Conservative management of cholestasis with and without fever in acute biliary pancreatitis

Santos, José Sebastião dos

doi:10.4240/wjgs.v4.i3.55

Cited by 8 publications

(6 citation statements)

References 39 publications

(53 reference statements)

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“…Regarding the scenario of cholestasis alone, patients who develop cholestasis due to more proximal CBD obstruction or from intra-hepatic causes do not appear to be predisposed to the development of pancreatitis. Yet, many patients with biliary pancreatitis have some degree of cholestasis 35 . We found that intra-ductal bile infusion followed by BDL could combine all three aspects of pancreatic duct obstruction, bile exposure, and cholestasis.…”

Section: Discussionmentioning

confidence: 99%

Intraductal Infusion of Taurocholate Followed by Distal Common Bile Duct Ligation Leads to a Severe Necrotic Model of Pancreatitis in Mice

Eisses

Lemon

et al. 2015

Pancreas

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Objectives The most common etiology for acute pancreatitis results from the impaction of gallstones or sludge in the distal common bile duct (CBD). The result is pancreatic duct obstruction, diversion of bile into the pancreas, or cholestasis. In the current study, we examined whether combining both aspects, that is, infusion of the bile acid taurocholate (TC) followed by bile duct ligation (BDL), could yield a more severe form of pancreatitis that mimics biliary pancreatitis. Methods In mice, following laparotomy, the CBD was infused with either normal saline (NS) or TC. Subsequently, the CBD was ligated at the ampulla. Results Mice receiving TC infusion followed by BDL (TC+BDL) had higher mortality compared to animals receiving intra-ductal NS with BDL (NS+BDL). The TC+BDL arm developed more severe and diffuse pancreatic necrosis. In addition, serum amylase, IL-6, and bilirubin, were significantly higher. However, pancreatic edema as well as lung and liver injury were unchanged between TC+BDL and NS+BDL. Conclusions In summary, the combination of bile infusion into the pancreas followed by BDL causes a more severe, necrotizing pancreatitis. We believe this novel model of pancreatitis is useful because it can be employed in transgenic mice and recapitulates several aspects of biliary pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Intraductal Infusion of Taurocholate Followed by Distal Common Bile Duct Ligation Leads to a Severe Necrotic Model of Pancreatitis in Mice

Eisses

Lemon

et al. 2015

Pancreas

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“…ВОПРОСЫ ОБЩЕЙ И ЧАСТНОЙ ХИРУРГИИ В в е д е н и е. Острый панкреатит, особенно его деструктивные формы, является одной из тяжелых хирургических патологий органов брюшной полости и относится к одной из важнейших проблем современной неотложной абдоминальной хирургии [10,11,15,18,23]. Об этом свидетельствуют как отсутствие единых и согласованных взглядов в выборе консервативной и хирургической тактик, так и значительная вариабельность количества послеоперационных осложнений и уровня летальности при этом тяжелом заболевании в различных хирургических клиниках [1,5,25]. Как утверждают [6,11,13,21], несмотря на достигнутые успехи в совершенствовании диагностики, интенсивной терапии, хирургических методов лечения, общая летальность при панкреонекрозе на протяжении последнего десятилетия остается на высоком уровне (от 10 до 30 %), а при распространенных инфицированных его формах достигает 85 % и более.…”

Section: «вестник хирургии» • 2018unclassified

Prediktory Significance of Dna Damage to Mononuclear Blood Cells in Early Diagnostics of Infected Pacreatic Necrosis

Saveliev¹,

Vinokurov²,

Кершенгольц³

2018

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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Кафедра факультетской хирургии, урологии, онкологии и оториноларингологии (зав.-проф. М. М. Вино ку ров), Медицинский институт «Северо-Восточный федеральный университет имени М. К. Аммо сова», г. якутск 2 Лаборатория экологической и медицинской биохимии, биотехнологий и радиобиологии (зав.-канд. биол. наук е. С. Хлебный), «институт биологических проблем криолитозоны» Сибирского отделения РАН, г. якутск ЦеЛь иССЛедОВАНия. Оценка предикторной значимости повреждения дНК мононуклеарных клеток крови у больных с панкреонекрозом. МАтеРиАЛ и МетОды. Работа основана на анализе результатов комплексного лечения 497 больных с панкреонекрозом и у которых проводились исследования дНК повреждения мононуклеарных клеток крови методом гель-электрофореза (метод «дНК-комет»). РеЗуЛьтАты. В ходе исследования удалось внедрить и эффективно использовать на практике метод «дНК-комет» в ранней диагностике развития панкреатогенной инфекции. ЗАКЛючеНие. Внедрение метода позволило снизить количество необоснованных оперативных вмешательств в стерильную фазу панкреонекроза в 1,9 раза и, наряду с комплексными лечебными мероприятиями, снизить уровень общей летальности с 11,1 до 3,9 %.

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“…In severe cases with AP, there can be pain, fever, cholestasis, mental confusion and hypotension due to ongoing pancreatic inflammation and necrosis and under this circumstances, an imminent ERCP can make the situation even worser [5]. Although, if we scrutinize the real life data, we will see that there is some kind of pressure on ERCP physicians to perform ERCP at night and or at weekends by the physicians seeing these patients with ABP in the emergency room [6].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Retrograde Cholangiopancreatography in Acute Biliary Pancreatitis

Sarıtaş¹,

Üstündağ²

2022

Recent Advances in Pancreatitis

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Acute pancreatitis (AP) is the most serious emergent disease in the gastroenterology field. The most common cause of AP is naturally gallstones. The most cases have mild disease and the illness limits itself in a short time period. In 15–20% of cases, the severe form of acute biliary pancreatitis (ABP) develops. Some patients have concomitant cholangitis. In these patients, releiving biliary obstruction with endoscopic retrograde cholangiography (ERCP) and endoscopic sphincterotomy (ES) is essential. However, correct timing of ERCP is a debate. While some authors and guidelines suggested that ERCP can be performed in first 24 hours, the others suggested its use during the first 72 hours. In the first 24 hours, ERCP is diffucult to apply due to ampullary edema and general ill situation of the patient. Rather than ERCP, agressive fluid replacement and supportive therapy are very much important in the first 72 hours of admission. Moreover, there is no consensus on timing of ERCP in patients with severe pancreatitis without cholangitis. But all international guidelines suggested that ERCP should be perfomed in all patients with mild or severe pancreatitis together with concomitant cholangitis during the first 72 hours. After resolution of ABP, cholecystectomy should be performed to prevent recurrent pancreatitis during the same hospitalization period (index cholecystectomy). If the patient is not suitable for cholecystectomy, ERCP and ES should be done to prevent further attacks of acute pancreatitis.

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Conservative management of cholestasis with and without fever in acute biliary pancreatitis

Cited by 8 publications

References 39 publications

Intraductal Infusion of Taurocholate Followed by Distal Common Bile Duct Ligation Leads to a Severe Necrotic Model of Pancreatitis in Mice

Intraductal Infusion of Taurocholate Followed by Distal Common Bile Duct Ligation Leads to a Severe Necrotic Model of Pancreatitis in Mice

Prediktory Significance of Dna Damage to Mononuclear Blood Cells in Early Diagnostics of Infected Pacreatic Necrosis

Endoscopic Retrograde Cholangiopancreatography in Acute Biliary Pancreatitis

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