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

Early differentiation of gallstone from nongallstone associated acute pancreatitis by imaging methods is often difficult. Timing of surgery in gallstone pancreatitis is controversial, but early surgery requires early demonstration of gallstones. This study assesses the value of easily available clinical and laboratory data in establishing gallstones as the etiology of pancreatitis. In 405 consecutive episodes of acute pancreatitis, data were collected prospectively on 14 clinical and laboratory variables. Gallstones caused 177 episodes and alcohol 135, 93 were due to other or unknown causes. Age, sex, and within 48 hours of admission, serum alkaline phosphatase, aminotransferases, amylase, and bilirubin were all significantly different (all p less than 0.001, chi square) in gallstone and alcohol groups. Multivariate analysis based on five of these variables enabled correct prediction of the presence or absence of gallstones in 50 of a further 56 episodes. This method may help in planning early interventional treatment of gallstone associated acute pancreatitis.
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PMID:The early identification of patients with gallstone associated pancreatitis using clinical and biochemical factors only. 619 78

Biochemical tests (serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, gammaglutamyltranspeptidase, bilirubin, and serum amylase) were performed upon admission in 84 patients with suspected (36) or proven (48) acute pancreatitis at the time of the first episode of acute abdominal pain suspected clinically as acute pancreatitis. These parameters all increased significantly more in patients with gallstone pancreatitis. Among them, the SGPT was the most discriminant test between biliary and nonbiliary pancreatitis. The positive predictive value of SGPT was 92%, when the cutoff point was chosen at twice the upper limit of normal. In patients with increased SGPT, a SGOT-SGPT ratio less than 1 is the rule (88%) for those with gallstone pancreatitis. This enzymatic determination allowed us to select more accurately the patients suitable for morphological procedures to confirm the biliary origin of the pancreatitis.
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PMID:Early detection of biliary pancreatitis. 619 68

Acute pancreatitis in a patient on oral contraceptive therapy is reported, and the relationship of estrogen administration to hyperlipemia and pancreatitis is discussed. A 23-year-old white woman was admitted to a hospital with epigastric pain, nausea, and vomiting. Three previous episodes of abdominal pain had been diagnosed as acute pancreatitis. On the present and previous admissions, she had just completed a cycle on her combination norethindrone 1 mg, mestranol 8 micrograms contraceptive. Laboratory results showed mild leukocytosis and elevated concentrations of blood glucose, alkaline phosphatase, serum amylase, and urine amylase. Serum cholesterol and triglycerides were elevated, and lipoprotein electrophoresis showed a type IV pattern. Abdominal sonogram revealed a normal pancreas, and all other test results were normal. The patient was treated with i.v. fluid replacement, dimenhydrinate, and meperidine hydrochloride. Within 72 hours she was asymptomatic, and serum amylase, triglyceride, and cholesterol concentrations had decreased. She was discharged with a diagnosis of acute pancreatitis secondary to oral-contraceptive-induced hyperlipidemia. Oral contraceptive therapy was not resumed. Predisposing factors, symptoms, and laboratory findings associated with estrogen-induced acute pancreatitis are presented, and the mechanisms through which serum lipid elevations and subsequent pancreatitis occur are discussed. Monitoring serum lipid concentrations before and during estrogen therapy is recommended. Research suggests that patients who are over 40 years old or have family histories of hyperlipemia are at particular risk, and that estrogen therapy should be discontinued if pancreatitis occurs.
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PMID:Estrogen-induced pancreatitis. 688 34

In order to assess the validity of a biochemical prediction of gallstones early in the course of acute pancreatitis by simple biochemical values (SGOT greater than or equal to 60 U/l, bilirubin greater than or equal to 1.6 mg/dl, alkaline phosphatase greater than or equal to 100 U/l) 297 patients with alcoholic, idiopathic and biliary pancreatitis were reinvestigated in a retrospective manner. The present study shows that a valid prediction by these values is not possible since 1) only about 40% of attacks of acute gallstone pancreatitis were associated with elevated SGOT, bilirubin and alkaline phosphatase concentrations and 2) there was a considerable overlap with the other etiological groups especially with idiopathic pancreatitis.
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PMID:[The problem of diagnosis of biliary calculi in acute pancreatitis by means of laboratory methods]. 743 50

Early and appropriate treatment of acute pancreatitis (AP) depends on early causal diagnosis. Published studies have shown favourable results following sphincterotomy performed within the 72 hours of onset of severe gallstone-associated AP. Among the various bio-clinical indices, the lipase/amylase (L/A) ratio, computed within 72 hours after onset, has been shown to discriminate between alcoholic and non alcoholic AP. Our study evaluates the data of biochemical disorders in 51 patients presenting with an episode of AP; these patients were divided into 3 groups: A: alcoholic AP, n = 15; B: biliary AP, n = 25; and C: post-ERCP AP, n = 11. These 3 groups were similar with respect to clinical severity of AP and CT scan. The time delays between onset of the symptoms and the biochemical assay were 1.9 +/- 0.3, 1.9 +/- 0.2 and 0.6 +/- 0.3 d (P < 0.01). AST, ALT, bilirubin, GGT and alkaline phosphatase were significantly (P < 0.05) greater in group B. Blamey's score was 0.5 +/- 0.2, 2.8 +/- 0.2 and 2.5 +/- 0.4 in groups A, B and C respectively. Serum amylase, serum lipase and L/A ratio were identical in groups A and B. The decrease in serum amylase after 48 hours was more important only in group B (56 +/- 8, 80 +/- 4, 47 +/- 3% respectively in groups A, B and C). L/A ratio was significantly greater in group C when compared with group A and B (1.7 +/- 0.4, 1.5 +/- 0.2 and 2.2 +/- 0.3 in groups A, B and C respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Is the identification of acute biliary and alcoholic pancreatitis by early pancreatic enzyme assay possible?]. 751 3

Determination of serum pancreatic enzymes remains the gold standard for the diagnosis of acute pancreatitis. Clinical symptoms and signs are of major importance in suspecting the disease, but they are not accurate enough to confirm the diagnosis. Among pancreatic enzymes, total amylase, pancreatic isoamylase and lipase are preferred, since simple, rapid and unexpensive enzymatic methods are commercially available. More expensive and cumbersome methods (e. g. ELISA for pancreatic elastase) are required if a significant delay to hospital admission occurs. In that case, other serum enzymes are usually normal or only lightly increased. To early define the etiology of acute pancreatic serum pancreatic enzymes lack of value. With this purpose, determination of AST, bilirubin and alkaline phosphatase may allow to distinguish between biliary and non-biliary origin of the disease.
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PMID:Clinical and laboratory diagnosis of acute pancreatitis. 754 60

Early distinction between acute alcoholic pancreatitis is important, because of possible emergency endoscopic sphincterotomy in case of biliary pancreatitis. The aim of this study was to evaluate the value of L/A ratio in the diagnosis of acute alcoholic pancreatitis. From 1990 to end 1993, 133 patients with acute pancreatitis were reviewed. Inclusion criteria were: 1) abdominal pain, 2) pathological serum amylase or serum lipase on admission or within 24 hours after beginning or abdominal pain, 3) acute pancreatitis at the echography or CT scan within 48 hours after admission. 60 patients met the inclusion criteria (31 alcoholic pancreatitis, 19 biliary pancreatitis and 10 pancreatitis of other causes). L/A ratio was studied in terms of delay from beginning of abdominal pain. There was no statistical difference between alcoholic and biliary pancreatitis at any time of the study, with the exception of admission. AST, ALT and alkaline phosphatase were higher in biliary pancreatitis than in alcoholic pancreatitis. AST and ALT were the best biochemical tests to diagnose biliary pancreatitis. Blamey's criteria can also contribute to diagnose biliary pancreatitis. These biochemical tests are the most helpful if they are collected very soon in the evolution of acute pancreatitis. It is concluded that L/A ratio is not helpful in the diagnosis of alcoholic acute pancreatitis.
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PMID:[Can the L/A ratio identify acute alcoholic pancreatitis?]. 757 83

This paper evaluates the treatment of common bile duct stones by endoscopic sphincterotomy (SE) and laparoscopic cholecystectomy (CL). 733 patients presenting with symptomatic cholelithiasis were operated on between March 1990 April 1993; 131 (18%) of them had a preoperative suspicion of common bile duct stones (LVBP): jaundice for 41, biliary acute pancreatitis for 27 and altered liver function tests for 63. 131 retrograde cholangiographies (CPRE) were attempted with an associated SE (113 cases) in the presence of LVBP, biliary pancreatitis, enlargement of common bile duct and appearance of forced papilla. CL was performed 24 to 48 hours later. CPRE +/- SE had no mortality; 1 patient presented a retroduodenal perforation of CBD, requiring surgery. 58 cases (44.2%) of LVBP were diagnosed, without a statistically significant difference according to the clinical pattern. In the group with altered liver function tests only alkaline phosphatase was significantly predictive of LVBP. There was no mortality or morbidity related to CL; conversion rate was 9.8%; 4 of 12 cases of conversion were related to persistence of stones in the common bile duct, without any possibility of laparoscopic extraction. Mean hospital stay was 7.4 days. Efficacy of this sequential method of treatment of LVBP was 91.3%: this method seems satisfactory, not dangerous and minimally invasive, and should be indicated for pre-operative suspected common bile duct stones.
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PMID:[Treatment of lithiasis of the common bile duct by endoscopic sphincterotomy and laparoscopic cholecystectomy]. 816 Nov 53

To evaluate the rationale of using antibiotics in acute pancreatitis and to determine whether the indication for their use depends upon the etiology of the pancreatitis, the records of 202 patients with acute pancreatitis were retrospectively reviewed. The incidence of abnormal body temperature, leukocytosis, bacteremia and the results of biochemistry tests in different etiologies of the disease were investigated. Pancreatitis was found to be alcohol-related (47 patients), gallstone-related (105 patients), idiopathic (26 patients) and miscellaneous (24 patients). On admission, 83 patients had abnormal body temperature and 146 patients showed leukocytosis. Bacteremia occurred in 20 patients. Of these, 15 had gallstone-related pancreatitis, two had pancreatic cancers and one developed bacteremia after endoscopic retrograde cholangio-pancreatography (ERCP). These 18 patients had abnormal biochemistry results (including high serum levels of direct bilirubin, alkaline phosphatase and gamma-glutamyltransferase) and dilated bile ducts on imaging studies, indicating biliary infections. The remaining two patients with bacteremia included one alcoholic patient and one patient with idiopathic pancreatitis. The most commonly involved pathogens were Escherichia coli and Klebsiella pneumoniae. In addition, eight patients (4%) developed secondary pancreatic infections during hospitalization; the blood cultures of seven of these patients were negative on admission. Although fever and leukocytosis are not good predictors of infection in acute pancreatitis our results showed that bacteremia is common in patients whose pancreatitis is related to gallstones, ERCP or pancreatic malignancy with obstructive jaundice. We recommend that antibiotics be used only in this subset of acute pancreatitis patients.
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PMID:Bacteremia in acute pancreatitis of different etiologies. 854 31

Preoperative common bile duct (CBD) clearance with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) is routinely performed in many centers where laparoscopic cholecystectomy (LC) is the procedure of choice for the treatment of cholelithiasis. The purpose of this study was to evaluate prospectively the results of the sequential endoscopic-laparoscopic management in patients with gallstones and suspected CBD stones. From November 1990 to May 1993, 700 consecutive patients were evaluated for LC. Preoperative workup included clinical history and physical examination; serum levels of bilirubin, alkaline phosphatase, and amylase; and ultrasonography. Preoperative ERCP was indicated in cases with previous or present jaundice or acute pancreatitis, altered liver or pancreatic blood tests, dilated CBD (> 6 mm) and CBD stones at ultrasonography. If CDB pathology was confirmed, ES was performed and treatment attempted. All patients were assigned to undergo LC within 48 h. Morbidity, mortality, hospital stay, and disability were recorded. Of 700 patients, 49 (7%) underwent ERCP. In 26 patients (54.2%), CBD stones were identified; ES was performed and stone extraction succeeded in 22 patients (84.6%). Two patients with intrahepatic stones were successfully treated with a percutaneous transhepatic approach and then underwent surgery. Two patients with cholecystocholedochal fistula underwent open surgery. In two cases ERCP showed a papillary stenosis, which was treated with ES. Of 44 patients, 35 (79.5%) underwent LC within 48 h. The overall morbidity (ERCP/ES plus LC) was 10.4%. No mortality occurred. The mean hospital stay was 4.5 days. Return to normal activities occurred within 11 days after LC. This sequential approach resulted in a safe and effective treatment of cholecystocholedocholithiasis and a decrease in the overall costs.
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PMID:Sequential endoscopic-laparoscopic treatment of cholecystocholedocholithiasis. 884 Apr 48


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