scholarly journals Hyperglycemia, Hypertriglyceridemia and Acute Pancreatitis in COVID-19 Infection

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A386-A387
Author(s):  
Marina Torres Torres ◽  
Kimberly Padilla Rodriguez ◽  
Norma Vergne-Santiago ◽  
Andrea del Toro Diez ◽  
Alex N Gonzalez Bossolo ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Epigastric Pain ◽  
Cell Damage ◽  
Abdominal Distension ◽  
Pancreatic Injury ◽  
Hemodynamic Instability ◽  
Insulin Requirement ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Gi Symptoms

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection primarily affects the respiratory tract, but gastrointestinal (GI) symptoms may obscure a secondary diagnosis. GI symptoms similar to the ones presented in acute pancreatitis (AP) have been reported. SARS-CoV-2 binds to angiotensin-converting enzyme 2 receptors, which have been identified in the lungs and pancreas. It has been discussed that systemic response to the infection prompts dysregulation in the affected organs. Hyperglycemia is an independent risk factor for increased mortality and thus a detailed assessment must be performed. A 47 year-old man with dyslipidemia arrived at the ER due to a severe constant epigastric pain of 1 day of evolution with back radiation associated with nauseas, emesis, and hyporexia. Upon examination he was tachycardic and in distress due to pain. Laboratories revealed normocytosis, normal hemoglobin, mild thrombocytopenia, hyperglycemia (150 mg/dL), corrected hyponatremia (130 mmol/L), and corrected hypocalcemia (7.4 mg/dL). Amylase (2,332 U/L) and lipase (2,990 U/L) were elevated. Triglycerides were 6,256 mg/dL and glycated hemoglobin was 6.1%. Abdominal CT scan revealed pancreatitis. He was admitted to the ICU due to severe AP due to hypertriglyceridemia with IV hydration and IV insulin infusion. During the first day of admission, he developed respiratory distress requiring intubation, marked abdominal distension, hemodynamic instability, and oliguria. Intra-abdominal pressure yielded 24 mmHg leading to the diagnosis of abdominal compartment syndrome. He underwent emergent abdominal decompressive laparotomy with Bogota Bag placement. COVID-19 PCR test was performed and reported positive. 72 hours later, triglycerides improved and IV insulin was discontinued, but hyperglycemic state prompted subcutaneous basal and correction boluses. Insulin requirement progressively decreased and was discontinued after 14 days. He continued to show clinical improvement and by day 40, the patient was successfully extubated and discharged after physical rehabilitation. SARS-CoV-2 infection has shown a complex multisystem involvement leading to variable presentations which can be fatal if not identified and addressed properly. Albeit, AP is a rare manifestation of COVID-19, clinicians should be aware and pay attention to the related complications. Proposed mechanisms for hyperglycemia and AP include β-cell damage. The pathogenetic role of COVID-19 in hypertriglyceridemia is unclear. Little attention has been paid to the extent of pancreatic injury caused by this virus. To our knowledge this is the second case presenting with hyperglycemia, hypertriglyceridemia, and AP in COVID-19 infection. As the global pandemic is still growing, elucidation of key pathways and mechanisms underlying these associations would aid in the treatment of patients with COVID-19 worldwide.

scholarly journals Abdominal compartment syndrome in severe acute pancreatitis (review of literature)

2020 ◽  
Vol 179 (2) ◽  
pp. 73-78
Author(s):  
L. A. Otdelnov ◽  
A. S. Mukhin
Keyword(s):  
Acute Pancreatitis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Medical Management ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Russian Science Citation Index ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

The study was performed for analysis of current understanding of intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis.The English and Russian articles about intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis were analyzed. The articles were found in «Russian Science Citation Index» and «PubMed».There is a pathogenetic relationship between increased intra-abdominal pressure and the development of severe acute pancreatitis.For today, it was shown that intra-abdominal hypertension in patients with severe acute pancreatitis is associated with significantly higher APACHE-II and MODS score, prevalence of pancreatic and peripancreatic tissue lesions, early infection of pancreatic necrosis and higher mortality.The article considers various variants of decompressive interventions such as decompressive laparotomy, fasciotomy and percutaneous catheter drainage. For today, there are no randomized studies devoted to researching effectiveness of different decompressive interventions.The study showed that it is necessary to regularly monitor intra-abdominal pressure in patients with severe acute pancreatitis. Patients with intra-abdominal hypertension require emergency medical management to reduce intra-abdominal pressure. Inefficiency of the medical management and development of abdominal compartment syndrome are indications for surgery. The effectiveness of different decompressive interventions requires further studies.

scholarly journals Diagnosis and Choice of a Method of Treatment of Intraabdominal Hypertension and Abdominal Compartment Syndrome

2019 ◽  
Vol 74 (3) ◽  
pp. 210-215
Author(s):  
Vil M. Timerbulatov ◽  
Shamil V. Timerbulatov ◽  
Radik R. Fayazov ◽  
Mahmud V. Timerbulatov ◽  
Elza N. Gaynullina ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
Early Diagnosis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) remain a complex problem of abdominal surgery. To date, the pathophysiological mechanisms, methods for determining intra-abdominal pressure (IAP) the frequency of its measurement, and the methods of conservative and surgical more and more researchers consider surgical decompression as a treatment. AIMS: Аnalysis of the results of the implementation of monitoring of intra-abdominal pressure and its impact on the outcomes of treatment of patients with severe acute pancreatitis and acute colon obstruction. MATERIALS AND METHODS: A study of 397 patients with emergency abdominal pathology including 197 with acute obstructive obstruction of the colon (AOOC), 200 severe acute pancreatitis (SAP) was performed. Patients (n=201) were included in the I (main) group, which was carried out using IAP as the main criterion for assessing the patient`s condition and when choosing a method of treatment, in II ― without taking then into account and monitoring. Measurement of IAP, blood lactate was determined primarily, then alternatively 4 to 6 hours. The survey included the study of biochemical indicators, endoscopic methods, visualization (ultrasound scanning, CT of the abdominal cavity organs). RESULTS: In the I group of IAH patients, I and II degrees were in 73.13%, in the II group in 79.5% IAH III and IV degrees, respectively, in 26.87% and 21.5% (p0.05). Measurement of IAP was carried out according to the I.L. Kron method, repeated measurement depending on the degree of IAH after 46 hours, simultaneously, as a predictor of internal ischemia, determined the level of lactate in blood and perfusion abdominal pressure. An algorithm for early diagnosis is suggested excess intraabdominal pressure. For I and II, the degree of IAH was treated with aggressive conservative therapy, with failure of intensive therapy III of IAH degree surgical treatment, with IV degree IAH emergency decompressive laparotomy. In the I group, the mortality was significantly lower than in the II group: IAH at III, with AOOC 27.7% and 50%, respectively (p0.05), at SAP 37.5% and 80% (p0.01), respectively, at IV degree IAH for AOOC 75% and 90% (p0.05), with SAP 75% and 88,8% (p0.05) respectively. CONCLUSIONS: The results of treatment of patients with IAH can be improved by its early diagnosis, intensive, aggressive therapy of IAH IIII degrees. At IAH I, II degrees conservative treatment is shown, persistent aggressive conservative treatment should be performed at IAH III degree, if it is unsuccessful and IV degree of IAH, an emergency decompressive laparotomy should be performed.

scholarly journals Rare presentation of acute pancreatitis in mild COVID-19

2021 ◽  
Vol 14 (11) ◽  
pp. e246720
Author(s):  
Brianna Hatch-Vallier ◽  
Vijay Jarodiya ◽  
Fadi Hawa ◽  
Rebecca Daniel
Keyword(s):  
Acute Pancreatitis ◽  
Liver Function ◽  
Epigastric Pain ◽  
Vital Signs ◽  
Pancreatic Injury ◽  
Direct Impact ◽  
Limited Data ◽  
Unique Case ◽  
Rare Presentation ◽  
Atypical Symptoms

Viral-induced pancreatitis has been well-defined; however, there are limited data regarding COVID-19 and pancreatitis. Most cases are commonly in conjunction with severe COVID-19 as well as lipase elevation. We describe a unique case of mild SARS-CoV-2 infection resulting in acute pancreatitis in the absence of lipase elevation. A 39-year-old patient with no medical history, presented with epigastric pain. Vital signs were unremarkable. Patient was positive for COVID-19. Liver function panel, calcium, triglyceride and lipase levels were all unremarkable. CT of the abdomen demonstrated acute pancreatitis without gallstones. Our case may indicate that pancreatic injury in SARS-CoV-2 infection is due to a direct impact on the pancreas by the virus, given the absence of lipase elevation and mild presentation. This case highlights the importance of suspecting pancreatitis in mild COVID-19 that present with atypical symptoms such as epigastric pain, even without lipase elevation.

scholarly journals Need for Screening Triglyceride Levels in Women on Oral Contraceptives

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A782-A782
Author(s):  
Alice Yau ◽  
Abidemi Idowu ◽  
Pramma Elayaperumal ◽  
Agnieszka Gryguc-Saxanoff ◽  
Jose Martinez ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Oral Contraceptive ◽  
Respiratory Distress ◽  
Epigastric Pain ◽  
Morbidly Obese ◽  
Oral Contraceptive Pills ◽  
Decompressive Laparotomy ◽  
Life Threatening ◽  
Clinical Awareness ◽  
Beta Hydroxybutyrate

Abstract Introduction: Oral contraceptive pills (OCPs) are the most used form of reversible contraceptives by women. Major risks are cardiovascular but OCPs also cause secondary hypertriglyceridemia (HTG) through effects of estrogen, which decreases hepatic triglyceride lipase and lipoprotein lipase activity. This causes increased triglycerides, cholesterol and free fatty acids,1 which then in turn can lead to life-threatening acute pancreatitis. Case Description: A 23-year-old morbidly obese (BMI 38.2 mg/kg2) female presented with severe epigastric pain, nausea and vomiting. She had a history of mild intermittent asthma, recently diagnosed pre-diabetes and recently started on OCPs. Initial labs were consistent with diabetic ketoacidosis with glucose 528 mg/dL (65-115 mg/dL), anion gap 21 mEq/L (5-15 mEq), and beta-hydroxybutyrate 2.00 mmol/L (0.02-0.27 mmol/L); and acute pancreatitis with triglyceride 4,425 mg/dL (30-200 mg/dL) and lipase >600 U/L (8-78 UL), confirmed on imaging. She rapidly deteriorated, developing acute hypoxemic respiratory distress requiring intubation and distributive shock requiring three vasopressors. She progressed into multi-organ failure with acute respiratory distress syndrome, ischemic liver and acute renal failure despite insulin drip, colloidal fluid resuscitation, continuous veno-venous hemofiltration and high positive end-exploratory pressures. She developed rhabdomyolysis, followed by abdominal compartment syndrome requiring decompressive laparotomy that resulted in large volume blood loss and retroperitoneal necrosis needing multiple laparotomies. Ultimately, she became non-responsive off sedation, attributed to malignant cerebral edema that progressed to brain herniation. While HTG was likely the cause of her pancreatitis, she had normal triglyceride levels on prior routine lab work while not on OCPs. Discussion: Severe acute pancreatitis is a life-threatening complication of HTG which may be precipitated by use of OCPs. We believe that there is a need for more research in this field and even propose periodic monitoring of HTG in women taking OCPs given the severity of the consequences. While there are currently no guidelines for monitoring lipid levels in women on OCP, appropriate clinical awareness of physicians prescribing OCPs to patients may prevent fatal outcomes. References: 1. Stumpf, M., Kluthcovsky, A., Okamoto, J., Schrut, G., Cajoeiro, P., Chacra, A. and Bizeli, R. (2018). Acute pancreatitis secondary to oral contraceptive-induced hypertriglyceridemia: a case report. Gynecological Endocrinology, 34(11), pp.930-932.

scholarly journals Pancreatitis with Electrocardiographic Changes Mimicking Acute Myocardial Infarction

2001 ◽  
Vol 15 (8) ◽  
pp. 522-526 ◽  
Author(s):  
Paul Khairy ◽  
Pierre Marsolais
Keyword(s):  
Myocardial Infarction ◽  
Acute Pancreatitis ◽  
Epigastric Pain ◽  
Hemodynamic Instability ◽  
Anterior Myocardial Infarction ◽  
Cardiac Pathology ◽  
St Segment ◽  
Electrocardiographic Changes ◽  
Mild Acute Pancreatitis ◽  
New Onset

A 64-year-old woman with mild acute pancreatitis presented with epigastric pain, nausea and vomiting while undergoing hemodialysis for chronic renal insufficiency. Serial electrocardiograms revealed new onset ST segment elevations in leads V2 to V4 mimicking an anterior myocardial infarction, followed by diffusely inverted deep T waves. No cardiac pathology was demonstrated by echocardiography or coronary angiography. A review of the literature and possible pathophysiological mechanisms of electrocardiographic changes in acute pancreatitis, such as metabolic abnormalities, hemodynamic instability, vasopressors, pericarditis, myocarditis, a cardiobiliary reflex, exacerbation of underlying cardiac pathology, coagulopathy and coronary vasospasm, are discussed.

scholarly journals Acute Pancreatitis after Colonoscopy: A Case Presentation and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Sahil D. Doshi ◽  
Yelina Alvarez ◽  
Shria Kumar ◽  
Octavia Pickett-Blakely
Keyword(s):  
Acute Pancreatitis ◽  
Splenic Flexure ◽  
Epigastric Pain ◽  
Left Ventricular ◽  
Screening Colonoscopy ◽  
Laboratory Evaluation ◽  
Mechanical Trauma ◽  
Abdominal Pressure ◽  
Cross Sectional ◽  
Ventricular Assist

We report a case of acute pancreatitis after an elective screening colonoscopy. A 51-year-old male with a left ventricular assist device for end-stage nonischemic cardiomyopathy and a family history of colorectal cancer was admitted for an expedited heart transplant evaluation. He underwent screening colonoscopy during this admission which was technically uncomplicated apart from requiring slight maneuvering at the splenic flexure. The following day, the patient developed acute epigastric pain and one episode of emesis. Subsequent laboratory evaluation revealed a significantly elevated lipase level and cross-sectional imaging consistent with acute pancreatitis. With no evidence of gallstones, alcohol use, and hypertriglyceridemia, the acute pancreatitis was deemed to be a complication of colonoscopy. The presumed mechanism of the pancreatitis was due to mechanical trauma from insufflation and abdominal pressure, applied to at the splenic flexure, which is in close proximity to the pancreatic tail. The patient was treated with supportive care (intravenous fluid, analgesia, and pancreatic rest) and improved significantly over a three-day period.

Role of Intra-Abdominal Pressure as a Prognostic Marker and Its Correlation with APACHE II and SOFA Scores in Patients of Acute Pancreatitis

2021 ◽  
Author(s):  
Arun Kumar Gupta ◽  
Ekta Yadav ◽  
Nikhil Gupta ◽  
Raghav Yelamanchi ◽  
Lalit Kumar Bansal ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Prognostic Marker ◽  
Apache Ii ◽  
Abdominal Pressure

scholarly journals Acute pancreatitis in a patient with COVID-19

2021 ◽  
Vol 14 (2) ◽  
pp. e239656
Author(s):  
Rawan A Rahman AlHarmi ◽  
Tahera Fateel ◽  
Jalila Sayed Adnan ◽  
Kamel AlAwadhi
Keyword(s):  
Acute Pancreatitis ◽  
Pulmonary Disease ◽  
Invasive Procedure ◽  
Pancreatic Injury ◽  
History Taking ◽  
Complicated Course ◽  
Operating Surgeon

COVID-19 mainly causes pulmonary disease. Involvement of gastrointestinal and hepatobiliary systems, among other systems, has been reported. We report a case of acute pancreatitis in a patient with resolving COVID-19 pneumonia. History taking and investigations excluded other causes of pancreatitis. This case demonstrates the possibility of pancreatic injury in patients with COVID-19, in line with previously reported similar cases. We believe that it is imperative to screen patients presenting with acute pancreatitis for SARS-CoV-2. It is also important to take into consideration that patients with a complicated course who require an invasive procedure such as drainage might pose a risk of transmission to the operating surgeon or interventionist.

scholarly journals Increased intra-abdominal pressure: is it of any consequence in severe acute pancreatitis?

HPB ◽  
2006 ◽  
Vol 8 (3) ◽  
pp. 227-232 ◽  
Author(s):  
G. Pupelis ◽  
H. Plaudis ◽  
K. Snippe ◽  
M. Rudakovska
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Abdominal Pressure

scholarly journals Ca 2+ toxicity and mitochondrial damage in acute pancreatitis: translational overview

2016 ◽  
Vol 371 (1700) ◽  
pp. 20150425 ◽  
Author(s):  
József Maléth ◽  
Péter Hegyi
Keyword(s):  
Acute Pancreatitis ◽  
Mitochondrial Permeability Transition ◽  
Clinical Investigation ◽  
Cell Damage ◽  
Specific Treatment ◽  
Experimental Models ◽  
Mitochondrial Damage ◽  
Cell Functions ◽  
Cellular Ca

Acute pancreatitis (AP) is a leading cause of hospitalization among non-malignant gastrointestinal disorders. The mortality of severe AP can reach 30–50%, which is most probably owing to the lack of specific treatment. Therefore, AP is a major healthcare problem, which urges researchers to identify novel drug targets. Studies from the last decades highlighted that the toxic cellular Ca 2+ overload and mitochondrial damage are key pathogenic steps in the disease development affecting both acinar and ductal cell functions. Moreover, recent observations showed that modifying the cellular Ca 2+ signalling might be beneficial in AP. The inhibition of Ca 2+ release from the endoplasmic reticulum or the activity of plasma membrane Ca 2+ influx channels decreased the severity of AP in experimental models. Similarly, inhibition of mitochondrial permeability transition pore (MPTP) opening also seems to improve the outcome of AP in in vivo animal models. At the moment MPTP blockers are under detailed clinical investigation to test whether interventions in MPTP openings and/or Ca 2+ homeostasis of the cells can be specific targets in prevention or treatment of cell damage in AP. This article is part of the themed issue ‘Evolution brings Ca 2+ and ATP together to control life and death’.

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