Persistent SIRS and acute fluid collections are associated with increased CT scanning in acute interstitial pancreatitis
Ayesha KamalMahya FaghihRobert A. MoranElham AfghaniAmitasha SinhaNasim ParsaMartin A. MakaryAtif ZaheerElliot K. FishmanMouen A. KhashabAnthony N. KallooVikesh K. Singh
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Background: The use of computed tomography (CT) in acute pancreatitis (AP) continues to increase in parallel with the increasing use of diagnostic imaging in clinical medicine.Aim: To determine the factors associated with obtaining >1 CT scan in acute interstitial pancreatitis (AIP).Methods: Demographic and clinical data of all adult patients admitted between 1/2010 and 1/2015 with AP (AP) were evaluated. Only patients with a CT severity index (CTSI) ≤ 3 on a CT obtained within 48 h of presentation were included.Results: A total of 229 patients were included, of whom 206 (90%) had a single CT and 23 (10%) had >1 CT during the first week of hospitalization. Patients undergoing >1 CT had significantly higher rates of acute fluid collection (AFC), persistent SIRS, opioid use ≥4 days, and persistent organ failure compared to those undergoing 1 CT (p < .05 for all). On multivariable analysis, only persistent SIRS (OR = 3.6, 95% CI 1.4–9.6, p = .01) and an AFC on initial CT (OR = 3.5, 95% CI 1.4–9, p = .009) were independently associated with obtaining >1 CT.Conclusion: An AFC on initial CT and persistent SIRS are associated with increased CT imaging in AIP patients. However, these additional CT scans did not change clinical management.Preface Contributors The history of chronic pancreatitis Molecular pathogenesis and gentic alterations in chronic pancreatitis Pathogenesis of chronic pancreatitis: Current state and trends Chronic pancreatitis: The role of nerves and neuroimmune interaction Diagnosis of chronic pancreatitis: Function tests Chronic pancreatitis: Diagnostic imaging Chronic pancreatitis: An attempt to classify Difficult decision-making in chronic pancreatitis: An interactive workshop Chronic pancreatitis diabetes mellitus and nutrition Conservative treatment of chronic pancreatitis 100th anniversary of pancreatic enzyme treatment Endoscopic treatment of chronic pancreatitis: Impact on long-term outcome Surgical treatment of chronic pancreatitis: Standard procedures Surgical treatment of chronic pancreatitis: Long-term results Index
Pathogenesis
Pancreatitis, chronic
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Several studies tried to define the proinflamatory and anti-inflamatory cytokine response in acute pancreatitis. In our prospective studywe focused on the role of IL-6, IL-8, and IL-10 in the prognosis of acute pancreatitis. One hundred and seventeen consecutive patients(65 males and 52 females) with diagnosis of acute pancreatitis were eligible for participation in the study. Conclusions: Pts with severe acute pancreatitis had elevated values of IL-6, IL-8 and IL-10. Because of its sensitivity, elevated IL-6 should be considered in the prediction of acute pancreatitis complications.
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Objective To determine whether enteral nutrition(EN) can attenuate the acute phase response and improve clinical disease severity in patients with acute pancreatitis.Methods APACHEⅡ score,computed tomography (CT),C reactive protein(CRP),and endotoxin were determined on 62 patients with acute pancreatitis.Patients were stratified according to disease severity and randomised to receive either parenteral nutrition (PN) or EN for seven days and then re-evaluated.Results Systemic inflammatory response syndrome (SIRS),sepsis,organ failure, and ITU stay were globally improved in the enterally fed patients.The acute phase response and disease severity scores were significantly improved following enteral nutrition without change in the CT scan scores.CRP:158± 30.21 to 84±26.33,P0.05,APACHEⅡ scores:(8.2±1.36)to(6.3±1.18),P0.05.In parenterally fed patients these parameters did not change but there was an increase in endotoxin levels.Enterally fed patients showed no change in endotoxin levels.Conclusions EN moderates the acute phase response,and improves disease severity and clinical outcome in acute pancreatitis. Enteral feeding modulates the inflammatory and sepsis respone in acute pancreatitis and is clmically beneficial.
Enteral administration
Inflammatory response
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Abstract This study examines the value of endoscopic pancreatography in chronic pancreatitis. With the cooperation of nine departments in Italy, the authors examined the pancreatograms of 1179 patients with chronic pancreatitis. The pancreatograms were abnormal in 80·6 per cent. There were difficulties in distinguishing between cancer and pancreatitis in 11·3 per cent, and difficulty in deciding whether the radiographs were normal or slightly abnormal in 6·8 per cent. The ability of pancreatography to diagnose chronic pancreatitis increased with the duration of the disease, reaching 92·3 per cent in those patients who had had chronic pancreatitis for 5 or more years. However, the failure to obtain a pancreatogram increased as calcification increased. A good correlation between abnormalities of the pancreatogram and of the pancreatic function tests was demonstrated.
Pancreatic Disease
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Acute pancreatitis is acute pancreatic inflammation which can lead to damage of surrounding tissues and other organic systems. In the case of acute pancreatitis, autodigestion of pancreatic tissue is induced as a result of activation of zymogenic forms of enzyme in the active proteolytic enzymes. In patients with acute pancreatitis occurs severe abdominal pain. The most important diagnostic markers are serum lipase and serum amylase. There are two forms of acute pancreatitis: mild acute pancreatitis and severe acute pancreatitis. The purpose of this study was to analyze and evaluate the nutritive status of a patient suffering from acute pancreatitis at arrival and release from KB Dubrava with a particular focus on patient's diet during hospital stay.
Pancreatic enzymes
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Aims: Acute fluid collections after acute pancreatitis carries risk of serious complications as infected pseudocyst and Wall off Necrose development. Hence, it is important to predict the development of acute fluid collections for treatment and management of acute pancreatitis. In this study, it is aimed to investigate predictive factors for development of acute fluid collections in patients with acute pancreatitis.
Methods: Total of 438 patients diagnosed with acute pancreatitis were screened. According to the Revised Atlanta Classification fluid development after acute pancreatitis was determined and the relationship between fluid development and the hematological/biochemical parameters of the patients at the time of admission was investigated. The best cut-off point of laboratory measurements for fluid development was determined by ROC analysis and the factors that may be most decisive in distinguishing between the patients with and without fluid development were determined by multivariate forward stepwise logistic regression analysis.
Results: It is found that developing acute fluid collections after acute pancreatitis was higher in patients with younger age and male gender. Also the risk of developing acute fluid collections after acute pancreatitis was found to be 6.2 times higher in patients with CRP/Albumin ratio greater than 1.09; 2.5 times higher in patients with ALP below 199.5 U/L; 1.9 times higher in patients with WBC greater than 11,6 ×10⁹/L and 1.5 times higher in patients with PLR above 197.1. Also the risk of developing acute necrotic collections after acute pancreatitis was 3 times higher in patients with serum calcium level below 8,6 mg/dl.
Conclusion: It has been determined that, presence of high CRP/albumin ratio, high NLR and low serum ALP level can be used as an indicator in predicting acute pancreatic and peripancreatic fluid development.
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The purpose of this study was to compare the performance between noncontrast-enhanced computed tomography (NECT) plus abdominal ultrasound (US) (NECT + US) with contrast-enhanced computed tomography (CECT) for the detection of hepatic metastasis in breast cancer patient with postsurgical follow-up.A total of 1470 patients without already diagnosed hepatic metastasis were included. All patients underwent US and multiphase CECT including the NECT. Independent reviewers analyzed images obtained in four settings, namely, abdominal US, NECT, NECT + US, and CECT and recorded liver metastases using a 5-grade scale of diagnostic confidence. Sensitivity, specificity (diagnostic performance), and area under the receiver operating characteristic curve (AUC, diagnostic confidence) were calculated. Interoperator agreement was calculated using the kappa test.Reference standards revealed no metastases in 1108/1470 patients, and metastasis was detected in 362/1470 patients. Abdominal US (P < 0.01) and NECT (P = 0.01) significantly differed from CECT, but NECT + US did not significantly differ from CECT in terms of sensitivity (P = 0.09), specificity (P = 0.5), and AUC (P = 0.43). After an additional review of abdominal US, readers changed the diagnostic confidence scores of 106 metastatic lesions diagnosed using NECT. Interobserver agreements were good or very good in all four settings. Additional review of abdominal US with NECT allowed a change in the therapeutic plan of 108 patients.Abdominal US + NECT showed better diagnostic performance for the detection of hepatic metastases than did NECT alone; its diagnostic performance and confidence were similar to those of CECT.
Contrast-enhanced ultrasound
Contrast Enhancement
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e c e n t s u r ve y s o n c h r o n i c pancreatitis carried out around the world shows that alcohol remains the main factor associated with chronic pancreatitis, even if at a frequency lower than that reported previously.It has further confirmed that heavy alcohol consumption and smoking are independent risk factors for chronic pancreatitis.Autoimmune pancreatitis accounts for 2%-4% of all forms of chronic pancreatitis, but this frequency will probably increase over the next few years.The rise in idiopathic chronic pancreatitis, especially in India, represents a black hole in recently published surveys.Despite the progress made so far regarding the possibility of establishing the hereditary forms of chronic pancreatitis and the recognition of autoimmune pancreatitis, it is possible that we are more inaccurate today than in the past in identifying the factors associated with chronic pancreatitis in our patients.
Etiology
Autoimmune Pancreatitis
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The article tells about current issues in the treatment of chronic pancreatitis in adults. Particular attention is paid to the use of enzyme preparations as replacement and symptomatic therapy in chronic pancreatitis. There is a brief description of antispasmodics used for relief of abdominal pain in chronic pancreatitis.
Pancreatitis, chronic
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