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An overweight patient with epigastric pain
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Acute pancreatitis causes upper abdominal pain, nausea and vomiting. The pain is most often present in the epigastric region and right upper quadrant and may radiate to the back (remember that the pancreas is retroperitoneal). It is sometimes relieved by leaning forwards.
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
The general management of uncomplicated acute pancreatitis is mainly supportive including bowel rest, fluid resuscitation, correction of electrolyte and metabolic abnormalities, and pain control. Volume depletion is frequently encountered due to vomiting and fluid sequestration into the retroperitoneum. Aggressive intravenous fluid replacement is necessary to prevent pancreatic necrosis and systemic complications. Patients are given nothing by mouth for bowel rest. Fluid and electrolyte balance is closely observed; in particular, correction of hypocalcemia and hypomagnesemia may be necessary. Abdominal pain is a prominent feature in acute pancreatitis and may be severe requiring analgesics. Intravenous opiates may be used cautiously for pain control during pregnancy. Meperidine and fentanyl are the preferred analgesics during pregnancy (129). Prophylactic antibiotics are not routinely recommended in uncomplicated pancreatitis if there is no evidence of infection (130). Although therapeutic delivery has been considered in the past, recent literature suggests that termination of pregnancy does not affect the outcome of acute pancreatitis and is not recommended (131).
Disorders of the digestive tract
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
In order to protect the pancreas from being damaged by the digestive enzymes it produces, those enzymes remain in an inactive form until they reach the duodenum. In the presence of gallstones, alcoholism and other conditions, the precursor enzymes can be activated while they are still in the pancreas, causing acute inflammation of the pancreas, known as acute pancreatitis. Chronic pancreatitis is due to repeated attacks of acute pancreatitis and is mainly associated with excessive alcohol consumption. Pancreatitis is rare, occurring in only one in 10 000, which includes men. In pregnancy it is usually associated with gallstones that block the pancreatic ampulla (Blackburn, 2007). There is some evidence that pancreatitis can be associated with pre-eclampsia (Opatrny, et al., 2004) and also that it may occur suddenly in the immediate postnatal period (Fukami, et al., 2003; Mechery and Burch, 2006).
Phytochemicals with protective effects against acute pancreatitis: a review of recent literature
Published in Pharmaceutical Biology, 2022
Yao Tang, Mingli Sun, Zhenning Liu
Acute pancreatitis is a complex disease caused by various pathogenic factors including biliary tract disease, excessive alcohol consumption, hyperlipidaemia, etc. As for the experimental studies, many unrelated stimuli were used to replicate human AP according to the previously published literature. Sodium taurocholate (NaT) or cerulein was mostly used to establish an experimental animal model of AP. NaT was retrogradely injected into the pancreatic duct to cause pancreatic acinar cells damage, and cerulein could promote the secretion of pancreatic proteolytic enzymes, leading to trypsinogen activation in pancreatic acinar cells. In addition, as shown in Table 1, hyperlipidaemia induced by a high‑fat diet or l-arginine injection in mice or rats was also used to induce AP. Nevertheless, none of the animal models can fully simulate the pathology of AP in humans.
Plasmapheresis in hypertriglyceridemia-induced acute pancreatitis
Published in Baylor University Medical Center Proceedings, 2022
Hafeez Shaka, Zain El-amir, Abdul Jamil, Robert Kwei-Nsoro, Farah Wani, Dushyant Singh Dahiya, Asim Kichloo, Ambika Amblee
Hypertriglyceridemia-induced acute pancreatitis (HTGAP) is a known complication of hypertriglyceridemia that can be fatal.1 Hypertriglyceridemia is reported to be the third leading cause of acute pancreatitis.2 HTGAP is characterized by the clinical syndrome of acute pancreatitis in the presence of severe hypertriglyceridemia (>1000 mg/dL) and the absence of other causes.3 Pancreatitis tends to be more severe in patients with HTGAP compared with other causes.4,5 The mainstay of management of acute pancreatitis is pancreatic rest, pain control, and fluid administration. In the subset of patients with HTGAP, insulin drip, and in select patients, plasmapheresis may be used as adjuvant therapy.6 There is a lack of randomized controlled studies investigating the benefit of plasmapheresis over other treatment modalities.1,2,7 In this study, we used 3 years of data from a national database to identify the demographic characteristics and outcomes of patients admitted with HTGAP who received plasmapheresis to obtain predictors of plasmapheresis in the national population. This study aimed to identify any factors that predict the choice of the procedure in these patients.
Successful management of germanium poisoning-induced multiple organ dysfunctions by combined blood purification therapy
Published in Current Medical Research and Opinion, 2020
Luyun Wang, Changlong Zheng, Daqiang Zhao
On day 8, his drowsiness ameliorated, but fatigue, dyspnea, and abdominal pain developed. The serum amylase markedly increased (Table 2). Abdominal computed tomographic (CT) scan showed normal structure of pancreatic body without tail, surrounded by a hypodense zone. Meanwhile, blood laboratory tests showed the levels of WBC and neutrophils increased and the calcium concentration was declined. These results indicated a diagnosis of acute pancreatitis. Elevated creatinine and bilirubin suggested the development of acute renal and liver injury. Intravenous somatostatin and omeprazole sodium were administrated, combined blood purification therapy and other supportive medications continued. The patient remained conscious with a total Glasgow Coma Scale (GCS) score of greater than 14 during hospitalization. He was drowsy at the peak of disease progress. On day 19, the patient received supportive therapy by ventilator due to pneumonia induced respiratory failure. Anti-infection treatment was strengthened. The Ramsay sedation scale was maintained between 2 and 3 during mechanical ventilation. In addition, the hemoglobin (Hb) level significantly declined during therapy and multiple blood transfusions were needed to maintain the Hb level at >75 g/L.