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Abdominal Radiology (New York) May 2020In patients with acute pancreatitis (AP), diagnostic imaging is performed for various reasons, including the detection of the etiology (e.g., biliary obstruction caused... (Review)
Review
In patients with acute pancreatitis (AP), diagnostic imaging is performed for various reasons, including the detection of the etiology (e.g., biliary obstruction caused by gallstones), diagnosis of pancreatitis in an unclear clinical setting, assessment of the severity of the process, and evaluation of its complications. In spite of the potential benefits of these imaging studies in the setting of AP, especially economic consequences but also medical risks are associated with diagnostic imaging, including increase of the effective radiation dose received by patients with AP and rising health care costs, frequently without impact on management. The rising incidence of acute pancreatitis in the Western world is escalating its financial burden with national health care expenses of over 2.5 billion dollars annually. Despite evidence-based national recommendations on utilization of diagnostic imaging in patients with AP, unnecessary imaging studies are still frequently performed, especially in the early hospital course. The purpose of this article is, therefore, to review the imaging guidelines for acute pancreatitis with regards to when and when not to image, with the aim to minimize inappropriate utilization.
Topics: Decision Making; Humans; Pancreatitis; Practice Guidelines as Topic; Severity of Illness Index; Unnecessary Procedures
PubMed: 31712865
DOI: 10.1007/s00261-019-02319-2 -
Expert Review of Gastroenterology &... Aug 2014Acute pancreatitis (AP) is a common medical condition with extensive morbidity and mortality. Approximately 210,000 Americans are hospitalized each year; and 5% of... (Review)
Review
Acute pancreatitis (AP) is a common medical condition with extensive morbidity and mortality. Approximately 210,000 Americans are hospitalized each year; and 5% of patients with AP will die. It is also an expensive condition, costing 2.6 billion dollars (United States) in 2009 alone. Moreover, the incidence is increasing - the National Hospital Discharge Survey showed hospitalizations increased from 78 per 100,000 in 2007 to 90 per 100,000 just three years later in 2010. There is no proven pharmacologic entity to treat the inflammatory response associated with acute pancreatitis; supportive care with IV fluids, bowel rest and pain control are the mainstays of therapy. Recently, new developments to help increase survival and minimize morbidity with several key interventions have been investigated. This summary highlights new studies and meta-analyses to provide current opinion on treatment of this morbid condition.
Topics: Acute Disease; Analgesics; Animals; Anti-Bacterial Agents; Combined Modality Therapy; Digestive System Surgical Procedures; Enteral Nutrition; Fluid Therapy; Humans; Pancreatitis; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 24766182
DOI: 10.1586/17474124.2014.907524 -
Current Opinion in Gastroenterology Sep 2021Approximately 20-30% of children who experience one episode of acute pancreatitis will have at least one additional episode. For some children, pancreatitis recurs... (Review)
Review
PURPOSE OF REVIEW
Approximately 20-30% of children who experience one episode of acute pancreatitis will have at least one additional episode. For some children, pancreatitis recurs multiple times and in a few years is followed by the diagnosis of chronic pancreatitis. Identifying risk factors for recurrent episodes and disease progression is critical to developing therapeutic interventions.
RECENT FINDINGS
Obesity is driving an increase in biliary stone disease and severe acute pancreatitis. Recurrent acute pancreatitis (RAP) may lead to the development of diabetes through autoimmune mechanisms. Cystic fibrosis or CFTR-related disorders may present as RAP and CFTR modulator therapy can increase or decrease the risk of acute pancreatitis in these populations. Children with Crohn disease have a three-fold risk of acute pancreatitis over the general population while children with ulcerative colitis are at increased risk for pediatric autoimmune pancreatitis, a disorder that may be distinct from autoimmune pancreatitis described in adults. Obstructive jaundice in the absence of identified mechanical factors may be a presenting sign of pediatric autoimmune pancreatitis.
SUMMARY
Pediatric RAP is a painful condition that leads to gland destruction and functional insufficiency. Risk factors are being clarified but preventive treatments remain elusive.
Topics: Acute Disease; Adult; Child; Cystic Fibrosis Transmembrane Conductance Regulator; Demography; Humans; Pancreatitis; Recurrence; Risk Factors
PubMed: 34120130
DOI: 10.1097/MOG.0000000000000764 -
SARS-CoV-2 and the pancreas: What do we know about acute pancreatitis in COVID-19 positive patients?World Journal of Gastroenterology Sep 2022Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause pancreatic damage, both directly to the pancreas angiotensin-converting enzyme 2 receptors (the...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause pancreatic damage, both directly to the pancreas angiotensin-converting enzyme 2 receptors (the transmembrane proteins required for SARS-CoV-2 entry, which are highly expressed by pancreatic cells) and indirectly through locoregional vasculitis and thrombosis. Despite that, there is no clear evidence that SARS-CoV-2 is an etiological agent of acute pancreatitis. Acute pancreatitis in coronavirus disease 2019 (COVID-19) positive patients often recognizes biliary or alcoholic etiology. The prevalence of acute pancreatitis in COVID-19 positive patients is not exactly known. However, COVID-19 positive patients with acute pancreatitis have a higher mortality and an increased risk of intensive care unit admission and necrosis compared to COVID-19 negative patients. Acute respiratory distress syndrome is the most frequent cause of death in COVID-19 positive patients and concomitant acute pancreatitis. In this article, we reported recent evidence on the correlation between COVID-19 infection and acute pancreatitis.
Topics: Acute Disease; Angiotensin-Converting Enzyme 2; COVID-19; Humans; Pancreas; Pancreatitis; SARS-CoV-2
PubMed: 36185634
DOI: 10.3748/wjg.v28.i36.5240 -
Digestive Diseases and Sciences Jun 2022Clinically significant ascites in acute pancreatitis (AP) is rarely encountered and is a result of multifactorial pathogenesis. Early reactionary ascites in AP usually... (Review)
Review
Clinically significant ascites in acute pancreatitis (AP) is rarely encountered and is a result of multifactorial pathogenesis. Early reactionary ascites in AP usually does not require any treatment and resolves spontaneously in majority of patients. A diagnostic analysis should be performed in case of ascites developing in the latter stages with increasing pain or worsening organ failure. Low serum albumin-ascites gradient ascites with amylase > 1000 U/l is highly suggestive of pancreatic ascites that is usually associated with duct disruption. A combination of nasojejunal feeding, subcutaneous octreotide, endoscopic drainage and rarely, surgery are employed in managing this difficult to treat condition. There is a need of further studies to better understand the clinical role of ascites as well as contribution of other factors like hypoalbuminemia and portal hypertension to its development in AP.
Topics: Acute Disease; Amylases; Ascites; Humans; Pancreatic Diseases; Pancreatitis
PubMed: 34036465
DOI: 10.1007/s10620-021-07063-6 -
Abdominal Radiology (New York) May 2020Ultrasound plays an essential role in the initial evaluation of patients with suspected or confirmed acute pancreatitis. In addition to evaluation of the pancreatic... (Review)
Review
Ultrasound plays an essential role in the initial evaluation of patients with suspected or confirmed acute pancreatitis. In addition to evaluation of the pancreatic parenchyma, ultrasound is used for assessment of the gallbladder, biliary tree, peripancreatic tissues, and regional vascular structures. While enlarged and edematous pancreas are classic sonographic features of acute pancreatitis, the pancreas may appear sonographically normal in the setting of acute pancreatitis. Nonetheless, sonographic evaluation in this setting is valuable because assessment for etiologic factors such as gallstones or evidence of biliary obstruction are best performed with ultrasound. Complications of pancreatitis such as peripancreatic fluid collections, venous thrombosis, or arterial pseudoaneurysm can be identified with careful and focused ultrasound examination. Knowledge of various scanning techniques can help to mitigate some of the commonly encountered barriers to sonographic visualization of the pancreas and right upper quadrant structures. Ultrasound can also be used for guidance of percutaneous treatment such as drainage of fluid collections or pseudoaneurysm thrombosis. Difficulty in differentiating edematous from necrotizing pancreatitis can be mitigated with the use of contrast-enhanced ultrasound to assess pancreatic parenchymal enhancement.
Topics: Contrast Media; Diagnosis, Differential; Humans; Pancreatitis; Ultrasonography
PubMed: 31844915
DOI: 10.1007/s00261-019-02364-x -
F1000Research 2018This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management... (Review)
Review
This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.
Topics: Acute Disease; Humans; Pancreatitis
PubMed: 30026919
DOI: 10.12688/f1000research.14244.2 -
Gastrointestinal Endoscopy Clinics of... Apr 2018Pseudocysts evolve from fluid collections and/or disruptions of the pancreatic duct. They may occur secondary to acute pancreatitis, pancreatic trauma, or chronic... (Review)
Review
Pseudocysts evolve from fluid collections and/or disruptions of the pancreatic duct. They may occur secondary to acute pancreatitis, pancreatic trauma, or chronic pancreatitis. Lacking the clinical information, radiologists may inappropriately call a fluid collection or any cystic lesion a pseudocyst. With no clear history of acute pancreatitis or chronic pancreatitis, this is rare. Complications include infection, intracystic hemorrhage, or rupture. Pseudocysts can become painful, especially with chronic pancreatitis, and can cause early satiety and weight loss when their size affects the stomach and bowel. Symptomatic pseudocysts can successfully be drained with via surgical, radiologic, or endoscopic drainage.
Topics: Ascitic Fluid; Drainage; Humans; Pancreatic Pseudocyst; Pancreatitis
PubMed: 29519326
DOI: 10.1016/j.giec.2017.11.001 -
Abdominal Radiology (New York) May 2020Acute pancreatitis is an increasingly common condition and can result in significant morbidity and mortality. Contrast enhanced computed tomography (CECT) is the primary... (Review)
Review
Acute pancreatitis is an increasingly common condition and can result in significant morbidity and mortality. Contrast enhanced computed tomography (CECT) is the primary initial imaging modality in the characterization of acute pancreatitis. In this article, we provide sample CECT technical acquisition parameters for pancreatic imaging. We also review the classification systems for acute pancreatitis and give examples of common and uncommon complications of acute pancreatitis.
Topics: Contrast Media; Humans; Pancreatitis; Tomography, X-Ray Computed
PubMed: 31559472
DOI: 10.1007/s00261-019-02236-4 -
AJR. American Journal of Roentgenology Mar 2016The objective of this article is to provide updates on acute pancreatitis in children regarding the imaging findings, causes, and complications based on a review of the... (Review)
Review
OBJECTIVE
The objective of this article is to provide updates on acute pancreatitis in children regarding the imaging findings, causes, and complications based on a review of the current studies in the pediatrics literature. We discuss the epidemiology of acute pancreatitis, the role of imaging and imaging findings in the diagnosis of acute pancreatitis, and the causes and complications of acute pancreatitis.
CONCLUSION
The incidence of acute pancreatitis is increasing in children. Imaging plays an important role in the diagnosis of acute pancreatitis because imaging findings can be used to establish the cause of acute pancreatitis, evaluate for complications of acute pancreatitis, and possibly predict the course of the disease.
Topics: Acute Disease; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Pancreatitis; Tomography, X-Ray Computed; Ultrasonography
PubMed: 26901022
DOI: 10.2214/AJR.14.14223