Acute Pancreatitis: Etiology, Clinical Presentation, Diagnosis, and Therapy (original) (raw)
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Acute pancreatis: Pathophysiology of acute damage
Great advances have been achieved in recent years in our understanding of the inflammatory diseases of the pancreas and in their clinical management. In this book, the Editors tried to highlight areas of particular interest regarding acute, chronic and recurrent pancreatitis, both reporting new concepts and evidence-based approaches. This book has not been designed to cover all areas of pancreatic disease in exhaustive detail, but rather to stimulate the reader with up-to-date reviews in areas where major progress has been made, including therapeutic pancreatic endoscopy and ultrasound endoscopy. Contributors of different countries, from Europe to USA, were also asked to provide evidence-based approaches that can guide diagnostic and therapeutic algorithms in the clinical practice. Advances in diagnostic techniques, including imaging modalities, have improved the diagnostic yield of the inflammatory diseases of the pancreas and, in particular, differentiation among benign and malignant pancreatic lesions. In the same way, technical advances have increased the effectiveness of the endoscopic treatment of pancreatitis, nowadays extended to the management of local complications which were before prerogative of the surgery alone. Compared to acute and chronic pancreatitis, recurrent pancreatitis remains the inflammatory disease of the pancreas that still raises more difficult issues, regarding the pathophysiology and the evolution of the disease, as well as the diagnostic and therapeutic work-up. This book must go to our readers, not only gastroenterologists and endoscopists, but also expert in internal medicine and surgery. All those with an interest in inflammatory pancreatic disease should find something worthwhile. We hope there will be many who will find a stimulus from these pages. Topics in medical gastroenterology, endoscopy, radiology and surgery have been addressed in the hope that our readers will include not only established specialists but also practicing clinicians, fellows, and students as well.
Peripartum pancreatitis is a rare clinical condition that occurs usually in the third trimester of pregnancy. Pancreatitis is usually secondary to gallstones, and it can lead to life-threatening and rare complications. We report a case of necrotizing postpartum pancreatitis that developed abdominal compartment syndrome (ACS) in early course, posterior reversible encephalopathy syndrome (PRES), and splanchnic and extrasplanchnic thrombosis later on. Case. 31-year-old female, one week after delivery, presented to the emergency department with abdominal pain, nausea and vomiting, tenderness in the epigastrium, and raised pancreatic enzymes. Ultrasound (USG) showed bulky pancreas with gallstones. She was diagnosed as having acute biliary pancreatitis and started to be hydrated and was supplemented with analgesia. Her condition deteriorated on the 2 nd day, and she was shifted to the surgical intensive care unit (SICU) where she developed abdominal compartment syndrome (ACS), respiratory distress, and acute kidney injury, requiring endotracheal intubation and ventilation. Computerized tomography (CT) showed pancreatic necrosis with multiple fluid collections and significant left-sided pleural effusion. Percutaneous drainage of pleural effusion was done, and she was stabilized to be weaned off from mechanical ventilation. On day 15, she underwent USGguided drainage of the pancreatic collection and ERCP (endoscopic retrograde cholangiopancreatography) on day 19. Post-ERCP, she had tonic colonic convulsions which were treated with benzodiazepines and phenytoin. It was diagnosed by imaging studies as posterior reversible encephalopathy syndrome (PRES). Her abdomen was still distended and tender; CT showed a significant pseudocyst with splanchnic and extrasplanchnic thrombosis. She had laparotomy, gastrocystostomy, and cholecystectomy on day 28th. She made uncomplicated recovery and discharged in good health. Conclusion. Peripartum pancreatitis can be complicated by ACS, PRES, and splanchnic and extrasplanchnic thrombosis.
AGA Institute Technical Review on Acute Pancreatitis
Gastroenterology, 2007
Pancreatic pseudocyst Pancreatic pseudocyst Chronic pancreatitis Chronic pancreatitis Pancreatic carcinoma Pancreatic carcinoma Biliary tract disease (cholecystitis, cholangitis, choledocholithiasis) Biliary tract disease (cholecystitis, cholangitis, choledocholithiasis) Intestinal obstruction, pseudoobstruction, ischemia, or perforation Intestinal obstruction, pseudoobstruction, ischemia, or perforation Acute appendicitis Acute appendicitis Ectopic pregnancy Other disorders Renal failure Renal failure Parotitis Macroamylasemia Ovarian cyst or cystic neoplasm Carcinoma of the lung Diabetic ketoacidosis Human immunodeficiency virus infection Head trauma with intracranial bleeding
DIAGNOSIS OF LOCAL COMPLICATIONS OF ACUTE PANCREATITIS AT THE STAGES OF ITS TREATMENT
2017
The aim. To study the diagnostic value of individual clinical and laboratory manifestations associated with the development of intra-and peripancreatic collections according to the Atlanta 2012 Classification Review for the timely addition or modification of the tactics. Materials and methods. 72 patients were examined. In accordance with the tasks, the patients were divided into 3 groups. The first (main) group of the study consisted of 30 (41.67 %) patients who used CT for indications and the classification of acute pancreatitis was used according to the View. The comparison group consisted of 32 patients (44.44 %) who were treated in 2011 and 2013, they used the Atlanta 1992 Classification. The control group consisted of 10 patients (13.89 %) who were hospitalized for scheduled surgical intervention in a satisfactory condition. The examination was performed three times: during hospitalization (first study), 1 week (second study) and 2 weeks after hospitalization or discharge (third study). Results and discussion. The most characteristic clinical symptom is abdominal pain, which in 100 % of cases is accompanied by necrotic pancreatitis, and 70 % - oedematosis. The main laboratory symptom was lymphopenia, which occurred in 70 % of cases (78.95 % and 54.55 % for necrotic and oedematosis pancreatitis, respectively). Nausea was observed at a frequency of 70.0 %, with a significantly higher incidence (p = 0.042) in patients with necrotic pancreatitis (84.21 %) than in the subgroup with oedematosis form disease (45.45 %). Among the local complications are dominated by encapsulated forms. Lymphocyte level was determined, which helps to predict the development of local complications, their infection and the need for surgical intervention. Conclusion.The most characteristic clinical symptom is abdominal pain, which in 100 % of cases is accompanied by necrotic pancreatitis, and 70 % - oedematosis. The main laboratory symptom was lymphopenia, which occurred in 70 % of cases (78.95 % and 54.55 % for necrotic and oedematosis pancreatitis, respectively). Among the local complications are dominated by encapsulated forms. Lymphocyte level was determined, which helps to predict the development of local complications, their infection and the need for surgical intervention.
Gastrointestinal complications in acute and chronic pancreatitis
JGH Open, 2019
Pancreatitis is one of the important medical conditions. Gastrointestinal (GI) complications of pancreatitis are important and lead to significant morbidity and mortality. Diagnosis of these complications is difficult and may require a strong clinical suspicion coupled with various imaging features. This review provides an extensive update of the whole spectrum of GI complication of pancreatitis, both acute and chronic, from inflammation, ischemia, and necrosis to obstruction, perforation, and GI fistulae. The focus is on the clinical and imaging features of this less commonly described aspect of pancreatitis.