The patient with acute gastrointestinal problems
Peate Ian, Dutton Helen in Acute Nursing Care, 2020
Its close proximity to the gall bladder and common bile duct make the pancreas particularly vulnerable to inflammation when these are diseased, with one of the most common causes of acute pancreatitis being gallstones or biliary tract obstruction. The second most common cause of acute pancreatitis is alcohol abuse. The underlying pathophysiology for this is unclear, but may be due to irritation causing spasm and obstructing the flow of secretions, trapping enzymes within the pancreas. Regardless of the cause, inflammation in the pancreas causes trypsin to be improperly secreted and trapped within the pancreas itself, causing auto-digestion and compounding inflammation. Patients who presented with alcohol-related acute pancreatitis are usually younger than those with gallstones or an unknown aetiology (NCEPOD 2016).
General Surgery
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh in 300 Essentials SBAs in Surgery, 2017
Which of the following statements is true regarding acute pancreatitis? Urinary amylase returns to normal within two to three days.Ultrasound can always confirm pancreatic inflammation.The presence of four or more Glasgow criteria indicate a severe attack of acute pancreatitis.Early ERCP is indicated in severe gallstone pancreatitis.There is no evidence that nasojejunal feeding is superior to TPN in the supportive management of acute pancreatitis.
Hepatobiliary Surgery
Gozie Offiah, Arnold Hill in RCSI Handbook of Clinical Surgery for Finals, 2019
Treatment of early complications➢ Severe pancreatitis (score >3) HDU/ITU admission for optimisation of fluid balance, respiratory, cardiovascular and renal support.➢ Radiological guided drainage of fluid collections, necrosis and abscesses may be required.➢ Surgical debridement/necrosectomy rarely carried out for infected necrosis and has very poor prognosis.➢ Cholecystectomy should be performed after recovery in patients with gallstone pancreatitis, to prevent recurrent attacks. In mild to moderate cases it is also recommended to do it in the same admission.
Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2022
Ming Li, Ao Wang, Shaohua Ren, Zhenyu Wang, Qing Wang, Chengyue Gou, Weichuan Zhao, Li Zhang, Ning Li
Acute pancreatitis is a potentially serious condition characterized by inflammation of the pancreas [1]. Acute pancreatitis occurs with an incidence of 4.6–100 per 100,000 persons [2,3] and is most commonly caused by the impaction of a gallstone in the common bile duct beyond where it joins the pancreatic duct [4,5]. Acute gallstone-related pancreatitis (AGP) is a common cause of hospitalization, and a potentially fatal condition [6], hence patients with AGP need appropriate treatment. The management of AGP includes fluid resuscitation, nutritional support, antibiotic therapy, endoscopic retrograde cholangiopancreatography (ERCP) to remove the calculi, and cholecystectomy to prevent disease recurrence [7,8]. Although early ERCP (within 72 h) is indicated for AGP associated with cholangitis, the timing of ERCP in patients without these features remains a debate [9].
Characterization of host defense molecules in the human pancreas
Published in Islets, 2019
Anton Stenwall, Sofie Ingvast, Oskar Skog, Olle Korsgren
In pancreatitis, an inflammatory process is triggered within the pancreas and a complex immune reaction results in fulminant disease, as reviewed by Habtezion.37 Gallstones and high alcohol intake are the two most common causes, but bacterial and viral infections are also known to trigger pancreatitis. The importance of defensins in the setting of pancreatitis has been the focus of highly relevant research, and several important findings point towards a role of host defense molecules in the immunological theatre of pancreatic inflammation. In 2010 Tiszlavicz showed that certain polymorphisms of defensin Beta 2 is associated with higher risk of developing acute pancreatitis,38 and in 2014 Cunha showed that the expression levels of antimicrobial peptides belonging to the α defensin family is increased in rats with acute pancreatic injury,39 suggesting the importance of antimicrobial peptides in pancreatic inflammation and pancreatitis.
Etanercept – A culprit agent in acute pancreatitis?
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Ferry Gunawan, Beenish Fayyaz, Tania Octaria Mihardja
A 62-year old female with a history of asthma, hypertension and hypothyroidism was started on etanercept for control of severe rheumatoid arthritis by her rheumatologist. Three weeks later, she presented to the emergency department with complaints of sudden-onset nausea, vomiting and abdominal pain. Her examination showed tachycardia, signs of dehydration and epigastric tenderness. Initial blood workup which included complete blood count, metabolic profile, liver profile and urinalysis was normal. Electrocardiogram, chest x-ray, and cardiac enzymes were also normal. However, she was found to have an amylase level of 430 IU/L and lipase level of 274 IU/L. Although, her US abdomen and CT scan abdomen showed no evidence of gallstone, cholecystitis and pancreatitis, patient was diagnosed with acute pancreatitis as she met 2 out of 3 criterias which were abdominal pain and serum amylase and/or lipase more than 3 times upper limit of normal.