Retrospective analysis of clinical problems concerning acute pancreatitis in one treatment center

Abstract

IntroductionSevere acute pancreatitis is still a difficult clinical problem, it is a challenge for medical teams, which should include the strategy of personalized medicine. In clinical observations, among patients with the fulminating course of acute pancreatitis developed during the first hours leading to irreversible multiorgan failure and death.AimTo evaluate the frequency of occurrence and analyze the progression and treatment of severe acute pancreatitis (AP) in patients hospitalized during the years 2004–2010 at the Clinical Surgery Ward.Material and methodsOne thousand and fifty patients treated for AP were included in the study; 97 patients with severe AP were subjected to a detailed clinical analysis.ResultsThe average age of the patients was 52.8 years. Relapses occurred in 14.9% of patients. The severe form of acute pancreatitis was diagnosed in 97 patients, which accounts for 9.2% of all the illnesses, and occurred significantly more often in male patients (p < 0.01). The most frequent etiological factors were cholelithiasis (46.4%), and idiopathic pancreatitis (27.8%); alcohol consumption was responsible for 22.7% of the cases; the occurrence of both a bile-derivative and alcoholic factor was found in 3.1% of the cases. A worsening clinical state resulted in laparotomy in 26 patients (26.8%), and re-laparotomy in 5 patients. Necrosectomy was performed on 15 patients, of whom 33.3% died due to complications. The total mortality in severe AP was 38.1%. The average age of the deceased was 66.5. Early deaths within 14 days were noted in 78.4% of patients (n = 29) who died due to severe AP.ConclusionsSevere AP in spite of implementing modern diagnosis and treatment methods is still associated with a high risk of death. Constant clinical observation and use of available prognostic scales are essential in improving AP prognoses.

Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin

“…Hypertriglyceridaemia (HT) is a rare but well known cause of AP, which can be a life-threatening complication if the degree of HT is severe enough. Hypertriglyceridaemia as a cause of AP reaches frequencies of 1–7%, according to the literature, when triglyceride levels reach more than 1,000 mg/dl [ 1 – 8 ]. More than 75% of HT-induced AP cases are either chronic alcoholics or uncontrolled diabetics [ 6 ].…”

Urinary Neutrophil Gelatinase–Associated Lipocalin as an Early Predictor of Disease Severity and Mortality in Acute Pancreatitis

“…[1][2][3][4] Improvement of outcome in severe AP (SAP) depends on early identification of patients with poor prognosis, treatment under intensive care unit (ICU) conditions, early administration of enteral nutrition, 5 as well as considering endoscopic retrograde cholangiopancreatography in patients with gallstone-induced disease. Patients with early signs of organ failure are at particularly high risk of death due to AP.…”

Fluid resuscitation in acute pancreatitis: Normal saline or lactated Ringer's solution?

“…NS may contribute to the development of metabolic statistically significant differences between the two study groups. These findings are particularly interesting in view of a major role of hypoperfusion in the pathogenesis of not only pancreatic necrosis but also organ failure [6,15,16] . Also notable is the result suggesting that RL does not significantly impact the need for enteral nutrition, when necessary [17] .…”