Acute Pancreatitis: Etiology, Clinical Presentation, Diagnosis, and Therapy

Cappell, Mitchell S.

doi:10.1016/j.mcna.2008.04.013

Cited by 146 publications

(159 citation statements)

References 140 publications

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“…An etiologic diagnosis can result in elimination of the precipitating factor and prevention of recurrence. Certain causes of pancreatitis have long-term consequences (eg,pancreatic cancer associated with hereditary pancreatitis) [18]. The most common obstructive cause of acute pancreatitis are gallstones: 40% of cases of acute pancreatitis.…”

Section: Etiology Of Acute Pancreatitismentioning

confidence: 99%

“…It is caused by migration of calculi from the gallbladder , towards the duodenum. Proposed mechanisms include biliary reflux into the pancreatic duct because transient obstruction of the ampulla during stone passage ,and pancreatic ductal hypertension from either stone impacted at the ampulla or ampullary trauma by stone passage [19].The increase in pancreatic duct pressure results in damage to the integrity of the duct system; bile reflux can activate trypsin and subsequent unregulated activation of trypsin within pancreatic acinar cells, and release of a series of inflammatory mediators [9,18]. Only 3-7% of patients with gallstones develop acute pancreatitis.…”

Section: Etiology Of Acute Pancreatitismentioning

confidence: 99%

“…In pancreas divisum normal fusion fails to occur: the dorsal duct drains most of the pancreas through the minor papilla and the ventral duct drains only the head of the pancreas through the major papilla. Pancreas divisum is diagnosed by pancreatography either by ERCP or MRCP [18,33,34].…”

Section: Pancreas Divisummentioning

confidence: 99%

“…Sphincter of Oddi dysfunction (SOD) has also been considered as controversial cause of acute pancreatitis [18,19,24,33,38].The sphincter of Oddi is a segment of circular and longitudinal muscle 6 to 10 mm long encircling the distal common bile duct and pancreatic duct. A resting pressure is maintained to allow the gallbladder to fill during fasting and prevent retrograde reflux of duodenal contents into the choledochus.…”

Section: Sphincter Of Oddi Dysfunctionmentioning

confidence: 99%

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Etiology of acute pancreatitis

2014

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AbstractAcute pancreatitis is a common disease with a benign course in the majority of patients, but it is associated with serious morbidity, and mortality close to 20% in up to 20% of cases. The incidence of acute pancreatitis seems to be rising in western countries. About 75% of all cases are caused by gallstones or alcoholism. The relative rate of gallstones versus alcohol as etiology depends on the age and the area of enrolment. A thorough evaluation allows cause identification in another 10% of cases, leaving about 15–20% as idiopathic. The most common causes, and a growing list of less frequent and sometimes very rare and controversial etiologies, are reviewed in this article. A classification on the pathogenic mechanisms of causes of acute pancreatitis based is used in this Review. The approach, or suggested plan of investigations, to determine the etiology of acute pancreatitis, based on the most recently published Guidelines is outlined.

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Section: Etiology Of Acute Pancreatitismentioning

confidence: 99%

Section: Etiology Of Acute Pancreatitismentioning

confidence: 99%

Section: Pancreas Divisummentioning

confidence: 99%

Section: Sphincter Of Oddi Dysfunctionmentioning

confidence: 99%

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Etiology of acute pancreatitis

2014

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“…Without prompt diagnosis and treatment, it can rapidly evolve to a medical emergency, leading into pancreatic necrosis and ultimately to death (1,2). Serum hypertriglyceridemia (HTG) is the third most frequent cause of AP after gallstones and alcohol, with a reported incidence of 1%-10% (3).…”

Section: Introductionmentioning

confidence: 99%

Plasmapheresis in the Management of Acute Pancreatitis due to Severe Hypertriglyceridemia—Reporting New Cases

Campos

Santos

Freitas

et al. 2017

jrenhep

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Acute pancreatitis is a potentially life-threatening disease. If the diagnosis and the treatment are not prompt, it can rapidly evolve to a medical emergency. Severe hypertriglyceridemia, defined as above 1000 mg/dl, is the third most common cause of acute pancreatitis. Conventional management includes fat dietary restriction and pharmacological treatment; however, these measures take time to be effective. Plasmapheresis seems to be an alternative and safe adjunctive therapy because it allows the rapid reduction of the trigger agent in circulation. Its use, especially in severe cases, has been increasingly reported. The authors report three cases of severe hypertriglyceridemia-induced pancreatitis in which early plasmapheresis was successfully used with other supportive clinical management.

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Severe Hypertriglyceridemia With Pancreatitis

2014

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IMPORTANCE Recurrent pancreatitis is a potentially fatal complication of severe hypertriglyceridemia. Genetic defects and lifestyle risk factors may render this condition unresponsive to current treatments. OBSERVATIONS We report this first case of long-term management of intractable near-fatal recurrent pancreatitis secondary to severe hypertriglyceridemia by a novel use of lomitapide, an inhibitor of microsomal triglyceride transfer protein, recently approved for treatment of familial homozygous hypercholesterolemia. The patient had been hospitalized many times for pancreatitis since age 15 years. Her serum triglyceride level averaged 3900 mg/dL while she received therapy with approved lipid drugs. She is homozygous for a coding mutation (P234L) in lipoprotein lipase, leaving her unable to metabolize triglycerides in chylomicrons and very low density lipoproteins (VLDL). Lomitapide reduces the secretion of chylomicrons and VLDL. Lomitapide, which was started when she was 44 years old after near-fatal pancreatitis, lowered her fasting triglyceride level from greater than 3000 mg/dL to a mean (SD) of 903 (870) mg/dL while she received 30 mg/d and to 524 (265) mg/dL while she received 40 mg/d; eliminated chronic abdominal pain; and prevented pancreatitis. However, fatty liver, present before treatment, progressed to steatohepatitis and fibrosis after 12 to 13 years. CONCLUSIONS AND RELEVANCE Lomitapide prevented pancreatitis in severe intractable hypertriglyceridemia but at a potential long-term cost of hepatotoxicity.

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Acute Pancreatitis: Etiology, Clinical Presentation, Diagnosis, and Therapy

Cited by 146 publications

References 140 publications

Etiology of acute pancreatitis

Etiology of acute pancreatitis

Plasmapheresis in the Management of Acute Pancreatitis due to Severe Hypertriglyceridemia—Reporting New Cases

Severe Hypertriglyceridemia With Pancreatitis

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