DOCSLIB.ORG

NUTRITIONAL MANAGEMENT in ACUTE and CHRONIC PANCREATITIS Earnest Alexander Jr., Pharm.D

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
NUTRITIONAL MANAGEMENT in ACUTE and CHRONIC PANCREATITIS Earnest Alexander Jr., Pharm.D NUTRITIONAL MANAGEMENT IN ACUTE AND CHRONIC PANCREATITIS Earnest Alexander Jr., Pharm.D. Reviewed by Susan C. Fagan, Pharm.D., FCCP, BCPS; and Mark Newnham, Pharm.D., BCPS, BCNSP admissions. The remaining 20–30% of patients are admitted Learning Objectives with severe pancreatitis with reported mortality rates of up to 25–30%. Therefore, the ratio of mild to severe acute 1. Evaluate the classification, clinical manifestations, and pancreatitis is about 4:1. long-term risks associated with acute and chronic Acute fluid collection occurs in 30–50% of acute pancreatitis. pancreatitis cases and typically resolves spontaneously. A 2. Assess common diagnostic tools used in acute and pseudocyst is a fluid collection that persists for 4–6 weeks chronic pancreatitis and evaluate their usefulness. and becomes encapsulated by a wall of fibrous or 3. Analyze patient-specific characteristics in determining granulation tissue. Asymptomatic pseudocysts do not the nutritional support needs and goals of patients with require treatment. If symptomatic, pseudocysts can be acute and chronic pancreatitis. managed surgically, radiologically, or endoscopically. A 4. Demonstrate an understanding of the role of enteral and small subset of patients with severe acute pancreatitis will parenteral nutrition support in managing acute and develop chronic pancreatitis or pancreatic necrosis. It is chronic pancreatitis. estimated that about 5–15% of patients with acute and 5. Develop a plan to provide nutrition support through an chronic pancreatitis develop necrotizing pancreatitis. appropriate route to a patient with acute and chronic Necrotizing pancreatitis is a devastating disease with pancreatitis. reported mortality rates of up to 50–80%. Appropriate surgical, antibiotic, and nutritional management reduces Introduction to Acute and these rates to about 5–20%. Chronic Pancreatitis Classifying and Diagnosing Epidemiology of Acute and Chronic Pancreatitis Pancreatitis Acute pancreatitis is defined as an acute inflammatory process of the pancreas with variable involvement of other Many scoring systems have evolved to identify patients regional tissues and remote organ systems. It is a relatively with severe pancreatitis who are at highest risk for organ common disease, affecting 200,000 individuals annually in failure and/or local complications, such as necrosis, abscess, the United States. Although it often runs a mild course, up or pseudocyst. Ranson criteria are scored based on to 30% of acute pancreatitis cases will be associated with 11 clinical criteria with prognostic importance and is the significant morbidity and mortality. Acute pancreatitis is most widely recognized system for classifying pancreatitis. characterized by the sudden onset of severe epigastric pain, Five of these criteria are measured at the time of admission which accounts for 3% of hospital admissions for abdominal and the other six in the first 48 hours after admission. The pain. Mild attacks account for 70–80% of acute pancreatitis number of Ranson criteria present at the time of assessment Fang J, DiSario JA. Nutritional management of acute pancreatitis. Curr Gastroenterol Rep 2002;4:120–7. Rettally CA, Skarda S, Garza MA, Schenker S. The usefulness of laboratory tests in the early assessment of severity of acute pancreatitis. Crit Rev Clin Lab Sci 2003;40:117–49. Pharmacotherapy Self-Assessment Program, 5th Edition 183 Nutritional Management in Acute and Chronic Pancreatitis during acute pancreatitis occur with a delay of 1–2 days, as Abbreviations in this it reflects the stimulation of hepatic synthesis of the acute phase reactants mediated by interleukin-6. Although the Chapter release of inflammatory mediators such as interleukin-6 and polymorphonuclear elastase occurs more rapidly, serum APACHE II Acute Physiology and Chronic CRP determination is still the most widely used individual Health Evaluation II marker for prognostic assessment of acute pancreatitis CRP C-reactive protein because of ease of use and widespread availability. EN Enteral nutrition C-reactive protein indicates pancreatic necrosis within TPN Total parenteral nutrition 48–72 hours after disease onset with an accuracy of about 90%. The Atlanta classification is an additional scoring system is correlated with the incidence of systemic complications that uses information obtained by contrast-enhanced and the presence of pancreatic necrosis. In addition to the computed tomography and clarified definitions of the Ranson criteria, the Glasgow criteria are scored using a different complications likely to be encountered with acute similar approach with only eight clinical criteria assessed pancreatitis. The Atlanta classification system categorizes during the first 48 hours. These scoring systems are detailed disease under the general heading of pancreatic necrosis. in Tables 1-1 and 1-2. Mild acute pancreatitis is associated Ultrasound or magnetic resonance pancreatography with two or fewer criteria with both the Ranson and combined with this system aid in distinguishing among Glasgow scoring systems. Despite some limitations in localized collections of necrotic tissues, acute pseudocysts, sensitivity and specificity, studies suggest that patients with and fluid collections. a Ranson or Glasgow criteria of 3 or higher have severe Evidence on computed tomography of hypoperfusion pancreatitis. correlates well with pancreatic necrosis. Computed The Acute Physiology and Chronic Health Evaluation II tomography is useful for diagnosing pancreatic necrosis (APACHE II) is an illness severity score and prognostic after the first 24 hours of symptom onset with sensitivity indicator based on 12 physiological variables, the patient’s further improving to about 100% between 4 and 10 days age, and any history of severe organ system dysfunction or after symptom onset. immunocompromised state. Traditionally, an APACHE II Interleukins (i.e., interleukin-6, interleukin-8, and score of 10 or higher indicates the presence of severe interleukin-18), trypsin activation peptide, procalcitonin, pancreatitis. However, many clinicians and researchers procarboxypeptidase-activation peptide, and phospholipase currently use a lower APACHE II score (6 or higher) to A2 also are markers of disease severity with proven validity, differentiate mild acute pancreatitis from severe acute but they are either too expensive or too time-consuming for pancreatitis. This lower APACHE II score has not yet been routine clinical practice. A single serological marker with fully adopted by all practitioners because of the increased absolute reliability to predict a severe attack of acute probability of erroneous classification of patients with mild pancreatitis at any time after onset of the disease is still not acute pancreatitis as severe. The distinction between available. APACHE II scoring cutoffs and the classification of mild Amylase and lipase are both enzymes released from the and severe acute pancreatitis is important in properly pancreas during acute pancreatitis. Despite widespread use evaluating the results of clinical data from recently of amylase and lipase concentrations for diagnosing acute published studies. Studies that classify severe acute pancreatitis, the prognostic ability of either enzyme to pancreatitis in patients with an APACHE II score of 10 or assess severity of disease has been consistently poor. The greater than three Ranson criteria ensures the exclusion of reason plasma concentrations of the pancreatic enzymes patients with mild disease. Unlike the Ranson or Glasgow have no value in predicting severity probably relates to the system, the APACHE II score is more flexible, allows for rapid decline in concentrations after an early peak. The peak classification of illness severity on admission, and may be occurs within the first 24 hours of symptoms, with amylase recalculated daily. A combination of the APACHE II with having a shorter half-life compared to lipase. The decrease either the Ranson or Glasgow scoring systems in research in concentrations over the course of several days limits the and clinical practice ensures sensitivity and specificity in accuracy of these enzymes in measuring pancreatic severity classifying acute pancreatitis and assessing progression of through the course of the disease. In addition, in the absence the disease. To ensure the inclusion of patients with severe of pancreatitis, serum lipase may increase up to 2-fold pancreatitis, studies should include only patients with three above normal in severe renal insufficiency (creatinine or more Ranson criteria or an APACHE II score of 10 or clearance of 20 ml/minute or less). Pancreatic enzyme more. concentrations also have limited value in diagnosing In many institutions, measurement of biochemical chronic pancreatitis, with concentrations often normal or markers has become a standard for prognostic assessment. low. The diagnosis of chronic pancreatitis is based on An advantage of the markers is that they can be measured recurrent abdominal pain, radiographic abnormalities, and repeatedly and thereby draw attention to the development of functional testing failures. Practitioners traditionally have severe disease more simply than the complex scoring monitored daily enzyme concentrations instead of patients’ criteria. The use of C-reactive protein (CRP) can detect overall clinical picture in patients with chronic pancreatitis. pancreatic necrosis in the majority of patients with However, published data would suggest that this practice is concentrations
Load more

Recommended publications
  • A CASE REPORT Introduction Acute Pancreatitis Is an Inflammato
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Archivio istituzionale della ricerca - Università di Palermo Acta Medica Mediterranea, 2014, 30: 33 THE UNSOLVED QUESTION OF ACUTE PANCREATITIS. PROGNOSTIC CRITERIA: A CASE REPORT CLAUDIO ENNA, GIUSEPPE TAORMINA, AURELIO SEIDITA, ALBERTO D’ALCAMO, MIRIAM CARTA, FLORIANA ADRAGNA, PASQUALE MANSUETO Internal Medicine, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University Hospital of Palermo, Italy ABSTRACT Acute pancreatitis is a severe pathologic condition that requires an early identification of patients at risk of developing poten- tially lethal complications. To date, the use of clinical scoring systems and evaluation of biochemical parameters are, by far, the most widely used means to stratify the risk, even if they seem approximate and inadequate. The computed tomography severity index has proved to be superior in predicting acute pancreatitis outcome. Here we report the case of an adult male, admitted to our Department with the initial diagnosis of acute edematous pancreatitis, which was proved later to be a necrotizing pancreatitis, in which the clini- cal and laboratory prognostic scores were inadequate and discrepant with the more accurate computed tomography severity index. Key words: Acute pancreatitis, Ranson’s criteria Glasgow score APACHE II score Balthazar’s score. Received November 18, 2013; Accepted December 31, 2013 Introduction Patients with pancreatic necrosis require to be close- ly monitored in intensive care unit, with a strict clini- Acute pancreatitis is an inflammatory process cal and laboratory follow-up, associated with CT and of pancreas characterized by sudden onset and is, to MRI examination(3).
    [Show full text]
  • Surgery Notes IIIII a PPROACH to ABDOMINAL MASSES 1111 IV IV OESOPHAGEAL DISEASES 1212
    CONTENTS Page I TRAUMA (MULTI-SPECIALTY APPROACH) 22 IIII APPROACH TO ABDOMINAL PAIN 1100 Surgery Notes IIIII A PPROACH TO ABDOMINAL MASSES 1111 IIVV OESOPHAGEAL DISEASES 1122 For the M.B.B.S. VV UPPER BLEEDING GIT AND ITS CAUSES 2211 VVII COLORECTAL DISEASES 1199 By Andre Tan VII LIVER DISEASES 3399 VIII PANCREA TIC DISEASES 4455 IIXX BILIARY TRACT DISEASES 5511 XX BREAST DISEASES 6600 XXII HEAD AND NECK MASSES 6699 XII SALIVARY GLAND SWELLINGS 7744 XIII THYROID DISEASES 7788 XIV PERIPHERAL ARTERIAL DISEASE 8855 XV ABDOMINAL AORTIC ANEURYSM 9933 XVI PERIPHERAL VENOUS DISEASE 9955 XVII UROLOGICAL DISEASES 9999 XVIII SURGICAL INSTRUMENTS 111100 TRAUMA (MULTI-SPECIALTY APPROACH) Management o f breathing -- Supplemental oxygen -- Ventilate as required if patient requires assistance with breathing AADVANCED TTRAUMA LLIFEIFE SSUPPORT ALGORITHM -- Needle thoracotomy for tension pneumothorax, followed by chest tube MAIN PRINCIPLES: -- Occlusive dressing for open pneumothorax -- Treat greatest threat to life first -- Definitive diagnosis is less important 3.3. CIRCULATION -- Time is important – – the “golden hour” after trauma is when 30% of trauma deaths Assessment of organ perfusion occur, and are preventable by ATLS -- Level of consciousness -- Skin colour and temperature, capillary refill -- Pulse rate and character – – all major pulses APPROACH -- Blood pressure 1.1. Primary survey and Resuscitation with adjuncts 2.2. Re-evaluation of the patient Classes of haemorrhagic shock 3.3. Secondary survey with adjuncts I II III IVIV 4.4. Post-resuscitation monitoring and re-evaluation Bld loss 5.5. Optimise for transfer and definitive care Amt (ml) <750 750-1500 1500-2000 >2000 Percentage <15<15 15-30 30-40 >40>40 Ht rate <100 >100 >120 >140 PRIMARY SURVEY – – ABCDE BPBP Normal Normal Decreased Decreased Cap refill Normal Prolonged Prolonged Prolonged 1.1.
    [Show full text]
  • Sample Chapter CHAPTER 16: Liver, Biliary Tract, & Pancreas Disorders BUY
    Sample Chapter CHAPTER 16: Liver, Biliary Tract, & Pancreas Disorders BUY NOW mhprofessional.com 728129654 – ©2021 McGraw Hill LLC. All Rights Reserved. CMDT 2022 677 Liver, Biliary Tract, & Pancreas Disorders Lawrence S. Friedman, MD 16 JAUNDICE & EVALUATION OF ABNORMAL hepatic uptake of bilirubin due to certain drugs; or impaired LIVER BIOCHEMICAL TESTS conjugation of bilirubin by glucuronide, as in Gilbert syn- drome, due to mild decreases in uridine diphosphate (UDP) glucuronyl transferase, or Crigler-Najjar syndrome, ESSENTIALS OF DIAGNOSIS caused by moderate decreases (type II) or absence (type I) of UDP glucuronyl transferase. Hemolysis alone rarely elevates the serum bilirubin level to more than 7 mg/dL » Jaundice results from accumulation of bilirubin in (119.7 mcmol/L). Predominantly conjugated hyperbiliru- body tissues; the cause may be hepatic or binemia may result from impaired excretion of bilirubin nonhepatic. from the liver due to hepatocellular disease, drugs, sepsis, » Hyperbilirubinemia may be due to abnormalities or hereditary hepatocanalicular transport defects (such as in the formation, transport, metabolism, or excre- Dubin-Johnson syndrome, progressive familial intrahe- tion of bilirubin. patic cholestasis syndromes, and intrahepatic cholestasis of » Persistent mild elevations of the aminotransferase pregnancy) or from extrahepatic biliary obstruction. Fea- levels are common in clinical practice and caused tures of some hyperbilirubinemic syndromes are summa- most often by nonalcoholic fatty liver disease rized in Table 16–2. The term “cholestasis” denotes (NAFLD). retention of bile in the liver, and the term “cholestatic jaundice” is often used when conjugated hyperbilirubine- » Evaluation of obstructive jaundice begins with ultrasonography and is usually followed by mia results from impaired bile formation or flow.
    [Show full text]
  • Ministry of Healthcare of Ukraine Danylo Halytsky Lviv National Medical University
    MINISTRY OF HEALTHCARE OF UKRAINE DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY DEPARTMENT OF SURGERY № 1 ACUTE PANCREATITIS Guidelines for Medical Students LVIV – 2019 2 Approved at the meeting of the surgical methodological commission of Danylo Halytsky Lviv National Medical University (Meeting report № ___ on __________ ____, 2019) Guidelines prepared: CHOOKLIN Sergiy Mykolayovych – PhD, professor of Department of Surgery №1 at Danylo Halytsky Lviv National Medical University KHOMYAK Volodymyr Vsevolodovych – PhD, associate professor of Department of Surgery №1 at Danylo Halytsky Lviv National Medical University Referees: ANDRYUSHCHENKO Viktor Petrovych – PhD, professor of Department of General Surgery at Danylo Halytsky Lviv National Medical University OREL Yuriy Glibovych - PhD, professor of Department of Surgery №1 at Danylo Halytsky Lviv National Medical University Responsible for the issue first vice-rector on educational and pedagogical affairs at Danylo Halytsky Lviv National Medical University, corresponding member of National Academy of Medical Sciences of Ukraine, PhD, professor M.R. Gzegotsky 3 I. Background The incidence of acute pancreatitis (AP) has increased during the past 20 years. Most patients develop a mild and self-limited course; however, 10% to 20% of patients have a rapidly progressive inflammatory response associated with prolonged length of hospital stay and significant morbidity and mortality. Patients with mild pancreatitis have a mortality rate of less than 1% but, in severe pancreatitis, this increases up to 10% to 30%.3 The most common cause of death in this group of patients is multiorgan dysfunction syndrome. Mortality in pancreatitis has a bimodal distribution; in the first 2 weeks, also known as the early phase, the multiorgan dysfunction syndrome is the final result of an intense inflammatory cascade triggered initially by pancreatic inflammation.
    [Show full text]
  • Multidisciplinary Approach to Treating Severe Acute Pancreatitis in a Low-Volume Hospital
    World J Surg (2019) 43:2994–3002 https://doi.org/10.1007/s00268-019-05114-8 ORIGINAL SCIENTIFIC REPORT Multidisciplinary Approach to Treating Severe Acute Pancreatitis in a Low-Volume Hospital 1 2 1 Alvaro Robin-Lersundi • Ana Abella Alvarez • Carlos San Miguel Mendez • 1 1 1 Almudena Moreno Elalo-Olaso • Arturo Cruz Cidoncha • Asuncio´n Aguilera Velardo • 2,3 1,4 Federico Gordo Vidal • Miguel-Angel Garcı´a-Uren˜a Published online: 22 August 2019 Ó Socie´te´ Internationale de Chirurgie 2019 Abstract Background Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality. Methods We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis. Results Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis.
    [Show full text]
  • Clinical Biliary Tract and Pancreatic Disease
    Clinical Upper Gastrointestinal Disorders in Urgent Care, Part 2: Biliary Tract and Pancreatic Disease Urgent message: Upper abdominal pain is a common presentation in urgent care practice. Narrowing the differential diagnosis is sometimes difficult. Understanding the pathophysiology of each disease is the key to making the correct diagnosis and providing the proper treatment. TRACEY Q. DAVIDOFF, MD art 1 of this series focused on disorders of the stom- Pach—gastritis and peptic ulcer disease—on the left side of the upper abdomen. This article focuses on the right side and center of the upper abdomen: biliary tract dis- ease and pancreatitis (Figure 1). Because these diseases are regularly encountered in the urgent care center, the urgent care provider must have a thorough understand- ing of them. Biliary Tract Disease The gallbladder’s main function is to concentrate bile by the absorption of water and sodium. Fasting retains and concentrates bile, and it is secreted into the duodenum by eating. Impaired gallbladder contraction is seen in pregnancy, obesity, rapid weight loss, diabetes mellitus, and patients receiving total parenteral nutrition (TPN). About 10% to 15% of residents of developed nations will form gallstones in their lifetime.1 In the United States, approximately 6% of men and 9% of women 2 have gallstones. Stones form when there is an imbal- ©Phototake.com ance in the chemical constituents of bile, resulting in precipitation of one or more of the components. It is unclear why this occurs in some patients and not others, Tracey Q. Davidoff, MD, is an urgent care physician at Accelcare Medical Urgent Care in Rochester, New York, is on the Board of Directors of the although risk factors do exist.
    [Show full text]
  • Endoscopic Management of Pancreatitis
    2001 년 도 대한쉐당도연구회 학술대회 口특 강口 Endoscopic Management of Pancreatitis Joseph W. Leung, M.D., FRCP., FACP., FACG C.W. Law Professor of Medicine, Chief, Division of Gastroenterology, University of California, Davis Health System and VA Northem Califomia Health Care System Leaming objectives: distal common duct. Characteristic EUS appearance 1. Understand the role of ERCP in the diagnosis has also been described in the diagnosis of pancreas and treatment of pancreatic diseases divisum. In addition, EUS guided fine needle aspi­ 2. Discuss the pathophysiology of acute and chro­ ration cyto10gy or biopsy is an effective too1 for the mc pancreatltls diagnosis of underlying pancreatic malignancy. Des­ 3. Discuss the management of pain associated with pite the advances in pancreaticobili앙y imaging, thera­ pancreatic diseases peutic ERCP continues to play an important role in 4. Endoscopic management of acute biliary pancre­ the treatment of pancreatic diseases. Endoscopy is atitis, idiopathic pancreatitis and pancreas divisum useful to rule out the presence of an ampullary 5. Endoscopic management of chronic pancreatitis tumor as a cause of pancreatitis. Endoscopic brush in c1uding strictures, stones and pseudocysts cytology, aspiration bile cytology and needle biopsy 6. Discuss parasitic infestation of the pancreatic also aid in the diagnosis of under1ying pancreatic system malignancies. INTRODUCTION DEFINITIONS Diagnostic and therapeutic ERCP play an im­ Acute pancreatitis is defined as inflammation of portant role in the management of patients with pan­ the pancreas with no residual damage upon reco­ creaticobiliaη problems. Diagnostic pancreatogram veη ， except in cases complicated by strictures or compliments ultrasound scan and CT scan in the pseudocyst formation.
    [Show full text]
  • Dentistry – Surgery IV Year
    Dentistry – Surgery IV year Which sign is not associated with peptic ulcer perforation: A 42-year-old male, with previous Sudden onset ulcer history and typical clinical picture of peptic ulcer perforation, on Cloiberg caps examination, in 4 hours after the Positive Blumberg sign beginning of the disease, discomfort in Free air below diaphragm on plain right upper quadrant, heart rate - abdominal film 74/min., mild abdominal wall muscles rigidity, negative Blumberg sign. Free Intolerable abdominal pain air below diaphragm on X-ray abdominal film. What is you diagnosis? Which ethiological factors causes Peptic ulcer recurrence peptic ulcer disease most oftenly? Acute cholecystitis Abdominal trauma, alimentary factor Chronic cholecystitis H. pylori, NSAID's Covered peptic ulcer perforation H. pylori, hyperlipidemia Acute appendicitis (subhepatic Drugs, toxins location) NSAID's, gastrinoma Most oftenly perforated peptic ulcers are located at: A 30-year-old male is operated on for peptic ulcer perforation, in 2,5 hours Posterior wall of antrum after the beginning of the disease. Fundus of stomach Which operation will be most efficient (radical operation for peptic ulcer)? Cardiac part of stomach Simple closure and highly selective Posterior wall of duodenal bulb vagotomy Anterior wall of duodenal bulb Simple closure Simple closure with a Graham patch Penetrated ulcer can cause such using omentum complications: 1). Abdominal abscess; Stomach resection 2). Portal pyelophlebitis; 3). Stomach- organ fistula; 4). Acute pancreatitis; 5). Antrumectomy Bleeding. 1, 2, 3; It has been abandoned as a method to treat ulcer disease 2, 3, 5; 1, 3, 5; A 42-year-old executive has refractory 3, 4, 5; chronic duodenal ulcer disease.
    [Show full text]
  • Acute Pancreatitis 18/04/2012
    Version 2.0 Acute Pancreatitis 18/04/2012 Acute inflammation of the pancreas, releasing exocrine enzymes that cause autodigestion of the organ. There may be involvement of local tissues and distant organs e.g. ARDS. Epidemiology • Common. 3% of all cases of abdominal pain admitted to hospital. Causes (Mnemonic - I GET SMASHED) Gallstones or EtOH (>80%) & Idiopathic (10%) most common. • Idiopathic • Gallstone • Ethanol (alcohol) • Trauma • Steroids • Mumps (paramyxovirus) and other viruses (Coxsackie, hepatitis, EBV, CMV) • Autoimmune disease/vasculitis (Polyarteritis nodosa, Systemic lupus erythematosus) • Scorpion sting (e.g. Tityus trinitatis), and also snake bites • Hypercalcemia, hypertriglyceridemia and hypothermia • ERCP, estrogens • Drugs (SAND - Steroids & sulfonamides, Azathioprine, NSAIDS, Didanosine & diuretics such as frusemide and thiazides), and duodenal ulcers Also hereditary pancreatitis and malignancy (1º or 2º pancreatic Ca) Presentation History: Most commonly constant epigastric/upper abdominal pain, sudden onset ± radiation to back, vomiting, history of EtoH use, gallstones. Take drug history. Exam: Epigastric tenderness, may have absent BS, moderate pyrexia, looking unwell with probable tachycardia with some dehydration. Cullen’s sign (flank) & Grey Turner’s (umbilicus) if haemorrhagic pancreatitis. Investigations Urine: U/A for bilirubin. Urinary trypsinogen activation peptide - but rarely done. Bloods: FBC, UEC, CMP, BSL, LFT, lipase/amylase (lipase ↑sensitive), CRP, ABG, coags, cultures ECG: non-specific ST-T wave
    [Show full text]
  • Review of Current Evidence in the Etiopathogenesis, Epidemiology, Diagnosis and Management of Acute Pancreatitis
    Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 29 March 2019 doi:10.20944/preprints201903.0282.v1 Review Review of Current Evidence in the Etiopathogenesis, Epidemiology, Diagnosis and Management of Acute Pancreatitis Samantha Varley 1*, Kirsten Rossi 2, Meghan Murray 3 and Alissa Nichole 4 1 Department of Gastroenterology, University Hospital of Udine, Udine, Italy; [email protected] 2 Department of Medicine, University Hospital of Udine, Udine, Italy; [email protected] 3 Department of Medicine, University Hospital of Udine, Udine, Italy; [email protected] 4 Department of Gastroenterology, University Hospital of Udine, Udine, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39 (0) 432 552751 Abstract: Acute pancreatitis (AP) is an inflammatory condition of the pancreas and is one of the most common ailments of the gastrointestinal system that results in significant morbidity and mortality. The main etiologic causes of AP are alcohol consumption, gallstones, hypertriglyceridemia, and biliary stones. The clinical signs and symptoms, and diagnostic criteria of AP are well established in the literature and multiple studies. Multiple scoring systems have been used to predict the severity, prognosis, and mortality associated with AP. The present review of the literature brings to light the significant and recent contributions in the etiology, risk factors, epidemiology, diagnosis, complications, prognosis and newest modalities in treatment that could be beneficial in the management of AP. Keywords: pancreatitis; epidemiology; diagnosis; complications; treatment; prognosis 1. Introduction Acute pancreatitis (AP) results from the premature activation of digestive enzymes released by the exocrine pancreas, mainly trypsinogen to trypsin, inside the acinar cells causing their self- digestion and stimulation of macrophages that induce the production of proinflammatory cytokines, Tumor necrosis factor-alpha (TNF- α), interleukins (IL) play a vital role in the pathogenesis of AP [1,2].
    [Show full text]
  • Validity of Ranson's Score for Predicting Mortality and Morbidity in Acute Pancreatitis
    ProceedingS.Z.P.G.M.l. vol: 17(2): pp. 67-70, 2003. Validity of Ranson's Score for Predicting Mortality and Morbidity in Acute Pancreatitis Shandana Tarique, Shahid Sarwar and Farrukh Iqbal Department of Medicine Jinnah Hospital Lahore and Department of Gastroenterology and Hepatology Shaikh Zayed Hospital Lahore SUMMARY Acute pancreatitis is one of the acute abdominal emergencies that need protracted hospital stay and intensive care. Degree of severity has to be assessed to gauge the severity of illness. Ranson scoring system is used to assess the severity and predict prognosis. Study was carried out to assess the validity of Ranson's criteria in patients with acute pancreatitis. Thirty patients of acute pancreatitis were enrolled. Ranson's criteria were applied to all of them. Patients were monitored and managed according to their condition. Out of thirty patients, 46.6% were above 55 years of age. Thirteen (43.3%) patients did not develop any complication. Ranson's score of 0-2 was found in 15 (50%) patients, of which 2 (13.3%) died. Complications occurred in 5 (33.3%). A score of 3-4 was seen in 9 (30%) cases and survival rate was I 00% despite complications. Score of 5-6 was seen in 5 (16.66%) cases. All had complications and 3 (60%) died. A score of 7-8 was found in one patient who survived. The score was insignificant in predicting the mortality with a p-value of 0.371, but had comparatively significant p-value of 0.062 in predicting development of complications. Ranson's criteria is not significant in predicting the outcome in the form of death from acute pancreatitis though there is some significance in predicting the occurrence of compI ications.
    [Show full text]
  • Guide for Answering Theory Questions in MS Surgery
    WBUHS (2011-2015) MS- PAPER – I -IV Guide for Answering theory questions in MS Surgery Dr. Arkaprovo Roy ASSOCIATE PROFESSOR DEPARTMENT OF GENERAL SURGERY Dr. Arkaprovo Roy ASSOCIATE PROFESSOR DEPARTMENT OF GENERAL SURGERY MEDICAL COLLEGE AND HOSPITAL, KOLKATA THE WEST BENGAL UNIVERSITY OF HEALTH SCIENCES MS (General Surgery) Examination, 2015 PAPER I Time Allowed: 3 Hours Full Marks: 100 Attempt all questions 1. How will you assess the nutritional status of a surgical patient? Define and classify artificial nutritional support (ANS). Give an account of enteral nutrition and its advantages and drawbacks. 4+4+8+4 2. Describe the lymph node status in relation to spread of carcinoma stomach. Discuss in detail the different types of gastric carcinoma and prognosis in respect to lymph node harvest. 5+10+5 3. Write short notes of the following: 5x6 a) Pharmacological therapy in patients awaiting surgery for pheochromocytoma. b) Retroperitoneal fibrosis. c) Ethics and law in surgical practice. d) Pathophysiology of short bowel syndrome. e) Metabolic response to trauma. 4. Answer briefly on the following. 4x71/2 a) Laparoscopic versus conventional surgery in pregnancy. b) Component separation and role of blood components in surgery. c) Graft rejection in transplants. d) Immunohistochemistry. THE WEST BENGAL UNIVERSITY OF HEALTH SCIENCES MS (General Surgery) Examination, 2015 April 2015 PAPER I Time Allowed: 3 Hours Full Marks: 100 Attempt all questions 1. How will you assess the nutritional status of a surgical patient? Define and classify artificial nutritional support (ANS). Give an account of enteral nutrition and its advantages and drawbacks. 4+4+8+4 Answer.
    [Show full text]