Nonsurgical Acute Pain
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2021
This chapter discusses the causes of nonsurgical acute pain and some of the problems specific to acute pain management in these patients. Common to many of these situations is the presence of both nociceptive and neuropathic pain, requiring a mix of treatment strategies. While there are obviously many other sources of acute pain, the general principles of management that have resulted from this work remain the same, regardless of the cause of the pain. Effective management of the different aspects of pain experienced in the acute phase of treatment, as well as the mixed nociceptive and neuropathic pain present in many patients, may require different strategies involving both pharmacological and nonpharmacological therapies delivered by a multidisciplinary team. Epidural and other regional analgesia can lead to better pain relief than systemic opioid analgesia in patients with fractured ribs. Opioids are best reserved for management of pain when the diagnosis of acute pancreatitis, and therefore acute nociceptive pain, can be confirmed.
Acute pancreatitis
Louisa Baxter, Neel Sharma, Ian Mann in The Junior Doctor’s Guide to Gastroenterology, 2018
Acute pancreatitis is particularly common in Western populations, with alcoholic pancreatitis being more prevalent in the USA, and gallstone-related pancreatitis occurring more frequently in Europe. Gallstones and alcohol are the major causes of acute pancreatitis. The inflammatory process that is seen in acute pancreatitis is allied to several cytokines, including TNF, IL-1, IL-6 and IL-8. Pancreatic enzymes can cause the erosion of blood vessels in the proximity of the pancreas. Surgical management is now rarely used in cases of acute pancreatitis, as the surgical role has diminished with the advent of minimally invasive interventional techniques. Initial management relies on aggressive resuscitation measures, particularly in the setting of sepsis and shocked patients. Patients typically present with abdominal pain, which is commonly dull in character, and often extremely severe. Discussion of cases of patients with severe acute pancreatitis is important, as this will ensure that these patients are commenced on the correct enteral nutrition programmes.
IVIM MRI of the Pancreas
Denis Le Bihan, Mami Iima, Christian Federau, Eric E. Sigmund in Intravoxel Incoherent Motion (IVIM) MRI, 2018
Healthy pancreatic parenchyma is known to be a well perfused. Both inflammatory and neoplastic conditions of the pancreas are characterized by alterations of microstructure, cellularity, and microvascularity. Pancreatic ductal adenocarcinomas, which are the most frequent malignant pancreatic tumors, often appear hypovascular compared to the healthy pancreatic parenchyma in conventional contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI). To date, there is no standardized intravoxel incoherent motion protocol for the examination of the pancreas across different institutions. Chronic pancreatitis and autoimmune pancreatitis are benign pancreatic diseases, which can be difficult to differentiate from malignant adenocarcinomas because of the at-times mass-forming aspect and the often hypovascular appearance compared to the healthy pancreatic parenchyma in conventional CT and MRI. The prognosis is poor at the time of diagnosis and is usually made at late stages of the disease due to its unspecific clinical signs and symptoms.
Acute pancreatitis during lambda cyhalothrin poisoning
Published in Toxin Reviews, 2014
Wang Wenjie, Lu Houqing, Liu Xuchun, Sun Gengyun
There have been no case reports on lambda cyhalothrin induced pancreatitis in the literature available. In this report, we present the case of a 48-year-old female who accidentally ingested lambda cyhalothrin developed pancreatitis. The patient survived despite the development of lactic acidosis and ventricular diastolic function. Concurrent acute pancreatitis is a severe complication leading to poor prognosis. Particular attention should be paid to prevention and the early discovery and treatment of complications to improve the success rate of recovery.
Acute Pancreatitis and Cholecystitis Associated with Postpartum HELLP Syndrome: A Case and Review
Published in Hypertension in Pregnancy, 2007
Satoshi Hojo, Kiyomi Tsukimori, Mio Hanaoka, Ai Anami, Naoyuki Nakanami, Kazuhiro Kotoh, Masahiro Nozaki
We report a case of preeclampsia associated with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and concomitant nonbiliary acute pancreatitis and cholecystitis in the first postpartum day. A thorough investigation ruled out known etiologies of both pancreatitis and cholecystitis. Following conservative treatment, the patient's HELLP syndrome, pancreatitis, and cholecystitis resolved on the third postpartum day. Preeclampsia is associated with microvascular abnormalities that may involve the splanchnic circulation. These abnormalities may cause not only HELLP syndrome but also pancreatitis and cholecystitis. Recognizing that ischemia can damage not only the liver but also the pancreas and gallbladder, could result in improvements in the diagnosis and management of pancreatitis in patients with preeclampsia.
Treating acute pancreatitis: what’s new?
Published in Expert Review of Gastroenterology & Hepatology, 2015
Vikesh K Singh, Robert A Moran, Elham Afghani, Enrique de-Madaria
The medical treatment of acute pancreatitis continues to focus on supportive care, including fluid therapy, nutrition, and antibiotics, all of which will be critically reviewed. Pharmacologic agents that were previously studied were found to be ineffective likely due to a combination of their targets and flaws in trial design. Potential future pharmacologic agents, particularly those that target intracellular calcium signaling, as well as considerations for trial design will be discussed. As the incidence of acute pancreatitis continues to increase, greater efforts will be needed to prevent hospitalization, readmission and excessive imaging in order to reduce overall healthcare costs. Primary prevention continues to focus on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and secondary prevention on cholecystectomy for biliary pancreatitis as well as alcohol and smoking abstinence.
Related Knowledge Centers
- Alcohol Drinking
- Alcoholic Pancreatitis
- Hemorrhage
- Necrosis
- Diabetes Mellitus
- Pancreatic Diseases
- Pancreas Transplantation