Acute Pancreatitis

2015 ◽  
Author(s):  
Robert A. Moran ◽  
Manavi Solanki ◽  
Vikesh K Singh
Keyword(s):  
Acute Pancreatitis ◽  
Scoring Systems ◽  
Abdominal Imaging ◽  
Infected Necrosis ◽  
Abdominal Ultrasonography ◽  
Endoscopic Image ◽  
Drug Classes ◽  
Upper Abdominal ◽  
Enhanced Computed Tomography ◽  
Prognostic Scoring Systems

Acute pancreatitis (AP) is defined as the presence of two of the following findings: (1) upper abdominal pain; (2) serum amylase or lipase greater than three times the upper limit of normal; and/or (3) characteristic findings of AP on abdominal imaging (contrast-enhanced computed tomography, magnetic resonance imaging, or abdominal ultrasonography). This review addresses AP, detailing the subclassification, epidemiology, pathophysiology, etiology, diagnosis and differential diagnosis, treatment, complications, and prognosis. Figures include abdominal imaging of patients with AP, an algorithm depicting pancreatic collections, and an endoscopic image of the gastric portion of the cystogastrostomy. Tables list systemic inflammatory response syndrome; classification of the severity of AP; etiologies of AP, gallstones, biliary sludge, microlithiasis, and crystals; secondary causes of hypertriglyceridemia; common drugs and drug classes associated with AP; conditions mimicking AP; diagnostic criteria for infected necrosis; and prognostic scoring systems for AP. This review contains 3 highly rendered figures, 9 tables, and 182 references. 

Acute and Chronic Pancreatitis

2020 ◽  
Author(s):  
Thomas J. Howard
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Physical Examination ◽  
Clinical Evaluation ◽  
Gallbladder Disease ◽  
Scoring Systems ◽  
Whipple Procedure ◽  
General Surgeon ◽  
Enhanced Computed Tomography ◽  
Acute And Chronic Pancreatitis

Clinical evaluation and surgical decision making in patients with acute pancreatitis (AP) and chronic pancreatitis (CP) are two of the most complex conditions that a general surgeon faces. Each entity has unique laboratory and radiographic investigations, operations, and postoperative care. The clinical evaluation, history, and physical examination of AP is described. The clinical features necessary for diagnosis are listed, and contrast-enhanced computed tomography is described as the gold standard for diagnosis. This review uses definitions and terminology developed at the Atlanta symposium in 1992. The severity of an episode of AP is described in terms of established scoring systems (APACHE II [Acute Physiology and Chronic Health Evaluation II], Glasgow Coma Scale score, Ranson criteria). AP can range from mild to severe necrotizing, with each described. The clinical course is described in detail. For CP, the history, physical examination, and diagnosis via investigative and imaging studies are described. The anatomic and morphologic subtypes of chronic pancreatitis are listed and the operations directed at patients with CP are detailed, and can involve drainage or combined resection and drainage.  This review contains 12 figures, 14 tables, and 48 references. Keywords: Acute pancreatitis, chronic pancreatitis, gallbladder disease, alcoholism, amylase, Whipple procedure

scholarly journals Mildly symptomatic liraglutide-induced acute pancreatitis in a patient with type 2 diabetes mellitus: a case report

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Mohammed Ali Gameil ◽  
Ahmed Hassan Elsebaie
Keyword(s):  
Acute Pancreatitis ◽  
Diabetic Patients ◽  
Abdominal Ultrasonography ◽  
Serum Lipase ◽  
Case Presentation ◽  
Clinical Challenge ◽  
Contrast Enhanced ◽  
Glucagon Like Peptide 1 ◽  
Enhanced Computed Tomography

Abstract Background Acute pancreatitis (AP) represents a serious clinical challenge as it can threaten the patient’s life if it is missed or improperly managed. Liraglutide is one of the glucagon-like peptide 1 receptor agonists (GLP1-RA) which represent a novel class of antidiabetic medications in the Egyptian market. Hereby, we report a case of liraglutide-induced acute pancreatitis with atypical presentation. Case presentation A 53-year-old Egyptian male patient with diabetes presented to the emergency department with abdominal discomfort and vomiting without significant abdominal pain. Serum lipase and amylase were elevated more than three folds the upper normal limit (NUL 300 and 110 U/L respectively); abdominal ultrasonography was inconclusive, but contrast-enhanced computed tomography was diagnostic. A diagnosis of liraglutide-induced AP was built after exclusion of other causes. After admission, his medications were modified and improved clinically after 1 week. Conclusion Mildly symptomatic AP in diabetic patients is a clinical challenge as it can be missed. Therefore, in certain clinical situations, AP should be suspected in patients administrating liraglutide particularly for those with autonomic neuropathy.

Prediction of severity, organ failure and gland necrosis development in acute pancreatitis: A prospective comparison of four prognostic scoring systems

2003 ◽  
Vol 124 (4) ◽  
pp. A398-A399
Author(s):  
Constantinos Chatzicostas ◽  
Maria Roussomoustakaki ◽  
Georgios Notas ◽  
Ioannis Mouzass ◽  
Ioannis Koutroubakis ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Scoring Systems ◽  
Prospective Comparison ◽  
Prognostic Scoring Systems

scholarly journals Analysis of the Power of Common Diagnostic Tools in the Management of Acute Pancreatitis

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Markus Nistal ◽  
Malai Zoltani ◽  
Ansgar W. Lohse ◽  
Nicola Di Daniele ◽  
Manfredi Tesauro ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Predictive Value ◽  
Medical Condition ◽  
Diagnostic Tools ◽  
Surgical Interventions ◽  
Therapeutic Consequences ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Upper Abdominal ◽  
Enhanced Computed Tomography

Acute pancreatitis (AP) is a serious medical condition usually associated with severe upper abdominal pain. The purpose of our study is to assess the therapeutic consequences of contrast-enhanced computed tomography (CE-CT) and the predictive value of CRP for severe pancreatitis. We included patients with a threefold increase of plasma lipase who had received a CE-CT or had a CRP of =150 mg/dl. A total of 74 out of 283 patients got a contrast-enhanced CT scan; in 11 cases the CT was followed by endoscopic or surgical interventions as therapeutic consequences compared with 19 out of 50 control cases. 69 out of 283 patients (24,3%) had CRP >150 mg/dl within 48 hours after admission. 32 of them had SAP. The CRP cutoff of 150 mg/L had a sensitivity of 80% and a specificity of 65%. The positive predictive value for SAP in patients beyond the cutoff is 46.4%. The negative predictive value for SAP in patients below the cutoff was 89.5%. Our results support the opinion that an early CE-CT is usually not indicated. CRP helps to assess the course of AP; levels below 150 mg/dl between the first 48 h indicate a mild course in most of the cases.

Acute and Chronic Pancreatitis

2020 ◽  
Author(s):  
Thomas J. Howard
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Physical Examination ◽  
Clinical Evaluation ◽  
Gallbladder Disease ◽  
Scoring Systems ◽  
Whipple Procedure ◽  
General Surgeon ◽  
Enhanced Computed Tomography ◽  
Acute And Chronic Pancreatitis

Clinical evaluation and surgical decision making in patients with acute pancreatitis (AP) and chronic pancreatitis (CP) are two of the most complex conditions that a general surgeon faces. Each entity has unique laboratory and radiographic investigations, operations, and postoperative care. The clinical evaluation, history, and physical examination of AP is described. The clinical features necessary for diagnosis are listed, and contrast-enhanced computed tomography is described as the gold standard for diagnosis. This review uses definitions and terminology developed at the Atlanta symposium in 1992. The severity of an episode of AP is described in terms of established scoring systems (APACHE II [Acute Physiology and Chronic Health Evaluation II], Glasgow Coma Scale score, Ranson criteria). AP can range from mild to severe necrotizing, with each described. The clinical course is described in detail. For CP, the history, physical examination, and diagnosis via investigative and imaging studies are described. The anatomic and morphologic subtypes of chronic pancreatitis are listed and the operations directed at patients with CP are detailed, and can involve drainage or combined resection and drainage.  This review contains 12 figures, 14 tables, and 48 references. Keywords: Acute pancreatitis, chronic pancreatitis, gallbladder disease, alcoholism, amylase, Whipple procedure

scholarly journals Haemoconcentration as a predictor of severity in acute pancreatitis

2016 ◽  
Vol 4 (1) ◽  
pp. 3-7
Author(s):  
Tanka Prasad Bohara ◽  
Dimindra Karki ◽  
Anuj Parajuli ◽  
Shail Rupakheti ◽  
Mukund Raj Joshi
Keyword(s):  
Acute Pancreatitis ◽  
Pearson Correlation ◽  
Characteristic Curve ◽  
Scoring Systems ◽  
Cost Effective ◽  
Receiver Operator Characteristic Curve ◽  
First Episode ◽  
P Value ◽  
Receiver Operator Characteristic ◽  
Chi Square

Background: Acute pancreatitis is usually a mild and self-limiting disease. About 25 % of patients have severe episode with mortality up to 30%. Early identification of these patients has potential advantages of aggressive treatment at intensive care unit or transfer to higher centre. Several scoring systems are available to predict severity of acute pancreatitis but are cumbersome, take 24 to 48 hours and are dependent on tests that are not universally available. Haematocrit has been used as a predictor of severity of acute pancreatitis but some have doubted its role.Objectives: To study the significance of haematocrit in prediction of severity of acute pancreatitis.Methods: Patients admitted with first episode of acute pancreatitis from February 2014 to July 2014 were included. Haematocrit at admission and 24 hours of admission were compared with severity of acute pancreatitis. Mean, analysis of variance, chi square, pearson correlation and receiver operator characteristic curve were used for statistical analysis.Results: Thirty one patients were included in the study with 16 (51.61%) male and 15 (48.4%) female. Haematocrit at 24 hours of admission was higher in severe acute pancreatitis (P value 0.003). Both haematocrit at admission and at 24 hours had positive correlation with severity of acute pancreatitis (r: 0.387; P value 0.031 and r: 0.584; P value 0.001) respectively.Area under receiver operator characteristic curve for haematocrit at admission and 24 hours were 0.713 (P value 0.175, 95% CI 0.536 - 0.889) and 0.917 (P value 0.008, 95% CI 0.813 – 1.00) respectively.Conclusion: Haematocrit is a simple, cost effective and widely available test and can predict severity of acute pancreatitis.Journal of Kathmandu Medical College, Vol. 4(1) 2015, 3-7

scholarly journals Accuracy of conventional and novel scoring systems in predicting severity and outcomes of acute pancreatitis: a retrospective study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Qing Wu ◽  
Jie Wang ◽  
Mengbin Qin ◽  
Huiying Yang ◽  
Zhihai Liang ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Scoring System ◽  
Characteristic Curve ◽  
Failure Prediction ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Severity Prediction ◽  
Index Of Severity ◽  
Glasgow Score

Abstract Background Recently, several novel scoring systems have been developed to evaluate the severity and outcomes of acute pancreatitis. This study aimed to compare the effectiveness of novel and conventional scoring systems in predicting the severity and outcomes of acute pancreatitis. Methods Patients treated between January 2003 and August 2020 were reviewed. The Ranson score (RS), Glasgow score (GS), bedside index of severity in acute pancreatitis (BISAP), pancreatic activity scoring system (PASS), and Chinese simple scoring system (CSSS) were determined within 48 h after admission. Multivariate logistic regression was used for severity, mortality, and organ failure prediction. Optimum cutoffs were identified using receiver operating characteristic curve analysis. Results A total of 1848 patients were included. The areas under the curve (AUCs) of RS, GS, BISAP, PASS, and CSSS for severity prediction were 0.861, 0.865, 0.829, 0.778, and 0.816, respectively. The corresponding AUCs for mortality prediction were 0.693, 0.736, 0.789, 0.858, and 0.759. The corresponding AUCs for acute respiratory distress syndrome prediction were 0.745, 0.784, 0.834, 0.936, and 0.820. Finally, the corresponding AUCs for acute renal failure prediction were 0.707, 0.734, 0.781, 0.868, and 0.816. Conclusions RS and GS predicted severity better than they predicted mortality and organ failure, while PASS predicted mortality and organ failure better. BISAP and CSSS performed equally well in severity and outcome predictions.

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