scholarly journals Suboptimal management of hypertriglyceridemia in the outpatient setting is associated with the recurrent pancreatitis

2019 ◽  
Author(s):  
Ping Yan ◽  
Hong-Xian Zhao ◽  
xia chen
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Discharge ◽  
Serum Amylase ◽  
Outpatient Setting ◽  
Lipid Lowering ◽  
Recurrent Acute Pancreatitis ◽  
Increasing Risk ◽  
Few Data ◽  
Risk Of Relapse

Abstract Background Hyperlipemia is a well-established etiology of acute pancreatitis (AP). However, few data are available in the medical literature about the management of triglyceride levels in the outpatient setting in patients with hypertriglyceridemic acute pancreatitis (HTG-AP). We evaluated the blood triglyceride levels and the follow-up of triglyceride management in patients with HTG-AP.Methods This retrospective study enrolled patients with HTG-AP from January 2013 to March 2019 in Affiliated Hospital of Southwest Medical of University. By reviewing the hospitalization records and the follow-up data, the clinical features, blood triglyceride levels, lipid-lowering medications use and blood triglyceride levels monitoring after hospital discharge were analyzed.Results 133 patients (46 women, 87 men; median age at presentation 37.4 years) diagnosed with HTG-AP were enrolled in the study. 32 cases (24.1%) presented with recurrent acute pancreatitis (RAP). Patients who had RAP were younger and had higher blood triglyceride levels compared with that of single attack ( P < 0.05). No difference of serum amylase levels, hospitalization duration and mortality rate were observed between non-RAP and RAP. Lipid monitoring was only observed in 12.8% of patients and 10 patients(7.5%) took medications to control blood triglyceride levels after hospital discharge. The follow-up of triglyceride levels in the outpatient setting were higher in RAP patients than that of non-recurrent cases ( P < 0.05). Among the patients who had measured their triglyceride levels after discharge, 83.3% of patients with RAP had at least 1 follow-up of triglyceride level that higher than 500 mg/dL, while no patient had one HTG-AP attack displayed triglyceride levels higher than 500 mg/dL.Conclusions Triglyceride levels after hospital discharge higher than 500 mg/dL may be associated with an increasing risk of relapse of clinical acute pancreatitis events. Inappropriate management of triglyceride control in the outpatient setting may be associated with an increasing risk of relapse of clinical HTG-AP events.

scholarly journals Acute Pancreatitis with Normal Amylase: A Case Report

2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jinous Manouchehri ◽  
Yadollah Rashidi
Keyword(s):  
Acute Pancreatitis ◽  
Laboratory Tests ◽  
Diagnostic Method ◽  
Serum Amylase ◽  
Clinical Signs ◽  
Rapid Diagnosis ◽  
Clinical Suspicion ◽  
Diagnostic Methods ◽  
Therapeutic Outcomes

: Rapid diagnosis in patients with acute pancreatitis is essential to optimal therapeutic outcomes. Upon clinical suspicion, various methods could be used to confirm the diagnosis based on the symptoms and examinations. Laboratory tests are an important diagnostic method in this regard based on the increased serum amylase/lipase. In this study, we described the case of a 31-year-old male patient presenting with the clinical signs of pancreatitis with normal amylase and elevated triglyceride in the follow-up. In case of strong clinical suspicion, other tests and diagnostic methods are recommended to confirm acute pancreatitis.

scholarly journals SUN-557 Hypertriglyceridemia-Induced Pancreatitis: Experience from a Quaternary Care Center

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sarah Béland-Bonenfant ◽  
Martine Paquette ◽  
Alexis Baass ◽  
Sophie Bernard
Keyword(s):  
Acute Pancreatitis ◽  
Lipoprotein Lipase ◽  
Care Center ◽  
Recurrent Acute Pancreatitis ◽  
Lipid Disorder ◽  
Lipid Clinic ◽  
Severe Hypertriglyceridemia ◽  
Rare Autosomal Recessive Disease

Abstract Severe hypertriglyceridemia is defined by triglycerides levels reaching 11,3 mmol/L (1000 mg/dL) or when chylomicrons are present in the circulation (1). Severe hypertriglyceridemia increases the risk of acute pancreatitis, a serious complication that can be recurrent and fatal. Severe hypertriglyceridemia is most often caused by an underlying primary chylomicronemia disease, either monogenic of multifactorial. Familial chylomicronemia syndrome is a rare autosomal recessive disease that can result from mutations in lipoprotein lipase in more than 90% of cases. Multifactorial chylomicronemia is an oligogenic or polygenic disorder characterized by a reduction in lipoprotein lipase activity. Primary chylomicronemia should be managed in a specialized lipid clinic before acute pancreatitis occur. However, primary chylomicronemia is underdiagnosed (2). This is why hospitalization for an acute episode of hypertriglyceridemia-induced pancreatitis is a window of opportunity to investigate these patients. The first objective of our study was to investigate retrospectively the quality of the follow-up of patients hospitalized for hypertriglyceridemia-induced acute pancreatitis, specifically looking at specialized lipid clinic referrals. The second objective was to correlate triglyceride (TG) levels with severity of the pancreatitis. A total of 1063 patients were hospitalized for acute pancreatitis at our center between 2012 and 2019. Twenty-five patients (2.35%) were diagnosed with hypertriglyceridemia-induced pancreatitis. Of those 25 patients, one died of pancreatitis complications, two were already diagnosed with primary chylomicronemia, and of the remaining twenty-two, 11 (50%) had a referral for an evaluation at a specialized lipid clinic. Those referrals resulted in three diagnoses of primary chylomicronemia, with a multidisciplinary follow-up. Regarding severity of pancreatitis, TG levels were positively correlated with patients being hospitalized in the intensive care unit (ICU) and also having longer stays in the ICU. Only half of patients hospitalized for a hypertriglyceridemia-induced pancreatitis at our center had a referral for lipid disorder evaluation upon hospital discharge. We believe it is important to raise awareness concerning primary chylomicronemia to avoid recurrent acute pancreatitis preceding diagnosis, seeing this pathology increases morbidity and mortality. 1. Valdivielso et al. Eur J Intern Med. 2014;25(8):689-94. 2. Brown et al. J Clin Lipidol. 2018;12(2):254-263.

scholarly journals Defining a Therapeutic Program for Recurrent Acute Pancreatitis Patients with Unknown Etiology

2014 ◽  
Vol 7 ◽  
pp. CGast.S13531 ◽  
Author(s):  
Vincenzo Neri ◽  
Francesco Lapolla ◽  
Alessandra Di Lascia ◽  
Libero Luca Giambavicchio
Keyword(s):  
Acute Pancreatitis ◽  
Sphincter Of Oddi ◽  
Diagnostic Process ◽  
Unknown Etiology ◽  
Sphincter Of Oddi Dysfunction ◽  
Endoscopic Retrograde ◽  
Recurrent Acute Pancreatitis ◽  
Therapeutic Program ◽  
Oddi Dysfunction

Aim To define a therapeutic program for mild-moderate acute pancreatitis (AP), often recurrent, which at the end of the diagnostic process remains of undefined etiology. Material and Methods In the period 2011-2012, we observed 64 cases of AP: 52 mild-moderate, 12 severe; biliary 39, biliary in alcoholic chronic pancreatitis 5, unexplained recurrent 20. The clinical and instrumental evaluation of the 20 cases of unexplained AP showed 6 patients with biliary sludge, 4 microlithiasis, 4 sphincter of Oddi dysfunction, and 6 cases that remained undefined. Results Among 20 patients with recurrent, unexplained AP at initial etiological assessment, we performed 10 video laparo cholecystectomies (VLCs), 2 open cholecystectomies and 4 endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomies (ERCP/ES) in patients who had undergone previous cholecystectomy; 4 patients refused surgery. Among these 20 patients, 6 had AP that remained unexplained after second-level imaging investigations. For these patients, 4 VLCs and 2 ERCP/ES were performed. Follow-up after six months was negative for further recurrence. Conclusion The recurrence of unexplained acute pancreatitis could be treated with empirical cholecystectomy and/or ERCP/ES in cases of previous cholecystectomy.

scholarly journals Transduodenal Sphincteroplasty and Transampullary Septectomy for Papillary Stenosis

HPB Surgery ◽  
1996 ◽  
Vol 9 (4) ◽  
pp. 199-207 ◽  
Author(s):  
S. B. Kelly ◽  
B. J. Rowlands
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Chronic Abdominal Pain ◽  
Recurrent Acute Pancreatitis ◽  
Papillary Stenosis ◽  
Relieve Pain

Twenty patients received transduodenal sphincteroplasty and transampullary septectomy between 1987 and 1993. Seven patients had post-cholecystectomy pain which was much improved or abolished in 5 of 7 patients at a mean follow-up of 4 years and 5 months. Four of five patients with chronic pancreatitis were improved at 3 years and 2 months. Three of five patients with recurrent acute pancreatitis were improved at 4 years and 5 months. One of three patients with chronic abdominal pain of hepatobiliary origin was improved at 3 years. Transduodenal sphincteroplasty and transampullary septectomy can relieve pain in patients with post-cholecystectomy pain, recurrent acute pancreatitis, chronic pancreatitis, and chronic abdominal pain of hepatobiliary origin, presumably by improving drainage of the obstructed ducts.

scholarly journals Recurrent Acute Pancreatitis Probably Induced by Rosuvastatin Therapy: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
JayaKrishna Chintanaboina ◽  
Deepa Gopavaram
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Report ◽  
General Population ◽  
Conservative Management ◽  
Case Reports ◽  
Underlying Mechanism ◽  
Intravenous Contrast ◽  
Recurrent Acute Pancreatitis

Context. Approximately 1.4–2% of all cases of acute pancreatitis are drug related in general population. The literature on statin-induced pancreatitis consists primarily of anecdotal case reports. We report a case of possible rosuvastatin-induced pancreatitis.Case Report. A 67-year-old female presented with progressively worsening abdominal pain and vomiting for 7 days. Home medications included rosuvastatin and clonidine. CT scan of abdomen, with intravenous contrast, showed findings consistent with acute pancreatitis. She responded to conservative management. Rosuvastatin was resumed at the time of discharge from the hospital, and she presented two months later with recurrence of acute pancreatitis. Further workup ruled out all likely causes of acute pancreatitis. Rosuvastatin was stopped completely when she was discharged the second time, and she did not have any further episodes of acute pancreatitis. She was completely asymptomatic throughout the 18-month follow-up period.Conclusion. This paper reinforces the possible association of rosuvastatin, a novel statin, with acute pancreatitis, even though the exact underlying mechanism of statin-induced pancreatitis remains unknown.

scholarly journals MO523PATIENTS FROM COVID-19 MOSTLY RECOVER FROM TUBULAR PROTEINURIA AND ACUTE KIDNEY INJURY AFTER HOSPITAL DISCHARGE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Antoine Bouquegneau ◽  
Justine Huart ◽  
Laurence Lutteri ◽  
Pauline Erpicum ◽  
Stéphanie Grosch ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Hospital Discharge ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Tubular Injury ◽  
Tubular Proteinuria ◽  
Heavy Proteinuria ◽  
Few Data

Abstract Background and Aims Proteinuria, hematuria and acute kidney injury (AKI) are frequently observed in hospitalized patients with COVID-19. However, few data are available on these parameters after hospital discharge. Method This retrospective, observational and monocentric study included 153 hospitalized patients, in whom urine total proteinuria and α1-microglobulin (a marker of tubular injury) were measured. Thirty patients died. Among the 123 survivors, follow-up urine and creatinine analyses were available for 72 patients (after a median of 51 [19;93] days following hospital discharge). Results The median proteinuria at hospitalization and follow-up (n=72) was 419 [239; 748] and 79 [47; 129] mg/g, respectively (p&lt;0.0001). The median concentrations of urinary α1-microglobulin (n=66) were 50 [25; 81] and 8 [0; 19] mg/g, respectively (p&lt;0.0001). Estimating glomerular filtration rate (eGFR) was lower during the hospitalization compared to the follow-up: 81 [62; 92] versus 87 [66; 98] mL/min/1.73m² (p=0.0222). At follow-up, a decreased renal function was observed in 10/72 (14%) of patients, with 50% of them presenting decreased renal function before COVID-19 hospitalization and others developing severe AKI and/or proteinuria during hospitalization. Conclusion In most hospitalized patients with COVID-19, proteinuria and eGFR significantly improved after hospital discharge. Only patients who developed severe AKI and/or heavy proteinuria will require a specific follow-up by nephrologists.

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