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

Management strategies in the nutritional support of the patient with acute pancreatitis have changed dramatically over the past 10 years. Prospective randomized trials show that maintaining gut integrity is equally as important as placing the pancreas at rest while inflammation within the gland resolves. In comparison to total parenteral nutrition and gut disuse, enteral feeding attenuates disease severity, reduces oxidative stress, and improves patient outcome. Nasojejunal feeds infused at or below the Ligament of Treitz should be provided to those patients with severe pancreatitis, as identified by a number of standardized scoring systems such as Ranson Criteria, APACHE II, Glasgow, and Imrie scores. Total parenteral nutrition should be reserved only for the patient with severe pancreatitis, initiated 4 to 5 days after peak inflammation in whom intolerance to enteral feeding has been shown and/or enteral access cannot be obtained. Vigilant monitoring is required to assure safe and effective delivery of enteral nutrients.
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PMID:Issues of nutritional support for the patient with acute pancreatitis. 1223 Mar 18

The stress injury of the gut organs due to ischemia constitutes the cause of complications and mortality after performance of radical operation for gastric cancer. Alcoholization of celiac nerves is proposed for an ischemic damage prophylaxis. Complications and mortality were analyzed in two groups of patients operated on, using endotracheal narcosis plus alcoholization and without it. Trustworthy lowering of the complications and mortality occurrence frequency, in 1.5-2 times accordingly, mainly owing to ischemic disorders (pancreatitis, the hole organs wall necrosis), were noted in conduction of alcoholization. The differencies observed were pronounced the most after performance of highly traumatic combined interventions.
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PMID:[Prophylaxis of microcirculation disorders caused by operative trauma and accompanying complications of radical surgery for gastric cancer]. 1237 35

The occurrence of BT has been well documented in experimental animal models of hemorrhagic shock, trauma, severe burns, cirrhosis, pancreatitis, and bacterial overgrowth. Translocation of viable bacteria and endotoxins into mesenteric lymph nodes and other gut-associated lymphatic tissue is thought to activate a complex interplay of mediators that initiates the SIRS. Multiple humoral and cellular systems cause synthesis, expression, and release of inflammatory mediators, such as toxic oxygen radicals, proteolytic enzymes, adherence molecules, and various cytokines. A massive sustained proinflammatory response can ultimately result in irreversible multiple organ dysfunction. Because BT is associated with splanchnic hypoperfusion, the cornerstone of therapy involves rapid resuscitation and restoration of tissue perfusion. If a septic focus can be identified, it should be removed. Gut protectants, promotility agents, antioxidants, and immune-enhancing diets have shown promise in improving length of survival in these critically ill patients.
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PMID:Bacterial translocation: clinical implications and prevention. 1238 Jan 71

Ventilator-associated pneumonia usually originates from the patient's oropharyngeal microflora. In selective digestive decontamination, topical antibiotics are applied to the oropharynx and stomach for prevention of pneumonia and other infections, possibly reducing infection-related mortality. Selective digestive decontamination is also used for the prevention of gut-derived infections in acute necrotizing pancreatitis and liver transplantation. Despite numerous clinical trials, selective digestive decontamination remains controversial. Reduction of the incidence of pneumonia is accepted, but the extent of reduction is debated. Mortality was not reduced in most individual trials, but this finding was calculated in meta-analyses, especially for combined use of topical and systemic antibiotics in surgical ICU patients. Some investigators reported increased resistance and a shift to Gram-positive pathogens. Today, it appears that selective means not only selective suppression of pathogenic bacteria but also selection of appropriate groups of patients for underlying diseases and severity of illness, and selection of ICUs, where the endemic resistance patterns might allow the use of selective digestive decontamination at a relatively low risk for increased selection pressure.
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PMID:Selective decontamination of the digestive tract. 1238 15

Alcoholic chronic pancreatitis and obstructive chronic pancreatitis are the most frequent and the better characterized types of pancreatitis. Recent advances in biology and genetics have brought new insights into the understanding of rare forms of chronic pancreatitis such as tropical chronic pancreatitis, hereditary chronic pancreatitis and chronic pancreatitis in cystic fibrosis. Some other rare forms of chronic pancreatitis have been identified: eosinophilic chronic pancreatitis, chronic pancreatitis after radiotherapy or during hypercalcemia, minimal change chronic pancreatitis and chronic pancreatitis associated with gut diseases or connectivitis. Recently, a particular form of non alcoholic chronic pancreatitis with duct destruction has been described often presenting as a pancreatic mass, leading in some cases to surgical resection of the pancreas. New insights into the understanding of chronic pancreatitis lead to new physiopathological concepts, and many arguments suggest that combined factors may lead to chronic inflammatory lesions of the pancreas.
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PMID:[Uncommon types of chronic pancreatitis]. 1248 56

Melatonin, a pineal secretory product, synthesized from l-tryptophan, has received increased attention because of its antioxidative and immunomodulatory properties. It has been detected in the gut and shown to protect the gastric mucosa, and liver from acute damage, but the role of melatonin in the protection of the pancreas against acute inflammation is not clear. The aim of this study was to investigate the effects of melatonin and its precursor, l-tryptophan, on caerulein-induced pancreatitis (CIP) and on ischemia/reperfusion (I/R)-provoked pancreatitis in rats. CIP was induced by subcutaneous infusion of caerulein to the rats (25 microg/kg). I/R was induced by clamping of the inferior splenic artery for 30 min followed by 2 hr of reperfusion. Melatonin (10, 25 or 50 mg/hr) or l-tryptophan (50, 100 or 250 mg/kg) was given as a bolus intraperitoneal (i.p.) injection 30 min prior to the onset of pancreatitis. CIP and I/R were confirmed by histologic examination and manifested by typical pancreatic edema, by an increase of plasma levels of amylase (by 500% in CIP and by 40% in I/R) and the pro-inflammatory tumor necrosis factor alpha (TNFalpha) (by 500%). Lipid peroxidation products such as malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE), were increased several fold in the pancreas CIP and I/R, whereas pancreatic blood flow (PBF) was significantly reduced in these animals. Pretreatment of rats subjected to CIP or to I/R with melatonin (25 or 50 mg/kg i.p.) or l-tryptophan (100 or 250 mg/kg i.p.) significantly reduced pancreatic edema, plasma levels of amylase and TNFalpha and diminished pancreatic MDA + 4-HNE contents, while enhancing PBF, pancreatic integrity and plasma levels of the anti-inflammatory interleukin 10 (IL-10). This was accompanied by a marked and dose-dependent rise of plasma melatonin immunoreactivity. Gene expression of N-acetyl transferase, an enzyme involved in melatonin biosynthesis, was detected in the pancreas of normal rats and was significantly enhanced in the rats with CIP. We conclude that exogenous melatonin, and that produced from l-tryptophan, attenuates pancreatic damage induced by CIP or by I/R and this effect may be attributable to the reduction in lipid peroxidation and TNFalpha release combined with an increase of plasma anti-inflammatory IL-10 in rats with acute pancreatitis.
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PMID:Protective effect of melatonin and its precursor L-tryptophan on acute pancreatitis induced by caerulein overstimulation or ischemia/reperfusion. 1248 71

Intestinal barrier failure and subsequent bacterial translocation have been implicated in the development of organ dysfunction and septic complications associated with severe acute pancreatitis. Splanchnic hypoperfusion and ischemia/reperfusion injury have been postulated as a cause of increased intestinal permeability. The urinary concentration of intestinal fatty acid binding protein (IFABP) has been shown to be a sensitive marker of intestinal ischemia, with increased levels being associated with ischemia/reperfusion. The aim of the current study was to assess the relationship between excretion of IFABP in urine, gut mucosal barrier failure (intestinal hyperpermeability and systemic exposure to endotoxemia), and clinical severity. Patients with a clinical and biochemical diagnosis of acute pancreatitis were studied within 72 hours of onset of pain. Polyethylene glycol probes of 3350 kDa and 400 kDa were administered enterally, and the ratio of the percentage of retrieval of each probe after renal excretion was used as a measure of intestinal macromolecular permeability. Collected urine was also used to determine the IFABP concentration (IFABP-c) and total IFABP (IFABP-t) excreted over the 24-hour period, using an enzyme-linked immunosorbent assay technique. The systemic inflammatory response was estimated from peak 0 to 72-hour plasma C-reactive protein levels, and systemic exposure to endotoxins was measured using serum IgM endotoxin cytoplasmic antibody (EndoCAb) levels. The severity of the attack was assessed on the basis of the Atlanta criteria. Sixty-one patients with acute pancreatitis (severe in 19) and 12 healthy control subjects were studied. Compared to mild attacks, severe attacks were associated with significantly higher urinary IFABP-c (median 1092 pg/ml vs. 84 pg/ml; P < 0.001) and IFABP-t (median 1.14 microg vs. 0.21 microg; P = 0.003). Furthermore, the control group had significantly lower IFABP-c (median 37 pg/ml; P = 0.029) and IFABP-t (median 0.06 microg; P = 0.005) than patients with mild attacks. IFABP correlated positively with the polyethylene glycol 3350 percentage retrieval (r = 0.50; P < 0.001), CRP (r = 0.51; P < 0.001), and inversely with serum IgM EndoCAb levels (r = -0.32; P = 0.02). The results of this study support the hypothesis that splanchnic hypoperfusion contributes to the loss of intestinal mucosal integrity associated with a severe attack of pancreatitis.
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PMID:Intestinal hypoperfusion contributes to gut barrier failure in severe acute pancreatitis. 1255 82

Selective digestive tract decontamination (SDD) is a method where topical non-absorbable antibiotics are applied to the oropharynx and stomach which primarily is aimed at the prevention of ventilator-associated pneumonia. The rationale for SDD is that ventilator associated pneumonia usually originates from the patients'own oropharyngeal microflora. SDD is also used for the prevention of gut-derived infections in acute necrotizing pancreatitis and in liver transplantation. Despite numerous clinical trials and several meta-analyses, SDD is still a controversial topic. It is now commonly accepted that the incidence of pneumonia is reduced,however, the concept of using topical antibiotics has its inherent limitations and the best results have been obtained by combination with a short course of intravenous antibiotics. Several issues surrounding the notorious difficulties in establishing the diagnosis of ventilator-associated pneumonia especially in the presence of antibiotics are an on-going matter of debate.Furthermore, pneumonia is the leading cause of death from nosocomial infections and its prevention was not adequately followed by reduced mortality in most individual trials, however, a benefit was suggested by recalculation of data in meta-analyses. Patients are not well defined by their need for ICU admission and mechanical ventilation and the attributable mortality of infections depends more on the type and severity of the underlying diseases. Recently published trials substantially improved our understanding as to which patients may derive most benefit from SDD.Currently, it seems that an improved survival can be achieved in surgical and trauma patients with severe but salvageable diseases, which might be classified e.g.by calculation of APACHE-II scores on admission.However, the most important drawback of SDD is the development of resistance and an increased selection pressure towards Gram-positive pathogens, especially in institutions with endemic multi-resistant microorganisms.Thus, it appears that "selective" must not only be interpreted as selective suppression of pathogenic bacteria but rather as selection of appropriate groups of patients with respect to underlying diseases and severity of illness. Furthermore, it means selection of ICUs where the endemic resistance patterns might allow the use of SDD at a relatively low risk for selection of resistant microorganisms, which is still the major concern associated with SDD.
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PMID:[Selective digestive tract decontamination in intensive care medicine. Fundamentals and current evaluation]. 1262

Bacterial translocation from gut has been assumed to be an infectious source in severe acute pancreatitis. The purpose of this study was to test the effect of intraperitoneal administration of oxygenated perfluorochemical on bacterial translocation associated with rat experimental acute necrotizing pancreatitis. Severe necrotizing pancreatitis was induced by retrograde injection of 3% sodium deoxycholate into the biliopancreatic ducts of male Wistar rats. Although mortality rate was not improved by the treatment, intraperitoneal administration of oxygenated perfluorochemical, perfulorodecalin reduced incidence of bacterial translocation to the mesenteric lymph nodes from 60% to 37% 12 hours after development of pancreatitis, and significantly reduced number of bacterial colonies detected after 24 hours. The treatment did not alter the villous height and crypt depth of the ileum. In this model for pancreatitis, however, accelerated apoptosis of the intestinal epithelium was detected histochemically by TUNEL staining and biochemically by DNA fragmentation ELISA, and the apoptotic changes were significantly suppressed by the treatment. These results indicate that intraperitoneal administration of oxygenated perfluorochemical inhibits apoptosis of intestinal epithelium and bacterial translocation induced in severe acute pancreatitis.
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PMID:Intraperitoneal administration of oxygenated perfluorochemical inhibits bacterial translocation associated with severe acute pancreatitis. 1269 18

To test the hypothesis that endotoxin is absorbed from the gut into the circulation in rats with experimental acute pancreatitis we studied two different animal models. In the first model necrotizing pancreatitis was induced by the ligation of the distal bilio-pancreatic duct while in the second, experimental oedematous acute pancreatitis was induced by subcutaneous injections of caerulein. In both experiments, in the colon of rats with acute pancreatitis endotoxin from Salmonella abortus equi was injected. Endotoxin was detected by immunohistochemistry in peripheral organs with specific antibodies. The endotoxin was found only in rats with both acute pancreatitis and endotoxin injected into the colon and not in the control groups. The distribution of endotoxin in liver at 3 and 5 days was predominantly at hepatocytes level around terminal hepatic venules, while in lung a scattered diffuse pattern at the level of alveolar macrophages was identified. A positive staining was observed after 12 hours in the liver, lung, colon and mesenteric lymph nodes of rats with both caerulein pancreatitis and endotoxin injected into the colon. We conclude that the experimental acute pancreatitis leads to early endotoxin translocation from the gut lumen in the intestinal wall and consequent access of gut-derived endotoxin to the mesenteric lymph nodes, liver and lung.
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PMID:Endotoxin translocation in two models of experimental acute pancreatitis. 1475 10


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