Acute and Chronic Pancreatitis

2020 ◽  
Author(s):  
Thomas J. Howard
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Physical Examination ◽  
Clinical Evaluation ◽  
Gallbladder Disease ◽  
Scoring Systems ◽  
Whipple Procedure ◽  
General Surgeon ◽  
Enhanced Computed Tomography ◽  
Acute And Chronic Pancreatitis

Clinical evaluation and surgical decision making in patients with acute pancreatitis (AP) and chronic pancreatitis (CP) are two of the most complex conditions that a general surgeon faces. Each entity has unique laboratory and radiographic investigations, operations, and postoperative care. The clinical evaluation, history, and physical examination of AP is described. The clinical features necessary for diagnosis are listed, and contrast-enhanced computed tomography is described as the gold standard for diagnosis. This review uses definitions and terminology developed at the Atlanta symposium in 1992. The severity of an episode of AP is described in terms of established scoring systems (APACHE II [Acute Physiology and Chronic Health Evaluation II], Glasgow Coma Scale score, Ranson criteria). AP can range from mild to severe necrotizing, with each described. The clinical course is described in detail. For CP, the history, physical examination, and diagnosis via investigative and imaging studies are described. The anatomic and morphologic subtypes of chronic pancreatitis are listed and the operations directed at patients with CP are detailed, and can involve drainage or combined resection and drainage.  This review contains 12 figures, 14 tables, and 48 references. Keywords: Acute pancreatitis, chronic pancreatitis, gallbladder disease, alcoholism, amylase, Whipple procedure

Acute and Chronic Pancreatitis

2020 ◽  
Author(s):  
Thomas J. Howard
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Physical Examination ◽  
Clinical Evaluation ◽  
Gallbladder Disease ◽  
Scoring Systems ◽  
Whipple Procedure ◽  
General Surgeon ◽  
Enhanced Computed Tomography ◽  
Acute And Chronic Pancreatitis

Clinical evaluation and surgical decision making in patients with acute pancreatitis (AP) and chronic pancreatitis (CP) are two of the most complex conditions that a general surgeon faces. Each entity has unique laboratory and radiographic investigations, operations, and postoperative care. The clinical evaluation, history, and physical examination of AP is described. The clinical features necessary for diagnosis are listed, and contrast-enhanced computed tomography is described as the gold standard for diagnosis. This review uses definitions and terminology developed at the Atlanta symposium in 1992. The severity of an episode of AP is described in terms of established scoring systems (APACHE II [Acute Physiology and Chronic Health Evaluation II], Glasgow Coma Scale score, Ranson criteria). AP can range from mild to severe necrotizing, with each described. The clinical course is described in detail. For CP, the history, physical examination, and diagnosis via investigative and imaging studies are described. The anatomic and morphologic subtypes of chronic pancreatitis are listed and the operations directed at patients with CP are detailed, and can involve drainage or combined resection and drainage.  This review contains 12 figures, 14 tables, and 48 references. Keywords: Acute pancreatitis, chronic pancreatitis, gallbladder disease, alcoholism, amylase, Whipple procedure

scholarly journals Positive predictive value of acute and chronic pancreatitis diagnoses in the Danish National Patient Registry: A validation study

2018 ◽  
Vol 48 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Jakob Kirkegård ◽  
Marie R. Mortensen ◽  
Ida R. Johannsen ◽  
Frank V. Mortensen ◽  
Deirdre Cronin-Fenton
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Medical Records ◽  
Patient Registry ◽  
National Patient Registry ◽  
Danish National Patient Registry ◽  
National Patient ◽  
Acute And Chronic Pancreatitis

Aims: To examine the validity of the diagnoses of acute and chronic pancreatitis registered in the Danish National Patient Registry. Methods: We identified all patients in the Danish National Patient Registry admitted to two Danish hospitals with acute or chronic pancreatitis from 1996 to 2013. From this population, we randomly sampled 100 patients with acute pancreatitis and 100 patients with chronic pancreatitis. For each cohort, we computed the positive predictive values and associated 95% confidence intervals (CIs) for the discharge diagnosis of acute or chronic pancreatitis using medical records as the gold standard. Results: We identified 2617 patients with acute pancreatitis and 1284 patients with chronic pancreatitis discharged from either of the two hospitals during the study period. Of these, 776 (19.9%) had a diagnosis of both acute and chronic pancreatitis and are thus present in both cohorts. From the 200 sampled patients, a total of 138 (69.0%) medical records were available for review. The positive predictive value for a diagnosis of acute pancreatitis in the Danish National Patient Registry was 97.3% (95% CI 90.5–99.2%) and for chronic pancreatitis 83.1% (95% CI 72.2–90.3%). Conclusions: The validity of diagnoses of acute and chronic pancreatitis registered in the Danish National Patient Registry since 1996 is generally high.

Determination of Plasma Glycoprotein 2 Levels in Patients With Pancreatic Disease

2004 ◽  
Vol 128 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Ying Hao ◽  
Jing Wang ◽  
Ningguo Feng ◽  
Anson W. Lowe
Keyword(s):  
Pancreatic Cancer ◽  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Tertiary Care ◽  
Pancreatic Disease ◽  
Pancreatic Acinar Cell ◽  
Enzyme Linked Immunosorbent Assay ◽  
Assay Sensitivity ◽  
Acute And Chronic Pancreatitis

Abstract Context.—Blood tests possessing higher diagnostic accuracy are needed for all the major pancreatic diseases. Glycoprotein 2 (GP2) is a protein that is specifically expressed by the pancreatic acinar cell and that has previously shown promise as a diagnostic marker in animal models of acute pancreatitis. Objective.—This study describes the development of an assay for GP2, followed by the determination of plasma GP2 levels in patients with acute pancreatitis, chronic pancreatitis, and pancreatic cancer. Design.—Rabbit polyclonal antisera and mouse monoclonal antibodies were generated against human GP2 and used to develop an enzyme-linked immunosorbent assay. The assay was tested in patients with an admitting diagnosis of pancreatic disease at 2 tertiary care facilities. The diagnosis of acute or chronic pancreatitis and pancreatic cancer was determined using previously established criteria that incorporated symptoms, radiology, pathology, and serology. Plasma GP2 levels were determined in 31 patients with acute pancreatitis, 16 patients with chronic pancreatitis, 36 patients with pancreatic cancer, and 143 control subjects without pancreatic disease. Amylase and lipase levels were also determined in patients with acute pancreatitis. Results.—The GP2 assay's sensitivity values were 0.94 for acute pancreatitis, 0.81 for chronic pancreatitis, and 0.58 for pancreatic cancer, which were greater than the 0.71 for acute pancreatitis and 0.43 for chronic pancreatitis (P = .02) observed for amylase. The lipase assay sensitivity for acute pancreatitis was 0.66. The accuracy of the GP2 assay was greater than that of the amylase or lipase assays for acute pancreatitis (GP2 vs lipase, P = .004; GP2 vs amylase, P = .003) when analyzed using receiver operator characteristic curves. When daily serial blood samples were obtained for 13 patients with acute pancreatitis, GP2 levels remained abnormally elevated for at least 1 day longer than the amylase or lipase levels. Conclusion.—The GP2 assay is a useful new marker for acute and chronic pancreatitis.

Acute Pancreatitis

2015 ◽  
Author(s):  
Robert A. Moran ◽  
Manavi Solanki ◽  
Vikesh K Singh
Keyword(s):  
Acute Pancreatitis ◽  
Scoring Systems ◽  
Abdominal Imaging ◽  
Infected Necrosis ◽  
Abdominal Ultrasonography ◽  
Endoscopic Image ◽  
Drug Classes ◽  
Upper Abdominal ◽  
Enhanced Computed Tomography ◽  
Prognostic Scoring Systems

Acute pancreatitis (AP) is defined as the presence of two of the following findings: (1) upper abdominal pain; (2) serum amylase or lipase greater than three times the upper limit of normal; and/or (3) characteristic findings of AP on abdominal imaging (contrast-enhanced computed tomography, magnetic resonance imaging, or abdominal ultrasonography). This review addresses AP, detailing the subclassification, epidemiology, pathophysiology, etiology, diagnosis and differential diagnosis, treatment, complications, and prognosis. Figures include abdominal imaging of patients with AP, an algorithm depicting pancreatic collections, and an endoscopic image of the gastric portion of the cystogastrostomy. Tables list systemic inflammatory response syndrome; classification of the severity of AP; etiologies of AP, gallstones, biliary sludge, microlithiasis, and crystals; secondary causes of hypertriglyceridemia; common drugs and drug classes associated with AP; conditions mimicking AP; diagnostic criteria for infected necrosis; and prognostic scoring systems for AP. This review contains 3 highly rendered figures, 9 tables, and 182 references. 

scholarly journals Mesenchymal Stromal Cell Therapy for Pancreatitis: A Systematic Review

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Sara M. Ahmed ◽  
Mahmoud Morsi ◽  
Nehal I. Ghoneim ◽  
Mohamed M. Abdel-Daim ◽  
Nagwa El-Badri
Keyword(s):  
Clinical Trials ◽  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Cell Therapy ◽  
Animal Studies ◽  
Meta Analysis ◽  
Cell Types ◽  
Inclusion Criteria ◽  
Acute And Chronic Pancreatitis ◽  
Substantial Heterogeneity

Background. Based on animal studies, adult mesenchymal stromal cells (MSCs) are promising for the treatment of pancreatitis. However, the best type of this form of cell therapy and its mechanism of action remain unclear. Methods. We searched the PubMed, Web of Science, Scopus, Google Scholar, and Clinical Trials.gov websites for studies using MSCs as a therapy for both acute and chronic pancreatitis published until September 2017. Results. We identified 276 publications; of these publications, 18 met our inclusion criteria. In animal studies, stem cell therapy was applied more frequently for acute pancreatitis than for chronic pancreatitis. No clinical trials were identified. MSC therapy ameliorated pancreatic inflammation in acute pancreatitis and pancreatic fibrosis in chronic pancreatitis. Bone marrow and umbilical cord MSCs were the most frequently administered cell types. Due to the substantial heterogeneity among the studies regarding the type, source, and dose of MSCs used, conducting a meta-analysis was not feasible to determine the best type of MSCs. Conclusion. The available data were insufficient for determining the best type of MSCs for the treatment of acute or chronic pancreatitis; therefore, clinical trials investigating the use of MSCs as therapy for pancreatitis are not warranted.

scholarly journals Validation of a commercial 1,2-o-dilauryl-rac-glycero glutaric acid-(6’-methylresorufin) ester lipase assay for diagnosis of canine pancreatitis

2018 ◽  
Vol 5 (1) ◽  
pp. e000270 ◽  
Author(s):  
Emily L Goodband ◽  
Gonçalo Serrano ◽  
Fernando Constantino-Casas ◽  
Joy Archer ◽  
Penny J Watson ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Sensitivity And Specificity ◽  
Glutaric Acid ◽  
Reference Interval ◽  
Pancreatic Tissue ◽  
Serum Samples ◽  
Technical Validation ◽  
Two Parameters ◽  
Acute And Chronic Pancreatitis

The objectives of this study were fourfold: technical validation of a commercial canine 1,2-o-dilauryl-rac-glycero glutaric acid-(6’-methylresorufin) ester (DGGR) lipase assay, to calculate a reference interval for DGGR lipase by the indirect a posteriori method, to establish biological validity of the assay, and to assess agreement between DGGR lipase and specific canine pancreatic lipase (Spec cPL) assays. Dogs with histologically confirmed acute pancreatitis (n=3), chronic pancreatitis (n=8) and normal pancreatic tissue (n=7) with stored (−80°C) serum samples were identified. Relevant controls were selected. Precision, reproducibility and linearity of DGGR lipase, and the effect of sample haemolysis and freezing, were assessed. Sensitivity and specificity of DGGR lipase and Spec cPL were determined. Agreement between these two parameters was calculated using Cohen’s kappa coefficient (κ). The DGGR lipase assay demonstrated excellent precision, reproducibility and linearity. Sample haemolysis and storage at −80°C for 12 months did not influence the assay. DGGR lipase (>245IU/l) and Spec cPL (>400µg/l) both showed poor sensitivity but excellent specificity for acute pancreatitis, and poor to moderate sensitivity but excellent specificity for chronic pancreatitis. Substantial agreement (κ=0.679) was found between DGGR lipase and Spec cPL. The validated DGGR lipase assay had similar sensitivity and specificity for the diagnosis of acute and chronic pancreatitis to Spec cPL. DGGR lipase is a reliable alternative to Spec cPL for the diagnosis of pancreatitis.

scholarly journals Risk of acute atherosclerotic cardiovascular disease in patients with acute and chronic pancreatitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Li-Chin Sung ◽  
Chuen-Chau Chang ◽  
Chao-Shun Lin ◽  
Chun-Chieh Yeh ◽  
Yih-Giun Cherng ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Acute Pancreatitis ◽  
Liver Cirrhosis ◽  
Chronic Pancreatitis ◽  
Control Group ◽  
Atherosclerotic Cardiovascular Disease ◽  
Research Database ◽  
Increased Risk ◽  
History Of ◽  
Acute And Chronic Pancreatitis

AbstractThe association between pancreatitis and acute myocardial infarction or stroke remains incompletely understood. This study aimed to evaluate the long-term risk of acute atherosclerotic cardiovascular disease (ASCVD) in people with acute and chronic pancreatitis. Using research database of Taiwan's National Health Insurance, we identified 2678 patients aged ≥ 20 years with newly diagnosed pancreatitis in 2000–2008. A cohort of 10,825 adults without pancreatitis was selected for comparison, with matching by age and sex. Both cohorts were followed from 2000 to the end of 2013, and incident acute ASCVD was identified during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of acute ASCVD associated with pancreatitis were calculated. Compared with the comparison cohort, the adjusted HR of acute ASCVD were 1.76 (95% CI 1.47–2.12) and 3.42 (95% CI 1.69–6.94) for people with acute pancreatitis and chronic pancreatitis, respectively. A history of alcohol-related illness (HR 9.49, 95% CI 3.78–23.8), liver cirrhosis (HR 7.31, 95% CI 1.81–29.5), and diabetes (HR 6.89, 95% CI 2.18–21.8) may worsen the risk of acute ASCVD in patients with chronic pancreatitis. Compared with people had no pancreatitis, patients with acute pancreatitis who had alcohol-related illness (HR 4.66, 95% CI 3.24–6.70), liver cirrhosis (HR 4.44, 95% CI 3.05–6.47), and diabetes (HR 2.61, 95% CI 2.03–3.36) were at increased risk of acute ASCVD. However, the cumulative use of metformin was associated with a reduced risk of acute ASCVD in the acute pancreatitis cohort (HR 0.30, 95% CI 0.17–0.50). Compared with the control group, patients with acute or chronic pancreatitis were more likely to have an increased risk of acute ASCVD, while the use of metformin reduced the risk of acute ASCVD. Our findings warrant a survey and education on acute ASCVD for patients with acute and chronic pancreatitis.

Plasma level and pancreatic gene expression of leptin in acute pancreatitis in rats and in acute and chronic pancreatitis in humans

2001 ◽  
Vol 120 (5) ◽  
pp. A726
Author(s):  
Peter C. Konturek ◽  
Jolanta Jaworek ◽  
J Bonior ◽  
Anastasios Maniatoglou ◽  
Holger Reh ◽  
...  
Keyword(s):  
Gene Expression ◽  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Plasma Level ◽  
Acute And Chronic Pancreatitis

scholarly journals The Analgesic Effect of the Mitochondria-Targeted Antioxidant SkQ1 in Pancreatic Inflammation

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Maximilian Weniger ◽  
Leonard Reinelt ◽  
Jens Neumann ◽  
Lesca Holdt ◽  
Matthias Ilmer ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Analgesic Effect ◽  
Tissue Injury ◽  
Behavioral Observation ◽  
Pancreatic Tissue ◽  
Mechanical Sensitivity ◽  
Risks And Benefits ◽  
Reduction Of Pain ◽  
Acute And Chronic Pancreatitis

Background. Chronic pancreatitis is one of the main risk factors for pancreatic cancer. In acute and chronic pancreatitis, oxidative stress is thought to play a key role. In this respect, the recently described mitochondria-targeted antioxidant SkQ1 effectively scavenges reactive oxygen species at nanomolar concentrations. Therefore, we aimed to characterize the influence of SkQ1 on tissue injury and pain in acute and chronic pancreatitis.Methods. Both acute and chronic pancreatitis were induced in C57BL/6 mice by intraperitoneal cerulein injections and treatment with SkQ1 was carried out by peroral applications. Hyperalgesia was assessed by behavioral observation and measurement of abdominal mechanical sensitivity. Blood serum and pancreatic tissue were harvested for analysis of lipase and histology.Results. SkQ1 did not influence pain, serological, or histological parameters of tissue injury in acute pancreatitis. In chronic pancreatitis, a highly significant reduction of pain-related behavior (p<0.0001) was evident, but histological grading revealed increased tissue injury in SkQ1-treated animals (p=0.03).Conclusion. After SkQ1 treatment, tissue injury is not ameliorated in acute pancreatitis and increased in chronic pancreatitis. However, we show an analgesic effect in chronic pancreatitis. Further studies will need to elucidate the risks and benefits of mitochondria-targeted antioxidants as an analgesic.

scholarly journals Elevated intracellular trypsin exacerbates acute pancreatitis and chronic pancreatitis in mice

2019 ◽  
Vol 316 (6) ◽  
pp. G816-G825 ◽  
Author(s):  
Xianbao Zhan ◽  
Jianhua Wan ◽  
Guowei Zhang ◽  
Lele Song ◽  
Fu Gui ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Mouse Model ◽  
Transgenic Mice ◽  
Transgenic Mouse ◽  
Inflammatory Cell ◽  
Transgenic Mouse Model ◽  
Inflammatory Cell Infiltration ◽  
Trypsin Activity ◽  
Acute And Chronic Pancreatitis

Intra-acinar trypsinogen activation occurs in the earliest stages of pancreatitis and is believed to play important roles in pancreatitis pathogenesis. However, the exact role of intra-acinar trypsin activity in pancreatitis remains elusive. Here, we aimed to examine the specific effects of intra-acinar trypsin activity on the development of pancreatitis using a transgenic mouse model. This transgenic mouse model allowed for the conditional expression of a mutant trypsinogen that can be activated specifically inside pancreatic acinar cells. We found that expression of this active mutated trypsin had no significant effect on triggering spontaneous pancreatitis. Instead, several protective compensatory mechanisms, including SPINK1 and heat shock proteins, were upregulated. Notably, these transgenic mice developed much more severe acute pancreatitis, compared with control mice, when challenged with caerulein. Elevated tissue edema, serum amylase, inflammatory cell infiltration and acinar cell apoptosis were dramatically associated with increased trypsin activity. Furthermore, chronic pathological changes were observed in the pancreas of all transgenic mice, including inflammatory cell infiltration, parenchymal atrophy and cell loss, fibrosis, and fatty replacement. These changes were not observed in control mice treated with caerulein. The alterations in pancreata from transgenic mice mimicked the histological changes common to human chronic pancreatitis. Taken together, we provided in vivo evidence that increased intra-acinar activation of trypsinogen plays an important role in the initiation and progression of both acute and chronic pancreatitis. NEW & NOTEWORTHY Trypsinogen is activated early in pancreatitis. However, the roles of trypsin in the development of pancreatitis have not been fully addressed. Using a genetic approach, we showed trypsin activity is critical for the severity of both acute and chronic pancreatitis.

Sign in / Sign up

Export Citation Format

Share Document