scholarly journals Acute Necrotizing Pancreatitis following Long-Term Antipsychotic Use

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
David T. Liebers ◽  
Adaora Ofomata ◽  
Ryan Badolato ◽  
Emily Mills ◽  
Pantea Farahmand
Keyword(s):  
Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Time Interval ◽  
Literature Discussion ◽  
Medication Regimen ◽  
Drug Induced ◽  
Antipsychotic Medications ◽  
Patients At Risk ◽  
Acute Necrotizing ◽  
Time To Onset

Introduction. Psychiatrists commonly use antipsychotic medications in the treatment of psychotic and mood disorders. A rare but known side effect of atypical antipsychotics is acute pancreatitis. Most cases of antipsychotic-induced pancreatitis occur within six months of initiation. The mechanism believed to cause this reaction is hypertriglyceridemia. Here, we present a unique case of antipsychotic-induced pancreatitis that deviates from previous cases in the time to onset of the pancreatitis and the mechanism of presentation. Case Presentation. We present a case of a patient with treatment-resistant schizophrenia managed for over a decade on olanzapine and haloperidol. Twelve years after stabilization on this medication regimen, the patient developed acute pancreatitis, which after extensive medical workup was attributed to his psychotropic medications. We review his medical and psychiatric history, his medical course and workup during the episode of pancreatitis, and review recommendations for patients at risk for antipsychotic-induced pancreatitis based on this case and the current literature. Discussion. This case illustrates that acute pancreatitis can occur long after the initiation of antipsychotic medications and may be mediated by mechanisms other than hypertriglyceridemia. While there are reports of antipsychotic-induced psychosis occurring within months, and in a limited set of cases, years, after medication initiation, the twelve-year time interval in the present case is by far the longest duration of an antipsychotic precipitating this adverse event recorded in the literature. This case highlights that although exceedingly rare, prescribers should be aware of the risk for drug-induced pancreatitis in patients stable on antipsychotic medications.

scholarly journals Familial Chylomicronemia Syndrome-Induced Acute Necrotizing Pancreatitis during Pregnancy

2021 ◽  
Vol 43 (03) ◽  
pp. 220-224
Author(s):  
Julia Cristina Coronado Arroyo ◽  
Marcio José Concepción Zavaleta ◽  
Eilhart Jorge García Villasante ◽  
Mikaela Kcomt Lam ◽  
Luis Alberto Concepción Urteaga ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Clinical Course ◽  
Necrotizing Pancreatitis ◽  
Rare Condition ◽  
Severe Hypertriglyceridemia ◽  
Fetal Complications ◽  
Acute Necrotizing ◽  
History Of ◽  
Important Objective

AbstractAcute pancreatitis is a rare condition in pregnancy, associated with a high mortality rate. Hypertriglyceridemia represents its second most common cause. We present the case of a 38-year-old woman in the 24th week of gestation with a history of hypertriglyceridemia and recurrent episodes of pancreatitis. She was admitted to our hospital with acute pancreatitis due to severe hypertriglyceridemia. She was stabilized and treated with fibrates. Despite her favorable clinical course, she developed a second episode of acute pancreatitis complicated by multi-organ dysfunction and pancreatic necrosis, requiring a necrosectomy. The pregnancy was ended by cesarean section, after which three plasmapheresis sessions were performed. She is currently asymptomatic with stable triglyceride levels. Acute pancreatitis due to hypertriglyceridemia represents a diagnostic and therapeutic challenge in pregnant women, associated with serious maternal and fetal complications. When primary hypertriglyceridemia is suspected, such as familial chylomicronemia syndrome, the most important objective is preventing the onset of pancreatitis.

The burden of acute pancreatitis and early experience of step-up approach for acute necrotizing pancreatitis at Military Hospital

2019 ◽  
Vol 22 (2) ◽  
pp. 11-17
Author(s):  
Sushil Bahadur Rawal ◽  
Uttam Laudari ◽  
Basanta Khatiwada ◽  
Anup Thapa ◽  
Manoj Kumar Jha ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Early Experience ◽  
Acute Necrotizing Pancreatitis ◽  
Military Hospital ◽  
Army Hospital ◽  
Acute Necrotizing ◽  
Hospital Resources ◽  
Open Necrosectomy

Introduction: Twenty-five percent of acute pancreatitis develops severe acute pancreatitis (SAP). SAP patients have prolonged hospitalization and require a substantial amount of manpower and hospital resources. The aim of this study was to give an insight into the burden of acute pancreatitis at a tertiary level military hospital and to share the experience of managing pancreatic necrosis with the application of the step-up approach. Methods: A prospective descriptive study of consecutive patients was conducted at Shree Birendra Army Hospital from 2017 June to 2017 November. Patients with a diagnosis of acute pancreatitis admitted were stratified according to severity as per Revised Atlanta classification 2012. Patients with acute necrotizing pancreatitis were enrolled for the step-up approach. Patient’s demography, baseline investigations, radiology, prognostic scoring scales and type of intervention were analyzed. The burden of severe acute pancreatitis at our center and the early experience of the step-up approach at our centre within the study period were studied. Results: Out of 35 five patients with acute pancreatitis, 7 (20%) subsequently developed severe acute pancreatitis. Among them, five patients subsequently developed necrotizing pancreatitis who were managed according to the step-up approach. Out of them, three patients subsequently underwent operative intervention in the form of minimally invasive procedures like percutaneous drain placement, laparoscopic necrosectomy, video-assisted retroperitoneal debridement, and open necrosectomy. Conclusion: Acute pancreatitis is a common presentation at our centre. The step-up approach in the management of acute necrotizing pancreatitis is a safe and feasible approach.

scholarly journals Staged treatment of acute necrotizing pancreatitis given the configuration of pancreatic necrosis (case report)

2021 ◽  
Vol 26 (2) ◽  
pp. 61-67
Author(s):  
А. V. Shefer ◽  
E. N. Belykh
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Clinical Observation ◽  
Necrotizing Pancreatitis ◽  
Fluid Collection ◽  
Acute Necrotizing ◽  
Data Configuration ◽  
Ct Data ◽  
High Level ◽  
Staged Treatment

A clinical observation of a successful staged treatment of a patient with severe acute pancreatitis based on early diagnosis of damage to the pancreatic duct according to CT data (configuration of pancreatic necrosis) and high level of amylase in the fluid collection is presented.

Frequency of Left Plueral Effusion in Acute Necrotizing Pancreatitis

2021 ◽  
Vol 15 (10) ◽  
pp. 3349-3351
Author(s):  
Hunain . ◽  
Farah Saleem ◽  
Muhammad Waqas Arshad ◽  
Kauser Shaikh ◽  
Mamoona Shaikh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pleural Effusion ◽  
Serum Amylase ◽  
Necrotizing Pancreatitis ◽  
Case Series ◽  
Acute Necrotizing Pancreatitis ◽  
Amylase Level ◽  
X Ray ◽  
Left Pleural Effusion ◽  
Acute Necrotizing

Objective: The aim of this study is to calculate the prevalence of left plueral effusion in acute necrotizing pancreatitis. Study Design: Observational/ case series Place and Duration: Conducted at surgery department of Saidu Teaching Hospital, Swat and Ibne Sina Hospital and Research Institute, Multan for duration of six months from January 2021 to June 2021. Methods: A total of 95 patients, both males and females, ranging in age from 15 to 65 years, were presented. After receiving informed written consent, the baseline comprehensive demographics of the patients presented were recorded, including age, gender, and body mass index. Patients with acute pancreatitis and serum amylase levels greater than 300U/dL were eligible to participate. Patients were subjected to X-ray and CT scans in their entirety. Prevalence of necrotizing pancreatitis was calculated by CT scan and for left plueral effusion X-ray of chest was taken. SPSS 24.0 version was used to analyze complete data. Results: Majority of the patients 65 (68.4%) were females and 30 (31.6%) were males with mean age 39.14+5.67 years. 26 (27.4%) cases had BMI less than 20kg/m2 and the majority were >20kg/m2. Gallstone was the most common cause of acute pancreatitis found in 45 (47.4%) cases, followed by alcoholism 25 (26.3%) and medications 12 (12.6%). Among 95 cases, prevalence of necrotizing pancreatitis was 42 (44.2%) in which 40 cases had left plueral effusion. Mortality rate among necrotizing pancreatitis was 13 (33.3%). Conclusion: We found that the majority of individuals with necrotizing pancreatitis experienced pleural effusion on the left side. Thus, patients with acute pancreatitis who have a high serum amylase level must be treated earlier if they have a left pleural effusion because of severity. Keywords: Plueral Effusion, Acute Necrotizing Pancreatitis, Mortality

Relationship of Arterial Changes in Acute Pancreatitis on CT Angiography with Modified CT Severity Index

2021 ◽  
Author(s):  
Sanya Vermani ◽  
Aditya Kaushal ◽  
Arshpreet Kaur ◽  
Mohit Singla
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Fluid Collection ◽  
Vascular Complications ◽  
Severity Index ◽  
Arterial Complications ◽  
Acute Necrotizing ◽  
Cect Scan ◽  
Enhanced Computed Tomography

Abstract Purpose To evaluate the prevalence of arterial changes in patients with acute pancreatitis (AP) on computed tomography angiography (CTA) and determine their association with etiology of AP, presence of necrosis, collections and severity of AP. Materials and Methods A total of 50 patients (20 women, 30 men; mean age: 43.04 ± 13.98; age range: 18–77 years) with AP underwent contrast-enhanced computed tomography (CECT) scan and CTA of abdomen, which was evaluated for necrosis and fluid collection (s). On CTA, splanchnic arterial structures were assessed for vascular complications. Association between vascular changes and presence of necrosis, fluid collections, etiology of AP and severity of AP (as assessed by modified computed tomography severity index CTSI) was determined. Results Arterial complications were seen in 28 percent (14/50). The most frequently involved artery was superior pancreaticoduodenal artery (12 percent), followed by splenic artery (8 percent) and right gastric artery (8 percent; Fig. 1). No significant association was seen between arterial changes and gallstone or alcohol-induced AP. Arterial changes showed a significant association with presence of acute necrotizing pancreatitis (ANP), presence of collections and severe AP (CTSI 8–10) (p < 0.05 for each). Conclusion Arterial changes on CTA are frequently seen in patients of AP having ANP. There is a significant association between arterial changes and presence of necrosis, collections and severe AP.

Comparison of sensitivity and specificity of serum poly-C avid ribonuclease activity and C-reactive protein concentration in detection of mild and severe acute pancreatitis

2004 ◽  
Vol 42 (5) ◽  
Author(s):  
Beata Kuśnierz-Cabala ◽  
Jerzy W. Naskalski ◽  
Boguslaw Kędra ◽  
Józefa Panek
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Clinical Course ◽  
Function Analysis ◽  
Necrotizing Pancreatitis ◽  
Ribonuclease P ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Acute Necrotizing ◽  
Mild Acute Pancreatitis

AbstractThe aim of this study was to compare diagnostic performance of C-reactive protein (CRP) and poly-C avid ribonuclease (P-RNase) levels in the prediction of a severe clinical course of acute pancreatitis (AP). The study included 36 patients with mild and 20 with severe AP. CRP concentration was measured by an immunonephelometric method and P-RNase activity by the rate of polycytidylate hydrolysis at pH 7.8. At the time of admission, both P-RNase and CRP levels were significantly increased in all patients when compared to healthy subjects (29.2 vs. 18.7 U/l and 91.1 vs. 2.89 mg/l; p<0.001). Up to days 3 and 4 a further increase in P-RNase was observed. On the other hand, the increase in CRP continued only through days 2 and 3 (p<0.001). Severe acute pancreatitis (SAP) and mild acute pancreatitis (MAP) differed significantly with respect to P-RNase levels on all days studied; whereas CRP levels differed significantly on days 2–5 but did not differ at admission. Receiver operating characteristic (ROC) curve function analysis yielded the best sensitivity of SAP detection for P-RNase, equaling 72.2%, at the cut-off point value 65.3 U/l on day 3 after admission. The sensitivity of CRP for detection of SAP was 85.0% at 125.7 mg/l on the 2nd day after admission. Both parameters studied were significantly associated with the severity of the AP clinical course; however, on days 1 and 2 postadmission, P-RNase was more specific for detection of SAP than CRP (94.4% vs. 77.1% on the 1st day and 94.4% vs. 55.5% on the 2nd day). In conclusion, P-RNase has shown an excellent performance for early differentiation of acute necrotizing pancreatitis.

scholarly journals Surgery Management of Pancreatitis with Complication: A Review Article

2022 ◽  
Vol 6 (1) ◽  
pp. 01-03
Author(s):  
Nanda Rachmad Putra Gofur ◽  
Aisyah Rachmadani Putri Gofur ◽  
Soesilaningtyas Soesilaningtyas ◽  
Rizki Nur Rachman Putra Gofur ◽  
Mega Kahdina ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Necrotizing Pancreatitis ◽  
Clinical Manifestations ◽  
Healing Time ◽  
Acute Necrotizing Pancreatitis ◽  
Close Monitoring ◽  
Necrotic Tissue ◽  
Acute Necrotizing ◽  
Walled Off Necrosis

Introduction: Acute pancreatitis is an inflammatory disease of the pancreas with clinical manifestations that vary from mild to severe manifestations to death. The incidence of pancreatitis varies in various countries in the world and depends on the cause such as alcohol, gallstones, and metabolic factors. The clinical picture and the main symptom in patients with acute pancreatitis is abdominal pain. Abdominal pain varies from mild to severe and excruciating. Abdominal pain that is felt is constant and dull, and is usually felt in the epigastrium and periumbilicus and often spreads to the back, chest, waist, and lower abdomen. Discussion: The onset of acute pancreatitis, the patient should be evaluated for hemodynamic status immediately and receive the necessary resuscitation measures. Patients with acute pancreatitis should receive aggressive intravenous rehydration (250 - 500 ml/hour with isotonic crystalloid fluid) as early as possible with close monitoring, unless contraindicated with cardiovascular and/or renal comorbidities. It is most effective within the first 12-24 hours, but after that the benefits may diminish. Debridement (necrosectomy) is the gold standard in infected acute necrotizing pancreatitis and peripancreatic necrosis. Indications for intervention either through radiological, endoscopic or surgical procedures in necrotizing pancreatitis are suspected or proven infected necrotizing pancreatitis with clinical deterioration, especially after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Sterile necrotizing pancreatitis with persistent organ failure several weeks after the onset of acute pancreatitis, particularly after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Conclusion: Surgical management is often used in pancreatitis associated with gallstones. Cholecystectomy within 48 hours of the complaint can increase healing time. In addition, cholecystectomy performed early may not increase the risk of complications secondary to surgery. Surgery is not performed in acute necrotizing pancreatitis until the inflammation is reduced and the fluid accumulation no longer increases in size.

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