subjects treated with MMI in the presence of suggestive symptoms. If the diagnosis is confirmed by elevated pancreatic enzymes, the drug should be discontinued.

  9. JPN Guidelines for the management of acute pancreatitis: cutting-edge information

    OpenAIRE

    Takada, Tadahiro; Kawarada, Yoshifumi; Hirata, Koichi; Mayumi, Toshihiko; Yoshida, Masahiro; Sekimoto, Miho; Hirota, Masahiko; Kimura, Yasutoshi; Takeda, Kazunori; Isaji, Shuji; Koizumi, Masaru; Otsuki, Makoto; Matsuno, Seiki

    2006-01-01

    The JPN Guidelines for the Management of Acute Pancreatitis are organized under the subject headings: epidemiology, diagnosis, management strategy, severity assessment and transfer criteria, management of gallstone pancreatitis, nonsurgical management, and surgical management. The Guidelines contain cutting-edge information on each of these subjects, as well as a section on the Japanese medical insurance system which provides information that should prove useful to physicians in other countri...

  10. Total Pancreatectomy and Islet Auto-Transplantation as Treatment for Ampullary Adenocarcinoma in the Setting of Pancreatic Ductal Disruption Secondary to Acute Necrotizing Pancreatitis. A Case Report

    Directory of Open Access Journals (Sweden)

    Uroghupatei P Iyegha

    2012-03-01

    Full Text Available Context Ampullary adenocarcinoma is the third most common periampullary malignancy. Obstruction of the main pancreatic duct is linked with an increased incidence of acute pancreatitis. Acute necrotizing pancreatitis leading to pancreatic duct disruption carries significant morbidity. When these conditions occur in combination, the treatment can be drastically limited as pancreaticoduodenectomy is not a viable option in the setting of friable ductal tissue, which precludes pancreatic ductal anastomosis and can lead to the complications of leak or stricture. Case report Our patient is a 72-year-old woman who developed pancreatic ductal disruption and splenic vein thrombosis as a result of acute necrotizing pancreatitis. Concurrently, she was found to have an ampullary adenoma with high-grade dysplasia. Her treatment options were limited, as she was neither a candidate for pancreaticoduodenectomy given the ductal disruption nor total pancreatectomy, which would render her a brittle diabetic. She was successfully treated with total pancreatectomy and islet auto-transplantation thereby resecting her ampullary lesion while both avoiding a pancreatic anastomosis and preserving pancreatic endocrine beta-cell function. Conclusion We report a case where total pancreatectomy and islet auto-transplantation can be considered as a viable option for treatment of ampullary lesions in a setting where standard surgical options are suboptimal.

  11. Pancreas divisum and duodenal diverticula as two causes of acute or chronic pancreatitis that should not be overlooked: a case report

    Directory of Open Access Journals (Sweden)

    De Filippo Massimo

    2008-05-01

    Full Text Available Abstract Introduction Pancreas divisum is a congenital anatomical anomaly characterized by the lack of fusion of the ventral and dorsal parts of the pancreas during the eighth week of fetal development. This condition is found in 5% to 14% of the general population. In pancreas divisum, the increased incidence of acute and chronic pancreatitis is caused by inadequate drainage of secretions from the body, tail and part of the pancreatic head through an orifice that is too small. The incidence of diverticula in the second part of the duodenum is found in approximately 20% of the population. Compression of the duodenal diverticula at the end of the common bile duct leads to the formation of biliary lithiasis (a principal cause of acute pancreatitis, pain associated with biliary lithiasis owing to compression of the common bile duct (at times with jaundice, and compression of the last part of Wirsung's duct or the hepatopancreatic ampulla (ampulla of Vater that may lead to both acute and chronic pancreatitis. Case presentation We describe the radiological findings of the case of a 75-year-old man with recurrent acute pancreatitis due to a combination of pancreas divisum and duodenal diverticula. Conclusion Magnetic resonance cholangiopancreatography is advisable in patients with recurrent pancreatitis (both acute and chronic since it is the most appropriate noninvasive treatment for the study of the pancreatic system (and the eventual presence of pancreas divisum and the biliary systems (eventual presence of biliary microlithiasis. Moreover, it can lead to the diagnostic suspicion of duodenal diverticula, which can be confirmed through duodenography with X-ray or computed tomography scan with a radio-opaque contrast agent administered orally.

  12. Emergency thyroidectomy: Due to acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Zulfu Bayhan

    2014-01-01

    CONCLUSION: Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  14. Relationship between peritoneal macrophages and inflammatory reaction in a rat model of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Objective To investigate the relationship between peritoneal macrophages(PMAs)and inflammatory reaction in a rat model of severe acute pancreatitis(SAP).Methods Sprague-Dawley rats were randomly divided into control group and SAP group.To induce SAP in rats,40 g/L sodium taurocholate(0.1 mL/100 g)was injected into the pancreatic duct through retrograde exposure of pancreatic bile duct in hepatic porta.One-third of rats were sacrificed at 3,6 or 12 h after modeling.PMAs were extracted,and incubated for 24 h ...

  15. MR imaging of acute pancreatitis: Correlation of abdominal wall edema with severity scores

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ru, E-mail: yangru0904@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Jing, Zong Lin, E-mail: jzl325@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhang, Xiao Ming, E-mail: zhangxm@nsmc.edu.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Tang, Wei, E-mail: tw-n-g-up@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Xiao, Bo, E-mail: xiaoboimaging@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Huang, Xiao Hua, E-mail: nc_hxh1966@yahoo.com.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Yang, Lin, E-mail: llinyangmd@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Feng, Zhi Song, E-mail: fengzhisong@medmail.com.cn [Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China)

    2012-11-15

    Objective: To study MRI findings of abdominal wall edema (AWE) in acute pancreatitis as well as correlations between AWE and the severity of acute pancreatitis according to the MR severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation III (APACHE III) scoring system. Materials and methods: A total of 160 patients with AP admitted to our institution between December 2009 and March 2011 were included in this study. MRI was performed within 48 h after admission. MRI findings of acute pancreatitis were noted, including AWE on the MRI. The abdominal wall area was divided into quarters, and each area involved was recorded as 1 point to score the severity of AWE. The severity of acute pancreatitis was studied using both the MRSI and the APACHE III scoring system. Spearman correlation of AWE with the MRSI and the APACHE III scoring system was analyzed. Results: In 160 patients with acute pancreatitis, 53.8% had AWE on MRI. The average AWE score was 1.2 {+-} 1.4 points. The prevalence of AWE was 30.5%, 64.5% and 100% in mild, moderate and severe AP, respectively, according to MRSI. AWE on MRI was correlated with MRSI scores (r = 0.441, p = 0.000). According to APACHE III scores, the averages were 2.0 {+-} 1.1 and 2.6 {+-} 1.1 points in mild AP and severe AP, respectively (P = 0.016). AWE was slightly correlated with the APACHE III scores (r = 0.222, p = 0.005). Conclusion: AWE on MRI in acute pancreatitis is common, which may be a supplementary indicator in determining the severity of AP.

  16. Gastric variceal bleeding due to pancreatitis-induced splenic vein thrombosis.

    Science.gov (United States)

    Gotto, Antonio; Lieberman, Michael; Pochapin, Mark

    2014-03-24

    Obscure gastrointestinal bleeding is a common clinical scenario. In the upper gastrointestinal tract, gastric varices can be frequently overlooked on endoscopy, particularly if not suspected or volume depleted. We report a case of suspected gastrointestinal bleeding in a patient with a childhood history of pancreatitis, who also experienced severe epigastric pain while in hospital. After transfer to an academic medical centre, the presence of gastric varices was identified and presumed to be due to splenic vein thrombosis. Pancreatitis is the most common cause of splenic vein thrombosis and accords with the patient's history, even though it occurred many years previously. This case highlights the importance of recognising pancreatitis-induced splenic vein thrombosis as a possible aetiology for upper gastrointestinal bleeding.

  17. Ascariasis as an Unexpected Cause of Acute Pancreatitis with Cholangitis: A Rare Case Report from Urban Area

    OpenAIRE

    Pochamana Phisalprapa; Varayu Prachayakul

    2013-01-01

    Context Ascaris lumbricoides is one of the most common parasitic infestations of human gastrointestinal tract. This parasiticinfestation might be asymptomatic and only few studies on extraintestinal ascariasis have been reported. Ascending cholangitis and acute pancreatitis as a result of the Ascaris lumbricoides migrating into the biliary system and pancreatic duct were very rare complications. Here, we presented a case report of biliary ascariasis induced acute pancreatitis with cholangitis...

  18. Pancreatitis aguda: Análisis de 97 pacientes Acute pancreatitis: Analysis of 97 patients

    Directory of Open Access Journals (Sweden)

    Débora Pellegrini

    2009-04-01

    manejo y pronóstico de la PA. El presente trabajo actualiza la casuística en Argentina.Acute pancreatitis (AP is a disease with several causes and diverse clinical course. In our environment there are not many papers on this entity and they approach punctual features inside the broad spectrum picture. The aim of this study is to determinate clinical features, etiology, handling and evolution of patients diagnosed with AP admitted in our Hospital during a three years period. The clinical records of patients with AP admitted at the British Hospital of Buenos Aires between April 2004 and April 2007 were retrospectively analyzed. Demographic data, etiology, treatment, severity of the illness, morbidity and mortality were evaluated. Ninety seven patients were diagnosed with AP during the analyzed period. Forty nine were male (50.5%. The average age was 58.5 ± 1.6 years (range 21-93. Ninety two patients presented only one episode of AP and five patients suffered two or more (recurrent pancreatitis. According to the etiology, 48 had a biliary origin, 23 were idiopathic, 11 post biliary tract procedures, 2 recognized an alcoholic origin and 13 other causes. The median hospital stay was 7 days. Twenty five percent required admission in Intensive Care Unit. Most of the patients (n: 66; 72% presented mild episodes according to the Ranson Score. The median of beginning oral feeding was 3 days. Regarding to complications, 13% have multiple organ failure, 8% pancreatic necrosis (4 infected, only one patient had a pseudocist and another patient a peripancreatic abscess. Mortality rate was 7.2% (7 cases, all with Ranson = 3. Although this is a short series, the biliar origin is still the most prevalent etiology in our population. The low number of alcoholic origin caught our attention. Mortality was similar to that described in other series, but the number of local complications was lower. Our data are consistent with other papers regarding management and prognosis, and update the

  19. Sporadic Burkitt Lymphoma Presenting as Acute Pancreatitis, Concurrent Sinusitis, and Enlarged Adenoids

    OpenAIRE

    2016-01-01

    Pancreatitis and sinusitis as presentations of Burkitt lymphoma are uncommon and rarely described in children. We describe here the case of a child who presented with symptoms suggestive of sinusitis unresponsive to antibiotics, with subsequent development of abdominal symptoms due to pancreatitis. He was eventually diagnosed with Burkitt lymphoma.

  20. Ectopic paraesophageal mediastinal parathyroid adenoma, a rare cause of acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Koutarelos Dimitrios

    2004-11-01

    Full Text Available Abstract Background The manifestation of primary hyperparathyroidism with acute pancreatitis is a rare event. Ectopic paraesophageal parathyroid adenomas account for about 5%–10% of primary hyperparathyroidism and surgical resection results in cure of the disease. Case presentation A 71-year-old woman was presented with acute pancreatitis and hypercalcaemia. During the investigation of hypercalcemia, a paraesophageal ectopic parathyroid mass was detected by computerized tomography (CT scan and 99mTc sestamibi scintigraphy. The tumor was resected via a cervical collar incision and calcium and