Clinicopathological Profile and Outcome of Acute Pancreatitis

Background: Acute pancreatitis is an important cause of morbidity and mortality among gastrointestinal disorders. But little is known about etiology and clinical profile in Indian population. Objective: To know clinicopathological profile, etiology and outcome of acute pancreatitis in study patients. Material and methods: This observational cross-sectional study was conducted in a tertiary care and research hospital in New Delhi India from May 2018 to November 2018. Total 30 established cases of acute pancreatitis were included in the study. Data were collected and processed by using SPSS version20 and result was obtained in tables and diagrams. Results: Among 30 patients, 21(70%) were male and 9(30%) female; 18 to 89 yrs of aged patients were included in the study with mean age 41.6±17.5 years, of 18-30 years of aged patients were more affected (10, 33.3%); patients of different occupation were studied;26(86.7%)patients were non-smoker and 4(13.3%) smoker; 16(53.3%) were non-alcoholic and 14(46.7%) patients had a habit of alcoholism of whom, all were male; patients who used to take e”5 units of alcohol per day were frequently affected (10, 71.4%) by acute pancreatitis, though it did not spared occasional drinkers (2, 14.3%);22(73.3%) patients had interstitial pancreatitis and 8(26.7%) had acute necrotizing pancreatitis;14(46.7%) patients had acute pancreatitis due to alcohol, 10 (33.3%) patients had gall stone, 2(6.7%) patients developed pancreatitis after ERCP;29(96.7%) patients presented with abdominal pain, 28 (93.3%) had vomiting, 21 (70%) patients had jaundice, 10 (33.3%) had fever, 18 (60%) patients had anemia, 17 (56.7%) patients develop ascites, 19 (63.3%) patients develop pleural effusion, 7(23.3%) patients developed ileus, and 3(10.0%) patients developed circulatory shock; 25(83.3%) patients developed organ dysfunction during in hospital care, of whom 11(36.7%) patients had transient and 14(46.7%) had persistent organ dysfunction; 5(16.7%) patients were complicated with pseudocyst, 6(20%) had walled of necrosis (WON), 7(23.3%) developed sepsis, 14(46.7%) developed renal dysfunction, 23(76.7%) developed hepatic dysfunction, 8(26.7%) developed respiratory dysfunction, 6(20%) developed pneumonia; 8(26.7%) patients had been suffering from different comorbidity; ultrasound of abdomen were abnormal in all 30(100%) patients; As per CTSI score, severe pancreatitis 14(46.7%), moderate pancreatitis 14(46.7%) and mild pancreatitis 2(6.7%); 24(80%) patients received only medical treatment and 6(20%) patients needed surgical or radiological intervention; 19(63.3%) patients were improved symptomatically, 8(26.7%) patients were cured and 3(10%) patients died during in hospital care. Conclusion: Alcohol was the predominant etiology of acute pancreatitis, mostly affecting young and middle aged male, but mortality was more in gall stone related pancreatitis. Hepatic dysfunction was observed frequently that may attribute to effect of chronic alcohol abuse. J Bangladesh Coll Phys Surg 2020; 38(2): 86-92

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A clinical study on epidemiology and etiological factors of acute pancreatitis-hospital based study in South India

International Surgery Journal ◽

10.18203/2349-2902.isj20213971 ◽

2021 ◽

Vol 8 (10) ◽

pp. 3060

Author(s):

Rajesh S. ◽

Raju P. V.

Keyword(s):

Acute Pancreatitis ◽

South India ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Gall Stone ◽

Geographical Location ◽

High Morbidity ◽

Care Hospital ◽

Etiological Factors ◽

Males And Females

Background: Acute pancreatitis is an important cause of acute abdomen with high morbidity and mortality. This study aimed to evaluate the epidemiology and etiological factors of acute pancreatitis in a tertiary care hospital in South India.Methods: This retrospective study was carried among 70 patients. Data was collected and analysis done based on age, gender, etiology and severity of acute pancreatitis.Results: Males were found more commonly affected than females in the ratio (M:F) of 5:1. Mean age of the study group was 37.2 years and maximum incidence was seen in the age group of 31 to 40 years. Overall alcohol was the most common etiological factor followed by idiopathic cause and gall stone disease.Conclusions: Males were more commonly affected than females with acute pancreatitis. Alcohol and gall stones were the leading cause of acute pancreatitis in males and females respectively. Alcohol was the most common cause in this geographical location.

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A Rare Triad: Hypercalcemia-Induced Necrotizing Pancreatitis Presenting as Severe Diabetic Ketoacidosis

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709621998477 ◽

2021 ◽

Vol 9 ◽

pp. 232470962199847

Author(s):

Krystal Mills ◽

Judith Aniekwena ◽

Tiffany Cochran ◽

Echezona Nsofor ◽

Nicolas Bakinde

Keyword(s):

Acute Pancreatitis ◽

Primary Hyperparathyroidism ◽

Diabetic Ketoacidosis ◽

Medical History ◽

Organ Dysfunction ◽

Clinical Course ◽

Necrotizing Pancreatitis ◽

Female Predominance ◽

Electrolyte Abnormalities

Primary hyperparathyroidism (PHPT) typically occurs in persons above 45 years, with a female predominance. PHPT induces a state of hypercalcemia, but acute pancreatitis is a rare sequelae of this hypercalcemia. We report a case of a 31-year-old man with no known medical history who presented in diabetic ketoacidosis with electrolyte abnormalities. His clinical course progressed to multi-organ dysfunction despite correction of metabolic derangements. Further workup led to the discovery of the uncommon triad by which previously undiagnosed PHPT precipitated severe diabetic ketoacidosis.

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A clinical study of risk factors of acute pancreatitis in a tertiary care centre in north India

International Surgery Journal ◽

10.18203/2349-2902.isj20172053 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1878 ◽

Cited By ~ 1

Author(s):

Pawan Kumar Jha ◽

Rajnish Chandran ◽

Pradeep Jaiswal ◽

Kumari Seema

Keyword(s):

Risk Factors ◽

Acute Pancreatitis ◽

Tertiary Care ◽

Gall Stone ◽

North India ◽

Care Centre ◽

Tertiary Care Centre ◽

Organ Systems ◽

Mild Acute Pancreatitis ◽

A Prospective Study

Background: According to Atlanta Symposium, acute pancreatitis (AP) was defined as an acute inflammatory process of the pancreas that may also involve peri-pancreatic tissues and/or remote organ systems. The objective of this study was to know the risk factors of acute pancreatitis in patients admitted in a tertiary care centre in north IndiaMethods: A prospective study was performed with admitted cases of patients with acute pancreatitis over 2 years period. Total 104 patients were selected for study. All data concerning aetiology were recorded and analysed in all patients forming study groups.Results: Among 104 patients with acute pancreatitis 68 (65%) were females and 36 (35%) were males. Mean age of our study group was 40.9 years and maximum incidence was seen in 36-45 years. Most common cause was biliary pancreatitis (63%) followed by alcohol (27%), idiopathic (6%), trauma (3%), infections (1%). In females, most common aetiology was gall stone (88%), in males most commonly by alcohol (78%). As per Atlanta classification 81 patients (77.8%) had acute mild pancreatitis and 23 patients (22.2%) had acute severe pancreatitis. Majority females (66.7%) were admitted in mild acute pancreatitis. The mean age of patients in mild acute pancreatitis was 39.6 years and in severe group was 45.4 years. Gall stone were the leading cause in both mild and severe acute pancreatitis.Conclusions: Females were more commonly affected than men by acute pancreatitis. The most common aetiology was gall stone followed by alcohol which was leading cause in the males.

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Valproic acid induced acute necrotizing pancreatitis

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v1i2.13577 ◽

2015 ◽

Vol 1 (2) ◽

pp. 86-88

Author(s):

Rabindra Gurung ◽

Asish Subedi ◽

Balkrishna Bhattarai

Keyword(s):

Valproic Acid ◽

Acute Pancreatitis ◽

Computerized Tomography ◽

Epigastric Pain ◽

Necrotizing Pancreatitis ◽

Gall Stone ◽

Acute Necrotizing Pancreatitis ◽

Nausea And Vomiting ◽

Acid Therapy ◽

Acute Necrotizing

Background: Valproic acid induced pancreatitis is a rare entity with an estimated incidence of one in 40000. Occurrence of acute necrotizing pancreatitis is even more uncommon with only very few cases being reported till date. We present a case of valproic acid associated acute necrotizing pancreatitis that complicated to develop pancreatic pseudo cyst.Case discussion: A 21-year-old male presented in our emergency room with sudden onset of severe epigastric pain along with nausea and vomiting. He gave history of having on valproic acid therapy for the last 13 months for seizure disorder. There was no history suggestive of gall stone disease, alcohol intake, hyperlipidemia, abdominal trauma or any surgical intervention. Clinical suspicion of acute pancreatitis was confirmed by revealing of necrotizing pancreatitis in contrast enhanced computerized tomography. Patient was admitted in the intensive care unit where valproic acid was stopped and phenytoin started. Clinical improvement was observed with conservative management while mild intermittent abdominal pain, nausea and vomiting persisted. Repeat computerized tomography done later revealed features of pancreatic pseudo cyst for which patient underwent definitive surgical management.Conclusions: Today, valproic acid is widely used for multiple disease conditions. Starting from 1979 till 2010, 107 cases of valproic acid induced acute pancreatitis have been reported. Acute pancreatitis is a serious condition with significant mortality despite optimal treatment. Unfortunately, it is underreported and underestimated especially following valproic acid use. Increasing frequency of valproic acid associated pancreatitis demands reconsideration of its use.Journal of Society of Anesthesiologists 2014 1(2): 86-88

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Clinical profile of patients with acute pancreatitis in a tertiary care centre in Tripura: A retrospective study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i6.29233 ◽

2020 ◽

Vol 11 (6) ◽

pp. 96-100

Author(s):

Surajit Kumar Das ◽

Saswati Das

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Retrospective Study ◽

Necrotizing Pancreatitis ◽

Gall Stone ◽

Clinical Profile ◽

Morbidity And Mortality ◽

Common Disease ◽

Grading System ◽

Etiological Factors

Background: Acute Pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis is an inflammatory process leading to abdominal pain, progressive destruction of exocrine tissue and in some patients a loss of endocrine tissue as well, with multiple organ failure and high mortality. Severity of acute pancreatitis is linked to the presence of systemic organ dysfunction and/or necrotizing pancreatitis. Aims and Objective: The present study was aimed to study the clinical profile of acute pancreatitis, the etiology and complications of acute pancreatitis received treatment in the Department of Surgery, Tripura Medical College & Dr. BRAM Teaching Hospital, Agartala, Tripura. Materials and Methods: This was a hospital based retrospective study which was conducted from January 2019 to December 2019. All patients with a diagnosis of acute pancreatitis were included in this study in order to find out the clinical presentations from the available clinical, laboratory and radiological data. Result: Of the 100 patients in this study, 96 were male and 4 were female. Minimum age in our study was 10 years and maximum were 70 years. Maximum numbers of patients were below 45 years of age. Alcohol was identified as the most important etiological factor associated with acute pancreatitis. Among the known etiological factors 90% of the cases were related to alcoholism and 4% were due to gall stone disease. Abdominal pain and vomiting were the most common symptoms in our study. Epigastric tenderness was present in 90% of the cases and guarding/rigidity in 50% of cases. 14% patients showed jaundice as a sign of acute pancreatitis. There was no major difference between the CT grading system and clinical grading system. Most of the patients recovered with conservative treatment. Adverse outcome was noted in one patient with acute necrotizing pancreatitis. Conclusion: Acute pancreatitis is one of the leading causes of increase in morbidity and mortality to society. Clinical assessment along with radiological findings correlated well with the morbidity and mortality. Our study identifies alcoholism as one of the most important etiological factors.

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Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000501 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000501

Author(s):

Manu K Nayar ◽

Noor L H Bekkali ◽

David Bourne ◽

Sophie Young ◽

John S Leeds ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Secondary Care ◽

Multiorgan Failure ◽

Tertiary Care ◽

Endoscopic Drainage ◽

Hub And Spoke ◽

Specialist Nurse ◽

Icu Stay

ObjectiveSevere acute pancreatitis (SAP) is associated with high mortality (15%–30%). Current guidelines recommend these patients are best managed in a multidisciplinary team setting. This study reports experience in the management of SAP within the UK’s first reported hub-and-spoke pancreatitis network.DesignAll patients with SAP referred to the remote care pancreatitis network between 2015 and 2017 were prospectively entered onto a database by a dedicated pancreatitis specialist nurse. Baseline characteristics, aetiology, intensive care unit (ICU) stay, interventions, complications, mortality and follow-up were analysed.Results285 patients admitted with SAP to secondary care hospitals during the study period were discussed with the dedicated pancreatitis specialist nurse and referred to the regional service. 83/285 patients (29%; 37 male) were transferred to the specialist centre mainly for drainage of infected pancreatic fluid collections (PFC) in 95% (n=79) of patients. Among the patients transferred; 29 (35%) patients developed multiorgan failure with an inpatient mortality of 14% (n=12/83). The median follow-up was 18.2 months (IQR=11.25–35.51). Multivariate analysis showed that transferred patients had statistically significant longer overall hospital stay (p<0.001) but less ICU stay (p<0.012).ConclusionThis hub-and-spoke model facilitates the management of the majority of patients with SAP in secondary care setting. 29% warranted transfer to our tertiary centre, predominantly for endoscopic drainage of PFCs. An evidence-based approach with a low threshold for transfer to tertiary care centre can result in lower mortality for SAP and fewer days in ICU.

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Necroptosis protects against exacerbation of acute pancreatitis

Cell Death and Disease ◽

10.1038/s41419-021-03847-w ◽

2021 ◽

Vol 12 (6) ◽

Author(s):

Michittra Boonchan ◽

Hideki Arimochi ◽

Kunihiro Otsuka ◽

Tomoko Kobayashi ◽

Hisanori Uehara ◽

...

Keyword(s):

Acute Pancreatitis ◽

Necrotizing Pancreatitis ◽

Neutrophil Infiltration ◽

Dependent Manner ◽

Protective Effects ◽

Interacting Protein ◽

Inflammatory Conditions ◽

Edematous Pancreatitis ◽

Genetic Deletion ◽

Dose Dependent

AbstractThe sensing of various extrinsic stimuli triggers the receptor-interacting protein kinase-3 (RIPK3)-mediated signaling pathway, which leads to mixed-lineage kinase-like (MLKL) phosphorylation followed by necroptosis. Although necroptosis is a form of cell death and is involved in inflammatory conditions, the roles of necroptosis in acute pancreatitis (AP) remain unclear. In the current study, we administered caerulein to Ripk3- or Mlkl-deficient mice (Ripk3−/− or Mlkl−/− mice, respectively) and assessed the roles of necroptosis in AP. We found that Ripk3−/− mice had significantly more severe pancreatic edema and inflammation associated with macrophage and neutrophil infiltration than control mice. Consistently, Mlkl−/− mice were more susceptible to caerulein-induced AP, which occurred in a time- and dose-dependent manner, than control mice. Mlkl−/− mice exhibit weight loss, edematous pancreatitis, necrotizing pancreatitis, and acinar cell dedifferentiation in response to tissue damage. Genetic deletion of Mlkl resulted in downregulation of the antiapoptotic genes Bclxl and Cflar in association with increases in the numbers of apoptotic cells, as detected by TUNEL assay. These findings suggest that RIPK3 and MLKL-mediated necroptosis exerts protective effects in AP and caution against the use of necroptosis inhibitors for AP treatment.

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Familial Chylomicronemia Syndrome-Induced Acute Necrotizing Pancreatitis during Pregnancy

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1722173 ◽

2021 ◽

Vol 43 (03) ◽

pp. 220-224

Author(s):

Julia Cristina Coronado Arroyo ◽

Marcio José Concepción Zavaleta ◽

Eilhart Jorge García Villasante ◽

Mikaela Kcomt Lam ◽

Luis Alberto Concepción Urteaga ◽

...

Keyword(s):

Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Clinical Course ◽

Necrotizing Pancreatitis ◽

Rare Condition ◽

Severe Hypertriglyceridemia ◽

Fetal Complications ◽

Acute Necrotizing ◽

History Of ◽

Important Objective

AbstractAcute pancreatitis is a rare condition in pregnancy, associated with a high mortality rate. Hypertriglyceridemia represents its second most common cause. We present the case of a 38-year-old woman in the 24th week of gestation with a history of hypertriglyceridemia and recurrent episodes of pancreatitis. She was admitted to our hospital with acute pancreatitis due to severe hypertriglyceridemia. She was stabilized and treated with fibrates. Despite her favorable clinical course, she developed a second episode of acute pancreatitis complicated by multi-organ dysfunction and pancreatic necrosis, requiring a necrosectomy. The pregnancy was ended by cesarean section, after which three plasmapheresis sessions were performed. She is currently asymptomatic with stable triglyceride levels. Acute pancreatitis due to hypertriglyceridemia represents a diagnostic and therapeutic challenge in pregnant women, associated with serious maternal and fetal complications. When primary hypertriglyceridemia is suspected, such as familial chylomicronemia syndrome, the most important objective is preventing the onset of pancreatitis.

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