• Title, Summary, Keyword: Acute pancreatitis

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Clinical Practice Guidelines for Acute Pancreatitis (급성 췌장염 진료 권고안)

  • Koh, Dong Hee
    • The Korean Journal of Gastroenterology
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    • v.72 no.6
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    • pp.281-285
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    • 2018
  • Acute pancreatitis is a common gastrointestinal disease that is associated with significant morbidity and consumes enormous health care resources. As such, it requires up-to-date evidence-based diagnosis and standard treatment guidelines with broad support from the clinician. Korean Pancreatobiliary Association has developed clinical practice guidelines for the diagnosis and treatment of acute pancreatitis to provide a framework for clinicians to manage acute pancreatitis and to improve national health care. The guidelines were divided into four parts: the diagnosis of acute pancreatitis, the assessment of the severity, the initial management, and the treatment of necrotizing pancreatitis and local complications of acute pancreatitis. In this article, we summarize and present the diagnosis and treatment guidelines for acute pancreatitis established in Korea.

Effects of Small Molecular Antioxidants on Cerulein-induced Acute Pancreatitis in Rat

  • Choi, Joo-Young;Kim, Kyung-Hwan
    • The Korean Journal of Physiology and Pharmacology
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    • v.2 no.5
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    • pp.629-635
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    • 1998
  • It has been suggested that oxygen free radicals are involved in the initiation process of acute pancreatitis, although its pathogenesis is not clear. This study evaluates the roles of oxygen radicals and the effects of small molecular antioxidants (rebamipide, N-acetyl-cysteine, allopurinol, ${\beta}-carotene)$ on the development of cerulein-induced acute pancreatitis. Acute edematous pancreatitis was induced by the intravenous infusion of cerulein at supramaximal dose of 10 ${\mu}g/kg/hour$ for 3.5 hours. The effects of antioxidants, rebamipide (100 mg/kg, i.p.), N-acetyl-cysteine (200 mg/kg, i.v.), allopurinol (20 mg/kg/hour), ${\beta}-carotene$ (50 mg/kg, i.p.), were examined. Cerulein administration resulted in a significant increase in serum amylase activity and pancreatic malondialdehyde (MDA), but not glutathione peroxidase (GSHpx). The glutathione (GSH) content in pancreatic tissue decreased dramatically. Pretreatment of N-acetyl-cysteine significantly decreased the cerulein-induced hyperamylasemia and maintained GSH content in pancreas, but MDA was slightly decreased. In addition, N-acetyl-cysteine ameliorated histological damage. Allopurinol and ${\beta}-carotene$ attenuated cerulein-induced hyperamylasemia, but histologically there was no difference from control. These results indicate that oxygen free radicals play an important role in the initiation of experimental acute pancreatitis. N-acetyl-cysteine is an effective antioxidant that ameliorates the cerulein-induced acute pancreatitis, and the possible therapeutic application of antioxidants against acute pancreatitis needs a further evaluation.

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An Update on Hypertriglyceridemia-Induced Acute Pancreatitis (고중성지방혈증 급성췌장염의 최신 지견)

  • Kim, Hong Ja
    • The Korean Journal of Medicine
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    • v.93 no.6
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    • pp.518-524
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    • 2018
  • Hypertriglyceridemia a major cause of acute pancreatitis, accounting for up to 10% of all cases. The pathophysiological mechanism of hypertriglyceridemia-induced acute pancreatitis (HTGP) is presumed to involve the hydrolysis of triglycerides by pancreatic lipase resulting in an excess of free fatty acids and elevated chylomicrons, which are thought to increase plasma viscosity and induce ischemia and inflammation in pancreatic tissue. Although the clinical course of HTGP is similar to other forms of acute pancreatitis, the clinical severity and associated complications are significantly higher in patients with HTGP. Therefore, an accurate diagnosis is essential for treatment and prevention of disease recurrence. At present, there are no approved guidelines for the management of HTGP. Different treatment modalities such as apheresis/plasmapheresis, insulin, heparin, fibric acids, and omega-3 fatty acids have been successfully implemented to reduce serum triglycerides. Following acute phase management, lifestyle modifications including dietary adjustments and drug therapy are important for the long-term management of HTGP and the prevention of relapse. Additional studies are required to produce generalized and efficient treatment guidelines for HTGP.

Balthazar Computed Tomographic Severity Index Application for Experimental Acute Necrotizing Pancreatitis in Dogs (개의 실험적 급성 괴사성 췌장염 평가에서 Balthazar Computed Tomographic Severity Index의 적용)

  • Choi, Ji-Hye;Choi, Min-Cheol;Yoon, Jung-Hee
    • Journal of Veterinary Clinics
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    • v.27 no.6
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    • pp.686-692
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    • 2010
  • Computed tomography (CT) is considered as gold standard in evaluating pancreatitis in human, but there have been only a few studies in veterinary field. Balthazar CT severity index (CTSI) used to assess the severity of acute necrotizing pancreatitis in human could be applicable to dogs, because the severity of acute pancreatitis depends on the area of pancreatic necrosis in dogs more than in human. In this study, 25 adult, clinically healthy beagle dogs were used. CT examinations was performed in normal pancreas, positive control group and acute necrotizing pancreatitis induced by autologous bile injection. Balthazar CTSI was applied to canine acute necrotizing pancreatitis in contrastenhanced CT image and compared with the result of histopathologic examination. The Hounsfield unit (HU) of normal canine pancreas was $52.44{\pm}4.58$ and the density was significantly decreased in acute necrotizing pancreatitis (P < .05). In contrast-enhanced CT examination, pancreatic density was decreased significantly and this area was compatible to pancreatic necrosis. Balthazar CTSI showed positive correlation with histopathologic evaluation with a sensitivity of 100% and a specificity of 88.89%. Balthazar CTSI can be applied to evaluate the severity of acute necrotizing pancreatitis in dogs.

Primary Hyperparathyroidism Presenting as Acute Pancreatitis (급성 췌장염으로 발현된 일차성 부갑상선 기능항진증 1예)

  • Kim Sung-Do;Chang Hang-Seok;Chung Woung-Yoon;Park Cheong-Soo
    • Korean Journal of Head & Neck Oncology
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    • v.15 no.1
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    • pp.76-79
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    • 1999
  • The relationship between acute pancreatitis and hyperparathyroidism has been described extensively in the past. Despite the rarity, the clinical progression of pancreatitis associated with hyperparathyroidism has been known to be so rapid and severe that it may cause death. When, furthermore, the pancreatitis is caused by hyperparathyroidism, the recovery from disease can be hardly expected unless the hyperparathyroidism is corrected. We present a case of acute pancreatitis in a 68-year-old man that have been caused by primary hyperparathyroidism. The clues of hyperparathyrodism were hypercalcemia and elevated parathyroid hormone, but he showed subtle or negative symptoms of hypercalcemia. After the excision of parathyroid adenoma, serum calcium level returned to normal and the symptoms and function of pancreas were recovered.

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Effects of Trypsin Inhibitors on Oleic acid Induced Acute Pancreatitis in Dogs (개에서 Oleic acid로 유발시킨 급성췌장염에 대한 Trypsin inhibitor의 투여효과)

  • 윤영민;최희인;조명행
    • Biomolecules & Therapeutics
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    • v.5 no.2
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    • pp.158-164
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    • 1997
  • To investigate the effects of trypsin inhibitors, aprotinin and urinary trypsin inhibitor (UTI), on the cute pancreatitis, this study was carried out in dogs of acute pancreatitis induced by oleic acid (0.28 mg/kg). Administration with aprotinin and UTI seemed to have a therapeutic effect on the clinical sign, ultrasonographic finding, histopathologic finding. But in amylase and lipase activity, there were no significant differences among three groups.

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Screening of Sera from Patients with Pancreatitis by an Apoptosis Assay of Skin-derived Cells (피부유래세포의 아포토시스 분석에 의한 췌장염 환자의 혈청 스크리닝)

  • Seok, Ae Eun;Son, Byoung Kwan;Lee, Jiyeong;Chung, Kwang Hyun;Lee, You-Rim;Kim, Doojin;Cha, Byung Heun;Kang, Hee-Gyoo
    • The Korean Journal of Gastroenterology
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    • v.74 no.4
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    • pp.219-226
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    • 2019
  • Background/Aims: An excessive inflammatory response is typical in acute pancreatitis and a significant cause of early mortality in severe acute pancreatitis. This is believed to be caused by inflammatory molecules or upregulated cytokine levels in the serum of patients. The aim of this study was to identify the serum-mediated apoptosis-inducing effects in acute pancreatitis patients. Methods: A skin tissue-derived cell line, BJ, was treated for 24 hours with the sera of 22 healthy volunteers (control) and 71 acute pancreatitis patients (22 with gallstone pancreatitis, 16 with alcoholic pancreatitis, and 11 with pancreatitis with other causes) collected at the time of hospital admission (active) and discharge (resolved). Apoptosis was analyzed by flow cytometry. Results: The average percentage of living cells, early apoptotic cells, and late apoptotic cells ranged from 78.8% to 85.0%, 5.5% to 7.3%, and 7.7% to 13.1%, respectively. The number of live cells increased significantly using the serum from the resolved state of gallstone-induced pancreatitis. In addition, the number of early apoptotic cells increased significantly using the serum from the resolved state of pancreatitis with other causes. The number of late apoptotic cells decreased significantly with the serum from the resolved state compared to the active state of gallstone- and alcohol-induced pancreatitis. Conclusions: Serum samples from patients with pancreatitis induced a change in the apoptosis profiles of skin-derived cells. These results indicate changes in the serum components in patients with acute pancreatitis.

Acute Pancreatitis after Carbamate Poisoning (카바메이트 중독 후 발생한 급성췌장염)

  • Park, Joseph;Kim, Yong Won;Oh, Se Hyun;Cha, Yong Sung;Cha, Kyoung Chul;Kim, Oh Hyun;Lee, Kang Hyun;Hwang, Sung Oh;Kim, Hyun
    • Journal of The Korean Society of Clinical Toxicology
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    • v.12 no.2
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    • pp.77-84
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    • 2014
  • Purpose: Carbamate insecticides are potent cholinesterase inhibitors capable of causing severe cholinergic toxicity. Use of carbamate rather than organophosphate insecticides has been increasing. Compared with organophosphate poisoning, relatively few studies have investigated carbamate-associated acute pancreatitis. We investigated general characteristics and pancreatitis of carbamate poisoning and the predictors, among those readily assessed in the emergency department. Methods: We performed a retrospective review of consecutive patients, aged over 18 years, who were admitted between January 2008 and April 2012 to an emergency department (ED) of an academic tertiary care center for treatment of carbamate poisoning. Patients who exhibited poisoning by any other material, except alcohol, were excluded. After application of exclusion criteria, patients were divided according to carbamate-induced pancreatitis and non-pancreatitis groups. Results: A total of 41 patients were included in this study. Among these 41 patients, the prevalence of acute pancreatitis was 36.6% (15 patients). Initial blood chemistry tests showed a statistically higher glucose level in the pancreatitis group, compared with the non-pancreatitis group (222, IQR 189-284 vs. 137, IQR 122-175 mg/dL, P<0.05). Regarding clinical courses and outcomes, a significantly higher proportion of patients developed pneumonia [10 (66.7%) vs. 6 (23.1%), P<0.05] and had a longer hospital stay (7 days, IQR 6-12 vs. 5 days, IQR 2-11, P<0.05), but no difference in mortality, in the pancreatitis group vs. the non-pancreatitis group. In multivariate analysis, the initial glucose was showing significant association with the presentation of carbamate-induced acute pancreatitis (odds ratio 1.018, 95% confidence interval 1.001-1.035, P<0.05). Conclusion: Carbamate-induced acute pancreatitis is common, but not fatal. Initial serum glucose level is associated with acute pancreatitis.

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Relevance of metal based Ayurvedic formulations in the management of recurrent acute/ chronic pancreatitis

  • Prakash, Vaidya Balendu;Prakash, Vaidya Shikha;Sharma, Shakshi;Tiwari, Sneha
    • CELLMED
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    • v.7 no.2
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    • pp.9.1-9.6
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    • 2017
  • Recurrent Acute Pancreatitis/ Chronic Pancreatitis (RAP/ CP) is generally marked by sudden onset of symptoms like severe abdominal pain, vomiting and weight loss that needs emergency hospitalization. Owing to irreversible and progressive nature of the disease and limitations of conventional treatment, many patients look for an alternative solution. Here, we report data of 250 well diagnosed cases of acute recurring/ chronic pancreatitis, enrolled in between January 1997 to August 2016, in our Ayurvedic clinical practice in Northern part of India. Ayurveda is well recognized as an independent medical system parallel to conventional medicines in India and a subject is free to opt for any system of medicine for the prevention and treatment of any ailment. The subjects were treated with a complex herbo-mineral formulation based on the principles of Rasa Shastra in Ayurveda that deals with the therapeutics of processed metals in the prevention and treatment of diseases. They were also prescribed a regulated balanced diet and lifestyle. Significant improvement has been noted in subjects who have completed the treatment.

Epstein-Barr Virus Infection with Acute Pancreatitis Associated with Cholestatic Hepatitis

  • Kang, Seok-Jin;Yoon, Ka-Hyun;Hwang, Jin-Bok
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.16 no.1
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    • pp.61-64
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    • 2013
  • Infection-induced acute hepatitis complicated with acute pancreatitis is associated with hepatitis A virus, hepatitis B virus or hepatitis E virus. Although rare, Epstein-Barr virus (EBV) infection should be considered also in the differential diagnosis if the patient has acute hepatitis combined with pancreatitis. We report a case of EBV infection with cholestatic hepatitis and pancreatitis with review of literature. An 11-year-old female was admitted due to 1-day history of abdominal pain and vomiting without any clinical symptoms of infectious mononucleosis. Diagnosis of reactivated EBV infection was made by the positive result of viral capsid antigen (VCA) IgM, VCA IgG, Epstein-Barr nuclear antigen and heterophile antibody test. We performed serologic tests and magnetic resonance cholangiopancreatography to exclude other viral or bacterial infection, autoimmune disorder, and structural problems. The patient's symptoms recovered rapidly and blood chemistry returned to normal with conservative treatment similar to previously reported cases.