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

During the past 3.5 years the authors have evaluated 191 patients, both retrospectively and prospectively, to establish factors which might help to identify those patients at higher risk of developing pancreatic abscesses. Those factors included etiology of pancreatitis, number of severity indices present, and specific indices present. Once an abscess developed, severity indices, etiology, and bacteriology were examined as factors in mortality. Six specific severity indices occurred more often (P less than 0.05) in patients developing abscesses. These indices were lactate dehydrogenase evaluation, leukocytosis, metabolic acidosis, hypoxemia, hypocalcemia, and fluid sequestration. In addition, seven of 18 abscess patients had six or more indices present as opposed to five of 161 pancreatitis patients. This was significant at P less than 0.05 level. The etiology of the pancreatitis was not a significant factor. Once an abscess developed, gram-negative infections were polymicrobial (8 of 9 patients) and were associated with a 56 per cent mortality. The gram-positive abscesses (6 patients) were all monomicrobial and none of these patients died. In addition, age greater than 55 years, serum glucose greater than 200 mg%, hematocrit decrease of 10 per cent, and fluid sequestration greater than 6 L were associated with a 50 per cent or greater mortality. The authors believe that patients presenting initially with six or more severity indices, especially the six mentioned above, are at significantly increased risk for developing a pancreatic abscess and those abscess patients with gram-negative abscesses, as well as having any of the four severity indices previously mentioned, have a much worse prognosis.
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PMID:Early diagnosis and outcome of pancreatic abscesses in pancreatitis. 380 Jan 61

Ultrasound and computed tomography have been used routinely over the last five years in the diagnosis of acute pancreatitis. This has made classification as to degrees of severity easier. In addition to the direct imaging of destruction of pancreatic parenchyma, these imaging methods also (preoperatively) make an exact assessment of the extension of peripancreatic necrosis and necrosis paths possible, as well as the presence of any gallstone disease or pancreatic abscess. Under the influence of these imaging procedures the indications for operation and the extent of surgical intervention has become more limited. High-risk "early operation" has been drastically reduced in number and is indicated only in very severe disease with organ complications. The "delayed operation" in the postacute stage of disease is largely restricted to local septic complications. Here excision of necrotic tissue and drainage is now largely preferred to resection, previously practised more frequently. Extensive necrotising processes with only minor clinical symptoms have now been observed as a result of early employment of ultrasound and computed tomography. The successful conservative treatment of these uncomplicated disease processes has contributed to an overall reduction in the mortality of postacute pancreatitis.
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PMID:[Hemorrhagic necrotizing pancreatitis and imaging procedures]. 388 12

Pancreatic abscess has become the most common cause of death from acute pancreatitis. Since computed tomography (CT) permits noninvasive imaging of the peripancreatic anatomy, the relationship of early CT findings to late pancreatic sepsis has been evaluated in 83 patients with acute pancreatitis. Pancreatic abscesses developed in 18 patients and were responsible for five of the six deaths in this study. Initial CT findings were graded: A = normal, in 12 patients; B = pancreatic enlargement alone, in 19; C = inflammation confined to pancreas and peripancreatic fat, in 17; D = one peripancreatic fluid collection, in 12; and E = two or more fluid collections, in 23. The incidence of pancreatic abscess in grades A and B was 0%; in grade C, 11.8%; in grade D, 16.7; and in grade E, 60.9%. The severity of pancreatitis was also graded by previously reported prognostic signs as "mild" (0-2 signs) in 56 patients, "moderate" (3-5 signs) in 22, and "severe" (greater than or equal to 6 signs) in five patients. The incidence of abscesses in mild disease was 12.5%; in moderate, 31.8%; and in severe, 80%. Fluid collections on CT resolved spontaneously in 19 of 35 (54.3%) patients. Abscess developed in two patients with no fluid collections on initial CT study. No abscess occurred in 31 patients with CT grades A or B, and in one of 22 patients (4.5%) with CT grade C or D and less than three positive prognostic signs. Among 30 patients with CT grade E or CT grade C or D and three or more positive prognostic signs, 17 (56.7%) developed abscesses. All deaths were in patients with five or more positive prognostic signs. Early imaging of the pancreas by CT identifies a group of patients with increased risk of pancreatic abscess. Identification of this group is improved further by use of early objective prognostic signs.
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PMID:Computed tomography and the prediction of pancreatic abscess in acute pancreatitis. 399 37

The clinical course of 19 patients with pancreatic phlegmon, as diagnosed by computed tomography (CT) and clinical criteria, was assessed retrospectively and compared to that of eight patients with pancreatic abscess diagnosed either at surgery or with percutaneous aspiration. Controls consisted of 55 patients with uncomplicated acute pancreatitis without CT scans and 11 patients with acute pancreatitis in whom CT scans were negative or only consistent with acute pancreatitis (no phlegmon). The age, sex, and presumed etiology of the pancreatitis were not significantly different in the four groups. Patients with phlegmon had a higher incidence of severe pancreatitis as defined by Ranson's criteria, presence of an abdominal mass, as well as a longer duration of fever, abdominal pain and leukocytosis than controls without CT scans. With the exception of a palpable abdominal mass and fever lasting over five days, the results were similar when comparing the phlegmon group and controls with CT scans, although the severity of the disease and prolonged abdominal pain tended to be increased in the former patients. There was no statistically significant difference in clinical or laboratory criteria between the phlegmon and abscess groups, although the latter group had longer hospital stays and periods with no oral intake (npo). Management of patients with phlegmon tended to include TPN, longer npo periods, antibiotics, and longer hospital stay than in controls without CT scans. Controls with CT scans were managed similarly to the phlegmon group because of prolonged amylase elevation and abdominal pain. Percutaneous aspiration was successful in differentiating abscess from phlegmon in five of six cases. Major complications were rare in the phlegmon group and spontaneous resolution was the rule. Pancreatic phlegmon is a distinct clinical/radiologic entity which may be very difficult to differentiate clinically from pancreatic abscess. Early percutaneous thin-needle aspiration of the inflammatory mass (under CT guidance) seems to be the diagnostic procedure of choice. Management is nonsurgical unless complications arise. The role of TPN and antibiotics is unknown, and controlled studies of these therapeutic approaches in pancreatic phlegmon are needed.
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PMID:Pancreatic phlegmon. Clinical features and course. 402 9

FOR MANY DECADES TWO TYPES OF ACUTE PANCREATITIS HAVE BEEN RECOGNIZED: the edematous or interstitial and the hemorrhagic or necrotic. In most cases acute pancreatitis is associated with alcoholism or biliary tract disease. Elevated serum or urinary alpha-amylase is the most important finding in diagnosis. The presence of methemalbumin in serum and in peritoneal or pleural fluid supports the diagnosis of the hemorrhagic form of the disease in patients with a history and enzyme studies suggestive of pancreatitis. There is no characteristic clinical picture in acute pancreatitis, and its complications are legion. Pancreatic pseudocyst is probably the most common and pancreatic abscess is the most serious complication. The pathogenetic principle is autodigestion, but the precise sequence of biochemical events is unclear, especially the mode of trypsinogen activation and the role of lysosomal hydrolases. A host of metabolic derangements have been identified in acute pancreatitis, involving lipid, glucose, calcium and magnesium metabolism and changes of the blood clotting mechanism, to name but a few. Medical treatment includes intestinal decompression, analgesics, correction of hypovolemia and other supportive and protective measures. Surgical exploration is advisable in selected cases, when the diagnosis is in doubt, and is considered imperative in the presence of certain complications, especially pancreatic abscess.
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PMID:Acute pancreatitis. 455 67

Fifty patients with mild to moderately severe acute pancreatitis of various causes were randomly allocated to treatment with either nasogastric suction and intravenously administered fluids (SD) or the oral intake of clear fluids (FF). No significant difference was found between the two groups as far as abdominal pain, abdominal tenderness, degree of hyperamylasemia and hospital stay were concerned. Mortality and such complications as pancreatic abscess, pseudocyst and persisting hyperamylasemia occurred equally in both groups. The findings suggest that nasogastric suction and intravenously administered fluids provided no advantage compared with a simple therapy, consisting of the oral intake of fluids ad libitum in the treatment of patients with mild to moderately severe pancreatitis of various causations.
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PMID:Initial treatment of acute pancreatitis. 619 68

After an introduction on the role of the biliary factors in the etiopathogeny of acute pancreatitis the authors present an analysis of their personal experience in this field. A total of 46 cases are discussed, with acute biliary pancreatitis, which were diagnosed during surgical interventions. Of the 46 patients 13 had an oedematous form of acute biliary pancreatitis, 22 had necrotizing pancreatitis with associated haemorrhage, 3 had suppurated pancreatitis and 6 had a pancreatic abscess. In 6 patients the acute pancreatitis was either associated with, or triggered by acute non-lithiasic cholecystitis, and in 40 cases the acute pancreatitis was associated to biliary lithiasis. Surgery was performed as a result of inefficient intensive care, as an immediate emergency, in 56.42% of the cases, and as a late emergency (at 3-7 days) in 28% of the patients. Surgery was performed late in 14.71% of the cases. The surgical intervention was mainly directed to the treatment of the biliary lesions, and for the solving of pancreatic lesions, especially of the suppurative and necrotizing and haemorrhagic ones. The postoperative death rate was 34.7%, and death occurred in aged patients, in those with severe forms of pancreatitis of the haemorrhagic type, (8 cases), and with pancreatic suppurations (6 cases).
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PMID:[Acute biliary pancreatitis. Anatomoclinical and therapeutic aspects]. 621

Acute pancreatitis is a clinical diagnosis. In most patients with uncomplicated acute pancreatitis, there is no need for radiologic confirmation or work-up. However, in some patients, the diagnosis may be in doubt, or associated abnormalities or complications of acute pancreatitis may be suspected by the patient's protracted course or severity of disease. In these patients, radiology can be extremely helpful. CT is the best single radiologic imaging modality to evaluate these patients. With modern scanners, there are no failures, and CT provides a complete view of the pancreas and peripancreatic tissues, despite overlying bowel gas or other anatomic features that may limit the sonographic evaluation. Sonography may be helpful in evaluating possible biliary complications of acute pancreatitis, in evaluating thin patients with a good sonic window to the pancreas, or in evaluating patients who have a clearly defined complication such as a large pseudocyst. Sonography is also helpful for serial studies following the size of the fluid collection. The complications of pancreatitis include fluid collections and pseudocysts, which may become infected or develop bleeding within them, vascular complications including occlusion of the splenic vein with secondary development of varices, pancreatic ascites, and pancreatic abscess. While these complications can be evaluated by various radiologic methods, they are most effectively evaluated by CT. However, for some cases in which the cause of a cystic mass is in doubt or for cases of suspected pancreatic abscess, radiologic studies may be unable to provide a definitive diagnosis. In these cases, percutaneous needle aspiration will assist in the diagnosis.
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PMID:Acute pancreatitis and its complications. Computed tomography and sonography. 635 18

Acute pancreatitis is a formidable problem that infrequently necessitates surgical intervention. Indications for operation may be divided into four main categories: (1) uncertain diagnosis, (2) deteriorating condition, (3) biliary pancreatitis, and (4) pancreatic abscess. One of the most important contributions concerning acute pancreatitis has been the development of predictive criteria that allow quantitation of the severity of disease and precise comparison of various reported series. During a 2-year period, 222 patients with acute pancreatitis were seen at our institution, and 62 of these patients (28%) underwent operation. Biliary pancreatitis accounted for 63% of our cases. The overall mortality of 24% was directly related to the severity of the pancreatitis. Cholecystectomy, during the same hospital admission, is advised for treatment of biliary pancreatitis.
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PMID:Surgical management of acute pancreatitis. 636 15

Pancreatic abscess is a highly lethal sequela of pancreatitis. The purpose of this study was to identify clinical and laboratory factors associated with the antecedent episode of pancreatitis or at the time of manifestation of a pancreatic abscess and factors related to its treatment that might have prognostic significance. The records of 66 consecutive patients with pancreatic abscess seen between 1966 and 1980 were reviewed. Factors adversely affecting survival included: severity of precipitating pancreatitis (p less than 0.03); sepsis and pulmonary dysfunction (p less than 0.05); and persistent postoperative sepsis (p less than 0.001). All four patients who were treated nonsurgically died. Of 62 patients treated surgically, 80% experienced serious complications, 31% required reoperations, and 40% died. No single surgical procedure, including marsupialization, proved to be superior. Surgical drainage offers the only possibility of survival for patients with pancreatic abscess. More thorough elimination of all focuses of infection is required, however, to reduce the high morbidity and mortality rates associated with persistent postoperative sepsis.
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PMID:Prognostic factors in pancreatic abscess. 647 50


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