Natural course of acute pancreatitis

Beger, H. G.; Rau, Bettina; Mayer, Jens; Pralle, U.

doi:10.1007/s002689900204

Cited by 438 publications

(204 citation statements)

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“…Indeed, the risks of acute pancreatitis are most of all infectious complications that are directly linked to the presence of necrosis, a favourable environment to the development of bacteria [3,7,[19][20][21][22][23][24][25][26][27][28]. The overall risk of infection does not exceed 10%, but in case of necrosis, it reaches 70%.…”

Section: Discussionmentioning

confidence: 99%

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

et al. 2006

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Background: This study was designed to determine the most important early CT parameters predictive of acute pancreatitis severity. Methods: Three hundred and seventy-one consecutive patients with acute abdominal pain and hyperamylasemia were enrolled. Three hundred and ten of the 371 patients met our inclusion criteria. Acute pancreatitis severity was evaluated using the 1992 Atlanta criteria. Different CT parameters were reported from the admission abdominal CT by two radiologists blinded from any clinical parameter, but the patientsÕ age and gender. These variables were fitted in a binary logistic regression model. Results: Acute pancreatitis was mild in 80% cases, severe in 20% cases and lethal in 12.69% cases. The following CT parameters were significantly associated with the severity of acute pancreatitis: the objective size of the pancreas (P = 0.001), the peripancreatic fat abnormalities (P = 0.001) and the extent of necrosis (P = 0.007). Moreover, the age of the patient revealed itself a highly significant (P = 0.001) indicator of disease severity. The association of the four CT criteria eventually showed a sensitivity of 73% and a specificity of 81% to predict acute pancreatitis severity. Conclusion: Although these criteria correlated with disease severity, our study identified that morphological CT criteria cannot be used to triage patients with severe and mild acute pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

et al. 2006

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“…2,3,12 Although most nontransplantation patients with AP tend to run a benign course, such complications as pancreatic pseudocyst and pancreatic abscess rarely occur. 19 However, in our patients, as in immunosuppressed renal transplant recipients, the incidence of these complications was greater. 4 The only death in this series of patients occurred in the patient with diffuse malignancy.…”

Section: Discussionmentioning

confidence: 45%

“…However, none of these patients had severe pancreatitis with pancreatic necrosis. In nontransplantation patients with AP, 19 mortality occurs predominantly in those with necrosis within the pancreas. Similarly, in renal transplant recipients, 6 of 11 of those who had severe AP combined with necrosis (54%) died.…”

Section: Discussionmentioning

confidence: 99%

Pancreatitis in adult orthotopic liver allograft recipients: Risk factors and outcome

et al. 2000

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Acute pancreatitis (AP) has been described after orthotopic liver transplantation but is uncommon in stable patients after the initial perioperative phase. The aim of this study is to review our experience with AP occurring more than 2 months after primary allografting and determine possible contributing factors plus patient outcome. A review of patient files and the unit database was performed. AP was diagnosed in 9 of 298 patients (3%) on 12 occasions. The incidence of AP was greater in men (8 of 163 men) than women (1 of 135 women; P F .04). Underlying factors to each episode of AP were biliary manipulation (4 of 12 episodes; 33%), history of recent alcohol ingestion (3 of 12 episodes; 25%), and malignancy in the region of the pancreas (2 of 12 episodes; 16%). AP was associated with a diagnosis of either hepatic artery thrombosis combined with biliary tract complications (P F .005) or malignancy (P F .004). In 7 of 12 episodes of AP (58%), conservative management alone was successful. In 3 of 9 patients (33%), subsequent surgery was required. One patient died of pancreatic malignancy. In conclusion, AP is uncommon in stable liver transplant recipients. Male sex, complications of hepatic artery thrombosis, and malignancy in the region of the pancreas are associated with AP in this study. (Liver Transpl 2000;6:362-366.)

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“…Yaflam› tehdit eden komplikasyonlar hemen daima fliddetli akut pankreatitde oluflur (13 Bu komplikasyonlar görüldükleri döneme göre erken (2-3 gün), orta (2-5 hafta) ve geç (aylar-y›llar) olarak s›n›fland›r›-l›rlar (Tablo 5). fiiddetli akut pankreatitin erken faz›n› aseptik bir inflamatuvar reaksiyon olan SIRS oluflturur ki bu çoklu organ yermezli¤i ve ölüme götürür.…”

Section: Komplikasyonlarunclassified

Akut pankreatitde tedavi

Dışıbeyaz¹

2015

Endoskopi Gastrointestinal

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Toplumdaki insidans› 100.000'de 5-20 olan akut pankreatitin en s›k nedeni %80 olguda alkol ve safra tafl› migrasyonudur. Olgular›n büyük ço¤unlu¤u hafif formda olup, sadece k›sa süreli hospitalizasyonla düzelebilirken, az bir k›sm› ciddi mortalitiye de neden olabilen fliddetli formda görülür. fiiddetli formlarda tedavi mutlak yo¤un bak›m koflullar›nda yap›lmal› ve hasta çok yak›ndan izlenmelidir. Bu nedenle bu amaçla gelifltirilmifl indeksler kullan›la-rak fliddetli formun önceden tan›nmas› çok önemlidir. Tedavi medikal ve giriflimsel (endoskopik/cerrahi) olmak üzere ikiye ayr›labilir. S›v› replasman›, a¤r› kontrolü, tromboz proflaksisi, antibiyotik proflaksisi, enteral beslenme, O 2 tedavisi medikal tedavide önemliyken, endoskopik retrograd kolanjiyopankreatografi ile biliyer pankreatitde tafl ekstraksiyonu, pankreas divisumda stent yerlefltirilmesi, sfinkter oddi disfonksiyonunda sfinkterotomi ve ayr›ca endoskopik/cerrahi nekroz debridman›, pseudokist drenaj› uygulanabilecek giriflimsel yöntemlerdir.The prevalence of acute pancreatitis in population is estimated as 100.000/5-20 and alcohol and bile stone migration are considered as causes in 80% of cases. Disease has a mild course in most cases and patients recover with a short term hospitalization. In minority of patients, disease has a severe course that may cause death eventually. Patients in last form should be treated in ICU and be monitored very closely. Therefore estimating the severity of the disease early in the course, using several severity indexes which is developed for this purpose is very important. The treatment includes medical and interventional (surgical / endoscopic) modalities. Fluid replacement, pain control, antibiotic prophylaxis , enteral feeding, thrombosis prophlaxis and O 2 support are considered as essentials of medical treatment. Invasive methods are consist of biliary stone extraction , stenting in pancreas divisium, sphincterotomy in Sphyncter of Oddi Dysfunction via endoscopic retrograde cholangiopancreatography and endoscopic or surgical debridman in pancreatic necrosis and pseudocyst drainage.

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Natural course of acute pancreatitis

Cited by 438 publications

References 43 publications

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

Pancreatitis in adult orthotopic liver allograft recipients: Risk factors and outcome

Akut pankreatitde tedavi

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