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

On admission, a group of high-risk patients who are potential candidates for surgery can be identified, in whom prompt initiation of preoperative enteral or parenteral nutrition may reduce postoperative morbidity and mortality irrespective of the nutritional status. Among these are patients with inflammatory bowel disease, gastrointestinal fistulas, and pancreatitis. Substantial nutritional support has little or no direct effect upon the pathogenesis of the disease, but the discontinuance of oral intake may well have a beneficial effect on the basic disease process. Thus, the provision of enteral or parenteral nutrition gives the patient an optimal opportunity to marshal host defenses in support of healing. In organ system failures, e.g., acute renal failure, liver failure, and pulmonary failure, appropriate nutritional support may assist the patient in coping with the abnormal intermediary metabolism resulting from such failure until satisfactory organ system function returns. From this review, it seems reasonably clear that the initially malnourished patient is less able to successfully withstand the adverse effects of vigorous therapy and/or severe illness than is the well-nourished individual. Hence, correction of malnutrition, either before initiating therapy or concomitant with the treatment, is very likely to be beneficial.
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PMID:Nutritional support in surgical practice: Part II. 210 71

A 21-year-old man presented with acute pancreatitis and acute renal failure. Diffuse bilateral renal cortical necrosis was diagnosed by renal biopsy and selective renal arteriography. The patient recovered from the attack of pancreatitis but remained anuric. Possible mechanisms for the association between acute pancreatitis and renal cortical necrosis are discussed.
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PMID:Acute pancreatitis and renal cortical necrosis. 213 Mar 2

Acute causes and chronic risk factors for the development of acute renal failure were analyzed in prospective acquired data of 261 patients in a medical ICU. The population was divided into a group requiring dialysis treatment for established renal failure (n = 95) and a collective maintaining mild renal insufficiency (n = 166). Bivariate and linear discriminant analyses revealed that, above all, variables related to bacterial infections (sepsis and administration of antibiotic agents) and pancreatitis contributed to the discrimination, followed by bleeding, volume depletion, and chronic liver disease in the discriminant function. Bivariate analysis also yielded significant results for mechanical ventilation, CNS depression, and surgery. The importance of the nephrotoxic properties of aminoglycosides may be outweighed by their role as an indicator of severe infectious disease. The overall correct classification rate of the discriminant function was 78.5%, which reflects the importance of the predictor variables, but does not allow individual predictions.
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PMID:Impairment of renal function in medical intensive care: predictability of acute renal failure. 218 66

Hemolytic-uremic syndrome (HUS) of childhood is a triad of acute hemolytic anemia, thrombocytopenia, and acute renal failure associated with a gastrointestinal prodrome. From 1977 to 1988, 134 patients with HUS were admitted to this institution. All patients presented with abdominal pain and diarrhea, which was virtually always bloody. Seventy-eight patients (60%) required dialysis. Five patients died (4%). One patient died as a result of colon perforation, the other four patients died of other nonsurgical complications of HUS. Three patients underwent exploratory laparotomy. One patient had a hemoperitoneum from mesenteric and transmural bleeding of the entire intraabdominal colon. Another patient had undergone surgery elsewhere for presumed intussusception with pancolitis found at exploration. Fourteen days postoperatively, he had a spontaneous perforation of the transverse colon. The third patient presented with pancolitis and perforation of the transverse colon. Despite surgical intervention he died on the sixth postoperative day. One other patient was treated conservatively for pancreatitis, which developed 3 weeks after her presentation with HUS. Complications requiring surgical intervention in HUS are rare, potentially lethal, and usually involve the colon.
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PMID:Surgical complications of the hemolytic-uremic syndrome. 227 21

In spite of continuous progress in intensive care during the past two decades, there is no definite proof that the prognosis of critically ill patients with acute renal failure has actually improved. Nevertheless, the development of hemofiltration and hemodiafiltration and of the continuous methods has extended the therapeutic spectrum and allows therapy to be adapted to the specific cardiovascular and metabolic situation of the individual patient. Detoxification is carried out intracorporeally in peritoneal dialysis or extracorporeally by means of filters and membranes with different filtration properties. Peritoneal dialysis is seldom indicated in operative patients, because of its low efficiency and the hypercatabolism that is often observed, except in situations where continuous abdominal lavage is desired, as in peritonitis or necrotizing pancreatitis. The standard detoxification method is hemodialysis in which the filter is perfused in the opposite direction to blood flow. Solute transport is the result of diffusion, osmosis and, to a minor extent, convection, and the elimination of small molecules is favored. As huge amounts of dialysate have to be used, a central water regeneration unit is the technical prerequisite for hemodialysis. In critically ill patients bicarbonate dialysis should be preferred, because it is hemodynamically better tolerated. Hemofiltration relies on convection rather than diffusion through a membrane with a cut-off between 20,000 and 50,000 daltons. The ultrafiltrate largely resembles plasma water. Fluid loss is substituted by appropriate electrolyte solutions allowing space for negative balances and hypercaloric parenteral nutrition. Hemofiltration is better tolerated than hemodialysis and was introduced to improve the elimination of toxic middle molecules. In intensive care units without access to hemodialysis or intermittent hemofiltration continuous arteriovenous hemofiltration (CAVH), first proposed by P. Kramer, has become an alternative, mainly because of its simplicity and the absence of hemodynamic side effects. The drawback of this method is its limited efficiency. In hypercatabolic patients daily ultrafiltration rates of 10-15 l will not reduce blood urea sufficiently. The same holds true for severe hyperkalemia. One attempt to increase efficiency is predilution, which involves adding part of the substitution fluid before the filter, to enhance blood flow and to increase the effective filtration pressure by lowering the oncotic pressure of the plasma. Predilution will increase the net urea clearance by some 20%. Another way to enhance filtration is to apply negative pressure to the membrane with the aid of an infusion pump at the filtrate side. The development of better filters with smaller resistances may further increase filtration rates.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Extrarenal elimination procedures in acute kidney failure]. 228 6

Acute pancreatitis is infrequently described in patients with end-stage renal disease (ESRD) who have not undergone transplantation. We observed 35 attacks of acute pancreatitis in 23 of 1001 patients with ESRD and one additional patient with irreversible acute renal failure, during a ten-year period. Pancreatitis occurred more frequently in association with peritoneal dialysis than with hemodialysis. Four patients died of complications related to a pancreatic pseudocyst, and a fifth died from hemorrhagic pancreatitis. The ten-year incidence of pancreatitis was 2.3% and the overall mortality was 20.8% in patients with ESRD treated without transplantation. We conclude that clinically evident acute pancreatitis occurs more often than has been previously recognized in patients with ESRD who have not undergone transplantation and, particularly, in those patients managed with peritoneal dialysis.
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PMID:Acute pancreatitis in patients with end-stage renal disease without transplantation. 353 Jan 64

Continuous arterio-venous haemofiltration (CAVH), a simple technique not employing pumps, was used for treatment of acute renal failure in 25 intensive care patients (mean age 52 +/- 16 [SD] years). Acute renal failure was due to trauma in 9 patients, occurred after surgery in 7 patients and was related to septicaemia in 5 patients, peritonitis in 2 patients and pancreatitis in one patient; in one patient acute renal failure developed during pregnancy after preexisting renal disease. Seventeen patients were oliguric and 8 patients were non-oliguric, with a mean daily urine output of 507 +/- 407 ml. At the start of CAVH the serum creatinine level was 511 +/- 198 mumol/l. The duration of treatment with CAVH was 1 to 36 days (average 9.3 days). Access to the circulation was by cannulation of the femoral artery and vein in 23 patients and by Scribner shunt in 2 patients. After an initial systemic dose of 2000 IU heparin, a continuous infusion of 250-1000 IU/hr into the arterial blood line was administered, adjusted to a partial thrombin time of 58 +/- 28 sec. With this heparin regimen a single haemofilter could be used for an average time of 2.6 +/- 1.2 days. The mean spontaneous filtration rate was 6 +/- 2 ml/min, resulting in the following serum levels: creatinine 490 +/- 187 mumol/l; urea 39 +/- 12.5 mmol/l; potassium 4.5 +/- 0.5 mmol/l. Nine catheter-associated complications occurred in 5 patients. The most important aspect of CAVH was its simplicity, optimal control of fluid balance and the possibility of unlimited parenteral nutrition. Uremia was adequately and continuously controlled. Prognosis of ARF was related to the patients' underlying illness.
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PMID:[Continuous arteriovenous hemofiltration for the treatment of acute kidney failure]. 398 93

For medical treatment of acute pancreatitis, only very few effective measures can be recommended. To put the gland to rest, the patient has to be maintained in a fasting state. Additionally, Cimetidine should be administered intravenously. A properly functioning nasogastric tube is an efficacious method of inducing the pancreas to rest. To maintain an adequate blood volume and in protecting the microcirculation of pancreas, the use of intravenous fluids that include colloids, is important. Sufficient replacement of electrolytes evidently seems to be indicated. Drug therapy consists of the administration of analgetics and of an adjuvant use of calcitonine or somatostatine, for reducing the pancreatic flow. Aprotinine given early and in sufficient amounts is to be recommended. Antibiotic prophylaxis should be utilized only when pancreatitis associated with biliary tract disease or postoperative pancreatitis seems to be apparent. Whenever systemic hypotension and shock occurs, plasma or dextran, together with sufficient but controlled amounts of intravenous fluids, must be administered. In acute renal failure dopamine has been used with success. Peritoneal dialysis or hemodialysis as an ultimate measure, has to be considered. In the case of respiratory distress syndrome, oxygen by nasal catheter must be applied.
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PMID:[Medical treatment of acute pancreatitis (author's transl)]. 615 71

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insights into the underlying mechanisms the lysosomal factors of polymorphonuclear (PMN) leukocytes and the plasma elastase-alpha 1-proteinase inhibitor complex were investigated in patients with acute and chronic renal failure. Lysosomal activity was evaluated in peripheral blood smears by the lysis of erythrocytes and plasma (halo formation) around each neutrophil induced by 0.25 M NaC1 borate buffer. In about half of the patients with chronic renal insufficiency on dietary treatment lysosomal activity of PMN leukocytes was reduced. The plasma concentration of elastase-alpha 1-proteinase inhibitor complex was normal in most subjects, but increased in three patients with the highest serum creatinine levels (greater than 13 mg/d1). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis, or dye-induced) halo formation was either reduced or absent. The plasma elastase-alpha 1-proteinase inhibitor complex was increased in 5/6 of the patients by a factor of two to four. Also in the patients on regular hemodialysis treatment halo formation of PMN leukocytes was substantially reduced, whereas the plasma levels of elastase-alpha 1-proteinase inhibitor complex was slightly increased. The finding of reduced lysosomal activity of PMN neutrophils in uremia may be partly due to an enhanced release of neutral proteinases into the circulation as indicated by the elevated plasma levels of elastase-alpha 1-proteinase inhibitor complex in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Granulocyte lysosomal factors and plasma elastase in uremia: a potential factor of catabolism. 620 47

A decrease in renal blood flow is believed to be important in the genesis of the acute renal failure of acute pancreatitis. In some instances, this decrease is undoubtedly due to hypovolemia, whereas in other instances, a circulating vasotoxic agent, possibly trypsin, has been incriminated. Using a canine model of pancreatitis induced by retrograde injection of bile along the pancreatic duct, the effects on renal blood flow of correcting the hypovolemia or administering aprotinin (a trypsin inhibitor) were studied using externally applied flow probes. Correcting the hypovolemia with N saline solution had no effect; the renal blood flow continued to decrease (p less than 0.05). When dextran 40 or dextran 75 was employed, the decrease in renal blood flow was prevented. After the administration of aprotinin, the renal blood flow actually increased (p less than 0.025) compared with preadministration values. It appears that aprotinin may have played a role in preventing this serious complication of pancreatitis.
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PMID:Effectiveness of normal saline solution, dextran 40 or dextran 75, and aprotinin (Trasylol) on renal blood flow preservation during acute canine pancreatitis. 620 98


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