Hypertriglyceridemic acute pancreatitis in emergency department: Typical clinical features and genetic variants

Background & Aims: Diverticulitis is often diagnosed in outpatients, yet little evidence exists on diagnostic evidence and demographic/clinical features in various practice settings. We assessed variation in clinical characteristics and diagnostic evidence in inpatients, outpatients, and emergency department cases and effects of demographic and clinical variables on presentation features.Methods: In a retrospective cohort study of 1749 patients in an integrated health care system, we compared presenting features and computed tomography findings by practice setting and assessed independent effects of demographic and clinical factors on presenting features.Results: Inpatients were older and more often underweight/normal weight and lacked a diverticulitis past history and had more comorbidities than other patients. Outpatients were most often Hispanic/Latino. The classical triad (abdominal pain, fever, leukocytosis) occurred in 78 (38.6%) inpatients, 29 (5.2%) outpatients and 34 (10.7%) emergency department cases. Computed tomography was performed on 196 (94.4%) inpatients, 110 (9.2%) outpatients and 296 (87.6%) emergency department cases and was diagnostic in 153 (78.6%) inpatients, 62 (56.4%) outpatients and 243 (82.1%) emergency department cases. Multiple variables affected presenting features. Notably, female sex had lower odds for the presence of the triad features (odds ratio [95% CI], 0.65 [0.45-0.94], P<0.05) and increased odds of vomiting (1.78 [1.26-2.53], P<0.01). Patients in age group 56 to 65 and 66 or older had decreased odds of fever (0.67 [0.46-0.98], P<0.05) and 0.46 [0.26-0.81], P<0.01), respectively, while ≥1 co-morbidity increased the odds of observing the triad (1.88 [1.26-2.81], P<0.01).Conclusion: There was little objective evidence for physician-diagnosed diverticulitis in most outpatients. Demographic and clinical characteristics vary among settings and independently affect presenting features.Abbreviations: AD: acute colonic diverticulitis; BMI: body mass index; CT: computed tomography; ED: emergency department; IBS: irritable bowel syndrome; ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification; IP: inpatient; KPSC: Kaiser Permanente Southern California; OP: outpatient.

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Acute Pancreatitis in Patients With Crohnʼs Disease: Clinical Features and Outcomes

Inflammatory Bowel Diseases ◽

10.1097/01.mib.0000186485.30623.ad ◽

2005 ◽

Vol 11 (12) ◽

pp. 1080-1084 ◽

Cited By ~ 33

Author(s):

Picha Moolsintong ◽

Edward V Loftus ◽

Suresh T Chari ◽

Laurence J Egan ◽

William J Tremaine ◽

...

Keyword(s):

Acute Pancreatitis ◽

Clinical Features

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True Hermaphroditism: Clinical Features, Genetic Variants and Gonadal Histology

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem.2001.14.4.421 ◽

2001 ◽

Vol 14 (4) ◽

Cited By ~ 19

Author(s):

N. Yordam ◽

A. Alikasifoglu ◽

N. Kandemir ◽

M. Caglar ◽

S. Balcı

Keyword(s):

Clinical Features ◽

Genetic Variants ◽

True Hermaphroditism ◽

Gonadal Histology

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The Relationship Between Etiology of Acute Pancreatitis and Its Clinical Features in Iranian Patients

Biomedical & Pharmacology Journal ◽

10.13005/bpj/1180 ◽

2017 ◽

Vol 10 (02) ◽

pp. 875-880

Author(s):

Seyed Jalal Hashemi ◽

Rahim Masjedizadeh ◽

Furuzan Mehran ◽

Arsalan Tahmasebi

Keyword(s):

Acute Pancreatitis ◽

Clinical Features ◽

The Relationship ◽

Iranian Patients

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Socio-demographic and Clinical Features of the Patients Diagnosed as Acute Coronary Syndrome Consulting the Emergency Department

Turkish Journal of Emergency Medicine ◽

10.5505/1304.7361.2012.25593 ◽

2012 ◽

Vol 12 (3) ◽

pp. 117-122

Author(s):

Mert Ozen ◽

Mustafa Serinken ◽

Atakan Yilmaz ◽

Sahika Ozen

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Clinical Features ◽

Coronary Syndrome

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Association of genetic variants in the GPX1 and GPX4 genes with the activities of glutathione-dependent enzymes, their interaction with smoking and the risk of acute pancreatitis

Biomedicine & Pharmacotherapy ◽

10.1016/j.biopha.2021.112591 ◽

2022 ◽

Vol 146 ◽

pp. 112591

Author(s):

Milena Ściskalska ◽

Halina Milnerowicz

Keyword(s):

Acute Pancreatitis ◽

Genetic Variants

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Mirtazapine-Induced Pancreatitis—A Case Report

Journal of Pharmacy Practice ◽

10.1177/0897190018760645 ◽

2018 ◽

Vol 32 (5) ◽

pp. 586-588 ◽

Cited By ~ 4

Author(s):

Riley D. Bowers ◽

Sara M. Valanejad ◽

Ashley A. Holombo

Keyword(s):

Emergency Department ◽

Adverse Drug Reaction ◽

Acute Pancreatitis ◽

Drug Reaction ◽

Insulin Infusion ◽

Serum Triglyceride ◽

African American Female ◽

Converting Enzyme ◽

Probability Scale ◽

Recent Alcohol Use

Acute pancreatitis has numerous etiologies, with the most common including gallstones, alcohol abuse, and medications such as angiotensin-converting enzyme (ACE) inhibitors, statins, and diuretics. Mirtazapine has been associated with increased serum cholesterol and serum triglyceride levels. However, few studies have reported dangerously elevated triglyceride levels resulting in acute pancreatitis. This report discusses a case of mirtazapine-induced pancreatitis in a 46-year-old African American female. The patient presented to the emergency department with pancreatitis, presumably alcohol-induced as with a prior admission, but she denied any recent alcohol use. Mirtazapine then became the suspected cause of her hypertriglyceridemia-induced pancreatitis and was discontinued. After discontinuing mirtazapine, and utilizing an insulin infusion, her triglyceride levels normalized and symptoms of pancreatitis resolved. Using the Naranjo Adverse Drug Reaction Probability Scale, a total score of 5 was calculated indicating a probable adverse drug reaction of acute pancreatitis from mirtazapine.

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Abstract TP174: Identifying Predictors for Final Diagnosis of Ischemic Events in an Emergency Department Observation Unit

Stroke ◽

10.1161/str.51.suppl_1.tp174 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Arooshi Kumar ◽

Koto Ishida ◽

Ava Liberman ◽

Cen Zhang ◽

Shadi Yaghi ◽

...

Keyword(s):

Emergency Department ◽

Clinical Features ◽

Univariate Analysis ◽

Final Diagnosis ◽

Minor Stroke ◽

Symptom Duration ◽

Facial Weakness ◽

Presenting Symptoms ◽

History Of ◽

Ischemic Events

Introduction: Transient neurologic events have high rates of diagnostic uncertainty. Emergency department observation units (ED-OU) allow an accelerated diagnostic work up for suspected transient ischemic attacks (TIAs). However, clinical decision support regarding which patients to admit to these units is lacking. This study aimed to identify clinical features that differentiate true ischemic events from nonischemic transient neurological attacks (NI-TNA) among patients admitted to an ED-OU for suspected TIA. Methods: A retrospective analysis was performed on consecutive patients admitted to the ED-OU at a single academic center for suspected TIA. Demographics, vascular risk factors, presenting symptoms, and details of the clinical presentation were abstracted from chart review. Final discharge diagnosis was dichotomized to either ischemic event (TIA or minor stroke, TIAMS) or NI-TNA based on the treating vascular neurologist’s final diagnosis. Standard statistical tests were used for comparison testing between the two groups. Significantly different factors with p<0.2 on univariate analysis were carried forward in a multivariable logistic regression model. Results: Of 186 consecutive patients, 101 (54%) had a final diagnosis of NI-TNA and 85 (46%) of TIAMS. The median population ABCD2 score was 4 [IQR 3-4]. On univariate analysis, older age (63 vs. 70, p<0.01), history of atrial fibrillation (AF) (12% vs. 26%, p=0.01), and facial weakness (5% vs. 14% p=0.03) were associated with TIAMS. Headache (24% vs. 12%, p=0.04) and symptom duration>60min (57% vs. 40%, p=0.02) were associated with NI-TNA. On multivariable analysis, only symptom duration>60 minutes predicted NI-TNA (OR 0.39, p=0.04) and only history of AF (OR 2.53, p=0.03) predicted TIAMS. Facial weakness was strongly predictive of TIAMS (OR 3.22, p=0.05), but not significant. Conclusion: We identified two clinical features that distinguished TIAMS from NI-TNA among patients admitted to an ED-OU for suspected TIA.These may be helpful in emergency room triage of TIAMS. Data from ED-OU can be used to identify factors associated with cerebral ischemia and improve current care pathways for patients with suspected TIA, so diagnostic evaluation is received in the most appropriate setting.

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Gastroenterology

Clinical SAQs for the Final FRCEM ◽

10.1093/med/9780198814672.003.0009 ◽

2019 ◽

pp. 133-142

Author(s):

Ashis Banerjee ◽

Anisa J. N. Jafar ◽

Angshuman Mukherjee ◽

Christian Solomonides ◽

Erik Witt

Keyword(s):

Ulcerative Colitis ◽

Emergency Department ◽

Acute Pancreatitis ◽

Spontaneous Bacterial Peritonitis ◽

Hepatitis A ◽

Short Answer ◽

Bacterial Peritonitis ◽

Accompanying Symptoms ◽

Short Answer Questions ◽

Emergency Doctor

This chapter on gastroenterology contains seven clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of gastrointestinal origin that may present in the emergency department include hepatitis A, spontaneous bacterial peritonitis, acute pancreatitis, ulcerative colitis, and haemorrhoids, among others. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.

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