Associated Liver Disease in Alcoholic Chronic Pancreatitis

Background: Alcohol is a common etiological factor in the pathogenesis of both pancreatic and liver disease. The frequencies of associated liver histological change in patients with alcoholic chronic pancreatitis (AICP) vary from series to series. Significant proportion of patients with alcoholic pancreatitis does have histological changes in liver. Subjects and Methods: The study was conducted at Narayana Medical College & Hospital, Chintareddy Palem, Nellore, Andhra Pradesh on liver-biopsy specimens from 23 patients with chronic alcoholic pancreatitis subjected to operation for pain, from August 2015 to July 2016 and all the patients had undergone liver biopsy at the time of surgery for AICP. The patients were followed as part of a prospective study of 33 patients who had been treated for chronic pancreatitis. The pathologists were requested to report on alcohol related histological changes in the specimen. Results: There were 23 patients and all were men. Chronic pancreatitis was due to alcohol abuse in all patients. The median age at surgery was 39.8 years. The mean duration of alcohol abuse was 20.5 years (range 6-29 years).The average alcohol intake was 122gm 36gms/day. Three patients had jaundice for 3-6 months duration. None of the patients had any other risk factor for liver disease and none of them had clinical or biochemical evidence of liver disease. The histological reports were, 4 patients had alcoholic hepatitis, 2 severe steatohepatitis, 1 granulomatous hepatitis, 3 cholestasitc changes, one fatty liver and 12 had no significant pathology. None of the patients had cirrhosis. Thus significant alcoholic liver disease was present in 30.4% (7/23) of the patients. There was no increased incidence of post-operative mortality and morbidity in patients with liver pathology. Conclusion: As reported in many other series, chronic alcoholic pancreatitis is associated with histological changes in liver in significant proportion of patients. However its clinical significance and prognosis of these patients are unknown.

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Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.012517 ◽

2018 ◽

Vol 17 (1) ◽

pp. 71-75

Author(s):

Fabiana Seifert Santos ◽

Karolaine Marcelina da Silva Sousa ◽

Thiago Augusto Cadorin de Castro ◽

Felipe Coelho Neto ◽

Rodrigo Gomes de Oliveira ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Rare Complication ◽

Clinical Signs ◽

Alcoholic Pancreatitis ◽

Chronic Alcoholic Pancreatitis ◽

Chronic Alcoholic ◽

Acute Hemorrhage ◽

Gold Standard Method ◽

Abdominal Bleeding ◽

Thoracic And Abdominal

Abstract Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.

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COMBINATION OF O BESITY AND MALNUTRITION AT A PATIENT WITH CHRONIC ALCOHOLIC PANCREATITIS (CASE REPORT)

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2018-8-6-475-479 ◽

2018 ◽

Vol 8 (6) ◽

pp. 475-479 ◽

Cited By ~ 1

Author(s):

N. S. Gavrilina ◽

L. Yu. Ilchenko ◽

I. G. Fedorov ◽

I. G. Nikitin

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Insufficiency ◽

Exocrine Pancreatic Insufficiency ◽

Alcoholic Pancreatitis ◽

Anthropometric Parameters ◽

Chronic Alcoholic Pancreatitis ◽

Chronic Alcoholic ◽

Enzyme Replacement ◽

Clinical Description ◽

Positive Effect

The article contains a clinical description of the case of combination of such two opposite states as obesity and malnutrition in a patient with chronic pancreatitis. The patient was hospitalized with exacerbation of chronic pancreatitis and alcohol abuse. The examination revealed exocrine pancreatic insufficiency and mild malnutrition. The patient was prescribed enzyme replacement therapy and additional oral sip feeding with a positive effect. After 10 weeks of exocrine pancreatic insufficiency were stopped, but malnutrition remained and required a longer course of treatment. The relevance of this problem, the main difficulties of diagnosis were presented in the article. All patients need to measure anthropometric parameters, BMI, lymphocytes, total protein, albumin. Using only BMI leads to hypodiagnosis of malnutrition in patients with chronic pancreatitis.

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Hereditary pancreatitis for the endoscopist

Therapeutic Advances in Gastroenterology ◽

10.1177/1756283x12467565 ◽

2013 ◽

Vol 6 (2) ◽

pp. 169-179 ◽

Cited By ~ 7

Author(s):

Milan R. Patel ◽

Amanda L. Eppolito ◽

Field F. Willingham

Keyword(s):

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Serine Protease ◽

Alcohol Exposure ◽

Alcoholic Pancreatitis ◽

Hereditary Pancreatitis ◽

Chronic Alcoholic Pancreatitis ◽

Chronic Alcoholic ◽

Increased Risk ◽

Endocrine Insufficiency

Hereditary pancreatitis shares a majority of clinical and morphologic features with chronic alcoholic pancreatitis, but may present at an earlier age. The term hereditary pancreatitis has primarily been associated with mutations in the serine protease 1 gene (PRSS1) which encodes for cationic trypsinogen. PRSS1 mutations account for approximately 68–81% of hereditary pancreatitis. Mutations in other genes, primarily serine protease inhibitor Kazal type 1 (SPINK1) and the cystic fibrosis transmembrane conductance regulator (CFTR) are also associated with hereditary pancreatitis. While chronic alcoholic pancreatitis may develop in the fourth or fifth decades, patients with hereditary pancreatitis may develop symptoms in the first or second decades of life. Hereditary pancreatitis is diagnosed either by detecting a causative gene mutation or by the presence of chronic pancreatitis in two first-degree or three second-degree relatives, in two or more generations, without precipitating factors and with a negative workup for known causes. Patients with hereditary pancreatitis may have recurrent acute pancreatitis and may develop pancreatic exocrine and endocrine insufficiency. Hereditary pancreatitis may involve premature trypsinogen activation or decreased control of trypsin. Recurrent inflammation can lead to acute pancreatitis and subsequently to chronic pancreatitis with parenchymal calcification. There is a markedly increased risk of pancreatic carcinoma compared with the general population. Patients are often referred for evaluation of pancreatitis, biliary or pancreatic ductal dilatation, jaundice, biliary obstruction, pancreatic duct stone or stricture, pancreatic pseudocysts, and for evaluation for malignancy. Medical treatment includes pancreatic enzyme supplementation, nutritional supplementation, diabetes management, and palliation of pain. Patients should avoid tobacco use and alcohol exposure. Hereditary pancreatitis is reviewed and recommendations for genetic testing are discussed.

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Asymptomatic Hepatopathy in Chronic Alcoholic Pancreatitis and its Clinico-Pathologic Comparison with Alcoholic Liver Disease and Non-Alcoholic Steatohepatitis

The American Journal of Gastroenterology ◽

10.14309/00000434-201110002-00341 ◽

2011 ◽

Vol 106 ◽

pp. S134

Author(s):

Deepak Singh ◽

Puja Sakhuja ◽

Archana Rastogi ◽

Sheetalnathan Rooge ◽

Ranjana Gondal ◽

...

Keyword(s):

Liver Disease ◽

Alcoholic Liver Disease ◽

Alcoholic Pancreatitis ◽

Chronic Alcoholic Pancreatitis ◽

Chronic Alcoholic ◽

Alcoholic Steatohepatitis

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СORRECTION OF MALNUTRITION IN PATIENTS WITH CHRONIC PANCREATITIS

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2019-9-1-70-80 ◽

2019 ◽

Vol 9 (1) ◽

pp. 70-80 ◽

Cited By ~ 1

Author(s):

N. S. Gavrilina ◽

L. Yu. Ilchenko ◽

G. A. Sedova ◽

I. G. Fedorov ◽

I. G. Nikitin

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Insufficiency ◽

Pancreatic Enzyme ◽

Alcoholic Pancreatitis ◽

Chronic Obstructive ◽

High Dose ◽

Chronic Alcoholic Pancreatitis ◽

Chronic Alcoholic ◽

Enzyme Replacement ◽

Group I

Aim:To estimate the frequency of occurrence malnutrition and efficacy its correction in chronic pancreatitis (CP).Materials and methods:148 patients were examined. Group I included 71 people with chronic alcoholic pancreatitis (CAP); group II — 77 patients with chronic obstructive pancreatitis (COP). Trophological status (TS) was investigated by criteria of V.M. Luft. Lymphocytes, pancreatic amylase, lipase, total protein, albumin, urine diastase and faecal elastase-1 were investigated before and after treatment. Two treatment options were used: combination therapy (CT, (Mezym-forte 10500 USP/day and pharmaconutrient Ensure 2 200 ml/day)) and high-dose pancreatic enzyme replacement therapy ((HD PERT), Kreon 120000 USP/day) for 10 weeks. 62 patients received HD PERT: 24 patients with CAP and 38 patients with COP; CT — 86 patients: 47 and 39, respectively.Results:The prevalence of malnutrition in patients with CP was 92% (n=136). Lymphopenia was determined in 44%, hypoproteinemia-in 11,5%, hypoalbuminemia-in 54%. 12 (8%) patients did not have malnutrition. In the group CAP: mild malnutrion was established in44, moderate — in 20, severe — 2, eutrophia — 6; in the group COP: mild malnutrion — in 33, moderate — in 37, severe — 0, eutrophia — 6. Aftertreatment in the group CAP: malnutrion moderate — in 7, mild — 58, eutrophia — 7, in the COP: malnutrion moderate — 37, mind — 31, eutrophy — 8.Conclusions:Malnutrition is frequent symptom complex in patients with CP. The severity of malnutrition is more severy in CAP. The most effective treatment malnutrition was CT in patients with CAP. HD PERT is indicated to correct exocrine pancreatic insufficiency.

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A case of splenic artery pseudoaneurysm rupture presenting as rectal bleeding in a regional hospital

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa504 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Jonathon N Holt ◽

Heinrich E Schwalb

Keyword(s):

Rectal Bleeding ◽

Splenic Artery ◽

Artery Aneurysm ◽

Regional Hospital ◽

Alcoholic Pancreatitis ◽

Chronic Alcoholic Pancreatitis ◽

Chronic Alcoholic ◽

Artery Pseudoaneurysm ◽

Previous Trauma ◽

Splenic Artery Pseudoaneurysm

Abstract Splenic artery pseudoaneurysm is a rare phenomenon most associated with chronic pancreatitis or previous trauma. Complications can include erosion and rupture into local structures, a situation that carries a reported mortality of 10–40%. A 58-year-old male with chronic alcoholic pancreatitis and a known splenic artery pseudoaneurysm presented to the emergency department of a regional hospital with rectal bleeding and sepsis. Computed tomography revealed a peri-splenic mass communicating with the splenic flexure. The patient was taken for an emergency splenectomy and left hemicolectomy and was confirmed to have rupture of the splenic artery aneurysm into the large bowel. This case presented with comparable features reported in the literature and demonstrates that access to emergency specialist surgical services in a regional setting offers the capability to manage rare, life threatening surgical emergencies.

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