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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute pancreatitis with severe belt-like upper abdominal pain developed within 1-4 weeks of starting medication in three patients (29-year-old man with ulcerative colitis; 43-year-old woman and 22-year-old woman with Crohn's disease) treated, for the first time, with 5-aminosalicylic acid (mesalazine), 500 mg three times daily. Concentrations of lipase initially were 545, 1182 and 3000 U/l, and of amylase 243, 449 and 129 U/l, respectively. Symptoms receded within a few hours after the drug had been discontinued, enzyme levels returning to normal in the course of the next 2-3 weeks. On repeating the drug in two of the patients, in lower dosage, the pancreatitis recurred within a few days. These observations support the view that 5-aminosalicylic acid can cause acute pancreatitis, perhaps as an allergic reaction.
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PMID:[Pancreatitis associated with 5-aminosalicylic acid]. 170 59

145 clinical observations of 114 patients with Crohn's disease and 65 observations of 47 patients with ulcerative colitis were analyzed prospectively concerning the prevalence of pathologically elevated levels of serumamylase or -lipase and acute pancreatitis. Painless hyperamylasemia or hyperlipasemia were found in 18 of 114 patients with Crohn's disease (15.8%) and in 10 of 47 patients with ulcerative colitis (21.3%) without morphological abnormalities on ultrasound. Range of elevated serumamylase levels differs from 35 to 68 U/L (Ref.-value less than 34 U/L), range of serumlipase levels varies from 199 to 858 U/L (Ref.-value less than 190 U/L). Pathologically elevated levels of serumamylase and -lipase persisted for 17.7 +/- 9.0 (5-28) days in Crohn's disease and 22.8 +/- 9.8 (7-33) days in ulcerative colitis. No relation to the activity or the duration of the disease, drug treatment or the weight loss of the patients could be shown. Acute pancreatitis was found in 4 of 114 patients (3.5%) with Crohn's disease, whereas in ulcerative colitis acute pancreatitis was diagnosed in 1 of 47 patients (2.1%). Regarding the promoting factors, drugs (azathioprine and salazosulfapyridine) and mechanical alterations of the bile duct (primary sclerosing cholangitis) or the pancreas (pancreas divisum) were found in 4 of the 5 patients. However the case of a 23 year old woman suffering from Crohn's ileocolitis who died of an idiopathic pancreatitis remains obscure.
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PMID:[Hyperamylasemia, hyperlipasemia and acute pancreatitis in chronic inflammatory bowel diseases]. 170 51

There is conflicting evidence of the effect of intravenous fat emulsions on pancreatic secretion. Intralipid is a safe component of intravenous nutritional support in patients with pancreatic fistulas, though it may minimally increase the volume, as well as the bicarbonate and amylase concentrations, of the output. Intravenous fat emulsions may rarely cause pancreatitis; this may be more likely in patients with Crohn's disease, given that three of the four reported cases occurred in patients with Crohn's disease. It is unclear whether hypertriglyceridemia secondary to the intravenous fat emulsion is a prerequisite for this complication to occur. Intravenous fat emulsions appear to be a safe component of intravenous nutritional support for the patient with pancreatitis, based on multiple studies proving their safety in a total of nearly 100 patients. It seems prudent to avoid hypertriglyceridemia secondary to intravenous fat emulsions, as this alone is a cause of pancreatitis, albeit uncommon, in patients with abnormalities of triglyceride metabolism. However, hypertriglyceridemia resulting from parenteral nutrition may be caused by glucose intolerance and not intravenous fat emulsion administration.
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PMID:Intravenous fat emulsions and the pancreas: a review. 173 36

Three cases of metronidazole-induced acute pancreatitis have been reported recently in three women who were being treated for nonspecific vaginitis. We report the fourth such case in a 63-year-old woman with long-standing Crohn's disease who developed acute pancreatitis that was temporally associated with the initiation of metronidazole therapy for a rectovaginal fistula. No other risk factors for pancreatitis were identified except for possibly Crohn's disease itself. We review the literature with regard to metronidazole-induced acute pancreatitis and suggest a possible mechanism. Metronidazole should be considered as a possible cause of acute pancreatitis, and its use should be discontinued if no other risk factor is found.
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PMID:Metronidazole-induced acute pancreatitis. 138 29

The authors studied the data concerning 101 patients who had undergone erroneous laparotomy for suspected acute surgical disease; these accounted for 0.4% of all the patients who were operated on for emergency indications in the same period. Eleven patients died. The operation was undertaken for an erroneous diagnosis of acute appendicitis (32 patients), acute cholecystitis (18), perforating gastric ulcer (15), peritonitis of unknown etiology (14), acute intestinal obstruction (5), strangulated hernia (3), destructive pancreatitis (3), tumor of the large intestine complicated by obstruction (3), abdominal abscess (2), thrombosis of the mesenteric vessels (1), ovarian apoplexy (1), closed abdominal trauma with injury to the viscera (4 patients). Diseases simulating the clinical picture of "acute abdomen" but not requiring an emergency operation were as follows: female reproductive (20 patients), pancreatic (11), renal diseases (11), hepatitis, cirrhosis of the liver (10), cardiovascular (9), pulmonary diseases (5), mesoadenitis (5), Crohn's disease (3), chronic colitis (3), carcinomatosis of the peritoneum (3), herpes zoster (3), and other diseases and injuries (20 patients). The main causes of the diagnostic and tactical errors were objective difficulties in the differential diagnosis due to similar symptomatology, as well as errors in the examination of the patient and haste in making a decision to make an operation.
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PMID:[Erroneous laparotomy in emergency surgery]. 177 33

We report a case of a 5-aminosalicylate-induced pancreatitis in a patient with Crohn's disease. These findings suggest that some side effects, traditionally thought to be related to sulphafapyridine, are really due to 5-aminosalicylate. The good prognosis of this rare complication depends on the early withdrawal of the drug. Therefore the degree of the clinical suspicion plays a essential role in the appropriate diagnosis, but a challenge with mesalazine must be carried out in those patients in which other causes of pancreatitis could not be excluded.
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PMID:[Acute pancreatitis due to 5-aminosalicylic acid]. 204 9

We report the case of a 23-year old woman suffering from Crohn's ileocolitis for 14 years who died of a prolonged shock followed by hyperglycaemia. The post-mortem examination showed an acute pancreatitis. There was no hint for Crohn's disease of the duodenum or primary sclerosing cholangitis (PSC). Unexplained Pancreatitis coincident with Crohn's disease might be a possible extraintestinal manifestation of the disease. However such association remains speculative at the moment. Further studies based on morphological, functional, immunological and epidemiological data are required. Review of the literature and our own data show the necessity to look attentive for other causes of acute pancreatitis associated with Crohn's disease (PSC, pancreas divisum, drug induced-pancreatitis).
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PMID:[Crohn disease-associated pancreatitis: is there a new extra-intestinal manifestation of the disease?]. 211 92

Crohn's disease (CD) is now accepted as a systemic illness. The importance of extraintestinal manifestations is underlined by the fact that such "complications" can be more prominent and even more difficult to control than the intestinal disease itself. Lately, evidence for a more than accidental association of pancreatitis and exocrine pancreatic insufficiency with CD is growing. This might have a significant impact on the treatment of abdominal pain and diarrhea in CD, symptoms which have so far been attributed exclusively to the intestinal rather than the extraintestinal manifestations of the disease.
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PMID:Crohn's disease: what about the pancreas? 222 90

During the past two decades, cholelithiasis has been recognized in increasing numbers of pediatric patients. This diagnosis should be considered in the event of upper abdominal complaints, particularly when one or more risk factors are evident. The etiology may be unknown or may be related to risk factors, including hemolytic conditions. In recent years, it has become evident that approximately 80% of gallstones in children are not due to hemolytic disease and that the remaining 20% are related to recurring hemolysis. The diagnosis of gallstones is best confirmed with ultrasonography. Routine ultrasonographic evaluation should be performed at intervals for all children who received TPA for more than 4 weeks, particularly those who have had ileal resection or have had chronic enteritis (Crohn disease). Cholecystectomy is the procedure of choice for symptomatic children with cholelithiasis, regardless of age. Cholecystectomy is recommended for the asymptomatic child younger than 3 years of age when echogenic shadows have been present for at least 12 months following resumption of oral feedings or when the gallstones are radiopaque. Also, cholecystectomy is advised for asymptomatic children who are older than 3 years of age if ultrasonographic studies confirm that echogenic foci with shadowing are true stones and not echogenic sludge. Complications of common bile duct obstruction, pancreatitis, perforation with bile peritonitis, and life-threatening sepsis may thus be prevented. Morbidity and mortality following cholecystectomy are expected to be relatively low in the pediatric age group.
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PMID:Cholelithiasis in infants, children, and adolescents. 240 28

6-Mercaptopurine (6-MP) has an important role in the treatment of inflammatory bowel disease. Its most frequent short-term complication has proven to be pancreatitis, which we have now seen in 13 of 400 (3.25%) patients (12 Crohn's disease, 1 ulcerative colitis) and which we here describe. The timing of the pancreatitis was such that it could not be attributed to sulfasalazine, which was also being taken by 9 patients, or corticosteroids, which were being taken by 7 patients. The dosage of 6-MP ranged from 50 to 100 mg daily, and the pancreatitis, which was uncomplicated in all cases, occurred within 8-32 days with one exception (6.5 mo). Symptoms included epigastric pain, back pain, fever, and nausea. The serum amylase was elevated in 12 patients. The average elevation was 5.9 times normal. In all cases, the 6-MP was discontinued and symptoms and signs returned to normal over a period of 1-11 days. No other complications of 6-MP occurred; there was no leukopenia. Of 7 patients rechallenged with 6-MP, all developed recurrent pancreatitis, including 4 in less than 24 h. In 3 patients, desensitization attempted by a gradual increase in dose from 1/8 tablet (approximately 6 mg) daily also led to recurrence. The timing of the initial pancreatitis and the recurrence at rechallenge are best explained by an allergic reaction. 6-Mercaptopurine should not be reinstituted once it has caused pancreatitis.
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PMID:Nature and course of pancreatitis caused by 6-mercaptopurine in the treatment of inflammatory bowel disease. 242 86


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