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Pancreatitis—Chronic
Published in Charles Theisler, Adjuvant Medical Care, 2023
Chronic pancreatitis is characterized by permanent and progressive structural or functional damage of the pancreas with scarring (fibrosis). This results in exocrine and endocrine insufficiency and, often, chronic disabling pain. The symptoms are identical to acute pancreatitis. Most patients with chronic pancreatitis are alcoholics. Symptoms of chronic pancreatitis can include abdominal pain, malabsorption, bleeding due to anemia, liver problems leading to jaundice, weight loss, nutritional deficiencies, and an inability to produce insulin, resulting in diabetes.1
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
Following resuscitation, she rapidly improves and PCA analgesia controls her pain. What is the likeliest cause of her pancreatitis?The commonest causes of pancreatitis are gallstone disease and alcohol.I would initially request an USS elicit the aetiology, i.e. to look for gallstones.If this was negative and the history did not suggest alcohol intake, I would measure serum calcium and cholesterol levels (in particular the triglycerides) and look for drug-related causes (e.g. steroids).
Chronic Pancreatitis: Small Duct Disease with Uncontrolled Pain
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Michael F. Nentwich, Jakob R. Izbicki
The indication for surgery in small duct disease is a severe, continuous uncontrollable pain that affects daily life and leads to repeated hospital admissions. During the course of disease, pain usually will not spontaneously decrease (“burnout”) with vanishing pancreatic tissue. This can result in an addiction to pain medication; yet without adequate pain relief, the pain can have a severe effect on the patient’s life. The ongoing destruction of pancreatic tissue is unpredictable and surgery does not cure a chronic pancreatitis, but it can offer sufficient pain relief. As surgery for chronic pancreatitis can be performed with acceptable morbidity and mortality rates (in specialized centers), it offers a durable and good therapeutic option for pain control as well as for management of chronic pancreatitis complications (strictures, pseudocysts, pseudo tumors, etc.) and surgery is favored by randomized controlled trials over endoscopic therapies.
Inherited causes of exocrine pancreatic insufficiency in pediatric patients: clinical presentation and laboratory testing
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Tatiana N. Yuzyuk, Heather A. Nelson, Lisa M. Johnson
The diagnosis and management of pancreatitis in MMA/PA follow general guidelines. Standard measurement of amylase and lipase levels alone or in conjunction with CT/MRI scan can help to confirm a diagnosis of AP. Nonspecific elevation of amylase and lipase without evidence of pancreatic inflammation on ultrasound has been reported in a PA patient during metabolic crises, demonstrating the benefits of a combined diagnostic approach of imaging and laboratory results [88]. Measurement of lipase and amylase is also recommended at 6–12 months intervals [77]. The treatment of pancreatitis includes pain management, intravenous fluid administration, and adequate nutritional support (enteral feeding or total parenteral nutrition adjusted for protein content) to avoid dehydration and metabolic decompensation [89].
Radiolabeled FAPI in pancreatic cancer: can it be an additional value in the management of patients?
Published in Expert Review of Anticancer Therapy, 2023
Laura Evangelista, Viviana Frantellizzi, Orazio Schillaci, Luca Filippi
To date, only two papers enrolled exclusively patients with pancreatic cancer undergoing FAPI PET [12,32]. Totally, 55 patients underwent FAPI PET for the identification of the suspicious mass/primary tumor (n = 43) and recurrent disease (n = 12). In primary tumor, FAPI detects more lesions than 2-[18F]FDG with a sensitivity of 100% vs. 73.1%, respectively; conversely specificity of FAPI was lower than 2-[18F]FDG (30% vs. 60%). However, both sensitivity and specificity of FAPI were higher than 2-[18F]FDG in the node-based analysis. Similarly, the sensitivity and specificity of FAPI was higher than 2-[18F]FDG for the identification of bone and visceral metastases at lesion-based analysis [32]. In recurrent/progressive disease, FAPI PET/CT was able to change the staging in 9/12 patients (upstaging in 8 patients and downstaging in 1). In many patients, indeed, FAPI PET/CT was able to detect the presence of metastatic lymph nodes, liver metastases and peritoneal carcinomatosis more than standard ceCT [12]. Both in the study by Rohrich et al. [12] and in the report by Pang et al. [32], the main limitation for the identification of the primary lesions was the presence of a diffuse uptake in the pancreatic gland due to inflammatory reason. Considering that pancreatitis can occur in malignant disease, the interpretation of the imaging should be particularly thorough, by taking into consideration also clinical data and anatomical imaging.
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.