Acute pancreatitis

Abstract

Acute pancreatitis (AP) is an important cause of morbidity and mortality worldwide and the annual incidence appears to be increasing. It presents as a mild self-limiting illness in 80% of patients. However, one-fifth of these develop a severe complicated life-threatening disease requiring intensive and prolonged therapeutic intervention. Alcohol and gallstone disease remain the commonest causes of AP but metabolic abnormalities, obesity and genetic susceptibility are thought be increasingly important aetiological factors. The prompt diagnosis of AP and stratification of disease severity is essential in directing rapid delivery of appropriate therapeutic measures. In this review, the range of diagnostic and prognostic assays, severity scoring systems and radiological investigations used in current clinical practice are described, highlighting their strengths and weaknesses. Increased understanding of the complex pathophysiology of AP has generated an array of new potential diagnostic assays and these are discussed. The multidisciplinary approach to management of severe pancreatitis is outlined, including areas of controversy and novel treatments.

Endoscopic retrograde cholangio-pancreatograhy and laparoscopic cholecystectomy in single session management of acute biliary pancreatitis

“…9 It may occur when there is out of balance of factors involved in maintaining cellular homeostasis. The initiating event may be anything that injures the acinar cell and impairs the secretion of zymogen granules; examples include alcohol use, gallstones, and certain drugs.…”

The team management of patient suffered of acute severe dyslipidaemic pancreatitis: The experience of one tertiary health centre

“…Uobičajen patogenetski scenario je prekid već postojećeg tretmana dislipidemije, uz prisustvo faktora koji precipitira nastanak pankreatitisa. Sobzirom na nemogućnost oralne aplikacije bilo kog leka, lečenje izbora dislipidemija u akutnom pankreatitisu je terapijska izmena plazme (TIP), čiji su rezultati u smislu korekcije dislipidemije brzi i očigledni i značajno utiču na prevenciju egzacerbacija pankreatitisa 1,7 . TIP predstavlja skup afereznih postupaka koji se odnose na eksfuziju (privremeno odstranjivanje) dela bolesnikove krvi, njeno razdvajanje na komponente, otklanjanje određenog volumena plazme koji je u fizičko-hemijskom pogledu patološki izmenjen ili sadrži patogeni supstrat i reinfuziju preostalog dela krvi uz obaveznu upotrebu najpogodnije nadoknade tečnosti 10 .…”

“…Dislipidemijski pankreatitis nastaje u slučajevima značajne hipertrigliceridemije (>10mmol/L), dok je gotovo iznimno uzrokovan hiperholesterolemijom 1,2,7,9 . Nagomilani etil estri masnih kiselina (EEMK), nastali uticajem EEMK sintetaza pri neoksidativnom metabolizmu masnih kiselina i etanola, dovode do oštećenja lizozoma, aktivacije proinflamatornih transkripcionih faktora i poremećaje intraćelijske homeostaze kalcijuma 3 .…”

In Search for a Better Marker of Acute Pancreatitis—Third Time Lucky?

“…Lipase is also known to increase in peptic ulcer disease, mesenteric ischemia, acute renal failure, bone fractures, crush injury, and fat embolism. In addition, analytical inaccuracies may be caused by the presence of multiple isoforms in the serum of pancreatitis patients and by the existence of macroforms (8 ). Alternative approaches, such as combined amylase and lipase testing, have been pursued to improve the diagnostic utility of amylase.…”