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

We report an interesting and rare case of a man with adenomyomatous hyperplasia of the ampulla of Vater presenting as acute pancreatitis, which to our knowledge, is only the second reported case in the English literature. The patient presented with an acute onset of abdominal pain, nausea and vomiting, without fever, chills or rigours. CT of the abdomen revealed changes of acute pancreatitis with a peripancreatic adenopathy, and abdominal ultrasound revealed a slightly hyperechoic and oedematous head of the pancreas, consistent with acute pancreatitis. Endoscopic retrograde cholangiopancreaticography revealed an ampullary lesion. Pathology of the ampullary lesion revealed an inflammatory polyp. Endoscopic ultrasound with endoscopic mucosal resection of the lesion revealed an adenomyomatous hyperplasia. The patient recovered well postendoscopic resection without recurrent pancreatitis or cholestasis.
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PMID:Adenomyomatous hyperplasia of the ampulla of Vater presenting as acute pancreatitis. 2460 2

An obese lady of 51 year with Type 2 Diabetes Mellitus for 13 years was prescribed Liraglutide, a glucagon like peptide (GLP-1) analogue (Victoza) for glycaemic control and reduction of weight. She was on gliclazide and Insulin prior to initiation of Liraglutide. Eight weeks after initiation of GLP -1 analogue, she developed severe abdominal pain, nausea and vomiting. She was admitted to a private hospital and evaluated. Biochemical tests and CT scan revealed presence of pancreatitis and she was treated for acute pancreatitis. Liraglutide was withdrawn and symptoms subsided. Subsequent follow-up showed that pancreatic enzyme levels were normal.
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PMID:Liraglutide-induced acute pancreatitis. 2532 99

Incretin-based therapies are steadily gaining clinical popularity, with many more products in the developmental pipeline. Current treatment recommendations incorporate GLP-1 RAs and DPP-4 inhibitors as important agents for consideration in the treatment of T2DM owing to their low hypoglycemia risk, ability to address postprandial hyperglycemia (DPP-4 inhibitors and short-acting GLP-1 RAs), and potential for weight reduction (GLP-1 RAs). These properties may likewise prove advantageous in older adults in whom hypoglycemia is particularly undesirable, although older adults may be more prone to the nausea and vomiting associated with GLP-1 RA therapy. Other safety issues for incretin-based therapies, such as pancreatitis, C-cell hyperplasia, and renal failure, should be considered when choosing an appropriate patient to receive such therapies. Ongoing CV outcome studies will further inform the health care community regarding the CV safety of incretin-based therapies. The availability of both short-acting and long-acting GLP-1 RAs currently allows practitioners to consider individualized blood glucose trends and therapeutic needs when choosing an optimal agent.
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PMID:Incretin-based therapies. 2545 46

Acute pancreatitis during pregnancy is a rare event, and can be associated with high maternal mortality and fetal loss. Gallstone disease is thought to be the most common causative factor of acute pancreatitis, but, in many cases, the cause remains unclear. We report a case of a 36-year-old woman at 35 wk of gestation, who presented with severe pain confined to the upper abdomen and radiating to the back. The patient was diagnosed with acute idiopathic pancreatitis, which was managed conservatively; she recovered within several days and then delivered a healthy baby. Therefore it is important to consider acute pancreatitis when a pregnant woman presents with upper abdominal pain, nausea and vomiting in order to improve fetal and maternal outcomes for patients with acute pancreatitis.
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PMID:Acute idiopathic pancreatitis in pregnancy: a case study. 2547 97

Pancreatitis has a myriad of different presentations although commonly presents with epigastric pain radiating to the back, nausea and vomiting. There are five case reports in the English literature of scrotal pain and swelling in severe alcoholic pancreatitis, two of which underwent surgical exploration. We present the first case of mild pancreatitis presenting with scrotal pain in the absence of any other symptoms or signs. We conclude that in any patient with unexplained scrotal pain, even in the absence of physical signs the possibility of pancreatitis should be considered.
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PMID:Acute scrotal pain as sole presentation of acute pancreatities. 2552 28

Glucagon-like peptide (GLP)-1 analogues such as liraglutide have gained popularity in the treatment of type 2 diabetes over the last years. By mimicking the effects of the native GLP-1, it enhances the glucose-dependent secretion of insulin, suppresses elevated glucagon secretion, increases satiety and slows down gastric emptying. Because of its ways of action it is not likely to cause hypoglycaemia in cases of overdosage. We present a 45-fold overdose of liraglutide (confirmed by P-liraglutide measurements) leading to nausea and vomiting, but no hypoglycaemia and no sign of pancreatitis.
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PMID:[A 45-fold liraglutide overdose did not cause hypoglycaemia]. 2565 May 14

Hyperemesis gravidarum is a severe manifestation of nausea and vomiting of pregnancy and it is associated with weight loss and metabolic abnormalities. It is known that abnormal laboratory values, including mildly elevated serum lipase level, could be associated with hyperemesis gravidarum. However, in this case report details of two women with hyperemesis gravidarum but with significantly elevated serum lipase levels were discussed. These patients presented with severe nausea and vomiting but without abdominal pain. They were found to have severely elevated lipase levels over 1,000 units/liter. In the absence of other findings of pancreatitis, they were treated with conservative measures for hyperemesis gravidarum, with eventual resolution to normal lipase levels. Although significantly elevated lipase level in pregnant patients with nausea and vomiting is a concern for acute pancreatitis, these two cases of significantly elevated serum lipase without other clinical findings of pancreatitis led to this report that serum lipase could be quite elevated in hyperemesis gravidarum and that it might not be an accurate biochemical marker for acute pancreatitis. Imaging studies are thus necessary to establish the diagnosis of acute pancreatitis.
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PMID:Significantly elevated serum lipase in pregnancy with nausea and vomiting: acute pancreatitis or hyperemesis gravidarum? 2570 46

Acute pancreatitis is a common acute surgical condition associated with high morbidity and mortality in severe cases. New guidelines for management have recently been published by the American College of Gastroenterology and by the International Association of Pancreatology in collaboration with the American Pancreatic Association. The main differences between the new and previous versions of the guidelines relate to the use of endoscopic retrograde cholangiopancreatography (ERCP) and the addition of the new severity category of 'moderately severe acute pancreatitis' All patients with pancreatitis should have its cause determined by features of the history, results of laboratory tests (liver function tests, serum calcium triglyceride levels) and findings on transabdominal ultrasound. Those with idiopathic pancreatitis should have endoscopic ultrasound as a first-line investigation. Acute pancreatitis should be managed with aggressive hydration with intravenous fluids and fasting. Oral feeding can be recommenced in mild pancreatitis once pain and nausea and vomiting have resolved. Patients with mild biliary pancreatitis should have a laparoscopic cholecystectomy during their index admission. In addition to aggressive intravenous fluid resuscitation and fasting, patients with severe pancreatitis should have enteral feeding (nasoenteric or nasogastric feeds) commenced 48 hours after presentation. Total parenteral nutrition should be avoided where possible. All patients with organ failure or severe pancreatitis as defined by the revised version of the Atlanta classification should be managed in an intensive care setting. Patients with biliary pancreatitis and concurrent cholangitis should have endoscopic retrograde cholangiopancreatography within 24 hours of presentation.
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PMID:Acute pancreatitis: update on management. 2592 4

Orlistat is a pancreatic lipase inhibitor which is used to treat obesity. Due to the increasing prevalence of obesity, orlistat use is thought to rise progressively. We report an interesting case caused by orlistat use caught in the early stages of acute pancreatitis through imaging; in addition, the case had significantly elevated serum amylase levels. A 54-year-old male who had a history of orlistat treatment started 7 days before was admitted to the emergency department with complaints of abdominal pain, nausea and vomiting lasting for 24 h. Abdominal computed tomography revealed peripancreatic fat tissue edema and a heterogeneous appearance of the pancreas. Based on these findings, it was concluded that edematous pancreatitis was in its initial stage. Orlistat is a drug that is increasingly widespread use due to obesity. More attention must be paid when planning to prescribe orlistat to patients if there are risk factors for acute pancreatitis (alcohol use, height, serum calcium and lipid levels).
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PMID:An Unexpected Result of Obesity Treatment: Orlistat-Related Acute Pancreatitis. 2607 34

Although the exact mechanism is unknown, incidence of drug-induced pancreatitis from corticosteroids is well established in the medical literature. Commonly reported in chronic steroid-dependent individuals who require large doses for a wide array of pathologies, the incidence of damage to the pancreas from low-doses have not been well described. We report a case of a 68-year-old woman who presented with severe abdominal pain, nausea and vomiting, 3 days after the initiation of low-dose methylprednisolone for osteoarthritis. Inpatient laboratory analysis revealed an elevated lipase of 1770 U/L and CT scan showing extensive necrotising pancreatitis involving the head, body and tail. Cessation of the causative medication and conservative treatment successfully led to resolution of symptoms. We present this case to inform clinicians of the precipitance of pancreatitis from modest strength corticosteroid management, so that more accurate and improved performance in pharmacological decisions can be made for patient care.
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PMID:Acute necrotising pancreatitis derived from low-dose corticosteroid use: an important reminder of clinical management. 2615 Jun 28


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