Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis and serum C-reactive protein, procalcitonin and lactate dehydrogenase for the diagnosis of pancreatic necrosis

A healthy, urban-dwelling man presented with lassitude, jaundice without increased liver enzymes or obstructive features on imaging, brief acute kidney injury, leucocytosis with near-normal C reactive protein and markedly increased serum amylase and lipase. Leptospirosis was not considered for 10 days because of the low incidence of the disease in the country, absent animal contact and physicians’ low index of suspicion. Presentation without fever and without the commonly associated abdominal pain, myalgia, headache, thrombocytopaenia or elevated serum creatine kinase added to the diagnostic challenge. Once an infectious cause of acute pancreatitis was contemplated, leptospirosis was immediately sought and diagnosed by PCR of urine and microscopic agglutination test, and he fully recovered on ceftriaxone. Physicians in countries with a low incidence of leptospirosis should be more aware of the possibility of the disease even when several key features such as fever or pain are missing and the patient has a rare infectious acute pancreatitis.

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C-reactive protein and lactate dehydrogenase isoenzymes in the assessment of the prognosis of acute pancreatitis

Journal of Gastroenterology and Hepatology ◽

10.1111/j.1440-1746.1992.tb00998.x ◽

1992 ◽

Vol 7 (4) ◽

pp. 363-366 ◽

Cited By ~ 22

Author(s):

C-C. CHEN ◽

S-S. WANG ◽

Y. CHAO ◽

C-W. LU ◽

S-D. LEE ◽

...

Keyword(s):

Acute Pancreatitis ◽

Lactate Dehydrogenase ◽

C Reactive Protein ◽

Reactive Protein ◽

Lactate Dehydrogenase Isoenzymes

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Early Continuous Veno-Venous Hemofiltration Is Effective in Decreasing Intra-Abdominal Pressure and Serum Interleukin-8 Level in Severe Acute Pancreatitis Patients with Abdominal Compartment Syndrome

Blood Purification ◽

10.1159/000480223 ◽

2017 ◽

Vol 44 (4) ◽

pp. 276-282 ◽

Cited By ~ 5

Author(s):

Jianmin Xu ◽

Ying Cui ◽

Xiangping Tian

Keyword(s):

Acute Pancreatitis ◽

Compartment Syndrome ◽

Blood Level ◽

Serum Amylase ◽

Control Group ◽

Abdominal Pressure ◽

C Reactive Protein ◽

Reactive Protein ◽

Liver And Kidney ◽

Abdominal Compartment

Objective: The aim of this study was to evaluate the efficacy of early continuous veno-venous hemofiltration (CVVH) in decreasing the intra-abdominal pressure (IAP) and serum interleukin-8 (IL-8) level in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS). Methods: Twenty-five ACS patients of SAP were enrolled in a prospective study conducted according to the standard management protocol. They were treated in the intensive care unit (ICU) of Affiliated Yidu Central Hospital of Weifang Medical College and underwent CVVH. Eleven patients were set up as the control group that received no hemofiltration and surgical treatment due to economic or other reasons but solely conventional treatment. Serum amylase, liver and kidney function, and C reactive protein were investigated before and after treatment. IAP and blood level of IL-8 were measured daily to investigate their time course of changes and the correlation between the 2 parameters. Results: Serum amylase levels, C-reactive protein and IAP were significantly lower and liver and kidney function was significantly better than those of the control group (p < 0.05). IAP on admission to the ICU was high, at 22.9 ± 2.1 mm Hg. The IAP was significantly lower to 17.2 ± 2.2 mm Hg (p < 0.01) 24 h after the initiation of CVVH, and thereafter decreased rapidly. The average blood level of IL-8 was high at 88.2 ± 25.1 ng/L on admission. However, it significantly decreased to 63.2 ± 18.7 ng/L (p < 0.01) 24 h after the initiation of CVVH, and subsequently decreased. There was a significant positive correlation between the blood level of IL-8 and IAP(r = 0.62, p < 0.01). Conclusions: CVVH is effective to decrease the IAP and the blood level of IL-8 in ACS patients of SAP. The blood level of IL-8 was significantly correlated with IAP, suggesting that IL-8 might play an important role in the pathogenesis of ACS. Early CVVH appeared to be effective in the treatment of ACS in patients with SAP through the removal of causative cytokines such as IL-8, and it thereby decreased interstitial edema to lower IAP and should be applied in the early stage of ACS. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=480223.

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