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Query: UMLS:C0001339 (acute pancreatitis)
 10,593 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Plasma concentrations of bilirubin, alkaline phosphatase (AP), and glutamic oxaloacetic transaminase (GOT) were measured during 122 attacks of acute pancreatitis in 114 patients, on the day of admission to hospital and 2 days after admission. Concentrations in 74 attacks associated with gallstones were compared with concentrations in 31 attacks in which no stones were found. 24 attacks were severe by clinical criteria. On the day of admission plasma GOT concentrations of more than 60 IU/l were found in 88% of attacks associated with gallstones, but in no attacks without gallstones. Plasma concentrations of more than 25 mumol/l bilirubin and more than 14 King-Armstrong units AP were found in 62% and 66% respectively, of attacks associated with gallstones, and 5% and 10%, respectively, of attacks without stones. In attacks associated with gallstones plasma concentrations of GOT and bilirubin usually fell over the first 48 h of admission. No correlation was observed between these biochemical values and the severity of the attack. In the absence of a history of excessive alcohol consumption, increases in plasma GOT on the day of admission to hospital suggest that gallstones are responsible for the pancreatitis.
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PMID:Biochemical prediction of gallstones early in an attack of acute pancreatitis. 8 54

Diagnostic peritoneal lavage using one litre of isotonic saline was performed on 27 patients with acute pancreatitis as soon as possible after diagnosis. There were no complications. Severe attacks (defined retrosepctively according to the progress of the attack) were characterised by the presence of free peritoneal fluid and by dark-coloured and often opalescent return fluid. The concentrations of albumin, aspartate aminotransferase (SGOT) and total protein in the return fluid provided good discrimination between severe and mild attacks, and there were also significant differences in the concentrations of amylase, urea, calcium, potassium, bilirubin, alkaline phosphatase, and the white cell count. Lavage successfully predicted severe disease in five patients whose condtion had been clinically assessed as mild.
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PMID:Early assessment of severity of acute pancreatitis using peritoneal lavage. 58 22

This is a report of our experience with 13 patients who had a distal common duct stricture associated with chronic relapsing pancreatitis. All patients, when first seen, had an elevated alkaline phosphatase level; eight of 13 patients also had an elevated serum bilirubin level. Five of the jaundiced patients had a febrile course; a preoperative diagnosis of acute cholangitis was made in four of these. Eight of the 13 patients have had a choledochoduodenostomy for relief of biliary obstruction; seven of these patients are living and well; one died of continued alcoholism and pancreatitis. One patient had a loop cholecystojejunostomy; decompression was inadequate and death due to septicemia secondary to ascending cholangitis ensued. Four patients have not yet had an operation. Two are symptomatic, but elective operation has been refused. Two have been lost to follow-up. We recommend investigation of the biliary tract in patients known to have chronic relapsing pancreatitis who also have persisting abdominal symptoms and an elevated alkaline phosphatase. If a stricture of the distal common bile duct is identified in the absence of acute pancreatitis, choledochoduodenostomy should be performed.
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PMID:Chronic pancreatitis: a cause of biliary stricture. 88 95

Early identification of severe gallstone-associated acute pancreatitis (GAAP) is a prerequisite for treatment with urgent endoscopic sphincterotomy. This study assesses the value of two clinicobiochemical scoring systems to this end. Over the 7-year period from 1983 to 1989, 100 consecutive patients with acute pancreatitis (45 related to gallstones, 36 to alcohol, and 19 of undetermined etiologies) had clinicobiochemical analysis within 48 hours of admission. The final diagnosis and outcome were retrospectively compared with the prediction achieved by the scoring systems. With regard to Blamey's criteria for early identification of gallstones, significant differences were found between the biliary and nonbiliary groups with respect to female sex, serum amylase concentration greater than or equal to 4,000 IU/L, alkaline phosphatase level greater than or equal to 300 IU/L, and alanine aminotransferase level greater than or equal to 100 IU/L (all p values less than 0.001). Age greater than or equal to 50 years was found to be significant (p less than 0.02) only in differentiating gallstone- versus alcohol-associated acute pancreatitis. When three or more positive factors were present, the sensitivity and specificity for predicting gallstones were 60% and 87%, respectively; the predictive value of a positive result was 79%, of a negative result 74%, and the overall accuracy was 75%. At a cutoff level of five, rather than three or more prognostic factors, the modified Ranson's criteria for patients known as having GAAP allowed a suitable discrimination of patients with an expected high risk of complications and mortality. When the two scoring systems (Blamey greater than or equal to 3 and Ranson greater than or equal to 3) were combined, 17 patients were predicted as having severe GAAP: 6 of these 17 patients were misdiagnosed as having biliary pancreatitis, whereas 9 patients with definite severe GAAP were not selected because of a Blamey score less than 3. More specific diagnostic tools are needed, and higher cutoff levels for prognostic scores are required for the prediction of severe GAAP, particularly in view of selecting patients for potentially dangerous approaches such as urgent endoscopic sphincterotomy.
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PMID:Predictability of clinicobiochemical scoring systems for early identification of severe gallstone-associated pancreatitis. 162 3

Eighty-three patients suffering from upper abdominal pain were studied to evaluate the contribution of commonly used biochemical markers in the diagnosis of acute pancreatitis. On admission to hospital, serum amylase, lipase, total bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and gamma-glutamyl transferase activities were measured. By stepwise logistic discrimination, only two determinations appeared to be of clinical value: lipase and alkaline phosphatase activities. A classification rule was established including these two measurements and its diagnostic performance evaluated by a jackknifed method amounted .83%. ROC curves were used to assess sensitivity and specificity. Our study clearly shows that serum lipase measurements should be preferred to amylase measurements, and that our two-test classification rule provides an efficient aid in clinical decision-making.
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PMID:Combined diagnostic value of biochemical markers in acute pancreatitis. 169 97

The aim of this study was to investigate the usefulness of serum bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (APh) and real time ultrasonography (US) in distinguishing between gallstone and non gallstone related acute pancreatitis (A.P.). The second aim was to evaluate whether or nor there was biliary tract hypertension. Both aims were designed in order to evaluate them in the early stage of A.P. Two Groups of patients were studied. Group 1--gallstone related A.P., 63 pts. Group 2--Non gallstone related A.P. 21 pts. Fifty nine (93.6%) of Group 1 and 11 (52.3%) of Group 2 had surgical confirmation. In the other, the diagnosis was based on US and C.T. Blood samples were taken during the three days after admission for biochemical test and US was performed within the same period. Statistical evaluation and Student's t test were used. Biochemical test: when the cut off level was expressed by the upper limit of normal (ULN), the highest diagnostic sensibility was (table 1): ALT 85.7%, APH 80.9%. AST 71%, bilirubin 65%. When the cut off level was chosen at twice the ULN (Table 1), the sensibility was: ALT 61.9%, bilirubin and AST 47%, APh 30%, Group 2 (Table 2) values higher than the ULN were: AST 42.8%, bilirubin 33%, ALT 19%, APh 14.2%. The differences between the two Groups were statistically significant: APh and bilirubin P less than 0.001, ALT less than 0.05 m AST, NS. Ultrasonography: Group 1: gallstones were detected in 96.6% (58/60). Biliary tree was not visualized in 10 (15.8%), diagnosed as normal in 38 (60.3%) and pathologic (dilatation and/or lithiasis) in 15 (23.8%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Value of laboratory tests and echography in the diagnosis of biliary disease in the initial phase of acute pancreatitis]. 209 97

A retrospective study has been carried out, comparing 87 patients with acute pancreatitis of biliary etiology and 53 patients with pancreatitis secondary to other causes. The clinical presentation, laboratory data, radiological findings (chest X-rays, radiography of the abdomen and gastrointestinal, echography), morbidity and mortality have been analyzed. In acute pancreatitis related to biliary disease, pain is most frequently located in the right hypochondrium and the levels of amylase, GOT, GPT an alkaline phosphatase were higher, although only the last two parameters showed significant differences. Morbidity (local and general complications) did not show differences in both groups, but mortality was higher in pancreatitis secondary to biliary disease (5.6% compared to 3.7%).
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PMID:[Acute pancreatitis of biliary etiology]. 239 Mar 55

Three clinicobiochemical systems have been proposed for predicting gallstones in acute pancreatitis based on one, three and five factors respectively, but have not been compared in a single prospective study. System 1 is based on the serum transaminase alone; system 2 uses alkaline phosphatase and bilirubin in addition to transaminase; and system 3 involves female gender, age, amylase and alkaline phosphatase in addition to transaminase. Over the 4-year period 1983-86, 368 patients with 391 episodes of acute pancreatitis had clinicobiochemical analysis within 48 h. Of these episodes, 220 were related to gallstones (56 per cent), 62 to alcohol (16 per cent) and 109 to other aetiologies or were idiopathic (28 per cent). Significant differences were found between the biliary and non-biliary groups with respect to sex (139 versus 59 women, P less than 0.002), age (65 +/- 17 versus 52 +/- 19 years, P less than 0.0001) and serum amylase (6041 +/- 6335 versus 4546 +/- 3990 units/l, P less than 0.0001), alkaline phosphatase (257 +/- 225 versus 141 +/- 137 units/l, P less than 0.0001), alanine transaminase (221 +/- 227 versus 72 +/- 119 units/l, P less than 0.0001) and bilirubin (40 +/- 39 versus 24 +/- 30 mumol/l, P = 0.0001). The sensitivity and specificity was 75 per cent and 74 per cent for the one-factor system, 74 per cent and 78 per cent for the three-factor system and 62 per cent and 80 per cent for the five-factor system. The predictive value of a positive result was 78.8 per cent, 81.5 per cent and 80.1 per cent and of a negative result 69.4 per cent, 70.1 per cent and 62.3 per cent for the three systems respectively. The performances of the one- and three-factor systems were marginally better than that of the five-factor system; the one-factor system, however, had the advantage of simplicity.
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PMID:Biochemical prediction of gallstones in acute pancreatitis: a prospective study of three systems. 245 Jun 14

Current trends in the treatment of gallstone pancreatitis require rapid diagnosis of cholelithiasis. This study evaluates the diagnostic potential of plasma aspartate aminotransferase (AST), alkaline phosphatase, and bilirubin on the day of admission to hospital in 215 attacks of acute pancreatitis. The optimal diagnostic cut-off level for AST was 60 IU/1. A transient elevation above 60 IU/1 was recorded in 111 (84.1%) of 132 attacks associated with gallstones, but in only 12 (14.5%) of 83 attacks without stones, and was unrelated to the severity of the attack. Elevated levels of alkaline phosphatase and bilirubin were also more common in attacks associated with gallstones but were less reliable for the identification of cholelithiasis than AST. As a sensitive indicator of hepatocyte disruption, the early and transient rise in plasma AST is consistent with the concept of transient ampullary obstruction in gallstone pancreatitis, and may be useful in identifying patients who require urgent surgical or endoscopic disimpaction.
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PMID:Biochemical identification of patients with gallstones associated with acute pancreatitis on the day of admission to hospital. 257 76

Fifty consecutive patients with acute pancreatitis were assessed with respect to a biliary origin of the disease. Endoscopic retrograde cholangiopancreaticography, surgery, and autopsy were used to define biliary pancreatitis. Ultrasound, computed tomography, and several laboratory tests (SGOT, SGPT, alkaline phosphatase, and bilirubin) were analyzed for their ability to detect a biliary origin of the disease. Ultrasound and computed tomography could not reliably make the diagnosis in the 10 patients found to have biliary disease. Receiver-operator-characteristic curves revealed that none of the laboratory tests assessed had sufficient sensitivity and specificity to determine the diagnosis, although all tests showed higher mean values in biliary pancreatitis. SGPT gave the best discrimination (positive predictive value 53%, negative predictive value 94%, cut off 40 units/liter). Therefore, initial ERCP is suggested for a reliable diagnosis of biliary origin of acute pancreatitis.
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PMID:Detection of biliary origin of acute pancreatitis. Comparison of laboratory tests, ultrasound, computed tomography, and ERCP. 265 35


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