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JPMA. the Journal of the Pakistan... May 2024Acute pancreatitis is a common cause of acute abdominal pain and can range from mild oedema to severe necrosis of the pancreas. It has a significant impact on morbidity,... (Review)
Review
Acute pancreatitis is a common cause of acute abdominal pain and can range from mild oedema to severe necrosis of the pancreas. It has a significant impact on morbidity, mortality and financial burden. The global prevalence of pancreatitis is substantial, with the highest rates observed in central and eastern Europe. Diagnosing acute pancreatitis involves considering clinical symptoms, elevated serum amylase and/or lipase levels, and characteristic imaging findings. The causes of acute pancreatitis include obstructive disorders, such as gallstones and biliary sludge, alcohol consumption, smoking, drug-induced pancreatitis, metabolic disorders, trauma, medical procedures, infections, vascular diseases and autoimmune pancreatitis. Appropriate management of acute pancreatitis involves determining the severity of the condition, providing supportive care, addressing the underlying cause, and preventing complications. Advances in classifying the severity of acute pancreatitis and implementing goal-directed therapy have contributed to a decrease in mortality rates. Understanding its prevalence, aetiology and management principles is crucial for clinicians to appropriately diagnose and manage patients with acute pancreatitis.
Topics: Humans; Pancreatitis; Acute Disease; Severity of Illness Index; Gallstones
PubMed: 38783446
DOI: 10.47391/JPMA.9280 -
Current Opinion in Pediatrics Jun 1997The etiology of acute pancreatitis in children is widely varied and includes idiopathic, drug-related, congenital, and posttraumatic causes. Most children have abdominal... (Review)
Review
The etiology of acute pancreatitis in children is widely varied and includes idiopathic, drug-related, congenital, and posttraumatic causes. Most children have abdominal pain and tenderness without evidence of peritonitis, and most patients will have elevated serum amylase levels initially or after a delay of about 12 hours. If the diagnosis remains equivocal or in the setting of trauma, an abdominal CT scan should be obtained. Initial treatment for all forms of acute pancreatitis includes bowel rest and support with intravenous fluids. A nasogastric tube should only be placed for symptomatic relief and prophylactic broad-spectrum antibiotics should be given only in the setting of necrotizing pancreatitis, especially if patients are receiving pharmacologic immunosuppression. Fever or decline in clinical status should prompt CT scan with intravenous contrast and possible fine needle aspiration to detect the presence of sterile or infected necrotizing pancreatitis. Positive cultures or severely worsening clinical status are indications for necrosectomy and debridement with sequential packing and explorations. All patients who have had an episode of gallstone pancreatitis should have a cholecystectomy after resolution of pancreatic inflammation but before discharge from the hospital.
Topics: Abdominal Injuries; Acute Disease; Biliary Tract Diseases; Child; Cholecystectomy; Humans; Pancreatitis; Pancreatitis, Acute Necrotizing
PubMed: 9229166
DOI: 10.1097/00008480-199706000-00014 -
California Medicine Aug 1972FOR MANY DECADES TWO TYPES OF ACUTE PANCREATITIS HAVE BEEN RECOGNIZED: the edematous or interstitial and the hemorrhagic or necrotic. In most cases acute pancreatitis is... (Review)
Review
FOR MANY DECADES TWO TYPES OF ACUTE PANCREATITIS HAVE BEEN RECOGNIZED: the edematous or interstitial and the hemorrhagic or necrotic. In most cases acute pancreatitis is associated with alcoholism or biliary tract disease. Elevated serum or urinary alpha-amylase is the most important finding in diagnosis. The presence of methemalbumin in serum and in peritoneal or pleural fluid supports the diagnosis of the hemorrhagic form of the disease in patients with a history and enzyme studies suggestive of pancreatitis. There is no characteristic clinical picture in acute pancreatitis, and its complications are legion. Pancreatic pseudocyst is probably the most common and pancreatic abscess is the most serious complication. The pathogenetic principle is autodigestion, but the precise sequence of biochemical events is unclear, especially the mode of trypsinogen activation and the role of lysosomal hydrolases. A host of metabolic derangements have been identified in acute pancreatitis, involving lipid, glucose, calcium and magnesium metabolism and changes of the blood clotting mechanism, to name but a few. Medical treatment includes intestinal decompression, analgesics, correction of hypovolemia and other supportive and protective measures. Surgical exploration is advisable in selected cases, when the diagnosis is in doubt, and is considered imperative in the presence of certain complications, especially pancreatic abscess.
Topics: Acute Disease; Alcoholism; Biliary Tract Diseases; Blood Coagulation Disorders; Calcium; Diabetes Mellitus; Diagnosis, Differential; Female; Humans; Hypercalcemia; Hyperlipidemias; Lipid Metabolism; Pancreatitis; Postoperative Complications; Pregnancy; Pregnancy Complications, Infectious
PubMed: 4559467
DOI: No ID Found -
Journal of Pediatric Gastroenterology... Feb 2023
Topics: Humans; Pancreatitis; Acute Disease
PubMed: 36705693
DOI: 10.1097/MPG.0000000000003669 -
Der Anaesthesist Mar 2014Acute pancreatitis is a potentially fatal disease with individually differing expression of systemic involvement. For this reason early diagnosis with subsequent risk... (Review)
Review
Acute pancreatitis is a potentially fatal disease with individually differing expression of systemic involvement. For this reason early diagnosis with subsequent risk stratification is essential in the clinical management of this frequent gastroenterological disorder. Severe forms of acute pancreatitis occur in approximately 20 % of cases often requiring intensive care monitoring and interdisciplinary therapeutic approaches. In the acute phase adequate fluid replacement and sufficient analgesic therapy is of major therapeutic importance. Concerning the administration of antibiotics and the nutritional support of patients with acute pancreatitis a change in paradigms could be observed in recent years. Furthermore, endoscopic, radiological or surgical interventions can be necessary depending on the severity of the disease and potential complications.
Topics: Acute Disease; Analgesics; Anti-Bacterial Agents; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Endoscopy; Enteral Nutrition; Fluid Therapy; Humans; Nutritional Support; Pain; Pain Management; Pancreatitis; Pancreatitis, Acute Necrotizing
PubMed: 24577182
DOI: 10.1007/s00101-014-2307-x -
The New England Journal of Medicine Apr 1994
Review
Topics: Acute Disease; Humans; Pancreatitis; Prognosis
PubMed: 7811319
DOI: 10.1056/NEJM199404283301706 -
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 -
Journal of Hospital Medicine Apr 2010Acute pancreatitis is a common disease most frequently caused by gallstone disease or excess alcohol ingestion. Diagnosis is usually based on characteristic symptoms,... (Review)
Review
Acute pancreatitis is a common disease most frequently caused by gallstone disease or excess alcohol ingestion. Diagnosis is usually based on characteristic symptoms, often in conjunction with elevated serum pancreatic enzymes. Imaging is not always necessary, but may be performed for many reasons, such as to confirm a diagnosis of pancreatitis, rule out other causes of abdominal pain, elucidate the cause of pancreatitis, or to evaluate for complications such as necrosis or pseudocysts. Though the majority of patients will have mild, self-limiting disease, some will develop severe disease associated with organ failure. These patients are at risk to develop complications from ongoing pancreatic inflammation such as pancreatic necrosis, fluid collections, pseudocysts, and pancreatic duct disruption. Validated scoring systems can help predict the severity of pancreatitis, and thus, guide monitoring and intervention.Treatment of acute pancreatitis involves supportive care with fluid replacement, pain control, and controlled initiation of regular food intake. Prophylactic antibiotics are not recommended in acute pancreatitis if there is no evidence of pancreatic infection. In patients who fail to improve, further evaluation is necessary to assess for complications that require intervention such as pseudocysts or pancreatic necrosis. Endoscopy, including ERCP and EUS, and/or cholecystectomy may be indicated in the appropriate clinical setting. Ultimately, the management of the patient with severe acute pancreatitis will require a multidisciplinary approach.
Topics: Acute Disease; Humans; Middle Aged; Pancreatitis; Prognosis; Shock, Septic
PubMed: 20394032
DOI: 10.1002/jhm.574 -
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 -
The Surgical Clinics of North America Apr 1988In order to recognize acute pancreatitis in the setting of the acute abdomen, the surgeon must be thoroughly familiar with the numerous etiologies of the disease. No... (Review)
Review
In order to recognize acute pancreatitis in the setting of the acute abdomen, the surgeon must be thoroughly familiar with the numerous etiologies of the disease. No specific test is available to diagnose acute pancreatitis. CT scanning is arguably the most useful single tool, but surgical judgment is critical. Most cases of acute pancreatitis resolve spontaneously without sequelae, but the spectrum of the disease also includes highly lethal forms associated with a variety of systemic complications. Operative intervention is indicated when other, more rapidly fatal, abdominal processes cannot be reliably excluded and when local complications develop.
Topics: Abdomen, Acute; Acute Disease; Diagnosis, Differential; Diagnostic Imaging; Humans; Pancreatitis
PubMed: 3279547
DOI: 10.1016/s0039-6109(16)44478-6