Acute Pancreatitis Research Papers - Academia.edu (original) (raw)

2025, The Egyptian Heart Journal

Hypertriglyceridemia (HTG) is a very common, yet underappreciated problem in clinical practice. Elevated triglyceride (TG) levels are independently associated with atherosclerotic cardiovascular disease (ASCVD) risk. Furthermore, severe HTG may lead to acute pancreatitis. Although LDL-guided statin therapy has improved ASCVD outcomes, residual risk remains. Recent trials have demonstrated that management of high TG levels, in patients already on statin therapy, reduces the rate of major vascular events. Few guidelines were issued, providing important recommendations for HTG management strategies. The goal of treatment is to reduce the risk of ASCVD and acute pancreatitis. The management stands on lifestyle modification, detection of secondary causes of HTG and pharmacological therapy, when indicated. In this guidance we review the causes and classification of HTG and summarize the current methods for risk estimation, diagnosis and treatment. The present guidance provides a focused u...

2025

Centrul Naţional de Sanătate PublicăThis article contains 33 sources including 7 national and 26 international journals, 97% are from the last 5 years. This study aims to identify the epidemiological pecularities and social impact of hepatitis B and D inthe Republic of Moldova. Bibliographic data sources show that in the United States seroprevalence hepatitis B is 0.1% - 2.0% in Western Europe, 2.0% - 8.0% in Mediterranean countries and Japan. Genotype circulating in neighboring countries is genotype D are seen more often in Russia (93%), Romania (67%). lt is estimated that 15-20 million people worldwide have chronic VHD or 5% of the population infected with hepatitis B, with substantial geographical differences. Worldwide, infectious diseases including hepatitis parenteral causes a significant burden on the health system by morbidity, disability and mortality still having a negative impact on the economy increased, especially for developing countries.Статья содержит 33 источника, в...

2025, PLOS ONE

Background Acute pancreatitis (AP) is a common presentation in patients admitted with acute abdomen. Whether Ringers lactate (RL) or Normal Saline (NS) as a resuscitation fluid is better still remains unclear. The aim of this study is to compare the efficacy of RL and NS in terms of control of systemic inflammation by measuring indirect markers specifically Systemic Inflammation Response Syndrome (SIRS) scores and C- Reactive Protein (CRP) level. Methods This was an open label randomized trial conducted in a tertiary level hospital of Nepal. Ethical approval was obtained prior to the study. Patients with acute pancreatitis were randomized to either RL or NS group for the fluid resuscitation. The fluid was given as per the study protocol for three days for hydration. Baseline SIRS and CRP were recorded on admission and subsequently as defined. All the data were analyzed using SPSS ver 20.0 software. Results Total 51 patients were enrolled, 26 in RL and 25 in NS group. The commonest e...

2025, Journal of Patan Academy of Health Sciences

Introduction: Early identification of severe acute pancreatitis is of paramount importance in the management and for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP) is a simple and accurate score for stratification in acute pancreatitis. This study was conducted to find out the accuracy of BISAP score in predicting outcomes of acute pancreatitis in local population. Method: We prospectively analyzed 96 patients with acute pancreatitis from February 2019 to December 2019. Revised Atlanta classification was used to stratify mild, moderately severe and severe pancreatitis. BISAP score was calculated within 24 hours of admission. Accuracy was measured by area under receiver operating curve (AUC). Result: Out of 96 patients, alcohol related acute pancreatitis accounted for 74.7%. There were 63.2% of mild AP, 37.3% of moderately severe AP, 9.4% of severe AP and 15.8 % of pancreatic necrosis. The AUC for moderately severe AP, severe AP and pancreatic necrosis w...

2025, International Surgery Journal

Acute pancreatitis is a potentially lethal condition resulting from an acute inflammatory process in the pancreas usually manifested by upper abdominal pain and raised concentration of pancreatic enzymes in blood, urine, peritoneal fluid at least 3 times the normal. 1 If the cause of the attack can be eliminated no further attacks may ensue. 2 Gall stone diseases and alcohol are the most common causes behind acute pancreatitis, the former is responsible for 30-70% of cases and the latter for 30% of cases. Once these two causes are excluded, there remains a group, approximately 20-25%, and in this context other predisposing factors like structural or functional alterations in the ductal system, microlithiasis, metabolic defects, trauma, hereditary and iatrogenic causes, obstruction, unknown causes, drugs, auto-immunity, infections, post-operative, post-endoscopic retrograde cholangiopancreatography (ERCP), trauma, hypertriglyceridemia and genetic factors may be ABSTRACT Background: Acute pancreatitis is a potentially lethal condition resulting from an acute inflammatory process in the pancreas usually manifested by upper abdominal pain and raised concentration of pancreatic enzymes in blood, urine and peritoneal fluid. Aims and objectives were to study the epidemiology and aetiopathogenesis of acute pancreatitis in Jammu region of Northern India. Methods: This was a descriptive cross-sectional hospital based study, conducted in the postgraduate department of surgery, Government Medical College Jammu for a period of 3 years and included all admitted patients with diagnosis of acute pancreatitis. The main outcome variable was to find the various etiological factors associated with acute pancreatitis. Results: In our study acute pancreatitis was found to be more common in younger people. Most of the patients in the study population were below 40 years of age. Majority of the patients presented first time to the hospital with the chief complaints of pain upper abdomen. In this study, we found that the two principal causes of acute pancreatitis in our population were gall stones and alcoholism which contributed a total of about 68% cases followed by other causes such as hyperlipidemia, drug induced pancreatitis, worm induced acute pancreatitis, post-surgical pancreatitis, post traumatic pancreatitis, and hypercalcemia. Conclusions: Acute pancreatitis is a disease with high morbidity and mortality, and is quite common in Northern India. As such there is a need to make our population aware regarding the impact of alcoholism and bad dietary practices in causation of acute pancreatitis.

2025, International Journal of Scientific Reports

Background: Acute pancreatitis is a serious condition caused by an acute inflammatory cascade in the pancreas usually with symptoms of upper abdominal pain and increased pancreatic enzymes in blood, urine, peritoneal fluid at least 3 times above the normal. Presence of permanent, morphologic and functional damage differentiates acute and chronic pancreatitis. Aims and objectives: The aims and objectives of this study was to study the aetiology of non-gall stone induced pancreatitis.Methods: It was an observational hospital-based study, which was designed and conducted in the department of general surgery, school of medical science and research, Sharda University, Greater Noida.Results: The mean age of study population was 33 years. Among 100 patients 5 patients were in age group of ≤20 years, 47 in 21-40 years, 31 in 41-60 years and 17 in >60 years. The study consisted of 100 patients among which the male to female ratio was 1.7. In our study, in 18% of the patient’s alcohol was ...

2025, International Journal of Applied Pharmaceutics

Objective: C-reactive and Pancreatic enzymes changes for COVID-19 patients were estimated. Methods: Eighty individuals of both sexes, age range (28-69 y), with a mean±SE of (46.2±1.7) were included in this study, Group I: COVID-19 patients and Group II Aged matched healthy people as the control group. Venous blood samples were taken for each individual, serum collected and enzyme-linked immunosorbent assay technique (ELISA) was used to estimate the levels of C-reactive protein, lipase, and amylase, and we used a capture chemiluminescence immunoassay for IgM and an indirect chemiluminescence immunoassay for IgG. Results: The mean serum levels of IgM, IgG, CRP, were significantly higher in the patient group than in the control group (1.7 vs. 0.7 AU/ml, 2.86 vs. 0.27 AU/ml, 7.6 vs. 4 mg/dl) respectively and pancreatic enzymes (lipase, and amylase) were significantly higher in the patient group than in the control group (86 vs. 54U/l, and 66 vs. 39U/l), respectively. Conclusion, COVID-19 patients have an increased risk of exocrine secretion (lipase and amylase enzymes) and pancreatic damage. This work highlights the importance of pancreatic enzyme (amylase and lipase) estimation in affected patients.

2025, International Journal of Clinical Pharmacy

Background-Medication discrepancies may occur at transitions in care and negatively impact patient outcomes. Objective-To determine if involving clinical pharmacists in hospital care, medication reconciliation and discharge medication plan communication can reduce medication discrepancies with a prospective, randomized, blinded, controlled trial. Setting-A large, tertiary care, academic medical center. Method-The intervention consisted of clinical pharmacist medication reconciliation, patient education and improved communication of the discharge medication plan, as devised by the hospital physician and care team, to primary care physicians and community pharmacists. Medication discrepancies were identified by blinded research pharmacists who reviewed primary care physician and pharmacy records at discharge through 90 days post-discharge to create 30-day

2025

Mlle BUCK-ROUCH, Médecine interne des animaux de compagnie M. CASSARD Hervé, Pathologie du bétail M. DOUET Jean-Yves, Ophtalmologie M. SEGUELA Jérôme, Médecine interne des animaux de compagnie M VERSET Michaël, Chirurgie des animaux de compagnie ASSISTANTS D'ENSEIGNEMENT ET DE RECHERCHE CONTRACTUELS Mlle BIBBAL Delphine, Hygiène et Industrie des Denrées alimentaires d'Origine animale M. CONCHOU Fabrice, Imagerie médicale M. GIN Thomas, Production et pathologie porcine M.

2025, Anaesthesia, Pain & Intensive Care

Introduction: Acute pancreatitis (AP) is an acute inflammatory disease of the pancreas. After diagnosis the initial management is preferably done in intensive care unit along with 4-6 hourly insulin sliding scale monitoring for hyperglycemia. Individuals with type II DM are more prone to develop AP. Glycosylated hemoglobin (HbA1c) reflects the blood glucose levels of over past two months and daily glucose levels do not affect its levels in the blood.Objectives: To find out the frequency of acute pancreatitis in diabetic patients both in type 1 and type 2.Study Design: Cross-sectional, comparative studyMethodology: This was a retrospective cross-sectional, comparative study based on 154 patients with acute pancreatitis in our tertiary care hospital over the duration of two years i.e. from January 2016 to December 2017. The data were entered and coded where necessary and statistically analyzed using SPSS version 20. Descriptive analysis was done to summarize data in the form of percen...

2025, JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Introduction: Chronic Pancreatitis (CP) is a long-standing inflammation of the pancreas that presents as episodes of acute inflammation or chronic damage, leading to alterations in the organ’s normal structure and function. Numerous studies have focused on inflammatory and oxidative stress markers in Acute Pancreatitis (AP), but similar studies in CP are rare. Aim: The aim of this study was to compare the serum levels of acute inflammatory and oxidative stress markers in CP patients with healthy controls, and to investigate the correlation between acute inflammatory markers and oxidative stress markers. Materials and Methods: This cross-sectional study was conducted at Jawaharlal Institute of Postgraduate Medical Education Research (JIPMER), Puducherry, India, from January 2018 to December 2021. Forty-five patients diagnosed with CP, based on clinical manifestations, Contrast-Enhanced Computed Tomography (CECT) of the abdomen, and histopathology reports, were enrolled along with 45 ...

2025, Journal of surgical case reports

We report a rare case that highlights acute pancreatitis as the protagonist of Fournier's Gangrene. This patient was treated with a radical debridement of his perineum at presentation and subsequently reconstructed with split thickness skin grafting. This is an unusual aetiology of necrotizing fasciitis with only one other case reported in the literature. This serves to emphasize to physicians that acute pancreatitis is a potential source when investigating and treating patients with Fournier's Gangrene.

2025

Целью работы является разработка метода прогноза тяжести инфекции и выбора вида дыхательной поддержки пациентов с COVID-19. Решаются задачи классификации исходного состояния и течения болезни у пациентов с инфекцией COVID-19 и построения математической модели динамики состояний пациентов в отделении интенсивной терапии. В работе анализируются данные анамнеза, оценивается влияние сопутствующих хронических заболеваний и возраста пациента на тяжесть COVID-19 и эффективность терапии. Построена и исследована математическая модель динамики состояний пациентов с COVID-19. Получены оценки параметров модели для групп пациентов с разными хроническими заболеваниями. Уточнена структура индекса коморбидности 1 , позволяющего оценить влияние сопутствующих хронических (коморбидных) заболеваний на тяжесть и исход COVID-19. Предложен подход к выбору эффективного метода поддержки дыхания у пациентов с тяжелыми формами инфекции COVID-19. Ключевые слова: COVID-19, математическое моделирование, марковская модель, коморбидность.

2025, Diabetes Technology & Therapeutics

Background: Postmarketing reports have linked exenatide use with acute pancreatitis and pancreatic cancer, but a definitive relationship has yet to be established. Subjects and Methods: We conducted a retrospective cohort analysis of patients with type 2 diabetes with employer-provided health insurance from 2007 to 2009. Multivariate models estimated the association between exenatide use and acute pancreatitis and pancreatic cancer. We required at least 1 year of exenatide exposure in the pancreatic cancer analysis. Sensitivity analyses were conducted that quasirandomized exenatide use based on patient out-of-pocket costs. Results: Among 268,561 patients included in the acute pancreatitis analysis, only 2.6% used exenatide. Hospitalization for acute pancreatitis was rare (0.247% of patients). In unadjusted and adjusted analyses, patients who did not use exenatide were more likely to be hospitalized for acute pancreatitis (0.249% vs. 0.196% in unadjusted analysis), but the difference was not statistically significant in either analysis (P = 0.22 and P = 0.70, respectively). Among 209,306 patients in the pancreatic cancer analysis, 0.070% were diagnosed with pancreatic cancer, and 0.88% had at least 1 year of continuous exenatide exposure prior to the diagnosis. Those with exenatide exposure had higher rates of pancreatic cancer compared with those without (0.081% vs. 0.070% in unadjusted analysis). In both unadjusted and adjusted analyses, the difference was not statistically significant (P = 0.80 and P = 0.46, respectively). In sensitivity analyses, results were similar. Conclusions: We found no association between exenatide use and either hospitalization for acute pancreatitis or pancreatic cancer in a large sample of privately insured U.S. patients.

2025, HPB

cadaveric grafts are not sufficient for several reasons, and an availability of graft vessels are limited. Method: We herein report the case of a 57-year-old patient who underwent LDLT due to a hepatitis B + D viruscoinfected liver cirrhosis that was complicated with hepatic artery dissection extended into celiac trunk. Because of massive gastric collateral varices, direct anastomosis to supraceliac aorta was not possible. Therefore, extraanatomical jump graft reconstruction was performed from right iliac artery to the graft's hepatic artery using autologous graft vein (Great saphenous vein). Result: The postoperative period was uneventful and the patient has been followed up with patent arterial flow. Conclusion: When there is no other option of reconstruction arteries, this method is feasible option for extraanatomical jump graft reconstruction.

2025, Updates in Surgery

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment...

2025, Updates in Surgery

Despite existing evidence-based practice guidelines for the management of biliary acute pancreatitis (AP), the clinical compliance with recommendations is overall poor. Studies in this field have identified significant discrepancies between evidence-based recommendations and daily clinical practice. The most commonly reported gaps between clinical practice and AP guidelines include the indications for CT scan, need and timing of artificial nutritional support, indications for antibiotics, and surgical/endoscopic management of biliary AP. The MANCTRA-1 (coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis) study is aiming to identify the areas for quality improvement that will require new implementation strategies. The study primary objective is to evaluate which items of the current AP guidelines are commonly disregarded and if they correlate with negative clinical outcomes according to the different clinical presentations of the disease. We attempt to summarize the main areas of sub-optimal care due to the lack of compliance with current guidelines to provide the basis for introducing a number of bundles in AP patients' management to be implemented during the next years. The MANCTRA-1 study is an international multicenter, retrospective cohort study with the purpose to assess the outcomes of patients admitted to hospital with a diagnosis of biliary AP and the compliance of surgeons worldwide to the most up-to-dated international guidelines on biliary AP. ClinicalTrials.

2025, Pediatric Review: International Journal of Pediatric Research

Acute pancreatitis as an initial presentation of SLE in paediatric age group is extremely rare and needs high level of suspicion to make timely diagnosis as results may be fatal when not treated on time.

2025, Pediatric Review: International Journal of Pediatric Research

2025, Vojnosanitetski pregled

Background/Aim. Early assessment of severity and continuous monitoring of patients are the key factors for adequate treatment of acute pancreatitis (AP). The aim of this study was to determine the value of procalcitonin (PCT) and Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system as prognostic markers in early stages of AP with comparison to other established indicators such as Creactive protein (CRP) and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Methods. This prospective study included 51 patients (29 with severe AP). In the first 24 h of admission in all patients the APACHE II score and BISAP score, CRP and PCT serum concentrations were determined. The values of PCT serum concentrations and BISAP score were compared with values of CRP serum concentrations and APACHE II score, in relation to the severity and outcome of the disease. Results. Values of PCT, CRP, BISAP score and APACHE II score, measured at 24 h of admission, were significa...

2025, Przeglad Gastroenterologiczny

Autoimmune pancreatitis (AIP) is an insidious disease of non-specific symptomatology. To make correct diagnosis three different findings must correlate: radiological imaging, serological markers, and histology. This is not easy, and furthermore an incorrect diagnosis can lead to incorrect management and even patient death. We present our experience with a case of AIP in a young woman (34 years old) affected by different autoimmune pathologies with a history of abdominal pain. The diagnosis was made correlating histological findings and anamnestic data, although there were no radiological or serological findings. However, the management of this case was complicated by acute pancreatitis. In our case, we had only a histological sample and anamnestic data. So in these cases of positive history for autoimmune disorders and unclear clinical signs, AIP should be considered in differential diagnosis.

2025, Gastroenterology Review

2025, Archives of Disease in Childhood

Twenty five children with non-traumatic relapsing acute or chronic pancreatitis who had been followed up from five months to seven years were studied. Seven had congenital anomalies, including two with choledochal cysts and four with pancreas divisum. Alcohol related disease was suspected in one child. The importance of diabetes in two patients and a positive family history in a further three is discussed, but in 12 children no association was found. Management was similar to that for adults. Surgical intervention was required in six patients, and percutaneous drainage of pseudocysts in a further three. Outcome has generally been good. Pancreatitis is unusual in children and has a different aetiological spectrum from that seen in adults. Trauma, drugs, and infection are relatively more common causes; gall stone and alcohol related disease are rarely seen.1 Most acute attacks are self limiting and do not result in permanent damage or disability. Over the past nine years we have studied 25 children with persisting problems due to relapsing acute and chronic pancreatitis.

2025, World journal of gastroenterology : WJG

To evaluate the accuracy of red cell distribution width (RDW) to platelet ratio (RPR) to predict in-hospital mortality in acute pancreatitis (AP). Between January 2010 and June 2012, 102 patients with AP were recruited to the study. In this retrospective cohort study, for all subjects, demographic data on hospital admission, AP etiology, co-morbid diseases, organ failure assessment, laboratory parameters and length of hospital stay were examined. Additionally, we used a non-invasive prediction method in addition to the RPR to evaluate the disease severity. Multivariate logistic regression analyses were used to evaluate the impact of RPR on hospital admission to predict mortality. The male-female ratio (59/43) was 1.37 with a median age of 56.5 years (17-89 years). In both univariate and multivariate analyses, RDW and RPR were presented as independent and significant variables on admission to predict mortality. The RPR obtained on hospital admission was persistently higher among non-...

2025, International Journal of Molecular Sciences

Acute pancreatitis (AP) is an inflammatory disorder of the pancreas that, when classified as severe, is associated with high morbidity and mortality. Promptly identifying the severity of AP is of extreme importance for improving clinical outcomes. The aim of this study was to compare the prognostic value of serological biomarkers, ratios, and multifactorial scores in patients with acute biliary pancreatitis and to identify the best predictors. In this observational and prospective study, the biomarkers, ratios and multifactorial scores were evaluated on admission and at 48 h of the symptom onset. On admission, regarding the AP severity, the white blood count (WBC) and neutrophil-lymphocyte ratio (NLR), and regarding the mortality, the WBC and the modified Marshall score (MMS) showed the best predictive values. At 48 h, regarding the AP severity, the hepcidin, NLR, systemic inflammatory response index (SIRI) and MMS and regarding the mortality, the NLR, hepcidin and the bedside index for severity in AP (BISAP) score, showed the best predictive values. The present study enabled the identification, for the first time, of SIRI as a new prognostic tool for AP severity, and validated hepcidin and the NLR as better prognostic markers than C-reactive protein (CRP) at 48 h of symptom onset.

2025, International Journal of Molecular Sciences

Acute pancreatitis (AP) is an inflammatory disorder of the pancreas that, when classified as severe, is associated with high morbidity and mortality. Promptly identifying the severity of AP is of extreme importance for improving clinical outcomes. The aim of this study was to compare the prognostic value of serological biomarkers, ratios, and multifactorial scores in patients with acute biliary pancreatitis and to identify the best predictors. In this observational and prospective study, the biomarkers, ratios and multifactorial scores were evaluated on admission and at 48 h of the symptom onset. On admission, regarding the AP severity, the white blood count (WBC) and neutrophil–lymphocyte ratio (NLR), and regarding the mortality, the WBC and the modified Marshall score (MMS) showed the best predictive values. At 48 h, regarding the AP severity, the hepcidin, NLR, systemic inflammatory response index (SIRI) and MMS and regarding the mortality, the NLR, hepcidin and the bedside index...

2025, International Journal of Molecular Sciences

Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and systemic complications. Numerous studies have been published about the pathogenesis of AP; however, the precise mechanism behind this pathology remains unclear. Extensive research conducted over the last decades has demonstrated that the first 24 h after symptom onset are critical for the identification of patients who are at risk of developing complications or death. The identification of these subgroups of patients is crucial in order to start an aggressive approach to prevent mortality. In this sense and to avoid unnecessary overtreatment, thereby reducing the financial implications, the proper identification of mild disease is also important and necessary. A large number of multifactorial scoring systems and biochemical markers are described to predict the severity. Despite recent progr...

2025, International Journal of Molecular Sciences

Acute pancreatitis (AP) is a severe disease associated with high morbidity and mortality. Clinical studies can provide some data concerning the etiology, pathophysiology, and outcomes of this disease. However, the study of early events and new targeted therapies cannot be performed on humans due to ethical reasons. Experimental murine models can be used in the understanding of the pancreatic inflammation, because they are able to closely mimic the main features of human AP, namely their histologic glandular changes and distant organ failure. These models continue to be important research tools for the reproduction of the etiological, environmental, and genetic factors associated with the pathogenesis of this inflammatory pathology and the exploration of novel therapeutic options. This review provides an overview of several murine models of AP. Furthermore, special focus is made on the most frequently carried out models, the protocols used, and their advantages and limitations. Final...

2025, Carolina Digital Repository (University of North Carolina at Chapel Hill)

The pathogenic mechanisms underlying acute pancreatitis are not clear. Two key pathologic acinar cell responses of this disease are vacuole accumulation and trypsinogen activation. We show here that both result from defective autophagy, by comparing the autophagic responses in rodent models of acute pancreatitis to physiologic autophagy triggered by fasting. Pancreatitis-induced vacuoles in acinar cells were greater in number and much larger than those induced with fasting. Degradation of long-lived proteins, a measure of autophagic efficiency, was markedly inhibited in in vitro pancreatitis, while it was stimulated by acinar cell starvation. Further, processing of the lysosomal proteases cathepsin L (CatL) and CatB into their fully active, mature forms was reduced in pancreatitis, as were their activities in the lysosome-enriched subcellular fraction. These findings indicate that autophagy is retarded in pancreatitis due to deficient lysosomal degradation caused by impaired cathepsin processing. Trypsinogen activation occurred in pancreatitis but not with fasting and was prevented by inhibiting autophagy. A marker of trypsinogen activation partially localized to autophagic vacuoles, and pharmacologic inhibition of CatL increased the amount of active trypsin in acinar cells. The results suggest that retarded autophagy is associated with an imbalance between CatL, which degrades trypsinogen and trypsin, and CatB, which converts trypsinogen into trypsin, resulting in intra-acinar accumulation of active trypsin in pancreatitis. Thus, deficient lysosomal degradation may be a dominant mechanism for increased intra-acinar trypsin in pancreatitis.

2025, Experimental Cell Research

Acinar cells in pancreatitis die through apoptosis and necrosis, the roles of which are different. The severity of experimental pancreatitis correlates directly with the extent of necrosis and inversely, with apoptosis. Apoptosis is mediated by the release of cytochrome c into the cytosol followed by caspase activation, whereas necrosis is associated with the mitochondrial membrane potential (ΔΨm) loss leading to ATP depletion. Here, we investigate the role of Bcl-2 proteins in apoptosis and necrosis in pancreatitis. We found up-regulation of prosurvival Bcl-2 proteins in pancreas in various experimental models of acute pancreatitis, most pronounced for Bcl-xL. This up-regulation translated into increased levels of Bcl-xL and Bcl-2 in pancreatic mitochondria. Bcl-xL/Bcl-2 inhibitors induced ΔΨm loss and cytochrome c release in isolated mitochondria. Corroborating the results on mitochondria, Bcl-xL/Bcl-2 inhibitors induced ΔΨm loss, ATP depletion and necrosis in pancreatic acinar cells, both untreated and hyperstimulated with CCK-8 (in vitro pancreatitis model). Together Bcl-xL/Bcl-2 inhibitors and CCK induced more necrosis than either treatment alone. Bcl-xL/Bcl-2 inhibitors also stimulated cytochrome c release in acinar cells leading to caspase-3 activation and apoptosis. However, different from their effect on pronecrotic signals, the stimulation by Bcl-xL/Bcl-2 inhibitors of apoptotic responses was less in CCK-treated than control cells. Therefore, Bcl-xL/Bcl-2 inhibitors potentiated CCK-induced necrosis but not apoptosis. Correspondingly, transfection with Bcl-xL siRNA stimulated necrosis but not apoptosis in the in vitro pancreatitis model. Further, in animal models of pancreatitis Bcl-xL up-regulation inversely correlated with necrosis, but not apoptosis. Results indicate that Bcl-xL and Bcl-2 protect acinar cells from necrosis in pancreatitis by stabilizing mitochondria against death signals. We conclude that Bcl-xL/Bcl-2 inhibition would aggravate acute pancreatitis, whereas Bcl-xL/Bcl-2 up-regulation presents a strategy to prevent or attenuate necrosis in pancreatitis.

2025, American Journal of Physiology-Gastrointestinal and Liver Physiology

Transcription factor nuclear factor-κB (NF-κB) is activated in cerulein pancreatitis and mediates cytokine expression. The role of transcription factor activation in other models of pancreatitis has not been established. Here we report upregulation of NF-κB and inflammatory molecules, and their correlation with local pancreatic injury, in a model of severe pancreatitis. Rats received intraductal infusion of taurocholate or saline, and the pancreatic head and tail were analyzed separately. NF-κB and activator protein-1 (AP-1) activation were assessed by gel shift assay, and mRNA expression of interleukin-6, tumor necrosis factor-α, KC, monocyte chemoattractant protein-1, and inducible nitric oxide synthase was assessed by semiquantitative RT-PCR. Morphological damage and trypsin activation were much greater in the pancreatic head than tail, in parallel with a stronger activation of NF-κB and cytokine mRNA. Saline infusion mildly affected these parameters. AP-1 was strongly activated ...

2025, Pancreatology

Pancreas divisum (PD) is the most common congenital variant of the pancreas and has been implicated as a cause of pancreatitis; however, endoscopic treatment is controversial. Our objective was to examine patient response to endotherapy for treatment of symptomatic PD in adult patients in a systematic review of the literature. A systematic review of all case series and caseecontrol studies with ten or more patients undergoing endotherapy for treatment of symptomatic PD indicated by acute recurrent pancreatitis (ARP), chronic pancreatitis (CP), or chronic abdominal pain (CAP) was performed. PubMed, Embase, and Web of Science databases were searched from inception through February 2013 using [pancreas divisum] AND [endoscopic retrograde cholangiopancreatography (ERCP)] OR [endotherapy] OR [endoscopy] as search terms. Importantly, the majority of studies were retrospective in nature, significantly limiting analysis capacity. Main outcomes measures included endotherapy response rate in patients with PD and ARP, CP, or CAP. Twenty-two studies were included in the review, with a total of 838 patients. Response to endoscopy was seen in 528 patients, but response rate varied by clinical presentation. Patients with ARP had a response rate ranging from 43% to 100% (median 76%). Reported response rates were lower in the other two groups, ranging from 21% to 80% (median 42%) for patients with CP and 11%e55% (median 33%) for patients with CAP. Complications reported included perforation, postendoscopic retrograde cholangiopancreatography pancreatitis, bleeding, and clogged stents. Endotherapy appears to offer an effective treatment option for patients with symptomatic PD, with the best results in patients presenting with ARP.

2025, Curēus

This case report discusses the diagnostic challenges and management complexities in a patient presenting with symptoms of diabetic ketoacidosis (DKA) and severe pancreatitis, complicated by concurrent hypertriglyceridemia (HTG) and superior mesenteric vein (SMV) thrombosis. The presence of DKA in acute pancreatitis suggests very severe impact on the pancreas. Hence, it calls for screening with CT imaging for complications like hemorrhagic pancreatitis, necrotizing pancreatitis, or even thrombus. Despite typical reliance on clinical presentation and serum lipase for diagnosing pancreatitis, this case emphasizes the necessity of contrast-enhanced CT imaging in ambiguous cases to identify critical complications like thrombosis and necrotizing pancreatitis. Furthermore, the patient's management involved insulin therapy for DKA and HTG-induced acute pancreatitis, deferring plasmapheresis and anticoagulation due to the risk of hemorrhagic transformation in pancreatitis. This approach highlights the need for individualized treatment strategies, especially in complex presentations with overlapping pathologies. The case also explores the potential for insulin as a first-line treatment in HTG-induced pancreatitis over plasmapheresis, contributing to evolving guidelines.

2025, Case Reports in Clinical Medicine

The most common vascular complication of acute pancreatitis is thrombosis of the splenic vein. Isolated thrombosis of the superior mesenteric vein is rare and may lead to mesenteric ischemia and bowel infarction. We report the case of a 39 years old patient received for acute pancreatitis with a Ranson score less than 3 and image scanner for a grade C of Balthazar and a superior mesenteric vein thrombosis. The outcome was favorable with improvement of symptoms under medical treatment including anti-coagulant therapy. The contrast enhancing abdominal CT showed an absence of superior mesenteric thrombosis.

2025, Pan African Medical Journal

Introduction: we present a rat experimental model used to evaluate the possible reduction in the extent of pancreatic tissue injury in acute pancreatitis cases, after administration of eugenol. Methods: one hundred and twenty Wistar rats were used, which were randomly assigned in 3 groups: sham (n=20), control (n=50) and eugenol (n=50). Acute pancreatitis was induced by biliopancreatic ligation in the control and eugenol groups, but not in the Sham group. In the eugenol group, eugenol was administered per-os. Five histopathological parameters, such as edema, inflammatory infiltration, duct dilatation, hemorrhage and acinar necrosis were evaluated. Results: at 72 h from acute pancreatitis induction, the total histological score was diminished in the eugenol group (p<0.0005) and duct dilatation and inflammatory infiltration were reduced compared to the control group (p<0.05). In addition, at 72 h, eugenol reduced pancreatic myeloperoxidase activity (p<0.0005). Conclusion: eugenol, a highly free radical scavenger agent, may have a preventive role in acute pancreatic injury, as it was evident in our rat experimental model.

2025, In Vivo

Background/Aim: This study investigated the anti-inflammatory effect of apigenin in an experimental model of acute pancreatitis. Inflammatory response was reflected by tissue expression of the cytokine TNF-α coupled with histological examination. Materials and Methods: Wistar rats were divided into three groups: Sham-group animals underwent laparotomy only, without any other interventions. Control-group animals underwent laparotomy and bilio-pancreatic duct ligation to induce pancreatitis without apigenin administration. Apigenin group animals were further treated with apigenin. Euthanasia was performed at 6, 12, 24, 48 and 72 h post-operatively. Apigenin slows progression and reduces severity of acute pancreatitis. Apigenin may serve as an adjunct to a more successful therapeutic strategy in acute pancreatitis.

Gallbladder disease encompasses a spectrum of conditions ranging from asymptomatic cholelithiasis to acute and chronic cholecystitis, functional acalculous variants, and malignant transformation. Chronic calculous cholecystitis remains the most prevalent manifestation, typically associated with gallstone formation, which affects up to 20–25 million individuals in the United States. Annually, more than 750,000 cholecystectomies are performed, underscoring the burden of disease. Risk factors include female sex, obesity, diabetes, hormonal exposure, advanced age, liver disease, and rapid weight loss. Acute presentations may mimic gastrointestinal or cardiovascular conditions, necessitating careful clinical differentiation.
The pathogenesis of cholecystitis involves either mechanical obstruction of the cystic duct, most commonly by gallstones, or functional hypokinesis of the gallbladder, frequently seen in critically ill patients. Historically, diagnostic modalities evolved from plain radiographs and contrast-based studies such as oral cholecystograms to more advanced imaging techniques. Modern diagnostics emphasize ultrasonography as the first-line modality, given its high sensitivity for gallstones and associated inflammatory changes. Computed tomography (CT) and magnetic resonance imaging (MRI), particularly magnetic resonance cholangiopancreatography (MRCP), are invaluable for evaluating complications and malignancy. Functional studies such as hepatobiliary iminodiacetic acid (HIDA) scans, with or without cholecystokinin stimulation, provide near-definitive diagnosis in equivocal cases, especially acalculous disease.
Correct interpretation of imaging findings is vital to prevent delayed diagnosis, which could lead to serious complications such as gangrenous cholecystitis, perforation, or advanced gallbladder cancer. Mastery of the strengths, limitations, and indications of each diagnostic modality remains essential for clinicians managing gallbladder disease in contemporary practice.

The abdominal examination remains a cornerstone of diagnostic medicine, offering immediate insights into gastrointestinal, hepatobiliary, vascular, and systemic pathologies. Despite technological advancements in imaging, the physical examination—culminating in the Digital Rectal Examination (DRE)—retains indispensable value in guiding diagnostic reasoning, triage, and therapeutic decision-making. This paper explores the abdominal and rectal examination in comprehensive detail, expanding on historical foundations, anatomical considerations, and advanced clinical maneuvers. The DRE, frequently underutilized in modern practice, is analyzed for its diagnostic yield in conditions ranging from anorectal disease to prostatic pathology and occult gastrointestinal bleeding. Issues of concern—including declining emphasis on bedside skills, medico-legal implications, and challenges in pediatric assessment—are critically evaluated. Furthermore, case-based evidence underscores the enduring relevance of these techniques in detecting rare or atypical conditions, influencing imaging selection, and improving patient outcomes. Finally, the role of interdisciplinary collaboration and documentation is highlighted as essential for optimizing diagnostic precision and clinical care in diverse healthcare settings.

X-ray imaging remains one of the most fundamental diagnostic modalities in modern medicine, despite the advent of advanced imaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI). Its widespread clinical adoption is attributed to its accessibility, low cost, portability, and relatively low radiation dose compared to cross-sectional imaging techniques. This review comprehensively examines the principles and practice of radiographic imaging, including system components, image acquisition, radiation production and interactions, image quality optimization, radiation protection strategies, and interprofessional communication in radiology. Special emphasis is placed on the physics of x-ray generation, photon-matter interactions, contrast mechanisms, and digital detector technologies. The discussion further extends to clinical applications across thoracic, abdominal, musculoskeletal, pediatric, and interventional radiology. The enduring role of radiography in medical practice, particularly in pediatric and trauma imaging, reflects its indispensable contribution to rapid diagnosis, patient management, and population-based screening programs such as mammography. Interprofessional collaboration is highlighted as a critical determinant of diagnostic accuracy and patient safety, given the multi-step workflow spanning ordering providers, technologists, and radiologists. This paper consolidates both technical and clinical aspects of x-ray examinations, reinforcing their continued centrality in diagnostic radiology and clinical decision-making.

2025, Cureus

Cullen's sign is well described in the literature as subcutaneous ecchymosis in the periumbilical region. It is most commonly represented with acute pancreatitis. Recently, there have been many case reports associated with this sign to different clinical scenarios. A 61-year-old gentleman reported to the ED with left flank pain, intermittent fever, and a periumbilical ecchymosis on abdominal examination. Numerous tests were performed to rule out the likelihood of acute pancreatitis. The patient was diagnosed with acute pyelonephritis and received appropriate treatment. Cullen's sign should raise suspicions of retroperitoneal or intraabdominal abnormalities. While the pathophysiological process underlying the emergence of this symptom frequently signals retroperitoneal bleed, this is not always the case.

2025, Journal of Clinical Oncology

The mechanism is unknown, and genetic predisposition to asparaginase-induced pancreatitis has not been previously identified. To determine clinical risk factors for asparaginase-induced pancreatitis, we studied a cohort of 5,185 children and young adults with acute lymphoblastic leukemia, including 117 (2.3%) who were diagnosed with at least one episode of acute pancreatitis during therapy. A genome-wide association study was performed in the cohort and in an independent case-control group of 213 patients to identify genetic risk factors. Risk factors associated with pancreatitis included genetically defined Native American ancestry (P , .001), older age (P , .001), and higher cumulative dose of asparaginase (P , .001). No common variants reached genome-wide significance in the genome-wide association study, but a rare nonsense variant rs199695765 in CPA2, encoding carboxypeptidase A2, was highly associated with pancreatitis (hazard ratio, 587; 95% CI, 66.8 to 5166; P = 9.0 3 10 29 ). A gene-level analysis showed an excess of additional CPA2 variants in patients who did versus those who did not develop pancreatitis (P = .001). Sixteen CPA2 single-nucleotide polymorphisms were associated (P , .05) with pancreatitis, and 13 of 24 patients who carried at least one of these variants developed pancreatitis. Biologic functions that were overrepresented by common variants modestly associated with pancreatitis included purine metabolism and cytoskeleton regulation. Older age, higher exposure to asparaginase, and higher Native American ancestry were independent risk factors for pancreatitis in patients with acute lymphoblastic leukemia. Those who inherit a nonsense rare variant in the CPA2 gene had a markedly increased risk of asparaginase-induced pancreatitis.

2025, Journal of clinical oncology : official journal of the American Society of Clinical Oncology

Acute pancreatitis is one of the common causes of asparaginase intolerance. The mechanism is unknown, and genetic predisposition to asparaginase-induced pancreatitis has not been previously identified. To determine clinical risk factors for asparaginase-induced pancreatitis, we studied a cohort of 5,185 children and young adults with acute lymphoblastic leukemia, including 117 (2.3%) who were diagnosed with at least one episode of acute pancreatitis during therapy. A genome-wide association study was performed in the cohort and in an independent case-control group of 213 patients to identify genetic risk factors. Risk factors associated with pancreatitis included genetically defined Native American ancestry (P < .001), older age (P < .001), and higher cumulative dose of asparaginase (P < .001). No common variants reached genome-wide significance in the genome-wide association study, but a rare nonsense variant rs199695765 in CPA2, encoding carboxypeptidase A2, was highly as...

2025, Journal of Pediatric Hematology/Oncology

Treatment with asparaginase for acute lymphoblastic leukemia (ALL) can cause acute pancreatitis. Complication of pancreatitis by pancreatic pseudocyst formation can prolong the hospital stay, delay chemotherapy, and necessitate long-term parenteral nutrition. We report five children with ALL who developed acute pancreatitis complicated by pancreatic pseudocysts. They required modifications to their chemotherapy regimen and prolonged parenteral nutrition but no surgical intervention. All five patients survive in first remission and their pseudocysts resolved after 3 to 37 months or continued to decrease in size at last follow-up. These cases illustrate that nonsurgical management of pancreatic pseudocyst is safe, though pseudocyst resolution may require many months. In addition, these patients demonstrate that oral feeding can be initiated after the acute episode of pancreatitis resolves even if a pseudocyst is present.

2025, Abdominal Radiology

from exocrine insufficiency, with diabetes mellitus (DM) being a frequent laboratory finding. While symptomatic cases are managed medically or surgically, the approach to asymptomatic or incidentally detected DPA remains unclear. Patients with incidentally detected DPA face a disconcertingly high risk of serious complications that significantly impact their long-term health. The incidence of diabetes mellitus among these individuals ranges from a staggering 10-83%, with 25-30% developing diabetesrelated complications. Furthermore, nearly 30% present with exocrine pancreatic insufficiency, leading to debilitating symptoms such as steatorrhea and malabsorption. The risk of pancreatitis is also alarmingly high, with some studies documenting occurrences as high as 40%. Additionally, patients with DPA are predisposed to pancreatic neoplasms, including pancreatic ductal adenocarcinoma, with approximately 15-20% developing such malignancies [1]. These alarming statistics underscore the critical Gautam Shubhankar

2025, BMJ open

Acute pancreatitis (AP) is associated with high morbidity and mortality in its most severe forms. Most patients with severe AP require intubation and invasive mechanical ventilation, frequently for more than 7 days, which is associated with the worst outcome. Recent increasing evidence from preclinical and clinical studies support the beneficial effects of epidural analgesia (EA) in AP, such as increased gut barrier function and splanchnic, pancreatic and renal perfusion, decreased liver damage and inflammatory response, and reduced mortality. Because recent studies suggest that EA might be a safe procedure in the critically ill, we sought to determine whether EA reduced AP-associated respiratory failure and other major clinical outcomes in patients with AP. The Epidural Analgesia for Pancreatitis (EPIPAN) trial is an investigator-initiated, prospective, multicentre, randomised controlled two-arm trial with assessor-blinded outcome assessment. The EPIPAN trial will randomise 148 pat...

2025, Critical Care

The awareness of the diagnostic difficulty and the documented high mortality risk of perioperative myocardial infarction (PMI) has led to the wide use of work up to rule out PMI after major noncardiac operations. This has caused stable postoperative patients to be kept in monitored hospital beds for extended periods of time and to be subjected to additional tests. We hypothesized that the mortality of PMI is high and, therefore, the wide use of postoperative work up to identify these patients is justifiable. We performed the following study to prove our hypothesis. All patients in the recovery room after major noncardiac operations who underwent work up to rule out PMI were identified and followed. The PMI work up included care in an electronically monitored unit, physical assessment, continuous ECG monitoring, and three 12lead electrocardiograms and cardiac enzymes obtained at six to eight hour intervals. Data collection included patient demographics; preoperative cardiac risk factors; incidence of intraoperative hypotension, hemorrhage and ECG changes; type of anesthesia and operative procedures and their durations; postoperative ECG and cardiac enzyme results; the incidence of PMI and patient outcome. Two hundred patients were studied; 85 males and 115 females. Their mean age was 62.9 years. Preexisting conditions included hypertension in 162 patients, peripheral arterial disease in 102, diabetes mellitus in 97, angina in 30, previous myocardial infarction in 41, and smoking in 107. Of 200 patients, 164 had an abnormal preoperative ECG. Vascular operations were performed in 104 patients, nonvascular abdominal operations in 48, and other operations in the remaining 48. Intraoperatively, hypotension occurred in 29 patients, blood loss of >500 ml in 25 and ECG changes in 10. There were no deaths. PMI occurred in 5/200 (2.5%) patients. Four had undergone vascular operations and one had had an abdominal operation. The mean age of the patients with PMI was 64.2 years. The duration of operation and blood loss were similar to those of patients without PMI. None of these patients developed cardiac failure or cardiogenic shock and none of them died. The incidence of PMI among patients undergoing noncardiac surgery is low and its mortality is negligible. Physicians should become more selective in the use of monitored beds and in the ordering of a work up to rule out PMI.

2025, ACTA MEDICA PERUANA

La ascitis quilosa (AQ) es una entidad rara, y puede manifestarse como una reacción peritoneal llamada peritonitis quilosa aguda (PQA). Presentamos el caso de un varón de 26 años, con cuadro abdominal agudo, por lo que es intervenido quirúrgicamente, encontrándose líquido lechoso turbio, en cavidad abdominal, realizándose una apendicectomía profiláctica, aspiración y lavado de cavidad, con colocación de drenajes. El análisis de líquido mostró aumento de triglicéridos y amilasa, gram y cultivos negativos; y la tomografía reveló una pancreatitis aguda (Baltazar C), todo ello confirmando el diagnóstico de AQ secundaria a pancreatitis. Paciente cursa con una evolución favorable con hidratación, analgésicos y dieta vía oral a tolerancia. En la literatura se han descrito muy pocos casos de PQA, y su asociación con pancreatitis aguda es bastante inusual. Pudiendo simular un cuadro abdominal agudo quirúrgico, cuyo tratamiento consiste en la exploración quirúrgica con drenaje peritoneal, pud...

2025, International Journal of Molecular Sciences

Acute pancreatitis (AP) is a major, globally increasing gastrointestinal disease and a biliary origin is the most common cause. However, the effects of bile acids (BAs), given systemically, on the pancreas and on disease severity remains elusive. In this study, we have investigated the roles of different circulating BAs in animal models for AP to elucidate their impact on disease severity and the underlying pathomechanisms. BAs were incubated on isolated acini and AP was induced through repetitive injections of caerulein or L-arginine; pancreatic duct ligation (PDL); or combined biliopancreatic duct ligation (BPDL). Disease severity was assessed using biochemical and histological parameters. Serum cholecystokinin (CCK) concentrations were determined via enzyme immunoassay. The binding of the CCK1 receptor was measured using fluorescence-labeled CCK. In isolated acini, hydrophobic BAs mitigated the damaging effects of CCK. The same BAs further enhanced pancreatitis in L-arginine- and...