scholarly journals Severe acute pancreatitis: clinical findings and therapeutic tools in Internal Medicine practice

2013 ◽  
pp. 9-18
Author(s):  
Generoso Uomo ◽  
Pier Giorgio Rabitti
Keyword(s):  
Internal Medicine ◽  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Severity Index ◽  
Clinical Findings ◽  
Early Event ◽  
Early Evaluation ◽  
Therapeutic Tools ◽  
Marshall Score ◽  
Fluid Collections

BACKGROUND Recent advances in pathophysiology and therapeutic measures suggest that patients suffering from acute pancreatitis (AP) should undergo an early evaluation and treatment in Internal Medicine wards. Severe AP, usually associated with pancreatic necrosis and peripancreatic fluid collections, may be frequently complicated by distant organ(s) involvement. RESULTS The dreadful multi-organ failure may occur as an early event (during the first week of the disease) or in association with the infection of pancreatic necrosis in a later stage. So, during the clinical outcome, physicians may be compelled to counteract cardio-circulatory, pulmonary, renal, hepatic, haematological and hydro-electrolytic complex derangements. Arterial hypotension and shock may be consequence of hypovolemia and/or hearth failure or septic shock syndrome. Pleural effusions are frequent in the early phase of the disease as well as pulmonary densifications and renal insufficiency. Urinary, pulmonary, and biliary infections may intervene during all phases of the disease whereas pancreatic necrosis and fluid collections infections are more frequent after the second week of hospitalization. Prognostic evaluation should be obtained by simple and precise scoring system such as the modified Marshall score and CT-scan severity index. CONCLUSIONS Treatment must be initiated as soon as possible with special focusing on fluid and nutritional supplementation, pain control, cardio-respiratory support, antiproteases and antibiotics. Invasive procedures such as endoscopic sphincterotomy in biliary AP with cholangitis and/or obstruction and percutaneous drainage should be utilized in specific cases. Surgical necrosectomy is mandatory in patients with documented infection of pancreatic necrosis.

scholarly journals Role of Computed Tomography In The Evaluation of Severity of Acute Pancreatitis

KYAMC Journal ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 738-744
Author(s):  
Md Mofazzal Sharif ◽  
Mahfuz Ara Ferdousi ◽  
Md Towhidur Rahman ◽  
Nayeema Rahman ◽  
Md Nayeem Ullah ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Clinical Outcome ◽  
Surgical Intervention ◽  
Gall Stone ◽  
Severity Index ◽  
Clinical Findings ◽  
Time Period ◽  
Mild Acute Pancreatitis

Title: Role of computed tomography in the evaluation of severity of acute pancreatitis.Introduction: Early diagnosis and determination of severity of acute pancreatitis is important for management and it depends largely on severity of disease. Medical treatment of mild acute pancreatitis includes conservative management while severe acute pancreatitis requires intensive care to surgical intervention (open or minimally invasive) in selected cases.Methodology: This prospective study was carried out to find out the correlation between modified CT severity index and patient's clinical outcome in acute pancreatitis enrolling 96 subjects in the department of Radiology and Imaging, BIRDEM during two years time period. Severity of acute pancreatitis was assessed by both clinical and imaging staging (Modified CT severity index) in mild, moderate and severe groups.Result: Mean age ( ± SD) of the study subjects was 35.48 ± 14.59 years and number of male was 60 (62.50%) and female was 36 (37.50%). Acute pancreatitis was associated with hypertriglyceridemia (19.79%), gall stone (12.5%), post ERCP (6.25%) and alcoholism (2.08%). Aetiology was unidentified in 59.73% subjects. Majority of the subjects with acute pancreatitis presented with abdominal pain, fever (20.08%), vomiting (54.41%) and oedema (25%). On imaging, diffuse pancreatic enlargement was noted in 29.16% subjects. Pancreatic inflammation with and without peripancreatic fat involvement were observed in 27.08% and 72.91% subjects respectively. Pseudocyst formation (13.54%), ascites (30.20%), renal fascia involvement (46.87%) and pleural effusion (37.5%) were seen in CT scan. Severity of acute pancreatitis was evaluated by clinical findings and CT severity index and the measure of agreement between clinical and imaging staging was almost perfect. CT severity index in acute pancreatitis had statically significant relation with clinical outcome (0.573), organ failure (0.674), need for surgical intervention (0.463) and hospital stay (0.235).Conclusion: Modified CT severity index in acute pancreatitis correlates with patient outcome. During reporting if this simple scoring system is applied then we can easily measure the severity and determine whether patient need medical or surgical intervention.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 738-744

Utility of the portal venous phase for diagnosing pancreatic necrosis in acute pancreatitis using the CT severity index

2018 ◽  
Vol 43 (11) ◽  
pp. 3035-3042
Author(s):  
Yoshifumi Noda ◽  
Satoshi Goshima ◽  
Keita Fujimoto ◽  
Hiroshi Kawada ◽  
Nobuyuki Kawai ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Severity Index ◽  
Portal Venous Phase ◽  
Venous Phase

scholarly journals Mechanisms and Management of Acute Pancreatitis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ari Garber ◽  
Catherine Frakes ◽  
Zubin Arora ◽  
Prabhleen Chahal
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Outlet Obstruction ◽  
Gallstone Pancreatitis ◽  
Drainage Procedure ◽  
Endoscopic Techniques ◽  
Persistent Abdominal Pain ◽  
Fluid Collections ◽  
Walled Off Necrosis

Acute pancreatitis represents a disorder characterized by acute necroinflammatory changes of the pancreas and is histologically characterized by acinar cell destruction. Diagnosed clinically with the Revised Atlanta Criteria, and with alcohol and cholelithiasis/choledocholithiasis as the two most prominent antecedents, acute pancreatitis ranks first amongst gastrointestinal diagnoses requiring admission and 21st amongst all diagnoses requiring hospitalization with estimated costs approximating 2.6 billion dollars annually. Complications arising from acute pancreatitis follow a progression from pancreatic/peripancreatic fluid collections to pseudocysts and from pancreatic/peripancreatic necrosis to walled-off necrosis that typically occur over the course of a 4-week interval. Treatment relies heavily on fluid resuscitation and nutrition with advanced endoscopic techniques and cholecystectomy utilized in the setting of gallstone pancreatitis. When necessity dictates a drainage procedure (persistent abdominal pain, gastric or duodenal outlet obstruction, biliary obstruction, and infection), an endoscopic ultrasound with advanced endoscopic techniques and technology rather than surgical intervention is increasingly being utilized to manage symptomatic pseudocysts and walled-off pancreatic necrosis by performing a cystogastrostomy.

scholarly journals Multiple extra-splanchnic venous thromboses - an unusual vascular complication of acute pancreatitis

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Junare Parmeshwar Ramesh ◽  
Chandnani Sanjay ◽  
Suhas Udgirkar ◽  
Nair Sujit ◽  
Debnath Prasanta ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Venous Thrombosis ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Splenic Vein ◽  
Vascular Complications ◽  
Vascular Complication ◽  
Consensus Guidelines ◽  
Clinical Presentations ◽  
Fluid Collections

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable clinical presentations. Splanchnic venous thrombosis is a well-known vascular complication of AP and commonly present as thrombosis of the splanchnic venous system: splenic vein (SplV), portal vein (PV) and superior mesenteric vein (SMV), either separately or in combinations. Involvement of extra-splanchnic vessels is rare and associated with morbidity and mortality. Vascular complications are late phenomena and usually associated with local complications of AP, namely acute fluid collections, necrotizing pancreatitis and walled-off pancreatic necrosis. Pathogenesis of venous thrombosis is multifactorial in which pancreatic inflammation and systemic inflammatory response play a key role. At present, there are no consensus guidelines on treatment and use of anticoagulation for venous thrombosis in the setting of AP. Limited literature suggests the use of anticoagulation in presence of PV with or without SMV thrombosis and extrasplanchnic vessel involvement. Literature on extra-splanchnic vessels involvement in acute pancreatitis is sparse. Here we present two cases with multiple extra-splanchnic vessels involvement and their management.

scholarly journals Relation of Pancreatic Enzymes and Serum Transaminases Levels with Modified CT Severity Index In Acute Pancreatitis

2016 ◽  
pp. 18-24
Author(s):  
Md Mofazzal Sharif ◽  
Md Towhidur Rahman ◽  
Mahfuz Ara Ferdousi ◽  
Md Abu Taher ◽  
Farzana Shegufta ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Computer Software ◽  
Clinical Information ◽  
Severity Index ◽  
Clinical Findings ◽  
Perfect Agreement ◽  
Female Ratio ◽  
Imaging Department ◽  
Mild Acute Pancreatitis

Introduction: Diagnosis of patients with severe acute pancreatitis as soon as possible is critical for achieving optimal outcomes. Management depends largely on severity. Medical treatment of mild acute pancreatitis is relatively straightforward. Treatment of severe acute pancreatitis involves intensive care. Surgical intervention (open or minimally invasive) is indicated in selected cases.Methodology: A total number of 59 subjects were enrolled in this present prospective study in the department of Radiology and Imaging, BIRDEM during two years aim to find out the correlation between CT severity index and patient serum enzyme levels in acute pancreatitis. Patients with clinically suspected and biochemically diagnosed acute pancreatitis referred to Radiology and Imaging department from department of gastroenterology (GHPD), BIRDEM for imaging investigation were enrolled in this study. Severity of acute pancreatitis was measured by both clinical and imaging staging (Modified CT severity index) in mild, moderate and severe groups. Subjects clinical information’s and serum enzymes were recorded and analyzed by computer software SPSS (Ver. 20-IBM).Result: Mean age of the study subjects was 36.43 ± 13.85 years. The age ranged from 20-63 years and the maximum number was found in 21 to 40 years age group. Male female ratio was almost 1.56:1. It was seen that diffuse pancreatic enlargement was noted in 20.33% subjects. Pancreatic inflammation with and without peripancreatic fat involvement were observed in 22.72% and 57.62% subjects respectively. Pseudocyst formation (11.86%), ascites (23.72%), renal fascia involvement (37.28%) and pleural effusion (30.5%) were seen in CT scan. The results of the interpreter analysis was Kappa = 0.852 with p < 0.001 when association of severity by clinical scoring and CT severity scoring was compared and revealed that measure of agreement, while statistically significant, was almost perfect agreement. CT severity index in acute pancreatitis had statistically significant (p is less than 0.05) relation with serum amylase (0.738), lipase (0.638), SGOT (0.581) and SGPT (0.365) during admission which was found on simple linear regression test.Conclusion: This present study concluded that modified CT severity index correlated well with patient’s enzymes level (Amylase, lipase, SGOT, SGPT) as well as clinical findings in acute pancreatitisBirdem Med J 2015; 5(1) Supplement: 18-24

scholarly journals Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention

2021 ◽  
Vol 37 (1) ◽  
pp. 13-21
Author(s):  
Ramlal Prajapati ◽  
Priyadarshini Manay ◽  
Kavin Sugumar ◽  
Vinay Rahandale ◽  
Rajeev Satoskar
Keyword(s):  
Acute Pancreatitis ◽  
Indian Population ◽  
Pancreatic Necrosis ◽  
Vital Signs ◽  
Scoring Systems ◽  
Severity Index ◽  
Inotropic Support ◽  
Prognostic Scores ◽  
Biochemical Tests ◽  
Tertiary Referral Center

Objective: Several predictive scoring systems are used in the prognostication of acute pancreatitis (AP). However, the quantity of evidence of these prognostic systems in the Indian population remains sparse. The aim of our study was to evaluate the usefulness of such prognostic scores to predict mortality, incidence of pancreatic necrosis and intervention in AP. Material and Methods: This was an observational study of patients diagnosed with AP between June 2012 and November 2013 in a tertiary referral center in India. Vital signs, biochemical tests and CT-findings were recorded to identify SIRS, Ranson’s score and CT-severity index at diagnosis. Chi square test was used to compare incidence of mortality, pancreatic necrosis, and intervention between mild versus severe acute pancreatitis groups. Results: A total of 100 patients with AP were treated during out study period. Ranson’s score more than 7 and presence of pancreatic necrosis were significantly associated with increased mortality (p< 0.05). SIRS, CTSI score more than 7, inotropic support, and complications were more frequently associated with patients with necrosis. Prophylactic antibiotics did not decrease mortality, but decreased intervention rate (p< 0.05). Presence of systemic inflammatory response syndrome (SIRS), Ranson’s score > 7, necrosis, inotropic support and presence of complications were associated with a greater rate of interventions including surgery and percutaneous procedures (p< 0.05). Conclusion: We validate SIRS, Ranson’s, and CTSI score as prognostic markers for AP in the Indian population. These predictors, when used in combination, can direct early monitoring and aggressive management in order to decrease mortality associated with severe AP.

scholarly journals Minimally invasive endoscopic treatment of necrotizing pancreatitis: A case report with images and review of the literature

2017 ◽  
Vol 63 (3) ◽  
pp. 207-209
Author(s):  
Cassia Lemos Moura ◽  
Priscila Pulita Azevedo Barros ◽  
Cristiane Mota Oliveira ◽  
Rogerio Colaiácovo ◽  
Juliana Marques Drigo ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Necrotizing Pancreatitis ◽  
Severe Case ◽  
Treatment Modalities ◽  
Endoscopic Drainage ◽  
Review Of The Literature ◽  
Fluid Collections

Summary Necrotizing pancreatitis with fluid collections can occur as a complication of acute pancreatitis. The management of these patients depends on the severity and involves multiple medical treatment modalities, as clinical intensive care and surgical intervention. In this article, we show a severe case of walled-off pancreatic necrosis that was conducted by endoscopic drainage with great clinical outcome.

Modified CT severity index for evaluation of acute pancreatitis and correlation with patient outcome

2020 ◽  
Vol 13 (3) ◽  
pp. 154-161
Author(s):  
Polysetty Obuleswar Prasad ◽  
◽  
N S Vidya ◽  
G V. Prasad ◽  
D R Anand ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Acute Pancreatitis ◽  
Severity Index

Clinical Profile and Outcomes in Patients with Acute Pancreatitis attending a Teaching Hospital at Gandaki Province, Nepal

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Subash Bhattarai ◽  
Merina Gyawali
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Age Groups ◽  
Data Entry ◽  
Kidney Injury ◽  
Severity Index ◽  
Clinical Profile ◽  
Cross Sectional ◽  
Systemic Complications ◽  
Keywords Alcohol

Background: Acute pancreatitis (AP) is inflammatory process of pancreas presenting with acute abdominal pain.The majority of patients have mild disease. Some patients develop local and systemic complications with increased morbidity and mortality. This study was undertaken to describe the clinical profile and outcomes in patients with acute pancreatitis.   Methods:  A cross-sectional hospital based study comprising of 62 consecutive patients with acute pancreatitis were enrolled between Jan 2019 to August 2020. Clinical profile at admission, complications and clinical outcomes including mortality were studied. Patients were classified into mild, moderately severe and severe acute pancreatitis based on revised Atlanta classification and modified CT severity index.  Data entry was done in Statistical Packages for the Social Sciences version 20. Results: The mean age of study subjects was 44±10.87 years with 43 (56%) males and 19 (44%) females (M:F=2.1:1). The commonest etiology of pancreatitis was alcohol (53.2%) followed by biliary pancreatitis (37.1%)  The most common presentation was abdominal pain (100%). The most common complication was pancreatic necrosis (21%) followed by acute kidney injury (19.4%) and pleural effusion (17.3%). Majority( 72.6%) was mild and 17.7% had severe acute pancreatitis. Mortality was seen in 6.5% patients. Mortality was observed in patients with persistent complications, organ failure, low serum calcium and high modified CT severity index.   Conclusions: Alcohol and gallstones were the two main etiologies of acute pancreatitis and were common in males, and in middle age groups. Majority presented with mild severity. Mortality was observed in some patients with severe acute pancreatitis.   Keywords: alcohol; biliary; CT severity index; mortality; outcome; pancreatitis          

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